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Fractional Excretion of Bicarbonate


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61. European Society of Endocrinology Clinical guideline for the management of hyponatraemia Full Text available with Trip Pro

as blood pressure progressively decreases. Because osmoregulated and baroregulated vasopressin secretion are interdependent, renal water excretion can be maintained around a lower set point of osmolality under conditions of moderately decreased circulating volume . As the circulatory hypovolaemia worsens, the serum vasopressin concentration dramatically increases and baroregulation overrides the osmoregulatory system. Osmosensitive neurons are located in the subfornical organ and the organum vasculosum (...) of blood needed for analysis, serum is frequently diluted before the actual measurement is obtained. The same volume of diluent is always used; the degree of dilution is estimated under the assumption that the serum contains 7% solid-phase particles. When the fraction of solid-phase particles is increased, the same amount of diluent results in a greater dilution, unbeknownst to the laboratory personnel (right side of figure). Consequently, the calculation of an ion level with the use of a degree

2014 European Society of Endocrinology

62. Genetics and Genomics for the Prevention and Treatment of Cardiovascular Disease: Update Full Text available with Trip Pro

a small fraction of secondary hypertension cases. Recent studies have attempted to assess the role of rare variants in renal salt-handling genes in essential hypertension and interindividual BP variability. However, once again, these “mendelian” genes make very small contributions to hypertension risk in the population. In 2004, Wilson and colleagues published data from an unusual white kindred, segregating hypomagnesemia, hypertension, and hypercholesterolemia, which they traced to a mitochondrial (...) ; the natriuretic peptide clearance factor NPR3 ; subunits of the soluble guanylate cyclase, GUCY1A3 and GUCY1A3 ; and adrenomedullin [ ADM ] and metal ion transporters [the iron transporter HFE and the zinc transporter SLC39A8 ]), together with novel renal genes (electroneutral sodium bicarbonate cotransporter SLC4A7 and phospholipase C-epsilon-1 isoform PLCE1 ). These findings are consistent with some earlier studies that have demonstrated a role for NPPA , NPPB , and endothelial nitric oxide synthase

2013 American Heart Association

63. KDIGO Clinical Practice Guideline for Acute Kidney Injury

on need for RRT 52 Figure 13. Sample questionnaire 73 Figure 14. Risk for contrast-induced nephropathy 78 Figure 15. Bicarbonate vs. saline and risk of CI-AKI 81 Figure 16. NAC and bicarbonate vs. NAC for risk of CI-AKI 85 Figure 17. Flow-chart summary of recommendations 96 Additional information in the form of supplementary materials can be found online at contents & 2012 KDIGO iv Kidney International (...) : Use the lowest possible dose of contrast medium in patients at risk for CI-AKI. (Not Graded) 4.3.2: We recommend using either iso-osmolar or low-osmolar iodinated contrast media, rather than high-osmolar iodinated contrast media in patients at increased risk of CI-AKI. (1B) 4.4.1: We recommend i.v. volume expansion with either isotonic sodium chloride or sodium bicarbonate solutions, rather than no i.v. volume expansion, in patients at increased risk for CI-AKI. (1A) 4.4.2: We recommend not using

2012 National Kidney Foundation

64. 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD

hypotension and drug side effects. (Not Graded) 3.1.4: We recommend that in both diabetic and non-diabetic adults with CKD and urine albumin excretiono30mg/ 24 hours (or equivalent*) whose of?ce BP is consistently4140mm Hg systolic or490mm Hg diastolic be treated with BP-lowering drugs to maintain a BP that is consistentlyr140mm Hg systolic andr90mm Hg diastolic. (1B) 3.1.5: We suggest that in both diabetic and non-diabetic adults with CKD and with urine albumin excretion of Z30mg/24 hours (or equivalent (...) *) whose of?ce BP is consistently4130mm Hg systolic or480mm Hg diastolic be treated with BP-lowering drugs to maintain a BP that is consistentlyr130mm Hg systolic and r80mm Hg diastolic. (2D) 3.1.6: We suggest that an ARB or ACE-I be used in diabetic adults with CKD and urine albumin excretion 30–300mg/ 24 hours (or equivalent*). (2D) 3.1.7: We recommend that an ARB or ACE-I be used in both diabetic and non-diabetic adults with CKD and urine albumin excretion4300mg/24 hours (or equivalent*). (1B) 3.1.8

