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diuretic resistence

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https://www.readbyqxmd.com/read/29453696/interrelationship-between-diabetes-mellitus-and-heart-failure-the-role-of-peroxisome-proliferator-activated-receptors-in-left-ventricle-performance
#1
REVIEW
Evangelos Oikonomou, Konstantinos Mourouzis, Petros Fountoulakis, Georgios Angelos Papamikroulis, Gerasimos Siasos, Alexis Antonopoulos, Georgia Vogiatzi, Sotiris Tsalamadris, Manolis Vavuranakis, Dimitris Tousoulis
Heart failure (HF) is a common cardiac syndrome, whose pathophysiology involves complex mechanisms, some of which remain unknown. Diabetes mellitus (DM) constitutes not only a glucose metabolic disorder accompanied by insulin resistance but also a risk factor for cardiovascular disease and HF. During the last years though emerging data set up, a bidirectional interrelationship between these two entities. In the case of DM impaired calcium homeostasis, free fatty acid metabolism, redox state, and advance glycation end products may accelerate cardiac dysfunction...
February 17, 2018: Heart Failure Reviews
https://www.readbyqxmd.com/read/29451109/-orthostatic-hypotension-in-elderly-patients
#2
J A H R Claassen
- Orthostatic hypotension is a condition in which there is insufficient recovery of the blood pressure drop which occurs after getting up, which causes a temporary reduction of cerebral perfusion. This increases the risk of falls resulting in injuries.- Orthostatic hypotension is most common in the elderly. The cause is usually multifactorial (including reduced circulating volume, reduced peripheral resistance and limited heart rate increase). Orthostatic hypotension caused by autonomic dysfunction is called neurogenic orthostatic hypotension...
2018: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/29433578/resistant-hypertension-on-treatment-reshypot-sequential-nephron-blockade-compared-to-dual-blockade-of-the-renin-angiotensin-aldosterone-system-plus-bisoprolol-in-the-treatment-of-resistant-arterial-hypertension-study-protocol-for-a-randomized-controlled-trial
#3
Elizabeth do Espirito Santo Cestário, Letícia Aparecida Barufi Fernandes, Luiz Tadeu Giollo-Júnior, Jéssica Rodrigues Roma Uyemura, Camila Suemi Sato Matarucco, Manoel Idelfonso Paz Landim, Luciana Neves Cosenso-Martin, Lúcia Helena Bonalume Tácito, Heitor Moreno, José Fernando Vilela-Martin, Juan Carlos Yugar-Toledo
BACKGROUND: Resistant hypertension is characterized when the blood pressure (BP) remains above the recommended goal after taking three antihypertensive drugs with synergistic actions at their maximum recommended tolerated doses, preferably including a diuretic. Identifying the contribution of intravascular volume and serum renin in maintaining BP levels could help tailor more effective hypertension treatment, whether acting on the control of intravascular volume or sodium balance, or acting on the effects of the renin-angiotensin-aldosterone system (RAAS) on the kidney...
February 12, 2018: Trials
https://www.readbyqxmd.com/read/29407090/long-term-prognostic-significance-of-urinary-sodium-concentration-in-patients-with-acute-heart-failure
#4
Satoshi Honda, Toshiyuki Nagai, Kunihiro Nishimura, Michikazu Nakai, Yasuyuki Honda, Hiroki Nakano, Naotsugu Iwakami, Yasuo Sugano, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Hiroyuki Yokoyama, Hisao Ogawa, Satoshi Yasuda, Toshihisa Anzai
BACKGROUND: Lower urinary sodium concentration (UNa) may reflect impaired renal perfusion, higher neurohormonal activity and diuretic resistance. However, the prognostic impact of UNa in patients with acute heart failure (AHF) has not been fully elucidated. METHODS: We investigate the association between UNa and clinical outcomes in 669 patients admitted with AHF in our prospective registry. Patients were stratified into tertiles based on UNa in a spot urine sample on admission...
March 1, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29397348/-resistant-hypertension-an-update
#5
N F Renna
An estimated 10% to 20% of hypertensive patients could be considered resistant to treatment (RH). These are patients who are not controlled using three drugs, at the maximum tolerated doses, including a diuretic, as well as those with high blood pressure controlled using four or more drugs. The term is used to identify patients that might benefit from special diagnostic and/or therapeutic consideration. The term 'refractory hypertension' has recently been proposed as a novel phenotype of antihypertensive failure...
January 31, 2018: Hipertensión y Riesgo Vascular
https://www.readbyqxmd.com/read/29388370/the-role-of-continuous-renal-replacement-therapy-in-the-management-of-acute-kidney-injury-associated-with-sinusoidal-obstruction-syndrome-following-hematopoietic-cell-transplantation
#6
Rupesh Raina, Ghada A Abusin, Prashant Vijayaraghavan, Jeffery J Auletta, Linda Cabral, Hasan Hashem, Beth A Vogt, Kenneth R Cooke, Rolla F Abu-Arja
Maintaining fluid balance, pre- and post-MA-HCT is essential and usually requires frequent administration of diuretics. Hepatic sinusoidal obstructive syndrome is potentially life-threatening, especially when associated with AKI and MOF. This study describes six patients who developed AKI-associated SOS and diuretic-resistant FO who subsequently underwent CRRT using standardized management guidelines for fluid balance post-HCT. Retrospective chart review was done for HCT patients between September 2011 and October 2013 at a tertiary care children's hospital...
