166 research outputs found
The Risk of Chronic Kidney Disease Associated With Urolithiasis and its Urological Treatments: a Review
Get PDFPURPOSE:
Urolithiasis can impair kidney function. This literature review focuses on the risk of kidney impairment in stone formers, the specific conditions associated with this risk and the impact of urological surgery.
MATERIALS AND METHODS:
The PubMed and Embase databases were searched for publications on urolithiasis, its treatment, and the risk of chronic kidney disease (CKD), end-stage renal disease (ESRD) and nephrectomy in stone formers.
RESULTS:
In general, renal stone formers carry twice the risk of CKD or ESRD, and for female and overweight stone formers the risk is even higher. Patients with frequent urinary tract infections, struvite stones, urinary malformations and diversions, malabsorptive bowel conditions, and some monogenic disorders are at high risk of CKD/ESRD. Shock wave lithotripsy or minimally-invasive urological interventions for stones do not adversely affect renal function. Declines in renal function generally occur in patients with pre-existing CKD or with a large stone burden requiring repeated and/or complex surgery.
CONCLUSIONS:
Although the effect size is modest, urolithiasis may cause CKD thus it is mandatory to assess patients with renal stones for their risk of developing CKD/ESRD. We suggest that all guidelines dealing with renal stone disease should include assessing this risk
Evaluation of an individualized dose titration regimen of patiromer to prevent hyperkalaemia in patients with heart failure and chronic kidney disease
Get PDFAIMS Hyperkalaemia risk precludes optimal renin-angiotensin-aldosterone system inhibitor use in patients with heart failure (HF), particularly those with chronic kidney disease (CKD). Patiromer is a sodium-free, non-absorbed potassium (K)-binding polymer approved for the treatment of hyperkalaemia. In PEARL-HF, patiromer 25.2 g (fixed dose) prevented hyperkalaemia in HF patients with or without CKD initiating spironolactone. The current study evaluated the effectiveness of a lower starting dose of patiromer (16.4 g/day) followed by individualized titration in preventing hyperkalaemia and hypokalaemia when initiating spironolactone. METHODS AND RESULTS This open-label 8-week study enrolled 63 patients with CKD, serum K4.3-5.1 mEq/L, and chronic HF, who, based on investigator opinion, should receive spironolactone. Eligible patients started spironolactone 25 mg/day and patiromer 16.8 g/day (divided into two doses), with patiromer titrated to maintain serum K4.0-5.1 mEq/L. Mean (standard deviation) serum Kwas 4.78 (0.51) mEq/L at baseline; weekly values were 4.48-4.70 mEq/L during treatment. Serum Kof 3.5-5.5 mEq/L at the end of study treatment (primary endpoint) was achieved by 57 (90.5%) patients; 53 (84.1%) had serum K4.0-5.1 mEq/L. One patient (1.6%) developed hypokalaemia, and two patients (3.2%) developed hypomagnesaemia. Spironolactone was increased to 50 mg/day in all patients; 43 (68%) patients required one or more patiromer dose titration. Adverse events (AEs) occurred in 36 (57.1%) patients, with a low rate of discontinuations [four (6.3%) patients]. The most common AE was mild to moderate abdominal discomfort [four (6.3%) patients]. CONCLUSIONS In this open-label study, patiromer 16.8 g/day followed by individualized titration maintained serum Kwithin the target range in the majority of patients with HF and CKD, all of whom were uptitrated to spironolactone 50 mg/day, patiromer was well tolerated, with a low incidence of hyperkalaemia, hypokalaemia, and hypomagnesaemia
Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement
Get PDFRecently published guidelines on the medical management of renal stone disease did not address relevant topics in the field of idiopathic calcium nephrolithiasis, which are important also for clinical research
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Essays in Housing and Immigration Economics
Get PDFThis dissertation contains four essays in housing and immigration economics. The first two chapters are essays on homelessness and homeless housing, and the last two chapters are essays on immigration policy and its impact on the receiving country. In the first chapter I estimate the causal effect of housing assistance for individuals experiencing homelessness on recidivism to homelessness and economic and social outcomes such as crime, employment, and health. Using a random case worker assignment design and a novel dataset constructed by linking administrative records from multiple public agencies in Los Angeles County, I estimate that housing assistance for single adults experiencing homelessness reduces future recidivism to homelessness by 20 percentage points over an 18-month period, compared to a baseline mean of 40 percent. The decline is driven by housing programs that provide long-term housing solutions and by individuals with physical disabilities and/or severe mental illness. Moreover, my findings suggest that housing assistance reduces crime, increases employment, and improves health, while not increasing reliance on social benefits. A simple cost-benefit analysis implies that up to 80 percent of housing costs are offset by these potential benefits in the first 18 months alone. Taken together, these findings demonstrate that well targeted housing assistance for the homeless with a focus on long-term housing solutions can be rehabilitative for a large segment of the homeless population. In the second chapter, I investigate the effect of housing sites that serve the homeless population on community-level outcomes such as street homelessness, crime, and property values. I construct a comprehensive data that geocodes the locations of all designated homeless housing sites in Los Angeles County. Using spatial and time variation in homeless housing sites, I estimate the exposure of a community to designated homeless housing sites over time and use changes in this exposure to recover the causal relationship. I find that communities that had an increase in homeless housing in their boundaries and vicinity experience a sizable decline in homeless encampments, overall crime, and homeless-related crimes, and that housing values in these communities had increased. In the third chapter (written with Ran Abramitzky, Philipp Ager, Leah Platt Boustan, and Casper Worm Hansen), we study the implications of an immigration policy in the 1920s, where the United States substantially reduced immigrant entry by imposing country-specific quotas. We compare local labor markets differentially exposed to the quotas due to variation in the national-origin mix of their immigrant population. US-born workers in more exposed areas did not benefit from the immigrant losses and even experienced occupational downgrading. Instead, local economies substituted toward other sources of labor and capital. In urban areas, immigrants were replaced with internal migrants and immigrants from quota-free countries. By contrast, farmers shifted toward capital-intensive agriculture and the immigrant-intensive mining industry contracted, highlighting the unintended consequences of the border closure.Finally, In the fourth chapter I study the impact of skilled immigration on innovation in the receiving country, measured by patenting rates. The setting of the study is the first-half of the 20th century in the US, a period characterized by mass migration from Europe to the US and rapid technological progress. Exploiting national immigration policy changes together with historical settlement patterns of immigrants' across US counties, I estimate the effect of skilled immigration on local patenting rates. I find that counties that received more skilled immigrants had no impact on total patenting rates, but that this null effect masks a positive effect on the growing electrical and chemical fields and a negative effect on the traditional mechanical and textiles fields. Furthermore, I find that most of the effect is due to skilled immigration from Non-English Speaking Countries and from Countries with long patenting traditions. I offer a mechanism by which skilled immigrants act as ``Transmitters of Knowledge," that is, they impact innovation primarily by introducing new knowledge that did not exist in their destination prior to their arrival
Optimal paricalcitol starting dose for parathyroid hormone suppression in secondary hyperparathyroidism
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