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1.
Niger J Clin Pract ; 23(11): 1590-1597, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33221787

RESUMEN

BACKGROUND: Hypertension is one of the commonest cause of chronic kidney disease (CKD) in Nigerians. We describe blood pressure (BP) control and kidney disease markers in patients with hypertension as part of measures to curb the burden of this chronic debilitating disease. METHODS: Patients with hypertension in the main tertiary hospitals in three states in north central Nigeria were evaluated for indicators of CKD, including proteinuria and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Patients had their early morning first void urine tested for proteinuria using Combi-10 test strips. eGFR was estimated using the MDRD equation. RESULTS: A total of 1063 subjects (63.1% females and 36.8% males) with a mean age of 55 ± 11 years were studied. Diabetes mellitus (DM) was present in 214 (20.6%) and 422 (39.7%) had optimal BP control. The median duration of hypertension was 6 years (range 1-44 years). Proteinuria occurred in 130 (12.2%), while 212 (19.9%) had reduced eGFR and 46 (4.3%) had proteinuria and reduced eGFR. The use of calcium channel blockers [adjusted odds ratio (AOR): 0.70, 95% Confidence Interval (CI) 0.50-0.99] and the use of more than two antihypertensive medications (AOR: 0.62, 95% CI 0.40-0.96) were associated with reduced odds of optimal BP control. Male sex (AOR: 1.75, 95% CI 1.14-2.70) and the use of renin-angiotensin-aldosterone system blocking medications (AOR: 2.07, 95% CI 1.18-3.64) were independently associated with proteinuria while DM (AOR: 1.69, 95% CI 1.06-2.55) and treatment with more than two medications (AOR: 1.86, 95% CI 1.09-3.17) were more likely to have reduced eGFR. CONCLUSION: A large proportion of hypertensive patients in north-central Nigeria have poorly controlled BP. Kidney damage is common among these patients.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Riñón/fisiopatología , Insuficiencia Renal Crónica/epidemiología , Adulto , Anciano , Antihipertensivos/efectos adversos , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea , Estudios Transversales , Femenino , Tasa de Filtración Glomerular , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Proteinuria/epidemiología , Insuficiencia Renal Crónica/complicaciones , Factores de Riesgo
2.
Clin Nephrol ; 71(1): 63-8, 2009 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-19203552

RESUMEN

We report a patient with scleroderma, renal cell carcinoma (RCC) and membranous nephropathy (MN). Certain clinical and laboratory features suggested that RCC caused or enhanced the other two conditions. A 55-year-old man developed scleroderma which progressed rapidly during its first 2 years with development of hypertension and acute renal failure, peak serum creatinine (SCr) 327 micromol/l (3.7 mg/dl) and partial improvement of the renal function (SCr 239 micromol/l or 2.7 mg/dl) after initiation of an angiotensin converting enzyme inhibitor. He subsequently developed nephrotic syndrome (urine protein excretion 9 gm/24-h) and progressive renal failure, with SCr 469 +/- 18 micromol/l (5.3 +/- 0.2 mg/dl). An anti-nuclear mitotic apparatus protein (NUMA) antibody, which is uncommon in scleroderma but has been linked to certain malignancies, was found in his serum. A left upper pole RCC was removed by heminephrectomy. MN was found in the renal parenchyma adjacent to the excised tumor. In the 3.5 years following surgery, the clinical manifestations of scleroderma have been arrested while the medications prescribed for this condition have been greatly reduced. Proteinuria is consistently less than 1 gm/24-h and 42 months after surgery serum creatinine was 256 micromol/l (2.9 mg/dl). Nutrition has also improved. Although this case may represent chance occurrence of three uncommon diseases (scleroderma, RCC, MN) in the same individual, the sustained improvement of the manifestations of scleroderma and MN after resection of the RCC contrasted to the rapid course of these conditions until the surgery, and the presence in the patient's serum of an autoantibody which is uncommon in patients with scleroderma, but has been linked to malignancy, suggest a pathogenetic relationship between the three conditions.


