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Dissertations / Theses on the topic 'Renal disease; Kidney failure'
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Chakrabarti, Shubro. "Mechanisms of fibrosis in feline chronic kidney disease." Thesis, Royal Veterinary College (University of London), 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.572451.
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McLelland, Elizabeth Victoria. "Identification of factors associated with, and preventative strategies in, diabetic nephropathy." Thesis, University of Wolverhampton, 1999. http://hdl.handle.net/2436/93526.
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Bergsten, Alicia. "Molecular studies of complications in end stage renal disease : focus on expression and variations of candidate susceptibility genes /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-425-2/.
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Tong, Ka-hang Matthew, and 湯嘉恆. "Cost-effectiveness of screening for chronic kidney disease: a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45174179.
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Goldstein, D. Jordi. "Effects of selective manipulation of fatty acids in experimental chronic renal disease." Thesis, Boston University, 1993. https://hdl.handle.net/2144/31818.
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Thesis (D.Sc.N.S.)--Boston University, Henry M. Goldman School of Graduate Dentistry, 1993 (Nutritional Sciences).Includes bibliography (leaves 176-187)
This dissertation has been presented in two related studies: A. Fish Oil Reduces Proteinuria and Interstitial Injury but not GIomerulosclerosis in the Milan Nomotensive Rat Rats of the Milan Normotensive strain (MNS) spontaneously develop severe Proteinuria and excessive glomemlar thromboxane (Tx)A2 PrOduction at a young age. These are accompanied by podocyte alterations and progressive focal glomerulosclerosis (FGS) and interstitial fibrosis. Since previous studies showed that pharmacologic... [TRUNCATED]
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Yeung, Nga-man, and 楊雅雯. "A guideline of nurse-delivered pre-dialysis education programme for stage 4 chronic kidney disease patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44626988.
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Gregory, Deborah M. "Patients' perceptions of their experiences with end-stage renal disease (ESRD) and hemodialysis treatment." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0031/MQ47421.pdf.
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Xiao, Shen. "Alterations of vascular endothelial nitric oxide synthase activity and substrate availability in chronic renal disease." Morgantown, W. Va. : [West Virginia University Libraries], 1999. http://etd.wvu.edu/templates/showETD.cfm?recnum=794.
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Thesis (Ph. D.)--West Virginia University, 1999.Title from document title page. Document formatted into pages; contains xvi, 184 p. : ill. Vita. Includes abstract. Includes bibliographical references.
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Yang, Bin. "Involvement of programmed cell death (apoptosis) and its regulators in experimental chronic renal scarring." Thesis, University of Sheffield, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.369894.
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Kennedy, David J. "Cardiovascular complications of ischemic renal disease : the effect of renal dysfunction on cardiac disease and the central role of cardiotonic steroids in the pathogenesis of uremic cardiomyopathy." Connect to full-text via OhioLINK ETD Center, 2005. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=mco1145302915.
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Thesis (Ph.D.)--Medical University of Ohio, 2005."In partial fulfillment of the requirements for the degree of Doctor of Philosophy in Medical Sciences." Major advisor: Joseph I. Shapiro. Includes abstract. Document formatted into pages: v, 265 p. Title from title page of PDF document. Bibliography: pages 52-59,94-100,129-134,171-176,200-263.
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Kossuth-Cabrejos, Stefano, Arquímedes M. Gavino-Gutiérrez, and Wilmer Silva-Caso. "Factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis in Lima, Peru." Page Press Publications, 2020. http://hdl.handle.net/10757/655593.
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The objective of the study is to analyze the factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis. The methodology used is based on a cross-sectional study in patients receiving hemodialysis at the Centro Nacional de Salud Renal. Severe pruritus was defined as a score on the visual analogue scale greater than or equal to 7, and the strength of association with the possible risk factors was assessed by calculating prevalence ratios. Regarding the results, 264 patients were included, 59.9% were male, with a mean time on hemodialysis of 10.26 ± 7.14 years. 75% experienced pruritus, of this group, 1 in 3 presented severe pruritus. Hyperphosphatemia and the use of antihistamines were associated with a higher prevalence of severe pruritus (RP 1.71, 95% CI 1.09-267 and RP 2.39, 95% CI 1.51-3.75, respectively). The positive serology for Hepatitis C Virus was described as a protective factor for presenting severe pruritus (RP 0.55, 95% CI 0.33 - 0.89). In conclusion, severe uremic pruritus is a frequent problem in patients with chronic terminal kidney disease who have hyperphosphatemia and treatment with antihistamines independently of the time they have been on hemodialysis.Revisión por pares
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Tong, Allison. "Towards consumer-centred health care and health research in nephrology understanding patient and family caregiver experiences and perspectives in chronic kidney disease /." Faculty of Medicine, 2008. http://hdl.handle.net/2123/4024.
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Doctor of Philosophy (PhD)Healthcare services and health research aim to improve the physical and psychosocial well being of consumers, and to offer responsive services needed and valued by them. Research in chronic kidney disease (CKD) has predominantly focused on investigating biomedical aspects and evaluating technological or pharmacological treatment interventions to improve medical management. While research into assessing patients’ and caregivers’ quality of life, and symptom burden, is growing minimal attention has been given to gaining a broad and in-depth understanding about the experiences, psychosocial issues and needs of patients and their caregivers. These need to be considered when planning and delivering patient-centred care and health research across the whole trajectory of CKD. The studies that form the major part of this thesis explore the perspectives, needs and experiences of CKD patients and their caregivers, within a broad and multidimensional framework encompassing aspects of the nature of the health and illness experiences and consumer perspectives. In Chapter 2, to understand what is known about parental experiences of caring for a child with CKD, the relevant qualitative literature was systematically reviewed and synthesized. Three inter-related clusters were identified: intrapersonal, interpersonal and external experiences. In Chapter 3, to gain a more detailed and broader understanding of this topic, in-depth interviews were conducted with parents of 20 children with CKD and 4 major themes were identified: absorbing the clinical environment, medicalising parenting, disrupting family norms, and coping strategies and support structures. In Chapter 4, to assess the effectiveness of support interventions for caregivers of patients with CKD, a systematic review was conducted which identified only three eligible studies that assessed only the effect of educational material on caregiver knowledge, not other domains. In Chapter 5, to describe and compare the broad range and depth of experiences and perspectives from predialysis, dialysis and transplantation patients, data from patient focus groups were analysed. The 5 themes that emerged from this data were: personal meaning of CKD, managing and monitoring health, lifestyle consequences, family impact, and informal structures. In Chapter 6, the focus groups were also used to elicit research priorities and identify reasons that patients used to develop their research priorities. A patient focused research agenda was elicited for CKD and 5 reasons that patients used to develop their research priorities were identified: normalisation of life, altruism, economic efficiency, personal concerns and clinical outcomes. During the focus groups, participants repeatedly expressed frustration about the poor public profile, and lack of community-based information on CKD prevention. So in Chapter 7, to assess how Australian news media covered prevention and early detection of CKD, I analysed television and newspaper stories that referred to CKD prevention or early detection. Kidney disease in general, and particularly the prevention and early detection of CKD, received virtually no media attention. When mentioned, it was mainly in the context of transplantation and donor stories, and seldom prevention or early detection, which appears largely unnewsworthy in its current form. At best, CKD received peripheral mention as a secondary concern in diabetes and obesity news stories which focused on lifestyle solutions. In Chapter 8, to develop a checklist for explicit and comprehensive reporting of qualitative studies (in-depth interviews and focus groups), I performed a comprehensive search in relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: 1) research team and reflexivity, 2) study design, and 3) data analysis and reporting. The overarching purpose of these studies was to gain a better understanding about the needs, experiences and perspectives of CKD patients and their caregivers. The findings describe the permanent, profound and pervasive impact of CKD on the lives of patients and caregivers across the whole illness trajectory. A more detailed and broader understanding about patient and caregiver perspectives, as presented in this thesis, can support a move towards advancing patient-centred healthcare and research in CKD.
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Heiwe, Susanne. "Experienced physical functioning and effects of resistance training in patients with chronic kidney disease /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-865-3/.
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Zelmer, Jennifer. "The economic burden of end-stage renal disease in Canada: present and future /." *McMaster only, 2005.
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Richards, Roselee Jayne. ""You look very well for a transplant" : autoethnographic narrative and identity in chronic kidney disease, kidney failure and the life post-transplant." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/19909.
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Thesis (PhD)--Stellenbosch University, 2012.ENGLISH ABSTRACT: Despite the high prevalence of chronic kidney disease, renal narratives are under-reported. Much of what is written on kidney failure is written by health care professionals for health care professionals and about patients. While medical experts and health care practitioners have one type of knowledge, their patients have another type of knowledge acquired through their experience of their own condition. From within the disability and patients’ rights movements urgent calls have been made for the authentic voices of disabled people and patients to be heard without the mediation of professional lenses. In response to this my dissertation combines personal and academic writing to explore my own experience of end-stage renal disease, dialysis, transplantation and the life after transplant. I have used autoethnography as a methodology. Autoethnography is a relatively new, somewhat postmodern form of inquiry that developed from the reflexive turn in anthropology and narrative studies in the latter part of the twentieth century. It is very useful in writing about the experience of illness and reflecting on illness narratives because, in autoethnographic writing, the observer and observed, the narrator and narrated, insider and outsider are the same person. This allows scope for exploring the problematics of representation and for finding alternatives to already existing ways of telling certain stories. Engaging with autoethnography’s postmodern aspects has allowed me to conceptualize experiences that, until I undertook this research, I have never been able to articulate, because the traditional (static) illness narrative forms did not speak to my experience or my understanding of my condition. The central issue in my dissertation lies in the question: How do I tell the story of chronic illness once I have had an organ transplant? Flowing from this are a number of sub-issues: Can my story change? How do I describe myself: The well, the ill, the impaired, the disabled, the afflicted? Do I describe myself living in no man’s land? In my narrative, do I oscillate between being well and ill, or do I occupy another territory entirely? And if I do, what is it? My study shows that writing the story (or stories) of chronic kidney disease is complex, nuanced and dynamic and that, far from being an extended liminal experience, kidney disease is littoral. This distinction is important in coming to narrative terms with an identity that is not damaged so much as different. Through this I hope to demonstrate to both outsiders and insiders, who often submit to narratives that are forced on them, that more satisfying alternatives can be found.
