ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Familiarity with renal issues that can challenge the care of patients with human immunodeficiency virus (HIV) should expedite diagnosis and therapeutic interventions. Among the most common problems are electrolyte and acid-base imbalances from many opportunistic infections or their treatments, including hyponatremia, hyperkalemia, hypokalemia, and hypo- and hypercalcemia. Acid-base disturbances, simple or mixed, can be due to underlying sepsis, opportunistic infections, or the therapy thereof. A recent report of seven patients with HIV with type B lactic acidosis failed to identify a satisfactory etiology. Elevations in creatinine or diminishing urine output should alert the physician to the possibilities of prerenal azotemia or acute tubular necrosis, which can result from progression of prerenal azotemia or can occur secondary to administered nephrotoxins, such as certain antibiotics and radiocontrast agents. Agents associated with nephrotoxicity include aminoglycosides, antifungal, antiviral, and radiocontrast agents, and nonsteroidal anti-inflammatory pain medications. Although prerenal azotemia and acute tubular necrosis are the most frequent causes of acute renal failure, the differential diagnosis should include acute interstitial nephritis, obstructive nephropathy, and glomerulopathies such as hemolytic uremic syndrome, thrombotic thrombocytopenia purpura, the newly described IgA nephropathy, and, in certain populations, HIV nephropathy.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The problem of hyperphosphatemia in patients with chronic renal failure is reviewed. The importance of high plasma phosphorus levels in the pathogenesis of hyperparathyroidism is concisely discussed. Basic concepts about phosphorus metabolism in normal persons and in patients with chronic renal failure are outlined. This is followed by a detailed discussion of the various therapeutic methods to control hyperphosphatemia. Dietary restriction, dialysance of phosphorus, and the use of the currently available phosphorus binders are comprehensively discussed. Finally, the various clinical situations associated with failure to control hyperphosphatemia are reviewed.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Lipid abnormalities are almost a constant feature of kidney disease. However, the contribution of deranged lipid metabolism to the increased incidence of cardiovascular disease among renal patients has not been definitely established. Conversely, the role of lipid abnormalities in the progression of renal disease has gained considerable experimental support. Both dietary and pharmacologic interventions, which reduce circulating lipid levels, have been proven to decrease the incidence of glomerulosclerosis in various animal models. Whether similar results can be achieved in renal patients is, at present, unknown. If the new lipid-lowering drugs prove useful in preventing the progression of both glomerulosclerosis and atherosclerosis, a major advance in the therapy for renal patients will be achieved.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The inherent variability of blood pressure means that the accuracy of a small number of clinic readings in estimating the true blood pressure is limited. In many patients, a clinic visit provokes an increase in blood pressure such that they may be misclassified as being hypertensive (white coat hypertension). This applies to about 20% of hypertensives. Ambulatory monitoring has the potential to overcome these limitations. The white coat effect may still occur in patients taking antihypertensive medications, although in some cases medication may lower the clinic pressure without affecting the ambulatory pressure. The diurnal rhythm of blood pressure is another major source of variability and is influenced by both extrinsic and intrinsic factors. Its pathologic significance is unclear. Antihypertensive medication generally lowers the set point of blood pressure but has relatively little effect on variability.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

An increasing number of population-based studies and clinical trials have examined the role of blood pressure in renal disease. Recent reports indicate that elevations of blood pressure, even within the normotensive range, may result in renal damage. The available evidence suggests that blood pressure reduction diminishes and may completely prevent the progressive deterioration of renal function in persons with established renal insufficiency. Blood pressure reduction with an angiotensin-converting enzyme inhibitor may provide the best means of achieving this goal, but other antihypertensive medications may be equally effective. Nonpharmacologic interventions can be used to lower blood pressure in hypertensive persons and prevent the development of hypertension in those with blood pressure in the high-normal range. Other recent studies examined the role of environmental nephrotoxins, unrecognized viral infections, lower socioeconomic status, access to health care, and genetic factors as determinants of renal disease and hypertension in the general population. Despite their overall importance, known risk factors for hypertension-related renal disease fail to explain the excess risk of this entity in blacks and other racial minorities.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This review summarizes papers and reports published during the past year that contribute important knowledge or perspectives about prevention of elevated arterial blood pressure. Emphasis is on controlled intervention trials, particularly the large, multicenter Trials of Hypertension Prevention-Phase I, but all relevant randomized trials known to the author are included. Observational epidemiologic studies that are cross-sectional, eg, the INTERSALT study and the US Pitt County Study, or longitudinal, eg, the large Health Professionals Followup Study and the National Health and Nutrition Examination Survey (I) Epidemiologic Followup Study, are also discussed. The recent evidence, when viewed in the context of the previously accumulated literature, supports the recommendations of two recent expert reports to the effect that 1) much knowledge is available to help avoid the rise of blood pressure with age that is the hallmark of the epidemic of hypertension in industrialized societies, and 2) efforts should be particularly directed toward control of obesity, increased physical activity, reduced salt intake, and moderation of alcohol use.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Factors regulating the temporal and spatial expression of kidney developmental programs are beginning to be identified. Evidence accumulated in the past few years indicates that the Hox and Pax genes, in particular, are important for early kidney development. A number of soluble growth factors were also shown to be essential for nephrogenesis to proceed in vitro. Errors in kidney development include Wilms tumor, a common childhood malignancy, which in many cases seems to be caused by faulty transcriptional regulation.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID