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Search Results: 1 - 10 of 11688 matches for " chronic renal insufficiency "
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Sulfonylurea Induced Severe Hypoglycemia in a Diabetic with Renal Failure— A Case Report  [PDF]
Abdul H. Zaid, Sunil Sapru, Jennifer Costello, Chirag Boradia
Journal of Biosciences and Medicines (JBM) , 2015, DOI: 10.4236/jbm.2015.311008
Abstract: Introduction: Persistent hypoglycemia in the setting of acute renal insufficiency while on sulfonylureas is potentially a life-threatening complication. A case of severe hypoglycemia in a diabetic with acute on chronic renal insufficiency while on glimepiride is described here. Case Report: A seventy-six years old man presented to our emergency department with gradually progressive generalized weakness, dyspnea on exertion and lightheadedness. His medical history included congestive heart failure, hypertension and chronic kidney disease from non-insulin dependent diabetes. He reported good compliance with his medications which included glimepiride, 2 mg daily. Patient’s spouse reported a blood sugar reading of 22 mg/dL at home which prompted the emergency department visit. On presentation, the patient was tachycardic, tachypneic and diaphoretic. Initial glucose meter reading was found to be 36 mg/dL and a blood glucose level on the metabolic panel was 49 mg/dL. Patient serum creatinine was 2.5 mg/dL, increased from a baseline of 1.8 mg/dL. While in the emergency room, the patient received 50% dextrose intravenously eventually requiring an intravenous infusion of 10% dextrose. Despite this treatment, the patient remained persistently hypoglycemic with blood sugars less than 80 mg/dL. A decision was made at this point to administer 50 micrograms of octreotide subcutaneously. Two hours later, the patient’s blood sugar started to improve and the intravenous 10% dextrose was discontinued. Eight hours later, the patient received another dose of 50 micrograms of octreotide and remained consistently euglycemic. Upon discharge, he was asked to discontinue glimepiride. Conclusion: Severe refractory hypoglycemia is a serious complication of sulfonylurea therapy in diabetics with renal insufficiency. Prompt recognition and initiation of octreotide are effective in reversing hypoglycemia in these instances rapidly and safely.
The Usefulness of Renal Doppler Parameters in Chronic Kidney Disease: Is There a Cut-Off Value to Estimate End Stage Kidney Disease?  [PDF]
Bozkurt Gulek, Gokhan Soker, Ertugrul Erken, Fatma Ulku Adam, Halil Ibrahim Varan, Sibel Ada, Nazan Z. Alparslan, Omer Kaya, Eren Erken, Behice Durgun
Open Journal of Radiology (OJRad) , 2016, DOI: 10.4236/ojrad.2016.61003
Abstract: Aims: In this study, Doppler parameters were studied in patients with advanced stage renal disease, and the relationship between Doppler parameters and renal disease stage was investigated. Doppler values were evaluated for a cut-off value between normal and end-stage kidney disease group. Materials and methods: 50 patients with chronic kidney disease and 15 patients belonging to the same age group and with normal serum creatinine levels were comprised of the study and control groups. Resistivity and pulsatality indices were measured at the main renal arteries and interlobular arteries at both sides. Results: Statistically significant differences were found between the PI and RI values obtained from the main renal and interlobular arteries. PI sums were compared with those from the control group, and a cut-off value of 2.15 was found, with a sensitivity of 90% and a specificity of 86.7%. Conclusion: Any increase in the RI and PI values obtained from the main renal and interlobular arteries must bring to mind the possibility of advancing renal damage and interstitial fibrosis. Patients with and without renal parenchymal damage can be differentiated by means of comparing the total PI values obtained from the right and left main renal and interlobular arteries.
