Renal failure intrinsic

Common laboratory tests are used to classify the cause of ARF. Functional ARF, which is not included in this table, would have laboratory values similar to those seen in prerenal azotemia. However, the urine osmolality-to-plasma osmolality ratios may not exceed 1.5, depending on the circulating levels of antidiuretic hormone. The laboratory results listed under acute intrinsic renal failure are those seen in acute tubular necrosis, the most common cause of acute intrinsic renal failure. 

Urinary electrolytes in renal failure this table is always difficult to recall but try to remember that in intrinsic renal failure the kidney is unable to concentrate urine effectively and so a poor quality, dilute urine is produced... 

The loop diuretics are usually required in treating chronic renal failure, since drugs with lesser intrinsic activity are not sufficiently effective when tubular function has been compromised greatly. Larger than normal amounts of furosemide are frequently employed, and thus it is especially important to monitor the patient for... 

Calcium and phosphate enter the body from the intestine. The average American diet provides 600-1000 mg of calcium per day, of which approximately 100-250 mg is absorbed. This figure represents net absorption, because both absorption (principally in the duodenum and upper jejunum) and secretion (principally in the ileum) occur. The amount of phosphorus in the American diet is about the same as that of calcium. However, the efficiency of absorption (principally in the jejunum) is greater, ranging from 70% to 90%, depending on intake. In the steady state, renal excretion of calcium and phosphate balances intestinal absorption. In general, over 98% of filtered calcium and 85% of filtered phosphate is reabsorbed by the kidney. The movement of calcium and phosphate across the intestinal and renal epithelia is closely regulated. Intrinsic disease of the intestine (eg, nontropical sprue) or kidney (eg, chronic renal failure) disrupts bone mineral homeostasis. 

As a consequence, no dose adjustments in patients with renal failure are warranted on the basis of intrinsic properties of HMR1964 (insulin glulisine). 

Increased free fraction will cause an increased clearance of MPA, resulting in lower total MPA concentrations that return to baseline values when the condition that caused the change in free fraction becomes normal.In chronic renal failure, however, the total MPA concentration is often within the guidelines for effective immunosuppression, but the free concentrations can be substantially elevated—placing the patient at increased risk for overimmunosuppression. It is hypothesized that chronic uremia causes reduction in the intrinsic clearance that results in zero order kinetics for MPA clearance. 

Prakash J, Sen D, Kumar NS, Kumar H, Tripathi LK, Saxena RK. Acute renal failure due to intrinsic renal diseases Review of 1122 cases. Ren Fail 2003 25 225-33. 

Hepatorenal syndrome, functional renal failure in the setting of cirrhosis in the absence of intrinsic renal disease, occurs in patients with cirrhosis as a result of intense vasoconstriction within the renal cortical vasculature. It is common and develops in approximately 40% of patients with cirrhosis and ascites within 5 years. The resultant reduction in blood supply to the kidneys causes avid sodium retention and oliguria. The vasoconstriction that occurs in the kidneys is in stark contrast to the state of systemic vasodilation that is characteristic of chronic liver failure. The pathophysiologic mechanism responsible for these effects is unknown, but is linked to the systemic vasodilation, hypovolemia, and hyperkinetic circulation seen in chronic liver failure. ... 

Acute intrinsic renal failure Vascular Vasculitis Polyarteritis nodosa Thrombotic thrombocytopenic purpura Hemolytic uremic syndrome Emboli Cholesterol Thrombotic... 

Acute intrinsic renal failure results from damage to the kidney itself. Conceptually, acute intrinsic renal failure can best be understood in terms of the structures within the kidney the small blood vessels. 

Splinter hemorrhages Endocarditis Intrinsic renal failure—glomerulonephritis... 

Hollenhorst plaque Cholesterol emboli Acute intrinsic renal failure—vascular... 

Roth spots Endocarditis Acute intrinsic renal failure—acute glomerulonephritis... 

Laboratory Test Prerenal Azotemia Acute Intrinsic Renal Failure Postrenal Obstruction... 

Clinically overt nephrotoxicity is the result of the intrinsic capacity of a toxin to damage renal cells or tissue, the susceptibility of the patient, and changes in disposition of the toxin fhat result in increased delivery to the target organ or tissue. In this chapter we will examine the latter aspect of nephrotoxicity and will focus on (i) drug interactions that potentially lead to nephrotoxicity and (ii) changes in drug disposition induced by renal failure. 

Chronic renal failure almost always is caused by intrinsic renal diseases and is characterized by slow, progressive development. Unlike the acute condition, chronic renal impairment generally is irreversible. The degree or loss of kidney functional capacity in the chronic condition is best described in terms of the intact nephron hypothesis, in which the diseased kidney is comprised of nephrons that are essentially nonfunctional because of pathologic conditions together with normal nephrons. Progressive renal impairment is the result of an increasing fraction of nonfunctional nephrons. 

Brown CB, CS, Cameron JS, Bewick M. High dose frusemide in acute reversible intrinsic renal failure. A preliminary ccmmunicadcm. Scott MedJ ( 974) 19,35-9. 

McCarthy JT, Torres VE, Romero JC, Wochos DN, Velosa lA Acute intrinsic renal failure induced by indom ethacin role of prostaglandin synthetase inhibitioiL Mayo Ctin Proc (1982) 57,289-96. 

McCarthy, J.T., Torres, V.E. and Romero, J.C., Wochos, D.N. and Velosa, J.A. (1982). Acute intrinsic renal failure induced by indomethacin Role of prostaglandin synthetase inhibition. Mayo Clin. Proc., 57, 289—96... 

There have been not been any reports indicating that renal dysfunction affects the intake and absorption of vitamin B12. However, renal failure is associated with gastric epithelial cell dysfunction, which may reduce the release of gastric intrinsic factor. Moreover, decreased renal function may induce anorexia, which results in a reduction in food intake (Kopple et al. 1999). 

Atrogenes" are a common set of genes whose expression is coordinately induced or suppressed in muscle during generalized wasting states (such as fasting, cancer cachexia, renal failure, and diabetes) [36,45]. These can be activated by intrinsic or extrinsic mnscle-fiber abnormalities. 

Table 19.1. The most common causes of acute renal failure with regard to the major pathogenetic mechanisms perirenal causes, intrinsic renal failure and postrenal etiology (modified from Andreoli 1999)...

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