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Urine Uric Acid

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201. Syndrome of inappropriate antidiuretic hormone

headache seizure coma no hx of recent diuretic use age >50 years pulmonary conditions (e.g., pneumonia) nursing home residence postoperative state malignancy medicine associated with SIADH induction central nervous system (CNS) disorder endurance exercise Diagnostic investigations serum sodium serum osmolality serum urea urine osmolality urine sodium diagnostic trial with normal saline infusion serum uric acid fractional excretion of sodium fractional excretion of urea serum TSH serum cortisol level (...) with the antidiuretic hormone AVP for binding at the vasopressin receptor, permitting free water excretion. Definition The syndrome of inappropriate antidiuretic hormone (SIADH) is characterised by hypotonic hyponatraemia, concentrated urine, and a euvolaemic state. The impairment of free water excretion is caused by increased arginine vasopressin (antidiuretic hormone or AVP) release. Pseudohyponatraemia due to hyperglycaemia, hyperlipidaemia, or hyperproteinaemia should be ruled out first. Renal failure, adrenal

2018 BMJ Best Practice

202. Allopurinol / lesinurad (Duzallo) - Gout

increase excretion of uric acid into the urine, by inhibition of transporters mediating reabsorption of uric acid by the kidney. Lesinurad also belongs to the oral uricosuric agents. c) intravenous pegloticase, a pegylated recombinant uricase. Uricase is an enzyme which converts uric acid to more soluble allantoin for renal excretion. Initiation of ULT could actually induce an arthritis gout attack, as instability of crystals deposits due to a sudden drop of Serum uric acid (sUA, also referred (...) and OAT4. Allopurinol is a xanthine-oxidase (XO) inhibitor. Allopurinol and its main metabolite oxypurinol lower the level of uric acid in plasma and urine by inhibition of xanthine oxidase, the enzyme catalyzing the oxidation of hypoxanthine to xanthine and xanthine to uric acid. The combination of lesinurad and allopurinol targets both excretion and production of uric acid, providing a dual-mechanism approach to effectively lower sUA levels. Secondary pharmacodynamic studies Lesinurad was tested

2018 European Medicines Agency - EPARs

204. Adalimumab (Hefiya) - Juvenile Rheumatoid Arthritis, Hidradenitis Suppurativa, Psoriasis, Ankylosing Spondylitis, Uveitis

Key Process Parameter LAL Limulus amoebocyte lysate LLOQ Lower limit of quantification LMW Low molecular weight LOD Limit of detection LOQ Limit of quantitation LTa Lymphotoxin a (also referred to as TNFß in the literature) MAA Marketing authorization application MCB Master Cell Bank MMC Multimodal chromatography MMRM Mixed model repeated measures MoA Mechanism of Action mRNA Messenger Ribonucleic Acid mTNF Membrane bound TNF mTNFa Membrane bound TNF a NAb Neutralizing antibody NK Natural Killer (...) /520007/2018 Page 14/128 The Applicant requested EMA scientific advice concerning quality, non-clinical and clinical development on 19 May 2011 (Procedure No.: EMEA/H/SA/2108/1/2011/III). 2.2 Quality aspects 2.2.1 Introduction The finished product (FP) is presented as solution for injection in a pre-filled syringe or pen containing 40 mg of adalimumab as active substance (AS). Other ingredients are adipic acid, citric acid monohydrate, sodium chloride, mannitol, polysorbate 80, hydrochloric acid

2018 European Medicines Agency - EPARs

205. Adalimumab (Halimatoz) - Juvenile Rheumatoid Arthritis, Psoriatic Arthritis, Rheumatoid Arthritis, Hidradenitis Suppurativa, Psoriasis, Ankylosing Spondylitis, Uveitis

arthritis KIPC Key in process control KPP Key Process Parameter LAL Limulus amoebocyte lysate LLOQ Lower limit of quantification LMW Low molecular weight LOD Limit of detection LOQ Limit of quantitation LTa Lymphotoxin a (also referred to as TNFß in the literature) MAA Marketing authorization application MCB Master Cell Bank MMC Multimodal chromatography MMRM Mixed model repeated measures MoA Mechanism of Action mRNA Messenger Ribonucleic Acid mTNF Membrane bound TNF mTNFa Membrane bound TNF a NAb (...) in the EU on 8 September 2003; the Marketing Authorisation Holder is AbbVie Ltd. The Applicant requested EMA scientific advice concerning quality, non-clinical and clinical development on 19 May 2011 (Procedure No.: EMEA/H/SA/2108/1/2011/III). 2.2 Quality aspects 2.2.1 Introduction The finished product (FP) is presented as solution for injection in a pre-filled syringe or pen containing 40 mg of adalimumab as active substance (AS). Other ingredients are adipic acid, citric acid monohydrate, sodium