2012 National Kidney Foundation

65. Clinical and diagnostic features of Bartter and Gitelman syndromes Full Text available with Trip Pro

[interquartile range (IQR) 0.7-18.1] years.Polyhydramnios and prematurity were seen in children with SLC12A1 and KCNJ1 mutations. Patients with CLCNKB mutations had the lowest serum potassium and serum magnesium and the highest serum bicarbonate levels. Fractional excretion of chloride was >0.5% in all patients prior to supplementation. Nephrocalcinosis at presentation was present in the majority of patients with SLC12A1 and KCNJ1 mutations, while it was only present in one patient with CLCNKB (...) . However, decreased eGFR and pathologic proteinuria was evident in a large number of these patients, highlighting the need to monitor glomerular as well as tubular function. Electrolyte abnormalities were most severe in CLCNKB mutations both at presentation and during follow-up. Fractional excretion of chloride prior to supplementation is a useful screening investigation in children with hypokalaemic alkalosis to establish renal salt wasting.

2017 Clinical kidney journal

66. Diabetic Kidney Alarm (DKA) Study

ketoacidosis (DKA), a condition associated with risks factors for tubular injury including dehydration, metabolic acidosis and acute glycemia. It is unknown whether DKA is associated with tubular injury. The investigators published the first report showing that youth with established T1D have more acidic urine and higher fractional excretion of uric acid (FeUA) than their non-diabetic peers, which may predispose to UUA-mediated tubulopathy. Furthermore, T1D is associated with vasopressin overactivity (...) Information provided by (Responsible Party): Petter Bjornstad, University of Colorado Denver School of Medicine Barbara Davis Center Study Details Study Description Go to Brief Summary: The overarching goals of this study are to determine whether tubular dysfunction (elevated urine sodium, bicarbonate and amino acids) and injury (elevated kidney injury molecule 1 [KIM-1], neutrophil gelatinase-associated lipocalin [NGAL] and matrix metallopeptidase 9 [MMP9]) exist in diabetic ketoacidosis (age 3-18

2017 Clinical Trials

68. Renal Grand Rounds - What Lurks in the Gap

acidosis likely represented chronic diarrhea and D-lactate production, and his rising anion gap when he presented was consistent with increased D-lactate production. In D-lactic acidosis, the findings of hypokalemia and a positive urine anion gap can provide a helpful clue. With elevated serum D-lactate levels, the fractional excretion of D-lactate approaches 100%, i.e. everything that's filtered is excreted. This is because the stereospecificity of the sodium-L-lactate cotransporter in the proximal (...) that progressed to encephalopathy with dysarthria. His baseline labs from a month prior to presentation were notable for a chronically low serum bicarbonate of 15-17 with no anion gap. When he presented he was hypokalemic to 2.5 and his bicarbonate had dropped to 11 with a new elevated anion gap of 25 and normal L-lactate. Metabolic acidosis was confirmed on VBG. Interestingly, his urine electrolytes demonstrated a positive urine anion gap of 26. He was ultimately diagnosed with D-lactic acidosis based on his

2017 Renal Fellow Network

69. Gastrointestinal Complications (PDQ®): Health Professional Version

. Stimulant laxatives Stimulant laxatives increase motor activity of the bowels by direct action on the intestines. Onset: 6 to 10 hours. Caution: Prolonged use of these drugs causes laxative dependency and loss of normal bowel function. Prolonged use of danthron discolors rectal mucosa and discolors alkaline urine red. Bisacodyl must be excreted in bile to be active and is not effective with biliary obstruction or diversion. Avoid bisacodyl with known or suspected ulcerative lesions of the colon (...) glycol (227.1 g), sodium chloride (5.53 g), potassium chloride (2.82 g), sodium bicarbonate (6.36 g), and sodium sulfate (anhydrous, 21.5 g). Do not add flavorings. Serve chilled to improve palatability. Can be stored up to 48 hours in the refrigerator. Use: To clear bowel with minimal water and sodium loss or gain. Opioid antagonists (naloxone, methylnaltrexone, naldemedine) Caution: Administer only if other drugs have failed. Subcutaneous methylnaltrexone, 0.15 mg per kilogram of body weight, can

