Nitrogen and potassium balance studies were conducted in six nondialyzed uremic patients. Each patient was investigated before and after supplementation with sodium bicarbonate and sodium chloride. Every period of the study lasted longer than 1 wk. Each patient had the same calorie and protein intake during the whole study. Urea nitrogen appearance was correlated with protein intake for the assessment of the compliance of patients with their diets. There was a significant decrease of blood urea nitrogen (p = 0.014) of 36% during bicarbonate supplementation and both metabolic balance studies improved significantly (p = 0.0005 and 0.0096). However, there was no significant improvement during sodium chloride administration indicating that the effect of bicarbonate was the result of the correction of metabolic acidosis and not of the expansion of the extracellular volume.

BackgroundDelayed hospital discharge (also known as Alternate Level of Care or ALC) is a global health care quality issue with negative implications for people (e.g., functional decline) and the health care system (e.g., costly interruptions in hospital flow and procedures). ALC disproportionately impacts people with cognitive impairment, and insight into the needs and experiences of this specific sub population and their carers is lacking. The purpose of this study was to understand the hospital experience of carers (e.g., family members) of patients with ALC and cognitive impairment who were waiting for long-term care from the hospital.MethodsThis is a qualitative descriptive study entailing 12 semi-structured interviews with 15 carers of patients with ALC from three hospitals in Northwestern Ontario. Interviews were conducted between October 2015 and February 2016. Two reviewers thematically analyzed the interview data.ResultsFive core themes were identified from the interview data: patient over person, uncertain and confusing process, inconsistent quality in care delivery, carers addressing gaps in the system, and personalization of long-term care.ConclusionsWaiting for long-term care from the hospital is a stressful and uncertain time for family carers. ALC is an ‘in-between’ phase when patients and carers may be at their most vulnerable yet receive the least care from the formal care system. Carers provide critical insight into the needs and behaviors of patients as well as processes that need to be improved to enhance their experience. Such insights will help health systems internationally as they grapple with the issue of ALC whilst trying to optimize engagement with patients and their families.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2272-6) contains supplementary material, which is available to authorized users.

The erythropoietin gene has been cloned in three mammalian species including man and recombinant erythropoietin is now used to treat the anaemia of chronic renal failure. Despite the isolation of the gene the precise cellular location of erythropoietin synthesis remains controversial. We present studies which demonstrate erythropoietin production by kidney tubular cells. Erythropoietin gene expression (messenger RNA) was detected by in situ hybridization using an oligonucleotide gene probe and the translated protein product by immunohistochemistry employing antibodies raised to pure recombinant DNA derived erythropoietin.

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CALCIUM OXALATE is one of the most common constitutents of renal calculi. The presence of this compound in the nucleus of most calcium-containing stones and the discovery by Hodgkinson (1969) that the smaller the stone the greater the proportion of calcium oxalate, have encouraged the idea that calcium oxalate may be an important factor in the initiation of renal stones. As calcium oxalate crystals are easily produced in vitro, a number of investigators have designed experiments to study the formation of these crystals and the effect of various substances on their growth rate. Lyon and Vermeulen (1965) grew oxalate crystals on wire loops suspended in water or a simple salt solution by the slow diffusion of calcium and oxalate ions through filter paper wicks into the media. Some compounds, considered to be potential inhibitors of crystal growth, were added to the media and the crystals examined after a number of days. Using a similar method, Sutor (1969) examined the effects on calcium oxalate growth of a wide variety of substances using an acetate buffer. A further paper by Sutor and Wooley (1970) examined the action of other compounds in the acetate buffer and also in human urine. In all these experiments the crystals were allowed to grow for approximately 1 week and then studied by simple observation. However, this method of assessment is subjective and not in any way quantitative. In this paper, a method is described for the estimation of crystal growth by measuring the calcium content of crystals. Substances which might be expected to inhibit calcium oxalate growth were added to acetate buffer and human urine. Their effects on the formation of crystals over a 24-hour period were studied.