Drugs that disrupt the fine equilibrium of renal function
Hugh Mcgavock in Pitfalls in Prescribing and How to Avoid Them, 2017
A common Accident and Emergency (A & E) 'salvage' operation is the rescue from certain death of patients whose plasma electrolyte balance has been dangerously disrupted by prescribed drugs every ion may be deficient or excessive in concentration, and the plasma pH and water balance may be upset. Sadly, the 'salvage' operation sometimes fails, and the patient dies due to failure of the prescriber to understand the following relatively simple facts: Remember that the adrenal hormone, aldosterone, causes sodium ion and water retention and potassium and hydrogen ion excretion by the kidneys. An actual clinical case submitted by a family doctor colleague. Consider the items in separately: These deplete all of the main plasma cations primarily K, but also Na, Ca and Mg. The elderly and patients in chronic renal failure are most at risk, but hypokalaemia, hyponatraemia, hypocalcaemia and hypomagnesaemia can occur at any age and without renal impairment in patients who are taking loop diuretics.
Demographics, Biology, and Physiology
K. Rao Poduri in Geriatric Rehabilitation, 2017
Biological causes that are age related include cardiac and pulmonary function, muscle strength, vital capacity, orthostatic changes, peripheral resistance, vital capacity, minute volume, and aerobic capacity. Psychological factors include beliefs about self, recovery, and rehabilitation in addition to delayed learning pace needing more repetitions. In the social arena, less frequent referrals to needed rehabilitative care, negative views of ageism, financial barriers, and self-ageism all impact the older adults in coping with disability and obtaining rehabilitation. The onset of aging along with the rate and extent of progression is very individualized and differs from individual to individual. Depending on the functional capacity, the biological age is the metric for the biology of aging, and not the chronological age. There are evolutionary, genetic, physiologic, and other theories of aging. The adrenal glands respond to aging with a decrease in aldosterone secretion that can explain the orthostatic hypotension experienced by aging population.
Kidney Structure and Physiology
Joseph D. Bronzino, Donald R. Peterson in Biomedical Engineering Fundamentals, 2014
The fundamental structural and functional organization of the nephron is conserved in the vertebrate kidney, and tissues with similar structure and function are observed throughout the animal kingdom. Direct measurements in animals have revealed that the hydrostatic pressure gradient across the glomerular capillary wall is normally about 45 mm Hg. Mechanical testing of basement membrane samples from kidney tubules indicates that this structure exhibits nonlinear mechanical properties, becoming stier as the strain is increased. Each kidney is capped by a closely approximated adrenal gland, each of which produces several important steroid hormones, including epinephrine and aldosterone. Fluids enter and exit the kidney through the hilum at the concave aspect of each organ. In the body, the hilum is oriented toward the abdominal great vessels. Upon penetrating the kidney at the hilum, the renal artery immediately branches into anterior and posterior divisions, and then arborizes into interlobar arteries that course radially between lobes of the parenchyma.
Progress in the identification of responsible genes and molecular mechanisms in primary aldosteronism
Published in Expert Review of Endocrinology & Metabolism, 2014
Frances McManus, Samantha Alvarez-Madrazo, John M Connell
Aldosterone, the mineralocorticoid hormone, plays an important role in blood regulation. Autonomous secretion of aldosterone is known as primary aldosteronism (PA), the most common cause of secondary hypertension. PA comprises a group of heterogenous disorders which makes their classification and management challenging. With the advent of the genomic era several germline and somatic mutations have been identified that are involved in the pathogenesis of primary aldosteronism. This article will review our current knowledge of the genetic mechanisms of familial hyperaldosterism, somatic mutations in genes encoding electrolyte channels and other potential genetic mechanisms implicated in the dysregulation of aldosterone production from in vitro and animal models. There is potential for novel targeted therapies and diagnosis for subsets of patient. The challenges to achieve them are highlighted in this review.
Adverse cardiorenal effects of aldosterone: is aldosterone antagonism beneficial?
Published in Expert Review of Cardiovascular Therapy, 2005
Steven G Coca, Mark A Perazella
Aldosterone has recently been recognized as an important factor in the development and progression of cardiorenal disease. Animal and human data suggest that aldosterone contributes importantly to several disease states. These include congestive heart failure, coronary heart disease and progression of kidney disease. Recently, the discovery that aldosterone antagonists decrease pathologic injury in the kidneys and nonepithelial tissues, such as the myocardium and endothelium, has generated great controversy regarding the actual mechanisms of benefit of these agents. The available data is reviewed and conclusions drawn regarding the relative benefits of modulating aldosterone effects in the cardiovascular system and the kidney. In particular, the authors review their effects on reductions in cardiovascular events and progression of chronic kidney disease, as well as the safety and tolerability of these agents.
Body mass index predicts aldosterone production in hypertensive postmenopausal women
Published in Clinical and Experimental Hypertension, 2020
Lijun Li, Xiaoling Hou, Xiaowen Geng, Yong Xu
Hypertension is a common clinical problem, and increased aldosterone is the most prevalent underlying characteristic. Related works have shown exciting results on the effects of various conditions on aldosterone content, but the correlation between aldosterone levels and body mass index (BMI) in premenopausal women has not yet been investigated. We herein report a cross-sectional analysis aimed to determine whether BMI is proportional to plasma aldosterone concentration in premenopausal and postmenopausal hypertensive women. The analysis of consecutive admitted female patients with hypertension revealed potential relationships among plasma aldosterone concentration, plasma renin activity, oestrogen, and BMI. It should be noted that plasma aldosterone concentration was significantly correlated with BMI (p
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