Management Of Chronic Renal Failure Research Articles

Biological Response Modifiers: Interferons, Interleukins, Recombinant Products, Liposomal Products

The concept of enhancing the normal immune response against infections and neoplasms has been considered for decades. The administration of various natural and synthetic products to simulate systemic infections has largely given over to the idea that specific cytokines can be used effectively when administered systemically. Interferons, interleukins, and hematopoietic growth factors may offer substantial clinical benefit in chronic viral infections, and cancers such as osteosarcoma, melanoma, and lymphosarcoma. Erythropoietin has been shown to have great utility in the management of chronic renal failure. At this point in time, only recombinant products derived from humans are commercially available, and they are expensive and not licensed for use in companion animals. Nevertheless, these products may have significant clinical impact on several highly fatal disorders of dogs and cats. When administered systemically, cytokines perturb complex regulatory pathways, and serious side effects may occur. Innovative delivery methods, such as liposomes, gene therapy, and even oral administration may increase the therapeutic index of these molecules. Biological response modification, cytokine biology, and associated delivery systems are rapidly changing fields, and the small animal veterinarian will need to watch for significant advances in these areas over the next several years.

Chronic Renal Failure and Its Management and Nephrolithiasis

Chronic renal failure (CRF) is the most common form of renal disease in dogs and cats. Although CRF occurs in dogs and cats of all ages, it is commonly considered a disease of older animals, and the incidence increases with age. This article presents guide-lines for the diagnosis and conservative management of chronic renal failure in dogs and cats. Nephrolithiasis is uncommon in dogs and cats, accounting for less than 3% of all urinary calculi. The mineral composition of the renolith is important in formulation of therapeutic and preventive management strategies. This article briefly reviews the epidemiology, diagnosis, and management of nephrolithiasis in the dog and cat.

What Role Does Dietary Protein Restriction Play in the Management of Chronic Renal Failure in Dogs?

Dietary protein restriction has been the mainstay of conservative medical management of canine renal failure for many years. Although dietary protein restriction minimizes many signs of uremia, its potential benefits to the progression of renal failure are now being questioned. Two case scenarios of different degrees of renal failure are described; guidelines for dietary protein restriction are based on currently available scientific knowledge.

Etiology, pathophysiology, diagnosis, and management of chronic renal failure in children

There are a large number of causes of chronic renal disease in children. This review updates recent findings on conditions that arise in childhood that lead to chronic kidney disease in adulthood (eg, polycystic kidney disease, reflux nephropathy) or cause chronic kidney disease in childhood. Recent studies addressing the etiology and genetics of chronic kidney disease, as well as its pathophysiology, prognosis, and treatment, are discussed.

Chronic viral hepatitis and the management of chronic renal failure

Effective control measures to reduce the spread of HBV in dialysis units have had a major beneficial impact on the management of patients with chronic renal failure (Table 3). The exact impact of chronic HBV infection on graft and patient survival following RT remains unclear, and the outcome may depend in great part on the severity of the pre-RT liver disease. RT should only be offered to HBV-infected patients after careful consideration of all the pertinent data, including results of liver biopsy. Advances in HBV vaccination may further decrease the risk of infection in patients on HD. Our understanding of HCV is evolving rapidly, but the question of the risk of transmission of HCV within dialysis units is still unsettled and thus recommendations about isolation of HCV-infected patients are not possible. Although RT does not appear to be deleterious in many HCV-infected patients, histologic and clinical evidence of severe liver disease should also prompt caution in offering RT. Longer term studies are required to assess the ultimate effect of RT in patients with HCV. Clearly, subjective improvement of quality of life associated with successful RT compared to chronic dialysis should not be withheld lightly. Pending further experience, use of organs from anti-HCV-positive donors in non-emergent situations is best avoided. The role of antiviral agents in RT recipients with chronic viral hepatitis also remains to be defined. Improved supportive care of patients with chronic renal disease, including erythropoietin therapy, as well as improved tests for anti-HCV screening of donor blood will help to further diminish exposure to HCV in HD units.

Effect of Meal Frequency on Serum Amino Acids and Creatinine Clearance in Young Men

Seven healthy men consumed a liquid formula diet either as 3 meals taken at 0, 4, and 8 hours, or as 72 equal portions taken at 10-minute intervals (sipping). Day-long mean serum amino acids were similar on both treatments. Sipping reduced the fall in serum creatinine levels by more than 50% (p < 0.01), and reduced urine creatinine output and creatinine clearance by 11% (p < 0.05). These results suggest that increased meal frequency warrants investigation as a potentially beneficial maneuver in the dietary management of chronic renal failure.

