RESUMO
Acute kidney injury (AKI), especially if recurring, represents a risk factor for future chronic kidney disease. In intensive care units, increased intra-abdominal pressure is well-recognized as a significant contributor to AKI. However, the importance of transiently increased intra-abdominal pressures procedures is less commonly appreciated during laparoscopic surgery, the use of which has rapidly increased over the last few decades. Unlike the well-known autoregulation of the renal cortical circulation, medulla perfusion is modulated via partially independent regulatory mechanisms and strongly impacted by changes in venous and lymphatic pressures. In our review paper, we will provide a comprehensive overview of this evolving topic, covering a broad range from basic pathophysiology up to and including current clinical relevance and examples. Key regulators of oxidative stress such as ischemia-reperfusion injury, the activation of inflammatory response and humoral changes interacting with procedural pneumo-peritoneum formation and AKI risk will be recounted. Moreover, we present an in-depth review of the interaction of pneumo-peritoneum formation with general anesthetic agents and animal models of congestive heart failure. A better understanding of the relationship between pneumo-peritoneum formation and renal perfusion will support basic and clinical research, leading to improved clinical care and collaboration among specialists.
RESUMO
Mutual trust, efforts, and commitment between patients and providers are essential for a successful, long-lasting renal transplant. From the renal transplant recipient's side, non-adherence to the medication has gained recognition as a predominant cause of late antibody-mediated rejection. Since the early 1970s, pharmacists have been involved in the care of transplant recipients and the incorporation of transplant pharmacists has improved the outcomes in solid organ transplantation. Such involvement of clinical pharmacists extends beyond improving graft outcomes: various studies demonstrated benefits in the care of diabetes, hypertension, and hyperlipidemia, with commensurate reduction of cardiovascular risk. From a unique perspective, this overview aimed to discuss the emerging role of Pharm. D.s and clinical pharmacists in general as it relates to team care, education of patients and healthcare providers and the sometimes conflicting relationship between physicians and pharmacists. Additional clinically relevant studies from culturally diverse settings are needed to explore the responsibilities of clinical team members to ensure optimized teamwork efforts without overlapping and duplication of efforts.
