ISSN:1062-4821    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This article reviews the new trends in the diagnosis, treatment and prevention of catheter-related bacteraemia in clinical nephrology. Among these are the newer diagnostic techniques of evaluating and obtaining culture specimens from central lines, such as timed cultures and use of the endoluminal brush. In general, attempts to salvage infected haemodialysis lines are unsuccessful. We review the data that pertain to the use of antibiotic-coated catheters in non-dialysis patients and discuss how these observations may be applied to end-stage renal disease patients.

ISSN:1062-4821    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Convective therapies such as hemofiltration, hemodiafiltration and double high flux dialysis have been shown to improve treatment delivered and treatment tolerance when compared to conventional dialysis therapies. The risk associated with these treatments is primarily in the quality of the substitution fluid. Technological advances now permit on-line produced substitution fluid, thereby significantly reducing the cost associated with hemofiltration and hemodiafiltration. The quality of the substitution fluid is only assured when the quality of the RO water used is within the guidelines set by the Association for the Advancement of Medical Instrumentation (AAMI). Therefore, the success of the application of this therapy is dependent on the water treatment protocols in the dialysis units. The success of this modality as a treatment for chronic renal failure is dependent on identifying those patient groups who will benefit most from this more efficient but more expensive treatment.

ISSN:1062-4821    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Patient non-compliance with the dialysis treatment prescription has often been overlooked as an important variable that contributes to outcomes in end-stage renal disease. This review discusses evidence from a limited number of researchers that such behavior may be as important as the traditional medical indicators that predict patient survival.

ISSN:1062-4821    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This review on non-hearfbeating donation focusses on three issues: the number of kidneys procured from a non-heartbeating donor programme, the transplant results and the influence of a non-heartbeating programme on public opinion regarding transplantation.

ISSN:1062-4821    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Discovery of novel biological and pharmaceutical agents directed against discrete molecular targets in the lympnocyte activation sequence has enabled the effective control of graft rejection by the use of combinatorial immunosuppressive therapy, Chimeric and humanized monoclonal antibodies against T-cell receptor CD3 complex chains or the IL-2 receptor block T-cell function without inducing activation, and do not cause the cytekine release syndrome of first generation products. Biological blockade of co-stimulatory molecules including CD40L and CD28 produces immunological allograft unresponsiveness in primates, though this effect is not yet proven in humans. Heterogeneity in clinical response to pharmaceutical agents is often explained by pharmacokinetic factors of absorption, metabolism and elimination. The use of microemulsion technology has increased the absorption and efficacy of cyciosporine in all organ transplants, so that there is little difference in efficacy between this agent and tacrolimus. Mycophenolate mofetil is not maximally effective alone, but significantly reduces the relative risk of acute rejection in combination with an immunophilin binding agent. It is also effective when introduced at the time of rejection. Whether it can replace other agents for maintenance immunosuppression is now under investigation. Sirolimus, the latest pharmaceutical agent to complete phase III trials, acts to inhibit IL-2 driven lymphocyte proliferation and reduces the risk of acute rejection to below 20%. Multiple pharmacokinetic interactions occur within and between these agents, so that pharmacokinetic monitoring is increasingly important. At present there are few tools to detect pharmacodynamic interactions, although reporter gene constructs and intracellular cytokine labeling offer exciting possibilities for biological monitoring. Despite these advances, none of these interventions confers demonstrable long-term benefit in graft survival or function. Acute rejection can not therefore be assumed to be a simple surrogate for chronic injury, and research must be re-focused to determine the relevant targets for long-term immunosuppression.

ISSN:1062-4821    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

An endothelin-transforming growth factor beta type 1 pathway is proposed to account for cyclosporin nephrotoxicity, Cyclosporin amplifies the production of endothelin. Enhanced endothelin production accentuates acute vascular events and promotes the synthesis and activation of transforming growth factor beta type 1, contributing to acute and chronic pathology. This scheme integrates many observations, including the involvement of the renin-angiotensin pathway and other activators of endothelin production, and provides a rationale for the amelioration of cyclosporin nephrotoxicity.

ISSN:1062-4821    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Glomerular filtration rate (GFR) is the standard measure of renal function and is critical for the management of renal diseases. Rigorous assessment of GFR requires the measurement of renal clearance of a filtration marker, such as inulin. This method, however, is not suitable for routine clinical practice. Labelled compounds as alternative filtration markers provide accurate and precise GFR measurement, but their use may be limited for safety reasons. Thus investigators have proposed clearance procedures using minute doses of non-radioactive contrast agents, including iothalamate and iohexol. Their renal clearance provides similar accuracy as inulin clearance in GFR estimation, but the need of urine collection again poses certain limitations to the procedure. Thus, plasma clearance of suitable exogenous markers, such X-ray contrast media, has been suggested for measuring renal function, in which the elimination rate of the tracer after a single intravenous injection is evaluated. Plasma clearance of these markers estimated by multiple blood samples provides precise information, but repeated sampling makes this method cumbersome. Abbreviated kinetic profiles have been proposed to predict GFR from the plasma disappearance curve. The simplified method that uses a one-compartment model corrected by the Bröchner-Mortensen formula gives an excellent correlation with inulin clearance and is currently employed for measuring GFR in multi-centre clinical trials.

ISSN:1062-4821    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Acute renal failure continues to be a difficult clinical problem despite developments in dialysis and critical care. Diagnosis of the etiology frequently determines treatment, Urinalysis remains an essential diagnostic tool in the approach to acute renal failure, particularly with the current emphasis on cost-containment and evidence-based medicine. This review focuses on some of the characteristic features in the urinalysis found in different forms of acute renal failure, current developments into the molecular basis for these urinary abnormalities, and new markers on the horizon.

ISSN:1062-4821    

出版商:OVID    

年代:1998

数据来源: OVID