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Urine Uric Acid

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241. 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

242. Chronic kidney disease in adults: assessment and management

of GFR 37 2.3 Classifying chronic kidney disease 38 2.4 Further resources 39 3 Research recommendations 40 Chronic kidney disease in adults: assessment and management (CG182) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 603.1 Self-management 40 3.2 Antiplatelet therapy 40 3.3 Renin–angiotensin–aldosterone system 41 3.4 Uric acid-lowering agents 41 3.5 Vitamin D supplements in the management of CKD–mineral (...) of at least 90 days. Stages 1 and 2 were defined by the presence of markers of kidney damage including albuminuria, urine sediment abnormalities, electrolyte and other abnormalities caused by tubular disorders, abnormalities detected by histology, structural abnormalities detected by imaging and a history of kidney transplantation. T o delineate an increased risk of adverse outcomes, the 2008 NICE guideline on chronic kidney disease suggested 2 key changes to this classification: the subdivision of stage

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

243. Chronic Myeloid Leukaemia: ESMO Clinical Practice Guidelines

- diate need for therapy because of high leukocyte counts or clinical symptoms. TKI therapy should be commenced immediately after con?rmation of BCR–ABL1 positivity. It is recommended to taper the hydroxyurea dose before its discontinuation. To avoidtumourlysis syndrome,2.5–3L?uid intakeisrecom- mended per day considering the individual cardiac and/or renal situ- ation. Sodium bicarbonate may be used to set the urine pH to 6.4– 6.8 for optimal uric acid clearance. Allopurinol may increase the risk (...) be used to set the urine pH to 6.4–6.8 for optimal uric acid clearance. Allopurinol may increase the risk of xanthine accumulation with renal failure and should therefore be restricted to patients with symptomatic hyperuricemia. • If the response to TKIs is a failure, the treatment must be switched to an alternative TKI, or alloSCT should be considered. Between optimal and failure, there is a grey zone that is de?ned as ‘warning’, meaning that the response must be monitored more carefully

2017 European Society for Medical Oncology

244. Investigation of Neonatal Conjugated Hyperbilirubinaemia

lactate and bicarbonate ? Calcium, phosphate ? Bilirubin (total and conjugated) ? ALT+/-AST, Alkaline phosphatase, GGT ? Albumin ? Cholesterol and triglycerides Metabolic investigations ? Galactose-1-phosphate uridyl transferase ? Alpha-1-antitrypsin level and phenotype ? Plasma and urine amino acids ? Urine organic acids (including succinyl acetone) ? Ward test urine for protein Endocrine investigations ? Thyroid function ? Cortisol (ideally after four hour fast) If low: perform short synacthen test (...) signs), Spine X-Ray: For evidence of Alagille syndrome (butterfly vertebrae) Cardiology assessment and CXR: If heart murmur present, or if other signs of Alagille syndrome. Other investigations for rare disorders: Blood: Lactate, ammonia, pyruvate, uric acid, carnitine and acyl carnitine Very long chain fatty acids or white cell enzymes (glycogen or lysosomal storage disorders) Bile acids (quantitative and qualitative): ideally when OFF ursodeoxycholic acid. If taking urso, specify on request form

2017 British Society of Paediatric Gastroenterology Hepatology and Nutrition

246. Measurement of Reactive Oxygen Species, Reactive Nitrogen Species, and Redox-Dependent Signaling in the Cardiovascular System

investigators and clinical researchers avoid experimental error and ensure high-quality measurements of these important biological species. Introduction Reactive oxygen species (ROS) and reactive nitrogen species (RNS) are produced in virtually all eukaryotic cells. These molecules regulate several physiological processes including proliferation, migration, hypertrophy, differentiation, cytoskeletal dynamics, and metabolism, but when available in excess, they react with lipids, proteins, and nucleic acids (...) Free radical; neutral form of hydroxide ion (HO − ) Superoxide anion Free radical; dioxide (1-); product of 1 e − reduction of dioxygen O 3 Ozone Trioxygen; an allotrope of oxygen OCl − Hypochloride anion Salt of hypochlorous acid ROOH Hydroperoxide Organic peroxide, protonated peroxyl radical ROO· Peroxyl radical Free radical; lipid peroxyl radical when R is a lipid carbon RO· Alkoxyl radical Free radical; lipid alkoxyl radical when R is a lipid carbon Reactive nitrogen species ·NO Nitric oxide