Factors That Influence the Choice of Dialysis Modality in the Elderly  [PDF]
Ana Elizabeth Figueiredo, Angélica Ribeiro de Freitas, Jéssica da Silva Lopes, Danusa Pires
Open Journal of Nursing (OJN) , 2014, DOI: 10.4236/ojn.2014.413102
This study aimed to identify the influencing factors on choice of dialysis modality in patients aged 60 years or more and the barriers and/or facilitators in the decision-making process. A descriptive, cross-sectional study was conducted involving patients undergoing renal replacement therapy for at least three months. Of the 55 patients included, 35 (64%) were under medical care before starting dialysis. The majority of patients, 55% (30), reported being consulted regarding the type of dialysis they would like. The most chosen therapy was hemodialysis with physician indication being the most influencing factor on the choice of dialysis modality. Visual and mobility problems were those principally reported by the elderly participants. This study suggests the need for greater pre-dialysis participation by the multidisciplinary team and emphasizes the importance of patient involvement in the decision-making process.
Prevalence and Factors Associated with Hepatitis B Virus Surface Antigen and Human Immunodeficiency Virus Antibodies in Chronic Hemodialysis Patients Followed-Up in Lomé, Togo  [PDF]
Mounerou Salou, Kossi Akomola Sabi, Amen Tevi, Koumavi Ekouevi, Sika Dossim, Fiali Lack, Maléwé Kolou, Yaotsè Anoumou Dagnra
Open Journal of Medical Microbiology (OJMM) , 2019, DOI: 10.4236/ojmm.2019.91003
Abstract: Introduction: In haemodialysis patients, the risk of acquiring blood-borne viral infections is an important cause of the dialysis’s process. Indeed, viral infections are quite common in chronic haemodialysis patients including those due to viral hepatitis B and HIV. Objective: Determine the prevalence of HIV infection and hepatitis B infection among chronic hemodialysis patients of Togo. Methods: A cross-sectional study was conducted in chronic hemodialysis patients of Togo from January 1st to December 31st, 2016. Sociodemographic and clinical data were collected. Antigen HBs was screened by a rapid immunochromatographic test (SD BIOLINE HBsAg), and HIV antibodies were detected using a combination of 2 rapid diagnostic test, SD BIOLINE HIV-1/2 (first step) and TRIDOT test (second step). Results: During the study period, 95 subjects were included. Patient’s age was ranking from 13 to 80 years with a mean of 46.6 years. The sex-ratio (M/F) was 1.8 and a duration average of dialysis was 51.7 months. The aetiologies of the chronic endstage kidney failure were related respectively to a vascular renal disease for 42.1% of the patients, glomerular nephropaty for 34.74%, interstitial nephropaty for 9.47% and hereditary for 3.16%. For 10.53% of the patients, the initial renal disease remained indefinite. Prevalence of antigen HBs and HIV antibodies were respectively 10.5% and 7.4%. The frequency of co-infection HBV and HIV was 1.1%. Conclusion: The rates of HBV infection and HIV infection remain high in chronic hemodialysis in Togo, somewhat which is linked to an endemic aspect of these two viruses in the country. The type of initial renal disease (glomerular) and the vascular way (the central catheters) established the risk factors for the HIV infection while for the infection of HVB no factor was incriminated.
Hyperhomocysteinemia in Chronic Renal Insufficiency
Velibor abarkapa , Zoran Sto i , Radmila eravica , Branislava Ilin i
Journal of Medical Biochemistry , 2007, DOI: 10.2478/v10011-007-0008-6
Abstract: Hyperhomocysteinemia is an independent risk factor for premature cardiovascular disease. Since the homocysteine level is elevated in patients with advanced chronic renal insufficiency, it has been presented as an important factor contributing to the development of cardiovascular complications in these patients. In this study we examined the level of homocysteine in patients with mild-moderate degree of glomerular filtration rate reduction (creatinine clearance >40 mL/min and <80 mL/min/1.73 m2). Thirty patients (f=15, m=15) were compared with healthy subjects (n=32, f=17, m=15). Blood samples were collected and subjected to assays for homocysteine, creatinine, creatinine clearance. The results show that homocysteine levels of patients were significantly higher than those of healthy subjects (12.75 ± 3.9 vs. 8.5 ± 1.75 μmol/L, p<0.001). The obtained results also show a significant negative relationship between the level of homocysteine and creatinine clearance (r=-0.8). In conclusion, hyperhomocysteinemia is a common finding not only in advanced chronic renal insufficiency, but also in patients with mild-moderate reduction of glomerular filtration rate, and may significantly contribute to premature development of cardiovascular complications.
