Renal function impairment diabetes mellitus

The filtration coefficient is determined by the surface area and permeability of the filtration barrier. An increase in the filtration coefficient leads to an increase in GFR if the filtration coefficient decreases, then GFR decreases. However, this factor does not play a role in the daily regulation of GFR because its value is relatively constant under normal physiological conditions. On the other hand, chronic, uncontrolled hypertension and diabetes mellitus lead to gradual thickening of the basement membrane and therefore to a decrease in the filtration coefficient and GFR, and impaired renal function. 

Metformin is a biguanide used to treat diabetes mellitus. It is contraindicated in patients undergoing general anaesthesia since anaesthesia can interfere with renal function. The risk of lactic acidosis associated with metformin increases in patients with renal impairment. Metformin should be stopped before and during surgery where anaesthesia is indicated. Metformin should only be restarted after the renal function has returned to normal. 

Renal function /mpa/rmenf Anuria, acute or chronic renal insufficiency and evidence of diabetic nephropathy are contraindications because potassium retention is accentuated and may result in the rapid development of hyperkalemia. Do not give to patients with evidence of renal impairment (BUN greater than 30 mg/dL or serum creatinine greater than 1.5 mg/dL) or diabetes mellitus without continuous monitoring of serum electrolytes, creatinine, and BUN levels. 

Severe hypoglycemia occurred in two elderly men with type 2 diabetes mellitus and mild to moderate impaired renal function, who took clarithromycin 1000 mg/day for respiratory infections, in addition to a sulfonylurea (glibenclamide 5 mg/day in one case and glipizide 15 mg/day in the other) (168). Both developed severe hypoglycemia within 48 hours of starting clarithromycin. 

Heparin-induced hypoaldosteronism is well documented, both in patients treated with standard heparin, even at low doses, and in patients treated with low molecular weight heparin (477,478). The most important mechanism of aldosterone inhibition appears to be a reduction in both the number and affinity of angiotensin II receptors in the zona glomerulosa (477). A direct effect of heparin on aldosterone synthesis, with inhibition of conversion of corticosterone to 18-hydroxycorticosterone, has also been suggested. This effect is believed to be responsible for the hyperkalemia that can occur in heparin-treated patients with impaired renal function and particularly in patients on chronic hemodialysis (479), or with diabetes mellitus, or who are taking other potentially hyperkalemic drugs. 

A previous medical history of non-insulin dependent diabetes mellitus and hypertension are added risk factors for developing acute renal failure, as they will predispose the patient to having a degree of chronically impaired renal function. 

Use caution with patients who have impaired cardiac, renal or hepatic function, hypertension, hyperthyroidism, diabetes mellitus, peptic ulcer, glaucoma, severe hypoxemia, or underlying seizure disorder. 

History of hypersensitivity to sulfonamides or thiazide diuretics, renal decompensation, anuria. Cautions Severe renal disease, impaired hepatic function, diabetes mellitus, elderly/debilitated,... 

Chronic renal failure is also frequently associated with diminished erectile function, impaired libido, and infertility. The mechanism is probably multifactorial low serum testosterone concentrations, diabetes mellitus, vascular insufficiency, multiple medications, autonomic and somatic neuropathy, and psychological stress. Men with angina, myocardial infarction, or heart failure may have erectile dysfunction from anxiety, depression, or concomitant penile arterial insufficiency. 

An example of metabolic acidosis occurring as a result of disease is uncontrolled diabetes mellitus (Table 3.4). The tissues cannot metabolize glucose properly and instead excessively metabolize fat to yield so-called ketone bodies which include aceto-acetic and beta-hydroxy-butyric acids. These are strong acids. Such acids are called non-volatile , or fixed because they cannot be blown off in the lungs as can CO2. Renal damage is another cause of metabolic acidosis as will be explained later, a normal mixed diet yields a preponderance of acid when metabolized and the urine is normally acid. When renal function is impaired, the kidney fails to excrete this metabolically-derived acid and the acid accumulates in the body. In surgical patients, a common... 

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