2016 American Heart Association

247. Contrast-induced Nephropathy

bicarbonate versus N-acetylcysteine plus IV saline; 8 RCTs comparing a statin versus IV saline; 5 RCTs comparing a statin plus N-acetylcysteine versus N-acetylcysteine; 6 RCTs comparing statin versus statin, statin by dose, or statins plus other agents; 5 RCTs comparing an adenosine antagonist versus IV saline; 6 RCTs investigating hemodialysis or hemofiltration versus IV saline; 6 RCTs comparing ascorbic acid versus IV saline, and 3 RCTs comparing ascorbic acid to N-acetylcysteine. Although we found many (...) of CIN (RR, 0.93; 95% CI, 0.68 to 1.27). The SOE was low for a clinically important reduction in CIN that was not statistically significant when comparing IV sodium bicarbonate with IV saline in patients receiving LOCM (RR, 0.65; 95% CI, 0.33 to 1.25). The SOE was low for a clinically important reduction in CIN that was not statistically significant when comparing ascorbic acid with IV saline (RR, 0.72; 95% CI, 0.48 to 1.01). The SOE was low that use of hemodialysis versus IV saline to prevent CIN

2016 Effective Health Care Program (AHRQ)

248. Surgical Management of Stones: AUA/Endourology Society Guideline

or distal ureteral stones who require intervention (who were not candidates for or who failed MET), clinicians should recommend URS as first-line therapy. For patients who decline URS, clinicians should offer SWL. (Index Patients 2,3,5,6) Strong Recommendation; Evidence Level Grade B 12. URS is recommended for patients with suspected cystine or uric acid ureteral stones who fail MET or desire intervention. Expert Opinion 13. Routine stenting should not be performed in patients undergoing SWL. (Index (...) ' published in 2014. 6 The surgical management of patients with various stones is described below and divided into 13 respective patient profiles. Index Patients 1-10 are non-morbidly obese; non-pregnant adults (≥ 18 years of age) with stones not thought to be composed of uric acid or cystine; normal renal, coagulation and platelet function; normally positioned kidneys; intact lower urinary tracts without ectopic ureters; no evidence of sepsis; and no anatomic or functional obstruction distal to the stone

2016 American Urological Association

249. Screening and Management of Lipids

- treated patients results in a reduction in the risk of cardiovascular events. Therefore niacin should not be used in conjunction with statins for reduction in cardiovascular events. Rare cases of rhabdomyolysis have been associated with concomitant use of statins and niacin in doses > 1 g. Niacin patients should have baseline ALT and glucose and uric acid, with follow up ALT at 3 months or at dose escalations, and periodically thereafter. Niacin is available over the counter (OTC) as a dietary (...) controlled trials; B=controlled trials, no randomization; C=observational trials; D=opinion of expert panel. 2 UMHS Lipid Therapy Guideline, May 2014 Table 1. Secondary Causes of Hyperlipidemia Secondary Cause Elevated LDL-C Elevated Triglycerides Diet Saturated or trans fats, weight gain, anorexia Weight gain, very low-fat diets, high intake of refined carbohydrates, excessive alcohol intake Drugs Diuretics, cyclosporine, glucocorticoids, amiodarone Oral estrogens, glucocorticoids, bile acid

2016 University of Michigan Health System

250. Heart failure - chronic

factors and to exclude with similar presentations. Possible tests include: Chest X-ray. Blood tests such as urea and electrolytes, estimated glomerular filtration rate (eGFR), full blood count, thyroid function tests, liver function tests, HbA1c, and fasting lipids. Urine dipstick for blood and protein. Lung function tests (peak flow and/or spirometry). Assess for and manage any underlying where appropriate. People with heart failure due to valve disease should be referred for specialist assessment

2019 NICE Clinical Knowledge Summaries

251. Biochemical metabolic levels and vitamin D receptor FokⅠ gene polymorphisms in Uyghur children with urolithiasis. (PubMed)

) and serum chlorine (Cl) (OR = 0.93, 95% CI: 0.88-0.97) were related to Uyghur children urolithiasis risk. A multiple logistic regression model showed CO2CP (OR = 1.17, 95% CI: 1.09-1.26), levels of uric acid (OR = 1.01, 95% CI: 1.00-1.01) and serum sodium (Na) (OR = 0.90, 95% CI: 0.82-0.99) were associated with pediatric urolithiasis. The risk of urolithiasis was increased with the F versus f allele overall (OR = 1.42; 95% CI: 1.01-2.00) and for males (OR = 1.52, 95% CI: 1.02-2.27). However, metabolic (...) levels did not differ by FokⅠ genotypes. In our population, CO2CP and levels of uric acid and serum Na as well as polymorphism of the F allele of the VDR FokⅠ may provide important clues to evaluate the risk of urolithiasis in Uyghur children.

