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Renal Disease; Fluid and Electrolyte Disorders
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
This involves treatment of the underlying glomerular disease. Blood pressure should be controlled and diuretics can improve the oedema. Renal replacement therapy may be necessary if the renal impairment is severe. Antibiotics are given in postinfective glomerulonephritis to ensure that the infection is eradicated.
Pharmacology of azole antifungal agents
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
The effect of organ dysfunction on drug elimination has been studied with each of the azole agents. Renal dysfunction is a concern for patients receiving fluconazole. In patients with renal dysfunction, it is advised to decrease the total daily dose of fluconazole by 50% [26]. Studies have also been conducted in patients requiring renal replacement therapy with either hemodialysis or continuous hemofiltration. For a traditional hemodialysis session, 25%–40% of fluconazole is removed depending on the duration of the session [91,92]. Therefore, supplementation is suggested following each dialysis session [26]. Continuous hemofiltration increased clearance of fluconazole ranging from 20 to 400 times baseline elimination in patients with acute renal failure suggesting that daily dosing should be continued in this population [93].
Critical care
Published in Sam Mehta, Andrew Hindmarsh, Leila Rees, Handbook of General Surgical Emergencies, 2018
Sam Mehta, Andrew Hindmarsh, Leila Rees
Indications for renal replacement therapy in renal failure are: metabolic acidosis, pH < 7.2K+>6.0mmol/lfluid overloadcomplications of uraemia.
Clinical characterisation and management outcome of obstetric patients following intensive care unit admission for COVID-19 pneumonia
Published in Journal of Obstetrics and Gynaecology, 2023
Esra Aktiz Bıçak, Süleyman Cemil Oğlak
The CT reports of patients interpreted by the radiology unit revealed that 17 (54.8%) had mild pulmonary involvement, 6 (19.4%) had moderate pulmonary involvement and 8 (25.8%) had severe pulmonary involvement (Figures 2, 3). Sixteen (51.6%) patients required HFOT, 6 (19.3%) patients required CPAP, and 5 (16.1%) patients required invasive mechanical ventilation. One intubated patient was extubated, and the others resulted in mortality. Six patients were transferred to the tertiary ICU due to the need for advanced follow-up and treatment. Sepsis complicated by septic shock and multiorgan failure occurred in 4 of those. Renal replacement therapy was performed on two of the patients with acute renal failure. Spontaneous pneumothorax developed in one patient and a left chest tube was inserted. Vasopressor therapy was performed in 3 patients with developed septic shock. The mean length of stay in the ICU and hospital was 4.9 ± 4.3 (1–18) days and 10.4 ± 5.1 (3–21) days, respectively (Table 2).
Transcriptional profile changes after treatment of ischemia reperfusion injury-induced kidney fibrosis with 18β-glycyrrhetinic acid
Published in Renal Failure, 2022
Yamei Jiang, Chengzhe Cai, Pingbao Zhang, Yongsheng Luo, Jingjing Guo, Jiawei Li, Ruiming Rong, Yi Zhang, Tongyu Zhu
We noticed that the systemic renal function was inconsistent with single renal function. Creatinine of the insulted left kidney in I/R + vehicle group increased to about three times the baseline, while systemic SCr increased less than twice the baseline. Moreover, GA treatment effect could be detected in single kidney but not systemic. We concluded that, firstly, I/R-induced fibrosis model established successfully according to the worst left renal function and the increasing fibrosis marker. Deng et al. [24] reported similar method for modeling fibrosis. They clamped the left renal pedicle for 30 min to establish acute kidney injury model and from the day 7 after I/R injury, fibrosis could be detected on Masson and Sirius red staining, and α-SMA and Collagen-I were increased significantly in qPCR and western blot. Secondly, using single kidney creatinine rather than systemic SCr was more accurate to monitor renal function for this model. We might say the normal or mild higher creatinine of the contralateral right kidney was temporary. The function of it gradually deteriorated due to the infiltration of a large amount of inflammatory cells [25]. In the long term, both kidneys will fibrotic and SCr will be much higher without any intervention. Just like in many clinical settings, patients with kidney diseases such as glomerulonephritis will have worse and worse renal function, in the end needing renal replacement therapy.
Urinary catheter monitoring of intra-abdominal pressure after major abdominal surgery, a cost-benefit analysis
Published in Journal of Medical Economics, 2022
John P. Ney, Vanessa Moll, Edward J. Kimball
We translated ICU days to cost using the daily cost of ICU days, and the additional cost of days where the patient was on mechanical ventilation in the ICU18. We estimated the cost of kidney failure requiring renal replacement therapy as a single value for the course of the hospitalization19. The cost of urinary catheter IAP monitoring was estimated at $200, the current unit price of a commercially available real-time urinary catheter monitor (Accuryn catheter, Potrero Medical, Inc.) The Accuryn monitor does not require periodic saline infusion and therefore does not require additional labor from ICU nurses to provide IAP monitoring. We did not estimate the additional costs of countermeasures to lower IAP. Many of these would be considered part of standard postoperative patient management, and early awareness of IAH would likely lead to fewer intensive procedures such as percutaneous catheter drainage. As the rates of percutaneous drainage (as opposed to less invasive measure) in response to IAH and decompressive laparotomy for ACS are highly dependent on specific pathology, clinical factors, and clinician judgment (with surgical management pursued in only six patients in Smit et al.), we elected not to make further assumptions for utilization of these measures in each arm of the model and therefore their costs are not included. All costs were inflated to 2020 dollars using the Consumer Price Index for medical interventions20 (Table 1).