Renal function

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Study on Renal Function in Patients with Subclinical Hypothyroidism  Response to Treatment with Levothyroxine

Study on Renal Function in Patients with Subclinical Hypothyroidism Response to Treatment with Levothyroxine

We recommend studying the renal function in every patient with thyroid dysfunction. Having excluded other causes of kidney failure, an improvement in GFR can be expected in patients with subclinical hypothyroidism after levothyroxine treatment. Rev Argent Endocrinol Metab 49:115-118, 2012.

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Slow induction of brain death leads to decreased renal function and increased hepatic apoptosis in rats

Slow induction of brain death leads to decreased renal function and increased hepatic apoptosis in rats

renal function shows no improvement over the course of the BD period even when MAP is maintained within the physiological range. Moreover, progressive diminished renal function was also observed after fast induction in which a hypotensive phase did not occur which indicates that local changes in the renal microcirculation are more likely to have caused the decreased renal function during the later stages of BD. We think that changes observed during the later stages of BD form a “second hit” in slow- inducted rats while this comprises the first (and single) hit in fast-inducted rats. Changes observed in the later stages of BD can be the result of one of the sole or com- bined effects of hemodynamic instability, inflammation,
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Nefropata inducida por medio de contraste en angiografas coronarias

Nefropata inducida por medio de contraste en angiografas coronarias

Introduction: Contrast-induced nephropathy (CIN) is defi ned as the impairment of renal function and is mea- sured as either a 25% increase in serum creatinine (SCr) from baseline or 0.5 mg/dL increase in absolute value, within 48-72 hours of intravenous contrast administration. Objectives: Objectives were to calculate incidence of CIN and to describe the clinical and periprocedural risk factors for patients receiving contrast media. Secondary objective was to compare mortality between group 1 and group 2. Material and methods: In a retrospective, observational, descriptive cohort study, patients who were admitted to the hospital for diagnostic and/or therapeutic coronary angiography between January 2014 to September 2015, the serum creatinine and glomerular fi ltration rate (GFR) prior to angiography and 72 hours later was measured. Results: 70 patients were included, of which 14.2% developed CIN. The leading risk factors for developing AKI were: age > 65 years (OR 12.6, CI95 1.6-105.9, p = 0.03); the presence of anemia (OR 7.5, CI95 1.8-31.2, p = 0.006); and procedural time more than 90 minutes (OR 16, CI95 3.1-85.3, p = 0.001). Higher mortality was observed in the NIC group (30% vs. 1.6%, p = 0.004). Conclusions: The incidence is higher than in the literature review. The leading associated risk factors were age > 65, anemia and procedural time > 90 minutes. The development of CIN carries a higher mortality.
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TtoCirrosis

TtoCirrosis

45. Ginès A, Escorsell A, Ginès P, et al. Inci- dence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology 1993;105:229-36. 46. Saló J, Ginès A, Quer JC, et al. Renal and neurohormonal changes following simulta- neous administration of systemic vasocon- strictors and dopamine or prostacyclin in cirrhotic patients with hepatorenal syn- drome. J Hepatol 1996;25:916-23. 47. Ginès A, Salmerón JM, Ginès P, et al. Oral misoprostol or intravenous prosta- glandin E2 do not improve renal function in patients with cirrhosis and ascites with hy- ponatremia or renal failure. J Hepatol 1993; 17:220-6.
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Accumulation of scandium in plasma in patients with chronic renal failure.

Accumulation of scandium in plasma in patients with chronic renal failure.

tissue deposits observed in the heart [13], exacerbating the alterations in renal function, and facilitating the progress of the disease. The linear correlations observed in the present study between plasma levels of Sc and the biochemical parameters of renal function (Table 4) support the above comments. Furthermore, we found high levels of plasma Sc, associated with the risk of low haematological values (Table 5), which also supports the view that the accumulation of Sc favours kidney damage, facilitating the onset of anaemia in patients with CRF. However, it is also possible that the Sc may exercise a toxic effect in the bone marrow and/or the erythrocytes.
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TítuloChronic renal dysfunction in maintenance heart transplant patients: the ICEBERG study

TítuloChronic renal dysfunction in maintenance heart transplant patients: the ICEBERG study

We found that the rate of change over time in GFR was independently associated with nonmodifiable factors such as age at transplant, female sex, and time since transplantation. Increasing age as a risk factor for developing renal dysfunction has been described in numerous previous studies [1], [3], [5], [6], [7], [9], [10], [12], [13]. Female sex and time since transplant were well-known risk factors for development of CRD in patients with heart transplantation, as well [1], [7], [9], [10], [12]. Comorbidities such as hypertension and diabetes were not related to the rate of change in renal function, in disagreement with previous studies [1], [4], [6], [9], [19], although there was a tendency to be associated with worsening of renal function. Remarkably, neither withdrawal of CNI therapy nor the use of renoprotective therapy (mainly ACE inhibitors) were associated with a better evolution in renal function. In fact, the creatinine slope was higher in those patients with CNI reduction or avoidance. These findings suggest that these therapy measures were carried out in patients with the most unfavorable evolution of renal function after transplantation and later, when the renal damage was irreversible [19].
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Hepatorenal syndrome: Current concepts related to diagnosis and management

