End-Stage Kidney Disease Is Overlooked as a Proximate Cause of Death at Autopsy

2020 ◽  
Vol 153 (6) ◽  
pp. 772-775
Author(s):  
Meredith A Reynolds ◽  
Kammi J Henriksen ◽  
Anthony Chang
Keyword(s):  
Kidney Disease ◽  
Renal Disease ◽  
Cause Of Death ◽  
Chronic Renal Disease ◽  
Systemic Disease ◽  
Final Diagnosis ◽  
End Stage Kidney Disease ◽  
Proximate Cause ◽  
Stage Renal Disease ◽  
End Stage

Abstract Objectives To determine how often end-stage kidney disease (ESKD) is implicated as a cause of death (COD) at autopsy. Methods We searched our autopsy database (2007-2017) using queries “end-stage renal disease,” “end-stage kidney disease,” “ESRD,” “chronic renal disease,” and “chronic kidney disease.” Final diagnosis and summaries were reviewed to determine if ESKD was appropriately correlated with the COD. Cases in which the COD was unrelated to kidney function were excluded. Results Eighty-five patients with a history of ESKD and histologic confirmation thereof were identified. Their CODs were cardiovascular (36%), infection/sepsis (41%), pulmonary (6%), gastrointestinal/hepatic (2%), central nervous system (3%), other systemic disease (7%), and unspecified (5%). ESKD was implicated as a contributing COD in 24 (28%) cases. Conclusions ESKD is often overlooked at autopsy, particularly in patients with cardiovascular or infectious disease. Accurate documentation of ESKD contributing to mortality is important for education, counseling, record maintenance, and directing research efforts.

scholarly journals The Pathogenesis of End-Stage Renal Disease from the Standpoint of the Theory of General Pathological Processes of Inflammation

2021 ◽  
Vol 22 (21) ◽  
pp. 11453
Author(s):  
Evgenii Gusev ◽  
Liliya Solomatina ◽  
Yulia Zhuravleva ◽  
Alexey Sarapultsev
Keyword(s):  
Kidney Disease ◽  
Renal Disease ◽  
Chronic Renal Disease ◽  
Classical Type ◽  
Low Grade ◽  
Systemic Complications ◽  
Life Threatening ◽  
Microcirculatory Disorders ◽  
Stage Renal Disease ◽  
End Stage

Chronic kidney disease can progress to end-stage chronic renal disease (ESRD), which requires the use of replacement therapy (dialysis or kidney transplant) in life-threatening conditions. In ESRD, irreversible changes in the kidneys are associated with systemic changes of proinflammatory nature and dysfunctions of internal organs, skeletal muscles, and integumentary tissues. The common components of ESRD pathogenesis, regardless of the initial nosology, are (1) local (in the kidneys) and systemic chronic low-grade inflammation (ChLGI) as a risk factor for diabetic kidney disease and its progression to ESRD, (2) inflammation of the classical type characteristic of primary and secondary autoimmune glomerulonephritis and infectious recurrent pyelonephritis, as well as immune reactions in kidney allograft rejection, and (3) chronic systemic inflammation (ChSI), pathogenetically characterized by latent microcirculatory disorders and manifestations of paracoagulation. The development of ChSI is closely associated with programmed hemodialysis in ESRD, as well as with the systemic autoimmune process. Consideration of ESRD pathogenesis from the standpoint of the theory of general pathological processes opens up the scope not only for particular but also for universal approaches to conducting pathogenetic therapies and diagnosing and predicting systemic complications in severe nephropathies.

scholarly journals Has Covid-19 reduced the management of end-stage kidney disease in 2020?

2021 ◽  
Vol 4 (1) ◽  
pp. 53-54
Author(s):  
Jacobs Lucas Pierre-michel ◽  
Frederic Collart ◽  
Thomas Baudoux ◽  
Catherine Bonvoisin ◽  
Jean-Marc De Smet ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Dialysis Initiation ◽  
Ambulatory Patient ◽  
End Stage Kidney Disease ◽  
Marked Decline ◽  
Stage Renal Disease ◽  
End Stage

The SARS-CoV-2 pandemic has been associated with a drop in diagnoses of several diseases in 2020, including cancers. In this letter addressed to the editor, the Groupement des Néphrologues Francophones de Belgique (GNFB), assessed whether there was a similar effect concerning end-stage renal disease (ESRD). Data of patients with ESRD form 25 of the 26 centers constituting the GNFB register were collected. In conclusion, the year 2020 was marked by an 8% drop in the incidence of overall treatments for ESRD. A particularly marked decline in outpatient dialysis initiation programs (PD and HDD). In addition, the interruption of transplant programs in academic centers as well as the closure of ambulatory patient clinics in a majority of hospitals was associated with a delay in nephrological management.

scholarly journals Chronic Constrictive Pericarditis in Association with End-Stage Renal Disease

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Roman L. Kleynberg ◽  
Vera M. Kleynberg ◽  
Leonid M. Kleynberg ◽  
Danny Farahmandian
Keyword(s):  
Kidney Disease ◽  
Renal Disease ◽  
Constrictive Pericarditis ◽  
End Stage Renal Disease ◽  
Uncontrolled Hypertension ◽  
End Stage Kidney Disease ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage ◽  
Pericardial Involvement

