Chinese Treatments for Kidney Damage

Kidney Function Restoration Program

You'll Learn: This Delicious Super Food Straight From Your Fridge is Loaded With Special Compounds that reverse free radical kidney cell damage. This food (freely available from a grocery store near you) has tremendous antioxidant activity. Antioxidants soak up and destroy free radicals. Free radicals are what cause much of the damage in inflammatory, degenerative and kidney diseases. The Popular Test Used By Korean Doctors which is barely used in America to check for potent kidney destroying toxins. Ridding your kidneys of these toxins is very easy but you first have to discover if you have them. The Essential Fatty Acid has shown in hundreds of people through multiple studies to put out inflammation and correct heart complications seen in kidney disease. This Miracle Nutrient Featured in the prestigious medical Journals of Nephron, Clinical and Experimental Nephrology, Renal Physiology and other double blind studies to produce significant results in reversing kidney problems, lowering blood pressure and study participants reported a boost in energy and focus. This Naturally Occurring Amino Acid Discovered by Russian scientists in the 1920s and published in over 100 studies worldwide has shown to slow down and possible stop kidney disease, improve your red blood cells (which are malfunctioning in renal disease), and increase mood and decrease fatigue. The National kidney Disease Foundation recommends suffers of renal disease get tested and supplement their diet with this nutrient. But very few medical professionals are actually doing this. The Delicious Tropical Fruit that is cultivated in the Caribbean, South America, Asia, Australia and parts of Africa that is toxic and poisonous to an injured kidney. If you have any decrease in kidney function you must stay far away from this fruit that is abundant in the spring and summer seasons. Continue reading...

Kidney Function Restoration Program Summary

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An Unconventional Emerging Heart Risk Factor Kidney Disease

Even mild kidney damage increases your chances of having a heart attack or stroke, or dying from one of these. And heart disease may be a warning sign that you have problems with your kidneys. Although the kidneys are tough, resilient workers, they aren't indestructible. Years of elevated blood pressure can damage them. Blood flow impeded by cholesterol-narrowed arteries causes problems in the kidneys, as do the high blood sugar and artery damage that accompany diabetes. In fact, the duo of high blood pressure and diabetes causes almost two-thirds of cases of kidney damage. Infection and inflammation account for most of the rest. T7_ Kidney damage usually goes unnoticed until it's too late. By the time symptoms such as fatigue, poor appetite, weight loss, and itching appear, little healthy kidney remains. At this point, it may be necessary to start dialysis, essentially having a machine filter the blood three times a week. Doctors use several yardsticks to measure kidney health. If...

Definition of Chronic Kidney Disease

Chronic kidney disease (CKD also chronic renal failure or chronic renal insufficiency) is broadly defined as a decrease in renal function that precedes end-stage renal disease (ESRD). ESRD is a diagnosis that implies dependence on renal replacement therapy in the form of either dialysis or transplantation. The pathophysiology of the disorder is related to the irreversible loss of nephron units caused by a wide array of insults, with Each kidney contains approximately one million nephrons whose function is to filter and excrete wastes and to regulate water, acid-base, and electrolyte homeostasis. Daily, the adult kidneys must perform this task on an average of 170-200 L of blood that arrives via the renal arteries. As nephrons are lost, the capacity to regulate electrolytes and acid-base balance is progressively impaired. Clinically observable renal dysfunction occurs when the number of healthy nephrons decreases by 50-60 . Some compensation for these defects occurs in the early stages...

Dialysis and Hemoperfusion

Dialysis is the process in which the blood is circulated through a bath in which a semipermeable membrane separates the components of the blood from the constituents of the dialysis fluid (Figure 3.1). In dialysis the various substances in blood will diffuse across into the dialysis bath provided that they are small enough (low molecular weight) to transit the membrane and their concentration is lower in the bath than in blood. Many factors relate to the potential effectiveness of dialysis. Tissue binding of the toxin, high volume of distribution for the toxin, and high molecular weight are three factors which diminish the efficacy of dialysis. Lithium, methanol, isopropanol, salicylates, theophylline, and ethylene glycol are examples FIGURE 3.1 Dialysis. Dialysis can be conducted with an external bath, in which case it is known as hemodialysis. It can also be carried out in the patient's peritoneal cavity (peritoneal dialysis). The latter form is easier to set up and does not require...

Chemistry and Hematologic Abnormalities in Chronic Kidney Disease

In contrast to acute renal failure (see Case 5), in which physical signs and symptoms related to fluid overload can be obvious, CKD develops insidiously and laboratory methods are essential for identifying the process so that interventions to arrest the decline in function can be made before frank uremia develops. The earliest change observable in the laboratory is usually urinary protein excretion. Increased serum creatinine and urea appear somewhat later, but can likely be detected in preclinical CKD in some cases. Because serum creatinine values are dependent on factors such as sex, age, and race, equations such as the MDRD equation have been proposed to estimate GFR when changes in creatinine values may not seem significant. Electrolyte abnormalities, acidosis, and hematological abnormalities such as anemia are almost never the initial findings of CKD in patients who are receiving adequate routine care by physicians. cystatin C. Incidentally, measurement of serum cystatin C has...

Kidney Disease

In kidney disease, the kidneys lose their ability to filter enough waste products from the blood and to regulate the body's balance of salt and water. Eventually, the kidneys slow their production of urine or stop producing it completely. Kidney disease can cause waste products to build up in the blood and insomnia or RLS often occur. Severe cases of kidney disease are treated with dialysis or a transplant, but this does not always return sleep to normal. When sleep problems persist, medication for insomnia or RLS may be needed.

Strategy and Selection of Drug Therapy139

The coexistence of hypertension and diabetes dramatically and synergistically increases the risk of microvascular and macrovascular complications. Overwhelming evidence supports aggressive treatment of hypertension in diabetic patients. Tight blood pressure control is cost-effective and is more rewarding than glycemic control. The optimal goal of blood pressure control in diabetics should be 130 80 mm Hg. In subjects who have diabetes and renal insufficiency, the blood pressure should be lowered to 125 75 mm Hg to delay the progression of renal failure. The choice of an antihypertensive agent should be based on proven effects on morbidity and mortality rather than on surrogate parameters, such as lipid or glucose. Limited data suggest that an angiotensin-converting enzyme (ACE) inhibitor is the agent of choice, especially in those who have proteinuria or renal insufficiency. b-Blockers can be the first-line agent in diabetics who have coronary heart

Reference Interval SI Units

Rapid rise in serum levels of urea nitrogen and creatinine and developing stability of hemoglobin, hematocrit, and thrombocyte values, together with barely elevated reticulocyte count, turned attention away from the hematological findings and focused it on acute renal failure. and the possibility of plasma exchange. A second consultant thought that acute renal failure secondary to acute tubular necrosis (ATN) was more likely and that anemia and thrombocytopenia were probably due to marrow suppression secondary to the infectious process. The pathologist also felt that TTP was unlikely and thus recommended against plasma exchange. Dialysis was started, and laboratory results reported on the fifth day were as follows Over the next several days the hematological picture improved spontaneously hemoglobin rose to 12 g dL (7.45 mmol L), hematocrit to 36 (0.36), and platelet count to 191 x 103 mL (191 x 109 mL). Serum electrolytes, acid-base values, and urea nitrogen, determined during this...

Oliguria with Metabolic Acidosis after Renal Transplantation

A 37-year-old white male with end-stage renal disease and on chronic hemodialysis presented 10 days after receiving a 1 B locus, 2 DR locus mismatch for a three of six HLA antigen mismatched kidney transplant (see section on HLA matching below). The kidney functioned within the first 48 hours with good urine output and a rapid decline of serum creatinine to 1.5mg dL (133 mmol L) and urea nitrogen to 23mg dL (8.2 mmol urea L). The patient had been placed on routine antirejection prophylactic therapy consisting of a calcineurin inhibitor and mycophenolate mofetil.

Pathophysiology of Nephrotic Syndrome

It is important to differentiate between the terms nephrosis and nephritis. Nephrosis is a clinical disorder defined by the following (1) proteinuria, (2) hypoalbuminemia, (3) peripheral edema, and (4) hyperlipidemia. In contrast, nephritis is a pathologically defined process involving inflammation in the kidney. It is possible (although not the case for the patient described here) that a patient could be nephrotic because of glomerulonephritis that causes significant urinary protein loss. Thus, nephritis and nephrosis are different, but not mutually exclusive, diagnoses. The symptoms of nephrosis represent an appropriate physiological response to abnormal circumstances within the body. For example, fluid retention and edema result from an alteration in the normal balance of hydrostatic and oncotic forces in the vascular space. Even under normal circumstances, the capillary wall is not watertight. Fluid is extruded from the proximal part of the capillary but is drawn back in by a...