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2019 PLoS ONE

252. Effects of antioxidant-rich foods on altitude-induced oxidative stress and inflammation in elite endurance athletes: A randomized controlled trial. (PubMed)

(23 ± 5 years), ingested antioxidant-rich foods (n = 16), (> doubling their usual intake), or eucaloric control foods (n = 15) during a 3-week altitude training camp (2320 m). Fasting blood and urine samples were collected 7 days pre-altitude, after 5 and 18 days at altitude, and 7 days post-altitude. Change over time was compared between the groups using mixed models for antioxidant capacity [uric acid-free (ferric reducing ability of plasma (FRAP)], oxidative stress (8-epi-PGF2α

2019 PLoS ONE Controlled trial quality: uncertain

253. Screening for Chronic Kidney Disease in Adult Males in Vojvodina: A Cross-sectional Study (PubMed)

, based on estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (ACR), and exploring the determinants and awareness of CKD.This cross-sectional study included 3060 male examinees from the general population, over 18 years of age, whose eGFR and ACR were calculated, first morning urine specimen examined, arterial blood pressure measured and body mass index calculated. Standard biochemistry methods determined creatinine, urea, uric acid and glucose serum concentrations as well (...) as albumin and creatinine urine levels.Prevalence of CKD in the adult male population is 7.9%, highest in men over 65 years of age (46.7%), while in the other age groups it is 3.6-12.6%. The largest number of examinees with a positive CKD marker suffer from arterial hypertension (HTA) and diabetes mellitus (DM). Only 1.3% of examinees with eGFR<60 ml/min/1.73 m2 and/or ACR≥ 3 mg/mmol had been aware of positive CKD biomarkers.Obtained results show the prevalence of CKD in adult males is 7.9%, HTA and DM

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2017 Journal of medical biochemistry

254. Newborn Nursing Care Pathway

to identify variances that may require further assessments Refer to: • Feeding • Weight Norm and Normal Variations • One clear void with possible uric acid crystals (orange/brownish color) • Urine pale yellow and odorless Parent education/ Anticipatory Guidance • Refer to >12 – 24 hr Variance • Refer to >12 – 24 hr Intervention • Refer to >12 – 24 hr Norm and Normal Variations • Voids within 24 hr • = 1 wet, clear, pale yellow diaper(s) 29 • Uric acid crystals in the first 24 hr Parent education (...) and pale yellow 34 Parent education/ Anticipatory Guidance • Refer to >12 – 24 hr Variance • Refer to >24 – 72 hr • Uric acid crystals may indicate dehydration after 72 hours • Urine concentrated • 12 – 24 hr Refer to: Healthy Families BC Website – www.healthyfamiliesbc.ca/parenting Physiological Health: elimination – u rine23 Newborn Guideline 13: Newborn Nursing Care Pathway Physiological Assessment 0 – 12 hours Period of Stability (POS) >12 – 24 hours >24 – 72 hours >72 hours – 7 days and beyond

2015 British Columbia Perinatal Health Program

255. Treatment Strategies for Patients with Renal Colic

Treatment Strategies for Patients with Renal Colic TITLE: Treatment Strategies for Patients with Renal Colic: A Review of the Comparative Clinical and Cost-Effectiveness DATE: 17 November 2014 CONTEXT AND POLICY ISSUES Urinary track calculi or urinary stones, formed from crystalized chemicals in the urine such as calcium oxalate, uric acid and cystine, occur in one of ten Canadians in their lifetime. 1 The obstruction of the urinary tract by calculi at the narrowest anatomical areas leads