Introduction of a Successful Pregnancy in a Patient with Advanced Chronic Renal Insufficiency
H. Saghafi,M. Abasi,N. Mehran
Qom University of Medical Sciences Journal , 2008,
Abstract: Background and ObjectiveIn the women with chronic renal insufficiency ovulation is suppressed therefore they rarely become pregnant. If pregnancy occurs, they might encounter many conflictions. It may lead to death (fetus or mother). The aim of this study was reporting a successful pregnancy in a patient with advanced chronic renal insufficiency.Case reportThe patient was a 32 years old woman with long period of infertility (8 years). The first main clinical symptom was abdominal pain especially in hypogastric area as well as hyperuremia, elevated levels of creatinine (2.9 mg/dl), mild proteinuria and hematuria. The urine specific gravity was 1010. Sonography data showed asymmetrical small kidneys. Other complaints were pruritus and flank pain during urination. The primary diagnosis was chronic renal failure due to probable chronic pyelonephritis. After an interval she returned with positive pregnancy test. She decided to continue the pregnancy in despite of obstetrician belief for aborting. During pregnancy, proteinuria reached to two plus, hemoglobin fell to 9.7, creatinine levels reached to 3.7 mg/dl and blood pressure was fluctuating between 110/80 and 130/85 mmHg. She admitted in the hospital in third trimester of pregnancy because of preterm labor. However the pain was suppressed after starting magnesium sulfate infusion. Keywords: Renal Insufficiency, Chronic Renal Insufficiency, Pregnancy
Caracteriza??o e etiologia da insuficiência renal cr?nica em unidade de nefrologia do interior do Estado de S?o Paulo
Ribeiro, Rita de Cássia Helú Mendon?a;Oliveira, Graziella Allana Serra Alves de;Ribeiro, Daniele Fávaro;Bertolin, Daniela Comelis;Cesarino, Claudia Bernardi;Lima, Lidimara Copoono Erdosi Quintino de;Oliveira, Sandra Mara de;
Acta Paulista de Enfermagem , 2008, DOI: 10.1590/S0103-21002008000500013
Abstract: objectives: characterize the pacients with chronic renal failure (crf) in dialythical program; verify the causes of the crf; identify the associated diseases to crf; measure the type of treatment and the actual access of the pacients to them. methods: this is a epidemiological descriptive research performed in a nephrology unit, and all pacients registered in the nefro data program were included. results: of the group of 217 patients registered in the studied unit, 68,2% have age of 40 or greater and 59,4% are male. regarding the base disease, 31,3% of the pacients have hipertensive nephrosclerosis, 25,3% have diabetes mellitus (dm) and 24,5% have glomerulonephritis. regarding the associated diseases, 42,4% of the pacients have systemic arterial hipertension (sah) 24,9% don't have comorbities, 19,8% have both sah and dm. regarding the type of vascular acess, 70,5% have arteriovenous fistula, being the utilization of the tenckhoff catheter exclusive of peritoneal dialysis in 13,3% of the studied cases. conclusion: the results allow a better planning with regard to the patients real needs.
Is the Distribution of Microorganisms and Peritonitis Affected by Seasonality in Peritoneal Dialysis?  [PDF]
Ana Elizabeth Figueiredo, Ana Carolina Gon?alves Kehl, Stephanie Thomaz Bottin, Wilem Gomes Daminelli
Open Journal of Nephrology (OJNeph) , 2014, DOI: 10.4236/ojneph.2014.44021
Introduction: Peritonitis continues to be the main complication for patients on peritoneal dialysis (PD). Objective: To determine the frequency of peritonitis according to the disease-causing microorganism and its distribution throughout the year, linking to seasonality. Methods: A retrospective study conducted in the Dialysis Unit of the Hospital São Lucas, PUCRS (HSL-PUCRS). Patients undergoing PD between January 1984 and September 2013 were included. Descriptive statistics were used and Fisher’s exact test with Monte Carlo simulation for comparison between the categorical variables. Results: Of 415 evaluated patients, 66% had at least one episode of peritonitis with an incidence rate of 0.68 episode/year. There were 601 peritonitis episodes in total. The most common microorganism was coagulase-negative Staphylococcus (26.6%, n = 160), followed by Staphylococcus aureus (16.3%, n = 98), with 16.3% of the sample being negative culture. Most episodes occurred in the months of January (10.3%, n = 62) and May (10.1%, n = 61), while June had the lowest occurrence (5.2%, n = 31). The number of episodes observed in January and May were significantly higher when compared to June (p < 0.001). No significant differences were found for the remaining months. There was no association between the microorganisms and months of the year (p = 0.841). Conclusion: The rate of peritonitis is in line with that recommended by the International Society for Peritoneal Dialysis. The distribution of peritonitis-causing germs over the months of the year would seem to be random.
