The American journal of the medical sciences
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Rapid correction of severe hyponatremia carries the risk of osmotic demyelination. Two recently introduced methods of correction of hyponatremia have diametrically opposite effects on aquaresis. Inhibitors of vasopressin V2 receptor (vaptans) lead to the production of dilute urine, whereas infusion of desmopressin causes urinary concentration. ⋯ Desmopressin is effective in hyponatremias presenting with dilute urine or developing urinary dilution after saline infusion. In this setting, desmopressin infusion helps prevent overcorrection of the hyponatremia. Monitoring of the changes in serum sodium concentration as a guide to treatment changes is imperative regardless of the initial treatment of severe hyponatremia.
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Vision loss from glaucoma has traditionally been described as loss of "peripheral vision." In this prospective study, we aimed to improve our clinical understanding of the visual symptoms caused by glaucoma by asking patients specific detailed questions about how they see. ⋯ Vision loss in patients with glaucoma is not as simple as the traditional view of loss of peripheral vision. Needing more light and blurry vision were the most common symptoms reported by patients with glaucoma.
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This study seeks to determine the most important patient factors and health care exposures available through administrative databases associated with antihypertensive nonadherence. ⋯ This cross-sectional study suggests that substance abuse, black race, emergency department visits and hospitalizations are risk factors associated with nonadherence. Outpatient visits are associated with a small decrease in nonadherence. Further studies are needed to determine the characteristics of outpatient visits that most improve adherence.
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Nephrotic syndrome is associated with an increased risk for thromboembolic complications. Until now, few studies have ever specified the risk of pulmonary thrombosis/embolism (PTE) in patients with nephrotic syndrome. In this study, we assessed the risk of PTE in a large cross-sectional study to identify risk factors in this population. ⋯ In adult patients with NS, high level of plasma D-dimer was closely associated with PTE, whereas proteinuria or serum albumin level was not in this study. Using plasma D-dimer level, we developed a concise model to predict the risk of PTE.
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Evidence indicates that chronic angiotensin II (AngII) infusion increases (pro)renin receptor ((P)RR) expression in renal inner medullary collecting duct (IMCD) cells. Recently, it has been shown that renal (P)RR expression is augmented during a low-salt (LS) diet. However, the role of AngII in mediating the stimulation of (P)RR during LS conditions is unknown. We hypothesized that AngII mediates the increased expression of (P)RR during low-salt conditions in IMCDs. ⋯ These data indicate that (P)RR is augmented in medullary collecting ducts in response to LS and that this effect is further enhanced by the increased intrarenal AngII content.