Intravenous fluid therapy in accordance with kidney injury risk: when to prescribe what volume of which solution

Acute kidney injury; Colloid solution; Intravenous fluid therapyLesión renal aguda; Solución coloidal; Fluidoterapia intravenosaLesió renal aguda; Solució col·loïdal; Fluidoteràpia intravenosaAcute kidney injury (AKI) is common in hospitalized patients while common risk factors for the development of AKI include postoperative settings, patients with baseline chronic kidney disease (CKD) or congestive heart failure. Intravenous (IV) fluid therapy is a crucial component of care for prevention and treatment of AKI. In this narrative review, we update the approach to IV fluid therapy in hospitalized patients including the timing of fluid prescription, and the choice of fluid type, amount and infusion rate along with the potential adverse effects of various crystalloid and colloid solutions, addressing specifically their use in patients with acute kidney disease, CKD or heart failure, and their potential impact on the risk of hospital-acquired AKI

Novel strategies in nephrology: what to expect from the future?

Artificial kidney; Chronic kidney disease; XenotransplantationRonyó artificial; Malaltia renal crònica; XenotrasplantamentRiñón artificial; Enfermedad renal crónica; XenotrasplanteChronic kidney disease (CKD) will become the fifth global case of death by 2040. Its largest impact is on premature mortality but the number of persons with kidney failure requiring renal replacement therapy (RRT) is also increasing dramatically. Current RRT is suboptimal due to the shortage of kidney donors and dismal outcomes associated with both hemodialysis and peritoneal dialysis. Kidney care needs a revolution. In this review, we provide an update on emerging knowledge and technologies that will allow an earlier diagnosis of CKD, addressing the current so-called blind spot (e.g. imaging and biomarkers), and improve renal replacement therapies (wearable artificial kidneys, xenotransplantation, stem cell-derived therapies, bioengineered and bio-artificial kidneys).Research by A.O. is supported by IS/Fondos FEDER (PI18/01 366, PI19/00 588, PI19/00 815, DTS18/00 032, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00 064) and PERSTIGAN AC18/00 071, ISCIII-RETIC REDinREN RD016/0009), Sociedad Española de Nefrología, FRIAT, Comunidad de Madrid en Biomedicina B2017/BMD-3686 CIFRA2-CM, Instituto de Salud Carlos III (ISCIII) RICORS program to RICORS2040 (RD21/0005/0001) and SPACKDc PMP21/00 109, FEDER funds. RD16/0009

The Mitochondrion: A Promising Target for Kidney Disease

Acute kidney injury; Chronic kidney disease; Mitochondrial dysfunctionLesión renal aguda; Enfermedad renal crónica; Disfunción mitocondrialLesió renal aguda; Malaltia renal crònica; Disfunció mitocondrialMitochondrial dysfunction is important in the pathogenesis of various kidney diseases and the mitochondria potentially serve as therapeutic targets necessitating further investigation. Alterations in mitochondrial biogenesis, imbalance between fusion and fission processes leading to mitochondrial fragmentation, oxidative stress, release of cytochrome c and mitochondrial DNA resulting in apoptosis, mitophagy, and defects in energy metabolism are the key pathophysiological mechanisms underlying the role of mitochondrial dysfunction in kidney diseases. Currently, various strategies target the mitochondria to improve kidney function and kidney treatment. The agents used in these strategies can be classified as biogenesis activators, fission inhibitors, antioxidants, mPTP inhibitors, and agents which enhance mitophagy and cardiolipin-protective drugs. Several glucose-lowering drugs, such as glucagon-like peptide-1 receptor agonists (GLP-1-RA) and sodium glucose co-transporter-2 (SGLT-2) inhibitors are also known to have influences on these mechanisms. In this review, we delineate the role of mitochondrial dysfunction in kidney disease, the current mitochondria-targeting treatment options affecting the kidneys and the future role of mitochondria in kidney pathology

COVID-19 Pandemic and mental health concerns: What should we expect?

