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Impaired Renal Concentrating Ability

Urine Concentrating Defect


Presentation

  • If none of these abnormal substances are present in the urine, there are two primary reasons why the kidney is producing concentrated urine with a high specific gravity.[rnceus.com]
  • Hypernatremia is present in approximately 2% of older patients admitted to hospital, but in almost 5% of those older than 75 years in one large survey. 4 Hypernatremia was present in roughly 30% of elderly patients admitted to a geriatric hospital with[dovepress.com]
  • (Instead use a modified Benedict’s copper reduction test Bilirubin Bilirubin is not present in the urine of normal healthy individuals.[lifeinthefastlane.com]
  • Presentation of observed values related to reference values. J. Clin. Chem. Clin. Biochem. ‎ Página 836 - Wilson JD. Braunwald E. Isselbacher KJ. Petersdorf RG, Martin JB. Fauci AS, Root RK (eds): Harrison's Principles of Internal Medicine. ‎[books.google.es]
  • Acute presentations of adipsic hypernatremia are treated by rehydration with free water or hypotonic fluids.[japi.org]
Physician
  • Provides a common language for nephrologists, nutritionists, endocrinologists, and other interested physicians to discuss the underlying research and translation of best practices for the nutritional management and prevention of renal disease Saves clinicians[books.google.com]
  • Cleveland Clinic Journal of Medicine. 1975 July;42(3):217-223 Abstract Current clinical practice requires that the physician understand and evaluate renal function.[mdedge.com]
  • "Patients are still going to be able to take their medicine on time and without assistance, as well as understand the information that their physician is sharing with them about their disease," he said.[sciencedaily.com]
  • KUGLER, COL, MC, USA, and THOMAS HUSTEAD, CPT, MC, USA, Dewitt Army Community Hospital, Fort Belvoir, Virginia Am Fam Physician. 2000 Jun 15;61(12):3623-3630. Management of abnormalities in water homeostasis is frequently challenging.[aafp.org]
  • American College of Physicians Complete Home Medical Guide. Goldmann DR, editor. 1999. New York: DK Publishing, Inc. Pp. 694-708, 1037. Harvard Medical School Family Health Guide. Komaroff I. 1999. New York: Simon & Schuster, Pp. 810-825.[labtestsonline.it]
Weakness
  • The symptoms include lethargy, weakness, and in more severe cases, changes in consciousness and seizures. 2 Few symptoms may be present until sodium levels exceed 160 mmol/L. 1 As noted earlier, many older patients may be hypodipsic, whereas others may[dovepress.com]
  • Six weeks after starting tenofovir the patient was brought to the emergency department with a 4-day history of progressive fatigue, weakness, confusion, oliguria, and myalgia.[ucsdlabmed.wikidot.com]
  • Reduced secretion can result in muscle weakness and potentiate non- depolarizeers. Acidosis. Chronic metabolic acidosis results from an inability to secrete protons and buffers such as PO 4 or to regenerate HCO 3. Calcium, etc.[amcresidents.com]
Surgical Procedure
  • After a major surgical procedure that produces high physiologic and psychological stress, increased secretion of antidiuretic hormone causes fluid retention within the vascular space.[rnceus.com]
  • If kidney disease is getting worse, the nephrologist may discuss hemodialysis (blood cleansing by removal of excess fluid, minerals, and wastes) or kidney transplantation (surgical procedure to implant a healthy kidney into a patient with kidney disease[surgeryencyclopedia.com]
  • This stress response, whether mediated by pain or by volume changes, is profound and lasts at least 2 to 3 days after the surgical procedure.[amcresidents.com]
Euthyroid
  • Abstract The renal concentrating ability was studied in ten patients with hypothyroidism and in 15 euthyroid controls.[ncbi.nlm.nih.gov]
Rapidly Progressive Glomerulonephritis
  • The conditions which may lead to a telescoped sediment are: 1) lupus nephritis 2) hypertensive emergency 3) diabetic glomerulosclerosis, and 4) rapidly progressive glomerulonephritis.[library.med.utah.edu]
Polydipsia
