Kidney insufficiency

Azotemia An excess of urea and other nitrogenous wastes in the blood as a result of kidney insufficiency. 

Albumin 18-20 Maintains plasma oncotic pressure transports small molecules Dehydration, anabolic steroids, insulin, infection Overhydration, edema, kidney insufficiency, nephrotic syndrome, poor dietary intake, impaired digestion, burns, congestive heart failure, cirrhosis, thyro id/adrena / pitu itary hormones, trauma, sepsis... 

Priapism Priapism has been reported from postmarketing surveillance of tinzaparin as a rare occurrence. In some cases, surgical intervention was required. Renal/Hepatic function impairment Delayed elimination of LMWHs may occur with severe liver or kidney insufficiency. Use with caution. 

Special risk Use with care in patients with a bleeding diathesis, uncontrolled arterial hypertension, or a history of recent Gl ulceration or bleeding, diabetic retinopathy, hemorrhage, and severe liver or kidney insufficiency. 

The diagnosis of hepatorenal syndrome calls for the exclusion of prerenal, renal or postrenal kidney insufficiency. (s. tabs. 17.4, 17.6) The presence of disease in both the liver and kidney in the sense of a pseudohepa-torenal syndrome must also be ruled out. (s. tab. 17.5)... 

Ventricular dysrhythmias have been reported after rapid infusion of large doses of DAMB (70) in patients with hyperkalemia and renal insufficiency, but not in patients with normal serum creatinine and potassium concentrations, even if they have received the drug over a period of 1 hour. Slower infusion rates and infusion during hemodialysis have been advocated in patients with terminal kidney insufficiency, in order to avoid hyperkalemia. 

Boric acid penetrates even intact skin, but it is readily absorbed through inflamed or otherwise damaged skin and through mucous membranes. After the application of wet compresses of boric acid to intact and eczematous skin in 21 patients over several days, blood concentrations of boric acid were generally not raised (3). One patient, however, did have a significant rise in blood boric acid concentration, which the authors ascribed to pre-existing kidney insufficiency. 

Morin D, Dumas ML, Valette H, Dumas R.Transitory acute kidney insufficiency and insulin-dependent aftertreatment of kala-azar with pentamidine and N-methylglucamine antimony. Archives francaises de pediatrie. 1991 May 48(5) 349-51. 

Acute kidney injury can be severe with foscarnet. Some degree of kidney injury has been reported to occur in as many as two-thirds of patients treated with foscarnet and has been a dose-limiting toxicity in 10-20% of cases [51-56]. Despite dose reduction or discontinuation of foscarnet, azotemia typically progresses for at least a few days before resolving. It may be possible to continue foscarnet at reduced doses in some patients with mild azotemia. Foscarnet-induced AKI is usually reversible, although temporary dialysis may be required [57]. Recovery may be slow, particularly in patients with preexisting kidney insufficiency. Elevated serum creatinine concentrations may persist for several months after discontinuation of foscarnet. Foscarnet nephrotoxicity may be also associated with mild proteinuria. Volume expansion with isotonic saline was effective in reducing the incidence of foscarnet nephrotoxicity to 13%, compared to 66% in non-hydrated historical controls, and allowed patients with prior kidney insufficiency to receive foscarnet without further reduction of kidney function [54, 58]. Intermittent, rather than continuous, infusion of foscarnet may also reduce the incidence of nephrotoxicity [52]. 

Like ACE inhibitors, ARBs may cause kidney insufficiency, hyperkalemia, and orthostatic hypotention. The same precautions that apply to ACE inhibitors for patients with suspected bilateral renal artery stenosis, those on drugs that can raise the potassium level, and those on drugs that increase the risk of hypotension apply to ARBs. Cough is very uncommon. Angioedema is also less likely to occur than with ACE inhibitors, but cross-reactivity has been reported. ARBs should be used cautiously in patients with a history of angioedema but, unlike ACE inhibitors, are not contraindicated. ARBs should not be used in pregnancy. 

Clinical picture. It is manifested by the following syndromes a) irritative - catarrhal expressions on the contact mucosa b) renotoxic - by oligo- or anuria, pathological deviations in urine indications and manifestation of kidney insufficiency c) cerebro-toxic - manifested by convulsions, delirious fits, sometimes by consciousness derangement, gradual fall into neurotoxic degradation and dementia events. 

Clinical manifestation. It includes several syndromes a) pulmotoxic and irritative syndrome - expressed by catarrhal changes on the contact mucosa and respiratory tract, toxic pulmonary oedema b) hemotoxic syndrome - expressed by severe hemolysis of different degrees, in the severe forms - hemolytic shock and anaemia c) hepatal syndrome - characterised by subicterus or icterus, increased liver and bilirubinaemia d) renal syndrome - by oliguria or anuria, pathological deviations in the urine and acute kidney insufficiency. In the extremely severe forms consciousness is disordered. Laboratory blood and urine chemical tests show evidence of phenol metabolites, data for blood damage (increased values of free hemoglobin, reduced number of erythrocytes), positive liver tests etc. 

Very recently examples of rheological studies on blood were published elsewhere [242]. As an example we want to discuss some results of these investigations here. Fig. 4.45 shows the surface tension response after a step-type area change of a pendent drop area by about 10% for 6 serum samples from one and the same patient at different stages of his acute kidney insufficiency [243]. 

Fig. 4.45 Surface tension response of serum from a 46 years old patient admission suffering from an acute kidney insufficiency admission to hospital (), thfir PY (O. Cl), after haemodialysis ( ), polyuria ( ), leaving the hospital ( )...

Not for use in persons with hypertension, liver disorders, edema, severe kidney insufficiency, low blood potassium, heart disease with edema, or congestive heart failure (Bensky et al. 2004 Bradley 1992 De Smet 1993 Mills and Bone 2005). 

Hyperkalemia was reported in a man with chronic kidney insufficiency who was taking noni. Analysis of a noni... 

Fioricet should be prescribed with caution in patients with known liver or kidney insufficiency. Liver and renal function laboratory tests should be performed to ensure safety when using the medication. 

Figure 12.4. Dynamic surface tensions as a function of log t for various biological liquids x, serum of a 49 years old patient suffering from acute kidney insufficiency A, gastric juice of an 18 years old patient suffering from gastric ulcer brain , liquor of a 13 year old patient suffering from cerebrospinal encephalitis 0 urine of a 49 years old patient suffering from chronic nephritis...

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