Hepatorenal syndrome: Current concepts related to diagnosis and management

Renal failure in cirrhotic patients is a very severe condition. Hepatorenal syndrome has the worst prognosis among all causes of kid- ney failure in such patients. Hepatorenal syndrome is diagnosed especially in cirrhotic patients with ascites who develop loss renal function, despite diuretic suspension and volume expansion with albumin and for whom other causes of kidney injury have been ex- cluded. Patients with hepatorenal syndrome should be treated with a vasoconstrictor in combination with albumin as a bridge to re- ceiving a liver transplant. The vasoconstrictor of choice is terlipressin or noradrenaline. In spite of higher drug-related costs associated to terlipressin, initial evidence demonstrates that, considering all direct medical costs involved, the treatment strategy us- ing terlipressin is probably more economical than that using noradrenaline.
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Contrast induced acute kidney injury in cirrhotic patients  A retrospective analysis

Contrast induced acute kidney injury in cirrhotic patients A retrospective analysis

ceiving IC are often compared to patients with unenhanced CT examinations. Unenhanced CT is an inferior imaging modality for most indications. As such it is often deliberately chosen as second best for patients thought to be at high risk of renal fail- ure if exposed to IC. This may be a cause for selec- tion bias due to undocumented confounders in those studies. The fact that the groups receiving no IC in these studies paradoxically had a higher incidence of renal dysfunction, a difference that was abol- ished after propensity score matching, gives more weight to this assumption. In our study, therefore, we chose patients with MRI examination as controls. Our cohort of patients was also relatively homoge- neous which may have reduced background noise and may have facilitated the detection of small changes in renal function. Gadolinium may be even more nephrotoxic than IC in equivalent x-ray attenuating doses. However, several reports have shown that low doses such as those used for MRI are safe even in patients with renal impairment. 12
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Factores relacionados con prdida de la funcin renal residual en pacientes en dilisis peritoneal

Factores relacionados con prdida de la funcin renal residual en pacientes en dilisis peritoneal

Background: Residual renal function (RRF) contributes to the quality of life of patients on dialysis. The preservation of RRF is associated with higher patient survival in peritoneal dialysis (PD), and is now accepted that RRF and peritoneal clearance are not of equal value in patient sur- vival. The aim of this study is to know the factors related to RRF loss in prevalent patients in continuous ambulatory peritoneal dialysis (CAPD). Methods: This is an analysis of secondary outcomes. Forty-three adult patients with type 2 diabetes were included. They had RRF preserved. Clinical and laboratory assessments were done in each visit during a year.
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TítuloIndoleamine, 2 3 dioxygenase activity could be an early marker of graft rejection in heart transplantation

TítuloIndoleamine, 2 3 dioxygenase activity could be an early marker of graft rejection in heart transplantation

Statistical analysis was performed by nonparametric tests (the Kruskal- Wallis or Pearson test) or Student t test. The association between act-IDO and the AR group during the first year post-HT was estimated by logistic regression analysis, adjusting for potential confounding parameters of donor and recipient sex and age and recipient’s renal function. SPSS (SPSS 15.0 Inc, Chicago, Ill, USA) and GraphPad Prism 4 were used for statistical analysis.

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Vol. 88, Núm. 06 (2017)

Vol. 88, Núm. 06 (2017)

Introduction: Acute tubulointerstitial nephritis (ATIN) is a rare entity in the pediatric age. It is de- fined by the infiltration of the renal parenchyma by mononuclear and/or polynuclear cells with se- condary involvement of the tubules, without glomerular injury. It can be triggered by infections or immunological diseases, drugs like NSAIDs or be of idiopathic origin. Objective: To raise awareness among pediatricians about the prescription of NSAIDs, especially to patients of less than a year old, since they can provoke renal damage. Case report: A ten month old child, with no nephrological an- tecedents of interest, was transferred to our hospital due to acute renal failure stage 3 KDIGO 2012. The three previous days received treatment with amoxicillin and ibuprofen for acute otitis media. Physical examination revealed mild eyelid edema with normal blood pressure. In the urine analysis, there were non-nephrotic proteinuria with tubular component, microhematuria and leukocyturia. Renal ultrasound showed no abnormalities. ATIN was suspected and so the antibiotic was changed to intravenous cefotaxime and ibuprofen was discontinued, opting for conservative management of acute renal damage. There was an increase in the number of creatinine up to 4.14 mg/dL and eosinophilia, with the immunological study being negative. Treatment with methylprednisolone was initiated, achieving normalization of renal function. Discussion: NTIA can be produced by any me- dication through an idiosyncratic immune reaction. Among the responsible drugs, there are ones commonly used in the pediatric age, such as NSAIDs. Therefore, the pediatricians should pay special attention during prescriptions and have a high diagnostic suspicion of this disease.
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Boldine Improves Kidney Damage in the Goldblatt 2K1C Model Avoiding the Increase in TGF beta

