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Clinical Journal of the American... Jul 2022AKI is a syndrome, not a disease. It results from many different primary and/or secondary etiologies and is often multifactorial, especially in the hospitalized patient.... (Review)
Review
AKI is a syndrome, not a disease. It results from many different primary and/or secondary etiologies and is often multifactorial, especially in the hospitalized patient. This review discusses the pathophysiology of three etiologies that cause AKI, those being kidney hypoperfusion, abdominal compartment syndrome, and urinary tract obstruction. The pathophysiology of these three causes of AKI differs but is overlapping. They all lead to a low urine flow rate and low urine sodium initially. In all three cases, with early recognition and correction of the underlying process, the resulting functional AKI can be rapidly reversed. However, with continued duration and/or increased severity, cell injury occurs within the kidney, resulting in structural AKI and a longer and more severe disease state with increased morbidity and mortality. This is why early recognition and reversal are critical.
Topics: Acute Kidney Injury; Azotemia; Biomarkers; Humans; Intra-Abdominal Hypertension; Kidney
PubMed: 35584927
DOI: 10.2215/CJN.15341121 -
Tierarztliche Praxis. Ausgabe K,... Feb 2019An impaired elimination of urinary excreted substances and an increase of these substances in the blood (azotemia) can also occur in rabbits and rodents. In addition to... (Review)
Review
An impaired elimination of urinary excreted substances and an increase of these substances in the blood (azotemia) can also occur in rabbits and rodents. In addition to renal diseases, prerenal and postrenal conditions can induce azotemia. A systematic evaluation of patients with azotemia is needed to find a diagnosis and to initiate an effective treatment. The article provides an overview of the diagnosis and therapy of common causes of azotemia in rabbits and rodents.
Topics: Animals; Azotemia; Rabbits; Rodentia
PubMed: 30808037
DOI: 10.1055/a-0828-4591 -
Enfermedades Infecciosas Y... Oct 2022
Topics: Acute Kidney Injury; Azotemia; Humans; Tigecycline
PubMed: 35624068
DOI: 10.1016/j.eimce.2022.05.002 -
Critical Care (London, England) Apr 2022Preclinical models of acute kidney injury (AKI) consistently demonstrate that a uremic milieu enhances renal recovery and decreases kidney fibrosis. Similarly,... (Review)
Review
Preclinical models of acute kidney injury (AKI) consistently demonstrate that a uremic milieu enhances renal recovery and decreases kidney fibrosis. Similarly, significant decreases in monocyte/macrophage infiltration, complement levels, and other markers of inflammation in the injured kidney are observed across multiple studies and species. In essence, decreased renal clearance has the surprising and counterintuitive effect of being an effective treatment for AKI. In this Perspective, the author suggests a hypothesis describing why the uremic milieu is kidney protective and proposes a clinical trial of 'permissive azotemia' to improve renal recovery and long-term renal outcomes in critically ill patients with severe AKI.
Topics: Acute Kidney Injury; Azotemia; Female; Fibrosis; Humans; Kidney; Male; Social Planning
PubMed: 35484549
DOI: 10.1186/s13054-022-03988-0 -
Primary Care Dec 2020Volume and electrolyte evaluation and management is seen frequently in primary care practices. Some of the most common abnormalities encountered in outpatient practices... (Review)
Review
Volume and electrolyte evaluation and management is seen frequently in primary care practices. Some of the most common abnormalities encountered in outpatient practices are prerenal azotemia, dysnatremias, and altered potassium levels. Perturbations in volume or electrolyte concentrations can lead to serious organ dysfunction as well as hemodynamic collapse. This review focuses on the maintenance and regulation of intravascular volume and electrolytes, specifically sodium and potassium.
Topics: Azotemia; Blood Urea Nitrogen; Body Water; Creatinine; Humans; Hyperkalemia; Hypernatremia; Hypokalemia; Hyponatremia; Kidney; Primary Health Care; Water-Electrolyte Imbalance
PubMed: 33121628
DOI: 10.1016/j.pop.2020.07.001 -
Clinical Journal of the American... Feb 2017Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs... (Review)
Review
Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error. A smaller number are due to rare idiosyncratic reactions. In this review, we highlight major emergencies that may occur during hemodialysis treatments, describe their pathogenesis, offer measures to minimize them, and provide specific interventions to prevent catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence.
