Whalendiaz7483

Subnormal GFR and elevated serum creatinine levels develop only when there is significant proteinuria. Prevention and Treatment The identification of biomarkers of early, non-invasive kidney injury, and their inclusion in clinical practice will contribute to the identification of the mechanisms involved in the development of renal syndromes, facilitating the development of more effective strategies in the prevention and treatment of SCD.Clinical Background Clinical infections and its most severe forms sepsis and septic shock are commonly associated with changes in kidney function. This acute kidney injury (AKI) is associated with increased risk of morbidity and mortality in hospitalized patients. Epidemiology Recent standardized, separate consensus definitions of sepsis and AKI have informed the epidemiology of these 2 distinct processes. While there is no consensus definition specific to sepsis-associated AKI, several studies have utilized the combined definitions of these two syndromes to identify those patients at the highest risk for adverse outcomes. Challenges Prevention of sepsis-associated AKI is difficult in part because patients will often present for medical care with the sepsis-associated AKI already clinically apparent. Additionally, for those that do not have AKI on presentation the ability to detect injury early is limited by the imperfect current gold standard biomarkers serum creatinine and urine output. Prevention and Treatment Despite these challenges, there has been increased investigation of novel biomarkers of AKI. Additionally, there has been intense investigation into the ideal care of patients with sepsis, AKI as well as sepsis-associated AKI. While there are limited specific therapeutic options outside of antibiotics for infections, several studies have investigated the use of care bundles to treat these syndromes. While there is continued investigation into novel therapeutics and the use of dialysis and extracorporeal modalities, these trials have failed to revolutionize clinical care. This review summarizes the current state of sepsis-associated AKI care and discusses strategies to improve care.Clinical Background Kidney transplantation (KT) is the best treatment for most patients with end-stage kidney disease (ESKD), providing better survival and quality of life and lower cost when compared to dialysis. Epidemiology Despite robust evidence showing the superiority of KT over dialysis, a significant percentage of ESKD patients worldwide do not access this treatment. Challenges Barriers resulting in inequalities and inequities in access to KT involves chronic kidney disease (CKD) diagnosis and management, including difficulties in accessing dialysis therapy before KT; suboptimal referral and enlistment to KT; and imbalance between supply and demand for organs. Low socioeconomic status has an important role in that scenario. Prevention and Treatment Strategies to minimize disparities in access to KT involve public policies to ensure access to CKD diagnosis and treatment, health education, continuous training of health providers, infrastructure, and allocation policies.An estimated one-third of adults in developed countries and more than 80% of the population in many low- and middle-income countries use herbal and traditional medicines to promote health or for the treatment of common diseases. Herbal medicines can cause kidney damage as a result of intrinsic toxicity, adulteration, contamination, replacement, misidentification, mistaken labeling, and unfavorable herb-drug interactions. The kidneys, due to their high blood flow rate, large endothelial surface area, high metabolic activity, active uptake by tubular cells, medullary interstitial concentration, and low urine pH are particularly vulnerable to development of toxic injury in the form of different syndromes like acute kidney injury, nephrolithiasis, chronic interstitial fibrosis, or uroepithelial cancer. Herbal medicines can also cause crystalluria or hypertension and some could increase potassium blood levels in patients with kidney damage. It is of critical importance that health care organizations around the world regulate herbal and traditional remedies in order to reduce the risk of herb-toxic acute kidney injury or chronic kidney disease. The nephrologist must be aware of the potential nephrotoxicity from herbal medicine and supplements. A careful history and specific questioning about use of herbal medicines use is essential.Clinical Background and Epidemiology Nutrition and obesity are both important and common clinical issues in chronic kidney disease (CKD). Protein-energy wasting predicts adverse clinical outcomes in CKD. Obesity is associated with poor health outcomes. Nutrition management, specifically a protein-restricted diet, has been shown to ameliorate glomerular injury and progressive CKD by reducing glomerular hyperfiltration and hypertension. A protein-restricted diet has favorable metabolic and hemodynamic effects and effects on CKD-mineral bone disease that may favorably impact patients' outcomes. On the other hand, obesity may adversely affect kidney function both directly by placing an increased metabolic demand on the kidneys and indirectly through various humoral mechanisms mediated via adiponectin, leptin, and resistin that lead to hyperinsulinemia, insulin resistance, abnormal lipid metabolism, activation of renin-angiotensin aldosterone system, chronic inflammation, and oxidative stress, and could result in diets. Pharmacologic and surgical interventions such as bariatric surgery for obesity require further evaluation in CKD.Digital health is an area that emerges from the association between health needs and technological solutions. With the growing access of people to the internet and the ease of acquiring equipment that allows internet connection, we are observing an exponential increase in the strategies that use technology to connect patients and healthcare providers. Telenephrology