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Urine Uric Acid

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221. 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

2018 European Association of Urology

222. Management of Chronic Kidney Disease

THE PROGRESSION 11 OF CHRONIC KIDNEY DISEASE 4.1 Treatment of Hypertension and Proteinuria for 11 Renoprotection 4.2 Glycaemic Control for Renoprotection 16 4.3 Protein Restriction for Renoprotection 17 4.4 Lipid Lowering for Renoprotection 17 4.5 Uric Acid Reduction for Renoprotection 18 4.6 Miscellaneous Agents for Renoprotection 18 4.7 Special Precautions Management of Chronic Kidney Disease in Adults (Second Edition) TABLE OF CONTENTS No. Title Page 5. INTERVENTIONS IN REDUCING THE RISK OF 20 (...) in one year or >10 ml/ min/1.73 m 2 within five years] ? eGFR 0.3 mg/mol) (exclude other causes e.g. urinary tract infection (UTI), congestive cardiac failure (CCF), others) Overt nephropathy Screen for microalbuminuria on early morning spot urine POSITIVE NEGATIVE Yearly test for microalbuminuria and renal function Retest twice in 3 - 6 months (exclude other causes e.g. UTI, CCF, others) • If 2 of 3 tests are positive, diagnosis of diabetic kidney disease is established • Quantify microalbuminuria

2018 Ministry of Health, Malaysia

223. Management of Hypertension (5th Edition)

of hypertension after 55 years or deterioration in BP control in a previously well-controlled patient • resistant hypertension • abdominal bruit; particularly if associated with a unilateral small kidney • flash pulmonary oedema • renal failure of uncertain cause in the presence of normal urine sediment • renal failure induced by ACEIs or ARBs • coexisting diffuse atherosclerotic vascular disease Renal angiography including measurement of the pressure gradient remains the gold standard in the diagnosis (...) Korotkoff V is absent. 238(Level III) Measurement of BP is similar to that of the general population, as stated earlier. 37 8.8.1.1 Proteinuria Significant proteinuria in pregnancy is defined as =300 mg protein in a 24 hour urine sample, or a spot urine protein-creatinine ratio =30 mg/mmol. 238 If the dipstick is the only test available, 1+ (30 mg/dl) is often, but not always, associated with =300 mg/day proteinuria. 238 Significant proteinuria reflects advanced disease and is associated with poorer

2018 Ministry of Health, Malaysia

224. A Sensitive and Specific Liquid Chromatography-Tandem Mass Spectrometry Method for the Determination of Intracellular and Extracellular Uric Acid (PubMed)

A Sensitive and Specific Liquid Chromatography-Tandem Mass Spectrometry Method for the Determination of Intracellular and Extracellular Uric Acid Uric acid (UA) is known to be a major biological antioxidant in plasma. However, there is a strong correlation between UA levels and cardiovascular risk. Recent studies suggest that in the intracellular environment, UA can become a prooxidant that causes endothelial dysfunction. For conducting detailed studies of UA's role in human pathogenesis (...) , there is a critical need for a sensitive and specific method for the determination of intracellular UA levels. We therefore developed a simple, sensitive method for determination of trace amounts of intracellular UA, as well as comparatively large amounts of UA in plasma and urine (for the determination of extracellular concentrations of UA), based on liquid chromatography and tandem mass spectrometry (LC-MS/MS). UA was separated from interferences by HPLC and quantified by mass spectrometry in the negative ESI

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2009 Journal of chromatography. B, Analytical technologies in the biomedical and life sciences

225. Solute carrier family 2, member 9 and uric acid homeostasis. (PubMed)

Solute carrier family 2, member 9 and uric acid homeostasis. The goal of this article is to review the possible physiological roles of the recently identified urate transporter, solute carrier family 2 (facilitated glucose transporter), member 9 (SLC2A9), in the renal handling of urate.Glucose transporter 9 is a high affinity hexose transporter encoded by the SLC2A9 gene found on human chromosome 4. The two splice variants SLC2A9b and SLC2A9a are expressed in the apical and basolateral (...) and can exchange glucose for urate. Indirect evidence also suggests that the transporter is electrogenic.This review proposes that SLC2A9 contributes significantly in two ways to the fluxes of urate across the proximal convoluted tubule. Firstly, the apical expression of SLC2A9b secretes urate back into the urine in exchange for lumenal glucose. Secondly, the basolateral membrane SLC2A9a could be the primary route for urate movement out of the epithelium into the peritubular space.

