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Review Article: Kidney Transplantation in the Elderly with End-stage Renal Disease |
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Fei Han, Jianghua Chen J Integr Nephrol Androl 2016, 3:109 (7 November 2016) DOI:10.4103/2394-2916.193497 The incidence of end-stage renal disease (ESRD) increases in the elderly population. Patients received kidney transplantation have better long-term survival and quality of life than those received maintaining dialysis. However, only a smaller proportion of the elderly patients receive kidney transplantation because of the concerns about high posttransplant complications such as infections and diabetes. In this review, we make a discussion on treatment strategies including prophylaxis of risk factors, donor selection, and postoperative monitoring to raise awareness and improve long-term prognosis in the elderly patients with ESRD. |
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Review Article: Reflections on the Medical History of the Kidney: From Alcmaeon of Croton to Richard Bright - Standing on the Shoulders of Giants |
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Donald E Greydanus, Musunkumuki Kadochi J Integr Nephrol Androl 2016, 3:101 (7 November 2016) DOI:10.4103/2394-2916.193496 Although renal disease has been present for over 200 millennia of Homo sapiens' existence, knowledge of the causes and management of these disorders has only emerged during the last 4000 years. Brilliant insights into human disease probably emerged from time to time over the long period of human existence, but observations could only be advanced after writing began in 3200 BC. Humans could then make observations, record these thoughts, and have others in their present and future critique them leading to improvement in this information. This discussion selectively considers some of the medical giants who led the way to clinical nephrology of the 21st century. It reflects on who taught us basic principles of renal disease that led to our current knowledge. Attention is given to the ancient Egyptians, Ancient Greeks, Galen of Pergamon, the Byzantine Greeks of the 5th-9th centuries, the Arab/Persian Physicians of the 9th-12th centuries, Moses Maimonides of the 12th century, selective Renaissance Physicians, and the father of modern nephrology - Richard Bright MD. This reflection celebrates au courant renal sagacity by celebrating the past clinicians who led the way from their eras to ours. |
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Review Article: Impact of Human Immunodeficiency Virus/AIDS on the Kidneys: Radiologist Perspective |
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Regina Chinwe Onwuchekwa J Integr Nephrol Androl 2016, 3:74 (4 August 2016) DOI:10.4103/2394-2916.187786 Human immunodeficiency virus (HIV)/AIDS is unique for its devastating impact on social, economic, and demographic developments. Recent studies have thrown more light on the reasons for the mortality and morbidity associated with HIV/AIDS in general and on its renal complications in particular. The classic involvement of the kidney by HIV infection in HIV-associated nephropathy (HIVAN) was reported in New York in 1984. HIVAN clinically presents with proteinuria and renal dysfunction and pathologically with focal segmental glomerulosclerosis. The imaging modality most commonly used in the assessment of renal dysfunction is ultrasonography, followed by computerized tomography. These renal lesions manifest in a protean number of ways in sonography. Renal survival has improved with the introduction of highly active antiretroviral therapy. |
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Review Article: Prevention, Diagnosis, and Treatment of Chronic Kidney Diseases in Older Adults: Current Status and Prospective |
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Guangyan Cai, Xiangmei Chen J Integr Nephrol Androl 2016, 3:71 (4 August 2016) DOI:10.4103/2394-2916.187785 The elderly are at high risk of chronic kidney disease, who has become a major population in the newly admission to dialysis treatment. So the elderly will be the focus of CKD prevention task in future. At present, challenges still remain in the diagnosis and treatment of CKD in the elderly: there is no unified criteria for CKD diagnosis in the elderly, un-settled treatment target of CKD complications in the elderly; complicated theraputic strategies in the elderly ESRD patients. We particularly stress the importance of patient-centered, instead of disease-oriented, individualized treatment in the prevention and treatment of CKD in the elderly.
