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Editorial Comment from Dr Schmid and Dr Wallbach to Acute kidney injury and intermediate-term renal function after clampless partial nephrectomy
No full textCardiorenal syndrome: causes, diagnosis and treatment of congestive nephropathy
No full textZusammenfassung Die kongestive Nephropathie (CN) ist eine Entität des kardiorenalen Syndroms, die wesentlich auf dem Boden einer venösen Kongestion und neurohormonellen Aktivierung entsteht. Eine Herzinsuffizienz, pulmonalarterielle Hypertonie, isolierte Trikuspidalklappeninsuffizienz und angeborene Herzfehler sind die häufigsten Ursachen. Es gibt bis dato keine allgemein akzeptierten diagnostischen Kriterien, jedoch scheint das Erfassen des intrarenalen venösen Blutflusses mittels Dopplersonographie die geeignetste Methode zu sein. Mit dieser Technik kann ein kontinuierlicher venöser Fluss (keine Kongestion) von den diskontinuierlichen Flussmustern pulsatil (leichte Kongestion), biphasisch (moderate Kongestion) und monophasisch (schwere Kongestion) differenziert werden. Der Venous Impedance Index und der Renal Venous Stasis Index sind zusätzliche dopplersonographische Kriterien zum Erfassen einer CN. Therapien mit Schleifendiuretika und/oder Natrium-Glukose-Kotransporter-2(SGLT-2)-Inhibitoren können eine venöse Kongestion nachweislich verbessern.Abstract Congestive nephropathy (CN) is an entity of the cardiorenal syndrome that essentially arises from venous congestion and neurohormonal activation. The most common underlying causes include heart failure, pulmonary arterial hypertension, isolated tricuspid valve insufficiency and congenital heart defects. Currently, there are no universally accepted diagnostic criteria; however, the most suitable method appears to be the recording of intrarenal venous blood flow using Doppler sonography. A distinction can be made between continuous venous flow (no congestion) and discontinuous flow patterns, categorized as pulsatile (mild), biphasic (moderate) and monophasic (severe congestion). The venous impedance index (VII) and the renal venous stasis index (RVSI) are additional Doppler sonographic criteria for detecting CN. Evidence supports the efficacy of loop diuretics and/or the administration of sodium-glucose cotransporter 2 (SGLT2) inhibitors in the management of venous congestion.Zusammenfassung Die kongestive Nephropathie (CN) ist eine Entität des kardiorenalen Syndroms, die wesentlich auf dem Boden einer venösen Kongestion und neurohormonellen Aktivierung entsteht. Eine Herzinsuffizienz, pulmonalarterielle Hypertonie, isolierte Trikuspidalklappeninsuffizienz und angeborene Herzfehler sind die häufigsten Ursachen. Es gibt bis dato keine allgemein akzeptierten diagnostischen Kriterien, jedoch scheint das Erfassen des intrarenalen venösen Blutflusses mittels Dopplersonographie die geeignetste Methode zu sein. Mit dieser Technik kann ein kontinuierlicher venöser Fluss (keine Kongestion) von den diskontinuierlichen Flussmustern pulsatil (leichte Kongestion), biphasisch (moderate Kongestion) und monophasisch (schwere Kongestion) differenziert werden. Der Venous Impedance Index und der Renal Venous Stasis Index sind zusätzliche dopplersonographische Kriterien zum Erfassen einer CN. Therapien mit Schleifendiuretika und/oder Natrium-Glukose-Kotransporter-2(SGLT-2)-Inhibitoren können eine venöse Kongestion nachweislich verbessern.Abstract Congestive nephropathy (CN) is an entity of the cardiorenal syndrome that essentially arises from venous congestion and neurohormonal activation. The most common underlying causes include heart failure, pulmonary arterial hypertension, isolated tricuspid valve insufficiency and congenital heart defects. Currently, there are no universally accepted diagnostic criteria; however, the most suitable method appears to be the recording of intrarenal venous blood flow using Doppler sonography. A distinction can be made between continuous venous flow (no congestion) and discontinuous flow patterns, categorized as pulsatile (mild), biphasic (moderate) and monophasic (severe congestion). The venous impedance index (VII) and the renal venous stasis index (RVSI) are additional Doppler sonographic criteria for detecting CN. Evidence supports the efficacy of loop diuretics and/or the administration of sodium-glucose cotransporter 2 (SGLT2) inhibitors in the management of venous congestion
Type 2A von Willebrand disease and systemic sclerosis: Vonicog alfa reduced gastrointestinal bleeding