Asunto(s)
Carcinoma de Células Renales/complicaciones , Carcinoma de Células Renales/patología , Glomerulonefritis Membranosa/complicaciones , Neoplasias Renales/complicaciones , Neoplasias Renales/patología , Esclerodermia Sistémica/complicaciones , Carcinoma de Células Renales/terapia , Glomerulonefritis Membranosa/diagnóstico , Glomerulonefritis Membranosa/terapia , Humanos , Neoplasias Renales/terapia , Masculino , Persona de Mediana Edad , Esclerodermia Sistémica/diagnóstico , Esclerodermia Sistémica/terapia
3.
Kidney Int ; 73(9): 1054-61, 2008 May.
Artículo en Inglés | MEDLINE | ID: mdl-18288103

RESUMEN

Increased demand for amino acids to sustain acute-phase protein synthesis could be the stimulus for the increased muscle protein catabolism during hemodialysis (HD). This could be attenuated by intradialytic amino-acid infusion. To test this, we measured the fractional synthesis rates of albumin, fibrinogen, and muscle protein in eight patients with end-stage renal disease at baseline before dialysis and during HD without or with amino-acid infusion. The percentage change in the fractional synthesis rates of albumin, fibrinogen, and muscle protein from baseline was significantly higher during HD with amino-acid infusion than without amino-acid infusion. Leg muscle proteolysis was significantly increased during unsupplemented HD compared with baseline, but this was not decreased by amino-acid infusion. Arteriovenous balance studies across the leg showed a net efflux of interleukin-6 (IL-6) from the muscle into the vein during HD. The fractional synthesis rate of albumin, fibrinogen, and muscle protein correlated with each other and with the IL-6 efflux from the leg. Leg muscle protein catabolism was positively related to IL-6 release from the leg and not associated with amino-acid availability. Our results show that intradialytic cytokine activation and not amino-acid depletion is the major protein catabolic signal during HD.


Asunto(s)
Albúminas/biosíntesis , Fibrinógeno/biosíntesis , Interleucina-6/fisiología , Fallo Renal Crónico/metabolismo , Fallo Renal Crónico/terapia , Riñón/metabolismo , Proteínas Musculares/biosíntesis , Diálisis Renal , Adulto , Aminoácidos/farmacología , Citocinas/fisiología , Femenino , Humanos , Masculino
4.
Arch Intern Med ; 153(20): 2317-21, 1993 Oct 25.
Artículo en Inglés | MEDLINE | ID: mdl-8215734

RESUMEN

BACKGROUND: Peritonitis is a common problem for patients receiving continuous ambulatory peritoneal dialysis. Episodes that do not respond to antibiotics within 96 hours are associated with substantial morbidity and mortality. The purpose of this study was to develop a method for identifying these patients at the time of hospital admission. METHODS: We reviewed all cases of peritonitis associated with continuous ambulatory peritoneal dialysis that occurred at the Albuquerque (NM) Veterans Affairs Medical Center during a 10-year period. Episodes of peritonitis were randomly assigned to a training set or a validation set. Persistent infections were those lasting more than 96 hours. For training cases, stepwise logistic regression was used to develop a predictive model for persistent infection using information available at the time of hospital admission. The model was then used to assign validation cases to "high-" and "low-risk" categories. The group difference in the proportion of persistent cases was tested by chi 2 analysis. RESULTS: Sixty patients had 120 episodes of peritonitis during the study period. Of 63 episodes assigned to the training set, 26 (41.3%) lasted more than 96 hours (persistent cases) and 37 were cured in 96 hours or less (usual cases). Compared with usual cases, persistent episodes were characterized by a higher age at presentation and a greater decline from preinfection values for hemoglobin and serum potassium, serum urea nitrogen, creatinine, albumin, and calcium. Advanced age and marked declines in serum potassium and albumin levels were identified by logistic regression as independent risk factors for persistent infection. The model identified 28 of 57 validation cases as high risk. Compared with low-risk cases, these episodes were much more likely to be persistent (64.3% vs 24.1%; P = .002) and result in death (32.1% vs 3.4%; P = .005). CONCLUSIONS: Advanced age and marked declines in serum albumin and potassium levels are poor prognostic signs in peritonitis associated with continuous ambulatory peritoneal dialysis. Patients with these findings should be treated aggressively.


