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Mark A Perazella

Publications and source records attributed to Mark A Perazella.

At least 19 recordsLinked to original sources
PubMed2007

Acute oxalate nephropathy associated with orlistat, a gastrointestinal lipase inhibitor.

Orlistat is an oral inhibitor of gastrointestinal lipase used for weight reduction in obese patients. Although most adverse drug effects manifest in the gastrointestinal tract, this is the first reported case of orlistat-induced acute kidney injury secondary to acute oxalate nephropathy in a white woman with underlying chronic kidney disease. Acute kidney injury was associated temporally with an increased dose of orlistat and the development of increased fat malabsorption (more frequent loose oily stools). Urine sediment showed abundant calcium oxalate crystals and increased 24-hour urine oxalate concentration. Kidney biopsy showed deposition of calcium oxalate crystals within tubular lumens, consistent with acute oxalate nephropathy. Orlistat therapy was discontinued, and oral fluid intake was increased. A second kidney biopsy performed 1 month later to evaluate the slow resolution of kidney failure did not show calcium oxalate crystals within tubules. A steady improvement in renal function subsequently was observed. Results of a repeated 24-hour urine oxalate collection performed 3 weeks later when kidney function had improved were within normal limits.

Acute Disease↗
PubMed2006

Extracorporeal blood purification therapies for prevention of radiocontrast-induced nephropathy: a systematic review.

BACKGROUND: Radiocontrast-induced nephropathy (RCIN) causes acute kidney injury and increases mortality. Studies have examined the capacity of various forms of extracorporeal blood purification therapies for the prevention of RCIN, with conflicting results. We conducted a systematic review of published trials to determine whether periprocedural extracorporeal blood purification prevents RCIN. METHODS: We searched PubMed, the Cochrane Collaboration Database, EMBASE, and CINAHL through January 2006 and bibliographies of retrieved articles and consulted with experts to identify relevant studies. Published studies of extracorporeal blood purification for the prevention of RCIN in patients receiving radiocontrast were included. Two authors reviewed all citations. The primary end point is the incidence of RCIN, defined as an increase in serum creatinine concentration (>or=0.5 mg/dL [>or=44 micromol/L]). Results were combined on the risk ratio scale. Random-effects models were used. Sensitivity analyses were performed to evaluate the effects of extracorporeal blood purification modality, study design, and sample size. RESULTS: Eight trials (6 randomized controlled trials, 2 nonrandomized trials) were included in the analysis (pooled sample size, 412). Six trials assessed hemodialysis, whereas 1 trial each assessed continuous venovenous hemofiltration and continuous venovenous hemodiafiltration. The incidence of RCIN was 35.2% in the standard-medical-therapy group and 27.8% in the extracorporeal-blood-purification group. Extracorporeal blood purification did not decrease the incidence of RCIN significantly compared with standard medical therapy (risk ratio, 0.97; 95% confidence interval, 0.44 to 2.14); however, intertrial heterogeneity was high. Limiting analysis to only randomized trials did not eliminate heterogeneity, but limiting analysis to only hemodialysis trials did. Periprocedural hemodialysis did not decrease the incidence of RCIN. CONCLUSION: This critical analysis of the published literature suggests that periprocedural extracorporeal blood purification does not decrease the incidence of RCIN compared with standard medical therapy.

Contrast Media↗
PubMed2006

Increased mortality in chronic kidney disease: a call to action.

The mortality rate among patients with chronic kidney disease is much higher than among those without. As glomerular filtration rate declines and patients approach end-stage renal disease, the mortality rate increases and patients at this stage are more likely to die than receive renal replacement therapy. The higher mortality and its underlying causes among chronic kidney disease patients is a serious issue. Lack of physician awareness of chronic kidney disease and its association with excess mortality remains a problem. In this review of current literature, we aim to increase this awareness among health care professionals and the general public and to call for action to improve survival in chronic kidney disease patients. The data strongly suggest that advancing kidney dysfunction leads to increased mortality risk. Contributing to the mortality associated with chronic kidney disease are the comorbidities that accompany this disease state. For instance, patients with chronic kidney disease and comorbidities are at 1.3 to 3.6 times more risk than patients without chronic kidney disease. Further, cardiovascular disease is the leading cause of death among chronic kidney disease patients. It appears that both traditional (such as diabetes mellitus, hypertension, and smoking) and nontraditional risk factors (C-reactive protein and interleukin-6 levels) present in the chronic kidney disease population promote the frequent development of cardiovascular disease. Therefore, therapies targeting both progression of chronic kidney disease and comorbidities such as cardiovascular disease are required to reduce mortality among these patients.

Anemia↗
PubMed2006

Reliability of a noninvasive device to measure systemic hemodynamics in hemodialysis patients.