Topics: Azotemia; Embolism, Air; Emergencies; Equipment Failure; Hemolysis; Hemorrhage; Humans; Hypersensitivity; Needles; Renal Dialysis; Root Cause Analysis; Water Supply
PubMed: 27831511
DOI: 10.2215/CJN.05260516 -
Compendium (Yardley, PA) Nov 2009When rupture or obstruction of the urinary tract prevents the normal collection and expulsion of urine from the body, the resulting azotemia is termed postrenal.... (Review)
Review
When rupture or obstruction of the urinary tract prevents the normal collection and expulsion of urine from the body, the resulting azotemia is termed postrenal. Postrenal azotemia can coexist with prerenal and/or renal azotemia. Detection of postrenal azotemia requires attentiveness to the history and physical examination findings and to the results of specifically directed diagnostic tests. Prompt correction of postrenal causes of azotemia limits the potential for intrinsic renal damage and can contribute to a positive clinical outcome; therefore, postrenal azotemia should be investigated in all azotemic patients.
Topics: Acute Disease; Animals; Azotemia; Cat Diseases; Cats; Disease Progression; Dog Diseases; Dogs; Ureteral Obstruction; Urinary Bladder
PubMed: 20180222
DOI: No ID Found -
Contributions To Nephrology 2010Prerenal failure is used to designate a reversible form of acute renal dysfunction. However, the terminology encompasses different conditions that vary considerably. The... (Review)
Review
Prerenal failure is used to designate a reversible form of acute renal dysfunction. However, the terminology encompasses different conditions that vary considerably. The Acute Kidney Injury Network group has recently standardized the acute kidney injury (AKI) definition and classification system; however, these criteria have not determined specific diagnostic criteria to classify prerenal conditions. The difference in the pathophysiology and manifestations of prerenal failure suggests that our current approach needs to be revaluated. Several mechanisms are recognized as contributory to development of a prerenal state associated with cardiac failure. Because of the broad differences in patients' reserve capacity and functional status, prerenal states may be triggered at different time points during the course of the disease. Prerenal state needs to be classified depending on the underlying capacity for compensation, the nature, timing of the insult and the adaptation to chronic comorbidities. Current diagnosis of prerenal conditions is relatively insensitive and would benefit from additional research to define and classify the condition. Identification of high-risk states and high-risk processes associated with the use of new biomarkers for AKI will provide new tools to distinguish between the prerenal and established AKI. Achieving a consensus definition for prerenal syndrome will allow physicians to describe treatments and interventions as well as conduct and compare epidemiological studies in order to better describe the implications of this syndrome.
Topics: Acute Kidney Injury; Azotemia; Comorbidity; Heart Failure; Humans; Risk Factors
PubMed: 20427996
DOI: 10.1159/000313723 -
Journal of Feline Medicine and Surgery Jul 2022Both hyperthyroidism and chronic kidney disease (CKD) are common long-term conditions in older cats, which might be diagnosed concurrently or develop at different times.... (Review)
Review
PRACTICAL RELEVANCE
Both hyperthyroidism and chronic kidney disease (CKD) are common long-term conditions in older cats, which might be diagnosed concurrently or develop at different times. Hyperthyroidism may mask the presence of CKD, and vice versa, by various mechanisms that are described in this review. Hyperthyroidism treatment options should be carefully considered when CKD has also been diagnosed.
CLINICAL CHALLENGES
Although it can be difficult to diagnose hyperthyroidism and CKD simultaneously, given that one condition may mask the other, it is important to consider the presence of both diseases when examining an older cat presenting with vomiting, weight loss, polyuria/ polydipsia, anorexia or sarcopenia. The concurrent presence of hyperthyroidism and CKD requires careful monitoring of glomerular filtration rate biomarkers, and adequate and prompt support of kidney function when normal thyroid function is re-established. Iatrogenic hypothyroidism is a recognised complication of all of the treatment options for hyperthyroidism, and increases the risk of azotaemia. Therapy with levothyroxine is recommended for cats that are hypothyroid and azotaemic.
EVIDENCE BASE
The information in this review draws on current literature and guidelines related to the pathophysiology, diagnosis and treatment recommendations for feline hyperthyroidism and CKD.
Topics: Animals; Cat Diseases; Cats; Glomerular Filtration Rate; Hyperthyroidism; Hypothyroidism; Renal Insufficiency, Chronic; Thyroxine
PubMed: 35481810
DOI: 10.1177/1098612X221090390 -
Journal of the American Society of... Sep 2016
Topics: Azotemia; Glucocorticoids; Humans; Muscle, Skeletal; Muscular Atrophy; Renal Insufficiency, Chronic
PubMed: 27059512
DOI: 10.1681/ASN.2016030284