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Albumin use in cirrhosis:a nephrology viewpoint on key considerations and cautionary notes

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Hepatobiliary Surgery and Nutrition 2024年第3期13卷 536-539页

作者： Abhilash Koratala Amir Kazory division of nephrology Department of MedicineMedical College of WisconsinMilwaukeeWIUSA division of nephrology Hypertension and Renal TransplantationUniversity of FloridaGainesvilleFLUSA

The constant need to reduce the variability of clinical practice and to improve the quality of care of the patients and their outcomes have led to the increasing emphasis on evidence-based *** there is a paucity of robust data on a specific topic or there are conflicting conclusions from available studies,clinical practice recommendations may prove helpful to fill the gap and assist with clinical *** are a variety of such recommendations,such as consensus statements,practice guidelines,and position statements,each with a specific set of methodology and *** statements are comprehensive documents meant to elucidate,justify,and recommend a particular approach to a clinical *** papers often present a detailed understanding of the issues in question,discuss the pros and cons of the available options,and provide the rationale for the position that is set *** other forms of clinical practice consensus,position statements innately provide information on the level of evidence and the strength of what the panel of experts agrees *** are several consensus group methods by which these statements can be *** is a systematic process to create and measure consensus,which is particularly well suited where input is required from a large number of geographically dispersed experts.

关键词： Cirrhosis hepatorenal albumin point-of-care ultrasound(POCUS) ultrasound

Cardiac evaluation of renal transplant candidates with heart failure

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World Journal of transplantation 2024年第4期14卷 44-49页

作者： Amer Ashaab Belal Alfonso Hernandez Santos Jr Amir Kazory Department of Medicine Division of NephrologyUniversity of Florida College of MedicineGainesvilleFL 32610United States division of nephrology Hypertension and Renal TransplantationUniversity of FloridaGainesvilleFL 32608United States

Patients with advanced kidney disease are at elevated risk of developing heart failure and appropriate risk stratification is important to permit them to receive kidney *** American Heart Association and American College of Cardiology joint statement provides guidance on risk stratification for the major cause of heart failure for these patients in its recommendations for coronary heart *** we provide an overview of the available literature on risk strati-fication for nonischemic heart failure and functional heart disease states such as pulmonary *** of these options for optimizing these patients be-fore transplant include optimizing their volume status,often with more agg-ressive *** transplantation remains the treatment of choice for patients with advanced kidney disease and cardiac disease,the correction of the azotemic substances with kidney transplantation has been associated with imp-roved survival than remaining on dialysis *** findings in the studies reviewed here are expected to help clinicians refine current strategies for evalua-ting potential kidney transplant recipients.

关键词： kidney transplantation Preoperative evaluation Clinical practice guidelines Heart failure Pulmonary hypertension

Point of care renal ultrasonography for the busy nephrologist: A pictorial review

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World Journal of nephrology 2019年第3期8卷 44-58页

作者： Abhilash Koratala Deepti Bhattacharya Amir Kazory division of nephrology Hypertension and Renal Transplantation University of Florida

The application of bedside ultrasonography in routine clinical practice has dramatically evolved over the last few decades and will likely continue to grow as technological advances lead to enhanced portability and affordability of the equipment. Despite mounting interest, most nephrology fellowship training programs do not offer formal training in renal ultrasonography and there is inertia among practicing nephrologists to adopt this skill as a practice-changing advancement. Lack of familiarity with the topic is considered a key reason for this inertia. Understanding of basic ultrasound physics, instrumentation, principles of optimal image acquisition and interpretation is critical for enhanced efficiency and patient safety while using this tool. Herein, we provide a brief overview of the basic principles of diagnostic renal ultrasonography as well as introduction to common sonographic pathologies encountered in day-to-day nephrology practice with illustrative images.

关键词： Ultrasound kidney Cyst Hydronephrosis Stone Point of care

Older candidates for kidney transplantation:Who to refer and what to expect?