2009 Current Opinion in Nephrology and Hypertension

226. Uric acid is associated with the rate of residual renal function decline in peritoneal dialysis patients. (PubMed)

Uric acid is associated with the rate of residual renal function decline in peritoneal dialysis patients. Uric acid (UA) is known to play a pathogenic role in chronic kidney disease (CKD). However, its effect in end-stage renal disease (ESRD) has not yet been elucidated. We explored the prevalence of hyperuricaemia and the relationship between UA and residual renal function (RRF) in peritoneal dialysis (PD) patients.The subjects of this study were 134 PD patients who started dialysis (...) at the Yonsei University Health System between January 2000 and December 2005. Timed urine collections were performed within 1 month of PD commencement and at 6-month intervals thereafter. The slope of decline of RRF over time was calculated by linear regression analysis of serial urinary urea and creatinine clearances for each patient. Biochemical and clinical data at the time of initial urine collection were considered as baseline.At baseline, 32.8% of the PD patients had hyperuricaemia (UA >or=7.0 mg/dl

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2009 Transplantation

227. Study of the Biological and Physical Manifestations of Spontaneous Uric Acid Kidney Stone Disease

with urine test results. Aim 2: The investigators will evaluate the effect of thiazolidinedione (pioglitazone) on excess fatty acid accumulation in kidney tissue and its correlation with uric acid stone formation in subjects with uric acid stones. Condition or disease Intervention/treatment Phase Uric Acid Kidney Stone Disease Drug: Pioglitazone Drug: Placebo Not Applicable Detailed Description: The study will use a combination of cell culture, animal, and human studies employing some of the latest (...) Study of the Biological and Physical Manifestations of Spontaneous Uric Acid Kidney Stone Disease Pathophysiology of Uric Acid Nephrolithiasis - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Pathophysiology

2009 Clinical Trials

228. Hypertension management and renin-angiotensin-aldosterone system blockade in patients with diabetes, nephropathy and/or chronic kidney disease

have some of the benefits of dihydropyridine calcium channel blockers in the management of diabetic nephropathy. 67 Through their ability to reduce intraglomerular pressure, blood pressure and uric acid levels, sodium glucose cotransporter-2 (SGLT-2) inhibitors may offer the possibility of renal protection. One study suggests that SGLT-2 inhibitors can offer a reduction in glomerular hyperfiltration. 68 Recent analysis of the Empagliflozin, Cardiovascular Outcomes and Mortality in Type 2 Diabetes (...) than 90 mmol per day (less than 2 g per day of sodium – equivalent to 5 g of sodium chloride) (Grade 1C). 2 In patients with type 2 diabetes, CKD and urine albumin excretion rate (AER) of less than 30 mg per 24 hours (albumin:creatinine ratio (ACR) less than 3 mg/mmol), we recommend that their target upright blood pressure should be less than 140/90 mmHg, using antihypertensive therapy in the maximum tolerated doses (Grade 1D). 3 In patients with type 2 diabetes, CKD and urine AER of greater than

2017 Association of British Clinical Diabetologists

229. BSR guideline on the management of gout

fractional clearance of uric acid in > 90% of patients with gout [ ]. Age, male gender, menopausal status in females, impairment of renal function, hypertension and the co-morbidities that comprise the metabolic syndrome are all risk factors for incident gout associated with decreased excretion of uric acid, as are the use of diuretic and many anti-hypertensive drugs, ciclosporin, low-dose aspirin, alcohol consumption and lead exposure. Tophi and chronic arthritis [ ], alcohol consumption [ ] and recent (...) [ , ] and secondary care [ , ] do not achieve reductions of serum uric acid (sUA) levels to the target level recommended in the BSR/BHPR (300 µmol/l) or EULAR (360 µmol/l) guidelines. Finally, as evidence has accumulated that the provision of information to patients with gout is suboptimal [ ] and qualitative studies have begun to define a range of patient and provider barriers to effective care [ ], preliminary data are emerging that demonstrate that these barriers can be overcome, and outcomes improved

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2017 British Society for Rheumatology

230. CRACKCast E127 – Rhabdomyolysis

is intracellular Necrosis of 100g of muscle can lead to serum potassium increase of 1 mmol/L Metabolic acidosis Dehydration, myoglobin induced kidney dysfunction Metabolic acidosis is also induced by the release of organic acids (eg, lactic acid, uric acid, sulfur-containing proteins). Hyperphosphatemia From muscle cell destruction Early hypocalcemia (calcium phosphate crystal deposition in the muscle cells) → late hypercalcemia (as the cytoplasm of necrotic muscle cells gets extruded into the circulation (...) kidney injury are: myoglobin cast formation in the distal convoluted tubules (in an acidic environment, myoglobin precipitates with uric acid to form obstructive casts) Direct cytotoxic action of myoglobin on the epithelial cells of the proximal convoluted tubules Myoglobin itself has been shown to exhibit peroxidase-like enzyme activity. Ferrihemate causes direct nephrotoxic effects along with the resultant increased oxidative stress within the tubular epithelial cell, leading to acute tubular