February 1, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29387462/dilemmas-in-the-dosing-of-heart-failure-drugs-titrating-diuretics-in-chronic-heart-failure
#7
David Pham, Justin L Grodin
Despite advances in medical therapy over the past few decades, the incidence of heart failure hospitalisation continues to rise. Diuretics are the most common therapy used to treat heart failure as they relieve congestion. However, there is a lack of guidance on how to best use these medications. Guidelines support the use of diuretics at the lowest clinically effective dose but do not specify a diuretic strategy beyond that. Here we review the diuretics available for treatment, potential mechanisms of diuretic resistance and ways to address this in the ambulatory setting, and review tools that have been developed to help guide diuretic use in the treatment of chronic heart failure...
November 2017: Cardiac Failure Review
https://www.readbyqxmd.com/read/29316186/organ-damage-changes-in-patients-with-resistant-hypertension-randomized-to-renal-denervation-or-spironolactone-the-denervhta-denervaci%C3%A3-n-en-hipertensi%C3%A3-n-arterial-study
#8
Anna Oliveras, Pedro Armario, Laia Sans, Albert Clarà, Susana Vázquez, Luis Molina, Júlia Pareja, Alejandro de la Sierra, Julio Pascual
Renal denervation and spironolactone have both been proposed for the treatment of resistant hypertension, but their effects on preclinical target organ damage have not been compared. Twenty-four patients with 24-hour systolic blood pressure ≥140 mm Hg despite receiving three or more full-dose antihypertensive drugs, one a diuretic, were randomized to receive spironolactone or renal denervation. Changes in 24-hour blood pressure, urine albumin excretion, arterial stiffness, carotid intima-media thickness, and left ventricular mass index were evaluated at 6 months...
January 5, 2018: Journal of Clinical Hypertension
https://www.readbyqxmd.com/read/29288880/diuretics-combined-with-compression-in-resistant-limb-edema-of-advanced-disease-a-case-series-report
#9
Tomasz Gradalski
INTRODUCTION: The extremity edema of advanced disease is a common, multifactorial feature, which impairs patient activities and quality of life. The most frequently chosen management is based on combined decongestive physiotherapy or pharmacotherapy (with diuretics or steroids). Subcutaneous lymphatic drainage in refractory edema may decrease the swelling, prevent spontaneous lymphorrhoea but also increase the risk of infection. Safe and effective conservative management in diuretics resistant edemas is lacking...
December 27, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29287767/resistant-hypertension-renal-denervation-or-intensified-medical-treatment
#10
REVIEW
Alberto Morganti, Giuseppe Mancia
Resistant hypertension (RH) can be diagnosed if blood pressure (BP) is not controlled with the combination of three antihypertensive drugs, including a diuretic, all at effective doses. Patients affected by this condition exhibit a marked increase in the risk of cardiovascular and renal morbid and fatal events. They also exhibit an increased activity of the sympathetic nervous system which is likely to importantly contribute at the renal and other vascular levels to the hypertensive state. Almost 10years ago renal denervation (RDN) by radiofrequency thermal energy delivery to the walls of the renal arteries was proposed for the treatment of RH...
December 27, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/29275380/double-hit-a-unique-case-of-resistant-hypertension
#11
Kristen Elizabeth DeCarlo, Nidhi Agrawal
A middle-aged woman with obesity, hyperlipidaemia and diet-controlled diabetes was referred for resistant hypertension. Her blood pressure (BP) was uncontrolled on five medications, including a diuretic. Physical exam revealed a systolic ejection murmur, and ECHO demonstrated moderate hypertrophy. Laboratory examination revealed elevated aldosterone level (20.7 ng/dL) and elevated aldosterone:renin ratio (41.4 (ng/dL)/(ng/mL/h)), meeting criteria for primary aldosteronism (PA), and confirmed by saline infusion testing...
December 22, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29224639/a-multinational-clinical-approach-to-assessing-the-effectiveness-of-catheter-based-ultrasound-renal-denervation-the-radiance-htn-and-require-clinical-study-designs
#12
RANDOMIZED CONTROLLED TRIAL
Laura Mauri, Kazuomi Kario, Jan Basile, Joost Daemen, Justin Davies, Ajay J Kirtane, Felix Mahfoud, Roland E Schmieder, Michael Weber, Shinsuke Nanto, Michel Azizi
Catheter-based renal denervation is a new approach to treat hypertension via modulation of the renal sympathetic nerves. Although nonrandomized and small, open-label randomized studies resulted in significant reductions in office blood pressure 6months after renal denervation with monopolar radiofrequency catheters, the first prospective, randomized, sham-controlled study (Symplicity HTN-3) failed to meet its blood pressure efficacy end point. New clinical trials with new catheters have since been designed to address the limitations of earlier studies...
