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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three isoforms of nitric oxide synthase (NOS) [neuronal NOS (bNOS), inducible NOS (iNOS) and endothelial NOS (eNOS)] are expressed in the kidney. The use of pharmacological inhibitors of these enzymes has been a major experimental tool to determine the role of nitric oxide (NO) in renal physiology and pathophysiology. Studies performed in both human and experimental animals demonstrate that NOS blockade increases renal vascular resistances and decreases the glomerular ultrafiltration coefficient. These studies also support the presence of an important interaction between NO, angiotensin and renal nerves in the control of renal function. Renal iNOS activity is significantly increased in various pathophysiological conditions including autoimmune tubulointerstitial nephritis and sepsis. Interestingly, recent evidence suggests that high NO levels secondary to increased iNOS activity may inhibit eNOS activity and through this mechanism lead to renal vasoconstriction and reductions in glomerular filtration rate. The use of NOS blockers has generated a great deal of information on the role of NO in the control of renal function and has also allowed us to begin to understand the high level of complexity of this system.
Nephrol Dial Transplant 2001
PMID:Effects of nitric oxide synthase blockers on renal function. 1136 13

Acute renal failure is an evolving syndrome in which new pathogenetic mechanisms have recently been elucidated. The evolution of the field of haemodialysis has led to a parallel development in the therapeutic approach to patients suffering from this syndrome. In particular, acute renal failure is more frequently seen as part of a more complex syndrome, defined as multiple organ failure. In this clinical setting, patients are almost inevitably confined to intensive care units and sepsis is a frequent underlying mechanism of organ failure. The use of new devices and new machines, together with a better understanding of the underlying mechanisms of solute and water removal, have allowed us to achieve higher levels of efficiency and clinical tolerance during artificial renal replacement therapy. The first objective has been reached by increasing the automation of the extracorporeal circuits and the operational levels of the different techniques; the second has been achieved by means of a new generation of monitoring techniques and new machines equipped with specific interfaces and alarms. This progress has made continuous forms of renal replacement (CRRT) possible and easy to perform without major problems or complications. The most promising and effective options for treating acute renal failure in critically ill patients are today offered by continuous renal replacement therapies. Classic indications, but also alternative non-renal indications, have been proposed for these techniques. The most advanced indication is the multiple organ dysfunction occurring in septic patients. The possible removal of proinflammatory mediators may permit a blockade of the systemic inflammation, a modulation of the altered immune response in these patients, and it may lead to a partial or total restoration of the lost homeostasis.
Nephrol Dial Transplant 2001
PMID:Continuous renal replacement therapy in critically ill patients. 1150 88

Sclerosing encapsulating peritonitis (SEP) is recognized as a serious complication of peritoneal dialysis. However, recovery is possible if an appropriate diagnosis and treatment are made. The term SEP is used most often, but is inaccurate, particularly the reference to peritonitis. A more accurate description would be "encapsulating peritoneal sclerosis" (EPS). From the therapeutic perspective, the diagnosis should be established before EPS develops. Early diagnosis is important. Furthermore, it is also important to determine the therapeutic tactics for EPS according to the disease stage. Most cases of EPS develop with manifestations of fever, increased levels of C-reactive protein (CRP), and slight ileus symptoms, accompanied by increased ascites ("inflammatory stage"). Following precise identification of the inflammatory stage, steroid administration should be initiated immediately with the onset of EPS. Methylprednisolone pulse therapy is recommended during the early stage. If the EPS is not relieved, or if it recurs within 1 month, the steroid dose should be decreased and the patient should be managed by total parenteral nutrition (TPN) ("encapsulating stage"). If ileus symptoms remain despite the absence of inflammatory findings and decreased ascites, laparotomy and enterolysis should be considered within 6 months ("ileus stage"). However, it is important that the enterolysis be performed without damaging the capsule-covered intestine. To date, we have successfully treated EPS in 18 of 19 patients using these options. In 3 patients, EPS was relieved by steroid administration. In 15 patients, EPS was relieved by total intestinal enterolysis. Enterolysis patients had satisfactory operative outcomes and eventually returned to their previous social activities. One patient experienced perforation of the small intestine and pan-peritonitis, and died of sepsis. In summary, EPS is not an incurable disease. It can be completely overcome by active diagnosis and treatment.
Adv Perit Dial 2001
PMID:Treatment options for encapsulating peritoneal sclerosis based on progressive stage. 1151 Feb 76

