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Renal Disease; Fluid and Electrolyte Disorders
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
There is inadequate water reabsorption by the kidney compared to that of sodium. Urine osmolality is abnormally low compared to the high plasma osmolality. It is usually caused by diabetes insipidus with dehydration and polydipsia. Diabetes insipidus can arise from: Inadequate vasopressin secretion from the posterior pituitary gland (cranial diabetes insipidus)Inadequate response of the kidneys to vasopressin (nephrogenic diabetes insipidus), which can be caused by genetic defects or as a side effect of a drug such as lithium, amphotericin or gentamicin
Diabetic Nephropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Initially, chronic renal failure is distinguished by reduced kidney reserve or insufficiency. This can progress to end-stage renal disease – another term for renal failure. As the tissues lose function, the remaining healthy tissues adapt and increase their function, limiting any obvious signs or symptoms. The kidneys, over time, cannot maintain normal electrolyte and fluid homeostasis. Concentration of the urine is an early change. There are then decreases in the ability to excrete excessive acid, phosphate, and potassium. Once renal failure is advanced, the GFR becomes less than or equal to 15 mL/minute/1.73 m2. Then, the kidneys cannot dilute or concentrate the urine effectively. Urine osmolality remains at about 300–320 milliosmoles/kg, which is close to the plasma osmolality (275–295 mOsm/kg). Variations in water intake no longer affect the urinary volume to any large degree. As the GFR is reduced, plasma concentrations of creatinine and urea rise. A normal GFR is more than 90 mL/minute/1.73 m2, but once this falls to under 15 mL/minute/1.73 m2, the creatinine and urea levels become high, and uremia manifests systemically. The creatinine and urea are markers for substances that cause the uremic symptoms.
General Physical
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
SMALL PRINT: serum and urine osmolality, sickle-cell screen. Urinalysis: glycosuria in diabetes, specific gravity raised in dehydration and reduced in diabetes insipidus and compulsive water drinking, may be proteinuria and/or microscopic haematuria in CKD.Fasting blood glucose or HbA1c: to definitively diagnose diabetes.FBC/ESR: Hb may be reduced and ESR elevated in Sjögren’s linked to connective tissue disorder; Hb may also be reduced in CKD.U&E: may suggest dehydration or CKD.Calcium: elevated in hypercalcaemia.Rheumatoid factor and other autoantibodies: Sjögren’s may be linked to rheumatoid arthritis, SLE or other connective tissue disease.Serum and urine osmolality: serum osmolality raised and urine osmolality low in diabetes insipidus; in compulsive water drinking, serum osmolality low.Sickle-cell screen: to detect sickle-cell anaemia.
No protective benefits of low dose acute L-glutamine supplementation on small intestinal permeability, epithelial injury and bacterial translocation biomarkers in response to subclinical exertional-heat stress: A randomized cross-over trial
Published in Temperature, 2022
Henry B. Ogden, Joanne L. Fallowfield, Robert B. Child, Glen Davison, Simon C. Fleming, Simon K. Delves, Alison Millyard, Caroline S. Westwood, Joseph D. Layden
The EHST commenced in the morning (08:30 ± 1 hour) to standardize the influence of circadian variation [34]. Upon laboratory arrival, participants provided a mid-flow urine sample to assess hydration status. Duplicate urine osmolality measurements were undertaken via freeze-point depression (Osmomat 3000, Gonotec, Berlin, Germany; CV = 0.5%) and urine-specific gravity using a digital refractometer (3741 Pen-Urine S.G, Atago Co. Ltd, Tokyo, Japan; CV = <0.1%). Participants measured their own nude body mass (180 MA, Tanita MC, Tokyo, Japan), before self-inserting a single-use rectal thermistor (Tcore; Phillips 21090A, Guildford, UK) 12 cm beyond the anal sphincter. A heart rate monitor was positioned around participants’ chest (EQ02, Equivital™, Cambridge UK) and was measured using a Sensor Electronics Module (SEM) unit (EQ02, Equivital™, Cambridge UK). Participant dress state was standardized using summer military clothing (i.e. jacket [neck zipped, sleeves extended], trousers, boxer briefs, socks, and trainers). The environmental chamber was regulated at ~35°C (glutamine: 35.3 ± 0.3°C; placebo: 35.3 ± 0.2°C; p = 0.15) and ~30% RH (glutamine: 31 ± 1%; placebo: 30 ± 1%; p = 0.44). On entry to the chamber, skin thermistors (EUS-UU-VL3-O, Grant Instruments, Cambridge, UK) were affixed to the participant using one layer (5 x 5 cm) of cotton tape (KT Tape®, KT Health, UT, USA); mean skin temperature (Tskin) was calculated using standard equations [35].
Handgrip Strength and Its Association With Hydration Status and Urinary Sodium-to-Potassium Ratio in Older Adults
Published in Journal of the American College of Nutrition, 2020
Joana Mendes, Patrícia Padrão, Pedro Moreira, Alejandro Santos, Nuno Borges, Cláudia Afonso, Rita Negrão, Teresa F. Amaral
Free water reserve (FWR) (mL/24-h) is determined by various parameters of water metabolism: beverages and food water intake, metabolic water, urine volume, and obligatory urine volume (22). It was calculated as follows: [24-hour urine volume − obligatory urine volume] (22). The obligatory urine volume is a theoretical volume defined as the water volume necessary to excrete 24-hour urine solutes at the age-related lower limit of maximum urine osmolality (mean (−2 standard deviations)) (22). Based on literature data of standardized tests of renal concentration capacity in subjects in industrialized countries, the lower limit of maximum urine osmolality has been estimated to be 830 mOsm/kg minus 3.4 mOsm/kg per year starting from an age of 20 years (22). Obligatory urine volume was calculated by the following formula: [solutes in urine 24-hour (mOsm/day)]/[830–3.4 × (age-20)] (22). This calculation implies that the obligatory urine volume to excrete the same amount of 24-hour urine solutes increases with aging, reflecting the poor ability to concentrate urine in the elderly (22). The hydration status was evaluated based on FWR and participants were considered at risk of hypohydration in case of negative FWR values (22).
Long QT syndrome caused by adrenal insufficiency secondary to IgG4-related hypophysitis: a case report and review of the literature
Published in Modern Rheumatology Case Reports, 2019
Ai Yaku, Kosaku Murakami, Hiroki Mukoyama, Shinsuke Shibuya, Ran Nakashima, Motomu Hashimoto, Hajime Yoshifuji, Koichiro Ohmura, Hironori Haga, Tsuneyo Mimori
The plasma concentration of antidiuretic hormone [1.4 pg/mL (normal 0.0–4.2 pg/mL)], urine volume (1050 mL/24 h), urine osmolality (394 mOsm/kg) and serum osmolality (289 mOsm/kg) were all within the normal range, and there was no indication of diabetes insipidus. Contrast-enhanced magnetic resonance imaging showed an enlarged pituitary gland and stalk, and pituitary high-intensity signals, consistent with hypophysitis (Figure 1(A)). Contrast-enhanced computed tomography and fluorodeoxyglucose-positron emission tomography revealed multiple enlarged glands (pituitary, lacrimal and submandibular) and lymph nodes (cervical, hilar and para-aortic), kidneys with multiple low-density lesions, right upper lobe consolidation with air bronchogram and abdominal aortic wall thickening (Figure 1(B–E)).