is a channel of communication that facilitates the access to the nephrologist for both primary care physicians and patients and has been implemented in several countries. Applications for smartphones are frequently used by both patients and healthcare providers, and these tools are changing the way we practice nephrology and medicine in general. Social networks emerge as an important way of communicating between healthcare professionals and patients and a source of connection for people with the same interests. Artificial intelligence, big data, and other technological solutions, including wearable devices that measure and monitor different health parameters, are revolutionizing healthcare and the field of nephrology. Implantable devices are in development, including devices to monitor electrolytes in dialysis patients, systems to track medication intake, wearables to monitor exercises, monitoring of blood pressure, heart rate, arrhythmia, and peripheral oxy-hemoglobin saturation, among others. The wearable artificial kidney, a device which would perform renal function during ambulation and social activities outside of the hospital, has been under investigation for many years. In this chapter, we highlight the most recent advances in digital health applied to nephrology.Clinical Background and Epidemiology Low physical activity is a common phenotype in individuals living with chronic kidney disease (CKD). It increases as renal function declines and is associated with adverse clinical outcomes and a poor quality of life (QOL). Both behavioral and disease-related factors contribute to the low physical activity levels in CKD. CKD has profound negative effects on skeletal muscle structure and function that are related to impairments in mitochondrial function, inflammation, oxidative stress, metabolic acidosis, and other uremia-related factors. These factors promote muscle protein catabolism and wasting, and impair strength, physical performance, and cardiorespiratory fitness. Moreover, the high burden of comorbid disease contributes to patient fatigue, fear of injury, and poor exercise self-efficacy. All of these factors reinforce patient's sedentary behavior, leading to a vicious cycle of disease and disability that further compromises their health and QOL. Data from both obser and the individual circumstances of those living with the disease.Clinical Background As a result of modern industrialization, air pollution has become a potential contributor to global burden of noncommunicable diseases, such as cardiovascular disease, respiratory disease, and kidney disease. Epidemiology Emerging epidemiological evidence has demonstrated that exposure to ambient air pollution is associated with an increased risk for the development and progression of chronic kidney disease (CKD) and CKD-related mortality. Exposure to PM2.5, even at relatively low concentrations, is a risk factor for a lower estimated glomerular filtration rate and a faster decline in glomerular filtration rate. It has been estimated that the global burden of CKD attributable to PM2.5 is 6.95 million incident cases of CKD per year. Low- and middle-income countries in the Eastern Mediterranean and South-East Asia regions experienced the highest urban air pollution levels, thus facing a heavier burden of related disease. Challenges Despite a growing awareness of kidney damage related to air pollution, large gaps still exist between the exact toxicological effect of particles on the kidney and the increasing prevalence of air pollution-related kidney diseases. Considering the geographic variation of air pollution, more longitudinal studies in different parts of the world are urgently needed, especially in those most affected countries. Prevention and Treatment Air pollution control should be regarded as a high priority in urban plan and policy making. Actions are required to narrow gaps in knowledge and clean air, thus preventing air pollution-related kidney disease.This review article summarizes current theories of the steady-state growth mode of dendrites in the form of elliptical paraboloids. The shape of dendrite tips is analyzed, temperature and solute concentration distributions are described in its vicinity, and a solution of the hydrodynamic problem of a viscous incompressible fluid flowing against a dendrite tip is developed. A significant difference in analytical solutions describing a dendrite tip as an elliptic paraboloid as compared to an axisymmetric morphology is shown. The system of nonlinear equations for determining the stationary velocity of dendrite growth and the radii of curvature of the dendrite tip along the major and minor axis of the ellipse, respectively, is derived. The developed theory is compared with experimental data on the growth of ice crystals consisting of D2O or H2O.Graphene (G) is regarded as a tremendous potential corrosion protection material owing to its perfect impermeability. However, the tendency of graphene nanosheets to agglomerate and the corrosion-promotion effect brought by its native high electrical conductivity seriously affect its anti-corrosion application. In this paper, high-energy ball milling was used to prepare graphene with excellent impermeability. Then, insulating poly(m-phenylenediamine) encapsulated graphene (G@PmPD, conductivity of 1.2×10-7 S cm-1) was prepared through non-covalent π-π interaction. The resulting amino-rich G@PmPD exhibits stable dispersibility and excellent compatibility in organic solvents and polymer matrix. Embedding 0.5 wt% of G@PmPD into the epoxy matrix, and the composite coating can effectively protect the steel substrate for up to 60 days. this website This superior corrosion resistance is attributed to the impermeability inherited by G@PmPD and the compactness improved by the cross-linking of G@PmPD and EP. Especially in the damaged state, the composite coating embedded with low conductivity G@PmPD triumphantly eliminated graphene's corrosion-promotion effect.