Boldine Improves Kidney Damage in the Goldblatt 2K1C Model Avoiding the Increase in TGF beta

The activation of the renin-angiotensin system (RAS) is a crucial factor in the development and progression of organ damage in hypertension, diabetes and CDK [25,28,44]. Accumulating evidence over the past several years suggest that TGF-β plays a pivotal role in the progression of many immune and non-immune-mediated renal diseases [13,42,45]. It is known that TGF- β is involved in the development of fibrosis [13], induces inflammatory response which is characterized by the infiltration of macrophages (ED-1) and over-expression of OPN [12,41], and can induce the expression of the NADPH-OX, one of the key enzymes in the ROS generation, contributing to OS [15]. In addition to TGF- β , AngII also contributes to the progression of renal disease through hemodynamic, as well as nonhemodynamic mechanisms [3,13]. These two apparently diverse factors, which are involved in the deterioration of renal function and structure during CKD, may be joined together by the observation that AII induces TGF- β expression [3,13]. Ozawa et al., in 2007, observed that in a model of Sprague Dawley rats stimulated with AngII for six days, and then three or six days without the stimulus, respectively, presented interstitial fibrosis, glomerular hypertrophy, infiltration of macrophages, an increase in the amount of mRNA of the chemoattractant protein MCP-1, and also in mRNA quantity of transforming growth factor- β (TGF- β ) [1]. It is also known that TGF- β stimulates the synthesis of extracellular matrix (ECM) and inhibits the action of proteases that degrade the matrix [10,11], influencing the development of fibrosis and inflammation in the kidney, causing deterioration of function and increasing renal damage [10,12,13]. In addition, TGF-β has been shown to have a close relationship with RAS in the development of hypertension and kidney damage in the 2K1C Goldblatt hypertensive model [3]. With this background, we wanted to study what happened to the mediators of RAS, such as ACE-1 (Figure 6) and TGF-β (Figure 7). According to the results the increase in ACE-1 and TGF-β were lower in 2K1C rats treated with boldine than that observed in untreated 2K1C rats.
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Changes in Frequency of Delayed Graft Function in Deceased Donor Renal Transplant Recipient in a Tertiary Care Center in Mexico

Changes in Frequency of Delayed Graft Function in Deceased Donor Renal Transplant Recipient in a Tertiary Care Center in Mexico

can be taken in the donor’s case to decrease the frequency of DGF such as the administration of furo- semide and mannitol as well as the preferential use of vasopressin, levothyroxine, or steroids instead of amines. These measures reduce the risk of developing renal microthrombi, usually occurring approximately 24 hours after establishing the diagnosis of brain death or after > 40 hours of hospitalization in the intensive care unit. Another intervention is prophylac- tic anticoagulation since it decreases the endothelial concentration of free radicals. Other experimental free radical inhibitors include heme-oxygenase-1 and propionyl-l-carnitine or anti-inflammatory agents such as Ginkgolide (BN 52021), a specific inhibitor of ICAM-1 expression, as well as the use of statins to prevent cholesterol-mediated injury. These manage- ment alternatives remain to be accepted 19 .
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Impacto de las fracturas vertebrales asociadas a osteoporosis en la calidad de vida relacionada con la salud en poblacin mexicana

Impacto de las fracturas vertebrales asociadas a osteoporosis en la calidad de vida relacionada con la salud en poblacin mexicana

Differences might be explain because subjects from the OPC have a symptomatic and established disease therefore pain intensity was greater (12.36 ± 5.6 vs. 10.75 ± 6.3; p = 0.028). Paradoxically, physical function was more affected in the random sample of Puebla City (34.5 ± 12.1 vs. 43.52 ± 18.4; p = 0.000); as well as greater difficulty in physical functioning such as dressing or bathing, but, de- spite the limitations in their DLA, their social func- tioning was better because they participated more in social activities, such as visiting friends and going to the movies or the theater (p = 0.00). Pain as a symptom has more of an impact on QoL than the re- maining dimensions included in this construct. The majority of asymptomatic VFx did not report pain, and might be the reason why they did not seek med- ical attention, and probably explain their deteriora- tion in physical functioning as a consequence of their aging. It is beyond of the scope of this study to determine the reasons of these findings and further studies need to be conducted to determine the probable causes of these differences.
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Prueba de renograma con captopril en hipertensión renovascular