Selection and Interpretation of Laboratory Results

Laboratory tests in nephrotic patients have four purposes to establish the clinical syndrome, to evaluate renal function, to define the underlying etiological process as well as possible, and to monitor the effects of therapy. In the present case, the protein loss proved to be urinary, as indicated by the positive urine dipstick test that was confirmed by the turbidemetric sulfosalicylic acid test. The amount of proteinuria in glomerular disease (including both nephrosis and nephritis) represents the filtered load from the glomerulus minus the protein reabsorbed by the renal tubule. It is usually fairly constant throughout the day and is thus called fixed proteinuria. In contrast, the absolute amount of protein excreted in other conditions may vary throughout the day. Since protein determination by dipstick reflects concentration and is affected by urine Decreased renal function in nephrotic patients at initial presentation, as indicated by high serum creatinine and serum urea...

Pharmacoeconomics and the regulatory process

The pharmacoeconomic considerations may also play a role in determining whether a biopharmaceutical reaches the market. This is especially true now with the focus on the cost of the health care system. Even if a product is proven effective, the FDA may consider the question whether it is effective from a cost-efficiency standpoint as well. Pharmacoeconomic considerations contributed significantly to the reluctance of the FDA to approve Centocor's expensive centoxin for septic shock.103 In contrast, another expensive product, erythropoietin, pays for itself because a number of dialysis patients can return to work.104 Uncertainties of the regulatory process suggest that a company should not base its fortune on one blockbuster drug. Another dimension to the economics is that once a drug is approved, significant off-label uses are discovered.103 104 The prices of biotechnology products are market driven, with the price controlled by the product efficacy and its competitiveness with...

Intracellular calcium levels Decrease myocardial apoptosis post reperfusion

Therapy and control of hyperglycemia also improves outcomes in critically-ill patients in whom withdrawal of sulfonylureas was not a significant factor 42 . Continuous infusion of intravenous insulin to maintain a blood glucose level that was at or less than 110 mg dL reduced death, septicemia, and renal failure in a predominantly non-diabetic Belgian population of surgical patients who were mechanically-ventilated and critically ill. Aggressive glucose control also reduced complications in diabetic patients who were undergoing cardiac bypass surgery 43-44 and reduced target vessel revascularization in diabetics who were undergoing percutaneous revascularization 45 . Glycemic control also is associated with a decreased risk for congestive heart failure in DM 46 .

Mushrooms Producing Orellanine

Orellanine is exclusively found in mushrooms of the genus Cortinarius (C. orellanus, C. speciocissimus). Orellanine is absent from C. splendens, although in a few cases of intoxication from this mushroom the symptoms developed were typical for orellanine poisoning (renal failure). The content of orellanine was determined as ca. 14 mg g dry weight in C. orellanus, and 9 mg g dry weight in C. speciocissimus. Toxicity of the medium-sized, fox-colored Cortinarius mushrooms remained undetected until 1952, when in Bydgosz (Poland) 102 persons fell ill after ingestion of C. orellanus, with 11 of them dying from renal failure 4 to 16 days after the meal (Grzymala, 1965). Remarkably, a similar collective poisoning with C. orellanus was reported from France, with 26 persons involved but no fatalities (due to timely intermittent dialysis) (Bouget et al., 1990). Lethal doses of orellanine are known for the mouse only, corresponding to 15 to 20 mg kg body weight for intraperitoneal, and 33 to 90...

Longterm Diabetes Complications As Used For Defining Diabetes Thresholds

Diabetes mellitus is characterised by hyperglycaemia, which is associated with long-term damage, dysfunction and failure of various organs. Several studies30,31 have confirmed relationships between hyperglycaemia and the risk of developing such micro- and macrovascular complications as retinopathy, neuropathy, nephropathy and cardiovascular disease. However, many have compared the rates of each condition in subjects already classified according to the diagnostic criteria as having diabetes or not. Few studies consider whether the current diagnostic glucose levels represent the best level for predicting an increased risk of such complications, and no formal statistical threshold for any complication has been consistently demonstrated. Using Receiver Operating Characteristic (ROC) curves, it is possible to determine the value of a diagnostic test which provides maximum sensitivity and specificity for predicting the occurrence of a given complication associated with diabetes32. A ROC...

Definition of Disease

Renal osteodystrophy is the term used to describe the abnormalities of the skeleton that can occur in association with chronic kidney disease. A wide spectrum of skeletal abnormalities may be seen in this setting, which range from high-turnover bone disease due to secondary hyperparathyroidism, known as osteitis fibrosa in its severe form, to the opposite end of the spectrum of bone turnover, where it can be excessively low and give rise to a skeletal abnormality known as adynamic bone disease. Some patients may also have mineralization defects in the skeleton, which may be manifested as osteomalacia. In many patients, there is evidence of both high bone turnover together with mineralization defects of bone, and this is termed mixed renal osteodystrophy. Abnormalities of the skeleton are extremely common in patients with advanced kidney diseases, even in the absence of symptoms, and symptomatic bone disease in this patient population is relatively unusual nowadays. It is important to...

Differential Diagnosis

There are several considerations in this patient that could account for her symptoms. The initial consideration is that she had hyperparathyroid bone disease, as a result of secondary hyperparathyroidism. In this regard, measurements of intact PTH had ranged within 300-400 pg mL, which is clearly above the normal interval for these PTH assays, in which the upper limit of normal would be approximately 65 pg mL. While at first glance this may indicate severe hyperparathyroidism, it is important to note that in the setting of advanced chronic kidney disease, there is known to be skeletal resistance to the actions of PTH, and higher than normal concentrations of PTH appear to be required to maintain bone turnover. In recent times, clinical practice guidelines have been introduced for the control of the abnormalities of mineral metabolism in patients with chronic kidney disease, and it is recommended that intact PTH should ideally be maintained between 150 and 300 pg mL in order to...

Additional Reading

Eknoyan, G., Levin, A., and Levin, N. W. Bone metabolism and disease in chronic kidney disease. Am. J. Kidney Dis. 42 1-201, 2003. Gonzalez, E. A., Sachdeva, A., Oliver, D. A., and Martin, K. J. Vitamin D insufficiency and deficiency in chronic kidney disease. A single center observational study. Am. J. Nephrol. 24 503-10, 2004. Martin, K. J., Gonzalez, E. A., and Slatopolsky, E. Renal osteodystrophy. In The Kidney, 7th ed., B. M. Brenner, ed., Saunders, Philadelphia, 2004, pp. 2255-304.

Mushrooms Causing Gastrointestinal Disorders

Paxillus syndrome is a food allergy, not a true poisoning. As a consequence, some who eat the mushrooms will not develop symptoms. Symptoms may include colic, vomiting, diarrhea, oliguria or anuria, kidney pain, hemoglobi-nuria, and renal failure. A hemagglutination test has been used for confirmation (Bresinsky and Besl, 1990).

Case Study 1 Child Abuse or Mother Abuse

The child appeared close to death but was resuscitated with endotracheal intubation and bicarbonate. The commercial laboratory reported an ethylene glycol of 911 mg L at this time. A second commercial laboratory confirmed the finding of ethylene glycol. Despite treatment for ethylene glycol overdose (dialysis and ethanol infusions), the child's condition deteriorated and he expired 3 days later. One of the commercial laboratories also tested a baby bottle allegedly used by the biologic mother who visited the baby 3 days before the last hospitalization. When this bottle was positive for ethylene glycol the mother was arrested, incarcerated, and charged with first degree murder.

DEXA dualenergy Xray absorptiometry

Diabetes mellitus An illness caused by decreased production of insulin or by decreased responsiveness of tissues to it. Insulin, produced by the pancreas, lowers blood glucose levels, and diabetes is characterized by high blood sugar levels. Type I diabetes, also called insulin-dependent diabetes or juvenile-onset diabetes, affects younger people who need insulin injections to control it. Type II diabetes, also called noninsulin-dependent diabetes or maturity-onset diabetes, usually affects middle-aged, overweight people and can often be controlled by a special diet and tablets to lower the blood sugar. Well-known complications of diabetes include blindness caused by damage to blood vessels of the retina, kidney failure caused by damage to the glomeruli that filter urine, and an increased chance of developing infections. Diabetes is also associated with less well-known complications that can affect muscles, joints, and soft tissues.

Physical instability 321 Denaturation

Folding is determined by the amino acid sequence or the primary structure of the protein. Failure of a protein to refold often results when the protein has undergone chemical or conformational changes. This may occur when the primary structure of a protein has been altered because of chemical instability. Sometimes, a protein may fold but not to its correct native structure. Denaturants such as guanidine hydrochloride or urea, followed by dialysis, can be used to recover the native state of such a misfolded protein.2 A protein that exhibits reversible unfolding is typically small (< 30 kDa), dilute (< 1 mg ml), and highly charged to inhibit aggregation.5

Assessment and other issues

Normal variations in dietary intake of MMA do not affect plasma levels. MMA is excreted in the urine and is closely correlated with plasma concentrations. Plasma MMA levels rise in renal failure and in cobalamin deficiency but not in folate deficiency. Plasma concentrations rise from normal values of 0.10.4 mmol L to 50-100 mmol L in vitamin B12 deficiency. MMA in urine or plasma is a sensitive measure of absolute and or functional vitamin B12 deficiency, and is especially useful in the diagnosis of sub-clinical vitamin B12 deficiency in the elderly.