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World Journal of transplantation 2016年第4期6卷 650-657页

作者： Beatrice P Concepcion Rachel C Forbes Heidi M Schaefer Department of Medicine Division of Nephrology and Hypertension Vanderbilt University Medical Center division of kidney and Pancreas transplantation Vanderbilt University Medical Center

The number of older end-stage renal disease patients being referred for kidney transplantation continues to increase. This rise is occurring alongside the continually increasing prevalence of older end-stage renal disease patients. Although older kidney transplant recipients have decreased patient and graft survival compared to younger patients, transplantation in this patient population is pursued due to the survival advantage that it confers over remaining on the deceased donor waiting list. The upper limit of age and the extent of comorbidity and frailty at which transplantation ceases to be advantageous is not known. Transplant physicians are therefore faced with the challenge of determining who among older patients are appropriate candidates for kidney transplantation. This is usually achieved by means of an organ systemsbased medical evaluation with particular focus given to cardiovascular health. More recently, global measures of health such as functional status and frailty are increasingly being recognized as potential tools in risk stratifying kidney transplant candidates. For those candidates who are deemed eligible, living donor transplantation should be pursued. This may mean accepting a kidney from an older living donor. In the absence of any living donor, the choice to accept lesser quality kidneys should be made while taking into account the organ shortage and expected waiting times on the deceased donor list. Appropriate counseling of patients should be a cornerstone in the evaluation process and includes a discussion regarding expected outcomes, expected waiting times in the setting of the new kidney Allocation System, benefits of living donor transplantation and the acceptance of lesser quality kidneys.

关键词： kidney transplant outcomes Frailty Elderly Expanded criteria donor Quality of life

Peritoneal dialysis for chronic cardiorenal syndrome:Lessons learned from ultrafiltration trials

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World Journal of Cardiology 2015年第7期7卷 392-396页

作者： Amir Kazory division of nephrology Hypertensionand Renal TransplantationUniversity of Florida

The current models of cardiorenal syndrome(CRS) are mainly based on a cardiocentric approach; they assume that worsening renal function is an adverse consequence of the decline in cardiac function rather than a separate and independent pathologic phenomenon. If this assumption were true,then mechanical extraction of fluid(i.e.,ultrafiltration therapy) would be expected to portend positive impact on renal hemodynamics and function through improvement in cardio-circulatory physiology and reduction in neurohormonal activation. However,currently available ultrafiltration trials,whether in acute heart failure(AHF) or in CRS,have so far failed to show any improvement in renal function; they have reported no impact or even observed adverse renal outcomes in this setting. Moreover,the presence or absence of renal dysfunction seems to affect the overall safety and efficacy of ultrafiltration therapy in AHF. This manuscript briefly reviews cardiorenal physiology in AHF and concludes that therapeutic options for CRS should not only target cardio-circulatory status of the patients,but they need to also have the ability of addressing the adverse homeostatic consequences of the associated decline in renal function. Peritoneal dialysis(PD) can be such an option for the chronic cases of CRS as it has been shown to provide efficient intracorporeal ultrafiltration and sodium extraction in volume overloaded patients while concurrently correcting the metabolic consequences of diminished renal function. Currently available trials on PD in heart failure have shown the safety and efficacy of this therapeutic modality for patients with chronic CRS and suggest that it could represent a pathophysiologically and conceptually relevant option in this setting.

关键词： Cardiorenal syndrome Peritoneal dialysis Heart failure Ultrafiltration

Refining the Role of Simultaneous Liver kidney transplantation

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Journal of Clinical and Translational Hepatology 2018年第3期6卷 289-295页

作者： Sabiha M.Hussain Kalathil K.Sureshkumar division of nephrology and hypertension Department of MedicineAllegheny General HospitalAllegheny Health NetworkPittsburghPAUSA

Adoption of the model for end-stage liver disease score by Organ Procurement and Transplant Network(OPTN)deceased donor liver allocation policy in 2002 has led to an increase in the number of simultaneous liver kidney(SLK)*** kidney function recovery following liver transplantation is difficult to predict,al ocation of the kidney for SLK trans-plantation thus far has not been based on much rationale and *** of OPTN policy towards SLK organ allocation has resulted in great variations among transplant centers regarding SLK *** use of kidneys towards SLK transplantation diverts deceased donor kidneys away from candidates awaiting kidney-alone *** OPTN/United Network of Organ Sharing has imple-mented medical eligibility criteria for adult SLK transplantation which also includes a concept of safety *** of the new policy is a move in a positive direction,providing consistency in our practice and evidence-based guidelines in selecting candidates for SLK *** policy needs to be monitored prospectively and modified based on new data that wil emerge over *** review outlines the literature on SLK transplantation and efforts towards developing rational policy on SLK organ allocation.