2017 CandiEM

231. CRACKCast E097 – Renal Failure

, hemoglobinuria Other Diseases and Conditions Severe liver disease Allergic reactions NSAIDs 6) List the RFs for contrast induced ATN According to LITFL Top 3: Pre-existing renal disease (especially Cr >120) Diabetes mellitus Age >75yrs Others: CHF Hypertension Hypovolemia Nephrotoxins (NSAIDs, cyclosporin, aminoglycosides, amphotericin) High dose contrast, intra-arterial worse than IV Cirrhosis/nephrotic syndrome Multiple myeloma PVD High uric acid and hypercholesterolemia 7) List the causes of postrenal (...) renal failure Box 87.3 Intrarenal and Ureteral Causes Kidney stone Sloughed papilla Malignancy Retroperitoneal fibrosis Uric acid, oxalic acid, or phosphate crystal precipitation Sulfonamide, methotrexate, acyclovir, or indinavir precipitation Bladder Kidney stone Blood clot Prostatic hypertrophy Bladder carcinoma Neurogenic bladder Urethra Phimosis Stricture 8) List the causes of pigment induced AKI Box 87.5 Rhabdomyolysis and myoglobinuria Crush injury Compartment syndrome Electrical injury

2017 CandiEM

232. CRACKCast E099 – Urological Disorders

(Magnesium, ammonium, phosphate) – 15% Occur exclusively in patients with UTIs because they require bacteria to split urea into precipitates Uric acid stones – 10% Occur in people with gout 20% of patients with urolithiasis have NO microscopic hematuria Imaging with CT KUB vs. U/S is recommended only if: First presentation of disease Do not improve with initial treatment Have a urinalysis suspicious for infection Have a solitary/transplanted kidney Diagnostic uncertainty Complete ureteric obstruction (...) ; prepubescent—supportive only [6] What are the causes of different urine colour pigmentation? Straight from Life in the fast lane Green Drugs: Cimetidine, Promethazine, Amitriptyline, Flutamide, Indomethacin, Methocarbamol, Methylene blue, Mitoxantrone, Propofol, Phenylbutazone, Triamterene Condition: Hartnup Disease, Indicanemia, Indicanuria Infection: Pseudomonas Infection Dyes: Carbolic Acid, Flavine derivatives, Indigo Blue, Methylene Blue, Resorcinol Other: Clorets, Listerine, Magnesium Salicylate

2017 CandiEM

233. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

renin activity PWV — pulse wave velocity QALY — quality-adjusted life-year RAAS — renin-angiotensin-aldosterone system RAS — renal artery stenosis SBP — systolic blood pressure SDB — sleep-disordered breathing T1DM — type 1 diabetes mellitus T2DM — type 2 diabetes mellitus UA — uric acid WCH — white coat hypertension 1. Introduction 1. Scope of the Clinical Practice Guideline Interest in childhood hypertension (HTN) has increased since the 2004 publication of the “Fourth Report on the Diagnosis

2017 American Academy of Pediatrics

234. Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of NASPGHAN and ESPGHAN

screen results not readily available Urine—urinalysis, culture, reducing substances (rule out galactosemia) Consider bacterial cultures of blood, urine and other ?uids especially if infant is clinically ill. Verify results of treatable disorders (such as galactosemia and hypothyroidism) from newborn screen Obtain fasting ultrasound Tier 2: Aim to complete a targeted evaluation in concert with pediatric gastroenterologist/hepatologist General—TSH and T4 values, serum bile acids, cortisol Consideration (...) of speci?c etiologies Metabolic—serum ammonia, lactate level, cholesterol, red blood cell galactose-1-phosphate uridyltransferase, urine for succinylacetone and organic acids. Consider urine for bile salt species pro?ling ID—direct nucleic acid testing via PCR for CMV, HSV, listeria Genetics—in discussion with pediatric gastroenterologist/hepatologist, with a low threshold for gene panels or exome sequencing Sweat chloride analysis (serum immunoreactive trypsinogen level or CFTR genetic testing