Food Allergy Symptoms

'Early allergy' (allergy Type I, II or III) may affect the mucous membrane of the oral cavity (OAS), the stomach (a surface or erosion-like mucous membrane inflammation), or the intestines (inflammatory changes of various degrees of intensity, from eosinophilic infiltration to ulceration or enteritis granuloma Caffarelli et al., 1998 ). Systemic manifestations may have a dramatic course, sometimes leading to death due to anaphylactic shock, which can develop in few minutes after food consumption. Early allergies may also affect internal organs, most frequently the upper respiratory tract (manifested as bronchial asthma). Delayed symptoms may affect the skin (nettle rash), joints (inflammations of single or numerous joints), muscles (myalgia), kidneys (nephrosis), and may also manifest as otitis media and recurrent pneumonia. They may also lead to changes in the central nervous system that cause character and mood changes, hypermotility or tiredness syndrome, headaches, 'chronic...

Learning from Endof Life Stories

Moments exist in medicine where the need for the human side dwarfs the need for technology and a statement that things have gotten a lot worse in the last week has more meaning than the kidney function is worse today. When patients, families, and physicians recognize that life is coming to an end, they fashion their decisions differently, often cease measures to support life, and concentrate on comfort. Together they often decide in advance not only what they should not do, but what will help. Reflecting on the meaning of these moments enhances our understanding of what is the essence of medical care for all patients and their families.

Golfers elbow See epicondylitis

Goodpasture's syndrome This is a rare, life-threatening autoimmune illness that causes lung hemorrhage and kidney failure. Ernest W. Goodpas-ture (1886-1960) first described the illness in 1919 when he was examining the lungs of patients who had died in the 1918-19 influenza epidemic and noted a new illness that affected the lungs and kidneys of one patient. In 1958, almost 40 years later, M. C. Stanton and J. D. Tange attached the name Goodpasture's syndrome to an illness that caused severe lung and kidney disease. In subsequent years

Answers and Discussion

Q3. (Answer a) From the half-life of methanol in the absence of dialysis (15 hours), one can calculate an elimination rate constant of 0.0459. In the formula for maximum serum level, therefore, k 0.049, t 20 hours, and C(init) 265 mg dL. Therefore, maximum concentration equals 664 mg dL.

Black fever See Rocky mountain fever

Blackwater fever Haemoglobinuric fever An acute disease of tropical regions characterized by intravascular haemolysis, haemoglobinuria and acute renal failure classically seen in European expatriates chronically exposed to Plasmodium falciparum. Symptoms include fever, vomiting and passage of red or dark-brown urine.

Ehrlichiosis human monocytic

Severe symptoms of the disease may include prolonged fever, kidney failure, meningoencephalitis, seizures, or coma. Between 2 percent and 3 percent of patients may die from the infection. While many of the symptoms overlap with Lyme, the HGE symptoms tend to peak very quickly, moving from health to severe debilitation in a few hours.

Definition of the Disease

Patients with ESRD, especially those on dialysis, can develop osteodystrophy with vastly differing histopathologic changes despite an initially common pathogenic pathway.1 Glomerular damage leads to retention of phosphate, while tubular injury reduces the production of 1,25(OH)2D3. Hyperphosphatemia further suppresses the production of 1,25(OH)2D3 and inhibits reabsorption in the kidney as well as absorption of calcium in the gut. Osteodystrophy is a result of the disruption and imbalance of complex High-turnover disease occurs as a result of decreased urine phosphate excretion secondary to renal insufficiency. Decreased excretion without decreased absorption ultimately results in hyperphosphatemia. This begins a cascade of events culminating in increased synthesis and release of PTH. Increased serum phosphate inhibits the activity of 1-a-hydroxylase, resulting in a decrease in 1,25(OH)2D3. 1,25(OH)2D3 stimulates intestinal absorption of biologically active ionized calcium. Decreased...

Is Disease Prevention Possible

Although p-cell function can be preserved and extended beyond the time of diagnosis, there is little realistic hope of restoring normal metabolic function at this stage of the disease. it is therefore logical to attempt p-cell rescue at an earlier stage when the p-cell mass is largely intact. Work done over the past 25 years has transformed our understanding of the sequence of events culminating in immune-mediated p-cell failure, but the average diabetes specialist is still in the position of a nephrologist unable to identify renal dysfunction until his patients present for dialysis. Some 90-95 of children with type 1 diabetes have (HLA) human leukocyte antigen genotypes conferring susceptibility to the disease, but only around 5 of those with the highest risk combination will develop diabetes in childhood. Prospective studies have shown that islet autoantibodies typically appear within the first three years of life3, although this should not be taken as dogma, and the influence of...

Fetus transmission to See transmission

Fibrates A class of drugs that are antihyperli-pidimics. Fibrates are fibric acid derivatives. These drugs work by speeding up the chemical breakdown of triglyceride-rich lipoproteins that circulate in the body. They are used in particular to lower levels of triglycerides, which they control better than the statin group of drugs. They are not very effective at reducing LDL cholesterol level or raising HDL cholesterol level. The most common side effects are stomach pain, bloating, and nausea. Liver enzyme levels can also become elevated, and a myositislike syndrome, especially in patients with impaired renal function, can occur. Decreased libido and impotence have occasionally been reported. Fibrates can increase the effect of medications that thin the blood, so their use should be monitored closely by the physician. See bezafi-brate ciprofibrate fenofibrate gemfibrozil.

Methods of Studying Sessile Prokaryotes

Novel techniques involving light microscopy include the use of submerged microscopy (Staley, 1971), capillary microscopy (Perfil'ev and Gabe, 1969), computer-enhanced image analysis (Caldwell and Germida, 1985), interference reflection microscopy (Fletcher, 1988), dialysis microculture (Duxbury, 1977), marked slides (Bott and Brock, 1970), soil films (Harris, 1972), transparent sections in tubular reactors to study biofilm development (Characklis, 1980), and light section microscopy to measure biofilm thickness (Loeb, 1980).

Prognosis and Treatment

Better recognition and earlier treatment have led to dramatic improvements in long-term survival.5 Survival rates of the initial metabolic crisis improved from 30 in the 1970s to better than 90 in the 1990s. The clinical course of the disease correlates mainly with response to vitamin B12. Patients with the mut0 phenotype are not responsive to vitamin B12 and have the worst prognosis. Nearly all of these patients suffer early death and severe developmental impairment. Patients with the mut2 or cblB phenotypes have an intermediate prognosis, with about half remaining well through their early teens. Patients with the cblA phenotype are very responsive to vitamin B12, and about 70 remain well into their teens. With increased survival, however, has come recognition of the long-term complications of the disease. The most common of these include growth and mental retardation, movement disorders related to the destruction of the basal ganglia, and chronic renal failure.6 Screening for...

Gayrelated immunodeficiency disease See gayrelated Immune Deficiency

Gemfibrozil A fenofibrate drug that is used to reduce triglyceride levels in patients. As can all fenofibrates, it can cause a rise in liver enzyme levels and possible myositislike syndrome, especially in patients with impaired renal function. In some people LDL level may rise when they are being treated with this drug. (Trade name is Lopid.)

Geographic variation 199

Gentamicin A broad-spectrum antibiotic of the aminoglycoside class that is derived from the fungi of the genus Micromonospora. Gentamicin is used to treat bacterial infections of the blood, central nervous system (meningitis), urinary tract, respiratory tract, digestive system, skin, bone, and soft tissue. In women living with HIV, gentamicin is used to treat PELVIC INFLAMMATORY DISEASE, a condition that develops when sexually transmitted infections such as chlamydia or gonorrhea are untreated. Gen-tamicin is available in a variety of forms, including topical cream, eye drops, ointment, and injectable solution. Gentamicin works by interfering with production of proteins in bacteria and ultimately kills them. It is relatively toxic compared to other antibiotics used for similar conditions and is used primarily when less toxic antibiotics are not effective or cannot be tolerated. Gentamicin works best when combined with drugs from other antibiotic classes. Standard gentamicin may be...

Medicare and Medicaid

Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines You are a kidney dialysis or kidney transplant patient. Medicare has two parts

When You Visit Your Doctor

(sound wave picture of the heart), or tests of thyroid or kidney function. Reduced pulses in the legs are often assessed by Doppler (sound wave) measurements or an equivalent noninvasive test. When these studies are completed and the lipid profile result has come back, your doctor is armed with the information needed to make recommendations about treating your lipid levels.

