Kidney disease renal failure

Mitic-Zlatkovic M, Stefanovic V. Acute effects of acetaminophen on renal function and urinary excretion of some proteins and enzymes in patients with kidney disease. Renal Failure 1999 21 525-532. 

Polycystic kidney disease (Polycyst in-1 activates canonical Wnt signaling pathway) Injury-induced renal fibrosis Heart failure Ulcerative colitis Osteoporosis-Pseudoglioma Syndrome (genetic syndrome of defective bone formation) Ulcerative colitis Familial Alzheimer s disease (through interaction with Presenilin-1) Familial Alzheimer s disease (through interaction with Presenilin-1)... 

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)... 

O Chronic kidney disease is a progressive disease that eventually leads to renal failure [end-stage renal disease (ESRD)]. 

These adaptations are lost as renal failure progresses. [Ca] X [POJ calcium-phosphorus product. (From Joy MS, Kshirsagar A, Paparello J. Chronic kidney disease Progression-modifying therapies. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 834, with permission.)... 

Uric acid excretion is reduced in patients with chronic kidney disease, putting them at risk for hyperuricemia. In patients with persistently acidic urine and hyperuricemia, uric acid nephrolithiasis can occur in up to 25% of patients in severe cases, uric acid stones can cause nephropathy and renal failure. Extreme hyperuricemia can occur because of rapid tumor cell destruction in patients undergoing chemotherapy for certain types of cancer (see Chap. 85). 

Acute renal failure is a rare but serious side effect of ACE inhibitors preexisting kidney disease increases the risk. Bilateral renal artery stenosis or unilateral stenosis of a solitary functioning kidney renders patients dependent on the vasoconstrictive effect of angiotensin II on efferent arterioles, making these patients particularly susceptible to acute renal failure. 

The pathophysiology, clinical manifestations, diagnosis, and treatment of acute renal failure and chronic kidney disease (CKD) or end-stage renal disease are discussed in Chaps. 75 and 76, respectively. 

Adult polycystic kidney disease (APKD) is one of the most common autosomal dominant diseases, affecting about 1/1,000 whites. The key feature of this disease is the progressive accumulation of renal cysts, which ultimately culminate in kidney failure. APKD is responsible for approximately 10% of end-stage renal disease in North America. Patients may also have hypertension, cerebral aneurysms, liver cysts, and cardiac valvular defects. 

As mentioned previously, renal failure markedly reduces total renal clearance, as well as metabolic clearance of nicotine and cotinine (Molander et al. 2000). Reduction of renal clearance is correlated with the severity of kidney failure renal clearance is reduced by half in mild renal failure, and by 94% in severe renal impairment. Markedly elevated levels of serum nicotine have been detected in smoking patients with end-stage renal disease undergoing hemodialysis (Perry et al. 1984). This is explained not only by reduced renal clearance, but also by lower metabolic... 

Renal dysfunctions can be diagnosed by different methods, depending on the severity of the condition. Examination of urine, which is produced by the kidneys, provides an important indication of renal insufficiency. The urine output, color, odor, acidity, specific gravity, and constituents are important prognostic factors of kidney status. However, in critically ill patients and in acute renal failures induced by several diseases including multiple organ failures and diabetes, urine examination may be impractical and redundant. Such patients require reliable and simple methods to diagnose the onset of renal failure. 

The commonest causes of death in the Jamaican patients with multiple myelomatosis were bronchopneumonia and other infectious complications, a finding which is compatible with the secondary antibody deficiency syndrome and impaired cellular immunity which occurs in patients with this disease. Bleeding manifestations and renal failure were not uncommon findings, and myeloma kidney was observed in 66% of the cases. Skeletal involvement was observed, but in many cases the typical lesions had to be searched for. Amyloidosis was present in as many as 21% of the patients (Tl) and this may be associated with the high number of patients in Jamaica that are known to excrete Bence Jones protein in myeloma (Mil). 

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