Renal failure
-
Review Case Reports Comparative Study
Acute hyperphosphatemia caused by sodium phosphate enema in a patient with liver dysfunction and chronic renal failure.
We report a case of acute hyperphosphatemia secondary to rectal administration of sodium phosphate and sodium biphosphate (Fleet enema). Parathyroid hormone and calcitonin levels were measured along with phosphate clearance and the tubular reabsorption of phosphate.
-
Multicenter Study Clinical Trial Controlled Clinical Trial
Therapeutic use of the natriuretic peptide ularitide in acute renal failure.
Ularitide is a member of the natriuretic peptide family. This hormone exhibits an N-terminal extension by four amino acids compared with atrial natriuretic peptide. Ularitide was shown to exert strong diuretic and natriuretic effects when infused intravenously. Its main action sites are the glomerulum, inducing preglomerular vasodilation and postglomerular vasoconstriction and thereby elevating the glomerular filtration rate, and the tubular system inhibiting Na(+)-reabsorption. In initial uncontrolled clinical trials, this peptide was shown to have beneficial effects in patients suffering from oliguric acute renal failure. ⋯ In summary, the incidence of mechanical renal replacement therapy in critically ill patients suffering from oliguric acute renal failure could not be altered positively by Ularitide administration according to our protocol. Further prospective clinical trials are needed to answer the question whether a different patient collective or a prophylactic administration of Ularitide are more promising approaches in the clinical setting of oliguric acute renal failure.
-
Overuse and abuse of phenacetin-containing mixed analgesics has contributed to end-stage renal disease. Combination analgesics, especially those coformulated with caffeine, have been implicated as imparting a greater risk of analgesic-associated nephropathy (AAN) than single or coformulated analgesics without caffeine. This has led to a recommendation that the sale of "two plus caffeine" analgesic mixtures be reclassified from over-the-counter to prescription only availability. ⋯ Thus distinct therapeutic benefits of ASA, acetaminophen and caffeine appear to outweigh any known risk. It is doubtful if preventing the availability of these products will significantly affect the role of analgesic abuse/overuse in end-stage renal disease. Better risk management would come from a focused educational program, developed in a close collaboration between industry, healthcare professionals and consumer organizations, such a program must warn against the potential dangers of analgesic and non-steroidal anti-inflammatory drug misuse.
-
Acute renal failure (ARF) is one of the most frequent and potentially life threatening complications following bone marrow transplantation (BMT). Several renal syndromes that occur are either unique or occur with a disproportionate frequency post-BMT. Clinically ARF can be classified according to the time of onset post-BMT. ⋯ Supportive treatment such as optimization of volume status and dialysis when indicated are important steps as specific therapy is rarely available. Therefore, efforts should be targeted to the prevention of ARF. This includes prophylaxis for tumor lysis syndrome and marrow infusion toxicity by hydration and alkaline diuresis, avoiding nephrotoxic agents, early recognition and treatment of infection and correction of volume depletion.