2015 PDQ - NCI's Comprehensive Cancer Database

70. From The Archives: Does Acetazolamide Prevent Altitude Sickness?

ascent to allow acclimatization is the key to preventing AMS; avoiding a direct ascent of 2750 meters is considered a standard recommendation. Acetazolamide is a carbonic anhydrase inhibitor and works by stimulating renal bicarbonate excretion. The increased blood acidity serves as a central stimulus to increase ventilation, thus facilitating adaptation to hypoxic conditions. Show me the data! Here are a few trials: Basnyat et al, looked at the efficacy of low-dose acetazolamide for the prophylaxis (...) . When one remains at the same altitude, this peripheral chemosensor increases its sensitivity to hypoxemia, and an even greater increase in ventilation ensues. The result is a rise in arterial oxygen content and a respiratory alkalosis which is only partially compensated by kidneys. Acetazolamide effectively mimics this normal acclimatization response, by inducing a respiratory acidosis (impaired cellular delivery of CO2 to the lungs) and a metabolic acidosis (enhanced renal bicarbonate excretion

2011 Clinical Correlations

71. Ceftaroline fosamil for injection (Teflaro)

was diagnosed during the course of the clinical trials. As with other cephalosporins, ceftaroline could potentially cause allergic and hypersensitivity reactions and antibiotic-associated diarrhea. Data from Clinical Pharmacology studies and the Phase 3 clinical trials provide sufficient information on directions for use, the appropriate recommended dose, and the need for dose adjustment in specific subpopulations. Because ceftaroline is primarily excreted through the kidneys, dose adjustment is recommended (...) fosamil is rapidly dephosphorylated to its active form, ceftaroline, in the plasma and distributed to tissues. It is also metabolized into an open ß-lactam ring metabolite, ceftaroline M-1, which may also be detected in the plasma. The pharmacokinetic properties of ceftaroline fosamil, ceftaroline, and ceftaroline M-1 have been characterized in mice, rats, rabbits, and monkeys using different dose levels administered intravenously or intramuscularly. The primary excretion for ceftaroline is renal

2010 FDA - Drug Approval Package

72. Nucleotide Analogue-Related Proximal Renal Tubular Dysfunction during Long-Term Treatment of Chronic Hepatitis B: A Cross-Sectional Study Full Text available with Trip Pro

or tenofovir as mono- or add-on therapy with lamivudine (LAM) >1 year. Serum and urine were collected. Fractional excretion of phosphate (FEPO4), uric acid (FEUA), and potassium was calculated. Renal losses were defined based on the criteria: protein (24-hour urine protein >150 mg), glucose (glycosuria with normoglycemia), phosphate (FEPO4 >18%), uric acid (FEUA >15%), potassium (renal potassium losses with hypokalemia), and bicarbonate (normal gap acidosis). Subclinical and overt proximal RTD were defined

2016 Gastroenterology research and practice

73. A Study to Evaluate Safety, Tolerability and Pharmacokinetics of Ascending Intravenous Single Dose and Repeat Dose of GSK3342830

reported. Part 1: Number of Participants With Abnormal Clinical Chemistry Parameters as a Measure of Safety-Grade 3 or Higher [ Time Frame: Day 2 ] Blood samples were collected and processed to measure the number of participants with abnormal blood urea nitrogen (BUN), creatinine, glucose, bicarbonate, sodium, potassium, chloride, calcium, aspartate aminotransferase (AST/SGOT), alanine aminotransferase (ALT/SGPT), alkaline phosphatase (ALP) levels, uric acid, total and direct bilirubin, total protein (...) and albumin. These were collected on Day 1, during Part 1(single dose escalation) of the study. Participants with abnormalities Grade 3 or higher were reported. Part 2: Number of Participants With Abnormal Clinical Chemistry Parameters as a Measure of Safety-Grade 3 or Higher [ Time Frame: Up to Day 15 ] Blood samples were collected and processed to measure the number of participants with abnormal BUN, creat, glucose, bicarbonate, sodium, potassium, chloride, calcium, AST/SGOT, ALT/SGPT, ALP levels, uric

