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California Medicine Mar 1950Alterations in serum potassium are common in many diseases. In a series of 390 determinations of serum potassium, the levels found were low in 24 per cent and high in...
Alterations in serum potassium are common in many diseases. In a series of 390 determinations of serum potassium, the levels found were low in 24 per cent and high in 2.6 per cent. The major causes of low serum potassium are (1) decreased potassium intake due to intravenous feedings which do not contain potassium; (2) increased loss of potassium in the urine due to accelerated tissue breakdown, or renal lesions; (3) loss from the gastrointestinal tract due to diarrhea, or fistulae, and (4) shift between serum and cells, due to metabolic causes, drugs or changes in pH. The major cause of high serum potassium is uremia with renal retention.Clinical symptoms and signs of low body potassium include muscle weakness and paralysis, which may lead to death in respiratory failure if not corrected, tachycardia, gallop rhythm, dilatation of the heart. The electrocardiogram shows inverted, low amplitude, or isoelectric T waves and a prolonged QT interval. Potassium chloride orally, subcutaneously or intravenously is recommended for use in the treatment of potassium deficits. It should not be used in the presence of oliguria or anuria or dehydration. The amounts of potassium necessary to correct deficits vary widely and cannot be predicted from the serum level. Special reference is made to the prevention and therapy of potassium deficits in diabetic acidosis. High serum potassium levels are difficult to correct. Suggested measures are administration of glucose, insulin or calcium, gastric or peritoneal lavage or use of the artificial kidney.
Topics: Anuria; Dehydration; Diarrhea; Electrocardiography; Humans; Hypokalemia; Oliguria; Potassium; Uremia
PubMed: 15405024
DOI: No ID Found -
Canadian Medical Association Journal Jun 1949
Topics: Anuria; Body Fluids; Humans; Urine
PubMed: 18127707
DOI: No ID Found -
Kidney International Mar 2010Autosomal recessive renal tubular dysgenesis (RTD) is a severe disorder of renal tubular development characterized by early onset and persistent fetal anuria leading to... (Review)
Review
Autosomal recessive renal tubular dysgenesis (RTD) is a severe disorder of renal tubular development characterized by early onset and persistent fetal anuria leading to oligohydramnios and the Potter sequence. At birth, blood pressure is dramatically low and perinatal death occurs in most cases. Skull ossification defects are frequently associated with RTD. The disease is genetically heterogeneous and linked to mutations in the genes encoding any of the components of the renin-angiotensin system (RAS). An intense stimulation of renin production is noted in the kidneys of patients with mutations in the genes encoding angiotensinogen, angiotensin-converting enzyme, or AT1 receptor, whereas absence or increased renin production is associated with REN defects depending on the type of mutation. The severity of the disease underlines the importance of a functional RAS in the maintenance of blood pressure and renal blood flow during fetal life. The absence or poor development of proximal tubules, as well as renal vascular changes, may be attributable to renal hypoperfusion rather than to a morphogenic property of the RAS. The less severe phenotype in mice devoid of RAS may be linked to differences between mice and humans in the time of nephrogenesis and maturation of the RAS. The identification of the disease on the basis of precise clinical and histological analyses and the characterization of the genetic defects allow genetic counseling and early prenatal diagnosis.
Topics: Animals; Anuria; Embryonic Development; Female; Fetal Death; Genes, Recessive; Genetic Heterogeneity; Humans; Infant, Newborn; Kidney Tubules; Mice; Mutation; Oligohydramnios; Pregnancy; Receptor, Angiotensin, Type 1; Renin; Renin-Angiotensin System; Skull
PubMed: 19924102
DOI: 10.1038/ki.2009.423 -
British Medical Journal Jan 1944
PubMed: 20785208
DOI: No ID Found -
Kidney Research and Clinical Practice Aug 2023This study was performed to investigate the feasibility of incremental peritoneal dialysis (iPD) in older patients.
BACKGROUND
This study was performed to investigate the feasibility of incremental peritoneal dialysis (iPD) in older patients.
METHODS
In this retrospective cohort study, we enrolled peritoneal dialysis (PD) patients with age ≥ 60 years old at our center from 2008 to 2017. The patients were divided into two groups based on the daily PD exchanges: iPD group (≤3 × 2 L exchanges), and full dose group (≥4 × 2 L exchanges). Kaplan-Meier curves and multivariate Cox regression models were applied to evaluate the risks of anuria and mortalities between groups.
