Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Five children (four boys and one girl) with chronic renal failure (CRF) developed congestive heart failure 0.5 to 11 years after the onset of the disease. Their ages were from 4 to 13 years old. They noticed tachypnea, tachycardia, cough, chest anxiety, general fatigue and their chest X-rays showed cardiomegaly with cardio-thoracic ratio (CTR) of from 55 to 63% and pulmonary congestion. Their echocardiograms showed no cardiomuscular hypertrophy, but the dilatation of left ventricular diastolic diameter (LVDd), and the decreased ejection fraction (EF) were observed. They were treated with water restriction, antihypertensive agents, cardiotonics and dialysis. Their clinical symptoms improved promptly, but their cardiomegary and echocardiographic findings improved gradually. The causes of heart failure in these patients seemed to be due to uremia, fluid overload and hypertension. The echocardiographic examination was useful for the management of the children with CRF in heart failure.
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PMID:[Echocardiographic assessment of cardiac function in the children of chronic renal failure with cardiomegary]. 129 69

To study the effect of treatment of anaemia with recombinant human erythropoietin (r-HUEPO) on neuromuscular function in patients undergoing haemodialysis for chronic renal failure, six patients were given r-HUEPO in an initial dose of 50 u/kg three times a week and their haemoglobin concentration was measured. The dose was increased by 25 u/kg every four weeks if the response was not satisfactory. In five patients anaemia had been corrected within 12 weeks of initiation of treatment. Neuromuscular function was evaluated before treatment, half way through, and after correction of anaemia by clinical examination and neurophysiological studies including motor nerve conduction velocity, distal latency, electromyography and test for neuromuscular fatigue. After correction of anaemia there was a significant increase in motor nerve conduction velocity, a decrease in the duration of motor unit action potential, and a lessening of neuromuscular fatigue. We conclude that treatment of anaemia with r-HUEPO in patients with chronic renal failure undergoing haemodialysis may improve neuromuscular function.
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PMID:Effect of treatment of anaemia with erythropoietin on neuromuscular function in patients on long term haemodialysis. 163 9

Concomitant renal and ocular lesions have been described in a few systemic diseases. The association of acute interstitial nephritis (AIN) and anterior uveitis without determined cause was first described in children. Recently, the same clinical association has been reported in adults. We report 3 cases of this association and present a review of the literature. Including our 3 patients, 7 cases of this association have been reported in adults. All patients were females aged 27-74 years. Initial symptoms were either ocular, or pseudoviral (fever, myalgia and fatigue). Histological renal studies revealed acute interstitial nephritis with tubular lesions. Immunofluorescence and electron microscopy were not contributive. Ocular prognosis was always good. In 5 patients, the evolution of renal function was excellent with complete resolution of acute renal failure within a few weeks. Chronic renal failure developed in two of the four patients who did not receive systemic steroid therapy (with evolution towards terminal renal failure in one patient). Three of the patients received 60 mg per day of prednisone and none of them developed chronic renal failure. Despite the small number of patients reported and the possibility of spontaneous regression, these data suggest a beneficial effect of systemic steroid therapy to prevent or reduce interstitial inflammation and subsequent fibrosis.
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PMID:Idiopathic acute interstitial nephritis associated with anterior uveitis in adults. 185 25