AFRIKAANSE OPSOMMING: Ondanks die hoë voorkomssyfer van chroniese nierkwale word nierverhale nie genoeg aangemeld nie. Die meerderheid van dit wat oor nierversaking geskryf word, word deur gesondheidsorgdeskundiges vir gesondheidsorgdeskundiges en oor pasiënte geskryf. Terwyl mediese deskundiges en gesondheidsorgpraktisyns een soort kennis het, het hulle pasiënte ’n ander soort kennis op grond van hulle ervaring van hulle eie toestande. Van binne die gestremdheid en pasiënteregte-bewegings het ’n dringende oproep weerklink vir die outentieke stemme van mense met gestremdhede en pasiënte om gehoor te word sonder die tussenkoms van professionele perspektiewe. In reaksie hierop kombineer my verhandeling persoonlike en akademiese beskrywings om my eie ervaring van eindstadium- nierkwale, dialise, oorplanting en die lewe na oorplanting te verken. Ek het outo-etnografie as metodologie gebruik. Outo-etnografie is ’n relatief nuwe, ietwat postmoderne vorm van ondersoek wat in die tweede deel van die twintigste eeu uit die refleksiewe wending in antropologie en narratiewe studies ontwikkel het. Dit is baie bruikbaar wanneer oor die belewenis van siekte en besinning oor siekte-narratiewe geskryf word aangesien die waarnemer en die waargeneemde, die verteller en dit wat vertel word, die ingewyde en die buitestander in outo-etnografiese skryfwerk dieselfde persoon is. Dit laat meer ruimte vir verkenning van die problematiek van voorstelling en vir die opspoor van alternatiewe vir reeds bestaande wyses om sekere stories te vertel. My bemoeienis met postmoderne aspekte van outo-etnografie het dit vir my moontlik gemaak om ervaringe wat ek tot en met hierdie navorsing nooit kon artikuleer nie, te konseptualiseer, aangesien die tradisionele (statiese) vorme van siekte-narratiewe nie tot my ervaring of my begrip van my toestand gespreek het nie. ‘Hoe vertel ek die storie van chroniese siekte nadat ek ’n orgaanoorplanting gehad het?’ is ’n sentrale vraagstuk in my verhandeling. Hieruit spruit ’n aantal newevraagstukke voort: Kan my storie verander? Hoe beskryf ek myself: Die gesonde persoon, die sieke, die verswakte, die gestremde, die aangetaste? Hoe beskryf ek myself wat in ’n niemandsland woon? Fluktueer ek in my narratief tussen gesond wees en siek wees of betrek ek ’n geheel ander gebied? En indien wel, wat is dit? My studie toon dat, om die storie (of stories) van chroniese niersiekte te skryf, kompleks, genuanseerd en dinamies is en dat niersiekte glad nie ’n uitgebreide liminale ervaring is nie, maar eerder littoraal is. Dit is belangrik wanneer daar tot ’n narratiewe verstandhouding gekom moet word met ’n identiteit wat nie soseer beskadig is nie, maar eerder anders. Hierdeur hoop ek om aan beide buitestanders en ingewydes, wat dikwels voor narratiewe wat op hulle afgedwing word, moet buig, te wys dat daar meer bevredigende alternatiewe gekry kan word.
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Marks, Angharad. "Outcomes and epidemiology of chronic kidney disease : the first Grampian laboratory outcomes morbidity and mortality study (GLOMMS-I)." Thesis, University of Aberdeen, 2013. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=202777.
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To identify those with kidney disease early and thus facilitate earlier instigation of disease-progression slowing treatments, new definitions of chronic kidney disease (CKD) were introduced in 2002 (KDOQI). After this, the worldwide introduction of estimated glomerular filtration rate (eGFR) reporting (2006 onwards), also facilitated more widespread identification of those with CKD. Prognosis in those with CKD identified in this way was not known and the numbers with CKD appeared higher than originally expected. This thesis aimed to improve understanding of outcomes in those who met the definition of chronic kidney disease and facilitate better directed care. Data-linkage of several healthcare datasets including to laboratory, morbidity and mortality healthcare data for individuals in the Grampian region with measures of renal function in 2003 allowed those aims to be addressed. Patterns in the testing of kidney function over time were also described. Mortality and RRT initiation during the GLOMMS-I cohort's 6.5 years of follow-up were described, as were variables that were associated with these outcomes. Other measures of decline of kidney function over time (progression), were explored and compared to the ultimate measure of progression - the initiation of RRT. Various models to predict outcomes (RRT initiation, mortality and survival) were explored. Measures of model performance including discrimination, calibration, goodness of model fit and predictive performance were described. Overall the aim of this thesis was met - to improve the understanding of the prognosis of those currently labelled with chronic kidney disease. The work in this thesis has also provided the necessary information to plan and start a much wider population based study of outcome in those both with and without CKD (GLOMMS-II).
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He, Jiang, Michael Shlipak, Amanda Anderson, Jason A. Roy, Harold I. Feldman, Radhakrishna Reddy Kallem, Radhika Kanthety, et al. "Risk Factors for Heart Failure in Patients With Chronic Kidney Disease: The CRIC (Chronic Renal Insufficiency Cohort) Study." WILEY, 2017. http://hdl.handle.net/10150/625054.
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Background-Heart failure is common in patients with chronic kidney disease. We studied risk factors for incident heart failure among 3557 participants in the CRIC (Chronic Renal Insufficiency Cohort) Study. Methods and Results-Kidney function was assessed by estimated glomerular filtration rate (eGFR) using serum creatinine, cystatin C, or both, and 24-hour urine albumin excretion. During an average of 6.3 years of follow-up, 452 participants developed incident heart failure. After adjustment for age, sex, race, and clinical site, hazard ratio (95% CI) for heart failure associated with 1 SD lower creatinine-based eGFR was 1.67 (1.49, 1.89), 1 SD lower cystatin C-based-eGFR was 2.43 (2.10, 2.80), and 1 SD higher log-albuminuria was 1.65 (1.53, 1.78), all P< 0.001. When all 3 kidney function measures were simultaneously included in the model, lower cystatin C-based eGFR and higher log-albuminuria remained significantly and directly associated with incidence of heart failure. After adjusting for eGFR, albuminuria, and other traditional cardiovascular risk factors, anemia (1.37, 95% CI 1.09, 1.72, P= 0.006), insulin resistance (1.16, 95% CI 1.04, 1.28, P= 0.006), hemoglobin A1c (1.27, 95% CI 1.14, 1.41, P< 0.001), interleukin-6 (1.15, 95% CI 1.05, 1.25, P= 0.002), and tumor necrosis factor-a (1.10, 95% CI 1.00, 1.21, P= 0.05) were all significantly and directly associated with incidence of heart failure. Conclusions-Our study indicates that cystatin C-based eGFR and albuminuria are better predictors for risk of heart failure compared to creatinine-based eGFR. Furthermore, anemia, insulin resistance, inflammation, and poor glycemic control are independent risk factors for the development of heart failure among patients with chronic kidney disease.
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潘建基 and Kin-kee Pun. "Carbohydrate metabolism in chronic renal and liver disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1986. http://hub.hku.hk/bib/B31981276.
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O'Brien-Connors, Marguerite A. "Individuals' experiences with end stage renal disease and hemodialysis treatment : implications for quality of life /." Internet access available to MUN users only, 2003. http://collections.mun.ca/u?/theses,157548.
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Scaife, Diane. "What is the lived experience of the client with end stage renal disease on hemodialysis?" Connect to Online Resource-OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=mco1176378463.
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Thesis (M.S.)--University of Toledo, 2006."In partial fulfillment of the requirements for the degree of Master of Science in Nursing." Major advisor: Jane C. Evans. Includes abstract. Document formatted into pages: v, 53 p. Title from title page of PDF document. Bibliography: pages 42-43.
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Righi, Samuel. "Increased Circulatory Lipopolysaccharide From a High Fat Diet Aggravates Inflammation and Exacerbates Renal Failure." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3444.
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Kidney failure is frequently associated with the risk factors linked to metabolic syndrome. Lipopolysaccharide (LPS) is a potent inflammatory molecule, which has increased absorption from the gut into blood circulation following a high fat and high-energy diet. We hypothesized that LPS from a high fat diet can amplify inflammation, thereby exacerbating chronic kidney disease and associated disorders. We have found that adding a high fat diet to renal insufficient mice significantly progressed their kidney disease as well as associated disorders, compared to both a high fat diet and renal insufficiency alone. Additionally, we were able to demonstrate in vitro that the combination of LPS and palmitic acid, a marker of high fat diet, induced inflammatory pathways significantly more than either LPS or palmitic acid alone. These results provide insight into connection between a high fat diet and the progression of chronic kidney disease as well as associated disorders.
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Galiyeva, Dinara. "Cardiovascular risk factor prevalence, mortality and cardiovascular disease incidence in patients who initiated renal replacement therapy in childhood : systematic review and analyses of two renal registries." Thesis, University of Edinburgh, 2017. http://hdl.handle.net/1842/28837.
