RESUMO
Kidney dysfunction is a common complication of hematopoietic cell transplantation (HCT) with proven negative impact on early and long-term mortality. Causes of this complication are diverse, usually overlapping, and poorly understood. Therefore, management implicates multidirectional investigations and simultaneous treatment of suspected causes. The etiology is frequently unconfirmed due to a lack of specific markers and prevalence of contraindications to renal biopsy among HCT recipients. Herein, we provide a summary of etiology and propose an algorithm for evaluation of kidney injury after HCT. We also map out the most urgent areas for research that aim to identify patients at risk of severe renal injury and develop nephroprotective strategies.
Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Nefropatias , Rim , Biomarcadores/metabolismo , Humanos , Rim/lesões , Rim/metabolismo , Rim/patologia , Nefropatias/etiologia , Nefropatias/metabolismo , Nefropatias/patologia , Nefropatias/prevenção & controle , PrevalênciaRESUMO
Patients with chronic kidney disease are immunocompromised and deterioration of kidney function builds up the defect of the cellular and humoral immunity. This makes the patients prone to severe life-threatening infections, and results in less effective vaccination. In addition, frequent hospitalizations, immunosuppressive therapy and renal replacement therapy are important risk factors for infection. The review presents recommendations and the evidence for the efficacy of vaccination in different populations of patients with kidney disease.
Assuntos
Insuficiência Renal Crônica/fisiopatologia , Vacinação/estatística & dados numéricos , Vacinas Atenuadas/uso terapêutico , Vacinas contra Hepatite B/uso terapêutico , Humanos , Vacinas contra Influenza/uso terapêutico , Vacinas contra Papillomavirus/uso terapêutico , Vacinas Pneumocócicas/uso terapêutico , Insuficiência Renal Crônica/terapia , Fatores de RiscoRESUMO
Hypertension is the most common chronic cardiovascular condition, with an increasing prevalence all over the world. Patients with refractory hypertension are the group most at risk for adverse cardiovascular events, but also present a particular diagnostic and therapeutic challenge. The present article reviews the mechanisms of development of resistant hypertension and the possibilities of pharmacological treatment and interventional approaches.
Assuntos
Anti-Hipertensivos/uso terapêutico , Resistência a Medicamentos , Hipertensão/tratamento farmacológico , Doenças Cardiovasculares/prevenção & controle , Humanos , Hipertensão/prevenção & controle , Prognóstico , Medição de RiscoRESUMO
Infections cause approximately 1/3 of acute kidney injury (AKI) cases and a substantial number of chronic and end-stage renal failure. Renal disease may also be a side effect of antimicrobial agents. In turn, people suffering from kidney diseases, especially requiring renal replacement therapy are predisposed to severe infections often of atypical clinical course.