The uremic syndrome is multifactorial, and affects most tissues and organs. Disturbances in protein and amino acid metabolism may play important roles, especially in chronic uremia, either directly or by production of toxic metabolites, with resultant negative nitrogen (N) balance, muscle wasting, reduced protein synthesis, and characteristically abnormal intracellular free amino acid concentrations. There are also grossly abnormal amino acid levels in the plasma of uremic patients, e.g., increases in conjugated amino acids, high levels of several nonessential and low levels of essential amino acids. The ratios of tyrosine/phenylalanine and of valine/glycine are decreased. The low tryptophan levels may contribute to encephalopathy as a result of an imbalance in neurotransmitter synthesis. Citrulline is found in excess; the explanation is unresolved. There are elevated concentrations of the sulfur-containing amino acids: cystine, taurine, cystathionine, and homocysteine. Excess of the latter is implicated in the atherogenesis of renal failure. Disturbed metabolism and interorgan exchange of amino acids in the uremic state explains some of the abnormalities in tissue and plasma concentrations of individual amino acids. Enzymatic defects are involved in the disturbed metabolism of branched chain amino acids (BCAA), with possible antagonism among them, which impairs growth and amino acid utilization. Carbohydrate intolerance, associated with insensitivity of peripheral tissues to insulin and hyperinsulinemia, elicits decreased plasma BCAA. Protein synthesis rates in normal and pathological conditions are more closely related to the intracellular amino acid pool than to plasma amino acid levels. Concentrations of individual amino acids in the plasma pool are poor indicators of their intracellular concentrations. Muscle contains the largest pool of protein and free amino acids in the body. In chronic renal failure patients, the intracellular concentrations of valine, threonine, lysine, and carnosine are low. With low protein diets and in hemodialysis, serine, tyrosine, and taurine often are also low. The low taurine may be related to fatigue and to uremic cardiomyopathies. The commonly used amino acid supplements generally fail to correct the intracellular amino acid deficits. A "New Formula" has been developed to correct these intracellular amino acid abnormalities, and to supplement a low protein diet. It provides more valine than leucine, increased tyrosine and threonine, and less histidine, leucine, isoleucine, lysine, methionine, and phenylalanine than in formulas customarily used for patients with chronic renal failure. It is uncertain whether other ap
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PMID:Amino acid metabolism in uremia. 267 58

In 10 patients with chronic renal failure (CRF), undergoing hemodialysis, we studied respiratory muscle strength and endurance. The data obtained was compared with those acquired from 10 age-, sex-, weight- and height-matched normal volunteers. Maximal static inspiratory pressures (PImax) measured at residual volume and maximal static expiratory pressure (PEmax) measured at total lung capacity were significantly lower in the CRF group, 58.2 +/- (SD)24.9 and 50.8 +/- (SD)24.2% of predicted, respectively (p less than 0.005, p less than 0.01). There was a significant correlation between PImax and PEmax (r = 0.827, p less than 0.001), indicating similar involvement of both inspiratory and expiratory muscle groups. Maximal voluntary ventilation (MVV), although 84.4% of the predicted value in the CRF group, was significantly lower than in the control group, where it was 114% of predicted (p less than 0.001). MVV also correlated significantly with PImax and PEmax (r = 0.764, p less than 0.001 and r = 0.807, p less than 0.001, respectively). All but one CRF patient had elevated erum inorganic phosphorus levels, and a significant correlation was found between the serum inorganic phosphorus levels and PImax and PEmax (r = 0.718, p less than 0.001). These data indicate that there is an impairment of respiratory muscle strength and endurance in patients with CRF which may predispose the patient to respiratory muscle fatigue.
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PMID:Effect of chronic renal failure on respiratory muscle strength. 324 15

Uremia is associated with decreased brain oxygen consumption in humans and with decreased brain energy consumption in rodent models of acute renal failure. We measured the levels of high-energy phosphates and glycolytic intermediates in the brain of dogs with acute or chronic renal failure. We used methods of rapid brain tissue fixation that trap these labile metabolites at their in vivo levels. Creatine phosphate, ATP, and glucose were normal in the brain of animals with renal failure, indicating a normal brain energy reserve. The brain energy charge, which is the fraction of the total adenine nucleotide pool that contains high-energy phosphates, (ATP + 1/2ADP)/(ATP + ADP + AMP), was also normal despite an 8% decrease in the total adenine nucleotide pool. Mild hypoxia failed to alter the level of any of these metabolites. The brain redox state, (NAD+)/(NADH), was normal to high in acute renal failure, suggesting that oxygen supply was not limiting oxygen consumption. In the face of normal brain energy reserves, energy charge, and redox state, the decreased energy consumption of uremic brain probably results from decreased demand rather than limited supply.
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PMID:Uremic encephalopathy: role of brain energy metabolism. 647 28

The benefits of EPO treatment, including improved exercise tolerance, amelioration of lassitude and fatigue, improved cognitive function, and enhanced quality of life in general, can be extended to symptomatic anemic chronic renal failure patients before their need for dialysis treatment. The favorable pharmacokinetics and erythropoietic response with weekly subcutaneous dosing of EPO make this treatment suitable and convenient for patients and health care providers alike. EPO treatment can be provided without undue concern about accelerating the deterioration of renal function, but patients require frequent follow-up and close monitoring while treatment is initiated and adjusted over the first 3 to 6 months, in order to promptly detect and treat any adverse reaction or failure to respond.
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PMID:Clinical application of recombinant erythropoietin in predialysis renal failure. 785 15