2018 European Medicines Agency - EPARs

206. Adalimumab (Hyrimoz) - Juvenile Rheumatoid Arthritis, Psoriatic Arthritis, Rheumatoid Arthritis, Ulcerative Colitis, Crohn Disease, Papulosquamous Skin Diseases, Hidradenitis Suppurativa, Ankylosing Spondylitis, Uveitis

of excipients Adipic acid Citric acid monohydrate Sodium chloride Mannitol Polysorbate 80 Hydrochloric acid (for pH adjustment) Sodium hydroxide (for pH adjustment) Water for injections 54 6.2 Incompatibilities In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products. 6.3 Shelf life 30 months 6.4 Special precautions for storage Store in a refrigerator (2°C–8°C). Do not freeze. Keep the pre-filled syringe / pre-filled pen in the outer carton in order (...) OF THE MEDICINAL PRODUCT Hyrimoz 40 mg solution for injection in pre-filled syringe adalimumab 2. STATEMENT OF ACTIVE SUBSTANCE One 0.8 ml pre-filled syringe contains 40 mg adalimumab. 3. LIST OF EXCIPIENTS Excipients: adipic acid, citric acid monohydrate, sodium chloride, mannitol, polysorbate 80, hydrochloric acid, sodium hydroxide, water for injections. 4. PHARMACEUTICAL FORM AND CONTENTS solution for injection 1 pre-filled syringe 2 pre-filled syringes 5. METHOD AND ROUTE(S) OF ADMINISTRATION Read

2018 European Medicines Agency - EPARs

207. ESC/ESH Management of Arterial Hypertension Full Text available with Trip Pro

influencing cardiovascular risk in patients with hypertension Demographic characteristics and laboratory parameters Sex (men >women) Age Smoking (current or past history) Total cholesterol and HDL-C Uric acid Diabetes Overweight or obesity Family history of premature CVD (men aged <55 years and women aged <65 years) Family or parental history of early-onset hypertension Early-onset menopause Sedentary lifestyle Psychosocial and socioeconomic factors Heart rate (resting values >80 beats/min) Asymptomatic (...) Peripheral artery disease Atrial fibrillation Demographic characteristics and laboratory parameters Sex (men >women) Age Smoking (current or past history) Total cholesterol and HDL-C Uric acid Diabetes Overweight or obesity Family history of premature CVD (men aged <55 years and women aged <65 years) Family or parental history of early-onset hypertension Early-onset menopause Sedentary lifestyle Psychosocial and socioeconomic factors Heart rate (resting values >80 beats/min) Asymptomatic HMOD Arterial

2018 European Society of Cardiology

208. Inotersen sodium (Tegsedi) - Amyloidosis

EMA/411876/2018 Page 4/142 List of abbreviations A/C Urine albumin/creatinine ratio ADA Antidrug antibodies AE Adverse event AESI Adverse event of special interest ALT Alanine aminotransferase ANCOVA Analysis of covariance aPTT Activated partial thromboplastin time ASO Antisense oligonucleotide AST Aspartate aminotransferase ATTR Transthyretin amyloidosis AUC/ AUC 0-168h Area under the curve / Area under the curve baseline to 168 hours BMI Body mass index BCRP Human breast cancer resistance (...) Interventricular septum Assessment report EMA/411876/2018 Page 5/142 IXRS Interactive voice/web-response system LBM Lean body mass LCRIS Local cutaneous reaction at the injection site LLN Lower limit of normal LSM Least squares mean LV Left ventricular 2’-MOE 2’-O-(2-methoxyethyl) mBMI Modified body mass index MMRM Mixed Effects Model with Repeated Measures mNIS+7 Modified Neuropathy Impairment Score+7 mRNA Messenger ribonucleic acid NIS Neuropathy Impairment Score NIS-C NIS-cranial nerve muscle strength NIS

2018 European Medicines Agency - EPARs

209. Care around stillbirth and neonatal death

disorder is suspected prior to birth, clinicians should: ? Seek consent from the parents for a metabolic autopsy ? Consult a metabolic physician or a histopathologist before collecting the following samples: o Blood sample (0.8ml) in lithium heparin tube (refrigerate) o Urine sample (5-10ml) o Knee cartilage and/or skin biopsy (3 x 2 mm punch biopsies) (sent to cytogenetics with request for fibroblast culture and store) ? Liver and muscle biopsies (for electron microscopy, histopathology and enzymology