Asunto(s)
Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/etiología , Factores de Edad , Anciano , Antibacterianos/uso terapéutico , Humanos , Masculino , Peritonitis/sangre , Peritonitis/tratamiento farmacológico , Potasio/sangre , Pronóstico , Curva ROC , Factores de Riesgo , Albúmina Sérica/análisis
5.
Int J Artif Organs ; 28(3): 229-36, 2005 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15818545

RESUMEN

We analyzed the changes in serum potassium concentration ([K]) and acid-base parameters in 43 episodes of dialysis-associated hyperglycemia (serum glucose level > 33.3 mmol/L), 22 of which were characterized as diabetic ketoacidosis (DKA) and the remaining 21 as nonketotic hyperglycemia (NKH). All episodes were treated with insulin therapy only. Age, gender, initial and final serum values of glucose, sodium, chloride, tonicity and osmolality did not differ between DKA and NKH. At presentation, serum values of [K] (DKA 6.2 +/- 1.3 mmol/L; NKH 5.2 +/- 1.5 mmol/L) and anion gap [AG] (DKA 27.2 +/- 6.4 mEq/L; NKH 15.4 +/- 3.5 mEq/L) were higher in DKA, whereas serum total carbon dioxide content [TCO2 ] (DKA 12.0 +/- 4.6 mmol/L; NKH 22.5 +/- 3.1 mmol/L), arterial blood pH (DKA 7.15 +/- 0.09; NKH 7.43 +/- 0.07) and arterial blood PaCO2 (DKA 26.2 +/- 12.3 mm Hg; NKH 34.5 +/- 6.7 mm Hg) were higher in NKH. At the end of insulin treatment, serum values of [K] (DKA 4.0 +/- 0.7 mmol/L, NKH 4.0 +/- 0.5 mmol/L), [AG] (DKA 16.3 +/- 5.4 mEq/L, NKH 14.9 +/- 3.0 mEq/L), [TCO2 ] (DKA 23.5 +/- 5.0 mmol/L, NKH 24.1 +/- 4.2 mmol/L), arterial blood pH (DKA 7.42 +/- 0.09, NKH 7.51 +/- 0.14) and arterial blood PaCO2 (DKA 31.8 +/- 6.7 mm Hg, NKH 34.2 +/- 8.3 mm Hg) did not differ between the two groups. Linear regression of the decrease in serum [K] value during treatment, (Delta[K]), on the presenting serum [K] concentration,([K]2 ), was: DKA, Delta[K] = 2.78 - 0.81 x [K]2 , r = -0.85, p < 0.001; NKH, Delta[K] = 2.44 - 0.71 x [K]2 , r = -0.90, p < 0.001. The slopes of the regressions were not significantly different. Stepwise logistic regression including both DKA and NKH cases identified the presenting serum [K] level and the change in serum [TCO2 ] value during treatment as the predictors of Delta[K] (R2 = 0.81). Hyperkalemia is a feature of severe hyperglycemia (DKA or NKH) occurring in patients on dialysis. Insulin administration brings about correction of DKA and return of serum [K] concentration to the normal range in the majority of the hyperglycemic episodes without the need for other measures. The initial serum [K] value and the change in serum [TCO2 ] level during treatment influence the decrease in serum [K] value during treatment of dialysis-associated hyperglycemia with insulin.


Asunto(s)
Equilibrio Ácido-Base/fisiología , Hiperglucemia/tratamiento farmacológico , Hiperglucemia/fisiopatología , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Potasio/sangre , Diálisis Renal/efectos adversos , Humanos , Hiperglucemia/etiología
6.
J Nucl Med ; 31(6): 1099-103, 1990 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-2348239

RESUMEN

We present a case of a 58-yr-old male to illustrate the scintigraphic, roentgenographic, clinical, and pathologic features of periarticular tumoral calcinosis that occurred in a hemodialysis patient. Soft-tissue calcifications developed 3 yr after onset of hemodialysis, became progressively larger during the ensuing five years, and culminated in voluntary withdrawal from dialysis because of the extreme discomfort and lack of mobility that resulted from the calcinosis. Histologically, an aplastic disorder was present with very low bone formation. On bone scintigraphy, intense calcium uptake in soft tissues implied that it was metabolically active. We hypothesize that this high metabolic activity contributed to the persistent hypercalcemia observed during the patient's last year of life.


