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Meanwhile, according to 2013 European Society of Cardiology (ESC) guidelines, a loop diuretic can only replace thiazide-type diuretics if there is renal impairment (Creatinine of more than 1.5 mg/dL or estimated glomerular filtration rate (eGFR) of less 30 mL/min/1.73 m 2 due to lack of long term cardiovascular outcome data and appropriate ...
An increase in osmolality causes the gland to secrete antidiuretic hormone (ADH), resulting in water reabsorption by the kidney and an increase in urine concentration. The two factors work together to return the plasma osmolality to its normal levels.
Fractional excretion of other substances can be measured to determine kidney clearance including urea, uric acid, and lithium. These can be used in patients undergoing diuretic therapy, since diuretics induce a natriuresis. Thus, the urinary sodium concentration and FE Na may be higher in patients receiving diuretics in spite of prerenal ...
Treatment is focused on preventing deposition of uric acid within the urinary system by increasing urine volume with potent diuretics such as furosemide. Raising the urinary pH to a level higher than 7 (alkalinization) is often difficult to attain, although sodium bicarbonate and/or acetazolamide are sometimes used in an attempt to increase ...
The substances cause an increase in the osmotic pressure within the tubule, causing retention of water within the lumen, and thus reduces the reabsorption of water, increasing urine output (i.e., diuresis). The same effect can be seen in therapeutics such as mannitol, which is used to increase urine output and decrease extracellular fluid volume.
An increase in serum creatinine can be due to increased ingestion of cooked meat (which contains creatinine converted from creatine by the heat from cooking) or excessive intake of protein and creatine supplements, taken to enhance athletic performance. Intense exercise can increase creatinine by increasing muscle breakdown.
Laxative abuse can mimic the serum electrolyte abnormalities, but fractional excretion of potassium will be low; Diuretic abuse could be suspected if urinary chloride excretion varies by time of day but may require a diuretic assay to detect; Surreptitious vomiting can cause metabolic alkalosis and hypokalaemia, but urinary chloride levels will ...
Excessive ADH causes an inappropriate increase in the reabsorption in the kidneys of solute-free water ("free water"): excess water moves from the distal convoluted tubules (DCTs) and collecting tubules of the nephrons – via activation of aquaporins, the site of the ADH receptors – back into the circulation. This has two consequences.