Acute kidney disease and renal recovery : consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

Consensus definitions have been reached for both acute kidney injury (AKI) and chronic kidney disease (CKD) and these definitions are now routinely used in research and clinical practice. The KDIGO guideline defines AKI as an abrupt decrease in kidney function occurring over 7 days or less, whereas CKD is defined by the persistence of kidney disease for a period of > 90 days. AKI and CKD are increasingly recognized as related entities and in some instances probably represent a continuum of the disease process. For patients in whom pathophysiologic processes are ongoing, the term acute kidney disease (AKD) has been proposed to define the course of disease after AKI; however, definitions of AKD and strategies for the management of patients with AKD are not currently available. In this consensus statement, the Acute Disease Quality Initiative (ADQI) proposes definitions, staging criteria for AKD, and strategies for the management of affected patients. We also make recommendations for areas of future research, which aim to improve understanding of the underlying processes and improve outcomes for patients with AKD

The Tumor Microenvironment: The Making of a Paradigm

What has been will be again, what has been done will be done again; there is nothing new under the su

Light paintings

Opinnäytetyössäni käsittelen omaa taiteellista tuotantoani. Aluksi kerron kuinka olen päätynyt tekemään sitä mitä teen ja esittelen kuvasarjani. Tämän jälkeen käyn läpi käsitteitä, jotka liittyvät työhöni. Oma työskentelyni on kehittynyt kohti valon kuvaamista. Kuvaan valoa tietyn ajan kuluessa tai aikaa tietyssä valossa. Miten päin asiaa haluaakaan ajatella. Tutkin valon luonteita vuorokauden- ja vuodenaikojen muutoksina. Kuinka erilainen valo on eri aikoina? Miten se muuttaa kohdettaan? Ja kuinka se suhteutuu ympäristön väreihin? Tekstissäni perehdyn valoon Claude Monetin kautta. Kävelyllä on ollut tärkeä merkitys teosteni synnylle. Se toimii inspiraation lähteenä ja oli merkittävässä roolissa ensimmäisissä sarjoissani. Käsittelen kävelyn teemaa Richard Longin työskentelyn avulla. Aika, vuodenajat, toisto ja sattuma, sekä valokuvauksen ja maalauksen suhde ovat aiheina seuraavissa luvuissa. Käyn näitä asioita läpi taiteilijoiden avulla, joiden teoksiin ja työskentelyyn olen tutustunut kirjoittaessani tätä lopputyötä. Yhteistä kaikille valitsemilleni taiteilijoille tai teoksille on pitkien ajanjaksojen käyttäminen. Muita yhdistäviä tekijöitä ovat työskentelymetodit, tekniikka tai visuaalinen lopputulos

gQuadruple whammyh- A preventable newly described syndrome of post.operative AKI in CKD II and CKD III patients on combination gTriple whammyh medications: A Mayo Clinic Health System, Eau Claire, Wisconsin experience

Background: The potential combination of diuretics..angiotensin.converting enzyme inhibitors..Non.steroidal anti-inflammatory drugs (diuretics-ACEIs-NSAIDs), the so.called etriple whammyf, to produce clinically significantnephrotoxicity in chronic kidney disease (CKD) is often unrecognized. In 2013, in the British Medical Journal, we described accelerated  post-operative acute kidney injury (AKI) in CKD patients concurrently on etriple whammyf medications, a new syndrome that we aptly named equadruple whammyf. Materials and Methods: Two case reports.Results: I.A 59-year-old Caucasian male, hypertensive CKD III, serum creatinine (SCr) 1.42 mg/dL, developed accelerated oliguric AKI afterelective right nephrectomy.Outpatient medications included Lisinopril-Hydrochlorothiazide and Nabumetone (NSAID). SCr rapidly more than doubled with metabolic acidosis and hyperkalemia within 24 hours, peaking at 4.02 mg/dL. eTriple whammyf medications were promptly stopped and the hypotension was corrected. SCr was 1.64 mg/dL and stable, afterthree months. II. A 46-year-old Caucasian male, hypertensive CKD II, SCr 1.21 mg/dL, developed accelerated AKI after elective right hip arthroplasty. Outpatient medications included Lisinopril and Hydrochlorothiazide.  Celecoxib (200 mg) was given pre.operatively. Within 36 hours, SCr rapidly more than doubled to 2.58 mg/dL, with metabolic acidosis. eTriple whammyf medications were promptly stopped and the hypotension was corrected. SCr was 0.99 mg/dL, and stable, after one month.Conclusion: We have described two cases of preventable accelerated AKI following post-operative hypotension in CKD patients concurrently on etriple whammyf medications. We dubbed this new syndrome gQuadruple Whammyh. It is not uncommon. eRenopreventionf, the pre-emptive withholding of (potentially nephrotoxic) medications, including etriple whammyf medications, pre-operatively, in CKD patients, together with the simultaneous avoidance of peri.operative hypotension would help reduce, if not eliminate such AKI - a call for more pharmacovigilance.Key words: Angiotensin converting enzyme inhibitors, acute kidney injury, chronic kidney disease, diuretics, Non-steroidal anti-infl ammatory drugs, post.operative hypotension, quadruple whammy, serum creatinine, triple whamm