Cadaveric renal transplantation after 60 years of age: A single center experience

Abstract We report the outcome of 121 cadaveric renal transplants performed in our institution between September 1985 and April 1992 in 117 patients, aged 60–71 years (mean 63 years) at the time of transplantation. Compared to 640 patients 20–59 years of age transplanted during the same study period, a nonstatistically significant difference was observed in the 5-year actuarial patient (80 % and 90 %, respectively, in recipients over and under 60 years of age) and transplant (80 % and 72 %, respectively, in recipients over and under 60 years oaf age) survival rates. However, elderly patients had significantly lower survival than recipients 20–29 years of age (P < 0.009). Fourteen patients died (all but one with a functioning graft) due to cardiovascular diseases (5%; 42.8% of total deaths), infections (3%; 28.6% of total deaths), and gastrointestinal complications (3%; 28.6% of total deaths). Younger patients showed a similar and nonsignificantly different incidence of cardiovascular- (35%) and infectious-(30%) related deaths. The incidence of acute rejection episodes and cytomegalovirus (CMV) infectious episodes was 27% and 24%, respectively, during the 1st post-transplant year. Ongoing acute rejection and CMV infectious episodes were significantly higher in patients who died than in those still alive (P < 0.002 and P < 0.02, respectively). Cyclosporin maintenance therapy was well tolerated in all patients but one, and 64% of the patients could be maintained without steroids. These data indicate that cadaveric renal transplantation is a safe and effective procedure in the management of chronic renal failure of selected patients 60 years of age or older.

Cadaveric renal transplantation after 60 years of age. A single center experience.

We report the outcome of 121 cadaveric renal transplants performed in our institution between September 1985 and April 1992 in 117 patients, aged 60-71 years (mean 63 years) at the time of transplantation. Compared to 640 patients 20-59 years of age transplanted during the same study period, a nonstatistically significant difference was observed in the 5-year actuarial patient (80% and 90%, respectively, in recipients over and under 60 years of age) and transplant (80% and 72%, respectively, in recipients over and under 60 years of age) survival rates. However, elderly patients had significantly lower survival than recipients 20-29 years of age (P < 0.009). Fourteen patients died (all but one with a functioning graft) due to cardiovascular diseases (5%; 42.8% of total deaths), infections (3%; 28.6% of total deaths), and gastrointestinal complications (3%; 28.6% of total deaths). Younger patients showed a similar and nonsignificantly different incidence of cardiovascular- (35%) and infectious-(30%) related deaths. The incidence of acute rejection episodes and cytomegalovirus (CMV) infectious episodes was 27% and 24%, respectively, during the 1st post-transplant year. Ongoing acute rejection and CMV infectious episodes were significantly higher in patients who died than in those still alive (P < 0.002 and P < 0.02, respectively). Cyclosporin maintenance therapy was well tolerated in all patients but one, and 64% of the patients could be maintained without steroids. These data indicate that cadaveric renal transplantation is a safe and effective procedure in the management of chronic renal failure of selected patients 60 years of age or older.

Management of Chronic Renal Failure During the First Year of Life: A European Perspective

Objective : To review the nutritional requirements of uremic children during the first year of life in terms of better management to preserve renal function and achieve optimal growth. Data sources : Published References and authors' personal unpublished observations on nutritional requirements and management of renal failure during the first year of life. Study selection : All appropriate data on calories, protein, water intake, electrolytes, vitamins and minerals, calcium, and phosphorus. Data synthesis : Requirements compared with Recommended Dietary Allowances for normal infants in the first year of life. Conclusions : Using criterion standard of growth rate in normal children, human milk or low-osmotic load, milk-based formula is recommended as primary intake. Weaning should be delayed, and introduction of solids should be supplied by low-protein cereals, maltodextrins, and fat. Psychological support should be an integral part of the treatment.

Management of chronic renal failure.

There is growing evidence that treatment of patients with renal function impairment will undergo a major shift within the next few years. Along with more or less successful attempts to alleviate the signs and symptoms of reduced renal function, new insights into renal pathophysiology as well as new therapeutic modalities have given rise to the notion that we may be able to retard the naturally occurring decline in renal function in patients with diabetic and nondiabetic nephropathy.

Recent advances in the management of chronic renal failure in childhood.

Recent advances in the management of chronic renal failure in childhood.

Effects of Medium Protein Diets in Dogs with Chronic Renal Failure

To study dietary management of chronic renal failure (CRF), 1600 dogs older than 5 y were screened for serum urea and serum creatinine concentration. Three hundred fifty-eight dogs (22.4%) showed values above normal (6.67 mmol/L of serum urea, 88.4 mul/L of serum creatinine). Sixty of these dogs with slight or moderate clinical signs of CRF, at least polyuria, were selected for the study. Thirty-two dogs were fed a commercial canned medium protein diet (MPD) [27% protein, 0.36% phosphorus in dry matter (DM)] and 28 dogs were fed a homemade diet (HMD; 21.5% protein, 0.38% phosphorus in DM). Dogs were reevaluated for clinical status, blood chemistry profile (urea, creatinine, total protein, calcium and phosphorus) and urinalysis at 9 intervals over 28 wk. In general, palatability of both diets was high and dogs maintained their body weight. Nevertheless eight dogs of the MPD and six dogs of the HMD group died or had to be killed during the study. In surviving dogs, serum urea, creatinine, phosphorus and [P x Ca] were significantly reduced nearly to the normal range after 4 wk. A slight increase at the end of the study occurred because clients did not adhere strictly to dietary instruction after recovery of the dogs. These results suggest that elderly dogs frequently show a mild or moderate CRF, and dietary treatment with medium protein and low phosphorus diets is effective in improving blood chemistry data as well as physical condition of those dogs.

