Moving forward from Cockcroft-Gault creatinine clearance to race-free estimated glomerular filtration rate to improve medication-related decision-making in adults across healthcare settings: A consensus of the National Kidney Foundation Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions.

Purpose: The goals of this paper are to (1) provide evidence and expert consensus to support a unified approach to estimating kidney filtration in adults with stable kidney function using race-free estimated glomerular filtration rate (eGFR) in place of Cockcroft-Gault estimated creatinine clearance (C-G eCrCL) for medical and medication-related decisions, and (2) demonstrate how adjusting eGFR results for an individual's body surface area (BSA) when it is higher or lower than 1.73 m2 will improve results for medication-related decisions.

Summary: C-G eCrCL is predominantly used by US pharmacists to determine eGFR for the purposes of medication-related decisions, even though more accurate eGFR equations exist.

Overcoming Barriers to Autologous Stem Cell Transplantation in Multiple Myeloma: Recommendations from a Multidisciplinary Roundtable Discussion.

Autologous stem cell transplantation (ASCT) is a standard of care treatment for patients with multiple myeloma (MM). However, only 20% to 30% of patients with MM for whom the procedure is indicated undergo ASCT. Barriers to ASCT may be informational, financial, logistic, or cultural and may affect patients and treating oncologists.

Virtual Reality in Chronic Kidney Disease Education and Training.

Patients with chronic kidney disease (CKD) often struggle to understand their disease and its treatment options. The learning content they receive does not provide the experience necessary to truly understand their disease and its treatment options. Nephrology care providers struggle to convey their knowledge effectively to patients, which leads to dissatisfaction.

Using Learning Science to Optimize Chronic Kidney Disease Education for Patients and Providers.

Many patients with chronic kidney disease (CKD) and their providers are dissatisfied with patients' depth of useful knowledge about CKD and its treatment options. This increases stress and decreases satisfaction, while increasing health care costs. In this article, we will apply learning science - the marriage of psychology and the neuroscience of learning - to examine problems seen in current CKD education.

Cholangiocyte Epithelial to Mesenchymal Transition (EMT) is a potential molecular mechanism driving ischemic cholangiopathy in liver transplantation.

Donation after circulatory death (DCD) has expanded the donor pool for liver transplantation. However, ischemic cholangiopathy (IC) after DCD liver transplantation causes inferior outcomes. The molecular mechanisms of IC are currently unknown but may depend on ischemia-induced genetic reprograming of the biliary epithelium to mesenchymal-like cells.

The effect of time spent outdoors during summer on daily blood glucose and steps in women with type 2 diabetes.

This study investigated changes in glycemic control following a small increase in time spent outdoors. Women participants with type 2 diabetes (N = 46) wore an iBUTTON temperature monitor and a pedometer for 1 week and recorded their morning fasting blood glucose (FBG) daily. They went about their normal activities for 2 days (baseline) and were asked to add 30 min of time outdoors during Days 3-7 (intervention).

Job analysis and role delineation: LPN/LVNs and hemodialysis technicians.

To provide safe and quality care to patients on hemodialysis, nephrology registered nurses must fully understand the roles of the healthcare providers to whom they delegate patient care. A job analysis survey of hemodialysis technicians and licensed practical nurses/licensed vocational nurses (LPNs/LVNs) was conducted by the Nephrology Nursing Certification Commission (NNCC) in 2011 to 1) revalidate the Certified Clinical Hemodialysis Technician (CCHT) test blueprint, 2) delineate differences in practice between entry-level technicians and experienced/advanced technicians, and 3) delineate differences in practice between hemodialysis technicians and LPNs/LVNs in hemodialysis settings. Significant differences in practice were identified among the three groups, which led to the development by NNCC of two additional certification examinations: the Certified Clinical Hemodialysis Technician-Advanced (CCHT-A) examination and the Certified Dialysis LPN/LVN (CD-LPN/LVN) examination.

De Novo Fibrillary Glomerulonephritis (FGN) in a Renal Transplant with Chronic Hepatitis C.

Chronic hepatitis C viremia (HepC) has been associated with numerous renal manifestations both in native kidneys and in the setting of renal transplantation. Glomerulonephritis (GN) of the renal allograft in the setting of HepC most commonly manifests as type 1 membranoproliferative GN (MPGN), either representing recurrence of the original disease or arising de novo. Other GNs were reported after transplantation in the patient with HepC including membranous nephropathy and thrombotic microangiopathy, as well as an enhanced susceptibility to transplant glomerulopathy.

The use of the laryngeal mask airway with mechanical positive pressure ventilation.

The purpose of this article is to discuss the benefits, safety, and efficacy of the laryngeal mask airway (LMA) and identify the risks and misconceptions associated with LMAs when used with positive pressure ventilation (PPV). Despite the abundance of supporting evidence that LMAs may be used successfully in a variety of age groups and surgical procedures using PPV, many anesthesia providers are still reluctant to choose an LMA when PPV is needed. This reluctance emerges from the misconception that when using an LMA with mechanical ventilation, there is an increased incidence of gastric insufflation, failed ventilation, and pulmonary aspiration.

Renal anatomy and overview of nephron function.

