Kidney disease insufficiency

When the hydantoins are used with odier CNS depressants (eg, alcohol, narcotic analgesics, and antidepressants), an additive CNS depressant effect may occur. The hydantoins are used cautiously in patients widi liver or kidney disease and neurologic disorders. Phenytoin is used cautiously in patients widi hypotension, severe myocardial insufficiency, and hepatic impairment. 

Diabetes mellitus is a complicated, chronic disorder characterized by either insufficient insulin production by the beta cells of die pancreas or by cellular resistance to insulin. Insulin insufficiency results in elevated blood glucose levels, or hyperglycemia As a result of the disease, individuals with diabetes are at greater risk for a number of disorders, including myocardial infarction, cerebrovascular accident (stroke), blindness, kidney disease, and lower limb amputations. 

Creatinine clearance < 60 mL/min/1.73 m2 (stages III-V chronic kidney disease), diabetes mellitus (with renal insufficiency), hypertension, chronic heart failure, cirrhosis, nephrosis, age >75 yr, cholesterol emboli syndrome, multiple myeloma (questionable)... 

Chronic kidney disease (CKD), also known as chronic renal insufficiency, progressive kidney disease, or nephropathy, is defined as the presence of kidney damage or decreased... 

Bumetanide is used for relieving edema associated with cardiac insufficiency, for liver and kidney diseases including nephrotic syndrome, for ascites, and hypertension. Synonyms of this drug are bumex and others. 

Renal effects Use with caution in chronic renal insufficiency aspirin may cause a transient decrease in renal function, and may aggravate chronic kidney diseases (rare). 

The choice of vitamin D preparation to be used in the setting of chronic kidney disease depends on the type and extent of bone disease and hyperparathyroidism. Individuals with vitamin D deficiency or insufficiency should first have their 25(OH)D levels restored to normal (above 30 ng/mL) with vitamin D. l,25(OH)2D3 (calcitriol) rapidly corrects... 

A variety of renal diseases may interfere with the kidney s critical role in volume homeostasis. Although renal disorders will occasionally cause salt wasting, most kidney diseases cause retention of salt and water. When loss of renal function is severe, diuretic agents are of little benefit, because there is insufficient glomerular filtration to sustain a natriuretic response. However, a large number of patients with milder degrees of renal insufficiency can be treated with diuretics when they retain sodium. 

Vitamin D deficiency remains the most common cause of rickets and osteomalacia in the world, with the exception of the United States and the Scandinavian countries where most dairy products are supplemented with this vitamin. This deficiency can be caused either by dietary habits or by insufficient exposure to ultraviolet light. The same type of symptoms can be observed when there is interruption of the normal vitamin D metabolic pathways due to a number of liver and/or kidney diseases. In addition, a number of inherited factors can lead to different types of vitamin D resistance which require massive supplements of vitamin D and/or minerals. Extensive reviews have been published depicting both the clinical features and their most likely causes, as well as the possible treatments of the different types of clinical disorders resulting from vitamin D deficiencies [113-117], The newly defined role for l,25(OH)2D3 upon the hematopoietic system could also have clinical relevance in bone disorders such as osteoporosis where patients have been shown to possess abnormal T-cell subsets [118]. 

Diltiazem was associated with the development of acute renal insufficiency in a patient being treated for severe retrosternal chest pain who had neither primary kidney disease nor urinary tract obstruction (8,9). 

Slaba SG, El-Hajj LF, Abboud GA, Gebara VA. Selective angiography of cerebral aneurysm using gadodiamide in polycystic kidney disease with renal insufficiency. AJR Am J Roentgenol 2000 175(5) 1467-8. 

A 62-year-old woman developed acute renal insufficiency after using topical ketoprofen for 5 days (11). She had several predisposing factors to NSAID-induced acute renal insufficiency, such as advanced age, chronic renal impairment due to polycystic kidney disease, and treatment with an ACE inhibitor and furosemide. 