PDGFD Binds to the p PDGFR

What is the biological significance of having two P PDGFR ligands First, the specificity of the molecules for the two PDGF receptors is different. The ability of the PDGF-B chain and the inability of the PDGF-D chain to form both homodimers and heterodimers, along with the ability of PDGF-B chain to bind and activate a PDGFR leads to different receptor activation profiles. Second, differential regulation of P-receptor activation might also be mediated by differential affinities of each of the dimers for receptor binding. It is conceivable that PDGF-BB and PDGF-DD ligation of P PDGFR could result in combinatorial signaling outcomes if the binding affinity for receptor differed significantly between PDGF dimers. At present, the differences in signal transduction between PDGF-BB and PDGF-DD have not been elucidated at a biochemical level. Although studies in NIH-3T3 fibroblasts showed that PDGF-BB had a lower EC50 for induction of cell proliferation than PDGF-DD (3), recent data from...

What Is Metabolic Syndrome continued

This cascade of changes isn't healthy. Damage to artery walls, high triglycerides, and increased chance of blood clots can lead to heart attacks and some strokes. Changes in the kidneys' ability to remove salt contribute to high blood pressure, another path to heart disease and stroke. And dwindling insulin production by the pancreas signals the start of type 2 diabetes, which greatly increases the chances of having a heart attack or stroke, as well as nerve, eye, and kidney damage.

Why carbon monoxide is such a deadly killer

The long-term effects of carbon monoxide poisoning for victims who recover are less clear. Those who recover from exposure to high levels, especially if they have been unconscious, can suffer effects on the memory and the brain and heart which may last some time or even be permanent. Some victims may suffer heart attacks some time after apparent recovery or succumb to pneumonia, especially the elderly. Similarly, despite an apparent full recovery, some weeks after the poisoning the victim may suffer from effects on the brain (for example, encephal-opathy) which can cause symptoms similar to Parkinson's disease or personality changes (irritability, for example) which can persist for some time. Loss of short-term memory is common. Muscle damage sometimes occurs, which can lead to renal failure. This is because the breakdown products of the muscle are excreted into the urine and overload the kidneys. These effects are most likely in those who are victims of severe poisoning.

Case Study 2 The Dangers of Special Nutrients

At this time her blood pressure was low at 94 62, heart rate was elevated, and temperature slightly low. Sclera were icteric. Clinical findings plus laboratory data revealed a host of abnormalities including anemia, hemolysis, hepatic dysfunction, renal failure, and thrombocytopenia. Relevant laboratory data are This patient was finally discharged after 26 days of hospitalization with a final diagnosis of liver and renal disease due to chromium toxicity. One year after discharge her liver and kidney function were normal on the basis of serum biochemistry testing.

Role of renin angiotensin aldosterone system activation

Nephropathy nephropathy nephropathy CHF, congestive heart failure CV, cardiovascular LVH, left ventricular hypertension IDNT, Irbesartan Diabetic Nephropathy Trial MI, myocardial CHF, congestive heart failure CV, cardiovascular LVH, left ventricular hypertension IDNT, Irbesartan Diabetic Nephropathy Trial MI, myocardial

Acute Promyelocytic Leukemia

The most important complication of ATRA-based therapy is the retinoic acid syndrome (RAS), a cardiorespiratory syndrome manifested by dyspnea, pulmonary infiltrates, pleural or pericardial effusions, episodic hypotension, and occasionally acute renal failure. Initial studies in which ATRA was administered as a single agent for induction reported an incidence of approximately 25 . With earlier recognition, the mortality rate of the patients with this syndrome has declined from approximately 30 to 5-10 . Diagnosis can be difficult as the symptoms are nonspecific. The pathogenesis of the syndrome is not completely understood, but tissue infiltration is always observed in RAS. Myeloid precursors and mature granulocytes, presumably the differentiating ATRA-treated APL cells, infiltrate into several organs, due to changes in their adhesive capacity and cytokine production. The best treatment approach is early recognition and initiation of dexamethasone.7

What can be done for those who do not have a target lesion or recoverable myocardium

Preliminary evidence suggests that LVADs are cost effective by reducing hospital admissions and in some cases returning young patients to employment 34 . Multisite pacing and implantable defibrillators are already widely accepted despite their limited symptomatic benefit 74 . Blood pumps provide better symptomatic relief and further clinical trials are needed to determine the survival benefit conferred by safer devices. The future lies with yet smaller pumps, which can be implanted without major surgery in these high-risk patients. Although the economic implications of widespread LVAD use are substantial, other treatments for terminal illness already set the precedent. Hemodialysis is extensively used for maintenance treatment of renal failure patients irrespective of age, providing 60 2-year survival 75 .

Medroxyprogesterone 307

Medicare one of our country's two major government-run health insurance programs (the other is medicaid), Medicare is a nationwide health insurance program for people aged 65 years and over, persons eligible for Social Security disability payments for at least two years, and certain workers who need kidney transplantation or dialysis. Medical health insurance protection is available to eligible persons without regard to their income. Medicare consists of two separate programs hospital insurance (part A) and supplementary medical insurance (Part B). The programs are financed from payroll taxes and premiums paid by beneficiaries. Medicare monies are deposited in special trust funds for use in meeting the expenses incurred by the insured. The program was enacted on July 30, 1965, as title xviii of the social security act, Health Insurance for the Aged, and became effective on July 1, 1966. Eligibility for Medicare is fairly straightforward anyone who has been entitled to social security...

Nerve Conduction Tests

That latency divided by the distance between the stimulating and recording electrodes gives a conduction velocity (usually 40 to 50 m sec). This is a good indicator of the state of the myelin sheath around that nerve. The amplitude of the response (usually greater than 10 pV in a sensory nerve and greater than 4 mV in a motor nerve) is an indicator of the number of axons in that nerve. Therefore, this test is the single best way to distinguish axonal neuropathies, which are usually due to metabolic (diabetes, renal failure) or toxic (alcohol, drugs) causes, from demyelinating neuropathies, which are usually genetic or dysimmune (GBS, chronic inflammatory demyelinating polyneuropathy CIDP ).

Maximizing Survival Potential in Very High Risk Cardiac Surgery

The mean age and risk profile of patients referred for cardiac surgery is constantly increasing. Surgeons are now inclined to accept high-risk patients because interventional cardiology provides less invasive alternatives for an overlapping patient cohort. As risk profile increases so does hospital mortality. A survey of 8641 patients who underwent coronary artery bypass operations in New England showed an overall mortality of 4.48 , of which 65 could be directly attributed to postcardiotomy myocardial failure 1 . In the PURSUIT trial, which randomized patients who had coronary bypass and unstable angina to a glycoprotein Ilb IIIa inhibitor or placebo, the 7-day mortality or myocardial infarction rate was 22.3 in almost 700 patients in the control arm 2 . A collective review of 279 patients who had dialysis-dependent coronary bypass reported a 12.2 hospital mortality 3 . Similarly the Mayo Clinic Group reported a 14 perioperative mortality for patients who had aortic valve replacement...

Rett Syndrome Research Foundation RSRF A

There is no specific treatment corticosteroid drugs and mannitol infusions control brain swelling dialysis or blood transfusions may correct blood chemistry changes a ventilator may assist breathing. This type of supportive care has reduced the death rate to 10 or 20 percent. (See also national reye's syndrome foundation for address, see Appendix I .)

OV Statin See nystatin

Overdose A dose of a drug sufficient to cause an acute reaction, such as mania, hysteria, coma, or even death. While an overdose is often one that clearly exceeds the normal dosage range recommended by the manufacturer, the optimal dose of many drugs varies from person to person. What may be an average dose for most people may be an overdose for some and an underdose for others. Numerous factors such as age, body size, nutritional status, and liver and kidney function have

Ischaemia Reperfusion Injury

Therapeutic strategies aiming at the early reperfusion and thus re-oxygenation of the ischaemic area. Unfortunately, even after the successful reconstitution of blood flow, the ischaemic tissue faces a new challenge reperfusion injury (RI). RI is characterised by an excessive inflammatory response, and it has been reported for almost every organ system, with severe consequences for the functional and structural integrity of the tissue (Lehr et al. 1993). Despite effective reperfusion, some capillaries might remain ischaemic (no-reflow). Depending on the duration and the extent of the ischaemic event, this might lead to a definitive occlusion of capillaries (Manciet et al. 1994). A high rate of left heart failure is associated with the occurrence of RI and no-reflow after acute myocardial infarction (Ito et al. 1996). RI is responsible for the majority of tissue injury in lung transplantation (Ross et al. 2000). In addition, organ failure such as acute renal failure is frequently...

Diagnosis of the Acute Hepatic Porphyrias and the Cutaneous Porphyrias

When a patient presents with acute, recurrent abdominal pain without clear source, especially accompanied by neurological abnormalities such as mental status changes, seizures, and peripheral neuropathies, the possibility of one of the acute hepatic porphyrias should be entertained and evaluated by qualitatively screening a fresh, random urine specimen of the patient for PBG (not porphyrins). The qualitative screening test for PBG uses p-dimethylaminobenzaldehyde (Erhlich's reagent). Whereas the classic Watson-Schwartz test and the Hoesch test are still used by some clinical laboratories, the American Porphyria Foundation recommends a rapid semiquantitative Thermo PBG test kit.3 If the screen is positive, then therapy should be begun immediately and one should not wait for confirmatory quantitative analyses. Quantitative PBG and porphyrins can be tested on the same random urine specimen. Plasma PBG and porphyrins (qualitative and quantitative) can also be obtained if the patient is in...