The kidneys are highly vascularized organs that are responsible for maintaining the body's internal environment. The nephron is the basic structural and functional unit of the kidney involved in the complex interplay between tubular and vascular components resulting in the excretion of fluid and solutes. The regulation of body fluid and solutes is governed by the processes of filtration, reabsorption, and secretion.

Severe secondary hyperparathyroidism.

The process of managing SHPT requires ongoing evaluation and revision. Although A.M.

Hyperkalemic emergencies. Mechanisms, manifestations, and management.

Care of the patient with hyperkalemia provides the critical care nurse with a challenging opportunity to use clinical knowledge, skills, and critical thinking. What is the cause of the hyperkalemia? What are the patient's signs and symptoms? What clues do the patient's history and physical assessment hold? What treatments are necessary and how will their effectiveness be measured? Finally, how can subsequent episodes of hyperkalemia be prevented in this patient? Knowledge about potassium, its functions and its regulatory mechanisms provides the critical care nurse with the opportunity to identify patients at risk and employ early, often life-saving, interventions.

Glutamine synthetase (GS) activity and spatial and temporal patterns of GS expression in the developing chick retina: relationship with synaptogenesis in the outer plexiform layer.

The profile of glutamine synthetase (GS) activity in the neural retina of chicken embryos and adults was studied alongside the in vivo spatio-temporal patterns of generation and morphogenesis of Müller cell and of retinal synaptogenesis. The rise of GS activity during development is not related to Müller cell differentiation but to synaptogenesis in the outer plexiform layer (opl). GS expression was investigated by immunoreaction with GS-specific antiserum.

Effects of ethanol on the inner layers of chick retina during development.

Optic nerve hypoplasia is an important malformation of the fetal alcohol syndrome whose teratogenic mechanisms are unknown. In our experimental model we have quantified the concentration of ethanol and acetaldehyde in the retina and vitreous humor of the developing chick. The effect of ethanol alone during retinal development was analyzed by conventional histological techniques and by immunostaining.

Immunohistochemical localization of GABA in chameleon retina (Chamaleo Chamaleo).

We used a policlonal antiserum against GABA and demonstrated GABA-immunoreactivity (GABA-IR) in several populations of amacrine cells in the inner nuclear layer (INL), and other cells in the inner plexiform layer (IPL) of the central and peripheral retina of the chameleon. Horizontal cells do not contain GABA-IR and the chameleon retina is therefore an exception among non-mammals. GABA-IR was not seen in cell bodies in the position of photoreceptor, bipolar and interplexiform cells suggesting that GABA is not involved in synaptic transmission in the outer plexiform layer of chameleon retina.

Case study of the anemic patient: epoetin alfa--focus on erythrokinetics.

Erythrokinetics is a physiologic process that regulates red blood cell dynamics. In keeping with the present trend of focusing on patient outcomes and costs, an erythrokinetic model provides a guideline for appropriate dosing of Epoetin alfa to maintain a hematocrit within the target range of 30% to 36%. Maintaining the patient's hematocrit at the optimal level influences patient outcomes by enhancing the quality of life and improving patient management by decreasing time and costs.

Nurse-physician collaboration and decision outcomes in transplant ambulatory care settings.

Objective: This study examined the nature of nurse-physician collaborative practice as reflected in problems presented by transplant patients in telephone contacts with clinical nurse specialists (CNSs).

Design: Exploratory descriptive study.

Sample/setting: The sample consisted of 202 renal and renal-pancreas transplant recipients who telephoned nurses at the outpatient clinic of a tertiary care medical center.

A recent decrease in the time to development of monomorphous and polymorphous posttransplant lymphoproliferative disorder.

We have noted a decrease in the time to development of posttransplant lymphoproliferative disorder (PTLD) over the last two and one-half years in our multiorgan transplant program. From February 1965 until December 1990, 1622 transplants were performed including 1489 kidneys (KTxp), 87 livers (LTxp), and 46 pancreata. Between February 1965 and July 1988 (group 1), there were 1260 transplants performed and nine cases of either monomorphous PTLD (M-PTLD, n = 8) or polymorphous PTLD (P-PTLD, n = 1) were diagnosed.

Renal physiology series: Part 1 of 8. Renal anatomy and overview of nephron function.

The kidneys are highly vascularized organs that are responsible for maintaining the body's internal environment. The nephron is the basic structural and functional unit of the kidney involved in the complex interplay between tubular and vascular components resulting in the excretion of fluid and solutes. The regulation of body fluid and solutes is governed by the processes of filtration, reabsorption, and secretion.

Case study: end stage liver failure patient managed with CAVH pretransplant.

The patient met 4 of the 5 expected outcomes. Effective therapy with CAVH was maintained in the ICU setting and in the operating room. The catheters functioned throughout the entire treatment without signs or symptoms of infection, bleeding, or thrombosis.

Psychiatric morbidity following implantation of the automatic implantable cardioverter defibrillator.

The automatic implantable cardioverter defibrillator (AICD) has found a place in the treatment of sustained ventricular tachycardia and in survivors of sudden arrhythmic death. However, little is known about the psychological impact of this device on patients and their families. In a group of 20 AICD recipients, examined between 3 and 21 months post-implantation, the prevalence of psychiatric disorder was 50%.