Biochemical Abnormalities during Renal Insufficiency

Bradley, Stanley E.

doi:10.1056/nejm194611212352106

Cited by 12 publications

(2 citation statements)

References 64 publications

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“…It is well known that patients with chronic renal disease have an impaired ability to conserve sodium (1)(2)(3)(4)(5)(6)(7). In a small number of patients this results in profound salt wasting (8)(9)(10)(11)(12)(13), but more commonly the defect is mild and becomes apparent only during severe sodium deprivation.…”

mentioning

confidence: 99%

The Mechanism of Salt Wastage in Chronic Renal Disease*

Coleman¹,

Arias²,

Carter³

et al. 1966

J. Clin. Invest.

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mentioning

confidence: 99%

The Mechanism of Salt Wastage in Chronic Renal Disease*

Coleman¹,

Arias²,

Carter³

et al. 1966

J. Clin. Invest.

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“…Since most hospitals have limited laboratory facili¬ ties, determination of the plasma bicarbonate, chloride, calcium, phosphorus, and nonprotein nitrogen levels will usually suffice as the basic laboratory data. Evaluation of the state of the extracellular fluid volume is based to a great extent on clinical signs.10 A marked deficit in extracellular fluid volume is characterized by ( 1 ) apathy, (2) anorexia, (3) illeus, (4) orthostatic hypotension, (5) tachycardia, (6) softening, shrinking, and longi¬ tudinal wrinkling of the tongue, (7) enophthalmos, (8) softness of muscles, Snd (9) below normal temperature.…”

Section: Electrolyte Disordersmentioning

confidence: 99%

Fluid and Electrolyte Disturbances in Prostatism

Lapides¹

1953

JAMA

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During the past decade or two great strides have been taken in reducing the morbidity and mortality associated with the treatment of prostatism. This progress has been attributed to earlier diagnosis, improved surgical techniques, introduction of modern antibiotic and chemotherapeutic agents, liberal use of whole blood, and, more recently, employment of fluid and electrolyte repair solutions. Since metabolic disorders are relatively frequent in the patient with urinary retention, it is apparent that fluid and electrolyte imbalances are common and important problems. In order to treat these disturbances rationally, one must have a knowledge of the role played by the kidney in the pathogenesis of the electrolyte disorders, as well as a comprehension of its clinical and laboratory manifestations. In this discussion an attempt will be made to indicate the causes of the electrolyte disorders, the types of imbalances most frequently encountered, and the rationale for the use of particular repair solutions. EFFECT OF BACK PRESSURE ON RENAL FUNCTION AND STRUCTUREComplete or partial obstruction of the lower urinary tract by an enlarged prostate results in urinary retention.The accumulation of urine in the bladder raises the intravesical pressure, which in turn leads to an increase in intraureteral and intrapelvic pressures. The increased pressure is reflected up the infundibula, calices, and tubules of the nephrons. Since effective glomerular filtration pressure is the difference between the intravascular hydrostatic pressure on the one hand and the sum of the osmotic pressure of the plasma proteins and the intrarenal tissue pressure on the other,1 it will be observed that the increase in intrarenal tissue pressure produced by the urinary retention will result in decreased glomerular filtration ( fig. 1). Glomerular filtration will be impaired further because of decreased blood flow due to compression of the blood vessels by the increased intrarenal tissue pressure.2 Tubular function will be dis¬ turbed also 3 because of a decrease in the peritubular capillary blood flow, which is due to compression of the vessels by increased intrarenal pressure.If the urinary retention is of short duration, it is prob¬ able that no structural changes will occur; however, pro¬ longed lower urinary tract obstruction will result initially in anemic and pressure atrophy of the tubules. Later, the glomeruli will be destroyed so that the kidneys in the end stage become connective tissue shells.4 It has been demonstrated experimentally in animals 4 that removal of the back pressure will result in structural repair and restoration of function, the degree being dependent on the period of obstruction. In man, following drainage of the bladder, improvement has been observed to take place in both glomerular and tubular function 5; the func¬ tion of the tubules, however, appears to recover to a greater extent. The period of time necessary for maximal improvement may be one to two months in some instances. ELECTROLYTE DISORDERSMechanism.-In the healt...

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