Urinary system acute renal failure

Urinary system In a prospective study, 87 patients with persistent >1 g per day proteinuria despite being on RAS blocker who were treated with add-on spironolactone (25 mg per day) therapy showed an acute fall in eGFR (5.1 9.4mL/min/1.73m ) in the first month of treatment with stabilisation thereafter [38]. Add-on spironolactone (n=32) therapy to a pre-existing antihypertensive regimen in patients with resistant HTN related to stage 3 CKD showed an increase in serum creatinine from 1.5 0.3 to 1.8 0.5mg/dl (P<0.0004) and the eGFR decreased from 48.6 8.7 to 41.2 11.5 mL/min/1.73 m (P< 0.0002). Acute renal failure occurred in one patient, which was resolved with discontinuation of spironolactone [35]. 

Urinary tract Scleroderma renal crisis (SRC) is one of the most feared complications of systemic sclerosis (SSc). It is characterised by acute renal failure usually accompanied by malignant hypertension. SRC has been associated with the use of CS in retrospective studies. An evidence-based systematic review was done by Canadian researchers [27 ]. They identified 26 prospective studies which included a total of 500 (81% women) SSc pafients, in which CS were administered as a new indication. The objective was to ascertain the risk of SRC in newly treated patients. Ten definite SRC cases were reported among the 500 patients, equivalent to a rate of 2%, out of which, eight had received pulse CS tiierapy (initial doses greater than 30 mg per day of prednisone equivalent), two medium doses of CS (initial doses between 16 and 30 mg per day of prednisone equivalent) and none low-dose CS. Considering only the 11 studies limited to early diffuse SSc patients, they identified nine definite SRC cases in 226 patients, which is equivalent to a rate of 4%. This study provides additional support for the association between CS and SRC previously reported in retrospective studies but does not eliminate the possibility that the association may be due to confounding by disease severity or by co-intervention. 

Assessing sodium concentration is of clinical relevance as low urine sodium concentration may indicate dehydration, while a relatively high urine sodium concentration suggests acute renal failure. Lvova and coworkers (2009) proposed an E-tongue composed of chemical sensors to detect urinary system dysfunctions and creatinine levels. The electrochemical system was composed of miniaturized metallic sensors and ISEs with PVC solvent polymeric membranes. The device enabled the correct classification of urine samples from healthy volunteers, according to creatinine levels and to predict the creatinine content of urine. 

Genitourinary system urinary frequency, acute urinary retention, oliguria with elevated blood pressure, azotemia, renal failure. 

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