Metabolites in human blood are closely associated with the state of an individual s health. Determination of metabolites is critical in clinical diagnosis, since they can serve as a criterion for judging the severity of the sickness. Of these metabolites, glucose, lactate and urea are most frequently determined. Special attention to determination of glucose in blood is due to the fact that diabetes is well known as a dangerous and widespread disease that results in a high glucose concentration in the blood. Some other effects of metabolites, such as urea and lactate, on shock, respiratory insufficiency, and heart and kidney diseases are understood to some extent. 

Under normal conditions each of the two million nephrons of the kidney work in an organized approach to filter, reabsorb, and excrete various solutes and water. The kidney is a primary regulator of sodium and water as well as acid-base homeostasis. The kidney also produces hormones necessary for red blood cell synthesis and calcium homeostasis. Impairment of normal kidney function is often referred to as renal insufficiency. Based on the time course of development, renal insufficiency has historically been divided into two broad categories. Acute renal failure (ARF) refers to the rapid loss of renal function over days to weeks. Chronic kidney disease (CKD)", also called chronic renal insufficiency (CRI) by some, is defined as a progressive loss of function occurring over several months to years, and is characterized by the gradual replacement of normal kidney architecture with interstitial fibrosis. Progressive kidney disease or nephropathy is... 

Renal blood flow and GFR decline progressively with age. Progressive sclerosis of glomemh occurs, and residual glomerular and tubular units increase function in compensation, similarly to patients with chronic kidney disease. This decline in renal function is not accompanied by a rise in the serum creatinine concentration due to the age-related decline in muscle mass and decreased creatinine generation. Older individuals are also more likely to have heart failure and hepatic insufficiency, which also reduce renal hlood flow. Together, these processes predispose the elderly to an increased risk of nephrotoxicity. ... 

Ehe-existent kidney disease, particularly diabetic nephropathy with renal insufficiency, is the major risk factor. Conditions associated with decreased renal blood flow, including congestive heart failure and dehydration, also confer risk. The presence of multiple myeloma has been considered a relative contraindication for contrast use, but the risk appears to be associated with concomitant dehydration, renal insufficiency, or hypercalcemia rather than the diagnosis itself. Both... 

Historically, reversible acute renal insufficiency occurred frequently in transplant recipients during the first 6 months of cyclosporine therapy. The incidence of chronic kidney disease in nonrenal transplant patients is reported to be from 10% to 83%. " Recent data indicate that the 5-year risk of CKD after transplantation of a nonrenal organ ranges from 7% to 21%, depending on the type of organ transplanted. In addition, the occurrence of CKD in these patients is associated with more than a fourfold increase in the risk of death. 

Acute renal insufficiency usually improves with dose reduction, and treatment of contributing illness or the discontinuation of interacting drugs. Chronic kidney disease is usually irreversible, but progressive toxicity may be limited by discontinuation of cyclosporine therapy or dose reduction, with the continuation of other immunosuppressants (e.g., prednisone or azathioprine). 

Hyperkalemia is much less common than hypokalemia. In facf if all patients with acute and chronic kidney disease were excluded, the true prevalence of hyperkalemia would be insignificant. Indeed, the incidence of hyperkalemia in hospitalized patients has been estimated to be 1.4% to 0% Most cases of hypokalemia are the result of overcorrection of hypokalemia with potassium supplements. Severe hyperkalemia occurs more commonly in elderly patients with renal insufficiency who receive potassium supplementation. ... 

Diabetic nephropathy consequently results in chronic renal insufficiency and need for dialysis. End-stage renal failure is accompanied by increased oxidative stress and patients are at increased risk to develop cardiovascular disease. Oxidatively modified LDL was shown to be localized in kidneys (Exner et al. 1996) and a role for OxPL in kidney disease was suggested. 

Adrenal insufficiency is responsible for renal sodium loss and failure of urine acidification in the tubules. Similarly, the reabsorption of sodium and the excretion of H are impaired in severe kidney disease. 

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