Anemia is an inevitable and potentially serious complication of chronic renal failure and one of the most important limiting factors in patient rehabilitation. Although adequate dialysis can control many of the symptoms of uremia, dialysis does not reverse anemia-associated fatigue, and thus, many patients are not rehabilitated. Human recombinant erythropoietin (epoetin) therapy has proven to be effective in reversing anemia and increasing hematocrit levels in the majority of patients with chronic renal failure. Among this patient population, increases in hematocrit level have resulted in improvements in the symptomatology of organ hypoxia, neurobehavioral indices, anorexia, insomnia, depression, and sexual disinterest and dysfunction, as well as a reduction in cardiomegaly. However, despite the availability of epoetin and the dramatic improvements in the complications associated with the anemic state observed following therapy, it appears that patient rehabilitation remains a challenge. One aspect of the continuing problem of rehabilitation appears to be the reluctance of the medical community to increase hematocrit levels above 30%, despite the fact that higher hematocrit levels are associated with greater improvements and that potential adverse events related to hemodynamic adaptation are manageable. Indeed, a comparison of the results from two Epoetin alfa clinical trials, one in which hematocrit levels were maintained at 35% and a large phase IV study in which the target hematocrit level appears to have been approximately 30%, clearly demonstrate the benefits of optimizing hematocrit levels and thus improving the potential for rehabilitation.
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PMID:In search of an optimal hematocrit level in dialysis patients: rehabilitation and quality-of-life implications. 802 33

The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage and administration of torsemide are reviewed. Torsemide belongs to the pyridine-sulfonylurea class of loop diuretics. Its primary site of activity is the thick ascending limb of the loop of Henle, where it blocks active reabsorption of sodium and chloride, resulting in diuresis, natriuresis, and other effects. Torsemide has high bioavailability, a relatively long half-life, and a prolonged duration of activity. It is highly protein bound. Clinical trials indicate that torsemide is effective in the treatment of hypertension and of edema and other symptoms in patients with chronic renal failure (CRF), hepatic dysfunction, or congestive heart failure (CHF). Torsemide has infrequent, mild, and transient adverse effects; among the most common are orthostatic hypotension, fatigue, dizziness, and nervousness. The recommended initial oral dosages of torsemide are 10-20 mg/day for CHF, 20 mg/day for CRF, 5 mg/day for hypertension, and 5-10 mg/day (in combination with a potassium-sparing diuretic or aldosterone antagonist) for hepatic cirrhosis. In most patients, the pharmacokinetic advantages of torsemide over other loop diuretics are unlikely to translate into a substantial edge in clinical outcomes, and in practice there may be no cost advantages. Although torsemide does not offer major advantages over other loop diuretics, it may be of benefit in patients who do not respond to or cannot tolerate other agents.
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PMID:Torsemide: a new loop diuretic. 852 33

The aim of the study was the analysis of the sequence of electrophysiological changes occurring in the skeletal muscles in patients with chronic renal failure treated with hemodialysis (HD) and intermittent peritoneal dialysis (IPD). In 30 patients (10 treated with IPD-group I, 20 with HD-group II) the global electromyography (EMG) was determined in the muscles: pectoralis, obliqus and rectus abd., biceps brachii, thenar and hypothenar. The fatigue test was determined in the m. biceps brachii. The examinations were done twice during the 12 months of observations. The analysis of the material showed that myoelectrical activity of the examined muscles was significantly lower compared to a control group and did not changed during the 12 months of observations. The results of the fatigue test showed that in uremic patients the fatiguability of m. biceps brachii was significantly greater and was deeper after 12 months of observations. The analysis of the maximal inspiratory and expiratory pressure showed that respiratory muscles in uremic patients were weak. The results of the measurements the hand grip pressure showed that hand muscles were weak also.
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PMID:[Myoneuropathy in patients with chronic renal failure treated with hemodialysis (HD) and intermittent peritoneal dialysis (IPD). I. Evaluation of myoelectric activity of selected skeletal muscles in patients with chronic renal failure treated with hemodialysis and intermittent peritoneal dialysis]. 875 53


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