2017 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

235. Supplementary Feedings in the Healthy Term Breastfed Neonate

clinical situations where evaluation and breastfeeding management may be necessary, but SUPPLEMENTATION IS NOT INDICATED, including: 1. The healthy, term, appropriate for gestational age infant when the infant is feeding well, urinating and stooling adequately, weight loss is in the expected range, and bilirubin levels are not of concern (depending on gestational age, time since birth, and any risk factors). • Newborns are normally sleepy after an initial alert period after birth (∼2 hours (...) ordering supplementation. , , 2. Weight loss nomograms for healthy newborns by hour of age can be found at: , iii. Delayed bowel movements, fewer than four stools on day 4 of life, or continued meconium stools on day 5 (120 hours). , 1. Elimination patterns for newborns for urine and stool should be tracked at least through to the onset of secretory activation. Even though there is a wide variation between infants, the patterns may be useful in determining adequacy of breastfeeding. , II-2. Newborns

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2017 Academy of Breastfeeding Medicine

236. Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

and Gout Prevalence and Pathogenesis Hyperuricemia is nearly universal in patients with cya- notic CHD, but clinical gout is relatively uncommon. Arthralgias, however, may be common. Hyperuricemia occurs as a result of increased production of uric acid and decreased renal clearance. Diuretics increase serum uric acid levels through hemoconcentration, decreased uric acid secretion, and increased reabsorption. Low frac- tional uric acid excretion is the primary mechanism of hyperuricemia in patients (...) with cyanotic CHD. 212,213 Hy- peruricemia is a marker of disease severity in cyanotic patients and is negatively correlated with cardiac index. Those with the highest uric acid levels had worse survival in a cohort of 94 patients with Eisenmenger syndrome. 214 Management Hyperuricemia is diagnosed by testing serum uric acid, which should be done annually in cyanotic CHD. 2 Di- agnosis of gout is difficult because patients with Eisen- menger syndrome often have pain resulting from hy- pertrophic

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2017 American Heart Association

237. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

and/or urine albumin:creatinine ≥300 mg/g). Table 5. CVD Risk Factors Common in Patients With Hypertension Modifiable Risk Factors Relatively Fixed Risk Factors Current cigarette smoking, secondhand smoking CKD Family history Diabetes mellitus Increased age Dyslipidemia/hypercholesterolemia Low socioeconomic/educational status Overweight/obesity Male sex Physical inactivity/low fitness Obstructive sleep apnea Unhealthy diet Psychosocial stress * Factors that can be changed and, if changed, may reduce CVD

2017 American Heart Association

239. Acute and Chronic Heart Failure

3A4 DCM dilated cardiomyopathy DES desmin DHA docosahexaenoic acid DIG-PEF ancillary Digitalis Investigation Group trial DNA deoxyribonucleic acid DOSE Diuretic Optimization Strategies Evaluation DPD 3,3-diphosphono-1,2-propanodicarboxylic acid DPP4i dipeptidyl peptidase-4 inhibitor DT destination therapy e′ early diastolic tissue velocity ECG electrocardiogram Echo-CRT Echocardiography Guided Cardiac Resynchronization Therapy ECLS extracorporeal life support ECMO extracorporeal membrane (...) oxygenation ED emergency department EF ejection fraction eGFR estimated glomerular filtration rate EHRA European Heart Rhythm Association EMA European Medicines Agency EMB endomyocardial biopsy EMF endomyocardial fibrosis EMPHASIS-HF Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure EPA eicosapentaenoic acid EPHESUS Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study ESC European Society of Cardiology EU European Union EULAR European League

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2016 European Society of Cardiology

240. CVD Prevention in Clinical Practice

, Management, and Avoidance CI confidence interval CKD chronic kidney disease CR cardiac rehabilitation CT computed tomography CTT Cholesterol Treatment Trialists' Collaboration CURE Clopidogrel vs. Placebo in Patients with ACS without ST-segment elevation CV cardiovascular CVD cardiovascular disease DALYs disability-adjusted life years DASH Dietary Approaches to Stop Hypertension DBP diastolic blood pressure DCCT Diabetes Control and Complications Trial DHA docosahexaenoic acid DM diabetes mellitus DPP-4 (...) dipeptidyl peptidase-4 eGFR estimated glomerular filtration rate ECDA European Chronic Disease Alliance ECG electrocardiogram ED erectile dysfunction EHN European Heart Network EMA European Medicines Agency EPA eicosapentaenoic acid EPIC European Prospective Investigation into Cancer and Nutrition EPODE Ensemble Prévenons l'Obésité des Enfants ESC European Society of Cardiology EU European Union FDA Food and Drug Administration (USA) FDC fixed dose combination FH familial hypercholesterolaemia GLP-1

2016 European Society of Cardiology

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