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Review Article: Recent Advances in Pharmacotherapy for Peyronie's Disease |
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Yang Luan, Jihong Liu J Integr Nephrol Androl 2016, 3:53 (26 April 2016) DOI:10.4103/2394-2916.181219 Peyronie's disease (PD) is an acquired fibrotic disease of the penile tunica albuginea accompanied by penile pain, curvature, erectile dysfunction, and psychosocial problems. Recent evidence suggests an increasing prevalence of PD with current uncertainty of its etiology and pathophysiology. According to the natural history of PD, the disease can be divided into acute phase and fibrotic phase that greatly determines the treatment plan. Oral, intralesional medication, and topical therapy are suitable for acute phase while surgical therapy is suggested only in fibrotic phase with the formation of stable plaques. Although a number of pharmacologic agents have been evaluated in preclinical and clinical studies, a few of them can be used in the clinic with satisfactory outcome. Recent studies showed promising results in improving symptoms and limiting disease progression, especially the only Food and Drug Administration-approved collagenase Clostridium histolyticum as well as some multimodal therapies. In this study, we reviewed currently available medications and focused on recent advances in PD pharmacotherapy. However, further high-quality studies are much needed to clarify the pathogenesis of PD and, more importantly, to find out effective and safe medicines for PD treatment. |
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Review Article: Chronic Kidney Disease in Pregnancy |
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Aarti Malavade, Praveen Malavade, Mohan Biyani, Swapnil Hiremath, Ayub Akbari J Integr Nephrol Androl 2016, 3:48 (26 April 2016) DOI:10.4103/2394-2916.181218 Pregnancy with chronic kidney disease carries substantial risk to the mother and the baby. Incidence of women becoming pregnant while having chronic kidney disease is increasing. The major risk to the mother is development of preeclampsia which may be hard to diagnose in patients with chronic kidney disease. Depending on the kidney function, women may also be at risk of decline in their kidney function. The major risk to baby is prematurity. The renal physiological changes that occur with pregnancy are quite profound and normal values of blood pressure, electrolytes and parameters to monitor kidney function are different then in non-pregnant state. Counselling these women about pregnancy and managing them through pregnancy remains a challenge. This review discusses the physiological changes that occur during pregnancy, risks of pregnancy with CKD and management of CKD during pregnancy. |
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Review Article: Proteinuria: A Cross Road Where the Complement and the Plasminogen-plasmin Systems Meet |
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Hernán Trimarchi, Cristina Duboscq J Integr Nephrol Androl 2016, 3:37 (26 April 2016) DOI:10.4103/2394-2916.181217 Proteinuria is the hallmark of nephrotic syndrome and a surrogate of progression of renal disease and a risk factor of cardiovascular morbidity. Once proteinuria occurs secondary to glomerular damage, its reabsorption at the proximal tubule causes a constant interstitial inflammation that will eventually lead to a graduate loss of kidney function due to fibrosis, ischemia and tubular atrophy. The plasminogen-plasmin system plays a local critical role in amplifying podocyte damage, deepening the generation of edema, cross-linking inflammatory components at the interstitium and determining the terminal fibrotic processes. Plasmin activity also causes inflammation through the complement system. The interaction between the complement and the plasminogen-plasmin systems is critical in the progression of interstitial inflammation. Plasmin is capable of cleaving C3 and C5 components of the complement system. Moreover, C3a and C5a fractions are chemoattractants of neutrophils and monocytes. The complement system is also involved in microvascular thrombosis contributing to glomerular sclerosis and interstitial fibrosis through ischemic processes. A regulator of plasmin activity is plasminogen activator inhibitor-1, a leading molecule involved in fibrosis and sclerosis, particularly augmented in glomerulopathies. Unraveling the interactions between the plasminogen-plasmin and complement systems will undoubtedly lead to more specific therapies for glomerular diseases. |
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Review Article: Precise Transurethral Enucleation of Prostate: New Surgery Treatment for Benign Prostate Hyperplasia |
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Huan Xu, Meng Gu, Qi Chen, Yan-bo Chen, Zhi-kang Cai, Zhong Wang J Integr Nephrol Androl 2016, 3:14 (1 February 2016) DOI:10.4103/2394-2916.175395 There have been many advances in the surgical treatment for benign prostate hyperplasia (BPH), moving from open surgery (retropubic and suprapubic open prostatectomy) to transurethral resection of the prostate (TURP, the historical gold standard and still the most commonly used approach), and onto endoscopic transurethral enucleation. The application of new laser and plasma technologies now allows the precise transurethral enucleation of the prostate (PTUEP). In our medical center, we have found great success using PTUEP. Many urologists have found that PTUEP reduces perioperative complications and risks during operation. It can be applied to all size prostates and can even be used with BPH patients taking anticoagulation medicine. PTUEP is quickly replacing TURP as an effective and less invasive approach to BPH surgery. |
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Review Article: Clinical Characteristics of Antineutrophil Cytoplasmic Antibodies Associated Vasculitis in the Elderly |
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Qiang He, Lina Shao J Integr Nephrol Androl 2016, 3:8 (1 February 2016) DOI:10.4103/2394-2916.175393 Antineutrophil cytoplasmic antibodies (ANCAs) associated vasculitis is a necrotizing vascular inflammation, usually involving multiple organs. It is one of the major diseases that cause deterioration of renal function rapidly in the elderly. The latest Chapel Hill Consensus Conference 2012 has updated the name of ANCA-associated vasculitis. Some high quality randomized clinical trials provide the evident basis for the treatment of vasculitis. However, elderly patients often suffer complex diseases, and are associated with underlying diseases, so it is difficult to be diagnosed and treated. It is very important to make optimized individual strategies of treatment for elderly patients with vasculitis.
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