Topical delivery of therapeutic peptides and proteins

Microdialysis is under evaluation for prediction of dermal pharmaco-kinetics. A microdialysis probe that functionally resembles a blood vessel is implanted under the skin (subcutaneous microdialysis concentric probe) or into the dermis (cutaneous microdialysis linear probe) and is perfused with a perfusion fluid. Following dialysis across the semipermeable membrane in the probe, the dialysate is collected and analyzed for the drug entering the skin and corrected by a probe recovery factor. Samples are protein free thus, analysis is easy.140 Microdialysis membranes with a high molecular weight cutoff are now available the technique works better with hydrophilic drugs and would thus be applicable for peptides and small proteins.

Personalized Medicine for a Renal Transplant Patient

A 35-year-old intellectually challenged African-American male was referred to the transplant clinic for pretransplant evaluation. The patient had end-stage renal disease (ESRD) due to tubular sclerosis. Tuberous sclerosis or tuberous sclerosis complex (TSC) is a rare, autosomal dominant disease that causes benign tumors to grow in the brain and other vital organs such as the kidneys, heart, skin, and eyes.1 It commonly affects the central nervous system and results in a combination of symptoms including seizures, developmental delay, skin abnormalities, and kidney disease. The incidence of TSC has been cited to be 1 in 10,000 with 50-84 of the cases being sporadic.2,3 TSC is caused by mutations in one of two tumor suppressor genes (TSC1 and TSC2).4 Although a peripheral lymphocyte genetic test exists for mutations in TSC1 and 2, TSC is still diagnosed primarily by a careful clinical exam along with computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. Some of the...

Noninsecticidal Organohalide Pesticides

Although the toxic effects of 2,4,5-T may even be somewhat less than those of 2,4-D, observations of 2,4,5-T toxicity have been complicated by the presence of manufacturing by-product TCDD. Experimental animals dosed with 2,4,5-T have exhibited mild spasticity. Some fatal poisonings of sheep have been caused by 2,4,5-T herbicide. Autopsied carcasses revealed nephritis, hepatitis, and enteritis. Humans absorb 2,4,5-T rapidly and excrete it largely unchanged through the urine.

Reproductive decisionmaking 421

Renal failure Failure of the kidneys or the surrounding region. Acute renal failure may be due to trauma any condition that impairs the flow of blood to the kidneys certain toxic substances bacterial toxins glomerulonephritis or acute obstruction of the urinary tract. Treatment includes specific therapy for the primary disease and either peritoneal dialysis or hemodialysis.

Practical considerations

Relative risk of the development or progression of nephropathy, retinopathy, and autonomic and peripheral neuropathy during the average follow-up of 7.8 years in the intensive therapy group, as compared with the conventional therapy group. (From Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003 348 383-93 with permission. Copyright 2003 Massachusetts Medical Society.)

Mechanisms of Renal Damage in Plasma Cell Dyscrasias An Overview

AAmyloidosis Center, Biotechnology Research Laboratories, Fondazione, IRCCS Policlinico San Matteo and Department of Biochemistry, University of Pavia, Pavia, bDepartment of Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy The kidney is a target organ in plasma cell dyscrasias. Usually the offending molecules are the monoclonal light chains (LCs), but the complete immunoglobulins can participate in the pathogenesis of organ damage. The primary structure of the monoclonal proteins is at the basis of the ultrastructural organization of their aggregates which translates into characteristic kidney injuries. The kidney targeting is due to the concurrence of several factors such as the local catabolism of monoclonal LCs, specific interactions of the monoclonal proteins with tissue and cellular components, and local environmental conditions. Glomerulopathy LCs interact with mesangial cells producing, through two distinct pathways, LC amyloidosis or monoclonal immunoglobulin...

Box 345 Organizations

There are many other places that you can turn to for information. An Internet search finds organizations such as the Alliance of Genetic Support Groups, the March of Dimes, and the National Organization for Rare Disorders. Some individuals who are trying to take an active role in communication about disorders in their families have established Web pages that present information or reach out to others with similar problems. There are several ways to locate an organization that provides information or support relative to a particular disease. For many different diseases, organizations raise funds for research, provide support groups, and provide information about the disease. One example is The Foundation Fighting Blindness, which supports research, carries on educational programs, has local chapters throughout the country, and holds national meetings attended by patients, family members, caregivers, and educators who want to understand more about forms of retinal degeneration, such as...

Prognostic Values Of Endothelial Progenitor Cells

The prognostic value of EPCs is not limited to chronic or acute cardiac dysfunction cerebrovascular diseases have been associated with a decreased number of circulating EPCs 113 hypertension was found to cause impaired EPC migration 109 -whereas pulmonary hypertension could be alleviated by transplantation of EPCs in an animal model 114 EPCs in diabetes mellitus type I and II patients have defects in proliferation and vascular tube formation 115, 116 and, chronic renal failure also leads to reduced EPC numbers, a deficit that is directly related to the elevated risk of cardiovascular disease in those patients 117 .

Keep Taking the Medicine There are No Safe Drugs Only Safe Ways of Using Them

10. 'FDA warns consumers to discontinue use of botanical products that contain aristolochic acid', FDA website (ii Apr. 2001) (http vm.cfsan.fda.gov dms addsbot.html) J. Kelly, 'Chinese herb leads to kidney failure, cancer', WebMD Medical News Archive website (7 June 2000) (http my.webmd. com content article 36 1728_58270)

Motivation of wtl suppressor function

The inactivation of wtl function may be seen as a consequence of genetic abnormalities of the gene. It is believed that up to 10-15 of Wilms' tumours may carry point mutations (Coppes et al., 1993 Gessler et al., 1994). Mutations occur in the coding sequence of the gene, but not in the wtl promoter (Grubb et al., 1995). Somatic mutation appears to be an early event. Nephrogenic nests are regarded as the precursors of Wilms' tumour. In two cases of Wilms' tumour where a somatic mutation was detected, an identical mutation has been found in the nephrogenic nests (Park et al., 1993). It has been reported that > 95 of Denys-Drash syndrome patients carry wtl mutations (Coppes et al., 1993). These occur in the zinc finger domain of wtl. Patients with Denys-Drash syndrome who develop Wilms' tumour, suffer from renal failure and show male pseudohermaphroditism and gonadal dysgenesis. These mutations totally abolish the DNA-binding ability of wtl protein (Little et al., 1995).

Toxicological And Carcinogenetic Effects Of CrIII

Chronic use of Cr picolinate has been reported to cause nephrotoxicity in humans if ingested in excess 22 . The patient, a 33-year-old woman, had ingested Cr picolinate 1200-2400 g d for 4-5 months to enhance weight loss. She had Cr plasma concentrations 2-3 times greater than the normal values and was presented with weight loss, anemia, thrombocytopenia, hemolysis, liver dysfunction (aminotransferase enzymes 1520 times normal, total bilirubin 3 times normal), and renal failure (serum creatinine 5.3mg dL blood urea nitrogen 152mg dL). All of these parameters returned to the normal values after she stopped consuming Cr picolinate for one year 22 .

Studies examining nonglycemic therapies

Finally, several studies will examine the role of lipid management in particular clinical situations common in patients who have diabetes mellitus, such as the SPARCL study (Stroke Prevention by Aggressive Reduction in Cholesterol Levels), which will evaluate the effects of atorvastatin in the setting of transient ischemic attack 39 , and the SHARP study (Study of Heart and Renal Protection), which will examine the effect of simvastatin versus simvastatin ezetimibe combination therapy in dialysis patients 40 .

Fetal Response To Maternal Hypoparathyroidism

Maternal hypoparathyroidism in human pregnancy has been associated with the development of intrauterine, fetal hyperparathyroidism. This condition is characterized by fetal parathyroid gland hyperplasia, generalized skeletal demineralization, subperiosteal bone resorption, bowing of the long bones, osteitis fibrosa cystica, rib and limb fractures, low birth weight, spontaneous abortion, stillbirth, and neonatal death (2). Similar skeletal findings have been reported in the fetuses and neonates of women with pseudohypoparathyroidism, renal tubular acidosis, and chronic renal failure (2). These changes in human skeletons differ from what has been found in animal models of maternal hypocal-cemia (discussed previously), in which the fetal skeleton and the blood calcium is generally normal.