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Background. The incidence of starting renal replacement therapy (RRT) among young people (< 20 years of age) in 2013 in Scotland was 7.7 per million (age-related) population. Little knowledge exists about cardiovascular risk factors (CVRFs), long-term survival and cardiovascular disease (CVD) outcomes in patients who initiated RRT in childhood. The main source of routine data for these patients is available from the European Society of Paediatric Nephrology/European Renal Association- European Dialysis and Transplant Association (ESPN/ERA-EDTA) registry. In Scotland nationally comprehensive data on patients receiving RRT is available from the Scottish Renal Registry (SRR). Aim and objectives. The overall aim of the thesis is to review relevant literature and conduct retrospective cohort studies describing CVRF prevalence, all-cause mortality and incidence of CVD outcomes in patients who initiated RRT in childhood. ESPN/ERA-EDTA registry data were used to describe the prevalence of anaemia, hypertension, dyslipidaemia and BMI categories and their association with all-cause and CV mortality. SRR data were used to describe all-cause mortality and CVD incidence and their association with age at start of RRT, sex, primary renal disease (PRD), type of RRT and period of start of RRT. Methods. Systematic searches were performed to identify relevant literature. For the ESPN/ERA-EDTA analyses patients who started RRT between 0 and 20 years of age and who had CVRF data were included. Patients were followed from date of first CVRF measurement until the earliest of death, loss to follow-up, reaching 20 years of age or the end of follow-up (December 31st 2012). Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality, comparing patients with and without each CVRF. For the SRR analyses, patients who started RRT under 18 years of age in the period from 1963 to 2013 were included in the analyses. To describe CVD incidence the SRR data were linked to national registers for death and CVD hospital admissions available from 1981 onwards. These analyses, therefore, included patients who started RRT between 1981 and 2013 with follow-up until first CVD event after start of RRT, end of follow-up period or censoring at death. Cox proportional hazard models were used to examine the association of age at initiation of RRT, sex, PRD, type of RRT and period of initiation of RRT with all-cause mortality and CVD incidence. Results. The systematic reviews revealed a gap in current knowledge about CVD incidence and the association of CVRFs with CVD outcomes in patients who initiated RRT in childhood. In total, 7,845 patients were included in the ESPN/ERA-EDTA registry analysis. The mean age of the patients was 9.5 (SE 0.06) years, 58.9% were male, and the most common PRD was congenital anomalies of kidney and urinary tract (CAKUT). The prevalence of dyslipidaemia, hypertension, anaemia overweight/obesity and underweight was 87.5%, 79.3%, 36.0%, 29.9% and 4.3%, respectively. During median follow-up of 3.7 (IQR 1.7-6.8) years 357 patients died. HRs for anaemia were 2.19 (95% CI 1.64-2.93) and 2.55 (95% CI 1.27-5.12) for all-cause and CVD mortality, respectively. The HR for all-cause mortality for underweight was 1.81 (95% CI 1.30-2.53). No other studied CVRFs were statistically significantly associated with all-cause and CVD mortality. In total, 479 patients were included in the SRR analyses of all-cause mortality. The most common PRD was CAKUT and 55.3% of patients were male. During a median follow-up of 18.3 (IQR 8.7-27.0 years) years 126 patients died. Twenty-year survival among patients initiated RRT in childhood was 77.6% (95% CI 73.8-81.3). Age at start of RRT, PRD and type of RRT were significantly associated with all-cause mortality. HR for all-cause mortality for patients who started RRT under 2 years of age was 2.50 (95% CI 1.19-5.25) compared to patients who started RRT at 12 to 18 years old. HR for all-cause mortality for patients with PRD other than CAKUT or glomerulonephritis (GN) was 1.58 (95% CI 1.05-2.39) compared to patients with CAKUT. HRs for all-cause mortality for patients who only received either HD or PD during follow-up were 19.4 (95% CI 10.4-36.4 and 19.5 (9.65-39.7), respectively, compared to patients who received a renal transplant. In total, 381 patients were included in the SRR analyses of CVD incidence. During a median of 12.9 (IQR 5.6-21.5) years of follow-up after initiation of RRT 134 patients (35.2%) developed CVD. The overall crude CVD incidence was 2.6 (95% CI 2.2-3.0) per 100 person-years. HRs for CVD were 1.69 (95% CI 1.05-2.74) for males compared to females, 1.72 (95% CI 1.02-2.91) for PRD other than CAKUT or GN compared to CAKUT and 8.38 (95% CI 3.31-21.23) and 7.30 (95% CI 2.30-23.16) for patients who only received either HD or PD during follow-up, respectively, compared to patients who received a renal transplant. Conclusions. This thesis has contributed to knowledge about CVRF prevalence, longer-term survival and CVD outcomes in patients who initiated RRT in childhood by identifying high prevalence of CVRFs and that CVD is a common complication. This study did not investigate whether anaemia, hypertension, dyslipidaemia and obesity are associated with a higher risk of developing CVD after start of RRT. Future research is needed to study whether treatment of anaemia, hypertension, dyslipidaemia and controlling body weight will reduce the risk of CVD and mortality in patients who initiated RRT in childhood.
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Byers, Dina Jo. "Predictors of african american women's perceived health status in the context of caring for a relative with end stage renal disease." View the abstract Download the full-text PDF version, 2008. http://etd.utmem.edu/ABSTRACTS/2008-011-Byers-index.html.
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Thesis (Ph.D. )--University of Tennessee Health Science Center, 2008.Title from title page screen (viewed on May 16, 2008 ). Research advisor: Mona N. Wicks, PhD. Document formatted into pages (vii, 87 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 63-73).
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Sonaglio, Etielle Pereira. "Prevalência e fatores associados à constipação intestinal em pacientes em hemodiálise." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2017. http://hdl.handle.net/10183/174722.
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Alterações gastrointestinais em pacientes com doença renal crônica são queixas comuns, sendo a constipação considerada um dos sintomas mais prevalentes. O tratamento deste sintoma é limitado nesta população, devido às modificações dietéticas impostas pela perda da função renal e métodos dialíticos, especialmente na hemodiálise. Dados locais sobre a prevalência e fatores associados à constipação são pouco conhecidos em nosso meio. Neste estudo transversal, foram incluídos 57 participantes que realizam hemodiálise há pelo menos 3 meses no Hospital Moinhos de Vento em Porto Alegre, Brasil. Um questionário foi utilizado para avaliar dados sociodemográficos e clínicos potencialmente associados à constipação, a qual foi definida utilizando os critérios de ROMA III. Foi diagnosticada constipação em 28 pacientes nesta amostra (49,1%). Do total da amostra, 34 indivíduos (59,6%) relataram estar utilizando ou já terem utilizado laxantes em algum momento. Entre os constipados, 23 (82%) relataram esse uso. Outros 11 indivíduos usam laxativos cronicamente, ainda que não tenham sido classificados como constipados pelos critérios de ROMA III. Considerando a autopercepção, relataram “dificuldade para evacuar” 21/57 (36,8%). A concordância entre a autopercepção de “dificuldade para evacuar” e constipação pelos critérios de ROMA III ocorreu em 34 (59,6%) dos indivíduos. Entre os 28 pacientes constipados, 17 (77,3%) referem que sintomas gastrointestinais interferem no seu bem-estar, enquanto que entre os 29 pacientes não constipados, somente 5 (22,7%) referem esta interferência (p = 0,01) Quando investigado os fatores potencialmente associados à constipação,a inatividade física (Razão de prevalência 53,4; Teste exato de Fisher p = 0,052) e o sexo feminino (Razão de Prevalência 1,6; Pearson X2 p = 0,07) apresentaram tendênciaà associação significativa. No entanto, não foi encontrada associação significativa entre constipação e escolaridade, faixa etária, utilização de carbonato de cálcio, presença de 8 diabetes, estado nutricional e consumo de fibras atual. Conclusões: A constipação intestinal é um sintoma frequente em pacientes em hemodiálise no nosso meio. A utilização dos critérios de ROMA III para o diagnóstico de constipação permite diagnosticar um maior número de casos quando comparado apenas à autopercepção. A maior parte dos pacientes da amostra faz ou já fez uso crônico de laxantes, ainda que boa parte destes não se considere constipado, ou seja, classificados como constipados pelos critérios de ROMA III. Considerando-se a alta prevalência e interferência no bem-estar, a abordagem sobre a presença de constipação deve ser rotineira nessa população, a fim de alcançar-se um diagnóstico e manejo corretos.Seventeen (77.3%) of the 28 constipated patients reported that their gastrointestinal symptoms interfered with their wellbeing, whereas just 5 (22.7%) of the 29 patients without constipation reported the same interference (p = 0.01). Investigation of factors potentially associated with constipation detected that inactivity (Prevalence ratio 53.4; Fisher’s exact test p = 0.052) and female sex (Prevalence ratio 1.6; PearsonX2 p = 0.07) exhibited tendencies towards a significant association. However, there were no significant associations between constipation and educational level, age group, use of calcium carbonate, presence of diabetes, nutritional status, or current fiber consumption. 10 Conclusions: Constipation is a common symptom among patients on hemodialysis in our country. Use of the ROMA III criteria diagnoses a higher number of cases of constipation than patients’ own perception alone. The majority of patients in the sample have used or were still using laxatives chronically, even though a considerable proportion of these patients were not considered constipated,they were not classified as constipated according to the ROMA III criteria. Considering its high prevalence and its impact on wellbeing, whether patients have constipation should be routinely investigated in this population, to enable correct diagnosis and management.
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PEREIRA, Juliana de Abreu. "Efeito da lactulose sobre os par?metros cl?nicos e bioqu?micos s?ricos de c?es azot?micos e n?o azot?micos." Universidade Federal Rural do Rio de Janeiro, 2012. https://tede.ufrrj.br/jspui/handle/jspui/1727.
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The Chronic Renal Failure (CRF) is characterized by a growing inability of the kidneys to maintain internal homeostasis. The affected animals show major changes as the increase in serum urea, creatinine and phosphorus. Currently, there is no specific treatment for nephropathic. Lactulose, a disaccharide formed by the reaction between fructose and galactose sacarol?ticas is assimilated by bacteria of the intestinal tract and these diminished competition by the population of urease-producing bacteria, limiting the production and absorption of ammonia and urea with consequent reduction in portal blood. Aiming to evaluate the effects of lactulose as adjuvant treatment of dogs with CRF were evaluated parameters indicative of liver function (enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) and renal (urea and creatinine) besides glucose and serum levels of Ca and P in dogs azot?micos not under normal handling and feeding, or not treated with lactulose orally for a period of 30 days, and serum urea and creatinine in dogs with CRF under different protocols therapeutic. feces showed normal color and odor, but diarrhea in animals treated with lactulose. animals as normal renal function, or not treated with lactulose showed no significant changes in blood glucose, serum activities of the enzymes ALT, AST and ALP, and values of urea and creatinine. animals treated with lactulose the phosphorus decreased progressively with a significant difference on days 21 and 30. biochemical analyzes for urea and creatinine nephropathic animals under different treatment protocols showed a reduction of these metabolites in animals of all groups , emphasizing the reduction of uremia and the effect of cetoan?logos and use of prebiotic lactulose in nephropathic dogs.
A Insufici?ncia Renal Cr?nica (IRC) ? caracterizada por uma crescente incapacidade dos rins em manter a homeostasia interna. Os animais acometidos apresentam como principais altera??es o aumento dos n?veis s?ricos de ur?ia, creatinina e f?sforo. Atualmente, n?o existe um tratamento espec?fico para nefropatas. A lactulose, um dissacar?deo formado pela rea??o entre frutose e galactose ? assimilado por bact?rias sacarol?ticas do trato intestinal e estas diminuem por competi??o a popula??o de bact?rias produtoras de urease, limitando a produ??o e absor??o de ur?ia e am?nia com consequente redu??o no sangue portal. Com os objetivos de avaliar os efeitos da lactulose como coadjuvante do tratamento de c?es com IRC foram avaliados os par?metros indicativos da fun??o hep?tica (enzimas alaninoaminotransferase (ALT), aspartatoaminotransferase (AST) e fosfatase alcalina (FA) e renal (ur?ia e creatinina), al?m da glicemia e n?veis s?ricos de Ca e P em c?es n?o azot?micos sob manejo e alimenta??o normais, tratados ou n?o com lactulose por via oral, por um per?odo de 30 dias e os n?veis s?ricos de ur?ia e creatinina de c?es com IRC sob diferentes protocolos terap?uticos. As fezes apresentaram cor e odor normais, por?m diarr?icas nos animais tratados com lactulose. Os animais normais quanto ? fun??o renal, tratados ou n?o com lactulose n?o apresentaram altera??es significativas na glicemia, atividades s?ricas das enzimas ALT, AST e FA; e nos valores de ur?ia e creatinina. Para os animais tratados com lactulose a fosfatemia sofreu redu??o progressiva com diferen?a significativa nos dias 21 e 30. An?lises bioqu?micas para ur?ia e creatinina dos animais nefropatas sob diferentes protocolos de tratamento indicou redu??o desses metab?litos em animais de todos os grupos, destacando-se a redu??o da uremia e o efeito ben?fico dos cetoan?logos e do uso do pr?-bi?tico lactulose em c?es nefropatas.
