Upper gastrointestinal endoscopy of stable dialysis patient reveals abnormalities in upto 61 percent of cases. Gastritis, duodenitis and mucosal lesions were commonly seen. Also seen on oesophagogastroduodenoscopy (OGD) are osophagitis, brunner gland hyperplasia, gastric fold thickening, angiodysplasia and nodular duodenitis (Kang et al., 1988). Pathogenesis of uremic lesions is not well understood. Fasting serum gastrin levels are commonly elevated in CRF patients since it is clear from serum by renal cortex (Gur et al., 1999). Levels of gastrin relate with gastric acidity suggesting that elevated gastrin level may represent a response to hypochlorhydria rather than a cause of gastroduodenal lesions (Ala-Kala et al., 1989). There is a lack of correlation between acid secretion and presence of upper gastrointestinal lesions and both basal and stimulated acid output can be normal, high or low. These findings suggest that neither hyperacidity nor hypergastrinemia play a major role in pathogenesis of uremic gastroduodenal lesions. Impaired mucosal cytoprotection has been postulated but not proven to cause gastroduodenal lesions in CRF patients (Rantala et al., 1996).
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likely to have an impact on the mineral content of a consumed product. The mineral content of the potatoes was drastically reduced by either cubing or shredding them and then boiling. Boiling shredded potatoes reduced levels of potassium, zinc, magnesium by 50 percent. Boiled potato cubes lost 35 percent of their total magnesium and zinc. Leaching, which refers to soaking food in water before cooking, had little effect on the mineral levels of the samples. This exist little benefit for renal failure patients trying to reduce potassium consumption by leaching potatoes. Those with compromised kidney function can decrease their mineral intake while still taking advantage of the other nutritional qualities of potatoes by boiling them, thinly sliced. “Our study offers information about the nutritional quality of potatoes and the effects of cooking on the contents of mineral nutrients,” the authors conclude. “It will likely result in changes in recommendations by medical staff working with patients who have compromised kidney function.”
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The study indicated that there is significance decrease on the level of the Hemoglobin, Hematocrit, Red Blood Cells count and Mean Cell Hemoglobin Concentration (P-value = 0.000) this agrees with Ali, Elyasaa et al(2011) . The study indicated that there is significance decrease on the level of the Hemoglobin, Hematocrit, Red Blood Cells count, Mean Cell Hemoglobin and Mean Cell Hemoglobin Concentration (P-value = 0.000), but there was insignificant increase in Mean Cell Volume this agrees with ALI, HALA (2011) . From the present study the followed are recommended, Patients on haemodialysis should be investigated before and after dialysis to control the risk of anemia. More studies should be done on iron status, platelets function and coagulation factors on haemodialysis patients, Increase rates of awareness among renal failure patients how to behave with their disease and how to protect themselves from complications. Genetic studies should be done to detect relationship between renal diseases and family history.
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evidence is provided that the in vitro inhibitor of erythropoiesis found in chronic renal failure patients' sera is identical with the polyamine spermine: (a) the inhibitor and radiolabeled spermine appeared in identical Bio-Gel P-2 effluent fractions; (b) when spermine was added to normal human sera at concentrations reported in sera of uremic patients, and studied in both […]
We identified a total of 212 sarcoma admissions to the ICU at MD Anderson between January 1, 2005, and December 31, 2012. We excluded 23 ICU admissions of patients who were admitted to the ICU multiple times during the study course. Of the remaining 189 admis- sions, 17 perioperative admissions were excluded, leav- ing a sample of 172 first-time ICU admissions. The study population was 45.9 % male with median age of 52 years (interquartile range [IQR] 38–62 years) (Supplemental Digital Content—Table 1). The most common sarcoma subgroups were unclassified high-grade sarcoma (25 %), bone sarcoma (Ewing sarcoma, osteosarcoma, and chon- drosarcoma; 17.4 %), vascular sarcoma (angiosarcoma and epithelioid hemangioendothelioma; 9.9 %), and leio- myosarcoma (7.6 %). The ICU mortality rate was 23.3 % (95 % CI 16.9–29.6 %), and the hospital mortality rate was 29.7 % (95 % CI 22.9–37.1 %). The median Charlson comorbidity index was 6 (IQR 6–7) owing to presence of metastatic cancer in most of the patients at the time of admission.
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Methods: PubMed and Medline database (1990 to July 2016) were searched for the terms “restless legs,” “restless legs syndrome,” “periodic limb movements,” “periodic limb movements in sleep” cross-referenced with “cardiovascular disease,” “heart disease,” “coronary artery dis- ease,” “coronary heart disease,” “heart arrhythmia,” “heart failure,” “congestive heart failure,” “echocardiogram,” “echocardiographic,” “hypertension,” “high blood pressure,” “cerebrovascular disease,” “stroke,” “autonomic nervous system,” “heart rate,” “heart rate variability,” “hypoxia,” “microcirculation,” “oxidative stress,” “inflammation,” “chronic kidney disease,” “end-stage renal disease,” “renal disease,” “hemodialysis,” “multiple sclerosis,” “Parkinson,” “Parkinson’s,” “iron deficiency anemia,” and “mortality.” Other relevant articles from the reference list of the above-matched manuscripts were also reviewed. Studies that did not specify the diagnostic criteria for RLS or manuscripts in languages other than English were excluded. Articles with emphasis in RLS secondary to pregnancy were not included in this manuscript.