RESULTS
A total of 238 patients (186 in full dose group and 52 in iPD group) were enrolled. The mean age was 67.8 ± 5.7 years, and 45.8% were females. The baseline glomerular filtration rate was 4.15 ± 2.39 mL/min/1.73 m2 . Multivariate Cox regression models showed that patients in the iPD group patients had significantly decreased risk of anuria (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.24-0.81; p = 0.008), and all-cause mortality (HR, 0.59; 95% CI, 0.36-0.98; p = 0.04). Additionally, the incidence of peritonitis was significantly lower in the iPD group than that in the full dose group (0.115 vs. 0.197 episodes per person-year, p = 0.03) during the 36 months of PD commencement.
CONCLUSION
Older patients with iPD were independently associated with better preservation of residual kidney function and survival outcomes. Moreover, iPD regimens are also associated with reduced incidence of peritonitis. The iPD strategy might offer a feasible option for older patients.
PubMed: 37559224
DOI: 10.23876/j.krcp.22.202 -
Medicine Nov 2018Emphysematous pyelonephritis (EPN) or cystitis (EC) is a severe infection of the urinary tract with high mortality. EPN is uncommon among the patients of end stage of... (Review)
Review
INTRODUCTION
Emphysematous pyelonephritis (EPN) or cystitis (EC) is a severe infection of the urinary tract with high mortality. EPN is uncommon among the patients of end stage of renal failure (ESRD) CASE PRESENTATION:: A 38-year-old male with uremia and anuria who was on hemodialysis was found to have gas formation in the bilateral pelvis, ureters, and urinary bladder by CT scan. The diagnosis was emphysematous pyelonephritis and cystitis. And Foley catheter was placed and bladder irrigation was performed. Escherichia coli infection was identified in urine culture and antibiotic was prescribed accordingly. Gas disappeared completely and the patient recovered uneventfully.
CONCLUSION
This is the first case report of asymptomatic EPN and EC in uremic patient, and conservative management was optimistic in this condition. More attention should be paid to EPN and EC happening to ESRD patients.
Topics: Adult; Anuria; Conservative Treatment; Cystitis; Emphysema; Escherichia coli Infections; Humans; Male; Pyelonephritis; Renal Dialysis; Uremia
PubMed: 30407278
DOI: 10.1097/MD.0000000000011272 -
Experimental and Clinical... Jun 2023This study was devised to investigate papal deaths due to acute kidney injury, a topic for which scarce data exist. (Review)
Review
OBJECTIVES
This study was devised to investigate papal deaths due to acute kidney injury, a topic for which scarce data exist.
MATERIALS AND METHODS
We studied all popes between John XXI, who died in 1277 of crush syndrome, and John Paul II, who died of anuria and urinary sepsis in 2005.
RESULTS
Between pontification years from 1277 to 2005, 21 of 78 popes (26.9%) died of acute kidney injury. Sepsis was identified as the leading cause of acute kidney injury and death in 20 of 21 popes (95.2%). Mean ± SE age at death of the 21 popes was 69.4 ± 2.26 years. Six popes (28.6%) died of stroke.
CONCLUSIONS
Sepsis-associated acute kidney injury, a syndrome with a complex pathogenesis and poor prognosis, which is far from being fully understood, contributed to a high number of papal deaths.
Topics: Humans; Aged; Acute Kidney Injury; Sepsis; Anuria
PubMed: 37496352
DOI: 10.6002/ect.IAHNCongress.20 -
Teratology Dec 1994Occasionally there is a drug whose record in pregnancy is so frequently associated with adverse outcome of so specific a pattern that it becomes clear that its use must... (Review)
Review
Occasionally there is a drug whose record in pregnancy is so frequently associated with adverse outcome of so specific a pattern that it becomes clear that its use must be restricted before scientific proof from epidemiological studies is obtained. I believe this to be the case with the drug class of ACEIs. There are mammalian models suggesting substantial fetotoxicity in a dose-related fashion. There is a strong and consistent pattern to the reported cases of ACEI-related adverse outcomes: the syndrome of oligohydramnios-anuria, neonatal hypotension, renal dysplasia, and hypocalvaria is too specific in association with the use of these drugs to be ignored. There is a very plausible biologic mechanism to explain the relationship. The features of ACEI fetopathy suggest that the underlying pathogenetic mechanism is fetal hypotension, which may also result from other exposures. Thus, while the fetopathy may not be truly specific to ACEIs, they are particularly liable to produce adverse fetal renal effects with their sequels (anuria-oligohydramnios, pulmonary hypoplasia, growth restriction) and hypocalvaria.
