Renal Disease; Fluid and Electrolyte Disorders
John S. Axford, Chris A. O'Callaghan in Medicine for Finals and Beyond, 2023
Blood pressure is usually measured with a sphygmomanometer, which uses an inflatable cuff around the arm. Good automatic devices are available, but it is still important to be able to check the action of these devices with a manual sphygmomanometer. Choose a cuff of the right size. If the patient has a large arm, use a large cuff or the reading will be falsely high.Wrap the cuff around the patient's arm and place a stethoscope over the brachial artery at the elbow.Inflate the cuff until no sound is heard and then slowly deflate it.When the first sounds start to be heard, this is the systolic pressure as indicated on the sphygmomanometer.When the sounds finally disappear, this is the diastolic pressure.
Cardiovascular, Hemodynamic, and Critical Care Considerations in the Patient With Necrotizing Enterocolitis
David J. Hackam in Necrotizing Enterocolitis, 2021
Hypotension is a perplexing problem for neonatologists. Although the ideal treatment approach is still under debate, even the mere definition of hypotension is not well established. One of the earliest studies by Zubrow et al. suggested that a normal mean arterial blood pressure (MABP) in a preterm infant should be greater than or equal to the estimated gestational age (EGA) in weeks, an approach that has been widely accepted into daily practice (9, 10). However, this study used only noninvasive blood pressure measurements, taken over long intervals (9). Accordingly, low blood pressure by this definition does not necessarily translate into inadequate end-organ perfusion (11, 12). A later retrospective study by Dempsey et al. demonstrated that extremely low-birth-weight (ELBW) infants with permissive hypotension (by the Zubrow definition) in the first 24 hours of life with signs of adequate end-organ perfusion had similar outcomes to infants who were normotensive, calling into question this “rule of thumb” (13). As a result, there has been a shift toward a functional definition of hypotension encompassing low blood pressure measurements in addition to signs of inadequate end-organ perfusion (14–16). Using the outcome of intraventricular hemorrhage (IVH), Miall-Allen et al. provided evidence to support the practice of maintaining the MABP above 30 mmHg, as the risk of IVH increases subsequent to the length of time a MABP is spent below 30 mmHg (1).
Diabetic Nephropathy
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
When the kidneys receive less blood flow than is needed, they respond as if the body is dehydrated and release aldosterone that stimulates the retention of sodium and water. The blood vessels fill with extra fluid and pressure increases. Usually, there are no symptoms, but when there is also severely elevated systemic blood pressure, there may be headache, blurry or double vision, bloody urine, confusion, and nosebleeds. The eventual outcome is chronic kidney disease. Often, systemic hypertension is more difficult to control with multiple medications when glomerular hypertension is also present. Some patients have stable systemic hypertension that suddenly worsens. Kidney abnormalities may develop suddenly, and there can sometimes be a fast development of pulmonary edema.
Association Between Dietary Selenium Intake and the Prevalence of Nonalcoholic Fatty Liver Disease: A Cross-Sectional Study
Published in Journal of the American College of Nutrition, 2020
Jing Wu, Chao Zeng, Zidan Yang, Xiaoxiao Li, Guanghua Lei, Dongxing Xie, Yilun Wang, Jie Wei, Tubao Yang
Venous blood samples were collected from subjects, after an overnight fast of 12 hours, into serum separation tubes (containing silica clot activators and gel separator), and were immediately centrifuged at 4 °C for 10 minutes at 3000 relative centrifugal force. Fasting blood glucose (FBG) was measured using the glucose oxidase enzyme method on a Beckman Coulter AU 5800 (Beckman Coulter Inc., Brea, CA, USA). The mean intra-and inter-assay coefficients of variation for FBG were 1.7% and 2.2%, respectively. An electronic sphygmomanometer was used to measure blood pressure (BP). A diagnosis of diabetes was made if the FBG of the subject was ≥ 7.0 mmol/L or if he/she was using any anti-diabetic therapy at the time. A subject had diagnosed hypertension if he/she had a systolic BP ≥ 140 mm Hg or a diastolic BP ≥ 90 mm Hg or if he/she was taking any antihypertensive agent at the time.