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This retrospective study assessed 211 consecutive patients undergoing elective or emergency open surgery for infrarenal AAA from 2000 to 2007. Forty-five patients were disquali- fied according to the exclusion criteria (aneurysms arising from arteritis associated with de novo mycotic or prosthetic graft infections and para-anastomotic aneurysms from prior bypasses), and four patients due to incomplete data (Fig. 1), leaving final enrollment at 162 patients. This study was ap- proved by the institutional review board and the ethics committee of our hospital.
In the search for pharmacological agents potentially useful for renal protection, diuretics have been investigated. Mannitol has been shown to increase renal blood flow while preserving glomerular filtration and maintaining the oxygen supply/demand ratio post-operatively in patients with AKI following cardiac surgery . However, mannitol used during minimally invasive partial nephrectomy had no influence on renal recovery . Loop diuretics, in particular furosemide, are frequently employed in the management of patients with acute lung injury. They are generally used to manage fluid balance and reduce pulmonary oedema. It has been postulated that driving urine output can improve renal function. However, available studies do not support the theory that furosemide improves renal function directly . Fenoldapam, a Dopamine D1 selective agonist, has shown some promise in small studies. Meta-analysis suggests that although it does not impact hospital mortality or renal replacement therapy, it may reduce post operative renal failure . Further multi centre clinical trials would be required to definitively establish the benefits.
15. M. R. Ansari, M. S. Laghari, and K. B. Solangi, “Acute renal failure in pregnancy: one year observational study at Liaquat University Hospital, Hyderabad,” Journal of the Pakistan Medical Association, vol. 58, no. 2, pp. 61–64, 2008.
Furthermore, 64 patients received azotioprine, 73 anti- hypertensive therapy; among the latter, 25 were treated with the beta-blockers, 18 with metoprolol, seven with atenolol. Table 5 summarises the data on the occurrence of MO in transplant patients with and without beta-blocker treatment. Comparison of the data reveals that adminis- tration of these anti-hypertensive agents, which are known to protect against migraine, did not influence MO devel- opment. Indeed, the onset or disappearance of MO showed no relation with doses nor with the type of beta-blocker used (metoprolol 50–200 mg, atenolol 50–100 mg). Tables 6 and 7 list the patient characteristics and the pat- tern of migraine attacks for subjects who developed MO after transplantation.
For patients with normal femoral artery and distal runoffs, a longitudinal arteriotomy limited to the distal CFA is sufficient. More commonly, extension of the arteriotomy across the profunda femoris origin and profundaplasty would be necessary. The distal anastomoses are completed in a bevelled end-to-side fashion using 5-0 polypropylene, carrying out retrograde and antegrade flushing manoeuvres before completing the anastomoses and restoring the flow. It is important to inform the anaesthetic team before clamp release, to combat blood pressure drop with reperfusion.
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associated with a 20% reduced risk of CKD. The UMOD gene is located at chromosome 16p12 and encodes the renal-specific protein uromodulin, or Tamm-Horsfall protein, which is the most abundant protein in the urine of healthy individuals. The function of uromodulin is still unclear but it may confer protection against inflam- mation and infection. Rare, highly penetrant mutations in the UMOD gene are known to cause medullary cystic kidney diease or familial juvenile hyperuricemic nephropa- thy. The UMOD gene is transcribed exclusively in renal tubular cells of the thick ascending limb of the loop of Henle. These findings hence suggest a common mechan- ism for CKD pathogenesis localized at the nephron’s loop of Henle with an important role of uromodulin.
BACKGROUND: The oral health status of chronic renal failure (CRF) patients undergoing treatment is complex due to other comorbid conditions. These patients appear to be predisposed to a variety of dental problems such as periodontal disease, narrowing of the pulp chamber, enamel abnormalities, premature tooth loss and xerostomia. Renal replacement therapy can affect periodontal tissues such as gingival overgrowth in immunosuppressed renal transplantation patients and increased levels of plaque accumulation, calculus formation, gingival inflammation, possible increase prevalence and severity of periodontal diseases in CRF patients. The presence of undiagnosed periodontitis may have significant effect on the medical management of CRF patient. Periodontitis has been found to contribute to systemic inflammatory burden including the elevation of C-reactive protein (CRP) in the general population dental care as well as primary preventive measures seems to be neglected in these patients.