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Brissos, Maria Elisa Elias. "A gestão da doença crónica: o caso particular da insuficiência renal crónica na região Alentejo." Master's thesis, Universidade de Évora, 2007. http://hdl.handle.net/10174/17291.
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O objetivo da presente pesquisa é a avaliação do estado atual das práticas organizacionais relacionadas com a prestação de cuidados de saúde aos doentes com Insuficiência Renal Crónica. A metodologia da pesquisa foi baseada num estudo retrospetivo por questionário que investiga hospitais e centros de saúde que integram a rede de cuidados de saúde do Serviço Nacional de Saúde (SNS) da Região Alentejo e que abordam a doença crónica objeto desta investigação. Recorrendo a um modelo de análise baseado no Modelo de Cuidados Crónicos (MCC) (cf. Guerra, 2002), incorporando nele os princípios teóricos da Gestão da Doença, foi feita uma avaliação pluridimensional de dados relacionados com as categorias essenciais do continuum de cuidados crónicos que incidem sobre a estrutura e o processo subjacentes às práticas de cuidados de saúde. Este modelo, constitui o quadro de referência conceptual que orienta a investigação e evidência as seis áreas essenciais da intervenção e avaliação do continuum de cuidados crónicos preconizados neste modelo: Organização dos cuidados de saúde, Ligações aos recursos da comunidade, Suporte à Auto-Gestão, Desenho do Sistema de Prestação, Suporte à decisão, Sistemas de Informação (Bonomi et al., 2000). Baseado nestas referências teóricas, sem negligenciar a vivência no âmbito da minha atividade profissional, colocou-se como hipótese que “Os diferentes grupos profissionais (médicos e enfermeiros) tem perspetivas semelhantes sobre a gestão da doença crónica no caso particular da Insuficiência Renal Crónica”. Recorrendo à análise quantitativa dos dados, com técnicas estatísticas descritiva e inferencial para a análise dos mesmos, entre os quais testes paramétricos para a análise das diferenças de médias respeitantes às seis categorias do questionário, tendo em conta o grupo profissional e as sub-regiões incluídas no estudo. Em face dos resultados alcançados conclui-se a inexistência da GD, tornando-se necessária e urgente a revisão do atual modelo de cuidados, já que o estudo demonstrou que o mesmo é inadequado para responder às necessidades do IRC. /ABSTRACT - The purpose of this research is to evaluate the current state of organizational practises related with health care to patients with Chronic Kidney Failure. The research methodology was based on a retrospective survey by questionnaire that analyses hospitals and health centers included in the health care network of the Alentejo region SNS (National Health Service), which approach the chronic disease under present research. Taking a model of analysis based on the Chronic Care Model (MCC) (cf. Guerra, 2002), merging the theoretical principles of Disease Guidance, a multidimensional evaluation has been made for data related with the essential categories of the chronic care continuum, which influence the structure and process underlying health care practices. Such model establishes the conceptual reference view that guides the research and demonstrates the 6 essential areas of interference and evaluation of the chronic care continuum preconized in this model: Health Care organization, Connection to the community resources, Self-Guidance support, Assistance System Design, Support to the decision, Information Systems (Bonomi et al., 2000). Based on these theoretical references and on the experience of my professional activity, following assumption arose: “The several Professional groups (doctors and nurses) have similar views over the chronic disease guidance in the particular case of Chronic Kidney Failure”. Taking the descriptive method with quantitive data analysis, descriptive and inferential statistics methods have been used for the same analysis, as well as parametric tests for analysis of the differences of averages regarding the 6 categories in the questionnaire, considering the professional group and sub-regions included in the survey. Facing respective results, ones conclude the inexistence of GD (Disease Guidance) and the urgent need to review the current care model, as the survey demonstrated such model does not comply with the IRC (Chronic Kidney Failure Patients) needs.
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Galil, Arise Garcia de Siqueira. "Prevalência de anemia e doença renal crônica em portadores de insuficiência cardíaca sistólica num ambulatório de hipertensos e diabéticos." Universidade Federal de Juiz de Fora (UFJF), 2008. https://repositorio.ufjf.br/jspui/handle/ufjf/2837.
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Introdução: A insuficiência cardíaca (IC) tem alta morbimortalidade que decorre de fatores causais e refratariedade ao tratamento. A doença renal crônica (DRC) e a anemia têm se associado a pior prognóstico em pacientes com IC grave, especialmente os hospitalizados. Há, porém, poucos estudos que avaliem a prevalência e as conseqüências da DRC e da anemia em pacientes com IC acompanhados ambulatorialmente. Objetivos: Avaliar a prevalência da DRC e anemia e o impacto de desfechos cardiovasculares em portadores de IC sistólica estágios B e C. Pacientes e Métodos: Foram estudados pacientes adultos, com idade >18 anos e diagnóstico de IC sistólica e com fração de ejeção (EF) ≤45%, selecionados do ambulatório do Serviço de Hipertensão, Diabetes e Obesidade do SUS de Juiz de Fora e acompanhados por 12 meses. A anemia foi definida como hemoglobina <12,0g/dl nas mulheres e <13,0g/dl nos homens. A reserva de ferro foi considerada adequada quando índice de saturação da transferrina encontrava-se ≥20% e a ferritina ≥100ηg/dl. A filtração glomerular foi estimada pela fórmula do estudo MDRD e a DRC foi definida como proposto pelo K/DOQI da National Kidney Foundation americana. Considerou-se com desfechos cardiovasculares (CV) a ocorrência de hospitalização e/ou morte decorrente da IC. Os dados demográficos, de exame físico e laboratorial foram obtidos do prontuário dos pacientes. Resultados: Foram avaliados 83 pacientes, com idade média de 62,7±12 anos, sendo 56,6% do sexo feminino. A média da fração de ejeção (FE) foi de 37,8+7,9% e a maioria dos indivíduos (60,2%) estava no estágio C. A prevalência de anemia foi de 24,09%; 30,30% no estágio B e 20% no estágio C. A prevalência de DRC foi elevada, presente em 49,4% da amostra, 42,4% no estágio B da IC e 54% no estágio C. Todos os pacientes com anemia tinham reserva de ferro normal e 68,6% apresentavam DRC concomitante. Os desfechos CV ocorreram em 26,5% da amostra. Na estratificação dos pacientes nos estágios B e C da IC e presença ou não de DRC, evidenciou que 100% e 64,7% apresentaram desfechos, respectivamente. Na análise multivariada, após ajustes para fatores prognósticos no período basal, o diagnóstico de DRC aumentou em 3,6 vezes a possibilidade de desfechos (IC 95%1,04-12,67, p=0,04), enquanto os níveis mais elevados de sódio sérico (R 0,807, IC95%0,862-0,992, p=0,03) e da fração de ejeção (R 0,925, IC95% 0,862-0,942, p= 0,03) se mostraram protetores. Conclusão: Na coorte de pacientes estudada, composta de pacientes com IC estágios B e C, a ocorrência de anemia foi compatível com a observada em outros estudos e com tendência de se associar com menor filtração glomerular. A DRC foi prevalente e independentemente se associou a maior risco de hospitalizações e mortes secundárias à descompensação cardíaca, especialmente nos pacientes assintomáticos.
Introduction: Chronic heart failure (CHF) has a high morbidity and mortality which are consequent to etiologic factors and no response to treatment. Anemia and chronic kidney disease (CKD) have been associated to worse outcome in patients with severe hospitalized CHF. So far, there is few studies that assessed the prevalence and the consequences of anemia and CKD in outpatients with CHF. Aim: To study the prevalence of CKD and anemia and the impact of CV end points in patients with systolic CHF followed in an outpatient clinic. Methods: This is prospective cohort study, dealing with adult patients older than 18 years of age and diagnosis of systolic CHF and ejection fraction (EF) ≤45%, selected from the Hypertension, Diabetes and Obesity Outpatient Clinic of SUS of Juiz de Fora. Anemia was defined as hemoglobin <12,0g/dL in women and <13g/dL in men and women after the menopause. Normal iron store was defined when transferring saturation index was >20% and/or ferritin >100ηg/dL. The glomerular filtration rate was estimated from serum creatinine usinf the MDRD study formula, and CKD was defined as suggested by the K/DOQI of National Kidney Foundation. CV endpoints were defined as death or hospitalization due to CHF, in 12 months follow up. Demographic and clinical date were obtained from the patients’ charts. Results: Eight three patients were studied, the mean age was 62.7±12 years, and 56.6% were female. The EF was 37,8+7,9%, and the majority of the patients had stage C CHF (60,2%). The prevalence of anemia was 24,1%; 30,3% in stage B and 50% in stage C. CKD was diagnosed in 49.4% of the patients, 42,4% of the stage B and 54% in the stage C. All patients with anemia had normal iron storage, and 68,6% had concomitant CKD. Cardiovascular endpoints were observed in 26.5% of the patients. When the sample was stratified in stages B and C of CHF and presence or absence of CKD, it was found that 100% and 64.7% had CV endpoints, respectively. After adjustments for all other prognostic factors at baseline, it was observed that the diagnosis of CKD increased in 3.6 folds the hazard of CV endpoints (CI 95% 1,04-12,67, p=0,04), whereas higher ejection fraction (R 0,925, IC 95% 0,862-0,942, p= 0,03) and serum sodium (R 0,807, IC 95% 0,862-0,992, p=0,03) were protectors. Conclusion: In this cohort of outpatients with CHF stages B and C, the occurrence of anemia was low and frequently associated with concomitant CKD. On the other hand, CKD was prevalent and independently associated with heightened risk for hospitalization and death secondary of cardiovascular causes, mainly in asymptomatic patients.
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Hagren, Birger. "Att leva med hemodialysbehandling." Licentiate thesis, Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-173-3/.
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Moreira, Arthur Navajas. "Efeito da movimentação ativa tíbio-társica na remoção da uréia em pacientes renais crônicos durante a hemodiálise." Pós-Graduação em Educação Física, 2014. https://ri.ufs.br/handle/riufs/4961.
