scholarly journals Mandibular Osteonecrosis Induced by Bisphosphonates in a Carrier of Chronicle Kidney Disease

2018 ◽  
Vol 4 (1) ◽  
pp. 1119-1125
Author(s):  
Kaohana Da Silva ◽  
Greison De Oliveira ◽  
Eleonor Garbin-Júnior ◽  
Natasha Magro-Érnica ◽  
Geraldo Griza ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Multiple Myeloma ◽  
Renal Function ◽  
Bone Resorption ◽  
Kidney Disease ◽  
Impaired Renal Function ◽  
Clinical Case ◽  
Treatment Protocol ◽  
Inorganic Pyrophosphate ◽  
Jaw Osteonecrosis

The bisphosphonates are synthetic substances of inorganic pyrophosphate that have been the basis of treatment of patients with osteolytic diseases, such as multiple myeloma, malignant hypercalcemia, Paget's disease, or patients with bone metastases. Its main pharmacological effect is inhibition of bone resorption caused by osteoclasts, which have a reduced function. Their adverse effects are infrequent but include pyrexia, impaired renal function, hypocalcemia, and more recently, maxillo-mandibular ostenecrose induced bofosfonatos. In this report we describe a clinical case of jaw osteonecrosis induced by bisphosphonates in patient with chronic kidney disease and the treatment protocol performed.

Risk of Stroke, Bleeding, and Death in Patients with Nonvalvular Atrial Fibrillation and Chronic Kidney Disease

Cardiology ◽  
2020 ◽  
Vol 145 (3) ◽  
pp. 178-186
Author(s):  
Yoav Arnson ◽  
Moshe Hoshen ◽  
Adi Berliner-Sendrey ◽  
Orna Reges ◽  
Ran Balicer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Impaired Renal Function ◽  
Bleeding Risk ◽  
Intracranial Bleeding ◽  
Increased Risk ◽  
Ckd Stage ◽  
Stroke Death

Introduction: Atrial fibrillation (AF) and chronic kidney disease (CKD) are both associated with increased risk of stroke, and CKD carries a higher bleeding risk. Oral anticoagulation (OAC) treatment is used to reduce the risk of stroke in patients with nonvalvular AF (NVAF); however, the risk versus benefit of OAC for advanced CKD is continuously debated. We aim to assess the management and outcomes of NVAF patients with impaired renal function within a population-based cohort. Methods: We conducted a retrospective observational cohort study using ICD-9 healthcare coding. Patients with incident NVAF between 2004 and 2015 were identified stratified by CKD stage. We compared treatment strategies and estimated risks of stroke, death, or any major bleeding based on CKD stages and OAC treatment. Results: We identified 85,116 patients with incident NVAF. Patients with impaired renal function were older and had more comorbidities. OAC was most common among stage 2 CKD patients (49%) and least in stages 4–5 CKD patients (27.6%). Higher CKD stages were associated with worse outcomes. Stroke rates increased from 1.04 events per 100 person-years (PY) in stage 1 CKD to 3.72 in stages 4–5 CKD. Mortality increased from 3.42 to 32.95 events/100 PY, and bleeding rates increased from 0.89 to 4.91 events/100 PY. OAC was associated with reduced stroke and intracranial bleeding risk regardless of CKD stage, and with a reduced mortality risk in stages 1–3 CKD. Conclusion: Among NVAF patients, advanced renal failure is associated with higher risk of stroke, death, and bleeding. OAC was associated with reduced stroke and intracranial bleeding risk, and with improved survival in stages 1–3 CKD.

Renal disease

2018 ◽  
Author(s):  
Quentin Milner
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Renal Disease ◽  
Replacement Therapy ◽  
Impaired Renal Function ◽  
Anaesthetic Management

This chapter describes the anaesthetic management of the patient with renal disease. The topics include estimation of renal function, chronic kidney disease, renal replacement therapy (including haemodialysis), acute renal failure, and the patient with a transplanted kidney. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. The effects of impaired renal function on the elimination of anaesthetic drugs are discussed.

scholarly journals Clinical significance of NT-proBNP levels in Chronic Kidney Disease Patients with or without Heart Failure: An Indian Perspective

2021 ◽  
Vol 3 (1) ◽  
pp. 01-03
Author(s):  
Charan Reddy KV
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Impaired Renal Function ◽  
Treatment Modalities ◽  
Function Evaluation ◽  
Clinical Use ◽  
Blood Samples ◽  
Indian Perspective

