0
selected
-
1.
Pain Management in CKD: A Guide for Nephrology Providers.
Koncicki, HM, Unruh, M, Schell, JO
American journal of kidney diseases : the official journal of the National Kidney Foundation. 2017;(3):451-460
Abstract
Although pain is one of the most commonly experienced symptoms by patients with chronic kidney disease, it is under-recognized, the severity is underestimated, and the treatment is inadequate. Pain management is one of the general primary palliative care competencies for medical providers. This review provides nephrology providers with basic skills for pain management. These skills include recognition of types of pain (nociceptive and neuropathic) syndromes and appropriate history-taking skills. Through this history, providers can identify clinical circumstances in which specialist referral is beneficial, including those who are at high risk for addiction, at risk for adverse effects to medications, and those with complicated care needs such as patients with a limited prognosis. Management of pain begins with the development of a shared treatment plan, identification of appropriate medications, and continual follow-up and assessment of efficacy and adverse effects. Through adequate pain management, providers can positively affect the health of individual patients and the performance of health care systems.
-
2.
[Takotsubo cardiomyopathy recurrence in patient with chronic kidney disease: case report and literature review].
Caccetta, F, Caroppo, M, Musio, F, Mudoni, A, Accogli, A, Zacheo, MD, Burzo, D, Mangia, R, Accogli, M, Nuzzo, V
Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia. 2016;(6)
Abstract
Takotsubo cardiomyopathy (CT) is a syndrome characterized by an acute and transient left ventricular dysfunction, electrocardiographic abnormalities suggestive of acute coronary syndrome, chest pain and/or dyspnea, left ventricular mid-apical segments akinesia and normal coronary angiography. It is mainly observed in postmenopausal women after an intense physical or mental stress. The course is usually favourable but sometimes severe complications occur. The recurrence rate is 2-10%. We present the case of a recurrence of CT in a female, 79 years old, with hypertension, diabetes, chronic kidney disease (CKD) stage 3 who was admitted to the emergency room for dyspnea and vomiting. The electrocardiogram (ECG) showed a sinusal rhythm and T wave inversion in the pre-cordial leads and the echocardiogram a typical feature of CT with depressed left ventricular systolic function (FE). The ECG ranged quickly with atrial fibrillation rhythm, followed by a major hypokinetic arrhythmia with advanced atrio-ventricular block which indicated the need for a temporary pacemaker placement. The patient was oligouric, with severe renal failure, hyponatremia, hyperkalemia and metabolic acidosis. A continuous renal replacement therapy (CRRT) was started. On the seventh day improvement in urine output, electrolyte and acid base imbalance and FE normalization occurred. The renal function improved gradually, but after 36 months, persisted CKD stage 4. The case report describes the development of a cardiorenal syndrome type 1 induced by CT recurrence and effectiveness of CRRT in the management of acute heart failure. It also suggests a potential role played by CKD as a risk factor in the onset and recurrence of CT.
-
3.
Preventing the progression of chronic kidney disease: two case reports and review of the literature.
Toor, MR, Singla, A, Kim, JK, Sumin, X, DeVita, MV, Michelis, MF
International urology and nephrology. 2014;(11):2167-74
Abstract
A variety of therapeutic modalities are available to alter the abnormalities seen in patients with chronic kidney disease (CKD). A comprehensive plan can now be developed to slow the progression of CKD. Two clinical cases of delay in the need for renal replacement therapy are described. This delay was achieved by using recognized recommendations for optimal diabetes therapy (HbA1c target 7 %), goals for blood pressure levels, reduction of proteinuria, and the proper use of ACEI/ARB therapies. Recent recommendations include BP <140/90 mmHg for patients <60 years old and <150/90 mmHg for older patients unless they have CKD or diabetes. Limits on dietary sodium and protein intake and body weight reduction will decrease proteinuria. Proper treatment for elevated serum phosphorous and parathyroid hormone levels is now appreciated as well as the benefits of therapy for dyslipidemias and anemia. Concerns regarding unfavorable outcomes with excess ESA therapy have led to hemoglobin goals in the 10-12 g/dL range. Finally, new therapeutic considerations for the treatment of acidosis and hyperuricemia are presented with data available to suggest that increasing serum bicarbonate to >22 mmol/L is beneficial, while serum uric acid therapeutic goals are still uncertain. Also, two as yet insufficiently understood approaches to altering the course of CKD (FGF-23 level reduction and balancing gut microbiota) are noted.
-
4.
Lead poisoning from an Ayurvedic herbal medicine in a patient with chronic kidney disease.
Prakash, S, Hernandez, GT, Dujaili, I, Bhalla, V
Nature reviews. Nephrology. 2009;(5):297-300
Abstract
BACKGROUND A 60-year-old man with a history of diabetes and hypertension was referred to a nephrology clinic for investigation of his elevated serum creatinine level. INVESTIGATIONS Physical examination; laboratory investigations, including measurement of whole-blood lead level, body lead burden and urine albumin:creatinine ratio; history of lead exposure and use of herbal medical products; and renal ultrasonography. DIAGNOSIS Stage 3 chronic kidney disease that was probably worsened by consumption of lead in the form of an Ayurvedic herbal remedy. MANAGEMENT Cessation of the herbal product, followed by lead-chelation therapy with calcium disodium ethylenediaminetetraacetic acid. The patient's whole-body lead burden and blood lead level decreased to acceptable levels and his serum creatinine value was within the normal range at final follow-up.
-
5.
A successful 39-week pregnancy on hemodialysis: a case report.
Coyle, M, Sulger, E, Fletcher, C, Rouse, D
Nephrology nursing journal : journal of the American Nephrology Nurses' Association. 2008;(4):348-55, 402; quiz 356
Abstract
Pregnancy in women on hemodialysis is very uncommon, and rates of spontaneous abortion, hypertension, pre-eclampsia, polyhydramnios, pre-term labor, and premature birth are high. This article documents a successful 39-week pregnancy in a woman who conceived at Stage 5 in chronic kidney disease and who started hemodialysis at 7 weeks gestation. The dialysis prescription included 3-hour treatments 5 times weekly. Blood urea nitrogen levels and fluid removal by ultrafiltration were managed according to the recommendations in the available literature. Erythropoietin and IV iron were utilized liberally for her worsening anemia. She was closely monitored by a multidisciplinary team at the dialysis center and by the perinatologist in her health care system. Pre-term labor and premature birth were avoided; however, she developed hypertension, pre-eclampsia, and polyhydramnios. She delivered a healthy female by scheduled cesarean section. There is limited data on management of this minority population, and much can be learned regarding mineral metabolism, safety and use of medications, control of hypoalbuminemia, and care practices to reduce the incidence of maternal complications and premature birth.