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The shank active movement be able to cause an increase in venous return contribute to the improvement of the treatment of hemodialysis, increasing peripheral circulation and therefore increases the removal of toxins from the blood. The aim of this study was to evaluate the effect of shank active movement on the index of urea clearance ( Kt / V ) and the percentage removal of urea ( PRU ) , and check the effect on blood pressure and heart rate in renal patients during chronic hemodialysis. The sample comprised 44 patients, aged between 23 and 72 years and mean height of 167 ± 11 cm and body mass 66.7 ± 14.4 kg, divided into two groups: a control group and an exercise group. The shank active movement was performed in the sitting position and the patient performing movements of dorsiflexion and plantar flexion. The drive was carried out using an adjustable wooden support so that the patient would remain in correct and comfortable position to perform the exercise. The exercise protocol was four sets of 15 repetitions, following an increase of 5 repetitions per month until complete four sets of 30 repetitions, in intervals of 60 seconds between sets . The results of the comparison groups had no significant difference in Kt / V did not alter the PRU with the shank active movement , however had high blood pressure compared with controls ( p < 0.001 ) and heart rate ( p < 0.05). It is concluded that the active protocol - shank movement was not effective to improve the Kt / V and the PRUA movimentação ativa tíbio-társica pode favorecer um aumento do retorno venoso, contribuindo para a melhora do tratamento da hemodiálise, incrementando a circulação periférica e, consequentemente, aumentando a remoção de toxinas do sangue. O objetivo deste estudo foi avaliar o efeito da movimentação ativa tíbio-társica sobre o índice de depuração de ureia (Kt/V) e o percentual de remoção de ureia (PRU), além de verificar o efeito disso na pressão arterial e frequência cardíaca de pacientes renais crônicos durante a hemodiálise. A amostra foi composta por 44 pacientes, com idades entre 23 e 72 anos e estatura média de 167 ± 11 cm e massa corporal de 66,7 ± 14,4 Kg, divididos em dois grupos: um grupo controle e o um grupo exercício. A movimentação ativa tíbio-társica foi realizada na posição sentada com o paciente realizando movimentos de dorsiflexão e flexão plantar. A movimentação foi realizada utilizando um suporte de madeira ajustável de forma que o paciente ficasse em posição correta e confortável para a realização do exercício. O protocolo de exercício foi de quatro séries de quinze repetições, seguindo uma progressão de cinco repetições por mês até que completássemos as quatro séries de trinta repetições, com intervalos de 60 segundos entre as séries. Os resultados encontrados, quando comparados os dos grupos, não apresentaram diferença significativa no Kt/V como também não se alterou o PRU com a movimentação ativa tíbio-társica; no entanto, apresentou-se elevação da pressão arterial comparado ao controle (p<0,001) e da frequência cardíaca (p<0,05). Conclui-se que o protocolo de movimentação ativa tíbio-társica não foi eficiente para melhorar o Kt/V e o PRU.
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Betonico, Carolina de Castro Rocha. "Efeito da insulina glargina sobre o controle glicêmico e risco de hipoglicemia em pacientes portadores de diabetes mellitus tipo 2 e doença renal crônica estágios 3 e 4: ensaio clínico, controlado e randomizado." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5135/tde-05042017-153224/.
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Diabetes mellitus (DM) é uma das principais causas de doença renal crônica terminal. Na doença renal diabética (DRD) observa-se um curso bifásico no padrão glicêmico, na fase inicial o aumento da resistência insulínica induz a hiperglicemia e, com perda progressiva da taxa de filtração glomerular, há redução na depuração dos medicamentos anti-hiperglicemiantes e insulina, aumentando o risco de hipoglicemias. Portanto, diante da perda da função renal, a reavaliação da terapia hipoglicemiante e ajustes constantes nas doses de insulina são necessários, com intuito de otimizar o controle glicêmico e minimizar seus efeitos colaterais. A revisão da literatura mostra diversos pontos sem resposta, principalmente relacionados à dose, ajuste da terapia insulínica, seguimento e monitoração do controle glicêmico em portadores de DM e DRC. O objetivo deste ensaio randomizado, cruzado, controlado foi comparar o controle glicêmico do tratamento com insulina glargina à insulina NPH em portadores de DM2 e DRD estágios 3 e 4. Pacientes e métodos: Trinta e quatro pacientes foram randomizados para receber insulina glargina uma vez ao dia ou insulina NPH em três aplicações diárias. Insulina lispro foi prescrita três vezes ao dia, em aplicações pré-prandiais nos dois grupos. Após 24 semanas de terapia, os pacientes tiveram seu esquema de insulina trocado para terapia insulínica oposta. Testes laboratoriais foram realizados após 12, 24, 36 e 48 semanas de estudo. O sistema de monitorização continua de glicose (CGMS) foi instalado ao término de cada terapia. Resultados: Dos 34 pacientes incluídos, 29 completaram as 48 semanas propostas no estudo, 2 pacientes perderam seguimento por má adesão e 3 pacientes não completaram o estudo em decorrência a eventos adversos (1 óbito, 1 ingresso em hemodiálise e 1 evento cardiovascular, todos em uso de insulina NPH). Após 24 semanas de tratamento com insulina glargina houve uma redução estatisticamente significante da média da HbA1c de 8,86 ± 1,4% para 7,95 ± 1,1% (p=0,0285), esta diferença não foi observada com a insulina NPH (8,21 ± 1,29% para 8,44 ± 1,32%). Durante o uso de insulina glargina o número de eventos noturnos de hipoglicemia foi menor comparado a insulina NPH (p=0,046); além disso, hipoglicemia grave ocorreu apenas na terapêutica com NPH. Conclusão: O tratamento com insulina glargina foi associado a melhor controle glicêmico e a redução do risco de hipoglicemia noturna quando comparada à insulina NPH,em pacientes portadores de DM e DRC estágios 3 e 4Diabetes mellitus is the leading cause of chronic kidney disease (CKD). Kidney disease diagnosis and its progression require re-evaluation of hypoglycemic therapy and constant dosing adjustments, to optimize glycemic control and minimize its side effects. Long acting insulin analogs and its pharmacokinetics have not been studied in different stages of kidney disease, nor is there consensus defining appropriate dose adjustment in patients with type 2 diabetes (T2DM) and CKD. The aim of this randomized, cross-over, open-label controlled clinical trial is to compare the glycemic response to intensive insulin treatment with NPH insulin or insulin glargine in T2DM patients and CKD stages 3 and 4. The primary efficacy end point was change in A1C from baseline. Thirty-four patients were randomized to receive insulin glargine once a day or NPH insulin, three times a day. Insulin lispro was prescribed as prandial insulin to both groups. After six months, patients switched to the other insulin therapy group. Laboratory tests were performed at baseline at 12, 24, 36 and 48 weeks. A continuous glucose monitoring system was implemented after 24 weeks and at the end of protocol. Results: Total of 29 subjects have completed the two branches of study, 2 patients dropped out due to low compliance and other 3 patients as a result of adverse events (1 death, 1 ingress on dialysis program, 1 cardiovascular event; all of them were on NPH therapy). After 24 weeks, average of A1c decreased on glargine group compared to baseline 8,86 ± 1,4% to 7,95 ± 1,1% (p=0,0285), but this difference was not observed on NPH group. There were no differences of insulin doses between both groups. Glargine group showed a tendency of lower risk of nocturnal hypoglycemia compared to NPH group (p=0,046). Conclusion: Insulin glargine improved glycemic control by reducing HbA1c without gain weight and with reduced tendency toward nocturnal hypoglycemic events compared with NPH insulin
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Pinho, Natália Alencar de. "Fatores associados à doença renal crônica em pacientes internados em um hospital universitário na cidade de São Paulo." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-19092013-154219/.
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Introdução: a doença renal crônica constitui importante problema de saúde pública mundial. Contudo, pouco se sabe sobre suas características em nosso meio. Objetivo: identificar os fatores associados à doença renal crônica em pacientes internados em um hospital universitário. Método: foram selecionados, aleatoriamente, 386 pacientes que constituíram dois grupos: com e sem doença renal crônica. A doença renal crônica foi definida pela presença de diagnóstico médico ou antecedente pessoal. Os dados foram obtidos do prontuário do paciente. Foram comparados os grupos com e sem doença renal crônica e os hipertensos com e sem doença renal crônica, mediante as variáveis de estudo. Estimou-se a taxa de filtração glomerular (eTFG) dos pacientes sem doença renal a partir das equações Modification of Diet in Renal Disease abreviada (MDRD4) e Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Verificou-se a associação da eTFG <90 mL/min/1,73m², pela MDRD4, com dados biossociais e comorbidades. O nível de significância foi de p<0,05. Resultados: a amostra foi 50,5% homens, 64,4% brancos, 50,7% com companheiro e idade de 58,2±18,6 anos. Os pacientes com doença renal crônica se distinguiram daqueles sem a doença (p<0,05) em relação a: viverem com companheiro (59,8% vs 47,3%); idade mais elevada (65,8±15,6 vs 55,3±18,9 anos); menor frequência de fumantes (11,1% vs 29,7%); terem antecedente pessoal de hipertensão arterial (75,2% vs 46,3%), diabetes (49,5% vs 22,4%), dislipidemia (23,8% vs 14,9%), infarto agudo do miocárdio (14,3% vs 6,0%) e insuficiência cardíaca congestiva (18,1% vs 4,3%); evolução a óbito (12,4% vs 1,4%); e maior tempo de internação (11 (818) vs 9 (612) dias); além dos exames laboratoriais, exceto glicemia e perfil lipídico. A análise de regressão logística indicou associação independente da doença renal crônica com as seguintes variáveis (OR, odds ratio; IC, intervalo de confiança de 95%): idade (OR 1,019, IC 1,003-1,036); hipertensão arterial (OR 2,032, IC 1,128-3,660), diabetes (OR 2,097, IC 1,232-3,570) e insuficiência cardíaca congestiva (OR 2,665, IC 1,173-6,056). Os hipertensos com e sem doença renal crônica foram distintos (p<0,05) em relação a: possuíam companheiro (64,3% vs 50,7%); uso de maior número de medicamentos (4,0 (2,05,0) vs 2,0 (0,5 4,0)), não fumantes (9,9% vs 25%); terem antecedentes pessoais para diabetes (53,5% vs 36,4%) e insuficiência cardíaca congestiva (19,8% vs 7,0%); uso de medicamentos anti-hipertensivos (79,1% vs 66,4%,); tratamento com insulina (24,4% vs 7,0%); além dos exames laboratoriais, exceto glicemia, perfil lipídico e ácido úrico. Houve boa concordância da classificação da eTFG de pacientes sem doença renal crônica