1,721,148 research outputs found
Idiopathic membranous nephropathy: management strategies.
No full textTreatment of idiopathic membranous nephropathy is based on a 'symptomatic' therapy that includes ACE inhibitors or angiotensin II receptor antagonists, and on an 'aetiological' therapy aimed at modulating underlying immunological mechanisms. The role of the latter is still debated given the usually indolent course of disease; furthermore, traditional immunosuppressants would not have an impact on patient and renal survival according to a systematic review of literature. However, up to 40% of untreated patients eventually develop end-stage renal disease and remission of nephrotic syndrome protects patients from related life-threatening complications and is the strongest positive prognostic factor for long-term kidney function. Therefore, immunosuppressive therapy seems to be rational in high-risk patients with nephrotic syndrome or deteriorating renal function. This article outlines a possible role for each 'aetiological' therapy on the basis of available evidence in order to provide some practical recommendations. The first-line therapy is based on a 6-month regimen of alternating corticosteroids and an alkylating agent ('Ponticelli' regimen), whereas oral ciclosporin and intramuscular corticotrophin (adrenocorticotrophic hormone) are alternatives that provide comparable results in terms of remission of proteinuria, with a different adverse effect profile. New drugs are emerging as potential treatments, such as mycophenolate mofetil, tacrolimus, intravenous immunoglobulins and rituximab. Specific settings, such as chronic renal failure or elderly age, require a careful balance between benefits and toxicity of immunosuppression. The tailor-made use of this repertoire of drugs can provide a tool to achieve remission of proteinuria and modify the natural course of idiopathic membranous nephropathy
[Audit on quality of life of patients with chronic kidney disease on dialysis and after transplant]
No full textSince the improvement of quality of life (QOL) in patients with chronic disease on dialysis (D-CKD) has been demonstrated to have significant effects on clinical outcome, QOL has been included among the principal targets for these patients. QOL is among the objectives of the Healthy People 2010 program of the United Nations and CKD is one of the 18 focus areas of the program. The process of improving clinical outcome for D-CKD patients is obviously correlated with the continuing attempts to improve the adequacy of dialysis, and this remains a milestone. Some recent studies, including the HEMO study, have demonstrated that the present standards for dialytic efficiency are adequate for morbidity and mortality outcomes. However, these concepts are rapidly evolving and there are emerging factors which should be monitored, such as a) frequency of hospitalization, b) QOL, c) patient's satisfaction, and d) transplantation rate. Each aspect should be taken into consideration when the general well-being of D-CKD patients is at stake. However, there is a lack of validated standards, and there are confounding effects related to different geographical areas, different degrees of morbidity, and different therapies. Health is defined by the WHO as the complete feeling of well-being, and transplantation obviously is a way to overcome the many difficulties encountered by D-CKD patients. It is true that QOL after transplant is affected by uncertainty about the final result, fear of having to go back on dialysis, or anger about unexpected complications. For these reasons special questionnaires have been designed for transplanted patients (e.g., SF-36). These indicate an improvement of QOL for transplanted compared with D-CKD patients, although QOL remains below the level of that of the healthy population. Post-transplant QOL tends to improve over time and will become superimposable to that of the healthy population in the long run. It is of paramount importance that each dialysis and transplantation center provide psychological support not only to patients but also to doctors and nurses
Drug-induced erythropoiesis and outcome: should we give up the haemoglobin target approach and return to the ratio between erythropoiesis-stimulating agents and haemoglobin?
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129. Stratta P, Messuerotti A, Canavese C. The full circle: from the minamata disaster to the sick building syndrome (Letter). Environ Health Perspect
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Rhematoid factor: the end of the term as we know it? Comment on the editorial by Liao et al
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