Asunto(s)
Calcinosis/etiología , Hipercalcemia/etiología , Hiperparatiroidismo , Artropatías/etiología , Diálisis Renal/efectos adversos , Humanos , Masculino , Persona de Mediana Edad
7.
Am J Kidney Dis ; 38(4): 862-6, 2001 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-11576892

RESUMEN

We investigated the hypothesis that the rate of loss of creatinine excretion with age in peritoneal dialysis (PD) patients differs from the rate predicted from the Cockroft-Gault formula (Cr(Pred)) by analyzing creatinine excretion data obtained from clearance studies of 925 patients on continuous ambulatory PD therapy with an age range of 12 to 91 years. Measured creatinine generation (Cr(Meas)) is the sum of creatinine excretion in urine plus dialysate (Cr(Excr)) plus an estimated metabolic degradation of creatinine. The effect of age on Cr(Excr) and the differences Cr(Excr) - Cr(Pred) and Cr(Meas) - Cr(Pred) were analyzed by linear regression. In 373 women, Cr(Excr) = W(16.9360 - 0.084A), r = -0.342, P < 0.001 (where W is weight in kilograms and A is age in years). The regression slope was one half of the slope in the Cockroft-Gault formula. Cr(Excr) - Cr(Pred) = -413.91 + 4.78A, r = 0.300, P < 0.001. Cr(Meas) - Cr(Pred) = -176.36 + 4.37A, r = 0.278, P < 0.001. In 552 men, Cr(Excr) = W(21.079 - 0.108A), r = -0.338, P < 0.001. The regression slope was approximately one half of the slope in the Cockroft-Gault formula. Cr(Excr) - Cr(Pred) = -493.25 + 6.28A, r = 0.267, P < 0.001. Cr(Meas) - Cr(Pred) = -66.41 + 3.63A, r = 0.143, P = 0.001. The rate of loss of creatinine excretion with age is one half of the rate predicted by the Cockroft-Gault formula in both women and men on PD therapy. Therefore, the difference between excretion (or measured generation) of creatinine and creatinine generation predicted by the Cockroft-Gault formula is not constant, but increases with age. The Cockroft-Gault formula systematically overestimates the effect of age on creatinine excretion in PD patients and is not suitable for predicting creatinine excretion in these subjects.


Asunto(s)
Algoritmos , Creatinina/análisis , Soluciones para Diálisis/química , Diálisis Peritoneal Ambulatoria Continua , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Creatinina/metabolismo , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Factores Sexuales
8.
Am J Clin Pathol ; 91(6): 717-20, 1989 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-2729184

RESUMEN

This case report documents successful diagnosis and therapy in a case of Mycobacterium chelonae peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD) and reviews problems associated with CAPD peritonitis resulting from the rapidly growing mycobacteria, M.chelonae and Mycobacterium fortuitum.


Asunto(s)
Infecciones por Mycobacterium/etiología , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/etiología , Doxiciclina/farmacología , Doxiciclina/uso terapéutico , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Mycobacterium/efectos de los fármacos , Infecciones por Mycobacterium/tratamiento farmacológico , Peritonitis/tratamiento farmacológico , Tobramicina/farmacología , Tobramicina/uso terapéutico
9.
Med Clin North Am ; 74(4): 961-74, 1990 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-2195265

RESUMEN

Renal osteodystrophy is multifactorial. Decreased calcium absorption from the GI tract, secondary to low calcitriol levels; hyperphosphatemia; skeletal resistance to the action of parathormone; and aluminum deposition on the surface of the bones are its main pathogenetic mechanisms. Its biochemical features include abnormalities in serum calcium, phosphate, alkaline phosphatase, parathormone, calcitriol, and aluminum concentration. Radiographic methods are of little use in the characterization of the type of osteodystrophy present, but they may be of help in assessing mineral loss from the skeleton. Clinical manifestations are from bones (pain, deformities, fractures) or from metastatic calcifications. Bone biopsy is the definitive means of diagnosis. The main histologic types of osteodystrophy include osteitis fibrosa, osteomalacia, mixed form (with features of both osteitis fibrosa and osteomalacia), and aluminum osteodystrophy (presenting as either osteomalacia or aplastic lesion). The management of renal osteodystrophy should address all the pathogenetic mechanisms. Correction of the abnormalities in calcium and phosphate metabolism and prevention of aluminum osteodystrophy are the cardinal rules of management. Specific measures (parathyroidectomy, chelation of aluminum) have clear-cut indications and usually require a bone biopsy.


