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Mannitol and other osmotic diuretics as adjuncts for treating cerebral malaria

Cerebral malaria can lead to coma and death, even when the patient is given anti‐malarial drugs. Death is caused by the malaria parasites in the brain that cause brain swelling, leading to pressure in the brain. Mannitol is a drug that sometimes reduces brain swelling in other situations, such as traumatic head injury.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Home‐based chemically‐induced whitening of teeth in adults

Tooth whitening products for use at home work over a short period of time but users should be aware of common side effects and note that long‐term data on their use are not yet available.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Nail fungus: Polish, cream or tablets?

Nail fungus can be very persistent. Topical treatment with nail polish may last as long as one year. Tablets for treating fungal nail infections usually have to be taken for several weeks or months. They are much more effective than topical treatments, but they have more side effects.Crumbly nails and a whitish-yellowish to brownish discoloration are typical signs of nail fungus. The nails may also become thicker and change shape. The affected part of the nail can become detached from the nail bed. Treatment options for nail fungus include nail polishes and creams as well as tablets. Nail polishes and creams are available in pharmacies without a prescription.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 14, 2015

How does the liver work?

The liver is one of the largest organs in the body. It has many important metabolic functions. For example, it converts the nutrients in our diets into substances that the body can use, stores those substances, and supplies cells with them when needed. It also takes up toxic substances and converts them into harmless substances, or makes sure they are released from the body.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 22, 2012

Nutritional support for acute kidney injury

Maintaining nutritional balance is vital in treating patients with acute kidney injury (AKI). Nutritional therapies, including parenteral nutrition (delivered via injection) and enteric (oral) nutrition are widely used. Eight randomised controlled trials (257 participants) were included in this review. Essential L‐amino acids may shorten the overall duration of kidney dysfunction and improved survival from AKI. However, due to the small number of participants and the poor quality of some studies, we are unable to provide recommendations for the use of nutritional support for treating AKI.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Low protein diets can delay kidney failure in people with kidney disease (diabetic kidney disease excluded)

Kidney disease (nephropathy) can lead to kidney failure (end‐stage kidney disease). A diet low in protein is sometimes recommended to try to slow the progression of kidney disease. Monitoring compliance with a protein‐restricted diet is possible by determining urea production since urea is a byproduct of the degradation of all proteins. If urea production is reduced then the accumulation of toxins will be limited.The review of studies for people with kidney disease (diabetic kidney disease excluded) found that low protein diets can delay end‐stage kidney disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Protein supplementation of human milk for promoting growth in preterm infants

Not enough evidence to show the effect of protein supplementation of breast milk for promoting growth in preterm babies. Breast milk is the best source of nutrition for full‐term babies but babies born preterm (before 37 weeks) have different nutritional needs. It is possible that premature breast milk may not meet all these needs. Preterm infants need more protein but also use up protein more quickly than full‐term babies. The review of trials found that adding protein to breast milk increases short‐term weight gain and body growth. However, too much protein given in formula can cause problems with infant development in the longer term. More research is needed to find the safest and most effective levels of protein supplementation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Early versus late administration of amino acids in preterm infants receiving parenteral nutrition

Early administration of amino acids results in positive nitrogen balance. Metabolic acidosis, elevated serum ammonia and hypoglycaemia are not a complication of early administration of amino acids. Elevated blood urea nitrogen (BUN) is consistently associated with early administration of amino acids. We included seven trials in this review. The number of study participants is small and the protocols of the studies included are not identical.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Rheum officinale (a traditional Chinese medicine) for the treatment of chronic kidney disease

Chronic kidney disease (CKD) is a long‐term, life threatening illness that is becoming more common. People who have CKD are monitored closely and treated with therapies that are determined according to the stage of their illness and whether they have other health problems. Treatment for CKD often involves drugs to control blood pressure and aid kidney function ‐ often angiotensin‐converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) ‐ along with restricting the amount of protein consumed. Practitioners of traditional Chinese medicine often use Rheum officinale (Da Huang, a type of rhubarb) to treat people with CKD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

How do the kidneys work?

