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Query: UMLS:C0035078 (renal failure)
 31,970 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Anticoagulation with trisodium citrate (510 mmol/l) at a rate of 126 ml/h in combination with a calcium-free, 35 mmol/l acetate dialysate and i. v. supplementation of calcium chloride (350 mmol/l) at a rate of 22.5 ml/h has been performed in renal failure patients at risk of bleeding or actively bleeding. Short-term use-i. e. on the average four dialyses in 15 patients-showed no adverse effects or clotting phenomena. However, long-term use-i. e. at least four weeks and on average sixteen dialyses in six chronic hemodialysis patients-caused paresthesias and muscular cramps possibly due to the combination of insufficient calcium supplementation and metabolic alkalosis. To prevent metabolic alkalosis, the acetate content of the dialysate and the infusion rate of citrate were reduced to 29.5 mmol/l and 100 ml/h, respectively. To prevent clotting at this infusion rate, a calcium and magnesium-free dialysate was used and i. v. supplementation of calcium chloride (350 mmol/l) and magnesium chloride (250 mmol/l) was performed at rates of 30 ml/h and 15 ml/h, respectively. Six chronic renal failure patients were dialyzed with this regimen for an average of four months. There were no side effects or metabolic alkalosis noted. When an equimolar amount of bicarbonate replaced the acetate in the calcium and magnesium-free dialysate, side effects and metabolic alkalosis were seen within three dialyses. When the bicarbonate concentration in the dialysate was reduced to 25 mmol/l neither side effects nor metabolic alkalosis was observed. Thus citrate anticoagulation in patients on chronic hemodialysis can only be performed when the buffer content of the dialysate is reduced.
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PMID:Citrate anticoagulation and dialysate with reduced buffer content in chronic hemodialysis. 154 Oct 63

When symptoms of peripheral neuropathy appear, the possibility that they have been induced by drugs should be considered. A large number of drugs of all kinds, several of which are considered indispensable, have been implicated in peripheral neuropathy. A list of some of these drugs is provided. Neuropathy is a universal and dose-limiting factor during treatment with vinca alkaloids, but is otherwise a rare complication of drug therapy. Drug-induced peripheral neuropathy is almost always due to a dose-dependent primary axonal degeneration caused either by toxic reactions or by metabolic changes in neurons or their surroundings. The use of drugs should be restricted, especially in patients with a risk for development of neuropathy or with already existing neuropathy, e.g. patients with hepatic or renal failure, diabetes mellitus, or malnutrition. Patients should be given vitamins, prophylactically or therapeutically, which will sometimes allow a treatment to be continued. In other cases of drug-induced neuropathy the drug should be stopped. Reversal depends on the severity of the neuropathy, intensity and duration of the treatment and existence of causative cofactors, but generally the prognosis is good. While waiting for recovery physiotherapy is of importance, and when paraesthesia and pain are troublesome the patient should be treated with carbamazepine, imipramine or lidocaine (lignocaine).
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PMID:Prevention and management of drug-induced peripheral neuropathy. 165 73

In 9 patients undergoing chronic hemodialysis for 2-10 years and suffering from encephalopathy (dialysis dementia) and peripheral neuropathy, 10 mg of biotin was given daily in three doses for 1-4 years. Within 3 months there was a marked improvement in all patients in respect to disorientation, speech disorders, memory failure, myoclonic jerks, flapping tremor, restless legs, paresthesia and difficulties in walking. It is recommended to start giving biotin regularly in any patient with advanced renal failure before severe neural or muscular lesions become manifest. The correlation of biotin with uremic neurologic disorders and the possible mechanism of its therapeutic action are discussed.
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PMID:Biotin in the management of uremic neurologic disorders. 632 32

A phase II-III study with cisplatinum alone or in combination was carried in 227 patients with advanced tumors. 21 received cisplatinum at 20 mg/mg2 daily five days. The other 206 patients received cisplatinum in different dosage and combination. In both groups of patients cisplatinum was given with hydratation and mannitol forced diuresis. There were 4 partial responders (19%) in the first group of patients and 117 responses (56,7%) in the other group with 43 complete responses in 35 germ cell tumors and 6 small cell lung cancer. Toxicity included 2 irreversible renal failure (0,8%), one in each group of patients. Clearance creatinine was below 50 ml/min before treatment in 22/227 (9,6%) of patients. Other toxic effects included gastrointestinal (100%) neurologic with paresthesias and electrophysiologic changes and hematologic suppression. We concluded that cisplatinum is a new effective agent in the treatment pf malignant diseases to be used every time in combination with other anticancer drugs.
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PMID:[Phase II-III- study of cis-diaminodichloroplatinum (cisplatinum) (author's transl)]. 701 98