Topics: Abnormalities, Drug-Induced; Angiotensin-Converting Enzyme Inhibitors; Animals; Disease Models, Animal; Ductus Arteriosus, Patent; Female; Fetal Growth Retardation; Humans; Kidney; Pregnancy; Renin-Angiotensin System; Skull
PubMed: 7778045
DOI: 10.1002/tera.1420500606 -
Journal of Clinical Laboratory Analysis Jul 2022Mitochondrial DNA (MtDNA) exposed to the extracellular space due to cell death and stress has immunostimulatory properties. However, the clinical significance of...
BACKGROUND
Mitochondrial DNA (MtDNA) exposed to the extracellular space due to cell death and stress has immunostimulatory properties. However, the clinical significance of circulating MtDNA in maintenance hemodialysis (MHD) patients and the precise mechanism of its emergence have yet to be investigated.
METHODS
This cross-sectional study consisted of 52 MHD patients and 32 age- and sex-matched healthy controls. MHD patients were further categorized into high and low circulating cell-free MtDNA (ccf-MtDNA) groups based on the median value. Copy number of MtDNA was quantified using TaqMan-based qPCR. Plasma cytokines were measured using ELISA kits. Reactive oxygen species (ROS) and mitochondrial membrane potential (Δψm) in peripheral blood mononuclear cells (PBMCs) were detected using DCFH-DA or JC-1 staining.
RESULTS
The copy numbers of ccf-MtDNA in patients with MHD were higher than those in healthy controls, and these alterations were correlated with changes of cytokines TNF-α and IL-6. Adjusted model in multivariate analysis showed that the presence of anuria and longer dialysis vintage were independently associated with higher levels of ccf-MtDNA. Meanwhile, although not statistically significant, an inverse correlative trend between urinary MtDNA and ccf-MtDNA was observed in patients with residual urine. Afterward, using PBMCs as surrogates for mitochondria-rich cells, we found that patients in the high ccf-MtDNA group exhibited a significantly higher ROS production and lower Δψm in cells.
CONCLUSIONS
Our data suggested that changes in ccf-MtDNA correlate with the degree of inflammatory status in MHD patients, and that the excessive MtDNA may be caused by mitochondrial dysfunction and reduced urinary MtDNA excretion.
Topics: Case-Control Studies; Cross-Sectional Studies; Cytokines; DNA, Mitochondrial; Humans; Inflammation; Leukocytes, Mononuclear; Mitochondria; Reactive Oxygen Species; Renal Dialysis
PubMed: 35708020
DOI: 10.1002/jcla.24558 -
The Israel Medical Association Journal... Jan 2009Renal tubular dysgenesis is a rare lethal kidney abnormality clinically manifested by olighydramnios, anuria and respiratory distress. Most of the information on this... (Comparative Study)
Comparative Study Review
BACKGROUND
Renal tubular dysgenesis is a rare lethal kidney abnormality clinically manifested by olighydramnios, anuria and respiratory distress. Most of the information on this entity is provided by case reports and short series.
OBJECTIVES
To evaluate the incidence and comparative frequency of clinical manifestations in different etiologic-pathogenic variants of RTD in Israel and in summarized published data.
METHODS
Stillborn and neonatal autopsy material from nine medical centers in northern and central Israel was studied. Information concerning pregnancy, labor and postnatal status and autopsy findings of cases with histologically, histochemically and immunohistochemically confirmed RTD were obtained from corresponding reports and from published material.
RESULTS
From the 1538 autopsies of fetuses (2 20 weeks gestation) and neonates that were performed between 1976 and 2007 we identified 12 cases of RTD (0.78%). Abnormality occurred more often (1.4%) in the Upper and Western Galilee than in Israel as a whole.
CONCLUSIONS
Our study and a review of the literature showed that the autosomal recessive variant of RTD was more frequent than twin-twin transfusion-induced. Most symptoms were similar in all variants of RTD, but their frequency was different in each of them.
Topics: Anuria; Autopsy; Congenital Abnormalities; Female; Humans; Incidence; Infant, Newborn; Israel; Kidney Tubules; Male; Oligohydramnios; Pregnancy; Respiratory Distress Syndrome, Newborn; Risk Factors
PubMed: 19344005
DOI: No ID Found