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Diabetes
Published in Sally Robinson, Priorities for Health Promotion and Public Health, 2021
The role of the two kidneys are to filter the blood. They filter approximately one litre of blood every minute, which is about a fifth of all the blood circulating in the body. Blood enters the kidneys, via the renal arteries, to be filtered inside the kidney (Figure 15.9). The kidney sorts out what needs to be conserved, such as water and other useful substances including protein molecules, from what can be disposed of, the waste. The useful substances are diverted to the blood in the renal vein, which transports them out of the kidney to other parts of the body. The waste is released as urine down the ureters, out of the kidneys, and into the bladder.
Anatomy & Embryology
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
Roughly a quarter of the cardiac output is supplied to the kidneys via the paired renal arteries. They branch from the aorta at the level of L2 just below the origins of the superior mesenteric (SMA) and adrenal arteries. The right artery passes behind the inferior vena cava (IVC) first, in contrast to the left, which passes almost directly to the kidney. Before entering the hilum, each artery initially gives off a single posterior segmental branch that passes behind the renal pelvis to supply the posterior aspect of the kidney. It can cause obstruction of the pelvi-ureteric junction if it passes in front of the ureter. After entering the hilum, the artery commonly divides into four anterior segmental branches (apical, upper, middle and lower). The divisions and blood supply of the anterior and posterior segmental arteries give rise to a longitudinal avascular plane, known as Brodel’s line, 1–2 cm posterior to convex border of the kidney. Segmental arteries give rise to lobar arteries within the renal sinus, which become interlobar arteries that lie in between the Columns of Bertin in the parenchyma. These give off arcuate branches, which become the interlobular arteries that eventually form the afferent arteries of the glomeruli. The renal vein lies in front of the artery in the renal hilum. The right vein is 2–4 cm in length in comparison to the left, which may be up to 10 cm. The left renal vein reaches the IVC by passing behind the SMA and in most cases in front of the aorta.
The Urinary System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Several vascular disorders affect the kidneys, including renal vein thrombosis, renal infarction, and malignant nephroangiosclerosis (literally, "hardening of the arteries of the kidney"). Malignant nephroangiosclerosis is also called malignant nephrosclerosis and malignant hypertension. Malignant nephroangiosclerosis is a necrosis of the renal arteries associated with hypertension, and it rapidly progresses to renal failure.
Comparison of the prophylactic antithrombotic effect of indobufen and warfarin in patients with nephrotic syndrome: a randomized controlled trial
Published in Renal Failure, 2023
Xin-Yi Gao, Yue-Ming Liu, Dan-Na Zheng, Yi-Wen Li, Hua Li, Xiao-Ling Xiong, Hong-Yu Chen, Hua Wang, Xiao-Yong Yu, Kai Qu, Juan Jin, Bo Lin, Qiang He
The primary outcomes were the incidence rates of thrombosis and bleeding. Thromboembolic events were confirmed by ultrasound (for deep vein thrombosis), renal magnetic resonance venography (for renal vein thrombosis), or computed tomography pulmonary ventilation-perfusion scan (for pulmonary embolism). Major bleeding referred to any of the following: fatal bleeding, two symptomatic bleeding events at a critical site, bleeding causing the Hb level to drop by ≥ 20 g/L (1.24 mmol/L), or bleeding requiring the transfusion of two or more units of whole blood or red blood cells [15]. Minor bleeding events were defined as bleeding not meeting the criteria for major bleeding but associated with medical intervention; contact with a physician; interruption of the study drug; or discomfort/impairment in performing daily activities, including gastrointestinal bleeding, nasal bleeding, subcutaneous hemorrhage, fundus bleeding, and non-glomerular origin hematuria. The secondary outcome was coagulation function (APTT, PT, TT, and D-dimer). In group C, INR values were also collected. The incidences of AEs and SAEs were recorded from the initial treatment until the final follow-up visit. AEs were summarized using the MedDRA system organ class and the preferred term. An independent data monitoring committee reviewed the cumulative safety data.
Trends and outcomes of venous thromboembolism in adult hospitalizations with acute myeloid leukemia: analysis of nationwide inpatient sample from 2010 to 2014
Published in Postgraduate Medicine, 2021
Sushmita Khadka, Dhanshree Solanki, Jagmeet Singh, Asim Kichloo, Neil R. Patel, Purnima Sharma, Savneek Chugh, Shantanu Solanki
From 2010 to 2014, there were 313,282 hospitalizations with a primary diagnosis of AML and 1,633 hospitalizations (0.1%) had VTE as a concurrent diagnosis (Figure 1). We observed a significant increase in the proportion of AML hospitalizations with VTE from 0.47% in 2010 to 0.56% in 2014 (P = 0.014). Most AML patients with concurrent VTE were in the 65–84 years age group (42.3% vs 39.9%; P < 0.0001), males (55.1% vs 54.1%; P < 0.0001), and White (78.8% vs 75.4%; P < 0.0001). Most AML-VTE hospitalizations were managed in large (67.3%), teaching (65.2%), and Southern hospitals (34.7%). Most AML-VTE patients were discharged to home (80.1%) whereas 16% were discharged to a facility. The proportions of other baseline characteristics are reported in Table 1. Majority of the VTE hospitalizations in AML were due to lower extremity DVT (44.7%) (Table 2). Pulmonary embolism (38.9%), upper extremity DVT (11.5%), and other venous thrombosis (4.9%) accounted for rest of the VTE hospitalizations (Figure 2). Other venous thrombosis included portal vein thrombosis, thrombosis of renal vein, and more diagnoses as depicted in Supplement 1. Medical Co-morbidities
Effect of carvedilol versus propranolol on acute and chronic liver toxicity in rats
Published in Drug and Chemical Toxicology, 2021
At the end of the rats were anesthetized with pentobarbital (50 mg/kg), and the liver was perfused in situ via the portal vein, using a non-recirculating system (Matsumoto et al. 2000). Briefly, the abdomen was opened, and the bile duct was cannulated with a polyethylene PE-10 tubing (i.d. 0.28 mm). The hepatic artery was ligated. A ligature was passed around the inferior vena cava (IVC) above the renal vein. The portal vein was then cannulated with a polyethylene PE-205 catheter. The liver was immediately perfused with Krebs–Henseleit bicarbonate solution (KHS) oxygenated with 95% O2–5% CO2 through silastic tubing (Hamilton et al. 1974) at 37 °C. The KHS had the following composition (mM): 118 NaCl, 4.7 KCl, 1.2 KH2PO4, 1.2 MgSO4, 2.5 CaCl2, 25 NaHCO3, and 11.0 glucose; pH 7.4. The IVC was cut below the ligature, thus allowing the perfusate to escape. Thereafter, the thorax was opened and supradiaphragmatic part of IVC was cannulated using a PE-240 catheter, and a ligature around the infrarenal IVC was tied. The liver was then perfused at 20, 40 and 60 ml/min through the portal vein, and the effluent escaped through the IVC cannula. The perfusion pressure was measured by continuously monitoring the height of perfusate in an open vertical capillary column (i.d.=2 mm) attached to the perfusion system just proximal to the inflow cannula when the perfusate was infused.