pelas equações MDRD4 e CKD-EPI (kappa 0,854). De acordo com a equação MDRD4, 54,4% tinham eTFG 90 mL/min/1,73m²; 37,7%, eTFG 60-89 mL/min/1,73m²; e 7,8%, eTFG <60 mL/min/1,73m². Pacientes com eTFG <90 mL/min/1,73m² se destacaram (p<0,05) por apresentar maior frequência de hipertensão arterial (63,3% vs 32,0%), diabetes (29,7% vs 16,3%) e dislipidemia (24,2% vs 7,2%) em relação a pacientes com eTFG 90 mL/min/1,73m². Conclusão: a doença renal crônica esteve associada a fatores de risco cardiovascular, em sua maioria, modificáveis.Introduction: chronic kidney disease is an important public health problem worldwide. Nevertheless, little is known about its features in our setting. Objective: identify factors associated with chronic kidney disease among hospitalized patients in a university hospital. Method: 386 patients were randomly selected and divided in two groups: with and without chronic kidney disease. Chronic kidney disease was defined by the presence of medical diagnosis or personal history. Data was acquired from medical records. Patients with and without chronic kidney disease, as well as hypertensive patients with and without chronic kidney disease, were compared with regard to the variables under study. Glomerular filtration rate (eGFR) of patients without chronic kidney disease was estimated using abbreviated Modification of Diet in Renal Disease (MDRD4) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. The association between eTFG <90/mL/min/1,73m² and biosocial data and comorbidities was assessed. Significance level was p<0,05. Results: the study sample was 50,5% male, 64,4% white, 50,7% living with partner, and 58,2±18,6 years-old. Patients with chronic kidney disease differed (p<0,05) from patients without, regarding to: living with partner (59,8% vs 47,3%); older age (65,8±15,6 vs 55,3±18,9 years-old); no smokers (11,1% vs 29,7%); personal history of hypertension (75,2% vs 46,3%), diabetes (49,5% vs 22,4%), dyslipidemia (23,8% vs 14,9%), acute myocardial infarction (14,3% vs 6,0%) and congestive heart failure (18,1% vs 4,3%); occurrence of death (12,4% vs 1,4%); and length of hospitalization (11 (818) vs 9 (612) days), as well as laboratory tests, excepted blood glucose level and lipidemic profile. Logistic regression indicated independent association of chronic kidney disease for the following variables (OR, odds ratio; CI, confidence interval at 95%): age (OR 1,019, CI 1,003-1,036); hypertension (OR 2,032, CI 1,128-3,660), diabetes (OR 2,097, CI 1,232-3,570) and congestive heart failure (OR 2,665, CI 1,173-6,056). Hypertensive patients with and without chronic kidney disease were different (p<0,05) regarding to: living with partner (64,3% vs 50,7%); greater number of continuous-use medication (4,0 (2,05,0) vs 2,0 (0,5 4,0)); no smokers (9,9% vs 25%); personal history of diabetes (53,5% vs 36,4%) and congestive heart failure (19,8% vs 7,0%); use of antihypertensive drugs (79,1% vs 66,4%); insulin therapy (24,4% vs 7,0%); as well as laboratory tests, excepted blood glucose level, lipidemic profile and uric acid. Relevant agreement was shown between eGRF classification by MDRD4 and CKD-EPI equations for patients without kidney disease (kappa 0,854). According to MDRD4 equation, 54,4% had eGRF 90 mL/min/1,73m²; 37,7%, eGFR 60-89 mL/min/1,73m²; and 7,8%, eGFR <60 mL/min/1,73m². Patients with eGFR <90 mL/min/1,73m² stood out (p<0,05) from those with eGFR 90 mL/min/1,73m² as presenting higher frequencies of hypertension (63,3% vs 32,0%), diabetes (29,7% vs 16,3%) and dyslipidemia (24,2% vs 7,2%). Conclusion: chronic kidney disease showed association with cardiovascular risk factors, most of which modifiable.
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Melin, Jan. "Renal Ischemia/Reperfusion Injury in Diabetes : Experimental Studies in the Rat." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5264-7/.
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Costa, Márcio Rodrigues. "Fatores associados à disfunção erétil em pacientes portadores de doença renal crônica em tratamento conservador." Universidade Federal de Goiás, 2016. http://repositorio.bc.ufg.br/tede/handle/tede/6277.
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Objective: The objective of this study was to determine the prevalence, severity, factors associated and that influence erectile function in patients with chronic kidney disease on conservative treatment. Methods: This transversal study was developed between May 2013 and December 2015. Male volunteer patients, heterosexual, 18 years of age or older, carriers of chronic renal disease on conservative treatment participated of this study. The patients had follow up in the specific ambulatories of chronic renal disease in two hospitals of Goiânia. The erectile dysfunction of the patients was assessed using the six erectile function domain questions (questions numbers 1 to 5 and 15) of the International Index of Erectile Dysfunction. While the questions of the International Index of Erectile Dysfunction were applied, the researchers reviewed medical records and filled search forms containing lifestyle habits, clinical, laboratory and sociodemographic data. The factors associated with erectile dysfunction in patients with chronic renal disease in conservative treatment were determined by univariate and multivariate logistic regression analysis. The prevalence and degree of erectile dysfunction among patients with chronic renal disease in conservative treatment in stage III versus IV/V were compared with the application of chi-square test. The correlation between glomerular filtration rate and International Index of Erectile Dysfunction score was estimated by Pearson correlation coefficient. Results: Among 245 patients with chronic renal disease on conservative treatment in the study, 71.02% had erectile dysfunction and the sexual disorder was severe in 36.73%. Individual analysis of the variables in these patients, without excluding the influence of one over the other, pointed erectile dysfunction associated with the age more than 50 years, body mass index less than 25, diabetes mellitus, stage IV/V of chronic kidney disease, cardiac arrhythmias and conduction disorders, benign prostatic hyperplasia, present or prior cigarette use, cigarette use for 10 years or more, pack-year cigarette index greater or equal to 20, alcohol usage time equal to or greater than 10 years, albumin less than 3.5 g /100 mL and creatinine clearance levels between 15 and 29 mL/min/1.73 m2. The conjunct analysis of the variables studied in this same group of patients has showed an independent association of erectile dysfunction with diabetes mellitus (P = 0.015). A comparison of patients with chronic renal disease on conservative treatment stage III versus IV/V has demonstrated a higher prevalence of erectile dysfunction in more advanced stages of chronic renal disease (P = 0.001) and similar frequency of severe, moderate, moderate to mild and mild erectile dysfunctions. Glomerular filtration rate has showed a positive correlation with the score of the International Index of Erectile Dysfunction. Conclusions: The prevalence of erectile dysfunction in patients with chronic renal disease in conservative treatment is high. Many factors are associated with erectile dysfunction in chronic renal disease population on conservative treatment. The only factor associated with erectile dysfunction that is not subject to influence from other agents is diabetes mellitus. The prevalence of erectile dysfunction increases with the progression of chronic renal disease on conservative treatment.
Objetivo: O objetivo deste estudo foi determinar a prevalência, gravidade e os fatores associados e influenciadores na função erétil de pacientes portadores de doença renal crônica em tratamento conservador. Material e métodos: Este estudo transversal desenvolveu-se entre maio de 2013 a dezembro de 2015. Participaram do estudo pacientes masculinos, voluntários, heterossexuais, com 18 anos de idade ou mais, portadores de doença renal crônica em tratamento conservador. Os pacientes tinham seguimento em ambulatórios específicos de doença renal crônica de dois hospitais em Goiânia. A disfunção erétil dos pacientes foi avaliada com as seis perguntas do domínio de função erétil (questões números 1 a 5 e 15) do International Index of Erectile Dysfunction. Enquanto as questões do IIEF eram aplicadas, os pesquisadores revisavam prontuários e preenchiam os formulários de pesquisa, que continham hábitos de vida, dados clínicos, laboratoriais e sociodemográficos. Os fatores associados à disfunção erétil nos portadores de doença renal crônica em tratamento conservador foram determinados por análise de regressão logística uni e multivariada. Compararam-se a prevalência e o grau de disfunção erétil entre pacientes com doença renal crônica em tratamento conservador em estágios III versus IV/V, com a aplicação do teste qui-quadrado. A correlação da taxa de filtração glomerular com o IIEF foi estimada pelo coeficiente de correlação de Pearson. Resultados: Dentre os 245 pacientes com doença renal crônica em tratamento conservador que participaram do estudo, 71,02% tinham disfunção erétil e, em 36,73%, o distúrbio sexual era grave. A análise individual das variáveis estudadas nestes pacientes, sem excluir a influência de uma sobre a outra, apontou associação de disfunção erétil com idade superior a 50 anos, índice de massa corpórea inferior a 25, diabetes mellitus, estágios IV/V de doença renal crônica, arritmias cardíacas e distúrbios de condução, hiperplasia prostática benigna, uso atual ou prévio de cigarro, uso de cigarro por 10 anos ou mais, índice maço-ano de cigarro maior ou igual a 20, tempo do uso de álcool igual ou superior a 10 anos, albumina inferior a 3,5 g/100 mL e níveis de depuração da creatinina entre 15 e 29 mL/min/1,73 m2. A análise conjunta das variáveis estudadas nesse mesmo grupo de pacientes apontou associação independente de disfunção erétil com diabetes mellitus (P = 0,015). A comparação entre portadores de doença renal crônica em tratamento conservadores estágios III versus IV/V demonstrou maior prevalência de disfunção erétil nos graus mais avançados de doença renal crônica (P = 0,001) e frequência similar de disfunção erétil grave, moderada, moderada a leve e leve. A taxa de filtração glomerular demonstrou correlação positiva com a pontuação do IIEF. Conclusões: A prevalência de disfunção erétil em portadores de doença renal crônica em tratamento conservador é alta. Muitos fatores associam-se à disfunção erétil na população portadora de doença renal crônica em tratamento conservador. O único fator associado à disfunção erétil que não está sujeito à influência de outros agentes é a diabetes mellitus. A prevalência de disfunção erétil aumenta com a progressão da doença renal crônica em tratamento conservador.
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Facio, Júnior Fernando Nestor. "Efeitos da anexina1 na isquemia e reperfusão renal: estudo funcional e histopatológico em modelo experimental." Faculdade de Medicina de São José do Rio Preto, 2006. http://bdtd.famerp.br/handle/tede/71.