The principal complications of continuous ambulatory peritoneal dialysis (CAPD), namely malposition of the dialysis catheter, peritonitis, exit site infection, leakage of dialysis fluid, sclerosing peritonitis, and renal cysts and tumors, are considered in this article. The techniques that are used to reposition displaced dialysis catheters and extend the duration of dialysis are described. The role of imaging in establishing the diagnosis of peritonitis is relatively small. However, both computed tomography (CT) and ultrasound may be used to identify loculation of fluid and localized sites of sepsis, and permit percutaneous drainage. Ultrasonography of the catheter track through the percutaneous tissues allows identification of pericatheter collections in patients with exit-site infection. The technique of CT peritoneography is helpful in establishing sites of dialysis fluid leakage. These commonly occur at the site of entry of the dialysis catheter, through abdominal incisions, or along the patent tunica vaginalis into the scrotum. The appearances on CT of sclerosing peritonitis reflect pathologic changes and are characterized by the presence of peritoneal thickening and calcification. Bowel obstruction, which may develop in sclerosing peritonitis, can be identified on abdominal radiographs or barium studies of the gastrointestinal tract. Acquired renal cystic disease and renal carcinomas occur in a significant proportion of patients undergoing CAPD. Ultrasound is the investigation of first choice in the identification and clarification of the pathology (cystic or solid) of suspected renal masses.
Semin Dial
PMID:Image-guided peritoneal access and management of complications in peritoneal dialysis. 1219 Oct 25

Vascular catheters have become essential tools for management of hospitalized or chronically ill patients requiring intensive medical treatments such as extracorporeal detoxification procedures. The increased use of such devices has been accompanied by a corresponding increase in complications, such as bloodstream infection and thrombosis. In a retrospective study 332 large bore catheters which were inserted in 182 patients in the inferior or superior vena cava were investigated. The complication rate was in internal jugular vein puncture (N = 231) with 20% low and in the subclavian vein puncture (N = 94) with 60.5% and in the femoral vein puncture (N = 7) with 57.1% very high. The majority of complications were puncture not possible, puncture of the artery, abscess, septicemia, bleeding and thrombosis. To minimize the complication rate the surface of some catheters were treated and the microdomain structured surface inserted. The first results are very encouraging and should help to make large bore catheters safer.
Ther Apher Dial 2003 Apr
PMID:Side-effects and complications in large-bore catheters for apheresis. 1291 47

Toray Industries Inc. has developed an endotoxin removal cartridge (Toraymyxin) composed of a polymyxin B immobilized, fibrous adsorbent. Toraymyxin has been listed as a blood purification medical device for endotoxin removal to be reimbursed by the Japanese national health insurance since 1994. Toraymyxin can be applied to patients with endotoxemia or suspected gram-negative infection, which fulfilll the conditions of Systemic Inflammatory Response Syndrome (SIRS) and have septic shock demanding vasopressor infusion. Since 1994, over 30,000 patients have received this treatment. The safety of this device has been confirmed and improvement of hemodynamic dysfunction has been shown to be a major benefit. Infection resulting from an acute abdominal condition requiring surgery has been shown to be one of the good indications for Toraymyxin. Further studies are now ongoing to establish Toraymyxin treatment as one of the options to treat sepsis and septic shock patients and to clarify the mechanisms involved in this therapy.
Ther Apher Dial 2003 Feb
PMID:Extracorporeal endotoxin removal for the treatment of sepsis: endotoxin adsorption cartridge (Toraymyxin). 1292 Nov 25

A 65-year-old woman with end-stage renal disease (ESRD) presented with bloody ascites. She had been maintained on peritoneal dialysis (PD) for 7 years and had eight episodes of peritonitis. She was eventually transferred to hemodialysis (HD) because of ultrafiltration failure. This was associated with "high" peritoneal transport by peritoneal equilibration test (PET). A period of "peritoneal rest" did not improve PET results. Within a year of transfer to HD, ascites developed, which was hemorrhagic upon evaluation. A computed tomography (CT) scan suggested encapsulating sclerosing peritonitis, which was confirmed upon peritonoscopy. The patient was treated with prednisone and tamoxifen. Encapsulating peritoneal sclerosis (EPS) is a devastating complication of PD. Although it is rare and its development often unpredictable, this case demonstrates several clinical features commonly observed in the condition. These include more than 6 years on PD, a high transporter status, recurrent peritonitis, and the development of blood-stained dialysis effluent (or ascites if PD has been discontinued, as was the case in this patient). The initial presentation is often incipient with vague abdominal pain. Symptoms are progressive, however, and EPS has a high mortality rate, with most patients dying within 1 year of diagnosis, usually from malnutrition and sepsis. Treatment options include systemic immunosuppression and regular peritoneal irrigation after transfer to HD. Response to treatment is more likely to occur in the early inflammatory stage of EPS, when symptoms are nonspecific and imaging is relatively normal. Hence a high degree of suspicion for the diagnosis should be present in patients "at risk" of this condition, as early diagnosis is essential if progressive encapsulation of the abdominal viscera is to be prevented.
Semin Dial
PMID:Bloody ascites in a patient after transfer from peritoneal dialysis to hemodialysis. 1296 97