Asunto(s)
Enfermedades Óseas/etiología , Fallo Renal Crónico/complicaciones , Diálisis Renal/efectos adversos , Aluminio/metabolismo , Biopsia , Enfermedades Óseas/diagnóstico , Enfermedades Óseas/terapia , Huesos/patología , Calcitriol/uso terapéutico , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/diagnóstico por imagen , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/metabolismo , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/patología , Deferoxamina/uso terapéutico , Humanos , Glándulas Paratiroides/cirugía , Radiografía
10.
Med Clin North Am ; 81(3): 749-66, 1997 May.
Artículo en Inglés | MEDLINE | ID: mdl-9167656

RESUMEN

Chronic renal failure is a complex syndrome encompassing clinical manifestations from all the organs in the body. The aims of conservative management are to prevent and treat the important clinical manifestations and to prevent the progression of renal failure.


Asunto(s)
Fallo Renal Crónico/terapia , Desequilibrio Ácido-Base/etiología , Desequilibrio Ácido-Base/fisiopatología , Animales , Progresión de la Enfermedad , Cardiopatías/etiología , Hematopoyesis , Humanos , Hiperglucemia/fisiopatología , Hiperglucemia/prevención & control , Hiperglucemia/terapia , Riñón/fisiopatología , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/metabolismo , Fallo Renal Crónico/fisiopatología , Potasio/metabolismo
11.
JPEN J Parenter Enteral Nutr ; 18(4): 355-8, 1994.
Artículo en Inglés | MEDLINE | ID: mdl-7933444

RESUMEN

Whereas estimates of percent deviation of body weight from ideal (F delta weight) are corrected for amputation, those of body mass index (BMI) are not, creating discrepancies in evaluating obesity. A correction of the BMI formula for amputation is proposed. The formula for BMI was corrected for amputation mathematically. The mathematical model predicts that the uncorrected BMI formula underestimates body fat in unilateral amputees and overestimates body fat in subjects with bilateral amputations at the same length of the legs. F delta weight and corrected and uncorrected BMI estimates were computed in 15 subjects with unilateral leg amputation and in 8 subjects with multiple amputations. BMI estimates were as follows: in unilateral amputees, corrected 24.1 +/- 4.1 kg/m2, uncorrected 22.2 +/- 3.9 kg/m2 (p < .001); and in multiple amputees, corrected 21.6 +/- 2.4 kg/m2, uncorrected 32.6 +/- 11.8 kg/m2 (p = .043). Linear regressions of F delta weight obtained from standard nutrition assessment on F delta weight computed from uncorrected and corrected BMI values were as follows: in unilateral amputees, uncorrected F delta weight = -0.079 + 0.932 x actual F delta weight, r = .974, p < .01, and corrected F delta weight = 0.002 + 1.005 x actual F delta weight, r = .997, p < .01; in multiple amputees, uncorrected F delta weight = 0.528 + 1.930 x actual F delta weight, r = .607, p is not significant, and corrected F delta weight = -0.010 + 0.920 x actual F delta weight, r = .936, p < .01.(ABSTRACT TRUNCATED AT 250 WORDS)


Asunto(s)
Amputados , Índice de Masa Corporal , Anciano , Complicaciones de la Diabetes , Femenino , Humanos , Masculino , Matemática , Persona de Mediana Edad
12.
Clin Nephrol ; 24(5): 256-60, 1985 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-3907908

RESUMEN

Fourteen episodes of peritonitis complicating chronic peritoneal dialysis were treated with intravenous injections of 1 gm of vancomycin weekly for 4 successive weeks. Peak (one hour after completion of injection) and trough (immediately before the next injection) serum and dialysate vancomycin levels were measured. Vancomycin treatment resulted in a cure in 12 episodes (85.7%). Serum vancomycin levels were always above therapeutic range, but did not rise, with subsequent injections, to toxic range. Dialysate vancomycin levels were therapeutic for more than 85% of the measurements. One patient, who failed to respond to vancomycin plus cephalosporins, was cured with intraperitoneal streptokinase plus the same antibiotics. In another patient, a relapse was cured with vancomycin plus oral rifampin. Dialysate vancomycin levels were therapeutic in the last two patients. Peritoneal catheters were not removed. No significant side effects of vancomycin treatment were observed.


Asunto(s)
Diálisis Peritoneal/efectos adversos , Peritonitis/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Vancomicina/administración & dosificación , Adulto , Anciano , Estudios de Evaluación como Asunto , Humanos , Inyecciones Intravenosas , Persona de Mediana Edad , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus pyogenes , Estreptoquinasa/uso terapéutico , Vancomicina/uso terapéutico
13.
Clin Nephrol ; 23(5): 213-7, 1985 May.
Artículo en Inglés | MEDLINE | ID: mdl-3891180

RESUMEN

Five patients, one woman and four men, aged 24 to 54 years, developed abnormally high hematocrits between 4 and 22 months after renal transplantation. In four patients, red cell mass was above normal and plasma volume below normal. In one patient, both red cell mass and plasma volume were below normal. The cause of the deranged plasma volume was not evident. Decreased plasma volume may either contribute to or may, in rare instances, be the only cause of apparent erythrocytosis in renal transplant recipients.