Prueba de renograma con captopril en hipertensión renovascular

El riñon, al igual que otros órganos, tiene mecanismos compensatorios que permiten mantener un flujo sanguíneo más o menos constante cuando ocurren variaciones en la presión de perfusión; esta propiedad es llamada "autorregulación" (1). La resistencia renal al flujo sanguíneo está determinada por las resistencias presentadas por las arteriolas aferentes y eferentes (2). Los mecanismos involucrados en la auto- rregulación no están claramente definidos. Se ha invocado un factor miogénico sobre la arteriola aferente para explicar la autorregulación del flujo en el riñon normal (3); el eje renina-
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Linezolid: idoneidad de prescripción y afectación de la función renal y hematológica

Linezolid: idoneidad de prescripción y afectación de la función renal y hematológica

Datos demográficos (nº pacientes, sexo, edad) y estancia hospitalaria en UCI. Número y tipo de cultivos positivos a microorganismos Gram positivos, excluyendo contaminantes; microor- ganismos Gram positivos aislados; infección por microorganismos Gram positivos resistentes a glucopéptidos; servicio prescriptor; número de prescripciones de linezolid en IAE e INAE; motivo del tratamiento con linezolid en INAE y presencia de insuficiencia renal (aclaramiento de creatinina < 25 mL/min) previa al tratamien- to o tras tratamiento con glucopéptidos; dosis diaria definida por 100 estancias-día (DDD/100 estancias-día) de vancomicina, teicoplanina y linezolid. Tratamiento previo y concomitante a linezolid con vancomicina y teicoplanina. Así como de linezolid en monoterapia. Mortalidad cruda. Alergia a glucopéptidos.
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The PIRO Concept: O is for organ dysfunction

The PIRO Concept: O is for organ dysfunction

[John C Marshall] Intuitively, I’ve always liked the idea of describing organ dysfunction as an intervention – in other words, ventilation or what you have to do to treat renal failure – having a sense that things are basically OK or things have completely failed or you’re somewhere in the middle. So to me, the acute lung injury model is a nice reflection of that. So I think there’s probably merits to having several levels. At this stage I think our understanding is that the more refinement we have in describing something, the more potential you have to get out of it. Obviously, continuous variables give you more information than dichotomous variables when you use statistical analysis, and at this stage we’re still trying to generate information – we don’t really know where the cut point is.
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Acute renal failure induced by carbon tetrachloride in rats with hepatic cirrhosis

Acute renal failure induced by carbon tetrachloride in rats with hepatic cirrhosis

Relationship between cirrhosis and renal dysfunction is not yet fully understood. A model of cirrhosis with acute hepatic and renal damage (RF), produced by CCl 4 in rats, with hemodynamic and renal functional alterations, similar to those observed in decompensated cirrhosis (DC) in man, was used to study chemical nephrotoxicity in animals. We performed in male Wistar rats hepatic and renal functional and hemody- namic studies in control, cirrhotic and decompensated cirrhotic (DC) groups. Cirrhosis was induced with car- bon tetrachloride by chronic administration. Associa- tion between liver and renal functional alterations was detected in rats with decompensated cirrhosis, showing fall in mean arterial pressure and reduction of glomer- ular filtration rate and filtration fraction. Renal hemo- dynamics did not change in cirrhotic rats, similarly to what occurs in compensated cirrhotic patients. Howev- er, DC rats exhibited increased sodium, glucose and phosphate urinary excretions and decreased ATP in re- nal cortex. DC animals had severe hypoglycemia. There was an extensive liver fibrosis. Glomeruli had hypercellularity and tubules showed extensive vacu- olization in cirrhotic and DC rats. The present study suggests that in this model, damage typical of acute tu- bular necrosis ensues in cirrhotic rats. We describe
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Aging Kidney Transplantation

Aging Kidney Transplantation

There are several immunological and non-immunological factors related to renal graft deterioration, and histological lesions such as interstitial fibrosis and tubular atrophy overlap with those observed in aging kidneys. Consequently, it has been proposed that kidney transplant senescence could contribute to graft loss. The process of cell senescence displays characteristics such as an increased expression of specific aging suppressor genes, shortened telomeres, mitochondrial changes, increased expression of negative regulators of the cell cycle, and immunological senescence. Additionally, tubular frailty characterizes the aged kidney, making it more susceptible to ischemia, reperfusion, toxic injury, and consequently, to inflammation. Moreover, renal tissue injury predisposes the older graft not only to progressive deterioration due to glomerular hyperfiltration, but also triggers acute rejection due to increased immunogenicity. In conclusion, renal graft senescence is a complex process, and its better understanding will help the nephrologist in its management in order to achieve a longer graft survival. (REV INVES CLIN. 2016;68:68-74)
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