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The Follow-Up Metabolic Medicine Hospital Consultation
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
The resolution of malnutrition and hypoproteinemia can also produce a fluid shift. As the colloid osmotic pressure increases, fluid will draw into the vascular space from the interstitium. This will expand the plasma volume temporarily. With normal renal function, the GFR should increase and allow for clearance of the excess fluid (Batuman et al. 1984).
Hypertension
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Nicardipine is a dihydropyridine calcium channel blocker that mostly acts as a vasodilator. It has fewer negative inotropic effects than nifedipine. Its primary use is for postoperative hypertension and during pregnancy. Dosages are increased every 15 minutes to the maximum dose, and the drug can cause flushing, headache, and tachycardia. It may decrease the GFR if the patient is renal-insufficient.
Radionuclide Examination of the Kidneys
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
The substance used for clearance measurement can be exogenous (injected into the patient’s blood in continuous infusion or as bolus injection) or endogenous (normally present in plasma in relatively stable concentration and excreted into the urine by glomerular filtration). In clinical practice, the most frequently used indicator of GFR is endogenous creatinine, a product of muscle metabolism. GFR is thus measured as creatinine clearance. Eqn. 12.2 can be used also for exogenous substances administered as bolus injection: decreasing concentration of the substance in plasma is then measured in blood samples obtained in the middle of several 30–60 minute intervals of urine collection, to which the Eqn. 12.2 is applied separately. Complete review of clearance methods can be found elsewhere [7, 18, 20, 21].
Assessment of hypertension-mediated organ damage in children and adolescents with hypertension
Published in Blood Pressure, 2023
Michał Pac, Łukasz Obrycki, Jan Koziej, Krzysztof Skoczyński, Anna Starnawska-Bojsza, Mieczysław Litwin
GFR estimation is a routine method of kidney function assessment. Two common paediatric formulas calculating estimated GFR are modified bedside Schwartz’s formula: eGFR [(ml/min/1.73 m2) = 0.413 (simplified coefficient for all age groups) x height (cm)/creatinine concentration (mg/dl) and a formula based on serum cystatin C concentration (Filler’s equation: Log(eGFR) = 1.962 + [1.123 × log(1/cystatin)]) [97]. A simplified formula combining both creatinine and cystatin can be used in children and young adults aged 1-18 years old [98,99]. eGFR calculated from the average values of the two consecutive single-marker eGFR values is less biased, more accurate and more precise. The Chronic Kidney Disease in Children Under 25 years (CKiDU25) equation is currently the recommended eGFR equation for children and young adults with CKD as it includes age- and sex dependent differences [100].
Updated perspectives on how and when lithium should be used in the treatment of mood disorders
Published in Expert Review of Neurotherapeutics, 2023
Janusz K. Rybakowski, Ewa Ferensztajn-Rochowiak
The most severe complication of long-term lithium therapy is interstitial nephropathy. It can develop after 10–20 years of treatment and manifests itself in increased creatinine concentration and a decreased glomerular filtration rate (GFR). The International Group for the Study of Lithium Treated Patients (IGSLI) evaluated the impact of lithium on kidneys in 312 patients from twelve centers, who were receiving lithium for 8–48 (mean 18) years. In this group, the mean decrease of GFR was 0.71% per year of age and 0.92% per year of lithium treatment. In about one-third of the patients, the GFR <60 ml/min/1.73 m2 was found more than in one assessment. Such a situation occurred more frequently in those receiving lithium for ≥15 years and in patients older than 55 years whereas, there were no patients with end-stage renal failure [66].
Renal and Hepatic Disease: Cnidoscolus aconitifolius as Diet Therapy Proposal for Prevention and Treatment
Published in Journal of the American College of Nutrition, 2021
Maria Lilibeth Manzanilla Valdez, Maira Rubi Segura Campos
Another important complication of LD is the HRS, a conjunction with renal disease. The pathophysiology of HRS is complex, but it can be related to 3 areas: the splanchnic bed, the sympathetic nervous system (SNS) and the cardiac system. In addition, there are three factors that favor the development of SHR: cirrhosis, ascites, and portal hypertension. The increase in portal vein pressure activates the release of endogenous vasodilators such as nitric oxide (NO), carbon monoxide (CO), and cannabinoids, increasing local plasma volume and rapidly decreasing mean arterial blood pressure. On the other hand, the release of vasopressin is necessary, activating the renin-angiotensin-aldosterone system, decreasing the GFR and retaining water and Na+, this would explain the development of ascites in patients with SHR. The consequence in the renal anatomy before the activation of the vasoconstrictors is the vasodilator stimulus that affects the tubular and hemodynamic function. Severe renal vasoconstriction causes a decrease in GFR. Persistent changes in circulation decrease cardiac output, with an increase in plasma renin, favoring the appearance of hypovolemia, renal hypoperfusion and the development of HRS (53).