Objective: N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are extremely useful in detecting heart failure (HF). However, the effects of renal inadequacy on NT-proBNP levels in patients presenting with or without HF remains less clear. We sought to examine the correlation of NT-proBNP levels in all CKD patients and cut-off values of NT pro-BNP level for the diagnosis of HF in stable CKD patients as well as CKD patients who are on haemodialysis (HD). Material and Methods: The study comprises 141 CKD patients of both sexes who presented with or without dyspnea to casualty of Lilavati Hospital, Mumbai, India, were prospectively enrolled, and blood samples collected to estimate NT-proBNP level. Results: NT-proBNP cut-off level of 1850 pg/mL for stable CKD patients not on dialysis has a sensitivity of 95% and specificity of 80 %. NT-proBNP cut-off level of 8000pg/ml for CKD patients on HD has a sensitivity of 87 % and specificity of 79%. NT-proBNP cut-off level of 4200 pg/mL for all CKD patients has a sensitivity of 85% and specificity of 81%, for diagnosis of HF. Conclusion: The clinical use of NT-proBNP is a valuable tool for the evaluation of dyspneic patients with suspected HF, irrespective of renal function. We recommend the above NT-proBNP cut-off levels for diagnosing HF patients in the presence of impaired renal function. Evaluation of the correlation between NT-proBNP levels in CKD is important to identify and to design treatment modalities in order to reduce CVD .Therefore, NT-proBNP measurement can be a valuable tool for diagnosis and evaluation of dyspneic patients for early initiation of HF treatment.

The effect of renal failure on drug handling in critical illness

2016 ◽  
Author(s):  
Myrna Y. Munar ◽  
Ali J. Olyaei
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Impaired Renal Function ◽  
Plasma Concentrations ◽  
Kidney Injury ◽  
Specific Patient ◽  
Diagnostic Agents ◽  
Developing Kidney ◽  
Drug Handling

The kidneys play an important role in the elimination of many drugs. In chronic kidney disease and acute kidney injury several pharmacokinetic processes are altered. Thus, patients with impaired renal function require adjustment of medication dosing. Many drugs require a loading dose to rapidly achieve therapeutic plasma concentrations. Subsequently, the dose or dosing interval may have to be adjusted as appropriate for the degree for renal function. The most common method to estimate renal function is use of the Cockcroft–Gault (CG) equation. It has been well validated, is easy to remember, and is fairly accurate in estimating kidney function. Most drugs are dosed based on the patient’s weight (mg/kg), which makes the CG method easier to use for most estimates. Other methods are available and a patient’s renal function should always be estimated based on the best available evidence for that specific patient. Patients with chronic kidney disease are at great risk of developing kidney injury from drugs or diagnostic agents. Exposure to nephrotoxins should be avoided as much as possible.

scholarly journals Prevalence of Mineral Bone Disease in Chronic Kidney Disease Patients using Biochemical Markers

2020 ◽  
Author(s):  
Reeta Choudhary ◽  
Charu Yadav ◽  
Pallavi Jain ◽  
Shyam Bihari Bansal ◽  
Beena Bansal ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Bone Disease ◽  
Biochemical Markers ◽  
Treatment Protocol ◽  
Health Concern ◽  
P Value ◽  
Bone Homeostasis ◽  
Chi Square

Introduction: Chronic Kidney Disease (CKD), a condition characterised by a gradual loss of renal function over the time, has emerged as a major public health concern with 17% prevalence in Indian population. Decrease in renal function in CKD leads to progressive metabolic derangements of mineral and bone homeostasis which in turn makes them susceptible to bone related and cardiovascular complications. Aim: To calculate the prevalence of Mineral Bone Disease (MBD) in CKD patients by estimation of biochemical markers Calcium (Ca), Phosphorus (P), Alkaline Phosphatase (ALP) and intact Parathyroid Hormone (iPTH) and to analyse their prevalence across different stages of CKD. Materials and Methods: This was a hospital based cross-sectional study conducted at Medanta-the Medicity hospital in 2300 previously diagnosed CKD cases who visited the Nephrology OPD for their follow-up visits, from October 2017 to December 2018. Serum levels of Ca, P, ALP and iPTH were estimated in VITROS 4600 and ARCHITECT I system automated analysers using commercially available kits. Stage-wise and overall prevalence of deranged levels of these markers was calculated and based on this the prevalence of MBD was calculated. Statistical analysis was done using SPSS version 24.0. Descriptive analysis of quantitative parameters was expressed as means and standard deviation. The analysis for comparison among three or more categories was done using one-way ANOVA. Categorical data was analysed using Chi square test for proportions and data was expressed as absolute number and percentage in a contingency table along with the chi square and p-values. The p-value <0.05 was considered statistically significant. Results: Prevalence of MBD in overall CKD patients was 81.6%; the stage-wise prevalence being 63.4% (stage 3), 76.9% (stage 4), 87.6% (stage 5) and 91.3% (stage 5D). The overall prevalence of hypocalcaemia, hyperphosphatemia, high ALP and secondary hyperparathyroidism was 27.8%, 48.3%, 26.5% and 75.6%, respectively. Conclusion: The present study reports an alarmingly high prevalence of MBD in CKD cases; the disease burden being maximum in stage 5 and 5D. This was despite the administration of relevant medications and supplements to prevent MBD. Thus, there needs to be some change in treatment protocol to reduce the prevalence of MBD to improve the quality of life and reduce mortality rate in CKD patients.

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