The kidneys are our body’s sewage treatment plants: They produce urine, which makes it possible to get rid of waste products that arise in the body or that we consume in food and drinks. These waste products include ammonia and urea, or medicine, drugs and toxins.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 7, 2015

How does the urinary system work?

The urinary system includes the kidneys, two ureters, the bladder and the urethra. The kidneys are our body’s “sewage treatment plant”: they filter toxins and other substances that we no longer need out of the body.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 7, 2015

Tidal versus other forms of peritoneal dialysis for patients with acute kidney injury

Acute kidney injury (AKI) is characterised by a sudden decline in kidney filtration and patients with AKI have reduced (or no) urine output. AKI is clinically defined by an increase in serum creatinine and decrease in glomerular filtration rate. People with AKI need renal replacement therapy usually in the form of kidney dialysis. At present, there is no universally accepted form of dialysis for most AKI patients. Peritoneal dialysis (PD) has been favoured because it causes fewer heart and lung problems, and patients do not need anti‐clotting drugs. Tidal PD (TPD) is an automated process that fills and drains the dialysis fluid, but retains a designated proportion so the peritoneum never completely empties.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Furosemide for prevention of morbidity in indomethacin‐treated infants with patent ductus arteriosus

There is no strong evidence of benefit from routine use furosemide, a loop diuretic, in preterm babies receiving indomethacin for treatment of patent ductus arteriosus. A blood vessel (ductus arteriosus), which is required for blood circulation for the fetus in the womb, closes soon after birth in babies born around the expected date of delivery (term infants). Babies born early (preterm) may develop symptoms if they do not close that blood vessel after birth. Preterm infants who have symptoms due to the ductus arteriosus may receive therapy (indomethacin) for closing that vessel. Indomethacin may decrease kidney function and the amount of urine. Furosemide, a medication which reduces body water (diuretic), might help limit the effects of indomethacin on the kidney. This review analyzed the effects of furosemide on preterm babies receiving indomethacin to close the ductus arteriosus. The review of trials found not enough evidence to recommend routine use of furosemide in preterm infants who receive indomethacin for closing a ductus arteriosus.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Intermittent versus continuous renal replacement therapy for acute renal failure in adults

Acute renal failure (ARF) is an abrupt reduction in kidney function with elevation of blood urea nitrogen (BUN) and plasma creatinine and a fall in urine output. In most cases correction of the underlying cause leads to recovery, however for many some form of renal replacement therapy (RRT ‐ a treatment that removes waste products, salts and excess water form the body) may be required. RRT can either be intermittent (IRRT‐ performed for less than 24 hours in each 24 hour period, two to seven times per week) or continuous (CRRT‐ performed continuously without any interruption throughout each day). It has been suggested that CRRT has several advantages over IRRT including better haemodynamic stability (blood pressure control and blood circulation), improved survival and greater likelihood of renal recovery. Our systematic review identified 15 randomised studies with 1550 patients comparing CRRT with IRRT. We did not find any difference between CRRT and IRRT with respect to mortality, renal recovery, and risk of haemodynamic instability or hypotension episodes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Atrial natriuretic peptide for preventing and treating acute kidney injury