关键词： Liver kidney transplantation Graft survival MELD score Creatinine GFR

Fluid overload as a major target in management of cardiorenal syndrome:Implications for the practice of peritoneal dialysis

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World Journal of nephrology 2017年第4期6卷 168-175页

作者： Amir Kazory division of nephrology Hypertension and Renal TransplantationCollege of MedicineUniversity of Florida

Congestion is an integral component of cardiorenal syn-drome and portends an adverse impact on the outcomes. Recent studies suggest that congestion has the ability ofmodulating the interactions between the kidney and the heart in this setting. Peritoneal dialysis （PD） is a home-based therapeutic modality that is not only offered to patients with end-stage renal disease to provide solute clearance and ultrafltration, but it has also been used in patients with refractory heart failure and fuid overload to help optimize volume status. Several uncontrolled studies and case series have so far evaluated the role of PD in management of hypervolemia for patients with heart failure. They have generally reported favorable results in this setting. However, the data on the outcomes of patients with end-stage renal disease and concomitant heart failure is mixed, and the proposed theoretical advantages of PD might not translate into improvedclinical endpoints. Congestion is prevalent in this patient population and has a signifcant effect on their survival. As studies suggest that a significant subset of patients with end-stage renal disease who receive PD therapy are hypervolemic, suboptimal management of congestion could at least in part explain these conficting results. PD is a highly fexible therapeutic modality and the choice oftechniques, regimens, and solutions can affect its ability for optimization of fluid status. This article provides an overview of the currently available data on the role and clinical relevance of congestion in patients with cardiorenal syndrome and reviews potential options to enhance decongestion in these patients.

关键词： Heart failure Peritoneal dialysis Congestion Cardiorenal syndrome

kidney disease in non-kidney solid organ transplantation

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World Journal of transplantation 2022年第8期12卷 231-249页

作者： Kurtis J Swanson division of nephrology and hypertension University of MinnesotaMinneapolisMN 55414United States

kidney disease after non-kidney solid organ transplantation(NKSOT)is a common post-transplant complication associated with deleterious *** disease,both acute kidney injury and chronic kidney disease(CKD)alike,emanates from multifactorial,summative pre-,peri-and post-transplant *** factors leading to kidney disease are shared amongst solid organ transplantation in addition to distinct mechanisms unique to individual transplant *** aim of this review is to summarize the current literature describing kidney disease in *** conducted a narrative review of pertinent studies on the subject,limiting our search to full text studies in the English *** disease after NKSOT is prevalent,particularly in intestinal and lung *** strategies in the peri-operative and post-transplant periods including proteinuria management,calcineurin-inhibitor minimization/sparing approaches,and nephrology referral can counteract CKD progression and/or aid in subsequent kidney after solid organ *** disease after NKSOT is an important consideration in organ allocation practices,ethics of *** disease after SOT is an incipient condition demanding further *** some truths have been revealed about this chronic disease,as we have aimed to describe in this review,continued multidisciplinary efforts are needed more than ever to combat this threat to patient and allograft survival.

关键词： Acute kidney injury Chronic kidney disease Solid organ transplant Native kidneys Calcineurin inhibitor toxicity Renal replacement therapy kidney after solid organ transplant

The emerging role of tubulin posttranslational modifications in cilia and ciliopathies

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Biophysics Reports 2020年第4期6卷 89-104页

作者： Kai He Kun Ling Jinghua Hu Department of Biochemistry and Molecular Biology Mayo Clinic division of nephrology and hypertension Mayo Clinic Mayo Translational Polycystic kidney Diseases Center Mayo Clinic

Tubulin posttranslational modifications(PTMs) add ‘ tubulin code”” to generate functional diversities of microtubules. Several types of tubulin PTMs accumulate on axonemes and basal bodies of cilia,including acetylation, glutamylation, glycylation and detyrosination. Among them, glutamylation, glycylation and detyrosination are mostly enriched in the B-tubules, whereas acetylation occurs on both Aand B-tubule of the microtubule doublets in a similar level. Recent studies indicate that tubulin PTMs are critical for the fine tuning of assembly/disassembly, maintenance, motility, and signaling of *** tubulin PTMs are strongly implicated in human disorders including ciliopathies and neuron degeneration. Here, we review the current understanding how tubulin PTMs regulate cilia formation and function, and their relevance to human health.

关键词： Tubulin posttranslational modifications(PTMs) Cilia Ciliopathies Acetylation Glutamylation Glycylation