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shortened 24-48 hr after peritoneal or hemodialysis. Studies on patients who were not dialyzed showed no statistically significant correlations between the PF3-A time and either the serum urea nitrogen, creatinine, calcium, or phosphorus. Furthermore, the PF3-A time was not affected by guanidinosuccinic or guanidinoacetic acids. We therefore conclude that the demonstrable platelet abnormality in patients with uremia is produced by an unknown dialyzable material.
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Although patients with CKD frequently have multiple abnormalities in their lipid profile, LDL-C reduction is the primary goal of therapy. The NKF recommends LDL-C < 100 mg/dl for patients with CKD. Currently the NKF does not recommend a more aggressive LDL goal for patients with CKD and symptomatic atherosclerotic disease. Based on the amended ATP III guidelines, it might be prudent to treat to an LDL goal of < 70 mg/dl in patients with CKD with atherosclerotic disease. As in the general population, statins are the cornerstone of therapy for dyslipidemia. Treatment with a statin in conjunction with therapeutic lifestyle changes is usually required to obtain these goals. All statins can be used safely in patients with CKD; however, differences in the pharmacokinetic properties give some statins a safety advantage in patients with advanced CKD (GFR < 30 ml/min/1.73 m 2 ). Because the
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Milrinone: The OPTIME-CHF study  examined the effects of IV milrinone in almost 1000 patients with AHF. IV milrinone administration was associated with some trends to improved decongestion such as a reduc- tion of treatment failures at 48 hours and less need for IV therapy in the active treatment arm, suggesting improve- ments in “backward failure”. However, IV milrinone did not reduce LOS or improve end organ damage or post- discharge readmissions and was associated with a sub- stantial increase in mortality, especially in patients with ischemic heart disease . A post-hoc analysis of OP- TIME-CHF has suggested that the increase in mortality associated with milrinone administration was more pro- nounced in patients with coronary artery disease, with the composite endpoint of death or re-hospitalization oc- curring in 36% versus 42% of the ischemic patients treated with placebo and milrinone, respectively, and no significant differences between the two treatments amongst the nonischemic patients (p = 0.01 for interac- tion) . It seems that administration of IV milrinone (similar to other inotropes, see below) in AHF results in better decongestion and dyspnea relief, but probably at the price of some myocardial damage leading to in- creased rather than decreased short and intermediate term mortality. Similarly to all inotropes (see below) US guidelines suggest that milrinone be considered in ex- treme cases of low output AHF where all other options to control patients’ symptoms have failed and patients are developing progressive hypoperfusion with signs of end organ dysfunction (Strength of Evidence C) . Euro- pean authorities recommend to consider milrinone main- ly if necessary to counteract the effects of beta blockers (Class IIb level of Evidence C) .
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acid production via catabolism. Correction of metabolic acidosis enhances response to vasopressors, improves cardiac contractility, ameliorates bone injury due to acid buffering, and reduces catabolism. Bicarbonate containing intravenous fluids correct acidosis, but proper use is required to limit excess volume repletion and minimize symptoms of hypocalcemia. Depending on the serum sodium concentration, sodium bicarbonate (50–150 mEq) can be added to a liter of either 5% dextrose in water or 0.45% normal saline to make an isotonic solution. Oral bicarbonate or bicarbonate precursors (citrate) are preferable in patients able to take pills or a liquid preparation. The goal is to correct the serum bicarbonate to approximately 22 mEq/L, depending on respiratory status and arterial pH.
Two hundred and thirty-eight (56.3%) patients were admitted and managed for heart failure secondary to hypertension. There were 132 (55.5%) males and 106 (44.5%) females in this group. Fifty-two patients (30 males and 22 females) were managed for CCF secondary to various cardiomyopathies. The predominant types were idiopathic dilated cardiomy- opathy 31 (7.3%), diabetes mellitus 9 (2.1%), HIV 6 (1.4%), alcohol 5 (1.2%), and restrictive idiopathic cardiomyopathy 1 (0.2%). There were 18 cases of CCF secondary to rheumatic valvular (mainly mitral) heart disease. These were made up of 13 (72.2%) females and 5 (27.8%) males. The mean
The incubation period after oral exposure is four to five weeks. HEV can be detected in stool one week before the onset of illness and it is present for two weeks. Because HEV is enterically transmitted, patients are infectious during fecal shedding. While HEV viremia is short-lived in most patients, it can persist for up to four months.
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One hundred fifteen patients aged 15 to 90 years, dia- gnosed with ARF in our tertiary hospital from November 1998 to May 2003, enrolled in this study. Sixty six (58%) of the patients were men and forty nine (42%) were women. The mean age of the patients was 64.5 ± 14.8 years and most of the patients were older than 60 years. The most common mechanism of ARF was ischemic acute tubular necrosis (51%). Except two patients, other all patients had at least one co-morbid condition and the rate of the patients with ≥ two co-morbid conditions was 46%. The mean APACHE III score was 64.5 ± 22.1 (minimum 26 and ma- ximum 145) and BUN and creatinine levels were 75.9 ± 3.1 and 4.36 ± 0.28 mg/dL respectively at the time of nephro- logy consultation.