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Urinary Tract Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Management should be at a center with a transplant nephrologist, and requires attention toward serial assessment of renal function, diagnosis and treatment of rejection, blood pressure control, and control of anemia. There is an overall success of pregnancy (live births) in women after renal transplantation of >90% [55]. Fertility can normalize soon after transplantation, so patients should be maintained on contraception until ready to attempt a pregnancy. If graft function is adequate and stable, pregnancy does not cause accelerated graft demise [56]. However, one case-control study suggested that graft function is adversely affected by pregnancy [57]. At 10-year follow-up, graft survival was 69% in pregnant patients and 100% in non-pregnant controls.
Extracorporeal Membrane Oxygenation (ECMO) Support for Cardiorespiratory Failure
Published in Wayne E. Richenbacher, Mechanical Circulatory Support, 2020
Ralph E. Delius, Angela M. Otto
Some ECMO patients also require renal support such as hemofiltration or dialysis. Involvement of a nephrologist with an interest in acute renal failure can be very helpful. Contact should be made early in any ECMO run in which dialysis may be needed.
Life Care Planning for Organ Transplantation
Published in Roger O. Weed, Debra E. Berens, Life Care Planning and Case Management Handbook, 2018
Renal patients awaiting transplantation are followed at close intervals by their nephrologists through their respective dialysis units and nephrology offices. While awaiting transplantation, pre-kidney transplant patients will have blood specimens forwarded to the histocompatibility laboratories (HLA) at periodic intervals (at least quarterly) for cross-matching with prospective cadaveric kidney donors and for monitoring of antibodies associated with rejection. This represents an ongoing cost born by the recipient candidate until transplantation is accomplished. Likewise, the cost of donor evaluations and eventual organ procurement are assumed by the organ recipient. Patients on hemodialysis will continue to dialyze three times weekly for a period of 3 to 4 hours with each dialysis. Home hemodialysis has become more popular over time with nightly hemodialysis taking place in the patient's home.
The efficacy and safety of roxadustat for anemia in patients with dialysis-dependent chronic kidney disease: a systematic review and meta-analysis
Published in Renal Failure, 2023
Qiaoqiao Zhou, Mian Mao, Jing Li, Furong Deng
Some studies had shown that inflammation can inhibit the body’s response to ESAs [45]. We were interested to understand whether inflammation has the same effect on roxadustat. Four studies observed a change from baseline in Hb level of patients with a CRP level exceeding ULN. Since the participants of one of the studies were patients newly initiating dialysis [26], we excluded that study and conducted a meta-analysis of the remaining 3 groups of stable dialysis patients [19,21,24]. As shown in Figure 11(B), the Hb level was higher for roxadustat than for ESAs (p = 0.03). In these studies, compared to patients with normal CRP levels, patients with elevated CRP had a lower Hb response, despite receiving a higher dose of ESAs. However, a similar inflammatory state did not affect the Hb response and dosage of roxadustat. This result indicates that roxadustat could increase Hb level even in the inflammatory state, and the dosage may not be affected. This provides a new way for nephrologists to treat anemia in dialysis patients with concomitant inflammatory conditions.
Development and validation of a novel nomogram to predict overall survival of patients with moderate to severe chronic kidney disease
Published in Renal Failure, 2022
Ning Li, Guowei Zhou, Yawei Zheng, Enchao Zhou, Weiming He, Wei Sun, Lu Zhang
This nomogram is based on the laboratory tests and census data obtained from the NHANES database. We included the prognosis factors which were commonly used in clinical practice. Therefore, it facilitates uncomplicated, efficient assessment for nephrologists. The external validation also proved that this nomogram could be applied to a variety of patients. Nonetheless, the limitations of this study also need to be addressed. First, although we did our best to include indicators that might be associated with CKD prognosis, some predictors such as neutrophil gelatinase-associated lipocalin or kidney injury molecular-1 were not included due to the limited data of the NHANES database. Second, our nomogram's prognosis was primarily based on laboratory indicators. Some prediction elements, such as nutrition, environment, and genetics, are also highly essential. Third, we performed external validation using patients from the NHANES database at different time points. However, multicenter clinical validation is also required to further evaluate the external ability of the nomogram.
The in- and out-of-hospital management of HF patients: results from a nationwide Belgian survey
Published in Acta Cardiologica, 2021
Liesbeth F. Ghys, Pieter Martens, Ward A. Heggermont, Laurence Gabriel, Alex Heyse, Pierre Troisfontaines, Michael Maris
Patients reach the cardiologist by general practitioners referral, direct appointment, or emergency after acute event, with no marked differences, as these three paths were indicated by 78%, 72% and 71% of the cardiologists respectively. The cardiologists’ perception of the role of the general practitioner, geriatrician and nephrologists in HF management is illustrated in Table 3. General practitioners are considered more important in the follow-up of HF patients, to monitor blood parameters and recognise worsening HF. Nephrologists are mostly consulted for treatment advice and for managing dialysis, and geriatricians for managing comorbidities and polypharmacy. Treatment advice by nephrologists and geriatricians was indicated by 75% and 50% of the dedicated HF cardiologists, compared to 61% and 29% of the non-dedicated HF cardiologists. In contrast, managing polypharmacy by geriatricians is perceived more importantly by non-dedicated HF cardiologists (80%) compared to the dedicated HF cardiologists (63%). However, none of the differences were significant.