2016 Clinical Trials

74. Clarifying Optimal Sodium Intake Project

to be associated with abnormal renal sodium excretion, including the following: Bartter syndrome SIADH Diabetes insipidus Serum sodium <125mmol Severe heart failure defined as NYHA Class III/IV OR left ventricular ejection fraction (LVEF) ≤30% High-dose loop or thiazide diuretic therapy, exceeding a total daily dose of frusemide 80mg, bumetanide 2mg, hydrochlorothiazide 50mg, bendroflumethiazide 2.5mg, indapamide 2.5mg, metolazone 2.5mg or the use of both a loop and thiazide diuretic Unable to follow (...) by (Responsible Party): Dr Andrew Smyth, University College Hospital Galway Study Details Study Description Go to Brief Summary: Hypertension is a leading risk factor for cardiovascular disease (CVD) globally, accounting for 25-35% of the population-attributable fraction. Sodium (salt) intake is a key determinant of blood pressure, and reducing sodium intake has emerged as an important target for population-based interventions to prevent CVD. However, there is considerable uncertainty about the optimal level

2016 Clinical Trials

75. Safety, Tolerability and Preliminary Pharmacokinetics (PK) and Pharmacodynamics (PD) of Single and Repeat Oral Doses of GSK3008356 in Healthy and Obese Subjects

corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red blood cells (RBC) and reticulocytes. Clinical chemistry parameters included blood urea nitrogen, aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transferase, alkaline phosphatase, uric acid, total protein, total and direct bilirubin, albumin, calcium, bile acids, chloride, creatinine, glucose (fasting/non-fasting), potassium, sodium and total carbon dioxide/bicarbonate. Urinalysis included specific gravity (...) , glucose (fasting/non-fasting), potassium, sodium and total carbon dioxide/bicarbonate. Urinalysis included specific gravity, potential of hydrogen (pH), glucose, protein, blood and ketones by dipstick and microscopic examination (within 120 minutes of collection). Part 2: Number of Participants With AE and SAE [ Time Frame: Up to Day 22 ] AE is any untoward medical occurrence in a participant or clinical investigation participant, temporally associated with the use of a medicinal product, whether

2016 Clinical Trials

76. Topical Multiple Ascending Dose Study for PF-06423264

aminotransferase, alanine aminotransferase, total bilirubin, lactate dehydrogenase, alkaline phosphatase, albumin, total protein); renal function (blood urea nitrogen, creatinine, uric acid); electrolytes (sodium, potassium, chloride, calcium, phosphate, bicarbonate); clinical chemistry (glucose, creatine kinase); immunology (CRP); urinalysis (dipstick [urine specific gravity, decimal logarithm of reciprocal of hydrogen ion activity {pH} of urine, glucose, protein, blood, ketones, bilirubin], microscopy [urine (...) post dose on Day 14 ] Volume of distribution is defined as the theoretical volume in which the total amount of drug would need to be uniformly distributed to produce the desired plasma concentration of a drug. Apparent volume of distribution after oral dose (Vz/F) is influenced by the fraction absorbed. Apparent Total Body Clearance (CL/F) for [ Time Frame: 0, 0.5, 1, 2, 4, 5, 6, 8, 12, 24 hours post dose on Day 1 and 0, 0.5, 1, 2, 4, 5, 6, 8, 12, 24, 36, and 48 hours post dose on Day 14

2016 Clinical Trials

77. Clinical Trial In Healthy Volunteers And Health Elderly Volunteers To Evaluate The Safety, Tolerability And Blood Concentration After Single And Multiple Escalating Oral Doses Of PF-06751979.