Rituximab treatment for refractory nephrotic syndrome in adults: a multicenter retrospective study
Published in Renal Failure, 2023
Xiaoyan Ma, Lu Fang, Lili Sheng, Xun Zhou, Shoujun Bai, Xiujuan Zang, Yakun Wang, Mengke Li, Zexin Lv, Qin Zhong, Xinyu Yang, Yishu Wang, Yan Hu, Danying Yan, Yingfeng Shi, Hui Chen, Jinqing Li, Min Tao, Shougang Zhuang, Yi Wang, Na Liu
A total of 75 patients were identified with RTX therapy for RNS. After a median follow-up period of 18.5 (12.5, 29.25) months, 48 patients entered the final analysis according to the inclusion and exclusion criteria (Figure 1). The baseline demographic and clinical characteristics were shown in Table 1. Of a total of 48 eligible patients with an average age of 47.88 ± 16.93 years old, 33 were males and 8 were smokers. Nine patients had diabetes, and 22 had hypertension. The average blood pressure was 135.08 ± 17.34/82.75 ± 10.74 mmHg. Median disease duration of 48 patients was 29.5 (IQR 1260) months. All the patients were with biopsy-proven INS, 15 (31.3%) with MCD, 5 (10.4%) with FSGS, 26 (54.2%) with MN, and 2 (4.2%) with MPGN. The immunosuppressive therapies of patients before RTX treatment were steroid only (12, 25%), cyclosporine or tacrolimus (24, 50%), cyclophosphamide (10, 20.8%), mycophenolate (1, 2.1%), and others (1, 2.1%). One patient with other immunosuppressive agents was a male with MCD who received steroid and leflunomide therapy. All patients had received at least one course of immunosuppression therapy, with a median of 2 (IQR 1–3) courses. The reasons of refractory for patients enrolled included steroid dependent (4, 8.3%), steroid-resistant (3, 6.3%), frequent relapsing (11, 22.9%), steroid intolerant (5, 10.4%), and resistance to immunosuppression (25, 52.1%).
Rebound sign: a case report and review of literature
Published in Clinical and Experimental Hypertension, 2022
Yuehai Wang, Changpeng Zhai, Yuqiang Zhang, Guangyong Huang, Shengjun Ma
A 60-year-old male complained of paroxysmal chest pain for 1 day. He had a five-year history of hypertension and hyperlipidemia, and had no history of allergy. The blood pressure is 165/108 mmHg. and the heart rate is 74 beats/min. No ST-T changes were found in electrocardiogram (ECG). There was a rise in troponin I of 0.066 ng/ml. The initial diagnosis is acute coronary syndrome and the patient underwent a transradial selective coronary angiography (CAG). Right coronary artery (RCA) was normal (Figure 1(a)), and then left coronary artery (LCA) angiography was performed with JL3.5 tube. After the first injection of contrast agent, we found that the proximal segment of LAD was blocked (Figure 1(b), Figure 2(o,u) and Video S1), while the blood perfusion in the distal segment of left circumflex artery (LCX) was slow (TIMI class II blood flow) (Video 1). At the same time, the patient presented with sudden chest tightness and sweating. The heart rate dropped rapidly to 40 beats per minute, and blood pressure dropped to 80/40 mmHg. The dry or wet rales were not heard in lung auscultation. There was no murmur in cardiac auscultation. ECG monitoring showed 0.3 mV of ST segment elevation.
Related Knowledge Centers
- Cardiac Cycle
- Vital Signs
- Circulatory System
- Heart
- Blood Vessel
- Mean Arterial Pressure
- Brachial Artery
- Mercury
- Pulse Pressure
- Respiratory Rate