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Previous issue date: 2006-03-14The aim of the present study was to investigate the effects of the use of the anti-inflammatory protein annexin 1 (Anx-A1), which is found in most cells. It is characterized by its ability in binding to calcium and phospholipids, conferring protection against the initial effects of ischemia-reperfusion injury. Right nephrectomy was performed on 48 adult males Wistar rat, with sizes ranging between 250-300 g, maintained on a diet normosodic , normoprotein and with water ad libitum. The animals was divided into 3 groups: Annexin-1/Ischemia (Anx-A1-I/R) (n=16), vehicle (PBS40)-Ischemia (Vehicle-I/R) (n=16) and Sham Group (n=16). The endovenous administration of Anx-A1 was made 30 minutes before ischemia of the left renal artery. The animals of each group were divided and studied at 2 and 7 days post-reperfusion, in respect to the glomerular, tubular and renal structure functions. The results showed that there was a reduction in the glomerular filtration rate (GFR) in the Vehicle-I/R Groups at 2 and 7 days post-reperfusion (0.42 ± 0.02 mL/min-100g and 0.48 ± 0.05 mL/min-100g, respectively). There was a significantly greater filtration rate in the Anx-A1-I/R Groups compared to the Vehicle-I/R Groups (0.86 ± 0.05 mL/min-100g and 0.73 ± 0.04 mL/min-100g, respectively). A significant difference between the Anx-A1-I/R and Sham Groups (p-value < 0.01) was also observed (7days). The fractional sodium excretion (FeNa) was significantly higher in the Vehicle-I/R Groups when compared to the Anx-A1-I/R and Sham Groups on the 2nd and 7th post-perfusion days. On the 2nd day of the study, the fractional sodium excretion was 0.17 ± 0.01% for the Anx-A1-I/R, 0.42 ± 0.03% for the Vehicle-I/R and 0.21 ± 0.01% for the Sham groups (p-value < 0.001). On the 7th day, the values were 0.27 ± 0.03%, 0.52 ± 0.03% and 0.29 ± 0.01%, respectively (p-value < 0.001). The potassium excretion fraction (FeK) on the 2nd and 7th post-perfusion days did not differentiate between the Anx-A1-I/R and Sham Groups, but it was significantly higher in the Vehicle-I/R Groups. The urinary-plasmatic osmolality ratio (U/Posm) showed a significant reduction in the Vehicle-I/R Groups after 2 and 7 days when compared with the Anx-A1-I/R and Sham Groups. A histopathologic evaluation of renal cortex samples, taken on the 2nd and 7th post-perfusion days, revealed a significant increase in the intravascular and transmigrated neutrophils in ischemic areas of the Vehicle-I/R Groups. Additionally, high rates of transmigrated neutrophils were identified in the ischemia-reperfusion areas of samples of renal medulla from the Vehicle-I/R Group taken on the 2nd and 7th days. There was a significant reduction of the neutrophil transmigration in samples of renal medulla on the 2nd and 7th post-perfusion days in the Anx-A1-I/R Groups, as well as a lower intravascular neutrophil rate. On the 2nd and 7th post-perfusion days, the Sham Group presented with structures of distal and proximal convoluted tubules and well-preserved brush-border structures in the renal cortex and medulla samples as seen by light microscopy. Similar results were evidenced in the Anx-A1-I/R Groups with preserved structures in the tubules, basal membrane and glomeruli. In the Vehicle-IR Groups, numerous monocytes, cellular debris inside proximal convoluted tubules, dilated capillaries and alterations in the basal membrane structure were seen. These results suggest that the administration of annexin-1 thirty minutes before renal ischemia in rat , prevents the transmigration of neutrophils and confers protection against the initial effects of ischemia-reperfusion injury, as well as providing protection to the glomerular, tubular and renal structure functions.
O presente estudo objetivou investigar os efeitos do uso da anexina 1 (Anx-A1), considerada proteína antiinflamatória e que está presente na maioria das células. Caracteriza-se pela sua habilidade em ligar-se ao cálcio e fosfolipídeos, conferindo proteção contra os efeitos iniciais da lesão por isquemia e reperfusão. Realizou-se nefrectomia à direita em 48 ratos (Wistar-adultos-machos), pesando entre 250-300 gramas, mantidos com dieta normosódica , normoprotéica e água ad libitum. Os animais foram divididos em 3 grupos: Anexina 1-Isquemia (Anx-A1-I/R) (n=16), Veículo(PBS-40)-Isquemia (Veic-I/R) (n=16) e grupo Sham (n=16). A administração de anexina1 endovenosa foi realizada 30 minutos antes do clampeamento da artéria renal esquerda. Após reperfusão, os animais de cada grupo foram divididos e estudados com 2 e 7 dias, quanto às funções glomerulares , tubulares e à estrutura renal. Os resultados mostraram que houve redução da taxa de filtração glomerular (RFG) nos grupos veículo-I/R com 2 e 7 dias de experimento (0,42 ± 0,02 ml-min-100g e 0,48 ± 0,05 ml-min-100g, respectivamente) e verificamos aumento significativo da taxa de filtração glomerular nos grupos Anx-A1-I/R comparados aos grupos veículo-I/R (0,86 ± 0,05ml-min-100g e 0,73 ± 0,04ml-min-100g, respectivamente). Observou-se diferença significativa entre os grupos Anx-A1-I/R e Sham com 7 dias (p<0,01). A excreção fracional de sódio (FeNa) apresentou-se significantemente aumentada nos grupos veículo-I/R, comparada aos grupos Anx-A1-I/R e Sham nos 2º e 7º dias de experimento; apresentando assim no 2º dia de estudo,Anx-A1-I/R (0,17 ± 0,01%), Veic-I/R (0,42 ± 0,03%) e Sham (0,21 ± 0,01%) (p<0,001); e no 7º dia, Anx-A1-I/R (0,27 ± 0,03%), Veic-I/R (0,52 ± 0,03%) e Sham (0,29 ± 0,01%) (p<0,001). A fração de excreção de potássio (FeK) com 2 e 7 dias de experimento não diferiram entre os grupos Anx-A1-I/R e Sham, mas a FeK aumentou significativamente nos grupos Veic-IR. A razão das osmolalidades urinário-plasmáticas (U/Posm) mostraram uma redução importante nos grupos Veic-I/R em experimentos com 2 e 7 dias, comparados aos grupos Anx-A1-I/R e Sham. A avaliação histopatológica revelou aumento significativo de neutrófilos intravasculares e transmigrados, em áreas isquêmicas dos grupos Veic-I/R, de amostras avaliadas da porção do córtex renal com 2 e 7 dias. Verificaram-se altas taxas de transmigração de neutrófilos nas áreas de isquemia-reperfusão nos grupos Veic-I/R com 2 e 7 dias, em amostras avaliadas de medula renal. Houve significativa redução do extravasamento de neutrófilos em análise quantitativa, nas amostras de medula renal com 2 e 7 dias de estudo, nos grupos anexina 1-I/R, bem como menor taxa de neutrófilos no espaço intravascular. À microscopia de luz, verificou-se que, em amostras de córtex e medula renal, com 2 e 7 dias, o grupo Sham apresentou estruturas dos túbulos contorcidos proximais, distais e borda em escova bem preservados. Notou-se resultados semelhantes nos grupos de anexina1-I/R, com estruturas preservadas nos túbulos, membrana basal e glomérulos. Nos grupos Veic-I/R, verificou-se a presença de debris celulares no interior de túbulos contorcidos proximais, capilares dilatados e alterações na estrutura da membrana basal. Estes resultados sugerem que a administração da anexina1, trinta minutos antes da isquemia renal em ratos, previne a transmigração de neutrófilos e confere proteção contra os efeitos iniciais da lesão por isquemia e reperfusão, bem como proteção das funções glomerulares, tubulares e da estrutura renal.
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Qureshi, Abdul Rashid Tony. "Malnutrition in patients with chronic renal failure /." Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-4458-X/.
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Huang, J. L. "Polycystic kidney disease and the renal circulation." Thesis, University College London (University of London), 2013. http://discovery.ucl.ac.uk/1416827/.
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Polycystic kidney disease (PKD) is the most common inherited cause of kidney failure affecting 1 in 1000 adults and children worldwide. Many studies focus on the disrupted cellular functions within the cyst epithelia but promising therapeutic strategies have not yet translated to clinically approved treatments for human PKD. This thesis takes a different approach and hypothesised that cyst growth requires the support of the underlying renal microvasculature and that targeting vessels could be an alternative therapeutic strategy. The renal vasculature in cystic and wild-type kidneys was first characterised using a mouse model of autosomal recessive PKD (ARPKD). It was found that mRNA levels of markers of blood and lymphatic endothelium were altered in cystic kidneys compared with wild-type. By immunohistochemistry, there was disorganisation of the vasculature with expansion of lymphatic capillaries surrounding the smaller cysts and regression of the microvasculature surrounding the larger cysts. Overall, the peri-cystic microvasculature shifted from a blood to a lymphatic endothelial phenotype. To test the potential of targeting the renal vasculature as a treatment for PKD, vascular endothelial growth factor-C (VEGFC) was administered to mouse models of both ARPKD and autosomal dominant PKD (ADPKD). The treatment significantly reduced disease severity as measured by kidney/body weight ratio by at least 28% in both models. In the model of ADPKD, serum blood urea nitrogen was also significantly reduced by around 35% indicating an improvement in renal function. Measurement of cyst characteristics revealed improvements in percentage cyst area, total number of cysts per kidney and the average cyst size. The treatment also restored normal renal vascular patterning and decreased the number of CD206+ macrophage cells which contribute to cyst growth. This thesis suggests that targeting the renal vasculature could be a therapy for PKD, with the potential to enhance current approaches.
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Ooi, Boon Teik. "Probabilistic modeling of kidney dynamics for renal failure prediction." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/85462.
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Thesis: M. Eng., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2013.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 85-90).
The large quantity of clinical data collected from the Intensive Care Unit (ICU) has made clinical investigation by a data-driven approach more effective. In this thesis, we developed probabilistic models for modeling variable kinetics and temporal dynamics of states. We applied the models to the prediction of acute kidney injury (AKI), but the models are applicable to other medical conditions as well. It is known that serum creatinine follows first-order clearance kinetics. We developed a stochastic kinetic model for first-order clearance and used it to model creatinine kinetics. Some properties implied by the model that are verifiable with the available data are consistent with the empirical results. Those properties are mean-reversion, variation with linear standard deviation, and convergence of variance to a finite value. Based on the stochastic kinetic model, creatinine can be treated as a lognormal random variable with state-dependent parameters. We model the temporal dynamics of kidney states and creatinine using a Hidden Markov Model. Observations of creatinine are assumed to be random variables, with baseline creatinine as mean. Each individual baseline is itself a random variable sampled from a population distribution. Baseline for each patient can be estimated by combining the population distribution and all creatinine observations of the patient using techniques similar to Bayesian inference. Prediction of acute kidney injury with this generative model gives an AUC of 0.8259 and 0.8497 for female and male population respectively.
by Boon Teik Ooi.
M. Eng.
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Wei, Jin. "Acute Kidney Injury and Chronic Kidney Disease." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/6780.
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Ischemia and reperfusion are natural steps during kidney transplantation, and IRI is considered one of the most important nonspecific factors affecting allograft dysfunction. Transplanted organs experience several episodes of ischemia, in which cold ischemia occurs during allograft storage in preservation solutions.
Even though cold ischemia has been studied extensively, all of the studies have been carried out in vitro and ex vivo models. There is no in vivo model available to examine renal IRI induced solely by cold ischemia.