Therapeutic window therapeutic ratio

Thiazide diuretic One of a group of related chemicals that stimulate secretion of urine, resulting in loss of water from the body a diuretic. Thiazides are used to treat swelling due to congestive heart failure or chronic liver or kidney disease. Brand names vary as per different types bendromethiazide, hydrochlorothiazide, hydroflumethiazide, chlorothiazide,

Trimethoprimsulfamethoxazole Tmpsmx A

First-line combination drug for Pneumocystis carinii pneumonia prophylaxis and treatment. Possible side effects include skin rash, pruritus, cytopenia, liver abnormalities, and gastrointestinal upset. This commonly used combination antibiotic has a variety of interactions and toxicities that need to be monitored. The most common side effect associated with the sulfa component is a skin rash, usually allergic in nature, which on rare occasions spreads to other body surfaces and becomes the life-threatening Stevens-Johnson syndrome. It is also known that the drug can increase the skin's sensitivity to ultraviolet light, so excessive exposure to the sun should be avoided while taking it. Common drugs that have been reported to interact with TMP SMX's liver effects include Coumadin (an anticoagulant) and Dilantin (an anticonvulsant). Elevated potassium levels sometimes also occur when on TMP SMX. High potassium may lead to abnormal heart rhythms and contractions. In the presence of kidney...

Science and Technology

With advances in molecular biology and biotechnology, which allows for the identification of new clinical molecular targets, newer pharmaceutical agents are being identified that act at these novel molecular sites in an attempt to ameliorate the disease condition. Moreover, new therapeutic approaches are being developed (e.g., gene therapy and biotech products) that present new challenges to the safety pharmacologist. Inherent in the novelty of new targets and new approaches is the risk of unwanted effects that may or may not be detected based on current scientific knowledge and techniques. The scientific challenge facing safety pharmacology is to keep pace, to adapt, and to incorporate new technologies in the evaluation of new drugs in non-clinical models and identifying the effects that pose a risk to human volunteers and patients. Recent examples include safety embracement of modern electrophysiological techniques to evaluate the effects of NCEs on ionic components of the cardiac...

Stem and Progenitor Cells in Allogeneic Transplantation

The lifelong use of immunosuppressive drugs is associated with numerous complications, including poor wound healing, opportunistic infections, drug-related toxicities, skin malignancies, low-grade lymphomas (called post-transplant lymphoproliferative disorders), and end-organ toxicity, including renal failure.73

LEspecific immunomodulation

SLE is a disease of unknown etiology characterized by a number of immune abnormalities including the formation of diverse antibodies to a number of nuclear and other cellular antigens. The presence of anti-double-stranded (ds) DNA antibodies is virtually diagnostic of this disease and rarely occurs in other conditions (Emlen et al., 1990). High-avidity IgG autoantibodies to anti-dsDNA are seen mostly in patients with nephritis and may correspond with, or predict changes in, disease activity (Aarden et al., 1976 Swaak et al., 1979 Linnik et al., 2005). handled properly and, instead, localize to organs such as the kidneys. This results in various degrees of cellular proliferation, inflammation, and fibrosis leading in some patients to renal failure. Numerous clinical studies have investigated anti-dsDNA antibodies and their relationship to flare and lupus nephritis. Experiments in mice have confirmed the association between anti-DNA antibodies and lupus nephritis Administration of these...

Endourology and Laparoscopic Surgery

The buzzword in all surgical specialties nowadays is minimally invasive. In urology, there is a similar effort to develop techniques by which surgeons can operate on the genitourinary system without actually opening the pelvic cavity. Endourol-ogy includes advanced training in laparo-scopic urologic surgery, percutaneous kidney surgery, and ureteroscopy. La-paroscopy is still relatively new to the urology world, and not all training programs afford residents enough experience to

Symptoms of Alcoholic Liver Disease

Ascites Ascites in alcoholic cirrhotics is due both to obstruction of hepatic lymphatic flow and to avid renal retention of sodium. Sodium retention arises because of marked peripheral vasodilation with a hyperdynamic circulation, high cardiac output, and low peripheral vascular resistance this situation leads to contraction of the central plasma volume.10 Spider angiomata and palmar erythema are probably manifestations of the peripheral arterial vasodilation. Reduced renal blood flow stimulates renin and aldosterone production, and despite total body sodium overload, very little sodium is excreted. Because renal cortical blood flow is maintained by prostaglandins, nonsteroidal anti-inflammatory drugs (such as ibuprofen), which inhibit cyclo-oxygenase, can lead to functional renal failure (the so-called hepatorenal syndrome) and exacerbation of sodium retention, and thus cause or worsen ascites.

Evaluation and Further Testing

Renal Artery Stenosis Doppler Ultrasound

N Diffuse changes e.g., renal failure, undetermined renal disease. Ultrasound is jj usually the primary imaging modality for evaluating these cases. Generally the -q process can immediately be classified as interstitial, glomerular, or atrophic on A n Indeterminate chronic renal disease Besides routine medical and serologic tests, special nephrologic procedures are used that include ultrasound-guided percutaneous renal biopsy. The most common cause of renal failure in a general hospital setting is diabetic nephropathy.

Role of PDGFD in Various Nephropathies

P PDGFR has recently been implicated in the pathogenesis of various kidney diseases. Various agents that inhibit P PDGFR signaling either by interfering with ligand binding to the receptor or inhibiting downstream signaling of the receptor have shown activity in various preclinical in vivo models. Perhaps the greatest evidence for a role of P PDGFR agonists in nephritis is seen in mesangioproliferative nephropathies, which include IgA nephritis. IgA nephritis is characterized by a process whereby patients are thought to exhibit a strong response of their IgA system to an antigenic challenge to a pathogen. Recent data point to a role for IgA-hinge region hypoglycosylation in the pathogenesis. It is thought that the hypoglycosylated IgA is preferentially deposited in the glomerular mesangium (39), whereupon it activates complement and a subsequent induction of an inflammatory response and concomitant mesangial cell proliferation and matrix deposition. The mesan-gium plays a crucial role...

Peripherally inserted central catheter PICC line

Peritoneal dialysis Dialysis (passing solute through a membrane) in which the lining of the peritoneal cavity is used as the dialysis membrane. Dialyzing fluid introduced into the peritoneal cavity is allowed to remain there for one or two hours and is then removed. The procedure may be repeated as often as indicated. The use of strictly sterile instruments helps prevent the development of peritonitis. Three related types of dialysis are intermittent peritoneal dialysis (performed using automated equipment), continuous cyclic peritoneal (treatments are performed every night with fluid remaining in the cavity until the next night), and continuous ambulatory peritoneal dialysis (a type of maintenance dialysis that uses an implanted peritoneal catheter).

There are No Safe Drugs Only Safe Ways of Using Them

The widespread use of phenacetin brought about a change in the way the drug was perceived and eventually used. It became more of a confection, so much so that people would take phenacetin powders regularly and prophylactically. They would give it, like a sweet, as a 'present' to friends. The nature of phenacetin as a potentially dangerous drug was temporarily forgotten. The widespread use of this drug resulted in the appearance of adverse effects, in particular damage to the kidneys. Although this was never proven to be solely due to phenacetin, rather than the combinations of drugs often taken which included phenacetin, the latter drug was the common denominator and so became associated with the adverse effect of 'analgesic nephropathy'. This paved the way for the reintroduction of paracetamol. It was found that in the body both antifebrin and phenacetin were changed mainly to paracetamol and that this was responsible for the therapeutic effects. Consequently paracetamol was...

Complications Of Heparin Therapy

Given to patients with renal insufficiency,34,35 but it has the disadvantage that with prolonged use antibodies develop and some of these can have serious deleterious effects, including anaphylaxis.40,41,42 Argatroban is primarily excreted by the kidney so that it cannot be used in people with severe renal failure but it can be used in patients with significant hepatic insufficiency.34,35,36 Both agents can be used in conjunction with vitamin K antagonists but it should be noted that argatroban by itself increases the INR beyond that observed with warfarin alone and this must be taken into account in controlling the vitamin K antagonist.37 The alternative antithrombotic agents should be continued until the platelet count is at least back to 100 x 109 L and or the INR is therapeutic for two consecutive days.34 Danaparoid has been used in the past but is no longer available for many countries. The pentasaccharide fondaparinux has been used as an alternative antithrombotic agent in HIT...

Detection of antiphospholipid antibodies aPL in dermatology

Of major concern is the problem of patients presenting with isolated livedo reticularis and aPL. Some of them are prone to develop ischemic cerebral events over years, as illustrated by our above-mentioned experience of Sneddon's syndrome (Frances et al., 1999). Low-dose aspirin is frequently prescribed in such patients for prevention of strokes, but its effectiveness is doubtful. These patients require careful investigation in order to detect possible latent APS-related organ involvement such as silent brain infarcts on MRI, heart valve lesion, or even APS nephropathy (in cases where there is systemic hypertension and or abnormal renal function tests). The results of these investigations may prompt the institution of warfarin therapy, eg. when a silent brain infarct is found, or lead to its empirical use (Khamashta, 2000).