OBJECTIVE: To evaluate the reliability of a noninvasive hemodynamic monitor in hemodialysis patients. METHODS: We enrolled 15 male patients (mean age 63+/-12 years) on stable chronic hemodialysis. Blood pressure and hemodynamic readings were obtained with the Dynapulse 500 Guardian device (Pulsemetric Inc., San Diego, California, USA), which measures systemic hemodynamics on the basis of oscillometric waveforms obtained through a cuff placed over the brachial artery. Measurements were taken sequentially, in duplicate, before, during and after hemodialysis, in the supine, seated and standing positions on four separate midweek dialysis sessions over a 2-week period. RESULTS: The repeatability of the method was tested using 200 pairs of valid measurements. The average values (+/-SD) were 137+/-22 mmHg for systolic blood pressure, 80+/-13 mmHg for diastolic blood pressure, 76+/-15 bpm for heart rate, 1320+/-268 mmHg/s for dP/dtmax, 2.8+/-0.5 l/min/m for cardiac index, and 1455+/-359 dyn/s/cm for systemic vascular resistance. The mean differences (+/-SD of the difference) between readings were 0.1+/-10.4 mmHg for systolic blood pressure, 0.3+/-6.0 mmHg for diastolic blood pressure, -0.2+/-8.0 bpm for heart rate, 0.2+/-234 mmHg/s for dP/dtmax, 0.03+/-0.26 l/min/m for cardiac index and -10+/-177 for systemic vascular resistance, yielding limits of agreement (95%) of -20 to 20 mmHg for systolic blood pressure, -11 to 12 mmHg for diastolic blood pressure, -16 to 17 bpm for heart rate, -458 to 458 mmHg/s for dP/dtmax, -0.5 to 0.5 l/min/m for cardiac index and -338 to 357 dyn/s/cm for systemic vascular resistance. Other hemodynamic parameters fared similarly, and coefficients of variation were all between 7 and 18%. CONCLUSION: We conclude that the Dynapulse 500 Guardian has adequate reliability indices in hemodialysis patients.

Aged↗
PubMed2005

Drug-induced renal failure: a focus on tubulointerstitial disease.

Therapeutic agents induce acute renal failure (ARF) by promoting various types of injury to the kidney. Acute interstitial nephritis (AIN) develops from medications that incite an allergic reaction, leading to interstitial inflammation and tubular damage. Acute tubular necrosis (ATN) is a dose-dependent process that develops from direct toxicity on tubular epithelia, typically in the absence of inflammation. Additional, less common patterns of drug-induced renal injury include osmotic nephropathy, crystal nephropathy, and acute nephrocalcinosis. This review focuses on the multitude of patterns of drug-induced renal failure due to tubulointerstitial disease.

Animals↗
PubMed2005

The cardiovascular implications of hypokalemia.

The role of potassium in the progression of cardiovascular disease is complex and controversial. Animal and human data suggest that increases in dietary potassium, decreases in urinary potassium loss, or increases in serum potassium levels through other mechanisms have benefits in several disease states. These include the treatment of hypertension, stroke prevention, arrhythmia prevention, and treatment of congestive heart failure. Recently, the discovery that aldosterone antagonists not only decrease sodium reabsorption and decrease potassium secretion in the nephron, but also decrease pathological injury of such nonepithelial tissues as the myocardium and endothelium, has generated great controversy regarding the actual mechanisms of benefit of these agents. We review the available data and draw conclusions about the relative benefits of modulating potassium balance versus nonrenal effects of aldosterone blockade in patients with cardiovascular disease.

Animals↗
PubMed2005

Percutaneous balloon cryoplasty: a new therapy for rapidly recurrent anastomotic venous stenoses of hemodialysis grafts?

Vascular access dysfunction is a major source of morbidity for end-stage renal disease patients on hemodialysis. The arteriovenous graft is a common access type for many of these patients. Frequent stenosis formation and thrombosis complicate this form of access. Patients may have a rapidly forming and recurrent venous stenosis at the graft-vein anastomosis that has been seen in both animal models and end-stage renal disease patients to be the result of neointimal hyperplasia. This venous lesion is particularly resistant and sometimes intractable to conventional angioplasty. As a result, new therapies have been developed to reduce the formation and/or recurrence of neointimal hyperplasia. These include special cutting balloons, drug-eluting stents, and endovascular brachytherapy. The authors present the cases of 5 patients with rapidly recurrent venous lesions at the graft-vein anastomosis that derived benefit from angioplasty with the cryoballoon. The time to stenosis or thrombosis in the arteriovenous grafts was increased from a mean of 3 weeks to more than 16 weeks with this technology. Cryotherapy with the cryoballoon (cryoplasty) may represent a useful therapy for patients with intractable stenoses at or near the venous anastomosis of arteriovenous grafts.