In the present study, we developed an in vivo mouse model to study renal IRI induced exclusively by cold ischemia through clamping the renal pedicle for 1 to 5 hours. During the ischemic phase, blood was flushed from the kidney with cold saline through a small opening on the renal vein. The kidney was kept cold in a kidney cup with circulating cooled saline, while the body temperature was maintained at 37℃ during the experiment. The level of kidney injury was evaluated by plasma creatinine, KIM-1, NAGL, GFR, and histology.
Plasma creatinine was significantly increased from 0.15±0.04 mg/dl in the sham group to 1.14±0.21 and 2.65±0.14 mg/dl in 4 and 5-hours ischemia groups at 24 hours after cold IRI. The plasma creatinine in mice with ischemic time <3 hours demonstrated no significant increase compared with sham mice. Changes in KIM-1, NAGL, GFR and histology were similar to plasma creatinine. 65
In summary, we developed and characterized a novel in vivo IRI-induced AKI mouse model exclusively produced by cold ischemia.
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Landreneau, Kandace Jo Costley Ward-Smith Peggy. "Adult hemodialysis patients' perceptions concerning choice among renal replacement therapies." Diss., UMK access, 2004.
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Thesis (Ph. D.)--School of Nursing. University of Missouri--Kansas City, 2004."A dissertation in nursing." Advisor: Peggy Ward-Smith. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed feb. 27, 2006. Includes bibliographical references (leaves 124-131). Online version of the print edition.
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Jiffri, Essam Hussain. "Altered renal intermediary metabolism and the onset of renal dysfunction in the streptozotocin-diabetic rat." Thesis, University of Aberdeen, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.302295.
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The present studies investigated the relationship between altered renal carbohydrate intermediary metabolism and kidney functional and structural changes in the adult Spraque-Dawley rat. Both the acute (upto 28 days) and chronic (60-120 days) diabetic states were invstigated. The single intraperitoneal injection of streptozotocin at a dose of 45mg/kg body weight produced a stable, non-ketotic, non-insulin dependent and reproducible diabetic state. Compared to age matched control animals (AMC), diabetic animals (DA) demonstrated a progressive increase in mean UFR, plasma glucose, creatinine, glycosuria values and urea clearance rate over the experimental course while creatinine clearance (CCR) fell from day 21 onwards reaching 50% of AMC values by day 120. Changes in renal and hepatic metabolite concentrations were apparent after 4 days of diabetes and two patterns emerged. Renal and hepatic glucose, glocuse-1-phosphate and β-hydroxybutyric acid concentrations progressively increased over the 120 days experimental period while reduced concentrations of glycolytic and other metabolic intermediates, namely, glucose-60-phosphate, fructose-6-phosphate, fructose-1,6-bisphosphate, glyceraldehyde-3-phosphate, dihydroxyacetone 3- phosphate and malonyl-CoA concentrations were present. Increased concentrations of BHBA in both the liver and kidney was accompanied by the progressive reduction of malonyl-CoA. Since gluconeognesis is favoured at the expense of glycolysis in these diabetic animals, the absence of phosphofructokinase activity may be explained by a decreased concentration of fructose-6-phosphate. Renal gluconeogenic enzymes such as fructose-1,6-phosphatase were mainly located in the kidney cortex, predominantly located in the proximal tubular epithelium and that glycolytic enzymes such as hexokinase occurred mainly in the kidney medulla, restricted essentially in distal segments. Histological examination demonstrated an increasing degree of renal clear cell changes affecting from 5-20% of cells noted from day 10 to day 120, respectively in the cortical renal tubules. In addition acute pyelonephritis was also observed in all diabetic animals on days 90 and 120.
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Khalaf, Fatimah. "Regulation of Renal Inflammation in Chronic Kidney Disease." University of Toledo Health Science Campus / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=mco1588943852414778.
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Clark, Laura Elizabeth. "The epidemiology of chronic kidney disease in Grampian." Thesis, Available from the University of Aberdeen Library and Historic Collections Digital Resources, 2009. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?application=DIGITOOL-3&owner=resourcediscovery&custom_att_2=simple_viewer&pid=33407.
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Winyard, Paul Julian Douglas. "The biology of kidney malformations." Thesis, University College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.265944.
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Metcalfe, Wendy. "End stage renal disease : outcomes and standards of care." Thesis, University of Aberdeen, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251850.
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A national study was devised to define, using prospective methods, the Scottish renal replacement therapy (RRT) population in terms of numbers, social circumstances, age, mode of presentation for RRT, aetiology of renal failure, comorbid illness, mode of RRT, hospitalisation, mortality and quality of life. The attainment of the recommended treatment standards (UK Renal Association) and their impact along with the factors listed above, upon patient outcomes was assessed. Care by a nephrologist prior to RRT increased the likelihood of a patient having definitive vascular access and attaining the haemoglobin standard, and decreased the time spent in hospital in the first year of RRT. The recommended percentage of patients did not attain haemoglobin, adequacy, albumin or other serum biochemistry standards throughout the first 18 months of RRT. The use of erythropoietin was fundamental to attaining recommended haemoglobin levels. Attaining the haemoglobin standard reduced the risk of death over two years and had beneficial influence upon the number of days spent in hospital. The presence of a fistula (or graft) was the most important factor positively influencing urea reduction ratio (URR). Increasing URR was shown to confer a survival benefit over 2 years in the group treated purely by haemodialysis and reduced time spent in hospital during the first year of treatment. A large demand upon in-patient services was demonstrated. Increased patient cormorbidity and age adversely affected frequency of hospitalisation and total time in hospital in the first year of treatment. Mortality is high amongst patients starting RRT. One year survival was 72.5% (84.2% excluding deaths in the first 90 days), two year survival was 58.5% (68% excluding 90 day deaths). 14% of the cohort died within the first 90 days of RRT. Comorbidity, age, serum albumin and attained haemoglobin significantly affected survival. This study expands the available evidence upon which to base future refinements to clinical practice and recommended standards of care. It provides vital data upon which to base future RRT service planning and research.
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Brunmark, Charlott. "Type IV collagen and renal disease." Lund : Dept. of Nephrology, University of Lund, 1994. http://books.google.com/books?id=owdrAAAAMAAJ.
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Loughrey, Clodagh Maria. "Lipoprotein oxidation in chronic renal failure." Thesis, Queen's University Belfast, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.318949.
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Ferreira, Luciana Carolina Lopes. "Autosomal dominant polycystic kidney disease - genetic diagnosis." Master's thesis, Universidade de Aveiro, 2012. http://hdl.handle.net/10773/10731.
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Mestrado em BiotecnologiaA doença renal poliquística autossómica dominante (ADPKD) é uma doença hereditária e monogénica comum que resulta no desenvolvimento de quistos renais que aumentam em tamanho e em número com o avanço da idade, muitas vezes conduzindo ao aparecimento da doença renal terminal. Cerca de 85% dos casos identificados são causados por mutações no gene PKD1, um gene complexo de elevadas dimensões (~ 47kb). Atualmente, a sequenciação completa do gene PKD1 permite, com elevada sensibilidade, detetar variantes alélicas e pode ser utilizada em determinadas situações clínicas para as quais as técnicas radiológicas não permitem obter um diagnóstico clínico definitivo. No entanto, o rastreio de mutações é muitas vezes inconclusivo devido à presença de várias cópias homólogas a este gene localizadas no cromossoma 16, e à elevada heterogeneidade alélica do PKD1. O presente trabalho teve como objetivo o desenvolvimento de um teste genético de diagnóstico para a ADPKD através da sequenciação da zona codificante e limites intrão/exão do gene PKD1, utilizando a tecnologia de Sanger e otimizado para amostras de sangue armazenadas em cartões FTA™. Procedeu-se à otimização da amplificação e sequenciação, das regiões de interesse, utilizando a tecnologia de BigDye™ Terminator V3.1 e o protocolo desenvolvido mostrou ser uma metodologia reprodutível. Mutações patogénicas foram rastreadas em amostras de dois indivíduos, não relacionados, com ADPKD. Num dos pacientes a análise revelou a presença de uma mutação causadora de um codão stop prematuro no exão 15, no segundo paciente foi detetada uma deleção de 19pb no intrão 31, originando uma alteração na frame de leitura e causando a terminação prematura da proteína. Além disso, a heterogeneidade do PKD1 foi verificada uma vez que foram detetadas várias variantes neutras nas amostras analisadas, sendo que três destas alterações resultaram em alteração de aminoácido. Este estudo demonstrou o potencial da sequenciação de Sanger no diagnóstico de doenças genéticas. Apesar de futuramente ser necessária a validação com mais amostras de pacientes com ADPKD, é possível concluir que a metodologia desenvolvida poderá conduzir a um diagnóstico genético eficaz.
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a common hereditary and monogenic disorder that results in renal cysts development that increases in number and size as the person gets older, often leading to end- stage renal disease. PKD1 is a large (~47kb) and complex gene that accounts for 85% of the identified cases of ADPKD. Currently, the full sequencing of PKD1 allows, with high sensibility, the detection of variations along the gene and this may be used in certain clinicai situations where imaging cannot provide a definitive clinicai diagnosis. However, the screening of mutation is often inconclusive because of multiple homologous copies of this gene on chromosome 16 and the high levei of allelic heterogeneity of PKD1. The research presented here had the objective to develop a genetic diagnostic test for ADPKD through PKD1 coding region and exon/intron boundaries sequencing, using Sanger technology and optimized for blood samples in FTA™ cards. The amplification and sequencing, using BigDye™ Terminator V3.1 technology, were optimized for the regions of interest, and the methodology showed to be reproducible. The screening for disease-causing mutations was performed in two unrelated individuais with ADPKD. The analysis revealed the presence of a truncating mutation in exon 15 in one of the patients, and a 19bp deletion in intron 31 of the other patient, which led to frameshifting and premature termination. In addition, the heterogeneity of PKD1 was observed, since there were detected several neutral variants in the analyzed samples, three of which resulting in amino acid substitution. This research demonstrated the potential of automated Sanger sequencing for diagnosis of genetic diseases. Although further validation using more samples from ADPKD patients is still needed, it is possible to conclude that this approach can lead to an effective molecular genetic diagnosis.
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Aasarød, Knut. "Renal involvement in inflammatory rheumatic disease : a study of renal disease in Wegener's granulomatosis and in primary Sjögren's syndrome." Doctoral thesis, Norwegian University of Science and Technology, Faculty of Medicine, 2001. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-1471.
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Avades, Tony. "Renal effects of X-ray contrast media in different experimental models." Thesis, University of Surrey, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.388979.
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Donohoe, Paul Thomas. "Cardiac ion currents in a rat model of renal failure." Thesis, King's College London (University of London), 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.324668.
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