  • Patients with hyponatremia from primary polydipsia or reduced solute intake usually recover with water restriction.[japi.org]
  • Severe diabetes insipidus is manifested by severe polyuria and polydipsia in the setting of markedly dilute urine. View/Print Table TABLE 4.[aafp.org]
  • Psychogenic Diabetes Insipidus is compulsive water-drinking (polydipsia). SIADH: Syndrome of Inappropriate Secretion of ADH. Excessive ADH secretion.[kumc.edu]
Hypertension
  • A Atchley and others studied the effects of hypertension, endocarditis, and circulatory diseases on the kidney and few years ago we never heard of kidney disease and now you are speaking of patients in the hundreds of thou spawned successive generations[books.google.com]
  • "That is something that needs to be managed, just like you would manage hypertension."[sciencedaily.com]
  • It is often caused by damage to the fine capillaries in the renal corpuscles (glomeruli), for example as a result of high blood pressure (hypertensive nephropathy), diabetes (diabetic nephropathy) or inflammatory kidney diseases (e.g.[pharma.bayer.com]
  • Introduction Acute renal failure (ARF) is defined as an acute decline in renal function characterized by an increase in blood urea nitrogen (BUN) and serum creatinine values, often accompanied by hyperkalemia, metabolic acidosis, and hypertension.[pedsinreview.aappublications.org]
  • Hypertension 1989, 14(5):570-577. [Pubmed] 25. Brown IJ, Tzoulaki I, Candeias V, Elliott P: Salt intakes around the world: implications for public health. Int J Epidemiol 2009, 38(3):791-813. [Pubmed] 26.[nefrologiaaldia.org]
Vascular Disease
  • diseases of the kidney 283 Hemolytic uremic syndrome and thrombotic thrombocytopenic purpura 297 Renal involvement in dysproteinemias 314 The hyperuricemic nephropathies 327 Therapy of renal disorders in liver disease 334 The management of renal insufficiency[books.google.com]
  • disease and cerebral vascular disease) people with complex diseases which may involve the kidneys – for example, systemic lupus erythematosus (this is a disease where a person’s immune system attacks and injures the body’s own organs and tissues) people[drbijoy.com]
  • Primarily a defect of thirst, hypodipsia is usually associated with destruction of the hypothalamic thirst center secondary to primary or metastatic tumors, granulomatous disease, vascular disease or trauma. Diabetes Insipidus.[aafp.org]
  • Rhabdomyolysis and Myoglobinemia Muscle necrosis ( rhabdomyolysis ) occurs most commonly with · direct trauma involving major crush or thermal injury; · acute muscle ischemia induced by vascular disease, injury, or prolonged immobilization; · compartment[amcresidents.com]
Neglect
  • According to the Nursing Home Reform Act of 1987, these facilities can be held liable for inadequate nutrition and hydration of a patient because of neglect. 28 In patients with hypernatremic dehydration resulting from neglect, there may be no laboratory[dovepress.com]
Polyuria
  • Obstet Gynecol 104:301–307 PubMed CrossRef Google Scholar Kujubu DA, Aboseif SR (2008) An overview of nocturia and the syndrome of nocturnal polyuria in the elderly.[link.springer.com]
  • Urine Analysis Physical Examination Urinary Output Volume : 1,500 ml / day (a) Polyuria Æ 2,500 ml / day Diabetes Mellitus Diabetes insipidus Chronic glomerulonephritis (b) OliguriaÆ 500ml1day Fever Diarrhea Acute renal failure (c) Anuria Æ Complete cessation[1pdf.net]
  • Thirst and polyuria, with a note on the effects of potassium deficiency and calcium excess. Lancet. 1959;1(7067):268–271. 27. Manitius A, Levitin H, Beck D, Epstein FH.[dovepress.com]
  • Severe diabetes insipidus is manifested by severe polyuria and polydipsia in the setting of markedly dilute urine. View/Print Table TABLE 4.[aafp.org]
  • Patients with partial loss of osmoregulation of vasopressin, develop a reduction in vasopressin level and subsequent polyuria before hyponatremia is fully corrected.[japi.org]
Kidney Failure
  • We discuss the continuum of kidney failure from the healthy kidney to complete renal support via dialysis or transplant.[nursingcenter.com]