The Management of Chronic Renal Failure: Ten Unanswered Questions

Journal Article The Management of Chronic Renal Failure: Ten Unanswered Questions Get access AM EL NAHAS, AM EL NAHAS Sheffield Kidney InstituteSheffield, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar JP WIGHT JP WIGHT Sheffield Kidney InstituteSheffield, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar QJM: An International Journal of Medicine, Volume 81, Issue 1, October 1991, Pages 799–809, https://doi.org/10.1093/oxfordjournals.qjmed.a068629 Published: 01 October 1991 Article history Accepted: 12 June 1991 Published: 01 October 1991

Final Examination: Advances in the Management of Chronic Renal Failure: The Use of Epoetin Alfa in Clinical Practice

Final Examination: Advances in the Management of Chronic Renal Failure: The Use of Epoetin Alfa in Clinical Practice

Evaluation of long-term aggressive dietary management of chronic renal failure in children

Ten children with chronic renal failure (CRF) were managed for 3 years using a strict low-protein and low-phosphorus diet supplemented by a mixture of the keto and amino forms of the essential amino acids and histidine (phase II). All of these children were previously managed for at least 2 years with a less rigorous diet of limited protein intake with no specific reduction of phosphorus (phase I). Energy, vitamin D, bicarbonate, phosphate binders and vitamin and mineral mixtures were added as required during both dietary phases. Data on dietary intake showed a significant fall in protein and phosphorus intake and a rise in calcium intake during phase II compared with phase I. Plasma calcium increased and phosphate fell, with an associated fall in intact parathyroid hormone levels. There was a marked improvement in urea creatinine ratios, which suggested an improved anabolic state. Cholesterol and triglyceride levels were improved. Height and weight velocity were increased, becoming significant after 3 years of phase II. Renal function deteriorated at a slower rate than predicted. The diet was well tolerated by the children, with fitness and school performance showing improvement. We conclude that long-term strict dietary management of children with CRF is feasible. Our data suggest an overall improvement in general health and an apparent reduction in the rate of deterioration of renal function.

Chronic renal failure

The appropriate management of chronic renal failure before dialysis or transplantation is vital to ensure optimum health and to achieve the maximum growth potential. Debbie Naylor describes the care these children need

Dietary Management of Canine and Feline Chronic Renal Failure

Nutritional therapy is the mainstay of management of chronic renal failure in dogs and cats. Diets designed for use in renal failure are typically reduced in protein, phosphorus, and sodium content. These and other dietary modifications are designed to prevent or ameliorate clinical signs of uremia, minimize disturbances associated with excesses or losses of electrolytes and minerals, arrest or retard progression of renal failure, and maintain adequate nutrition.

Urologic Disorders of the Geriatric Dog

Disorders of the urinary system are common in geriatric dogs. Common urinary disorders that are seen in older dogs include chronic renal failure, urinary incontinence, bladder tumors, and prostate problems. Therapy for chronic renal failure is aimed at both slowing the progression of the disease and ameliorating the signs of uremia. Therapeutic recommendations for the conservative medical management of chronic renal failure include reducing dietary protein, moderately reducing salt intake, maintaining normal serum phosphorus levels, providing free access to water, avoiding stress, supplementing water soluble vitamins, using anabolic steroids to treat the anemia of chronic renal failure, treating acidosis, and controlling hypocalcemia. Urinary incontinence can often be controlled or eliminated. The appropriate approach to management of this disorder is to identify and remove specific causes. Common causes of urinary incontinence are urethral incompetence, urinary tract infection, and polyuria and polydypsia. Bladder tumors are, fortunately, not a common tumor of dogs, but are more common in geriatric dogs than in the young. The most common bladder tumor is the transitional cell carcinoma. Therapy for this tumor is usually palliative because of its malignant nature and because it is usually located in the neck of the bladder. Its location in the bladder often makes it impossible to resect the tumor completely without removing the entire bladder and diverting the ureters. New chemotherapeutic modalities are being evaluated that may increase life expectancy after diagnosis and, therefore, improve prognosis. Prostate disease is also seen in older dogs. Types of prostate abnormalities seen in dogs include prostatic hyperplasia, cysts, abscesses, acute and chronic infection, and neoplasia. The institution of proper therapy requires an accurate diagnosis; neutering is often recommended as a part of therapy regardless of the type of prostatic disease present.

Management of chronic renal failure in China

Management of chronic renal failure in China

Management of chronic renal failure.

Management of chronic renal failure.