No full textVon Willebrand disease (VWD) is a bleeding disorder caused by qualitative or quantitative defects of von Willebrand factor (VWF). This case report of a patient with systemic sclerosis and gastrointestinal bleeding from angiodysplasias seeks to address the key clinical question of a useful diagnostic and therapeutic approach in this setting. The extent of vascular malformations and the frequency of bleeding episodes were unusually severe, and we reached a diagnosis of inherited type 2A VWD. After an insufficient effect of treatment with factor VIII (FVIII)/VWF, prophylactic administration of vonicog alfa, a recombinant VWF preparation without FVIII, was initiated. This therapy led to a substantial reduction of transfusion requirements and the improvement of angiodysplasias. In refractory gastrointestinal bleeding, hemostaseological evaluation is crucial, as inherited disorders of hemostasis may go unnoticed, especially in patients with underlying autoimmune diseases, where complications may be ascribed to the underlying disease.Open-Access-Publikationsfonds 202
Baroreceptors in the carotid and hypertension—systematic review and meta-analysis of the effects of baroreflex activation therapy on blood pressure
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Plasma Exchange or Immunoadsorption in Demyelinating Diseases: A Meta-Analysis
No full textMultiple sclerosis (MS) is an inflammatory disease mainly affecting the central nervous system. In MS, abnormal immune mechanisms induce acute inflammation, demyelination, axonal loss, and the formation of central nervous system plaques. The long-term treatment involves options to modify the disease progression, whereas the treatment for the acute relapse has its focus in the administration of high-dose intravenous methylprednisolone (up to 1000 mg daily) over a period of three to five days as a first step. If symptoms of the acute relapse persist, it is defined as glucocorticosteroid-unresponsive, and immunomodulation by apheresis is recommended. However, several national and international guidelines have no uniform recommendations on using plasma exchange (PE) nor immunoadsorption (IA) in this case. A systematic review and meta-analysis was conducted, including observational studies or randomized controlled trials that investigated the effect of PE or IA on different courses of MS and neuromyelitis optica (NMO). One thousand, three hundred and eighty-three patients were included in the evaluation. Therapy response in relapsing-remitting MS and clinically isolated syndrome was 76.6% (95%CI 63.7–89.8%) in PE- and 80.6% (95%CI 69.3–91.8%) in IA-treated patients. Based on the recent literature, PE and IA may be considered as equal treatment possibilities in patients suffering from acute, glucocorticosteroid-unresponsive MS relapses
The Rapid Atrial Swirl Sign for Ultrasound-Guided Tip Positioning of Retrograde-Tunneled Hemodialysis Catheters: A Cross-Sectional Study from a Single Center
No full textBackground: Chronic kidney disease (CKD) is a common medical problem in patients worldwide, with an increasing prevalence of patients with end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT). In patients requiring RRT for more than two weeks or those who develop ESKD, tunneled hemodialysis catheter (HDC) insertion is preferred, based on a lower risk for infectious complications. While the efficacy of ultrasound (US)-guided tip positioning in antegrade-tunneled HDCs has previously been shown, its application for the insertion of retrograde-tunneled HDCs has not been described yet. This is especially important, since the retrograde-tunneled technique has several advantages over the antegrade-tunneled HDC insertion technique. Therefore, we here report our first experience of applying the rapid atrial swirl sign (RASS) for US-guided tip positioning of retrograde-tunneled HDCs. Methods: We performed a cross-sectional study to assess the feasibility of applying the RASS for US-guided tip positioning of retrograde-tunneled HDCs. We performed a total number of 24 retrograde-tunneled HDC insertions in 23 patients (requiring placement of a HDC for the temporary or permanent treatment of ESKD) admitted to our Department of Nephrology and Rheumatology at the University Medical Center Göttingen, Germany. Results: The overall success rate of applying the RASS for US-guided tip positioning of retrograde-tunneled HDCs was 24/24 (100%), with proper tip position in the right atrium in 18/23 (78.3%), or cavoatrial junction in 5/23 (21.7%) when RASS was positive and improper position when RASS was negative in 1/1 (100%), confirmed by portable anterior-posterior chest radiography, with only minor post-procedural bleeding in 2/24 (8.3%). In addition, this insertion technique allows optimal HDC flow, without any observed malfunction. Conclusion: This is the first study to investigate the efficacy of the RASS for US-guided