  • Acute kidney failure. Available online at . Accessed March 2014. MedlinePlus Medical Encyclopedia. Interstitial nephritis. Available online at . Accessed March 2014. MedlinePlus Medical Encyclopedia. Acute tubular necrosis. Available online at .[labtestsonline.it]
  • failure (loss of ability to reabsorb water) Severe kidney infection (pyelonephritis) There are no risks with this test.[medlineplus.gov]
  • failure) with the patient.[surgeryencyclopedia.com]
  • Within the intestine, the bilirubin is converted into stercobilin (excreted in faeces) and urobilinogen (excreted by the kidneys). Failure of conjugated bilirubin to reach the intestines (e.g. biliary obstruction) will result in bilirubinuria.[lifeinthefastlane.com]
Uremia
  • […] management of renal insufficiency 495 Management of renal osteodystrophy 505 Peritoneal dialysis 516 Jonas Bergstrom M D 521 Dialysis access surgery 533 Dialyzers and water treatment 545 Dialysis ultrafiltration and hemofiltration 555 Use of drugs in uremia[books.google.com]
  • In uremia (kidney failure) the increase is mainly in urea, creatinine and uric acid. Uric acid and the other NPN-compounds are measured rarely in this context.[ucsdlabmed.wikidot.com]
  • Tubular Necrosis (iii) Renal calculi (iv) Damage of Renal tissue (i) Chronic Nephritis (ii) Polycystic kidney (iii) Renal calculi (iv) Urethral constriction Features (i) Oliguria (ii) Anuria (iii) Proteinuria (iv) Hematuria (v) Edema (vi) Acidosis (i) Uremia[1pdf.net]
  • Uremia: Renal failure makes urea accumulate in the blood. However, urea is not as toxic as some other metabolites that accumulate, so uremia toxicity usually isn't due to urea per se. DIURESIS: An increase in water excretion.[kumc.edu]
  • RBCs Normochromic normocytic anemia; decreased parenchymal erythropoetin production reduced stem cell transformation into erythrocytes; uremia reduces RBC lifespan ; Upper GI and dialysis losses, and dietary deficiency. (Urea is a mucosal irritant.[amcresidents.com]
Renal Insufficiency
  • insufficiency 495 Management of renal osteodystrophy 505 Peritoneal dialysis 516 Jonas Bergstrom M D 521 Dialysis access surgery 533 Dialyzers and water treatment 545 Dialysis ultrafiltration and hemofiltration 555 Use of drugs in uremia and dialysis[books.google.com]
  • insufficiency –“Medullary washout” –Diuretic use –Adrenal insufficiency Blood losses –Hemorrhage Redistribution of extracellular fluid –Hypoalbuminemia –Nephrotic syndrome –Liver disease Vasodilation –Sepsis –Anaphylaxis Skin losses of fluids –Excessive[pedsinreview.aappublications.org]
  • The risk is markedly increased in diabetic renal insufficiency, hypovolemia, congestive heart failure, and myeloma.[amcresidents.com]
  • Fouque D, Laville M, Boissel JP, Chifflet R, Labeeuw M, Zech PY: Controlled low protein diets in chronic renal insufficiency: meta-analysis. BMJ 1992, 304(6821):216-220. [Pubmed] 30.[nefrologiaaldia.org]
  • Values below 90 ml/min are indicative of diminished glomerular filtration rate seen with renal insufficiency Increased values in pregnancy,exercise etc The test has particular value in the general assessment of renal function in cases when plasma analyses[drbijoy.com]
Nocturia
  • Obstet Gynecol 104:301–307 PubMed CrossRef Google Scholar Kujubu DA, Aboseif SR (2008) An overview of nocturia and the syndrome of nocturnal polyuria in the elderly.[link.springer.com]
  • (v) Clinically, the loss of concentrating ability is manifested by nocturia (passage of urine at night) Urine Dilution Test (i) Bladder is Emptied. (ii) 1,000 to 1,200 ml of water is given to the patient.[1pdf.net]
  • These patients had higher plasma AVP levels, suggesting normal central response to osmolality and hypernatremia but an impairment in tubular response to AVP. 14 This impaired responsiveness partially accounts for nocturia in older persons. 22 In addition[dovepress.com]
  • […] the tubular concentrating capacity or ADH failure [ diabetes insipidus] Increased osmotic load (diabetes mellitus) Excessive water intake (physiological response) Drug-induced (outdated tetracycline, lithium) Deficiency of vasopressin Associated with nocturia[drbijoy.com]