In this retrospective study, we evaluated the causative factors, outcomes, and complications of therapy in 35 patients (16 girls, 19 boys) started on chronic peritoneal dialysis (CPD) between 1997 and 2002. Average age at initiation of CPD was 9.3 +/- 4.4 years. All patients started on continuous ambulatory peritoneal dialysis (CAPD). Nine patients switched to ambulatory peritoneal dialysis (APD) during the follow-up period. The most common cause leading to end-stage renal disease (ESRD) in the patients was reflux nephropathy (22.9%). The major complication during therapy was peritonitis, with 41 episodes seen in 17 patients (1 episode per 18 patient-months). Of the children on APD, 7 developed 17 episodes of peritonitis (1 episode per 8.3 patient-months); of the children on CAPD, 10 developed 24 peritonitis attacks (1 episode per 24.9 patient-months). The other complications were inguinal hernia in 3 patients, subcutaneous leak in 4 patients, dialysate leak in 2 patients, pericardial effusion in 1 patient, umbilical hernia in 1 patient, hydrothorax in 1 patient, and cuff protrusion in 3 patients. During the follow-up period, 4 patients died owing to sepsis or cardiopulmonary complications. Only 1 patient was transferred to hemodialysis (owing to persistent Candida peritonitis). We think that CPD therapy is a good choice of treatment modality in the management of children with ESRD.
Adv Perit Dial 2003
PMID:Outcome in children on chronic peritoneal dialysis. 1476 77

Complications resulting from infection remain a major problem for hemodialysis catheters, with significant numbers of catheters being removed due to catheter-related sepsis. Numerous strategies have been employed to reduce the occurrence of infection and improve long-term outcomes, with varying degrees of success. One promising approach is coating the external surface of catheters with silver using physical vapor deposition processes. This article reviews results of animal and clinical experiments conducted to assess efficacy and biocompatibility of silver-coated dialysis catheters. It is concluded that silver coatings can reduce bacterial colonization and occurrence of infection associated with these devices.
Ther Apher Dial 2003 Dec
PMID:Silver coating of dialysis catheters to reduce bacterial colonization and infection. 1501 35

For the treatment of multiple organ failure (MOF) through sepsis, we have commonly applied various blood purification modalities during the perioperative period. From January 1996 to December 2000, 33 patients with MOF through sepsis were admitted and operated on in the First Department of Surgery, Akita University School of Medicine, and 21 of these 33 patients were treated using various blood purification modalities during the perioperative period: endotoxin-adsorbing therapy using polymyxin B (PMX) in 17 patients, continuous hemofiltration (CHF)/continuous hemodiafiltration (CHDF) in 15 patients, and plasma exchange (PE) and CHDF in 3 patients. Of the outcome of these 33 patients with MOF through sepsis, 17 survived and 16 died (48% mortality). Of the 21 patients with MOF through sepsis treated by surgery and blood purification, 12 survived and 9 died (43% mortality). We evaluated APACHE II and the number of failed organs before operation. Amongst the group with 12 survivors and 9 deaths, Acute Physiology and Chronic Health Evaluation II (APACHE II) was 15 +/- 5, 23 +/- 2 and the number of failed organs was 2.7 +/- 0.7, 3.9 +/- 0.8, respectively. An increased APACHE II score and number of failed organs were significantly associated with mortality. As to the treatment of MOF through sepsis due to acute peritonitis, patients with APACHE II scores ranging from 15 to 20, and those with 2-3 failed organs seem to be the candidates for the application of blood purification during the perioperative period.
Ther Apher Dial 2004 Jun
PMID:Treatment of multiple organ failure through sepsis by surgery and blood purification. 1515 68


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