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Disease-a-month : DM Jun 1998This section discusses the reasons different diuretic agents inhibit salt reabsorption at specific sites within the renal tubule. It also includes a brief review of how... (Review)
Review
This section discusses the reasons different diuretic agents inhibit salt reabsorption at specific sites within the renal tubule. It also includes a brief review of how diuretics reach their target site of action along the nephron, together with a discussion of how disease states may affect the delivery of diuretics to those sites. When diuretics are administered to edematous patients, the natriuretic response is often blunted. In addition, increased renal tubular salt avidity is observed after administration of loop diuretics. The elements required to successfully achieve adequate natriuresis under such conditions are analyzed. Because achieving diuresis may result in significant hypokalemia, hyponatremia, metabolic alkalosis, and worsening prerenal azotemia, the prevention and management of these complications of diuretic therapy are also reviewed. A description of successful use of diuretics in specific edematous states, such as congestive heart failure, chronic renal failure, nephrotic syndrome, and liver disease, is followed by a brief discussion of the management of resistant edema and the use of diuretics in nonedematous states, including essential hypertension and other conditions.
Topics: Diuretics; Edema; Heart Failure; Humans; Hypertension; Kidney Diseases; Liver Cirrhosis
PubMed: 9679501
DOI: 10.1016/s0011-5029(98)90003-7 -
Frontiers in Medicine 2021The decreased ability of the kidney to regulate water and monovalent cation excretion predisposes patients with chronic kidney disease (CKD) to dysnatremias. In this... (Review)
Review
The decreased ability of the kidney to regulate water and monovalent cation excretion predisposes patients with chronic kidney disease (CKD) to dysnatremias. In this report, we describe the clinical associations and methods of management of dysnatremias in this patient population by reviewing publications on hyponatremia and hypernatremia in patients with CKD not on dialysis, and those on maintenance hemodialysis or peritoneal dialysis. The prevalence of both hyponatremia and hypernatremia has been reported to be higher in patients with CKD than in the general population. Certain features of the studies analyzed, such as variation in the cut-off values of serum sodium concentration ([Na]) that define hyponatremia or hypernatremia, create comparison difficulties. Dysnatremias in patients with CKD are associated with adverse clinical conditions and mortality. Currently, investigation and treatment of dysnatremias in patients with CKD should follow clinical judgment and the guidelines for the general population. Whether azotemia allows different rates of correction of [Na] in patients with hyponatremic CKD and the methodology and outcomes of treatment of dysnatremias by renal replacement methods require further investigation. In conclusion, dysnatremias occur frequently and are associated with various comorbidities and mortality in patients with CKD. Knowledge gaps in their treatment and prevention call for further studies.
PubMed: 34938749
DOI: 10.3389/fmed.2021.769287 -
Journal of Veterinary Internal Medicine Sep 2021Radioiodine ( I) is the treatment of choice for hyperthyroidism in cats, but current I-dosing protocols can induce iatrogenic hypothyroidism and expose azotemia.
BACKGROUND
Radioiodine ( I) is the treatment of choice for hyperthyroidism in cats, but current I-dosing protocols can induce iatrogenic hypothyroidism and expose azotemia.
OBJECTIVES
To develop a cat-specific algorithm to calculate the lowest I dose to resolve hyperthyroidism, while minimizing risk of iatrogenic hypothyroidism and subsequent azotemia.
ANIMALS
One thousand and four hundred hyperthyroid cats treated with I.
METHODS
Prospective case series (before-and-after study). All cats had serum concentrations of thyroxine (T ), triiodothyronine (T ), and thyroid-stimulating hormone (TSH) measured (off methimazole ≥1 week). Using thyroid scintigraphy, each cat's thyroid volume and percent uptake of Tc-pertechnatate (TcTU) were determined. An initial I dose was calculated by averaging dose scores for T /T concentrations, thyroid volume, and TcTU; 80% of that composite dose was administered. Twenty-four hours later, percent I uptake was measured, and additional I administered, as needed, to deliver an adequate radiation dose to the thyroid tumor(s). Serum concentrations of T , TSH, and creatinine were determined 6 to 12 months later.