2014 Canadian Agency for Drugs and Technologies in Health - Rapid Review

256. Polycythaemia/erythrocytosis

but clinically normal haemoglobin. JAK2 V617F mutation — positive finding is definitive for polycythaemia vera. Negative finding does not rule it out as around 5% of cases involve other mutations. Serum uric acid (optional) — frequently elevated in polycythaemia vera. Abdominal ultrasound — to detect splenomegaly (suggestive of polycythaemia vera) where physical examination is equivocal. Differential diagnosis What else might it be? The differential diagnoses of polycythaemia vera include: Essential (...) , leading to secondary erythrocytosis. Examine the digits, measure oxygen saturation, and listen to the chest — clubbing of digits, oxygen saturation <92% in room air, and/or abnormal heart or breath sounds may suggest secondary erythrocytosis caused by underlying cardiopulmonary disease. Carry out urine dipstick analysis to identify possible renal causes of secondary erythrocytosis. Consider . Take blood samples (without a tourniquet if possible) for haemoglobin, mean corpuscular volume (MCV

2018 NICE Clinical Knowledge Summaries

257. An evidence-based narrative review of the emergency department evaluation and management of rhabdomyolysis. (PubMed)

of muscle cells leading to the release of numerous intracellular molecules, including potassium, calcium, phosphate, uric acid, and creatinine kinase. There are a number of potential etiologies, including exertion, extreme temperature changes, ischemia, infections, immobility, drugs, toxins, endocrine causes, autoimmune reactions, trauma, or genetic conditions. Findings can include myalgias, muscle weakness, or dark-colored urine, but more often include non-specific symptoms. The diagnosis is often (...) determined with an elevated creatinine kinase greater than five times the upper-limit of normal. Severe disease may result in renal failure, electrolyte derangements, liver disease, compartment syndrome, and disseminated intravascular coagulation. Treatment includes addressing the underlying etiology, as well as aggressive intravenous hydration with a goal urine output of 300 mL/h. Bicarbonate, mannitol, and loop diuretics do not possess strong evidence for improved outcomes. Renal replacement therapy

2019 American Journal of Emergency Medicine

258. Effects of ChondroT on potassium Oxonate-induced Hyperuricemic mice: downregulation of xanthine oxidase and urate transporter 1. (PubMed)

, the effect of ChondroT was evaluated on xanthine oxidase (XOD) activity in vitro. The anti-hyperuricemic effect of ChondroT was also studied in potassium oxonate (PO)-induced hyperuricemic model mice. Uric acid (UA) and XOD were evaluated in the serum, urine, and liver of the mice. In addition, we measured serum creatinine (Cr) and blood urea nitrogen (BUN) levels as well as mRNA expression of the mouse urate transporter 1 (mURAT1) to evaluate kidney function and urate excretion in hyperuricemic

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2019 BMC Complementary and Alternative Medicine

259. The death of King Charles II

pressure as a result of kidney disease could have caused a stroke, but there was no post-mortem evidence of that. A suggestion that he died of mercury poisoning is based on dubious supposition and weak evidence. My own interpretation is shown in the figure below. It is clear that Charles had repeated episodes of gout. The ulcer on his foot may have been due to that. Chronic gout, untreated, would almost certainly have led to deposits of uric acid in the kidneys and chronic renal impairment (...) bark and Goa stone were used to counteract fever, and the former might have been effective, since it contains quinine. However, most of these measures would have been ineffective or even dangerous, depending on the doses used and the frequency with which they were administered. In contrast, much could have been done today to treat Charles and to have prolonged his life considerably, and with good quality. His chronic gout would have been alleviated by medicines that increase uric acid excretion

2018 CEBM blog

260. Chronic Kidney Disease for the Medical Resident: A Cheat Sheet for Primary Care Providers

electrolytes for eGFR and electrolyte abnormalities (e.g. metabolic acidosis) ● Complete Blood Cell Count (Anemia) ● Lipid profile ● Uric Acid ● Serum albumin ● Renal ultrasound ○ to look for hydronephrosis, obstruction, cysts, stones, and assess kidney size and characterization ● Urinalysis ○ Quantify proteinuria with urine protein-to-creatinine ratio (Urine albumin-to-creatinine will miss multiple myeloma Bence-Jones proteins) ○ Look for hematuria or other signs of glomerulonephritis ● Consider biopsy (...) of everything a PCP should know about protecting the most important organ. Definition CKD is defined as: 1) The presence of markers of kidney damage for greater than 3 months in blood, urine, or on imaging a) e.g proteinuria, non-urological hematuria, polycystic kidney disease, horseshoe kidney, etc. OR 2) The presence of a GFR of less than 60 mL/min/1.73 m 2 for more than 3 months Risk Factors The is diabetes (44%), followed by hypertension (29%). The cause is usually from an which is damaging

2018 Renal Fellow Network

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