2019 Centre of Research Excellence in Stillbirth

210. Diagnosis and Management of Glycogen Stored Diseases type VI and IX a practice resource of ACMG

and hypoglycemia include liver ultrasound, serum transaminases (AST, ALT), ?-glutamyl transferase (GGT), liver function tests (prothrombin time, albumin), blood glucose, lactate, uric acid, basic chemistry, creatine kinase (CK), plasma total and free carnitine, acylcarnitine profile, urinalysis, urine organic acids, cholesterol, triglycer- ides, and complete blood count (CBC) with manual differential white cell count. It is important to check for presence of plasma ketones as serum ß-OHB during episodes (...) difficulties and overnight irritability are common. Due to the protean and nonspecific symptoms in GSDs VI and IX, they are almost certainly underdiagnosed. GSD IX has been diagnosed in adults who were being evaluated for hepatic cirrhosis. Unlike GSD I, lactic acid and uric acid concentrations are usually normal, 24 although postprandial lactic acid can be elevated. 25 Clinical variability in GSD VI Glycogen storage disease type VI (GSD VI) has variable severity and can present in infancy/early childhood

2019 American College of Medical Genetics and Genomics

212. Bladder Stones

management of bladder stones specifically; therefore, we refer the reader to the general guidance on the medical management of urinary tract stones in Chapter 3.4.9 of the EAU Urolithiasis Guidelines [ ]. Stones composed of uric acid or struvite can be dissolved by chemolysis. Uric acid stones can be dissolved by oral urinary alkalinisation when a pH > 6.5 is consistently achieved, typically using an alkaline citrate or sodium bicarbonate. Careful monitoring is required during therapy [ ]. Irrigation (...) chemolysis is possible for struvite or uric acid stones; a two-way or three-way Foley catheter can be used [ ]. See also Chapter 3.4.4. of EAU Urolithiasis Guidelines [ ]. 3.3.3. Bladder stone interventions Minimally invasive techniques for the removal of bladder stones have been widely adopted to reduce the risk of complications and shorten hospital stay and convalescence. Bladder stones can be treated with open, laparoscopic, robotic assisted laparoscopic, endoscopic (transurethral or percutaneous

2019 European Association of Urology

213. Paediatric Urology

in diagnosing urinary tract infections in small children. Pediatr Nephrol, 2011. 26: 1923. 329. Whiting, P., et al. Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatr, 2005. 5: 4. 330. Koch, V.H., et al. [Urinary tract infection: a search for evidence]. J Pediatr (Rio J), 2003. 79 Suppl 1: S97. 331. Ma, J.F., et al. Urinary tract infection in children: etiology and epidemiology. Urol Clin North Am, 2004 (...) . 31: 517. 332. Ramage, I.J., et al. Accuracy of clean-catch urine collection in infancy. J Pediatr, 1999. 135: 765. 333. Roberts, K.B., et al. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics, 2011. 128: 595. 334. Tosif, S., et al. Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: an observational cohort study. J

2019 European Association of Urology

214. Urolithiasis

tomography of the kidneys, ureters and bladder for urolithiasis. J Med Imaging Radiat Oncol, 2017. 61: 582. 52. Poletti, P.A., et al. Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic. AJR Am J Roentgenol, 2007. 188: 927. 53. Zheng, X., et al. Dual-energy computed tomography for characterizing urinary calcified calculi and uric acid calculi: A meta-analysis. Eur J Radiol, 2016. 85: 1843. 54. Niemann, T., et al. Diagnostic performance of low-dose CT (...) of percutaneous chemolysis in the management of urolithiasis: review and results. Urolithiasis, 2013. 41: 323. 127. Bernardo, N.O., et al. Chemolysis of urinary calculi. Urol Clin North Am, 2000. 27: 355. 128. Tiselius, H.G., et al. Minimally invasive treatment of infection staghorn stones with shock wave lithotripsy and chemolysis. Scand J Urol Nephrol, 1999. 33: 286. 129. Rodman, J.S., et al. Dissolution of uric acid calculi. J Urol, 1984. 131: 1039. 130. Becker, G. Uric acid stones. Nephrology, 2007. 12

2019 European Association of Urology

215. General medicine: Heat-related chronic kidney disease mortality in the young and old: differing mechanisms, potentially similar solutions?