Facial lesions caused by renal osteodystrophy in a patient with chronic renal insufficiency: a case report
Karsburg, Rafael Machado;Campos, Kátia Regina de;Peres, Maria Paula de Siqueira Melo;Bologna, Sheyla Batista;Louren?o, Silvia Vanessa;Franco, Juliana Bertoldi;
Revista Odonto Ciência , 2012, DOI: 10.1590/S1980-65232012000200013
Abstract: purpose: chronic renal insufficiency (cri) is the last stage of a chronic renal condition in which the kidney loses its filtration and endocrine functions. chronic endocrine hypofunction causes generalized damage to the body known as uremic syndrome, which affects the central nervous system as well as the cardiovascular, hematologic, dermatologic, ophthalmic, endocrine, respiratory, gastrointestinal and skeletal systems. the present study reports the case of a female patient with cri who presented facial osteodystrophy of the osteitis fibrosa type, and highlights the main features of this condition. case description: a 24-year old, female, caucasian patient presented chronic glomerulonephritis recurrence and lost the transplanted kidney five years before, undergoing arteriovenous fistula hemodialysis three times a week. she presented swelling of the left masseter area with a hard consistency on palpation, covered by intact skin, swelling at the bottom of the left atrium, with a hard consistency on palpation, a mucosa-like color and absence of inflammation signs, suggesting expansive bone lesions on the face. these features were compatible with hyperparathyroidism brown tumor and/or osteodystrophy. the ct scan showed expansive bone lesions of heterogeneous appearance on the left jaw, maxilla/nasal floor, and right frontotemporal suture areas. the clinical and histopathological characteristics of the lesion, in association with pht hormone high serum levels led to renal osteodystrophy diagnosis. the patient was referred to the nephrology services. conclusion: osteodystrophic bone alterations have a high prevalence in renal disease patients, and the dentist must take these alterations into consideration in bone lesion diagnosis for this specific group of patients.
Insuficiencia renal crónica y crecimiento
Pasqualini,T.; Ferraris,J.;
Medicina (Buenos Aires) , 2003,
Abstract: many children with chronic renal insufficiency (cri) show growth retardation. our objective is to describe the natural history of growth in patients with cri, its pathogenesis and its optimization. final height remains below percentile 3 in 77% of male and 71% of female patients. the etiology of growth retardation in these children is multifactorial: age at onset, primary renal disease, fluid and electrolyte abnormalities especially acidosis, renal osteodystrophy, inadequate caloric intake and perturbations of growth factors are all implicated. post tx, immunosuppressive corticoid therapy and reduced glomerular filtration rate have a significantly negative effect on final height. growth retardation in both cri and renal tx patients is not the result of abnormal growth hormone secretion or decreased levels of igf-i, but rather of elevated levels of igf-i binding proteins inhibiting the bioavailability of the igfs. optimization of growth includes reduced corticoid dose, alternate-day instead of daily prednisone therapy, or substituting deflazacort for methylprednisone. several studies have shown that growth hormone (gh) therapy at a dose of 30 ui/m2/week results in growth improvement and this led the food and drug administration to approve the use of gh prior to tx. the response to gh is better during conservative therapy, less in allograft recipients and substantially less while undergoing dialysis. in conclusion, in those children with short stature, gh treatment should begin at an early age and during conservative therapy, trying to shorten dialysis in order to attain better height at the time of renal transplantation.
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