Potassium disorders are common and may precipitate cardiac arrhythmias or cardiopulmonary arrest. They are an anticipated complication in patients with renal failure, but may also occur in patients ...with no previous history of renal disease. They have a broad clinical spectrum of presentation and this paper will highlight the life-threatening arrhythmias associated with both hyperkalaemia and hypokalaemia. Although the medical literature to date has provided a foundation for the therapeutic options available, this has not translated into consistent medical practice. Treatment algorithms have undoubtedly been useful in the management of other medical emergencies such as cardiac arrest and acute asthma. Hence, we have applied this strategy to the treatment of hyperkalaemia and hypokalaemia which may prove valuable in clinical practice.
Summary The outcome of cardiopulmonary resuscitation (CPR) has been reported to be worse in patients with renal failure compared with those with normal renal function. It is likely that this ...increased mortality may be at least partly attributable to sub-optimal and highly variable treatment strategies used in cardiac arrest in patients with renal failure, but this issue has not previously been explored. Such patients undoubtedly pose a challenge to advanced life support (ALS) providers, and renal unit staff are not trained to provide specialist advice after a patient has sustained a cardiac arrest. There are few studies investigating the epidemiology, safety or outcome of cardiac arrest in patients with renal failure and there are no generally accepted resuscitation guidelines for this special circumstance. In this article we discuss the unique problems of resuscitating patients with renal failure and propose a suitable management strategy.
We aimed to determine the mortality rate, cause of death, and rate of end-stage kidney disease (ESKD) in adults with nephrotic syndrome (NS).
We conducted a national registry–based study, including ...all 522 adults who had a kidney biopsy for NS in Scotland in 2014–2017. We linked the Scottish Renal Registry to death certificate data. We performed survival and Cox proportional hazards analyses, accounting for competing risks of death and ESKD. We compared mortality rates with those in the age- and sex-matched general population.
A total of 372 patients had primary NS; 150 had secondary NS. Over a median follow-up of 866 days, 110 patients (21%) died. In patients with primary NS, observed versus population 3-year mortality was 2.1% (95% CI 0.0%–4.6%) versus 0.9% (0.8%–1.0%) in patients aged <60 years and 24.9% (18.4%–30.8%) versus 9.4% (8.3%–10.5%) in those aged ≥60 years. In secondary NS, this discrepancy was 17.1% (5.6%–27.2%) versus 1.1% (0.9%–1.2%) in <60-year-olds and 49.4% (36.6%–59.7%) versus 8.1% (6.6%–9.6%) in ≥60-year-olds. In primary NS, cardiovascular causes accounted for 28% of deaths, compared with 18% in the general population. Eighty patients (15%) progressed to ESKD. Incidence of ESKD by 3 years was 8.4% (95% CI 4.9%–11.7%) in primary and 35.1% (24.3%–44.5%) in secondary NS. Early remission of proteinuria and the absence of early acute kidney injury (AKI) were associated with lower rates of death and ESKD.
Adults with NS have high rates of death and ESKD. Cardiovascular causes account for excess mortality in primary NS.
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These European Resuscitation Council (ERC) Cardiac Arrest in Special Circumstances guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment ...Recommendations. This section provides guidelines on the modifications required to basic and advanced life support for the prevention and treatment of cardiac arrest in special circumstances; specifically special causes (hypoxia, trauma, anaphylaxis, sepsis, hypo/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), special settings (operating room, cardiac surgery, catheter laboratory, dialysis unit, dental clinics, transportation (in-flight, cruise ships), sport, drowning, mass casualty incidents), and special patient groups (asthma and COPD, neurological disease, obesity, pregnancy).
Hypothermic cardiac arrest is associated with a high mortality despite advances in pre-hospital rescue, rewarming techniques and intensive care management. Prolonged resuscitation is justified and ...full neurological recovery has been described using various methods of extracorporeal rewarming (Vretenar DF, Urschel JD, Parrott JCW et al. Ann Thorac Surg 1994; 58: 895–898; Hughes A, Riou P, Day C. Emerg Med J 2007; 24: 511–512). Extracorporeal rewarming is usually required at temperatures below 32°C or in the presence of cardiovascular instability or neurological dysfunction (Wilkey SA. Am J Clin Med 2004; 1: 4–11). Resuscitation guidelines suggest cardiopulmonary bypass (CPB) as the method of choice in cardiac arrest, but in practice availability is restricted (Soar J, Deakin CD, Nolan JP et al. Resuscitation 2005; 67: S135–S170). Continuous veno-venous haemofiltration (CVVH) is an alternative, but underutilized approach which warrants further consideration given its ease and wider availability.
Diffuse renal cortical necrosis from any cause is rare in the Western World. Over the last 5 decades, there have been isolated case reports of acute cortical necrosis as a consequence of acute ...pancreatitis, but the long-term outcome of these patients has not previously been reported. Here, we report 3 young men, aged 16-21 years, who have presented over the past 19 years with severe acute pancreatitis associated with oliguric acute renal failure. They were all found to have diffuse renal cortical necrosis and consequently made no renal recovery. Despite the appreciable mortality associated with acute pancreatitis complicated by acute renal failure, they all survived the initial illness and all have successfully undergone renal transplantation. We present a detailed account of each patient including diagnostic strategies and discuss the possible factors contributing to a favorable outcome in these patients.
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