Abstract:
BACKGROUND:Fistula failure has been classified as early and late. Early failure refers to those cases in which the arteriovenous (AV) fistula never develops to the point that it can be used or fails within the first 3 months of usage. It has been common practice to abandon these early failures; however, aggressive evaluation and treatment of early fistula failures has been shown to result in the salvage of a large percentage. The two most common causes of the failure seen at this time are juxta-anastomotic stenosis (JAS) and the presence of accessory veins. Both of these can be easily diagnosed by physical examination. This study reports the results of early fistula failure managed aggressively in an attempt at salvage. METHODS:These studies were conducted in six freestanding outpatient interventional facilities in different regions of the United States. Interventional nephrologists are employed at all of these facilities except one that is operated by an interventional radiologist. Each patient was first evaluated angiographically to identify the anatomy of their AV fistula and detect abnormalities that might be present. Stenotic lesions were then treated with angioplasty and accessory veins thought to be significant were obliterated. All patients were then followed to determine if the fistula was usable for dialysis. RESULTS:One hundred patients were identified that met the definition of early failure. Venous stenosis was present in 78% of these cases. In 43% of the cases, the lesion was in the JAS location. In 15%, this was the only lesion present. In 24%, it was associated with an accessory vein, in 6% with a proximal stenosis, and in 4% with both. A proximal stenosis lesion was present in the fistula in 36%. In 6%, it was associated with an accessory vein, in 6% with a JAS, and in 4% with both. The definition of arterial anastomosis stenosis was met in 38% of the cases. This was always in association with JAS. In four cases, a stenotic lesion was present in the artery above the anastomosis. An accessory vein was present in 46% of the cases. In 12% of the cases, this was the only lesion present. In 24% of the cases, this anomaly was associated with JAS, in 6% with proximal stenosis, and in 4% with both. Angioplasty was performed to treat venous stenosis in 72% of the cases with a 98% success rate. Angioplasty of the arterial anastomosis was performed in 38 cases with a 100% success rate. Accessory vein obliteration was performed in 46% of the patients with a 100% success rate. The overall complication rate in this series was 4%, of these 3% were minor and 1% were major. It was possible to initiate dialysis using the fistula in 92% of the cases. Actuarial life-table analysis showed that 84% were functional at 3 months, 72% at 6 months, and 68% at 12 months. CONCLUSION:If correctable pathology is detected in patients with early fistula failure, the incidence of correctable lesions is relatively high and an aggressive therapeutic approach can be expected to have a high yield.
journal_name
Kidney Intjournal_title
Kidney internationalauthors
Beathard GA,Arnold P,Jackson J,Litchfield T,Physician Operators Forum of RMS Lifeline.doi
10.1046/j.1523-1755.2003.00210.xsubject
Has Abstractpub_date
2003-10-01 00:00:00pages
1487-94issue
4eissn
0085-2538issn
1523-1755pii
S0085-2538(15)49488-8journal_volume
64pub_type
杂志文章abstract::Unilateral ureteral obstruction in rabbits leads to an influx of macrophages into the kidney, a proliferation of interstitial cells, and an increase in arachidonic acid metabolism. The role of the macrophage in the metabolic changes of hydronephrosis was investigated by using endotoxin and nitrogen mustard. The in viv...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1984.127
更新日期:1984-07-01 00:00:00
abstract::We report the first case of a mitochondrial DNA (mtDNA) deletion diagnosed by renal biopsy. An eight-year-old girl with megaloblastic anemia and severe growth retardation developed progressive renal insufficiency accompanied by partial Fanconi syndrome. Histologic examination of the renal biopsy disclosed nonspecific ...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1994.181
更新日期:1994-05-01 00:00:00
abstract:BACKGROUND:The mechanisms of cyclosporine (CsA)-induced nephrotoxicity are not fully understood. While hemodynamic changes may be involved in vivo, there is also some evidence for tubular involvement. We previously showed direct toxicity of CsA in the LLC-PK1 renal tubular cell line. In the current study we examined me...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1046/j.1523-1755.1998.00202.x
更新日期:1998-12-01 00:00:00
abstract::A genome-wide association study (GWAS) indicated that myeloperoxidase-ANCA associated vasculitis (AAV) is associated with HLA-DQ. However, susceptibility alleles in these loci have been under-investigated. Here we genotyped 258 Chinese patients with myeloperoxidase-AAV and 597 healthy control individuals at HLA DRB1, ...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1016/j.kint.2019.06.015
更新日期:2019-10-01 00:00:00
abstract::Large epidemiological studies clearly demonstrate that multiple episodes of acute kidney injury contribute to the development and progression of kidney fibrosis. Although our understanding of kidney fibrosis has improved in the past two decades, we have limited therapeutic strategies to halt its progression. Myofibrob...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1016/j.kint.2017.03.037
