In the past two decades, a substantial increase in the incidence of acute kidney injury (AKI) and kidney injury requiring dialysis has occurred in North America. This increase has coincided with an increase in the incidence of end-stage renal disease (ESRD), which has exceeded that expected based upon the prevalence of chronic kidney disease (CKD). In order to better understand the association between these conditions, there has been a proliferation of studies that have examined the risks of incident and progressive CKD following AKI. Animal studies have shown that failed differentiation of epithelial cells following renal ischaemia-reperfusion injury might lead to tubulointerstitial fibrosis, supporting a biological mechanism linking AKI and CKD. Strong and consistent associations between AKI and incident CKD, progression of CKD and incident ESRD have also been shown in epidemiological studies. In this Review, we summarize the wealth of available data on the relationship between AKI and CKD, and discuss the implications of these findings for the long-term clinical management of patients following AKI. We also identify areas of active investigation and future directions for research.
A detailed study of dose data has been made for 100 coronary angiography examinations performed on a digital X-ray unit. Dose-area product (DAP) data have been analysed in terms of fluoroscopy and radiography for different projections. Projections patterns were similar for all cardiologists studied and the contribution to DAP from fluoroscopy was 32%. Data for 10 patients, selected because the percentage contributions to DAP from fluoroscopy and radiography were similar to the mean for the group, were used to derive conversion factors from DAP to effective dose. The mean DAP was 14 Gy cm2 and the effective dose 3.1 mSv. Conversion factors, based on the same protocol, were derived for a range of tube potentials and filtrations for use in estimation of effective doses with other units.
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