Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Review of recent research on hepatitis C therapy for 54th annual meeting of the American association for the study of liver diseases

结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

The latest advances in hepatology were presented in oral and poster presentations. In order to cover the varying subspecialties, the sessions were divided into various sections including 'Acute Liver Failure and Artificial Liver Support', 'Biliary Tract and Immunologic Liver Diseases', 'Cellular and Molecular Biology', 'Clinical and Experimental Hepatobiliary Surgery', 'Hepatotoxicity and Cell Death', 'Transport and Biliary Physiology', 'Viral Hepatitis', 'Evaluation and Treatment of Biliary Disease', 'Necrosis/Apoptosis', 'Portal Hypertension', 'Blood Flow and Vascular Disorders of Cirrhosis', 'Liver Transplantation', 'Fibrogenesis', 'Hepatocellular Carcinoma', 'Metabolism and Genetic Disease', and 'Public Policy, Epidemiology and Decision Analysis'. Drug therapy focused on treatments for viral hepatitis, autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis, and recurrent viral disease following liver transplant. High dose interferon therapy or various combinations of interferon/ribavirin (ICN Pharmaceuticals Inc) therapy seem to offer the best current therapy for chronic HCV. PEGylated interferon (F Hoffmann-La Roche Ltd) offers hope for treatment and histologic improvement in patients with chronic HCV. Following liver transplantation, combination interferon/ribavirin therapy may also find success, but caution with new potent immunosuppressant monoclonal antibodies is advised. For HBV, intramuscular H-BIG (NABI) appears to be effective and less costly than iv H-BIG administration following liver transplantation. Percutaneous radiofrequency ablation may hold promise over conventional ethanol injection therapy for small hepatocellular carcinoma. Autoimmune hepatitis may respond to tacrolimus therapy whereas budesonide therapy did not provide any advantage to prednisone therapy. For primary biliary cirrhosis, eicosapentate and ursodeoxycholic acid may provide benefit to some patients while silymarin from milk thistle did not provide any additional benefit. In primary sclerosing cholangitis, high dose ursodeoxycholic acid may provide benefit. Ursodeoxycholic acid may also provide benefit for mothers with intrahepatic cholestasis of pregnancy by decreasing pruritus, lowering laboratory values and allowing deliveries to occur closer to term.

Digestive disease week 2000. American Association for the Study of Liver Diseases

Hypochloremia on admission and mortality risk in patients with acute decompensated heart failure: a systematic review and meta-analysis

1. Ungprasert P, Carmona EM, Utz JP, Ryu JH, Crowson CS, Matteson EL. Epidemiology of sarcoidosis 1946-2013: a population-based study. Mayo Clin Proc. 2016;91(2):183-188. 2. Reich JM, Johnson RE. Incidence of clinically identified sarcoidosis in a northwest United States population. Sarcoidosis Vasc Diffuse Lung Dis. 1996;13(2): 173-177. 3. Swigris JJ, Olson AL, Huie TJ, et al. Sarcoidosisrelated mortality in the United States from 1988 to 2007. Am J Respir Crit Care Med. 2011;183(11): 1524-1530. 4. Reich JM. Shortfalls in imputing sarcoidosis to occupational exposures. Am J Ind Med. 2013; 56(4):496-500. 5. Winterbauer RH, Belic N, Moores KD. Clinical interpretation of bilateral hilar adenopathy. Ann Intern Med. 1973;78(1):65-71.

In Reply—Epidemiology of Sarcoidosis

Pythiosis is a form of infectious disease caused by Pythium insidiosum. Infected patients can present with 1) cutaneous/ subcutaneous, 2) vascular, 3) ocular, and 4) disseminated diseases. Systemic disease occurs following vascular invasion and is considered fatal when large arteries are involved. Infection/sepsis, commonly from bacterial infection, is one of major causes of AKI in hospitalized patients. Invasive fungal infections can also cause septic shock and is associated with high mortality. However, the incidence of renal involvement in these patients with pythiosis and their outcomes are still unclear. Therefore, we performed a systematic literature search for reported cases of pythiosis with kidney involvement. We found two case reports of systemic pythiosis with renal involvement. The locations of acquired infection were reported in Mexico and Texas, United States. Although systemic pythiosis with renal failure is rarely reported, it is serious and fatal condition. Journal of Nature and Science, 1(5):e92, 2015

Pythiosis with renal involvement- Rare but Fatal Disease: A Systematic Review

https://www.internationaljournalofcardiology.com/article/S0167-5273(13)00695-5/pdf

Patompong Ungprasert

Papers

Hypochloremia on admission and mortality risk in patients with acute decompensated heart failure: a systematic review and meta-analysis

In Reply—Epidemiology of Sarcoidosis

Pythiosis with renal involvement- Rare but Fatal Disease: A Systematic Review

Coronary AVM: Abnormal communication is the issue

Risk of Cardiovascular Disease in Patients with Juvenile Idiopathic Arthritis: A Systematic Review and Meta-analysis -