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:Tumor necrosis factor (TNF) receptor family members, such as Fas and TNF receptor 1 (TNFR1), are thought to induce apoptosis in a variety of cells and organs. Although a number of potential scenarios have been postulated for the involvement of these receptors in the pathogenesis of acute renal failure (ARF),...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1046/j.1523-1755.2003.00709.x
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:The clinical demographics of chronic dialysis patients are changing worldwide. However, long-term data from regional dialysis registries have not yet been analyzed and reported. METHODS:The Okinawa Dialysis Study (OKIDS) registry included all chronic dialysis patients treated in Okinawa, Japan, since 1971. ...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1046/j.1523-1755.2002.00147.x
更新日期:2002-02-01 00:00:00
abstract::The possibility that the rabbit collecting tubule is heterogeneous with respect to electrical and morphologic properties was examined in isolated segments. Collecting tubules from rabbits treated with desoxycorticosterone acetate were dissected from various locations within the cortex and outer medulla, and the transe...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1978.167
更新日期:1978-12-01 00:00:00
abstract::The purpose of these studies was to quantitatively assess the role of endogenous angiotensin II activity in controlling transport in the proximal convoluted tubule (PCT) and whole nephron. We used the nonpeptide angiotensin II receptor antagonist DuP 753, which lacks the agonist and kinin/prostaglandin-inducing proper...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1990.228
更新日期:1990-09-01 00:00:00
abstract:BACKGROUND:Adrenomedullin (ADM) exerts antiproliferative effects on rat mesangial cells in vitro and, therefore is a possible renoprotective agent. In contrast, nitric oxide (NO) is capable of exerting both cytoprotective and cytotoxic actions. It was the objective of the present study to examine whether NO stimulates ...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1046/j.1523-1755.2002.00330.x
更新日期:2002-05-01 00:00:00
abstract:BACKGROUND:Studies in animal models have shown that the alternative pathway of complement is activated in the kidney after ischemia/reperfusion. In addition, mice deficient in complement factor B, a necessary component of the alternative pathway, are protected from ischemic acute renal failure. The purpose of this stud...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1111/j.1523-1755.2005.67109.x
更新日期:2005-02-01 00:00:00
abstract::Effect of insulin-like growth factor-1 (IGF) on the synthesis of glomerular proteoglycans (PGs) in an ex vivo recirculating organ perfusion system was investigated. Kidneys were perfused with a medium (approximately 80 ml) containing [35S]-sulfate (250 microCi/ml) and IGF (62.5 to 625 ng/ml). After radiolabeling, a sm...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1992.188
更新日期:1992-05-01 00:00:00
abstract:BACKGROUND:Crystals of calcium oxalate monohydrate (COM) and excess oxalate ions (OX) stimulate an array of responses inducing localized injury and inflammation in the kidneys. These inflammatory responses are key regulators of development of nephrolithiasis. We propose that monocyte chemoattractant protein-1 (MCP-1), ...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1046/j.1523-1755.2002.00106.x
更新日期:2002-01-01 00:00:00
abstract::Recently, 4 new risk scores for the prediction of mortality and cardiovascular events were especially tailored for hemodialysis patients; these scores performed much better than previous scores. Tripepi et al. found that these risk scores were even more predictive for all-cause and cardiovascular death than the measur...
journal_title:Kidney international
pub_type: 评论,杂志文章
doi:10.1016/j.kint.2016.11.022
更新日期:2017-03-01 00:00:00
abstract::The addition of spironolactone or hydrochlorothiazide enhances the antialbuminuric effect of renin-angiotensin blockers. However, comparative studies on the effect of different diuretics are lacking. We conducted a prospective randomized crossover study to compare the effects of spironolactone (25 mg/day), hydrochloro...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.2015.249
更新日期:2015-12-01 00:00:00
abstract::Utilizing [5-15N] and [2-15N]-labeled glutamine and gas chromatography mass spectrometry methodology, we examined the pathways of ammoniagenesis under basal and acute acidotic conditions of pH 7.0 and pH 6.8, respectively. LLC-PK1 cultures were incubated for one hour with gentle rocking in a bicarbonate buffer of pH 7...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1994.137
更新日期:1994-04-01 00:00:00
abstract::Medial arterial calcification involves chondrogenic/osteogenic transdifferentiation of vascular smooth muscle cells (VSMCs). Zhao et al. report that phosphate activates the mammalian target of rapamycin (mTOR) cascade in VSMCs, leading to downregulation of Klotho. Furthermore, rapamycin was shown to halt medial calcif...
journal_title:Kidney international
pub_type: 评论,杂志文章
doi:10.1038/ki.2015.223
更新日期:2015-10-01 00:00:00
abstract::The acutely injured mammalian kidney mounts a cellular and molecular response to repair itself. However, in patchy regions such intrinsic processes are impaired and dysregulated leading to chronic kidney disease. Currently, no therapy exists to treat established acute kidney injury per se. Strategies to augment human ...