COVID-19 Pandemic and mental health concerns: What should we expect? COVID-19 Pandemisi ve psikiyatrik endişeler: Bundan sonraki süreçte ne beklemeliyiz

Emergence of tic disorder in a pediatric patient associated with risperidone and aripiprazole treatment

An atypical anti-psychotic drug, risperidone, used in the treatment of schizophrenia, bipolar mania and irritability associated with autism spectrum disorder works primarily by inhibiting serotonergic (5-HT2A) and dopaminergic (D2) systems. 1 Common adverse effects include cerebrovascular events, tardive dyskinesia, neuroleptic malignant syndrome, orthostatic hypotension, cytopenia, Parkinson-like symptoms, motor impairment, seizures, metabolic alterations and hyperprolactinemia

Effects of bariatric surgery on psychological well-being among adolescents: a case series study from Turkey

Objective: Our aim is to determine the psychiatric outcomes of bariatric surgery among adolescent patients with obesity, a condition with high psychiatric comorbidity rates. Methods: Psychiatric evaluation of the patients includes Beck Depression Inventory, Beck Anxiety Inventory, Eating Attitudes Test and World Health Organization Quality of Life questionnaire (WHOQOL-BREF) prior to surgery and at post-operative year. Results: Adolescent patients admitting for bariatric surgery have high rates of psychiatric comorbidities. We report significant improvement in psychological well-being of the adolescent patients following sleeve gastrectomy procedure including depression, anxiety and feeding behavior scores and quality of life. Discussion: Limited number of studies regarding the psychiatric outcomes of bariatric surgery on adolescent patients are present in the literature. Improvement in depression and quality of life scores have also been reported in previous studies, whereas, no comprehensive study on anxiety and feeding behavior scores, to our knowledge, had been performed. Therefore, our case series study is significant by demonstrating the psychiatric outcomes of bariatric surgery more thoroughly. In addition, higher reductions in BMI have been observed following sleeve gastrectomy procedure compared to the findings in the literature mostly including roux-en-Y gastric bypass procedure in adults. We propose that psychiatric comorbidities of the adolescent patients should be more prominent determinant of decision making procedure for bariatric surgery

Cardiorenal Metabolic Consequences of Nighttime Snacking: Is it an Innocent Eating Behavior?

PURPOSE OF REVIEW: Health consequences of nighttime eating, as a publicly discussed eating behavior type, have been speculated lately. Nighttime eating has been linked to various metabolic outcomes including hyperlipidemia, hypertriglyceridemia, hyperglycemia, weight gain, elevated blood pressure, obesity, and metabolic syndrome, and cardiorenal outcomes such as atherosclerosis, a decline in eGFR, and proteinuria. RECENT FINDINGS: Although the exact underlying pathophysiological mechanism is not yet clear, multiple hypotheses including disrupted circadian rhythm, altered hormonal levels, and decline in cellular regeneration have been proposed. In this review, we aim to evaluate the growing literature on nighttime eating behavior in terms of metabolic and cardiorenal outcomes, pathophysiological basis, and potential therapeutic alternatives

Is there any robust evidence showing that SGLT2 inhibitor use predisposes to acute kidney injury?

A novel class of oral glucose lowering drugs, sodium-glucose co-transporter type 2 inhibitors (SGLT2is), has shown additional beneficial effects on body weight, serum uric acid levels, blood pressure, and cardiac and renal function. Conflicting data have been published regarding the potential risk of acute kidney injury (AKI) when using SGLT2is. Aim of this manuscript was to review the current literature on this issue. SGLT2is induce a mild acute decline in estimated glomerular filtration rate, attributed to the effect of proximal tubular natriuresis on tubuloglomerular feedback through increased macula densa sodium delivery, leading to afferent arteriole vasoconstriction and reduced intraglomerular pressure. This functional effect with a subsequent rise in serum creatinine fulfills the creatinine-based criteria for AKI, as defined in clinical practice and trial settings. Other proposed potential mechanisms as to how SGLT2is lead to AKI include osmotic diuresis leading to volume depletion, increased urinary uric acid levels, intratubular oxidative stress, local inflammation and tubular injury. Despite the warning published by the US Food and Drug Administration in 2016 about a potential risk of AKI and the report of some clinical cases of AKI after treatment with SGLT2is, large observational real-life retrospective studies, randomized controlled trials and propensity-matched analyses of data from clinical practice unambiguously demonstrate that SGLT2is are safe for the kidney and do not predispose to AKI. In conclusion, while we can probably stop worrying about AKI risk when using SGLT2is, the question whether these agents should be withheld in the presence of clinical situations at high risk for AKI remains unaddressed