Diagnostic investigations and differential diagnoses

When cutaneous signs are associated with general symptoms and or other organ or system involvement of vasculitis, differential diagnoses are primarily other systemic diseases, like systemic lupus erythematosus, and secondary vasculitides, attributed to infections, neoplasia, hematologic malignancies or drugs. Indeed, many drugs have been reported to be potential causative agents of vasculitis (Table 5). Differential diagnoses of isolated purpuric lesions are numerous and relatively easy to make (thrombotic and or thrombocytope-nic purpuras idiopathic thrombocytopenic purpura, disseminated intravascular coagulopathy, thrombopathies vascular purpuras, with exclusion of vasculitides Ehlers-Danlos disease, scorbut, amyloidosis, Bateman's purpura, etc.). Embolic or atheromatous thromboses should also be ruled out when confronted with isolated distal necrosis or necrotic purpura. McDuffie's hypo-complementemic urticarial vasculitis is a rare systemic disease, characterized by the presence...

Vitamin K status and health 3211 Adults

The first intervention study to look at the influence of vitamin K on bone strength was published by Akjba et al (1991) who recruited 17 dialysis patients losing bone mass due to renal insufficiency. They supplemented the patients with 45 mg vitamin K2 for 1 year and measured bone mass at different points on the skeleton. They found loss of bone was reduced in the vitamin K group. The findings were confirmed in subsequent studies by Orimo et al (1992) who carried out a placebo-controlled trial studying 546 patients with osteoporosis to whom they gave either 45mg vitamin K2 or 1 mg 1-a-hydroxy vitamin D3 for 48 weeks. Arm BMD increased by 2.1 in the vitamin K group but decreased by 2.4 in the vitamin D group (P < 0.001) no difference in vertebral BMD was found. A more recent study reported that 45mg vitamin K2 or placebo given for 2 years to 241 osteoporotic women increased BMD and significantly reduced occurrence of new fractures (14 in the vitamin K vs. 35 in the placebo group)...

Differential Diagnosis of Metabolic Acidoses

In normal anion gap metabolic acidosis (also known as hyperchloremic metabolic acidosis), the loss of bicarbonate is equal to the increase in serum chloride concentration. The most common causes of this type of metabolic acidosis are diarrhea, early renal failure, hypoaldosteronism, and renal tubular acidosis. Other less common causes include carbonic anhydrase inhibitor use and ureteral diversion surgery. In increased anion gap metabolic acidosis, there is typically an increase in unmeasured anions related to the acid that produces H+, causing the acidemia. The most common causes of increased anion gap metabolic acidosis are lactic acidosis, ketoacidosis (due to diabetes mellitus, starvation, or alcohol) and chronic renal failure. Ingestions of toxic substances are less common causes, but important differential diagnostic considerations. Aspirin and toxic alcohols, including methanol and ethylene glycol, are the most common culprits. Isopropanol, while considered a toxic alcohol,...

Agents targeting Tcells

Since T-helper cells may contribute directly to cutaneous tissue damage in LE by stimulating both macrophages and cytotoxic, specific inhibition of the T-helper cells using anti-CD4 was considered as a suitable approach to suppress disease activity (Owen and Harrison, 2000). Therefore, a recombinant chimeric CD4 monoclonal antibody (cM-T412) was investigated in clinical trials for its efficacy in the treatment of LE (Prinz et al., 1996). Treatment of five patients with chronic discoid LE including two patients with systemic involvement resulted in an immediate improvement in the skin lesions. Moreover, proteinuria as an index of lupus nephropathy was fully resolved and the antibody was well tolerated. Further controlled clinical trials are required to prove these very promising though preliminary results.

Diagnostic investigations

Systemic Sclerosis Mouse Skin Score

In patients with acute or chronic renal failure, the acute onset of induration involving the upper and lower limbs may herald a nephrogenic fibro-sing dermopathy (Swartz et al., 2003). No effective treatment has been found, yet. No histocompati-bility antigens or laboratory abnormalities were shown to be consistently associated with this condition. Histology detected the presence of smooth muscle actin-positive myofibroblasts. Swartz, R.D., Crofford, L.J., Phan, S.H., et al. 2003. Neph-rogenic fibrosing dermopathy a novel cutaneous fibrosing disorder in patients with renal failure. Am. J. Med. 114, 563.

MDRD Equation for GFR

The Modification of Diet in Renal Disease Study (MDRD) was a randomized, multicenter clinical trial that followed the effects of three different amounts of dietary protein and phosphorus intake and two different doses of blood pressure control on the rate of loss of kidney function in persons with various chronic kidney diseases. All patients in this study had GFR determined by 125I-iothalamate clearance to monitor their renal function.5 Within this study, new equations for GFR were developed from a large randomized training set (n 1628) using the patients' laboratory and demographic data and their measured GFRs. Important excluded groups in this study to note were type 1 diabetics, type 2 diabetics taking insulin, and patients with normal renal function. Several equations using demographic and laboratory values such as creatinine, urea nitrogen, and albumin were developed and validated against actual GFR in a different set of patients in the study.6 The most widely used MDRD equation...

Tricothecenes and other mycotoxins

Ochratoxin and Balkan nephropathy Another important and widespread fungal toxin is ochratoxin, which is also found in cereals and, to a lesser extent, in coffee and cocoa beans. The toxin Ochratoxin A is the most commonly found and is produced by the Aspergillus type of fungus. Exposure occurs in many countries in Europe and affects farm animals as well as humans. The major toxic effect in both humans and animals is kidney damage and cancer of the kidney. The available epidemiological evidence indicates that the disease called Balkan nephropathy is associated with consumption of food contaminated with ochratoxin, and the toxin has been detected in the blood of people living in areas with a high incidence of the disease. Balkan nephropathy is a chronic (persistent) disease involving kidney dysfunction and failure which occurs particularly in the Balkan countries. The disease is also associated with a high level of kidney cancer.

No of antihypertensive agents Trial Target BP mm Hg 1234

Improves renal outcomes in patients with type 2 diabetes and nephropathy over and above the improvement attributable to blood pressure control alone. The renoprotective effect of losartan corresponded to an average delay of 2 years in the need for dialysis or kidney transplantation. The recent RENAAL study and the Irbesartan Type 2 Diabetic Nephropathy Trial found ARBs to offer the greatest benefit for slowing progression of renal disease in type 2 diabetic nephropathy. In contrast, however, the HOPE trial showed that ACE inhibitors, specifically ramipril, have the greatest evidence for prevention of CV outcomes in patients with renal insufficiency, regardless of diabetic status. CV outcomes were secondary endpoints in the RENAAL and IDNT trials, and with the exception of heart failure for losartan, no benefits on CV outcomes were statistically significant. Because evidence has shown that patients with elevated serum creatinine levels (> 1.4 mg dL) are just as likely to die from CV...

Myositis and Myopathy

Alcohol can cause acute and chronic muscle problems. Acute myopathy usually occurs in alcoholics after a heavy binge. It causes symptoms of muscle pain, weakness, and elevated enzyme levels. Most muscles are involved, enzyme levels are often very high, and rhabdomyolysis can occur. usually, unless rhabdomyolysis leads to kidney failure, recovery is complete. Alcohol can also cause muscle atrophy and a chronic, painless proximal myopathy. The onset of symptoms is gradual, and muscle enzymes are normal or elevated only a little. The cause of alcoholic myopathy is not known, but direct toxic effects of alcohol on the muscle combined with the effects of poor nutrition may contribute. Also, many alcoholics have diarrhea or vomiting and thus lose potassium and magnesium. This can increase the severity of muscle symptoms. Patients with chronic alcoholic myopathy are more likely to have alcohol-induced heart muscle disease (cardiomyopathy), a condition that can lead to heart failure and...

Individual drug review

Inhibitors also reduce insulin resistance. ACE inhibitors decreased the incidence of new-onset diabetes mellitus in the Captopril Prevention Project (CAPPP) 26 and the Heart Outcomes Prevention Evaluation (HOPE) 27 studies. This is believed to occur secondary to improved insulin sensitivity, which also might result in better glycemic control in diabetic patients 28,29 . No large, randomized, placebo-controlled trial involved only diabetic patients with ACE inhibitors. Nevertheless, the benefit of ACE inhibitors in diabetic patients who had hypertension was well-illustrated in the HOPE trial. In the HOPE 27,30 study, 56 of the subjects were hypertensive and 39 were diabetic. The HOPE study demonstrated that the benefits of ACE inhibitors extend far beyond BP reduction. Although the reduction in mean BP was only 2.4 1.0 mm Hg with ramipril during the 4.5-year study period, there was an impressive 37 risk reduction in death from CV causes and a 24 decrease in all-cause mortality 30 ....

The Pedigree as a Diagnostic Tool

Take, for example, the family history of Susan, a 30-year-old computer technologist, and a mother of three. She is interested in information about how she can be screened for renal cell cancer because her father, Sam, was recently diagnosed with clear-cell renal carcinoma. If Susan has any family members with brain or spinal tumors (hemangioblastomas), renal cysts or cancer, adrenal tumors (pheochromocy-tomas), or retinal angiomas, a diagnosis of von Hippel-Lindau syndrome should be considered.