to hyperuricaemia. This has been postulated to lead to glomerular hypertension and renal tubular injury. A pilot study performed on sugar cane workers in El Salvador demonstrated higher mean end-of-work serum levels of uric acid versus morning levels (428 μmol/L vs. 387 μmol/L), with the vast majority demonstrating concurrent glomerular filtration rates <60 mL/min. Resultant activation of the aldose reductase pathway within the kidney leads to increased levels of glucose and fructose. Fructose (...) temperatures and nephrology: the climate change problem . 11. Lloyd EL . ABC of sports medicine. Temperature and performance--II: Heat . 12. Roncal-Jimenez C , Lanaspa MA , Jensen T , et al . Mechanisms by which dehydration may lead to chronic kidney disease . 13. Roncal-Jimenez C , García-Trabanino R , Barregard L , et al . Heat stress nephropathy from exercise-induced uric acid crystalluria: a perspective on mesoamerican nephropathy . 14. Roncal Jimenez CA , Ishimoto T , Lanaspa MA , et al . Fructokinase

2019 Evidence-Based Medicine

216. Guideline on the evaluation and medical management of the kidney stone patient - 2016 update

of Evidence 3, Grade C Recommendation): 14-20 • Children ( 5.8 serum bicarbonate serum potassium Pure apatite stone Hypocitraturia Serum electrolytes Urine pH Ammonium chloride load test* Potassium citrate *Optional; PTH: parathyroid hormone; ?: high; ?N: at the high end of normal range; : low.CUAJ • November-December 2016 • Volume 10, Issues 11-12 E354 dion et al. Focus of treatment for uric acid stones should, therefore, primarily be to correct urine pH above 5.5 and increase urine volume rather than (...) , and ammonium excretion. This results in unbuffered hydrogen ions and a lowering of the urinary pH. 134 Based on the num- ber of metabolic syndrome traits, the risk of stone formation may go up two-fold. 135 Dietary and medical prophylaxis options are shown in Fig. 2. In patients with uric acid stones, alkalinization of the urine targeting a urine pH of 6.5 is the first-line therapy. Allopurinol may be used as adjunctive therapy in patients with hyperuricemia or hyperuricosuria (Level of Evidence 1-3, Grade

2017 CPG Infobase

218. Association of Uric Acid With Change in Kidney Function in Healthy Normotensive Individuals. (Abstract)

of eGFR decrease in both women and men (HR, 1.13 [95% CI, 1.04-1.39] per each 1-mg/dL increase in uric acid level); in multivariable analyses adjusting for age, sex, body mass index, blood glucose level, total cholesterol level, mean blood pressure, urine albumin-creatinine ratio, and serum triglyceride level, the association remained highly significant (HR, 1.28 [95% CI, 1.12-1.48]). Results were similar using different estimating equations and when the association was examined in sex-specific (...) Association of Uric Acid With Change in Kidney Function in Healthy Normotensive Individuals. Despite recent evidence, the role of uric acid as a causal factor in the pathogenesis and progression of kidney disease remains controversial, partly because of the inclusion in epidemiologic studies of patients with hypertension, diabetes, and/or proteinuria.Prospective observational cohort.900 healthy normotensive adult blood donors (153 women, 747 men) evaluated at baseline and after 5 years.Serum

2010 American Journal of Kidney Diseases

219. The alkalizer citrate reduces serum uric Acid levels and improves renal function in hyperuricemic patients treated with the xanthine oxidase inhibitor allopurinol. Full Text available with Trip Pro

The alkalizer citrate reduces serum uric Acid levels and improves renal function in hyperuricemic patients treated with the xanthine oxidase inhibitor allopurinol. Hyperuricemia, an integral component of metabolic syndrome, is a major health problem causing gout and renal damage. Urine alkalizers such as citrate preparations facilitate renal excretion of the uric acid, but its supportive effect on xanthine oxidase inhibitors has not been tested yet. We performed a randomized, prospective study (...) of the effect of a combination of allopurinol and a citrate preparation on renal function in patients with hyperuricemia, employing 70 patients who had hyperuricemia with serum uric acid levels ≥7.0 mg/dL, or those diagnosed as having hyperuricemia in the past.They were randomly enrolled into two study groups: the allopurinol monotherapy (MT) group or combination treatment (CT) group with allopurinol and a citrate preparation. Allopurinol (100-200 mg/day) in the absence or presence of a citrate preparation

2010 Endocrine research Controlled trial quality: uncertain

220. Heart Failure Full Text available with Trip Pro

. Weak FOR Low Nutraceuticals N-3 Polyunsaturated fatty acids may be considered in patients with HFrEF despite receiving maximally tolerated or target doses of an ACE inhibitor (or ARB) and a beta blocker (unless contraindicated), with or without an MRA, to decrease mortality and cardiovascular hospitalisation. Weak FOR Low Non-pharmacological management Models of care to improve evidence-based practice Referral to a multidisciplinary heart failure disease management program is recommended

2018 Cardiac Society of Australia and New Zealand

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