Pericardial involvement in end-stage renal disease (ESRD) is manifested most commonly as acute uremic or dialysis pericarditis and infrequently as chronic constrictive pericarditis (CCP). We report a 27-year-old patient with a history of uncontrolled hypertension, end-stage-renal disease on hemodialysis, who presented with recurrent ascites, dyspnea, and hypotension. After diagnosis with CCP, a partial pericardiectomy was performed; however, the patient did not improve and a salvage total pericardiectomy soon followed. He continued to decompensate and expired following a terminal extubation. No definitive cause of constrictive pericarditis was found. Nonetheless, we surmise it may have developed secondary to his end-stage renal disease. A literature review revealed end-stage kidney disease as a relatively uncommon cause of CCP; only a few other such associations have thus far been reported.

scholarly journals Investigation of the Impact of Endodontic Therapy on Survival among Dialysis Patients in Taiwan: A Nationwide Population-Based Cohort Study

2021 ◽  
Vol 18 (1) ◽  
pp. 326
Author(s):  
Chih-Chien Chiu ◽  
Ya-Chieh Chang ◽  
Ren-Yeong Huang ◽  
Jenq-Shyong Chan ◽  
Chi-Hsiang Chung ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Root Canal ◽  
Dialysis Patients ◽  
Root Canal Therapy ◽  
Risk Of Death ◽  
Stage Renal Disease ◽  
End Stage

Objectives Dental problems occur widely in patients with chronic kidney disease (CKD) and may increase comorbidities. Root canal therapy (RCT) is a common procedure for advanced decayed caries with pulp inflammation and root canals. However, end-stage renal disease (ESRD) patients are considered to have a higher risk of potentially life-threatening infections after treatment and might fail to receive satisfactory dental care such as RCT. We investigated whether appropriate intervention for dental problems had a potential impact among dialysis patients. Design Men and women who began maintenance dialysis (hemodialysis or peritoneal dialysis) between January 1, 2000, and December 31, 2015, in Taiwan (total 12,454 patients) were enrolled in this study. Participants were followed up from the first reported dialysis date to the date of death or end of dialysis by December 31, 2015. Setting Data collection was conducted in Taiwan. Results A total of 2633 and 9821 patients were classified into the RCT and non-RCT groups, respectively. From the data of Taiwan’s National Health Insurance, a total of 5,092,734 teeth received RCT from 2000 to 2015. Then, a total of 12,454 patients were followed within the 16 years, and 4030 patients passed away. The results showed that members of the non-RCT group (34.93%) had a higher mortality rate than those of the RCT group (22.79%; p = 0.001). The multivariate-adjusted hazard ratio for the risk of death was 0.69 (RCT vs. non-RCT; p = 0.001). Conclusions This study suggested that patients who had received RCT had a relatively lower risk of death among dialysis patients. Infectious diseases had a significant role in mortality among dialysis patients with non-RCT. Appropriate interventions for dental problems may increase survival among dialysis patients. Abbreviations: CKD = chronic kidney disease, ESRD = end-stage renal disease, RCT = root canal therapy.

scholarly journals The Severity of Diabetic Retinopathy Is an Independent Factor for the Progression of Diabetic Nephropathy

2020 ◽  
Vol 10 (1) ◽  
pp. 3
Author(s):  
Shi-Chue Hsing ◽  
Chia-Cheng Lee ◽  
Chin Lin ◽  
Jiann-Torng Chen ◽  
Yi-Hao Chen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Kidney Disease ◽  
Renal Disease ◽  
Disease Progression ◽  
Renal Disease Progression ◽  
Hazard Ratios ◽  
Stage Renal Disease ◽  
End Stage

(1) Background: It has rarely been studied whether the severity of diabetic retinopathy (DR) could influence renal disease progression in end-stage renal disease (ESRD) and chronic kidney disease (CKD) in patients with type 2 diabetes. The aim of this study was to evaluate renal disease progression in ESRD and CKD according to DR severity in patients with type 2 diabetes. (2) Methods: We included 1329 patients and divided the cohort into two end-points. The first was to trace the incidence of ESRD in all enrolled participants and the other was to follow their progression to CKD. (3) Results: Significantly higher crude hazard ratios (HRs) of ESRD incidence in all enrolled participants were noted, and this ratio increased in a stepwise fashion. However, after adjustment, DR severity was not associated with ESRD events. Therefore, a subgroup of 841 patients without CKD was enrolled to track their progression to CKD. Compared with no diabetic retinopathy, the progression of CKD increased in a stepwise fashion, from mild nonproliferative diabetic retinopathy (NPDR) to moderate NPDR, to severe NPDR and to proliferative diabetic retinopathy (PDR), both in the crude and adjusted models. (4) Conclusions: The severity of retinopathy appeared to be associated with renal lesions and the development of CKD. Our findings suggest that the severity of DR is a risk factor for progression to CKD. Therefore, diabetic retinopathy is useful for prognosticating the clinical course of diabetic kidney disease.

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