Special Considerations

Greenfield et al. reviewed data on 148 suprarenal IVC filters and compared outcomes to 1932 infrarenal IVC filters placed during the same period.58 Overall there was no statistically significant difference in the complication rates between the two filter groups. Recurrent PE was documented in 8 and 4 of suprarenal IVC and infrarenal IVC filters, respectively. Caval occlusion was found in 5 of patients. There were no renal complications.58 Forty-six IVC filters that were inadvertently placed in the suprarenal IVC, jux-tarenal IVC, or renal vein were compared to patients with IVC filters.17 No differences in filter efficacy were identified. PE after filter placement was identified in 7 of patients, but renal complications were not discussed.17 Although suprarenal IVC filter placement does not appear to be complicated by a preponderance of renal vein thrombosis, in patients with advanced malignancy, a single functioning kidney, chronic kidney disease, or previous renal vein thrombosis,...

Secondary forms of HSP

Henoch-Schonlein purpura nephritis (HSPN) has been described in association with hypersensitivity. Indeed, several drugs such as ciprofloxacin, acetyl-salicylic acid, vancomycin, carbidopa levodopa, cocaine, ACE inhibitors, carbamazepine and strep-tokinase have been implicated in HSP induction (Disdier et al., 1992 Moots et al., 1992 Kaneko et al., 1993 Drago et al., 1994 Chevalier et al., 1995 Niedermaier and Briner, 1997 Prajapati and Cas-son, 1997 Sola et al., 1997 Michail et al., 1998).

Circulating immune complexes 103

Cidofovir is approved as a systemic treatment for new or relapsing cytomegalovirus (cMV) retinitis. cidofovir is not approved to treat other types of cMV infection or cMV in non-HIV-infected people. cidofovir interferes with the multiplication of cMV, thereby slowing the destruction of the retina (the light-sensitive tissue at the back of the eye) and loss of vision. Note too that it slows, but does not permanently stop, the progression to cMV retinitis. people taking the drug may continue to lose their vision and should have regular eye examinations at least every six weeks to determine whether a change in treatment is required. It may also act against CMV disease in other parts of the body, but there is less clinical evidence to support its use in these cases. Its primary advantage over ganciclovir and foscarnet is that cid-ofovir is administered intravenously on a weekly or a biweekly basis instead of daily, eliminating the need for an in-dwelling...

Alveolar proteinosis See pulmonary alveolar

Amenorrhea Absence or suppression of menstruation. Amenorrhea is normal before puberty, after menopause, and during pregnancy and lactation. Primary amenorrhea is the failure of the menstruation cycle to begin at puberty this may result from a congenital defect in the reproductive organs. The term usually refers to a condition caused by reasons other than these. secondary amenorrhea is the suspension of menstruation after it has been established at puberty, and may result from an illness, a change of environment, or irradiation or removal of the uterus or ovaries. it is also associated with certain metabolic disorders (obesity, malnutrition, diabetes) and certain systemic diseases (syphilis, tuberculosis, nephritis). Amenorrhea may also result from emotional causes (excitement, anorexia nervosa), pituitary disorders (hormonal imbalance of estrogen, progesterone, or follicle-stimulating hormone), or eating disorders (obesity, anorexia).

Unfractionated Heparin Therapy

Unfractionated heparin has been used extensively to prevent and treat VTE. However, more recently LMWHs have been evaluated against several different controls for the same clinical problems, and in most countries LMWH has replaced UFH for the treatment of VTE in most cases either entirely or predominantly in the out-of-hospital setting. However, there are patients in whom UFH by continuous infusion continues to be used primarily because the anticoagulant effect can be reversed by stopping the intravenous infusion and or administering protamine sulphate.12 Such patients include critically ill patients in the intensive care unit or cardiovascular unit, patients who may be candidates for interventions requiring interruption of anticoagulant therapy, for example, for surgical procedures or thromboly-sis or in patients with severe renal failure.12 In some countries, UFH is the anticoagulant of choice for patients suffering PE who are hemodynamically unstable. 5. Patients with miscellaneous...

Fungal toxins toxic toadstools and magic mushrooms

Probably the most poisonous mushroom in Britain is the death cap mushroom (Amanita phalloides), which is also found in other parts of the world (see Figure 19). It may occasionally be eaten by mistake, although poisoning with this mushroom is rare. The mushroom contains a number of toxins several phallotoxins and several amatoxins. The phallotoxins produce violent gastroenteritis four to eight hours after the mushroom is eaten. The amatoxins have a delayed toxic effect, targeting the liver and kidneys, and causing destruction of the cells of both. After eating the mushroom one may experience few if any symptoms, apart from nonspecific effects like nausea, followed by vomiting and diarrhoea. There can be a phase of perhaps two days in which the victim seems to recover. However, he or she can then suffer liver and kidney failure, as indicated by jaundice and alterations in the chemistry of the blood, such as low levels of sugar in the blood and high levels of nitrogen containing waste...

The Vogue for Mercurachrome

Medicine in the United States in the decades around 1900. In 1912, Young had operated on James Buchanan (Diamond Jim) Brady for a urinary obstruction caused by a chronically enlarged prostate. The flamboyant Brady had been turned away by other doctors because of complications he had, among other things, diabetes, Bright's disease (nephritis), infection of both kidneys, inflammation of the bladder, and severe heart disease, from which he later died. Surgeons in New York and Boston had told him that an operation would kill him. Young successfully removed the obstruction with a new instrument he had invented, without need for the general anesthesia that concerned others he had consulted. Brady was enormously relieved and grateful, though he continued to suffer from his other conditions and remained a patient of Young's until his death in April 1917.19 Hostile fire was not lacking. In December 1927, for example, Young wrote to H.A.B. Dunning complaining of an item in JAMA. In reply to a...

Gary C Starling PhD William J LaRochelle PhD and Gulshan Ara PhD

The platelet-derived growth factor (PDGF) family members are molecules that are associated with malignant transformation, neovascularization, and tumor-stromal interactions. Widespread usage of genomic technologies has lead to the identification of a fourth family member, PDGF-D. In this chapter, we focus on the discovery, structure, and function of PDGF-D, a latent, protease-activated growth factor that has recently been implicated in the development of various types of cancer and kidney disease. Key Words Platelet-derived growth factor (PDGF) PDGF-D neoplasia nephritis receptor activation CUB domain growth factor domain.

Box 144 Manipulating Gene Expression To Treat Sickle Cell Anemia

Complications can include strokes, lung congestion, and pneumonia. The consequence of this incorrect amino acid is an abnormal hemoglobin molecule that causes red blood cells to become rigid and deformed (shaped like a sickle) and to block the capillaries. Over time, lung and kidney damage can accumulate. Treatments include antibiotics, vitamins, avoiding dehydration, carrying out transfusions, and, in rare cases, even bone marrow transplants.

Chromatographic Purification

The samples containing homogeneous r-hGH bands on SDS-PAGE (Fig. 3) should be pooled (approx 20 mL) and dialyzed against a lower urea gradient in each dialysis change, changing after every 8 h as described in the following buffers. 6. When the dialysis step is complete, lyophilize the r-hGH and use for the subsequent gel filtration step (see Note 12). 12. Carry out dialysis with decreasing concentrations of urea at each step. The risk of protein aggregation is high during the removal of urea. Depending on the nature of a protein, the dialysis time and stepwise decreases of urea can be optimized to reduce the extent of any protein aggregation.

Inorganic Compounds Of Silicon

In addition to SiH4, the inorganic silanes produced for commercial use are dichloro- and trichlorosilane, SiH2Cl2 and SiHCl3, respectively. These compounds are used as intermediates in the synthesis of organosilicon compounds and in the production of high-purity silicon for semiconductors. Several kinds of inorganic compounds derived from silanes have potential uses in the manufacture of photovoltaic devices for the direct conversion of solar energy to electricity. In general, not much is known about the toxicities of silanes. Silane itself burns readily in air. Chlorosilanes are irritants to eye, nasal, and lung tissue. The toxicities of silane, dichlorosilane, and tetraethoxysilane, Si(OC2H5), have been reviewed for their relevance in the semiconductor industry.11 The major effects of silane and tetraethoxysilane appeared to be nephrotoxicity (kidney damage).

Outcome after circulatory support for postcardiotomy cardiogenic shock

Pae and colleagues 93 from the Pennsylvania State University reviewed combined registry data on the use of first-generation temporary LVADs between 1985 and 1990. A total of 965 patients were treated for postcardiogenic shock, of whom 45 were weaned from the system and 25 were discharged from the hospital. Notably 90 of patients who survived to leave the hospital were weaned from the pump within 1 week. Those requiring univentricular support alone faired better irrespective of whether pulsatile pneumatic or nonpulsatile centrifugal pumps were used. Patient age greater than 70 years was the principle determinant of mortality. Irrespective of multiple complications, including bleeding, stroke, and renal failure, patients who left the hospital had 2-year actuarial survival of 82 , and 86 were in NYHA functional class I or II. In rare instances of device dependency (4.5 ) those patients who did not have contraindications to transplantation were sustained until a donor organ became...

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