RESULTS
The median calculated I dose was 1.9 mCi (range, 1.0-10.6 mCi); 1380 cats required additional I administration on day 2. Of the cats, 1047 (74.8%) became euthyroid, 57 (4.1%) became overtly hypothyroid, 240 (17.1%) became subclinically hypothyroid, and 56 (4%) remained hyperthyroid. More overtly (71.9%) and subclinically (39.6%) hypothyroid cats developed azotemia than euthyroid cats (14.2%; P < .0001).
CONCLUSIONS AND CLINICAL IMPORTANCE
Our algorithm for calculating individual I doses resulted in cure rates similar to historical treatment rates, despite much lower I doses. This algorithm appears to lower prevalence of both I-induced overt hypothyroidism and azotemia.
Topics: Algorithms; Animals; Cat Diseases; Cats; Hyperthyroidism; Hypothyroidism; Iodine Radioisotopes; Thyroxine
PubMed: 34351027
DOI: 10.1111/jvim.16228 -
Parasites & Vectors May 2022Three species of Leishmania cause disease in humans in Israel and are endemic in the Middle East: Leishmania infantum, Leishmania tropica and Leishmania major. These...
BACKGROUND
Three species of Leishmania cause disease in humans in Israel and are endemic in the Middle East: Leishmania infantum, Leishmania tropica and Leishmania major. These species infect dogs and cats, but little is known about their prevalence in pet populations and their clinical manifestations. A study on dog and cat Leishmania infection was conducted in a focus of human L. tropica infection in central Israel with the aim of getting insight on leishmaniosis in pets in an area where human infection is highly prevalent.
METHODS
Blood, demographic and clinical data were collected from dogs and cats brought for veterinary care in a focus of human L. tropica infection during 2018-2020. kDNA PCR and internal transcribed spacer1 high-resolution melt analysis PCR (ITS1 HRM PCR) with DNA sequencing were performed for the detection of Leishmania and species determination.
RESULTS
Forty-three of 189 dogs (22.8%) and 44 of 152 cats (28.9%) were positive for Leishmania spp. infection by kDNA PCR. The ITS1 HRM PCR detected six dogs (3.3%) infected with L. infantum and one (0.5%) with L. tropica, whereas six cats (3.9%) were found infected by L. infantum and five (3.3%) by L. tropica. Four of the five L. tropica-positive cats suffered from weight loss, four had azotemia, two with mild and two with severe azotemia and progressive renal disease. Three cats had gingivostomatitis; three had skin lesions with abscess and ulcers in two and scales and hair loss in another cat, which was also FIV +. This is the first report of feline L. tropica infection in Israel. Clinical information on cats with this infection from previous studies elsewhere is scarce.
CONCLUSIONS
A high rate of Leishmania spp. infection, mostly estimated as sub-clinical, was found in dogs and cats admitted for veterinary care in an L. tropica focus. Among the animals in which infection could be characterized to the species level, more dogs were infected with L. infantum than with L. tropica while 5 of 11 cats were infected with L. tropica and had signs of systemic and skin disease not described before in feline L. tropica infection.
Topics: Animals; Azotemia; Cat Diseases; Cats; DNA, Kinetoplast; Dog Diseases; Dogs; Female; Humans; Israel; Leishmania infantum; Leishmania tropica; Leishmaniasis; Leishmaniasis, Visceral; Male
PubMed: 35534906
DOI: 10.1186/s13071-022-05272-0 -
Annals of the Academy of Medicine,... Oct 2022There is a lack of guidelines or formal systematic synthesis of evidence for nutrition therapy in older critically ill patients. This study is a scoping review to... (Review)
Review
INTRODUCTION
There is a lack of guidelines or formal systematic synthesis of evidence for nutrition therapy in older critically ill patients. This study is a scoping review to explore the state of evidence in this population.
METHOD
MEDLINE and Embase were searched from inception until 9 February 2022 for studies that enrolled critically ill patients aged ≥60 years and investigated any area of nutrition therapy. No language or study design restrictions were applied.
