Acute Kidney Injury in the Patient with Cancer.

Over the last three decades, advancements in the diagnosis, treatment, and supportive care of patients with cancer have significantly improved their overall survival. However, these advancements have also led to a higher rate of cancer-related complications. Acute kidney injury (AKI) and chronic kidney disease (CKD) are highly prevalent in patients with cancer, and they are associated with an increased risk of all-cause mortality. This bidirectional interplay between cancer and kidney, termed "the kidney-cancer connection" has become a very active area of research. This review aims to provide an overview of some of the most common causes of AKI in patients with cancer. Cancer therapy-associated AKI is beyond the scope of this review and will be discussed separately.

Acute Kidney Injury in Patients With Cancer: A Review of Onconephrology.

Over the past 2 decades, significant research and advancements have been made in oncology and its therapeutics. Thanks to novel diagnostic methods, treatments, and supportive measures, patients with cancer live longer and have a better quality of life. However, an unforeseen consequence of this progress has been increasing medical complications, including acute kidney injury. The purpose of this review is to provide an overview of the epidemiology and most common causes of acute kidney injury in patients with cancer unrelated to oncological treatment.

Amlodipine in the Era of New Generation Calcium Channel Blockers.

Amlodipine is a classical drug with varied properties extending from control of blood pressure to as an antianginal and anti atherosclerotic agent. Amlodipine is a longer acting dihydropyridine calcium channel blocker, effective for 24 hours BP control and cause no BP variability. It is a powerful, well-tolerated, and safe antihypertensive agents that is widely used either alone or as a key component of combination therapy for hypertension. Its effective BP reduction has shown proven benefits in cardiovascular event reduction that is supported with strong evidences from large randomised controlled trials. Combination therapies of amlodipine with other agents eliciting renin-angiotensin-aldosterone system blockade (angiotensin II receptor blockers or renin inhibitors) have shown effective blood pressure-lowering strategies in CV risk reduction and progression of renal disease. Novel type of calcium channel blockers have been developed which have additional properties of blocking T and N subtypes of calcium channels and apart from their class effects they exerts specific action on heart rate and renin aldosterone system. They are considered to be more renoprotective due to this additional properties. Amlodipine is most potent and longer acting agent compared to the newer CCBs, its effectiveness in BP lowering still makes it the agent of choice among all the CCBs.

Spironolactone is effective in treating hypokalemia among peritoneal dialysis patients.

BACKGROUND: Hypokalemia is common in peritoneal dialysis (PD) patients and is associated with increased cardiovascular and all-cause mortality. The management approach for such patients routinely includes spironolactone at our centre. We undertook this study to assess the efficacy of spironolactone for the treatment of hypokalemia in PD patients. METHODS: Retrospective chart review of PD patients at a single centre. Serum potassium was compared prior to initiation of spironolactone and two months afterwards. Indication for spironolactone and changes in blood pressure (BP), weight, and serum creatinine were also recorded. RESULTS: The chart review identified 53 patients who fit our selection criteria. The mean age was 64 +/- 15 years and the majority was treated with continuous cyclic peritoneal dialysis. Serum potassium rose from 3.7 +/- 0.5 to 4.2 +/- 0.5 mmol/L (P<0.0001) after 2 months with a mean dose of spironolactone of 28.5+/-15.2 mg (median dose 25 mg). A significant reduction in systolic BP was observed from 150+/- 18 to 137 +/-24 (P = 0.002); a non- significant reduction in diastolic BP was also observed. The rise in potassium was constant in the range of 0.4 to 0.5 mmol/L regardless of whether spironolactone was initiated for hypokalemia, diuresis, or as an antihypertensive. There was no change in serum creatinine or body weight two months after introduction of spironolactone. CONCLUSIONS: Spironolactone is safe and effective in treating hypokalemia in PD patients. It is also an effective antihypertensive agent and merits further study in the PD population.

Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality.

OBJECTIVES: To describe the clinical characteristics and in-hospital mortality of chronic dialysis-dependent end-stage kidney disease patients with septic shock in comparison to septic shock patients not receiving chronic dialysis. METHODS: Using an international, multicenter database, we conducted a retrospective analysis of data collected from 10,414 patients admitted to the intensive care unit (ICU) with septic shock from 1989 to 2013, of which 800 (7.7 %) were chronic dialysis patients. Data on demographic characteristics, sites of infection, microbial pathogens, antimicrobial usage patterns, and in-hospital mortality were aggregated and compared for chronic dialysis and non-dialysis patients. Multivariate time-varying Cox models with and without propensity score matching were constructed to determine the association between dialysis and in-hospital death. RESULTS: Septic shock secondary to central venous catheter infection, peritonitis, ischemic bowel, and cellulitis was more frequent in chronic dialysis patients. The isolation of resistant organisms (10.7 vs. 7.1 %; p = 0.005) and delays in receiving antimicrobials (6.0 vs. 5.0 h) were more common in chronic dialysis patients than in non-dialysis patients. Delayed appropriate antimicrobial therapy was associated with an increased risk of death in chronic dialysis patients (p < 0.0001). In-hospital death occurred in 54.8 and 49.0 % of chronic dialysis and non-dialysis patients, respectively. After propensity score matching, there was no difference in overall survival between chronic dialysis and non-dialysis patients, but survival in chronic dialysis patients decreased over time compared to non-dialysis patients. CONCLUSIONS: The demographic and clinical characteristics of chronic dialysis patients with septic shock differ from those of similar non-dialysis patients. However, there was no significant difference in mortality between the chronic dialysis and non-dialysis patients with septic shock enrolled in this analysis.

Dialysate Calcium Concentration, Mineral Metabolism Disorders, and Cardiovascular Disease: Deciding the Hemodialysis Bath.

Patients with end-stage kidney disease treated with dialysis are at increased risk to experience fractures and cardiovascular events than similar-aged people from the general population. The enhanced risk for these outcomes in dialysis patients is not completely explained by traditional risk factors for osteoporosis and cardiovascular disease. Mineral metabolism abnormalities are almost universal by the time patients require dialysis therapy, with most patients having some type of renal osteodystrophy and vascular calcification. These abnormalities have been linked to adverse skeletal and cardiovascular events. However, it has become clear that the treatment regimens used to modify the serum calcium, phosphate, and parathyroid hormone levels almost certainly contribute to the poor outcomes for dialysis patients. In this article, we focus on one aspect of mineral metabolism management; dialysate calcium concentration and the relationships among dialysate calcium concentrations, mineral and bone disorder, and cardiovascular disease in hemodialysis patients.

Inadvertent transmission of polycystic kidney disease in kidney transplantation.

BACKGROUND: Although organ donors are rigorously tested, occasionally an unidentified donor disease can be transmitted to the recipient. These conditions include malignancies, infections, and, rarely, congenital diseases. CASE REPORT: We report a case of an inadvertent transmission of polycystic kidney disease from a 40-year-old trauma victim to both kidney recipients. There was no family history of renal disease in the donor. The renal allografts gradually increased in size with the development of cysts and functioned for 10 and 14 years. CONCLUSIONS: We report a case of inadvertent transmission of polycystic kidney disease from an unsuspecting deceased donor to both the recipients through renal allograft. Both the grafts lasted long enough to suggest that polycystic kidneys from deceased donors can be considered for transplantation.