journal_title:Kidney international
pub_type: 杂志文章,评审
doi:10.1016/j.kint.2017.07.030
更新日期:2018-01-01 00:00:00
abstract::Peptides representing potential antigenic regions of the NC-1 and 7-S domains of the human alpha 1 and alpha 2, and bovine alpha 3 chains of type IV collagen were synthesized either chemically or by the recombinant DNA technique and tested by ELISA using antibodies raised in rabbits against the whole type IV collagen ...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1993.16
更新日期:1993-01-01 00:00:00
abstract::Steroid Resistant Nephrotic Syndrome (SRNS) in children and young adults has differing etiologies with monogenic disease accounting for 2.9-30% in selected series. Using whole exome sequencing we sought to stratify a national population of children with SRNS into monogenic and non-monogenic forms, and further define t...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1016/j.kint.2016.10.013
更新日期:2017-04-01 00:00:00
abstract::X-ray films of the hand skeleton (mammography technique), serum chemistry, and quantitative bone histology (micromorphometry of undecalcified sections, iliac crest spongiosa) were compared in 25 patients on maintenance hemodialysis. The X-ray findings correlated better with serum PTH levels than with bone histology. O...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1978.45
更新日期:1978-04-01 00:00:00
abstract:BACKGROUND:Idiopathic nephrotic syndrome is a proteinuric disease secondary to the release of a nonidentified circulating glomerular permeability factor by T cells. Because specificities of T-cell activation in idiopathic nephrotic syndrome remain unknown, we evaluated transcriptional activation of T cells in nephrotic...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1111/j.1523-1755.2005.00322.x
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:alpha 2 Macroglobulin (alpha 2M), a protease inhibitor, is often increased in plasma of patients with the nephrotic syndrome. Although it has been speculated that synthesis is increased, no direct measurements have been performed. METHODS:alpha 2M synthesis in both normal subjects (N = 4) and nephrotic pati...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1046/j.1523-1755.1998.00018.x
更新日期:1998-08-01 00:00:00
abstract::Glomerular deposition of hepatitis B virus (HBV) antigens are observed in chronic HBsAg carriers with different glomerulonephritides yet the etiologic role of HBV remains uncertain. We examined the paraffin section of kidney biopsies from 40 chronic HBsAg carriers with membranous nephropathy (MGN), mesangiocapillary g...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.1996.519
更新日期:1996-12-01 00:00:00
abstract::Angiotensin converting enzyme (ACE) inhibitors are known to lower urinary protein excretion in human renal disease. This proteinuria lowering effect of ACE inhibition has been hypothesized to be a result of renal hemodynamic changes due to the inhibition of angiotensin II (Ang II) production. To test this hypothesis w...
journal_title:Kidney international
pub_type: 临床试验,杂志文章
doi:10.1038/ki.1991.268
更新日期:1991-10-01 00:00:00
abstract::Injury resulting from ischemia-reperfusion injury is a multifactorial process involving compromised function in both the tubular and the vascular compartments. Multiple vasoactive compounds have been implicated in the profound vasoconstriction that occurs in response to ischemia-reperfusion injury, and many of these f...
journal_title:Kidney international
pub_type: 评论,杂志文章
doi:10.1038/ki.2011.145
更新日期:2011-08-01 00:00:00
abstract::It is well known that uremia causes an increase in the serum anion gap (AG); however, whether changes in the AG occur earlier in the course of chronic kidney disease is not known. Here we investigated whether different measures of the AG, as a marker of kidney function, are associated with mortality. To do this, we an...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.2012.196
更新日期:2012-09-01 00:00:00
abstract::The role of peritoneal dialysis (PD) in renal replacement therapy (RRT) remains unclear. There are no controlled trials to provide hard evidence of its efficacy. Comparative studies with haemodialysis from different centres and countries have given conflicting results even when allowing for case mix. Data from the Uni...
journal_title:Kidney international
pub_type: 杂志文章,评审
doi:10.1046/j.1523-1755.1998.00183.x
更新日期:1998-12-01 00:00:00
abstract::Acute kidney injury (AKI) is a major complication of cardiac bypass surgery. We examined whether levels of liver fatty acid-binding protein (L-FABP) can be an early biomarker for ischemic injury by measuring this protein in the urine of 40 pediatric patients prior to and following cardiopulmonary bypass surgery. AKI w...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/sj.ki.5002721
更新日期:2008-02-01 00:00:00
abstract::Autophagy is a dynamic and highly regulated process of self-digestion responsible for cell survival and reaction to oxidative stress. As oxidative stress is increased in uremia and is associated with vascular calcification, we studied the role of autophagy in vascular calcification induced by phosphate. In an in vitro...
journal_title:Kidney international
pub_type: 杂志文章
doi:10.1038/ki.2012.482
更新日期:2013-06-01 00:00:00