ABSTRACT
BACKGROUND: Patients with stage 5 chronic kidney disease (CKD) begin chronic hemodialysis with variable diuresis levels correlated to a comparable low glomerular filtration rate. Residual diuresis influences long-term evolution of the hemodialyzed patient, modifying the prognosis even if optimal Kt/ V is achieved. AIM OF THE STUDY: The present study emphasizes the main determining factors of diuresis in a cohort of stage 5 CKD subjects at the beginning of hemodialysis. MATERIAL AND METHODS: 216 patients with stage 5 CKD starting chronic hemodialysis were included in the study, and were grouped according to their residual diuresis: group A (urine output ≤ 500 mL/ day); group B (urine output between 500-1200 mL/ day); group C (urine output ≥ 1200 mL/ day). RESULTS: Glomerular etiology, cardiac systolic dysfunction, severe malnutrition, emergency dialysis initiation and lack of permanent vascular access were proved to be associated with significant low diuresis. Age, gender, estimated glomerular filtration rate (GFR) and the presence of systemic hypertension did not influence the amount of daily diuresis. CONCLUSIONS: In CKD stage 5 patients, residual diuresis presents large variations in conditions of comparable low GFR. Factors influencing residual diuresis may be distinct from those that influence residual GFR.
Subject(s)
Diuresis , Renal Dialysis , Renal Insufficiency, Chronic/physiopathology , Renal Insufficiency, Chronic/therapy , Adult , Age Distribution , Aged , Albumins/metabolism , Female , Glomerular Filtration Rate , Humans , Hypertension/complications , Hypertension/physiopathology , Male , Malnutrition/complications , Malnutrition/physiopathology , Middle Aged , Renal Insufficiency, Chronic/complications , Systole , Young AdultABSTRACT
Thromboangiitis obliterans (Buerger's disease) represents an inflammatory disease of limbs' small arteries and veins causing vascular thrombosis, and partial or total obstruction. It affects mostly male gender aged 40 years old. The peculiarity of our case is underlined by presenting a 62 years, chronic tobacco user and not compliant female patient known with thromb oangiitisobliterans for almost 15 years. The arteriographic and clinical features with concomitant and sever affected upper and lower limbs are highly suggestive, emphasizing the possibility of Buerger's disease development even in female patients.
Subject(s)
Fingers/blood supply , Lumbosacral Plexus/surgery , Smoking/adverse effects , Thromboangiitis Obliterans/pathology , Thromboangiitis Obliterans/surgery , Toes/blood supply , Toes/surgery , Amputation, Surgical , Diagnosis, Differential , Disease Progression , Female , Fingers/pathology , Humans , Middle Aged , Risk Factors , Sympathectomy/methods , Thromboangiitis Obliterans/etiology , Toes/pathology , Treatment OutcomeABSTRACT
In the present article, we discuss the case of 67-year-old female patient diagnosed with inferior limbs calciphylaxis and hemodialyzed since 2006. The clinical manifestations and pathological lab findings are typical for this rare and extremely severe complication in chronic hemodialyzed individuals. The favorable treatment response to sodium thiosulfate, not often used as elected therapy in international studies, represents the particularity of the case.
Subject(s)
Arterioles/pathology , Calciphylaxis/drug therapy , Calciphylaxis/etiology , Chelating Agents/therapeutic use , Kidney Failure, Chronic/complications , Leg/blood supply , Renal Dialysis/adverse effects , Thiosulfates/therapeutic use , Aged , Calciphylaxis/diagnosis , Calciphylaxis/surgery , Chelating Agents/administration & dosage , Diagnosis, Differential , Female , Humans , Skin Transplantation , Thiosulfates/administration & dosage , Treatment OutcomeABSTRACT
Acute pancreatitis is often complicated by acute renal failure, either isolated or part of multiple organ failure. Preexisting chronic kidney disease worsens the prognosis, especially when the pancreatitis is severe and/or other major comorbidities are present. In case of acute-on-chronic renal failure secondary to acute pancreatitis, an early application of renal replacement therapy has improved the prognosis of patients included in the present clinical study.