A case of acute hepato-renal failure which developed after the oral intake of rifampicin is reported. Allergic reaction on the drug was accompanied by chill, weakness, paraesthesia, skin itch and facial swelling. The case described in the article appears to be all the more interesting due to the fact that severe lethal complication has developed in patient who had a history of allergic reactions on rifampicin.
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PMID:[Acute hepatorenal failure occurring after taking rifampicin]. 820 24

The problem of pruritus in dialyzed patients remains unsolved. The aim of this study was to analyse the relationship between pruritus and clinical symptoms and signs, and electrophysiological aspects of peripheral neuropathy, both somatic and autonomic. 51 patients with end-stage renal failure undergoing hemodialysis were examined. Diabetics were excluded. Apart from taking history and physical examination, conduction velocities in peripheral nerves were determined, and R-R interval variation (RRIV: assessment of vagal function) and sympathetic skin response (SSR) tests were performed. Pruritus was present in about 63% of patients. In majority of them, symptoms and sings of neuropathy were also found. A significant relationship between pruritus and paresthesia was noted. This indicates a possible relationship between pruritus and secondary neuropathy.
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PMID:[Uremic neuropathy--II. Is pruritus in dialyzed patients related to neuropathy?]. 1008

The problem of pruritus in uremic dialysed patients remains unsolved. The etiology of pruritus has not been precisely explained, and sometimes no efficient treatment is available. The aim of this study was to analyse the relationship between somatic neuropathy and pruritus as well as the relationship between pruritus and dysautonomia. Fifty-one patients with end-stage renal failure underwent basic neurological examination, nerve conduction velocity studies, and pruritus assessment by means of a questionnaire. Two tests were used to assess the autonomic nervous system, namely the R-R interval variation test in basal and profound breath conditions (RRIV) and the sympathetic skin response (SSR). Pruritus was found in 63% patients of the sample. Most of them had clinical symptoms and signs of peripheral sensorimotor neuropathy and dysautonomia. About 59% of uremic patients revealed abnormally reduced RRIV. About 45% of patients had abnormal (delayed or absent) SSR. The pruritus in uremic patients occurred significantly more frequently (P < 0.01) in patients with paresthesia. A nonsignificant but sizeable trend towards a relationship of pruritus with hypohidrosis and pathological SSR results was also observed. There was no relationship between the pruritus presence and RRIV results. According to our results the activity of the nervous system might play an important role in the mechanism of uremic pruritus, but paradoxically this latter appeared more tightly related to somatic neuropathy than to autonomic dysfunction. Our results also suggest that SSR may become a useful technique for the assessment of autonomic dysfunction in uremic patients.
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PMID:Is pruritus in chronic uremic patients related to peripheral somatic and autonomic neuropathy? Study by R-R interval variation test (RRIV) and by sympathetic skin response (SSR). 1148 29

