Kidney Water And Electrolytes

Kidney,
water and
Electrolytes

   

• Introduction:
  
     
  
  The levels
  of total homocysteine in serum is positively associated
  with the presence of microalbuminuria.
  
    
  
  1. 
  Glomerular disease in children has good response
  and complete remission with steroids, predicts a good
  long-term prognosis.
  
      
  
  2.  There was a slower decline in glomerular filtration rate (using creatinine clearances) in the patients given enalapril compared with placebo. The demonstration of a protective effect of enalapril on renal function in normotensive patients underscores the potential usefulness of these drugs in the preservation of glomerular filtration rate in patients with type 2 diabetes.
  
    
  
  Pancreas transplantation can reverse the lesions of diabetic nephropathy. However, more than 5 years of normoglycemia are required.
  
     
  
  3.  Overall, survival of both patients and kidney with antineutrophil cytoplasm antibody (ANCA)-associated crescentic GN has improved markedly in the last 2 decades with the use of corticosteroids and cyclophosphamide
  
    
  
  4.  Finding of renal dysfunction after exposure to ACE inhibitors is a sensitive detector of severe renovascular disease in patients at risk.
  
    
  
  5.  Henoch-Schonlein purpura (HSP) – Most patients with HSP and renal involvement have a good prognosis.
  
    
  
  6.  Serum levels of prostate-specific antigen (PSA) have been used as a tool for the early detection of prostatic cancer. One of the limitations of this test has been the lack of specificity of PSA levels in the range of 4 to 10 ng/mL PSA is present in serum in a bound form, but it is also present as free PSA. It has been postulated that measurements of these two moieties of PSA in serum may help to discriminate between cancer of the prostate and prostatitis or benign hyperplasia of the prostate.
  
     
  
  7.  Sickle cell disease is an inherited disorder. Chronic progressive renal insufficiency has emerged as a major cause of death. The development of the nephrotic syndrome and focal segmental glomerulosclerosis usually precedes the development of renal insufficiency in these patients.
  
     
  
  8.  Angiotensin II modulates the expression of transforming growth factor b (TGF-b). Ying and Sanders reported that an increase in dietary salt intake, by increasing the synthesis of TGF-b, may directly promote the development of
  glomerulosclerosis.
  
     
  
  9. 
  Ginsburg et al. examined the effect of estrogen
  replacement therapy on the lipoprotein profile of
  postmenopausal women with ESRD. 
  Total cholesterol increased with estradiol
  treatment, caused by a rise in HDL cholesterol without
  changes in LDL cholesterol.
  There was a slight decrease in the levels of
  triglycerides.
  
    
  
  10.
  A decrease in sodium intake contributed to a
  safe, effective, and feasible therapy for hypertension
  in older individuals.
  
    
  
  11.
  Blood pressure increased with alcohol
  consumption. Also,
  left ventricular mass index increased with alcohol
  intake.
  
    
  
  12.
  Bradykinin has a role in the decrease of blood
  pressure observed after the administration of ACE
  inhibitors. This
  raises the question as to whether the new antagonists of
  the angiotensin II receptor are as potent in controlling
  blood pressure as ACE inhibitors.
  
    
  
  13.
  It has been shown that hepatitis C virus (HCV) is
  transmissible by organ transplantation.
  HCV infection at the time of referral for
  transplantation is
  associated with an increased risk of death.
  Nevertheless, they conclude that transplantation
  probably has a more beneficial than adverse effect on
  long-term survival. Thus, HCV-positive status alone is not a contraindication for renal
  transplantation.
  
   
  
  Hematocrit
  levels in excess of 0.51 may develop in 5% to 17% of
  renal transplant recipients within 2 years of the
  operation.  Erythrocytosis
  of any etiology enhances the risk of thromboembolic
  events. ACE inhibitors have been shown to be safe and effective in the
  treatment of posttransplant polycythemia.
  
   
  
  14.
  In transplanted kidneys, one of two forms of
  vascular disease may be found: (1) arteriosclerosis of
  arteries and arterioles, or (2) sclerosis of the
  glomeruli.
  
   
  
  15.
  Peritoneal dialysis in this study seems to be an
  appropriate modality of renal replacement therapy in the
  elderly. A new
  modality of hemodialysis, nocturnal hemodialysis is
  conducted at home for 8 to 10 hours.
  
   
  
  16.
  In a related study, 85 patients undergoing
  peritoneal dialysis for ESRD caused by diabetic
  nephropathy, the use of erythropoietin was associated
  with a greater risk of peripheral vascular events.
  
   
  
  17.
  Patients with moderate or severe renal
  insufficiency have a decreased sensitivity to the
  hypoglycaemic effects of insulin.
  
   
  
  18.
  Administration of 1,25-dihydroxyvitamin D3 has
  been shown also to improve insulin secretion and
  sensitivity to the hormone in peripheral tissues.
  
    
  
  19.
  There is a need to be cautious in prescribing ACE
  inhibitors for patients at risk for the development of
  renal stones.