tip positioning of retrograde-tunneled HDCs in patients with ESKD. Application of the RASS for US-guided tip positioning is an accurate and safe procedure for the proper placement of retrograde-tunneled HDCs.Background: Chronic kidney disease (CKD) is a common medical problem in patients worldwide, with an increasing prevalence of patients with end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT). In patients requiring RRT for more than two weeks or those who develop ESKD, tunneled hemodialysis catheter (HDC) insertion is preferred, based on a lower risk for infectious complications. While the efficacy of ultrasound (US)-guided tip positioning in antegrade-tunneled HDCs has previously been shown, its application for the insertion of retrograde-tunneled HDCs has not been described yet. This is especially important, since the retrograde-tunneled technique has several advantages over the antegrade-tunneled HDC insertion technique. Therefore, we here report our first experience of applying the rapid atrial swirl sign (RASS) for US-guided tip positioning of retrograde-tunneled HDCs. Methods: We performed a cross-sectional study to assess the feasibility of applying the RASS for US-guided tip positioning of retrograde-tunneled HDCs. We performed a total number of 24 retrograde-tunneled HDC insertions in 23 patients (requiring placement of a HDC for the temporary or permanent treatment of ESKD) admitted to our Department of Nephrology and Rheumatology at the University Medical Center Göttingen, Germany. Results: The overall success rate of applying the RASS for US-guided tip positioning of retrograde-tunneled HDCs was 24/24 (100%), with proper tip position in the right atrium in 18/23 (78.3%), or cavoatrial junction in 5/23 (21.7%) when RASS was positive and improper position when RASS was negative in 1/1 (100%), confirmed by portable anterior-posterior chest radiography, with only minor post-procedural bleeding in 2/24 (8.3%). In addition, this insertion technique allows optimal HDC flow, without any observed malfunction. Conclusion: This is the first study to investigate the efficacy of the RASS for US-guided tip positioning of retrograde-tunneled HDCs in patients with ESKD. Application of the RASS for US-guided tip positioning is an accurate and safe procedure for the proper placement of retrograde-tunneled HDCs
Risk factors for catheter-related infections in patients receiving permanent dialysis catheter
No full textAbstract Background Due to rising vascular comorbidities of patients undergoing dialysis, the prevalence of permanent hemodialysis catheters as hemodialysis access is increasing. However, infection is a major complication of these catheters. Therefore, identification of potential predicting risk factors leading to early infection related complications is valuable, in particular the significance the CRP (C-reactive protein)-value is of interest. Methods In this retrospective study 151 permanent hemodialysis catheters implanted in 130 patients were examined. The following data were collected at the time of catheter implantation: CRP-value, history of catheter-related infection, microbiological status, immunosuppression and diabetes mellitus. The primary outcomes were recorded over the 3 months following the implantation: catheter-related infection, days of hospital stay and death. Catheter removal or revision, rehospitalization and use of antibiotics were identified as secondary outcomes. Results We identified a total of 27 (17.9%) infections (systemic infection: 2.26 episodes/ 1000 catheter days, local infection: 0.6 episodes/ 1000 catheter days). The development of an infection was independent of the CRP-value (p = 0.66) as well as the presence of diabetes mellitus (p = 0.64) or immunosuppression (p = 0.71). Univariate analysis revealed that infection was more frequent in patients with MRSA-carriage (p < 0.001), in case of previous catheter-related infection (p < 0.05) and of bacteremia or bacteriuria in the period of 3 months before catheter implantation (p < 0.001). Catheter removal or revision (p = 0.002), rehospitalization (p = 0.001) and use of antibiotics (p = 0.02) were also more often observed in patients with MRSA-carriage. Conclusions The CRP-value at the time of implantation of a permanent hemodialysis catheter is not associated with the development of early catheter related infections, but an individual history of catheter-related infection, MRSA-carriage and bacteremia or bacteriuria in the period of 3 months prior to catheter implantation are significant risk factors
Long-term effects of baroreflex activation therapy: 2-year follow-up data of the BAT Neo system
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