Asunto(s)
Trasplante de Riñón , Volumen Plasmático , Policitemia/etiología , Adulto , Eritropoyetina/análisis , Femenino , Hematócrito , Hemoglobinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Policitemia/sangre , Policitemia/fisiopatología , Complicaciones Posoperatorias
14.
Clin Nephrol ; 44(5): 316-21, 1995 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-8605712

RESUMEN

This study attempted to define the minimal dose of dialysis needed to produce a target KT/V in continuous peritoneal dialysis (CPD). In a training set of 143 clearance studies performed in 92 CPD patients, logistic regression identified low urine volume (UV) and low dialysate drain volume normalized by body water (DV/V) as predictors of weekly KT/V urea < or = 1.70. Solution of the regression equation with UV fixed at 0.00 1/24 h and at different probabilities of low KT/V provided a series of minimal DV/V values consistent with weekly KT/V > or = 1.70 in anuria. The accuracy of the logistic regression model and of the DV/V cut-offs was tested in a validation set (VS) of 189 urea kinetic studies performed in another 102 CPD patients. In the VS, the area under the Receiver Operating Characteristic curve generated by the regression model was 0.832 (95% Confidence Interval: 0.798-0.866). The DV/V cut-off value of 0.301 per 24 h, calculated by solving the regression model at p = 0.442 and with UV = 0, identified studies with weekly KT/V < 1.70 with a sensitivity of 89.3% and a specificity of 78.1% in anuric VS subjects (n = 60). Use of only the first urea kinetic study from each patient did not modify the predictors of KT/V or the cut-off values derived from solution of the regression model. The DV/V cut-off of 0.324 per 24 h, derived from the logistic regression model predicting KT/V < or = 1.90, identified KT/V < 1.90 in VS anuric subjects with a sensitivity of 94.3% and a specificity of 81.0%. Low UV and DV/V predict low KT/V urea in CPD. Prescribed 24 h exchange volume in anuric CPD subjects should be calculated to produce DV/V values exceeding 0.301 1/24 h per 1 body water for a KT/V of 1.70 and 0.324 1/24 h per 1 body water for a target weekly KT/V of 1.90.


Asunto(s)
Soluciones para Diálisis/administración & dosificación , Diálisis Peritoneal Ambulatoria Continua , Urea/orina , Creatinina/orina , Femenino , Humanos , Modelos Logísticos , Masculino , Estudios Retrospectivos , Orina
15.
Am J Med Sci ; 287(1): 27-30, 1984.
Artículo en Inglés | MEDLINE | ID: mdl-6367467

RESUMEN

UNLABELLED: We followed sequentially the plasma potassium concentration in five, essentially anuric, hyperglycemic patients with no known abnormality of potassium metabolism and treated only with insulin. Acid-base balance, external potassium and fluid balance, and weights did not change during observation. The following changes in plasma potassium concentration (delta K) were noted: In initial hyperkalemia (three patients) delta K was -1.8 +/- 0.1 mmol/l (p less than 0.005). In normokalemia (one patient) delta K was -1.3 mmol/l. In hypokalemia (one patient) delta K was +0.1 mmol/l. The correlation between the starting potassium concentration and the change in potassium concentration was -0.88 (p = 0.05). CONCLUSIONS: When only parenteral insulin is used for treatment and acid-base balances and body weights do not change during treatment in anuric hyperglycemia: a) The change in potassium concentration is dependent on the starting plasma potassium concentration, b) hyperkalemic patients will drop their plasma potassium concentration toward normal, and c) hypokalemic patients may not need potassium replacement.