Workup

  • Kashani, Biomarkers for Early Detection of Acute Kidney Injury, The Journal of Applied Laboratory Medicine: An AACC Publication, September 2017, jalm.2017.023325; DOI: 10.1373/jalm.2017.023325 (May 1, 2017) Arora, P Chronic Kidney Disease Workup.[labtestsonline.it]
  • Because he had past admissions for hypernatremia coming from multiple different facilities, further workup was pursued. Unfortunately, the initiation of the workup was delayed, only beginning after hydration had corrected his SNa to 150 mmol/L.[dovepress.com]
  • […] session the reader should be able to: Identify the most common non-protein nitrogenous substances in serum Describe the influence of diet on serum urea-nitrogen Discuss the use of serum urea-nitrogen, serum creatine, and glomerular filtration rate in the workup[ucsdlabmed.wikidot.com]
Nephrolithiasis
  • […] and recipient selection in renal transplantation 587 Immunosuppression and treatment of rejection in renal transplantation 595 XIII 606 Renal tubular and metabolic dysfunction following kidney homotransplantation 617 Infectious malignant surgical 630 Nephrolithiasis[books.google.com]

Treatment

  • Each chapter integrates basic and clinical approaches, from cell biology and genetics to diagnosis, patient management and treatment.[books.google.com]
  • 545 Dialysis ultrafiltration and hemofiltration 555 Use of drugs in uremia and dialysis 567 Donor and recipient selection in renal transplantation 587 Immunosuppression and treatment of rejection in renal transplantation 595 XIII 606 Renal tubular and[books.google.com]
  • Without treatment, coma and central respiratory failure occur by days 7 to 10.[orpha.net]
  • Treatment If the declining renal function is recognized promptly, treatments can slow its progression.[pharma.bayer.com]
  • Urinary and plasma levels of adenosine 3′:5′-cyclic monophosphate (cyclic AMP) after an intravenous injection of bovine parathyroid hormone (PTH) were measured in 12 patients on long-term lithium treatment and in nine control subjects.[clinsci.org]

Prognosis

  • Prognosis Prognosis is good for those who are diagnosed early, treated promptly and who follow a strict lifelong diet. The documents contained in this web site are presented for information purposes only.[orpha.net]
  • Water and sodium disturbances predict prognosis of acute disease in long term cared frail elderly. Arch Gerontol Geriatr. 2005;40(3):317–326. 6. Darmon M, Timsit JF, Francais A, et al.[dovepress.com]
  • The estimation of plasma urea or creatinine should be done as a guide to progress and prognosis if there is severe renal damage or obstruction[drbijoy.com]
  • What is this patient’s prognosis? Case 3 An 87-year-old retired tailor appears in his physician’s office complaining of the slow onset of ankle and shin swelling, mild shortness of breath, and fatigue.[ucsdlabmed.wikidot.com]
  • However, the prognosis for recovery is good if no coexistent organ failure exists.[amcresidents.com]

Etiology

  • Hypernatremia may be broadly viewed in four major etiologic categories, as follows 13 : Primary Hypodipsia.[aafp.org]
  • Etiology MSUD is due to mutations in genes encoding 3 of the 4 subunits of the branched chain 2-ketoacid dehydrogenase (BCKAD) complex.[orpha.net]
  • Assessment of the clinical circumstances and urine studies help determine the etiology, while management of hypernatremia involves fluid resuscitation and avoiding neurological complications from hypernatremia or its correction.[japi.org]
  • The syndrome is due to several diseases of different etiology. The disease is characterized by diffuse sclerosis of glomeruli, loss of nephrons, and loss of protein into the urine.[ucsdlabmed.wikidot.com]

Epidemiology

  • Summary Epidemiology Birth prevalence of MSUD is estimated at around 1/150,000. Classic MSUD may account for 50-75% of cases.[orpha.net]
  • Mech Ageing Dev 131:270–275 PubMed CrossRef Google Scholar Mallett VT (2005) Female urinary incontinence: what the epidemiology data tell us.[link.springer.com]
  • By Carlos Navarro-Colorado and Stéphanie Laquière Carlos Navarro-Colorado is a medical doctor, with a MSc Epidemiology. He has ten years...[ennonline.net]
Sex distribution
Age distribution

Pathophysiology

  • Causes of Prerenal Acute Renal Failure Pathophysiology Prerenal ARF … View Full Text Log in using your username and password Log in through your institution You may be able to gain access using your login credentials for your institution.[pedsinreview.aappublications.org]
  • .: Pathogenesis and pathophysiology of Itai-itai disease: a report of two cases and its clinical study (in Japanese). Jpn. J. Intern. Med., 73 , 838 (1984). Google Scholar 2. Aqus, Z. S., Pusbtt, J.[link.springer.com]
  • Pathophysiology of hyponatremia Renal water excretion depends on the diluting ability of the nephron.[japi.org]
  • The urine sodium determination should be used as a guide in noneuvolemic states to determine whether further evaluation for renal failure or pathophysiologic renal sodium loss is required.[aafp.org]

Prevention

  • Provides a common language for nephrologists, nutritionists, endocrinologists, and other interested physicians to discuss the underlying research and translation of best practices for the nutritional management and prevention of renal disease Saves clinicians[books.google.com]
  • It may be a compensatory mechanism to prevent polyuria in acute renal failure (“acute renal success”).[amcresidents.com]
  • As in the case presented, it is essential to consider multiple causes of hypernatremia to prevent recurrence and significant morbidity and mortality and to prevent false accusations of substandard care.[dovepress.com]
  • In the most advanced stage (end-stage renal failure), the blood has to be cleansed by alternative means using medical procedures such as dialysis (hemodialysis or peritoneal dialysis) to prevent the body being poisoned.[pharma.bayer.com]
  • Acta Clin Belg 62:278–290 PubMed Google Scholar Shamliyan T, Wyman J, Bliss DZ, Kane RL, Wilt TJ (2007) Prevention of urinary and fecal incontinence in adults.[link.springer.com]

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