Acute kidney injury (AKI) is a generic term for an abrupt and sustained decrease in kidney function resulting in retention of nitrogenous (urea and creatinine) and a fall in urine output. Sepsis (infection), shock, trauma, kidney stones, kidney infection, drug toxicity or drug abuse are common causes of AKI. AKI is common in hospitalised patients, with the overall incidence of AKI estimated to be around 24‐30 cases/1000 hospital discharges and 6% of those are critically ill. Sepsis, hypovolaemia, drug toxicity, major surgery and diagnostic investigations using radiocontrast dyes are some of the most common associated causes of hospital‐acquired AKI. Restoration of kidney function is the goal of any treatment and can involve drug interventions or kidney dialysis. Atrial natriuretic peptide (ANP) has been shown to increase urine production and to reduce kidney inflammation. The aim of this review was to investigate the use of ANP in preventing AKI and treating established AKI. We identified 19 studies (11 prevention and 8 treatment) using low or high dose ANP, enrolling 1,861 patients. There was no difference in the number of deaths between ANP and control for studies preventing or treating AKI. The need for dialysis was significantly lower in both the low dose ANP treatment and prevention studies as well as for patients undergoing major surgery. The length of time spend in hospital and ICU was shorter for patients receiving low dose ANP. High dose ANP was associated with more hypotension and cardiac arrhythmias in patients with established AKI. ANP may be associated with improved outcomes when used in low doses for preventing AKI and in managing postsurgery AKI. There were no significant adverse events in the prevention studies, however in the high dose ANP treatment studies there were significant increases in hypotension and arrhythmias.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Is continuous renal replacement therapy beneficial for people with rhabdomyolysis?

Rhabdomyolysis is a potentially life‐threatening condition where damaged muscle tissue breaks down quickly, and products of damaged muscle cells are released into the bloodstream. Of these products, a protein called myoglobin is harmful to kidney health and can lead to acute kidney injury. There is some evidence to suggest that continuous renal replacement therapy (CRRT) may provide benefits for people with rhabdomyolysis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Nail fungus: Overview

Nail fungus is very common. Experts think that it often develops from untreated athlete's foot. It takes time to get rid of brittle, discolored, or thickened nails. Local treatment using nail polish can take up to a year. Tablets take effect more quickly, but have more side effects.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 14, 2015

Androgens for the anaemia of chronic kidney disease in adults

Anaemia, which occurs when red blood cell and haemoglobin levels fall below normal, is a common problem among adults with chronic kidney disease (CKD). Anaemia can cause breathlessness, dizziness and chest pain (angina); reduce ability to think clearly; limits ability to exercise; and contributes to sexual problems, poor appetite and reduced quality of life. Anaemia may also cause longer hospital stays, and sometimes death.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Lipid‐lowering agents for nephrotic syndrome

Nephrotic syndrome is a relatively rare disease in which the kidneys leak protein into the urine. A common early sign is swelling in the feet and face. Other signs and symptoms of nephrotic syndrome include low levels of protein in the blood, and high levels of fats in the blood, particularly cholesterol and triglycerides.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Higher versus lower protein intake in formula‐fed low birth weight infants

Dietary protein is needed for normal growth and development. The protein intake required for growth of the low birth weight infant has been estimated by the growth rate of the fetus to be 3.5 to 4.0 g/kg/d. Controlling the amount of protein given to low birth weight babies (less than 2.5 kg) fed with formula is important. Too much protein can raise blood urea and amino acid (phenylalanine) levels, and this may harm neurodevelopment. Too low protein intake may limit the growth of these infants. The review authors searched the medical literature to identify studies that compared protein intake as follows: between 3 and 4 g of protein per kg of infant body weight each day versus less than 3.0 g/kg/d or greater than 4.0 g/kg/d by low birth weight infants fed formula during their initial hospital stay. Increased protein intake resulted in greater weight gain of around 2.0 g/kg/d. Based on increased body incorporation of nitrogen, this was associated with increased lean body mass. The present conclusion was based on six studies that changed only the protein content of the formula and was supported by three additional studies that made changes in other nutrients as well. No significant difference in the concentration of plasma phenylalanine was noted between infants fed high or low protein content formula. The review was limited in the conclusions made because differences in protein content among comparison groups in some of the individual trials were small and formulas differed substantially across studies; some studies included healthier and more mature premature infants. Study periods varied from eight days to two years, so information on long‐term outcomes was limited. Existing research is not adequate to allow specific recommendations regarding formula with protein content that provides more than 4.0 g/kg/d.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

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