In response to a question on how to avoid the rare, inadvertent intravascular or ip injection of hypertonic saline solution during therapeutic abortion, 3 consultants replied. According to Reid and Frigoletto, to avoid intravascular or ip infusion, place a small indwelling polyethylene catheter in the amniotic sac rather than a metal needle. This virtually precludes the possibility of inadvertent iv injection. When and if necessary, correct catheter placement may be confirmed by the use of fluoroscopy and amniography prior to the injection of hypertonic saline solution. The chemical imbalances associated with this accident are those encountered in severe hypernatremia with resultant brain edema and hemorrhagic softening. Bizarre paresthesia, pyrexia, altered consciousness, and, eventually, convulsions preceded the fatal cases. Peritoneal dialysis may be life saving in the event of ip injection. Naturiuretics, appropriate parenteral fluid administration, and possibly exchange transfusion might be indicated for intravascular accidents. In Goodlin's hospital there have been no cases of acute hypernatremia in the last 500 therapeutic abortions done with hypertonic saline solution. This is believed to be related to 2 changes in technique: 1) not losing the amniotic space by removing only as much amniotic fluid as can easily be obtained and 2) using a simple gravity infusion technique for the instillation of the hypertonic saline solution. During infusion it is essential that the patient be alert, for the first symptoms of intravascular injection are a slight pain, burning, or a feeling of warmth in the pelvis. If these minor symptoms are ignored and the procedure is continued, a sensation of flushing occurs throughout the body with tingling in the scalp and ringing in the ears followed finally by seizures, apnea, or coma or both. Late symptoms are those of hemolytic anemia and renal failure. From experience, serum sodium levels during these events are as high as 185 mEq/1. Along with occurrence of acute hypernatremia the contents of the amniotic cavity are sometimes extruded extraovularly through the fallopian tube into the peritoneal cavity when labor begins. Cases with serum sodium levels of 170 mEq/1 some 6-7 hours after saline instillation were observed, but by contrast these patients' only symptoms were extreme thirst and peritoneal discomfort (Lancet 1: 305, 1968). The treatment of hypernatremia is to force fluids either by mouth or iv. Since most commercial 5% dextrose in water solutions are actually 4.5% (regulations permit a 10% error), such hypotonic fluids are useful for treating hypernatremia.
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PMID:Hypernatremia from intravascular saline infusion during therapeutic abortion. 1230 84

The objective of this study is to determine whether preoperative serum calcium, parathyroid hormone, or adenoma weight is predictive of postoperative hypocalcemia after removal of a parathyroid adenoma. A retrospective chart review was performed for consecutive parathyroidectomy patients over a 6-year period at a community-based teaching institution. Patients with renal failure (serum creatinine >1.7), hyperplastic disease, and parathyroid carcinoma were excluded. The outcome measures were postoperative serum calcium and the presence of signs or symptoms such as paresthesias, anxiety, or Chvostek's sign. One hundred forty-one patients underwent parathyroidectomy during the study period. Fifty-four patients were excluded as a result of hyperplastic disease, renal failure, carcinoma, or unavailable records. Of the remaining 87 patients 25 (28.7%) developed hypocalcemia (serum calcium < 8.0), and ten patients (11.5%), developed symptoms. The mean preoperative calcium levels for the normocalcemic and hypocalcemic groups were 10.9 and 10.6, respectively (P < 0.217). The mean preoperative parathyroid hormone levels (normal 10-54) were 214 and 139, respectively (P < 0.305), and the mean adenoma weights were 1.059 and 1.337 g respectively (P < 0.343). This study demonstrates no statistically significant difference in the mean preoperative serum calcium levels, parathyroid hormone levels, or adenoma weight between normocalcemic and hypocalcemic patients postoperatively.
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PMID:Are preoperative serum calcium, parathyroid hormone, and adenoma weight predictive of postoperative hypocalcemia? 1251 13

A 51-year-old white woman presented with thickening of the scalp located at the vertex and left lateral occiput without hair abnormalities or alopecia. Skin biopsies of the thickened scalp showed thickening of the subcutaneous tissue with proliferation of mature subcutaneous fat cells but no signs of inflammation or hair abnormalities. During 2.5 years of follow-up, scalp thickening progressed over the entire hair-bearing scalp and persisted without signs of further progression at 3.5 year follow-up. Lipedematous scalp is an extremely rare diagnosis. It is defined by a thickening of the subcutaneous layer of the scalp and can be distinguished from lipedematous alopecia, in which subcutaneous thickening is associated with diffuse alopecia and shortening of scalp hairs. A total of seven cases of lipedematous alopecia and two cases of lipedematous scalp have been reported. We report the third case of lipedematous scalp in a 51-year-old white woman associated with early symptoms of meningitis. Additional features described in the literature include pruritus, pain, and paresthesia of the scalp as well as associated medical problems such as hyperelasticity of skin and laxity of joints, renal failure, and diabetes mellitus. This sporadic disorder is predominantly located at the vertex and occiput. The etiology and pathogenesis of lipedematous scalp and alopecia remain unclear. The treatment is symptomatic.
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PMID:Hyperplasia of the subcutaneous adipose tissue is the primary histopathologic abnormality in lipedematous scalp. 1277 88


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