RESULTS
Thirty-two studies (5 randomised controlled trials) with 6 topics were identified: (1) nutrition screening and assessments, (2) muscle mass assessment, (3) route or timing of nutrition therapy, (4) determination of energy and protein requirements, (5) energy and protein intake, and (6) pharmaconutrition. Topics (1), (3) and (6) had similar findings among general adult intensive care unit (ICU) patients. Skeletal muscle mass at ICU admission was significantly lower in older versus young patients. Among older ICU patients, low muscularity at ICU admission increased the risk of adverse outcomes. Predicted energy requirements using weight-based equations significantly deviated from indirect calorimetry measurements in older vs younger patients. Older ICU patients required higher protein intake (>1.5g/kg/day) than younger patients to achieve nitrogen balance. However, at similar protein intake, older patients had a higher risk of azotaemia.
CONCLUSION
Based on limited evidence, assessment of muscle mass, indirect calorimetry and careful monitoring of urea level may be important to guide nutrition therapy in older ICU patients. Other nutrition recommendations for general ICU patients may be used for older patients with sound clinical discretion.
Topics: Adult; Humans; Aged; Critical Illness; Enteral Nutrition; Nutritional Support; Nutritional Requirements; Intensive Care Units; Energy Intake
PubMed: 36317573
DOI: 10.47102/annals-acadmedsg.2022160 -
Journal of the American Veterinary... Feb 2020To evaluate the utility of commercially available reagent test strips for estimation of BUN concentration and detection of azotemia in pet rabbits () and ferrets ().
OBJECTIVE
To evaluate the utility of commercially available reagent test strips for estimation of BUN concentration and detection of azotemia in pet rabbits () and ferrets ().
SAMPLE
65 blood samples from 53 rabbits and 71 blood samples from 50 ferrets of various health statuses.
PROCEDURES
BUN concentrations were measured with a clinical laboratory biochemical analyzer and estimated with a reagent test strip. Results obtained with both methods were assigned to a BUN category (range, 1 to 4; higher categories corresponded to higher BUN concentrations). Samples with a biochemical analyzer BUN concentration ≥ 27 mg/dL (rabbits) or ≥ 41 mg/dL (ferrets) were considered azotemic. A test strip BUN category of 3 or 4 (rabbits) or 4 (ferrets) was considered positive for azotemia.
RESULTS
Test strip and biochemical analyzer BUN categories were concordant for 46 of 65 (71%) rabbit blood samples and 58 of 71 (82%) ferret blood samples. Sensitivity, specificity, and accuracy of the test strips for detection of azotemia were 92%, 79%, and 82%, respectively, for rabbit blood samples and 80%, 100%, and 96%, respectively, for ferret blood samples.
CONCLUSIONS AND CLINICAL RELEVANCE
Test strips provided reasonable estimates of BUN concentration but, for rabbits, were more appropriate for ruling out than for ruling in azotemia because of false-positive test strip results. False-negative test strip results for azotemia were more of a concern for ferrets than rabbits. Testing with a biochemical analyzer remains the gold standard for measurement of BUN concentration and detection of azotemia in rabbits and ferrets.
Topics: Animals; Azotemia; Blood Urea Nitrogen; Ferrets; Rabbits; Reagent Strips; Urea
PubMed: 31999516
DOI: 10.2460/javma.256.4.449 -
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 -
Electrolyte & Blood Pressure : E & BP Dec 2007Nephrotoxicity is the most common and clinically significant adverse effect of calcineurin inhibitors. Cyclosporine and tacrolimus nephrotoxicity is manifested by both... (Review)
Review
Nephrotoxicity is the most common and clinically significant adverse effect of calcineurin inhibitors. Cyclosporine and tacrolimus nephrotoxicity is manifested by both acute azotemia and chronic progressive renal disease and tubular zdysfunction. An elevation in the plasma potassium concentration due to reduced efficiency of urinary potassium excretion is common in cyclosporine-treated patients; it may be severe and potentially life-threatening with concurrent administration of an angiotensin converting enzyme inhibitor, which diminishes aldosterone release. Tubular injury induced by cyclosporine can also impair acid excretion. This may be presented as a hyperchloremic metabolic acidosis associated with decreased aldosterone activity and suppression of ammonium excretion by hyperkalemia. Some patients treated with cyclosporine develop hypophosphatemia due to urinary phosphate wasting. Renal magnesium wasting is also common presumably due to drug effects on magnesium reabsorption. Hypomagnesemia has also been implicated as a contributor to the nephrotoxicity associated with cyclosporine. Both cyclosporine and tacrolimus are associated with hypercalciuria. Attention must be paid to drug dose, side effects, and drug interactions to minimize toxicity and maximize efficacy.