Asunto(s)
Anuria/sangre , Hiperglucemia/sangre , Insulina/uso terapéutico , Potasio/sangre , Equilibrio Ácido-Base , Adulto , Anuria/complicaciones , Anuria/tratamiento farmacológico , Glucemia/análisis , Femenino , Humanos , Hiperglucemia/complicaciones , Hiperglucemia/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Factores de Tiempo
16.
Am J Med Sci ; 288(1): 37-9, 1984.
Artículo en Inglés | MEDLINE | ID: mdl-6465193

RESUMEN

A patient presented with acute hemorrhagic pancreatitis complicated by both renal cortical necrosis and Purtscher's retinopathy. Either of these two complications is rare and never before have both been reported in the same patient. The patient's renal insufficiency required hemodialysis; it gradually improved over two years when dialysis could be discontinued. The patient's retinopathy included bilateral hemorrhages and cotton wool spots; visual fields and acuity remained normal. Funduscopic lesions disappeared by three months after the acute event. These two rare vasculo-occlusive complications of pancreatitis simultaneously occurring in one individual might suggest complement-mediated leukostatic mechanisms.


Asunto(s)
Hemorragia/complicaciones , Necrosis de la Corteza Renal/etiología , Pancreatitis/complicaciones , Enfermedades de la Retina/etiología , Enfermedad Aguda , Adulto , Femenino , Humanos , Necrosis de la Corteza Renal/patología , Enfermedades de la Retina/patología , Hemorragia Retiniana/etiología
17.
Alcohol ; 4(2): 77-9, 1987.
Artículo en Inglés | MEDLINE | ID: mdl-3580136

RESUMEN

Linear elimination parameters were computed after intravenous administration of the same dose (11 mmol/kg) of intravenous ethanol in anesthetized dogs twice with a period of 7-8 days (group A, n = 10) or 6 hours (group B, n = 8) between the two studies. For rate of elimination, clearance and time of disappearance of half the dose, routine statistical methods (paired t-test, correlation) showed no difference between the first and the second study of either group; however, for each of these three elimination parameters, quantitative analysis showed significant disparities between the first and second studies of each group. For Widmark ratio r, which is a measurement of ethanol distribution rather than elimination, both the routine statistical methods and the quantitative analysis showed no difference between the first and second study of either group. In dogs, the assumption that blood alcohol curve is reproducible in individuals may not be valid.


Asunto(s)
Etanol/metabolismo , Animales , Perros , Etanol/administración & dosificación , Etanol/sangre , Etanol/orina , Femenino , Infusiones Intravenosas , Cinética
18.
Alcohol ; 5(2): 111-6, 1988.
Artículo en Inglés | MEDLINE | ID: mdl-3395458

RESUMEN

We computed by linear kinetics predicted equilibrated plasma concentrations, elimination parameters and availability of ethanol for fasting anesthetized dogs who received the same dose (11 mmol/kg) of ethanol twice, once intragastrically and once intravenously. Agreement between predicted (y) and observed (x) equilibrated plasma levels above 3 mmol/l was for intragastric ethanol y = 0.031 + 1.008x (r = 0.973) and for intravenous ethanol y = 0.2 + 0.99x (r = 0.992). Linear elimination (elimination rate, clearance, time of disappearance of half the dose) was significantly slower and Widmark's ratio r was significantly greater for intragastric than for intravenous ethanol. Apparent availability of intragastric ethanol, computed by dividing the intragastric by the intravenous plasma ethanol concentration at zero time (both values extrapolated from the linear portion of the blood alcohol curve), was 0.739 +/- 0.125. Considerable ethanol residuals were present in the stomach four hours after intragastric instillation. We conclude that retention of ethanol in the stomach, probably because of anesthesia, created the apparent differences in elimination of ethanol between intragastric and intravenous administration. Despite gastric retention, decrease of ethanol levels was linear above 3 mmol/l after intragastric instillation.


Asunto(s)
Etanol/farmacocinética , Administración Oral , Anestesia Intravenosa , Animales , Disponibilidad Biológica , Perros , Etanol/administración & dosificación , Etanol/sangre , Ayuno , Femenino , Contenido Digestivo , Semivida , Infusiones Intravenosas , Tasa de Depuración Metabólica
19.
Perit Dial Int ; 21(5): 471-9, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-11757831