Aged↗
PubMed2005

Pharmacology.

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Drug-Related Side Effects and Adverse Reactions↗
PubMed2005

Calcific uremic arteriolopathy in a transplanted kidney.

Calcific uremic arteriolopathy is a severe and life-threatening condition that develops in patients with kidney disease. Most commonly, it presents with skin rash and painful subcutaneous nodules. However, other organs may be involved. We report a case of a young man who developed renal failure in the transplanted kidney. Renal biopsy demonstrated myointimal calcification in the renal arteries consistent with this diagnosis.

Adult↗
PubMed2005

The role of aldosterone blockers in the management of chronic heart failure.

The neurohormonal model of congestive heart failure (CHF) has replaced the previously accepted hemodynamic model. A shift in this paradigm has allowed alterations in therapy of CHF such that agents that target the neurohormonal axis and specifically the renin-angiotensin-aldosterone system, with drugs such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers, are utilized. Employment of these drugs markedly improves survival in patients with CHF. Recent animal and human data demonstrate that aldosterone is directly pathogenic in this disease process and is insufficiently suppressed by these agents. Furthermore, when aldosterone is directly antagonized, vascular and myocardial damage is greatly ameliorated in both experimental animals and humans. Significant mortality benefits of aldosterone antagonists in patients with CHF from systolic dysfunction have been subsequently witnessed. Herein, the pathophysiology of CHF, the beneficial role of aldosterone antagonists in this disease process, and potential adverse consequences of these agents are reviewed.

Aldosterone↗
PubMed2005

Effect of intravenous iron on haemodialysis catheter microbial colonization and blood-borne infection.

BACKGROUND: Intravenous (i.v.) iron is employed to treat absolute and relative iron deficiency in end-stage renal disease patients. However, there exists the possibility that i.v. iron increases infection risk. This pilot study examines whether i.v. iron gluconate acutely increases tunnelled haemodialysis catheter colonization, microbial growth, or blood-borne infection. METHODS: Nineteen patients with haemodialysis catheters who met criteria to receive an i.v. iron load entered the study. Six matched patients with catheters who did not receive iron were controls. Blood aspirated from the catheter prior to initiation of haemodialysis was sent for qualitative/quantitative cultures. The study consisted of three baseline cultures, five cultures during iron (125 mg of ferric gluconate per treatment), and three cultures following iron administration. Patients were monitored for infection for 30 days following iron. RESULTS: Fifteen iron-treated patients and six controls completed the study. Thirty-three per cent of treated patients were colonized at baseline; 66% were colonized following iron. Thirty-three per cent of controls (2/6) were colonized at baseline; no new colonization developed during follow up. Neither treated patients nor controls had significant microbial growth within catheters; one patient in the iron-treated group developed candidaemia. CONCLUSION: Intravenous iron is not associated with acute microbial growth in catheters or clinical infection. However, a trend towards increased catheter colonization following iron administration exists.

Adult↗
PubMed2005

Drug-induced nephropathy: an update.

Medications cause renal disease by promoting various types of injury in the kidney. Several drugs reduce renal perfusion and cause prerenal azotemia. Vascular disease can develop following exposure to various medications through direct and indirect effects. A number of glomerular lesions have been described with therapeutic agents and illicit drugs. Acute interstitial nephritis occurs from a drug-induced allergic reaction, which promotes interstitial inflammation and tubular damage. Acute tubular necrosis is a dose-dependent process that occurs from direct drug toxicity on tubular epithelia. Other less common patterns of drug-induced tubular injury include osmotic nephropathy, crystal nephropathy and acute nephrocalcinosis. Finally, postrenal azotemia from structural or functional obstruction of the urinary tract also complicates therapy with a number of medications.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Adverse cardiorenal effects of aldosterone: is aldosterone antagonism beneficial?

Aldosterone has recently been recognized as an important factor in the development and progression of cardiorenal disease. Animal and human data suggest that aldosterone contributes importantly to several disease states. These include congestive heart failure, coronary heart disease and progression of kidney disease. Recently, the discovery that aldosterone antagonists decrease pathologic injury in the kidneys and nonepithelial tissues, such as the myocardium and endothelium, has generated great controversy regarding the actual mechanisms of benefit of these agents. The available data is reviewed and conclusions drawn regarding the relative benefits of modulating aldosterone effects in the cardiovascular system and the kidney. In particular, the authors review their effects on reductions in cardiovascular events and progression of chronic kidney disease, as well as the safety and tolerability of these agents.

Aldosterone↗