PubMed: 24459511
DOI: 10.5049/EBP.2007.5.2.126 -
Kidney Medicine Feb 2024Chronic myelomonocytic leukemia (CMML) is a hematologic malignancy affecting the bone marrow and resulting in peripheral blood monocytosis. Kidney and urinary tract... (Review)
Review
Chronic myelomonocytic leukemia (CMML) is a hematologic malignancy affecting the bone marrow and resulting in peripheral blood monocytosis. Kidney and urinary tract involvement is common and can present dramatically with life-threatening consequences. Kidney involvement can be the result of direct or indirect mechanisms, including prerenal azotemia, glomerular disease, tubulointerstitial involvement, and renovascular disorders. Urinary tract involvement, electrolyte and acid-base disorders, as well as nephrotoxicity from treatment of the disorder can also occur. Given this multifactorial pathogenesis involving several mechanisms concomitantly, nephrologists must exercise heightened awareness and maintain a low threshold for kidney biopsy. There is a pressing need for future research endeavors to elucidate and target the manifestations of CMML that involve the kidneys with the ultimate goal of augmenting overall prognosis and therapeutic outcomes.
PubMed: 38313809
DOI: 10.1016/j.xkme.2023.100769 -
Journal of Veterinary Internal Medicine 2010Hyperthyroidism complicates the diagnosis of chronic kidney disease (CKD) as it increases glomerular filtration rate. No practical and reliable means for identifying...
BACKGROUND
Hyperthyroidism complicates the diagnosis of chronic kidney disease (CKD) as it increases glomerular filtration rate. No practical and reliable means for identifying those cats that will develop azotemia after treatment for hyperthyroidism has been identified. Hyperthyroidism is associated with proteinuria. Proteinuria has been correlated with decreased survival of cats with CKD and with progression of CKD.
HYPOTHESIS
Proteinuria and other clinical parameters measured at diagnosis of hyperthyroidism will be associated with the development of azotemia and survival time.
ANIMALS
Three hundred client owned hyperthyroid cats treated in first opinion practice.
METHODS
Retrospective, cohort study relating clinical parameters in hyperthyroid cats at diagnosis to the development of azotemia within 240 days of diagnosis and survival time (all cause mortality). Multivariable logistic regression analysis was used to identify factors that were predictive of the development of azotemia. Multivariable Cox regression analysis was used to identify factors associated with survival.
RESULTS
Three hundred cats were eligible for survival analysis and 216 cats for analysis of factors associated with the development of azotemia. The median survival time was 417 days, and 15.3% (41/268) cats developed azotemia within 240 days of diagnosis of hyperthyroidism. Plasma concentrations of urea and creatinine were positively correlated with the development of azotemia. Plasma globulin concentration was negatively correlated with the development of azotemia. Age, urine protein:creatinine ratio, and the presence of hypertension were significantly correlated with decreased survival time. Urine specific gravity and PCV were significantly correlated with increased survival time.
CONCLUSIONS AND CLINICAL IMPORTANCE
The proteinuria associated with hyperthyroidism is not a mediator of progression of CKD; however, it does correlate with all cause mortality.
Topics: Animals; Azotemia; Cat Diseases; Cats; Female; Hyperthyroidism; Male; Retrospective Studies
PubMed: 20649748
DOI: 10.1111/j.1939-1676.2010.0550.x