<0.5*LLN,>1.75*upper limit of normal [ULN]; WBC<0.6*LLN,>1.5*ULN; lymphocytes; neutrophils; basophils; eosinophils; monocytes<0.8*LLN,>1.2*ULN; coagulation(prothrombin ratio>1.1*ULN), liver(bilirubin>1.5*ULN; aspartate aminotransferase; alanine aminotransferase; alkaline phosphatase; gamma GT>0.3*ULN; protein; albumin<0.8*LLN,>1.2*ULN); renal(blood urea nitrogen, creatinine>1.3*ULN; uric acid>1.2*ULN); electrolytes(sodium<0.95*LLN,>1.05*ULN; potassium; chloride; calcium; bicarbonate<0.9*LLN,>1.1 (...) would need to be uniformly distributed to produce the desired blood concentration of a drug. Apparent volume of distribution after oral dose (Vz/F) is influenced by the fraction absorbed. Part B: Maximum Observed Plasma Concentration (Cmax) of PF-06751979 [ Time Frame: pre-dose, 0.5, 1, 2, 4, 6, 8, 12 and 24 hours post dose on Day 1; pre-dose, 0.5, 1, 2, 4, 6, 8, 12 and 24 hours post dose on Day 7; pre-dose, 0.5, 1, 2, 4, 6, 8, 12, 24, 48, 72, 96 and 120 hours post dose on Day 14 ] Part B: Area

2016 Clinical Trials

78. A case of severe osteomalacia caused by Tubulointerstitial nephritis with Fanconi syndrome in asymptomotic primary biliary cirrhosis. Full Text available with Trip Pro

of phosphate, increased fractional excretion of uric acid and generalized aminoaciduria. An intravenous bicarbonate loading test suggested the presence of proximal renal tubular acidosis (RTA). These biochemical data indicated Fanconi syndrome with proximal RTA. A kidney biopsy demonstrated the features of tubulointerstitial nephritis (TIN). The patient was also suspected as having primary biliary cirrhosis (PBC) because of high levels of alkaline phosphatase, IgM and the presence of anti-mitochondrial M2 (...) , mineralization defects, and phosphate deficiency has not been recognized as a complication of PBC.We report the case of a 49-year-old Japanese woman who complained of multiple fractures. Hypophosphatemic osteomalacia was diagnosed from a low serum phosphorus level, 1,25-dihydroxyvitamin D3 level, high levels of bone specific alkaline phosphatase and the findings of bone scintigraphy, although a bone biopsy was not performed. Twenty four hour urine demonstrated a low renal fractional tubular reabsorption

2015 BMC Nephrology

79. Ethnopharmacological investigation of the diuretic and hemodynamic properties of native species of the Brazilian biodiversity. Full Text available with Trip Pro

, urea, creatinine, and angiotensin converting enzyme (ACE) activity were evaluated in collected serum. The involvement of the renal cortical blood flow and antioxidative activity in the hypotensive and diuretic effects was also determined.Water and Na(+), Cl(-) and Na(+) excretion rates were significantly increased by ES-EG, while urinary bicarbonate excretion was reduced. Moreover, ES obtained from E. grandiflorus was able to significantly increase renal blood flow and reduce mean arterial pressure (...) Ethnopharmacological investigation of the diuretic and hemodynamic properties of native species of the Brazilian biodiversity. Although Echinodorus grandiflorus, Cuphea carthagenensis, and Phyllanthus tenellus infusions are used in Brazilian folk medicine due to their possible diuretic effect, none of these species was critically investigated as a diuretic drug. So, the aim of this study was to evaluate the possible acute diuretic activity of ethanol soluble fractions (ES) obtained from

2015 Journal of Ethnopharmacology

80. Sodium Intake in Chronic Kidney Disease (STICK)

Frame: 24 months ] Change in 24-hour urinary protein from baseline to final visit [ Time Frame: 24 months ] Increase in risk category for prognosis of CKD as measured by the KDIGO 2012 CKD classification table [ Time Frame: 24 months ] Change in 24-hour urinary sodium excretion from baseline to final visit [ Time Frame: 24 months ] Change in mean systolic and diastolic blood pressure from 24-hour ambulatory blood pressure monitoring completed at baseline and final visit [ Time Frame: 24 months (...) -infectious glomerulonephritis, IgA nephropathy, thin basement membrane disease, Henoch-Schonlein purpura, proliferative glomerulonephritis, membranous nephropathy (including lupus nephritis), rapidly progressive glomerulonephritis, minimal change disease, or focal segmental glomerulosclerosis Prior or planned renal transplantation Prior, current or planned renal dialysis Medical diagnosis known to be associated with abnormal renal sodium excretion, including Bartter syndrome, SIADH, diabetes insipidus

2015 Clinical Trials

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