1.
Screening for latent tuberculosis in refugees with renal failure.
Shantha, GP, Kumar, AA, Bhise, V, Sivagnanam, K, Subramanian, KK, Kanade, P, Khanna, R
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia. 2012;(1):8-14
Abstract
Refugee camps are prone for easy spread of infections of various kinds and tuberculosis (TB) is no exception. Refugees with renal failure are often a vulnerable group because they are immunocompromised due to reasons such as poor nutrition, overcrowding and immune suppression due to renal failure. Latent pulmonary TB is a particular problem in this patient population as it is not easily diagnosed and has immense potential for spread. Tuberculin Skin Test (TST), although easy to perform and is cost-effective, suffers from the limitations of giving false positive results due to cross-reaction with the vaccination. Chest radiography though cheap, has not yet been validated in refugee populations for this purpose. Sputum analysis shows promise due to ease of performing but again has not been validated in refugees. Newer assays such as IF-γ show great promise but needs large scale studies for validation and cheaper assays need to be developed for use in resource poor refugee setting. In short, an ideal tool for effective screening of latent TB in refugees with renal failure is lacking. Future studies are required to identify this ideal tool.
2.
How to feed patients with renal dysfunction.
Bellomo, R
Blood purification. 2002;(3):296-303
Abstract
Renal dysfunction is common in critically ill patients and its presence has, in the past, posed serious challenges to nutritional support. Such challenges were due to the increased azotemia induced by protein or amino acid administration, the fluid overload caused by the administration of nutrients and the difficulties associated with the control of these complications by means of conventional dialytic techniques. The development and increasing application of continuous renal replacement therapy (CRRT) has removed such concerns, because control of azotemia and fluid balance can be predictably and reliably achieved in all patients. Accordingly, the presence of renal failure should in no way influence the amount or type of nutritional support administered to a critically ill patient. We recommend that approximately 30-35 kcal/kg/day be administered enterally and begun within the first few hours of admission to the intensive care unit and that protein intake be kept in the 1.5-2 g/kg/day range. Accumulating evidence also suggests that immune-enhancing enteral preparations decrease the duration of hospital stay, the number of infections and perhaps mortality. Such preparations should be used in these patients. Finally adequate vitamin and trace element supplementation is recommended to counterbalance the decrease in antioxidants and the loss of some vitamins during CRRT. Available evidence suggests that if these steps are applied as part of a protocol-based approach to the nutritional support of patients with renal failure, their morbidity and perhaps mortality can be significantly decreased.