RESUMEN

OBJECTIVE: To determine whether specific preventive measures reduce the rate of peritoneal catheter-related infections and peritoneal catheter loss due to Staphylococcus aureus. DESIGN: Structured literature synthesis. METHODS: Relevant studies were identified by MEDLINE search, from personal files, and from the reference lists of retrieved articles. We analyzed English-language studies on treatment targeted at S. aureus, with at least 10 subjects and at least 3 months of follow-up, and data on staphylococcal peritoneal dialysis catheter infections. We excluded noncontrolled studies. Two investigators abstracted data using a structured form. RESULTS: We evaluated six studies with concurrent controls and eight studies with historical controls. In one randomized, placebo-controlled, blinded study, periodic nasal mupirocin ointment reduced the rate of staphylococcal exit-site infection from 0.42 to 0.12 episodes/patient-year (p = 0.006), but had no effect on the rates of staphylococcal tunnel infection, peritonitis, or catheter loss. In one randomized study without placebo control, periodic oral rifampin reduced the rate of staphylococcal exit-site infection from 0.65 to 0.22 epi/pt-yr (p = 0.011), but had no effect on the rate of staphylococcal peritonitis. In another nonblinded, randomized, controlled study, the use of either rifampin or mupirocin was associated with low rates of staphylococcal catheter infections and catheter loss. In one study with historical controls, the rate of staphylococcal exit-site infection and peritonitis was lower after oral rifampin prophylaxis. In seven other studies comparing nasal or exit-site mupirocin to historical controls, the rate of staphylococcal exit-site infection decreased from 0.17 to 0.05 epi/pt-yr, the rate of staphylococcal peritonitis decreased from 0.18 to 0.06 epi/pt-yr, and the rate of catheter loss decreased from 0.09 to 0.05 epi/pt-yr during the mupirocin period. CONCLUSION: The literature provides strong evidence that staphylococcal carriage prophylaxis using either oral rifampin or mupirocin ointment in the nares or exit site reduces significantly the rate of exit-site infection due to Staphylococcus aureus. Weaker evidence based on studies with historical controls suggests that rifampin or mupirocin prophylaxis also reduces the rate of staphylococcal peritonitis and peritoneal catheter loss. Studies with a stronger level of evidence are needed to verify this last point.


Asunto(s)
Profilaxis Antibiótica , Diálisis Peritoneal/efectos adversos , Infecciones Estafilocócicas/prevención & control , Catéteres de Permanencia/efectos adversos , Contaminación de Equipos/prevención & control , Contaminación de Equipos/estadística & datos numéricos , Medicina Basada en la Evidencia , Humanos , Incidencia , Mupirocina/uso terapéutico , Nariz/microbiología , Diálisis Peritoneal/instrumentación , Peritonitis/etiología , Peritonitis/microbiología , Rifampin/uso terapéutico , Infecciones Estafilocócicas/etiología , Staphylococcus aureus/aislamiento & purificación
20.
Perit Dial Int ; 13 Suppl 2: S338-40, 1993.
Artículo en Inglés | MEDLINE | ID: mdl-8399604

RESUMEN

Clinical and biochemical parameters associated with the removal of the peritoneal catheter and death following continuous ambulatory peritoneal dialysis (CAPD) peritonitis were analyzed in 120 episodes of peritonitis. Episodes resulting in catheter removal (n = 24, 20%) and those ending in patient death (n = 12, 10%) were respectively compared with episodes in which peritoneal catheters were saved and from which the patients survived. Variables associated with catheter removal included advanced age, long duration of peritonitis, coexisting exit-site/tunnel infection, infection caused by pseudomonas or fungi, elevated aspartate aminotransferase (AST) and malnutrition at presentation with peritonitis (serum albumin 29.5 +/- 7.6 g/L vs 33.8 +/- 4.8 g/L in episodes in which the catheters were saved, p = 0.014), and worsening malnutrition during peritonitis. Variables associated with death from peritonitis included diabetes mellitus, persistence of the infection, removal of the peritoneal catheter, infection with pseudomonas, malnutrition prior to the infection (serum albumin 29.5 +/- 3.2 g/L vs 34.7 +/- 4.2 g/L in survivors, p < 0.001), presentation with elevated AST and worsening malnutrition, and the development of pronounced malnutrition during infection (serum albumin 18.1 +/- 4.1 g/L vs 28.9 +/- 5.8 g/L in survivors, p < 0.001). Deaths were caused primarily by cardiovascular events. Both removal of the peritoneal catheter and death as consequences of CAPD peritonitis are associated with malnutrition and pseudomonas infection. In addition, death is more frequent in diabetic patients.


Asunto(s)
Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/mortalidad , Humanos , Persona de Mediana Edad , Diálisis Peritoneal Ambulatoria Continua/mortalidad , Peritonitis/sangre , Peritonitis/etiología
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