January 2018: American Heart Journal
https://www.readbyqxmd.com/read/29203397/pro-arrhythmic-effects-of-low-plasma-k-in-human-ventricle-an-illustrated-review
#13
REVIEW
Beatriz Trenor, Karen Cardona, Lucia Romero, Juan F Gomez, Javier Saiz, Sridharan Rajamani, Luiz Belardinelli, Wayne Giles
Potassium levels in the plasma, [K+]o, are regulated precisely under physiological conditions. However, increases (from approx. 4.5 to 8.0mM) can occur as a consequence of, e.g., endurance exercise, ischemic insult or kidney failure. This hyperkalemic modulation of ventricular electrophysiology has been studied extensively. Hypokalemia is also common. It can occur in response to diuretic therapy, following renal dialysis, or during recovery from endurance exercise. In the human ventricle, clinical hypokalemia (e...
November 24, 2017: Trends in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29169714/-idiopathic-nephrotic-syndrome
#14
O Boyer, V Baudouin, E Bérard, C Dossier, V Audard, V Guigonis, I Vrillon
Nephrotic syndrome (NS) is defined by massive proteinuria and hypoalbuminemia, with resulting hyperlipidemia and edema. The most common cause of NS in children is idiopathic nephrotic syndrome (INS), also called nephrosis. Its annual incidence has been estimated to 1-4 per 100,000 children and varies with age, race, and geography. Many agents or conditions have been reported to be associated with INS such as infectious diseases, drugs, allergy, vaccinations, and malignancies. The disease may occur during the 1st year of life, but it usually starts between the ages of 2 and 7 years...
December 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/29142756/usefulness-of-central-venous-saturation-as-a-predictor-of-thiamine-deficiency-in-critically-ill-patients-a-case-report
#15
Genri Numata, Satoshi Kodera, Hiroyuki Kiriyama, Atsuko Nakayama, Eisuke Amiya, Arihiro Kiyosue, Masaru Hatano, Eiki Takimoto, Masafumi Watanabe, Issei Komuro
Background: Central venous oxygen saturation (ScvO2) reflects the balance of oxygen delivery and consumption. Low ScvO2 indicates the presence of inadequate oxygen delivery, while high ScvO2 indicates reduced oxygen consumption and is sometimes associated with a high mortality rate in critically ill patients from dysoxia. Thiamine is an essential cofactor in cellular aerobic metabolism. Thiamine deficiency is more prevalent than was previously thought, and underlies severe conditions in critically ill patients...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/29100270/albuminuria-confers-renal-resistance-to-loop-diuretics-via-the-stimulation-of-nlrp3-inflammasome-prostaglandin-signaling-in-thick-ascending-limb
#16
Yibo Zhuang, Zhanjun Jia, Caiyu Hu, Guixia Ding, Xintong Zhang, Yue Zhang, Guangrui Yang, Rajeev Rohatgi, Songming Huang, John Ci-Jiang He, Aihua Zhang
Renal resistance to loop diuretics is a frequent complication in a number of kidney disease patients with elusive mechanism. Employing human renal biopsy specimens, albumin overload mouse model, and primary cultures of mouse renal tubular cells, albuminuria effect on NKCC2 expression and function and the underlying mechanisms were investigated. In the renal biopsy specimens of albuminuric patients, we found that NKCC2 was significantly downregulated with a negative correlation with albuminuria severity as examined by immunohistochemistry...
September 29, 2017: Oncotarget
https://www.readbyqxmd.com/read/29075541/unusual-complication-of-multidrug-resistant-tuberculosis
#17
Prerna Sharma, Ravindra Nath Sahay
INTRODUCTION: Capreomycin is a second-line drug often used for multidrug-resistant tuberculosis which can result in nephrotoxic effects similar to other aminoglycosides. We describe a case of capreomycin induced Bartter-like syndrome with hypocalcemic tetany. CASE REPORT: 23-year-old female patient presented with carpopedal spasms and tingling sensations in hands. Patient was being treated with capreomycin for two months for tuberculosis. On further investigation, hypocalcemia, hyponatremia, hypomagnesemia, hypokalemia, and hypochloremic metabolic alkalosis were noted...
2017: Case Reports in Nephrology
https://www.readbyqxmd.com/read/29063302/effects-of-tolvaptan-on-urine-output-in-hospitalized-heart-failure-patients-with-hypoalbuminemia-or-proteinuria
#18
Koji Takagi, Naoki Sato, Shiro Ishihara, Michiko Sone, Hideo Tokuyama, Kenji Nakama, Toshiya Omote, Arifumi Kikuchi, Masahiro Ishikawa, Kenichi Amitani, Naoto Takahashi, Yuji Maruyama, Hajime Imura, Wataru Shimizu
Hypoalbuminemia is an independent prognostic factor in hospitalization for heart failure (HHF). Hypoalbuminemia or proteinuria is related to resistance to loop diuretics. Tolvaptan is an oral non-peptide, competitive antagonist of vasopressin receptor-2. It has been used for the treatment of volume overload in HHF patients in several Asian countries. Several studies have demonstrated marked improvement in congestion in HHF patients. However, whether tolvaptan is useful for HHF patients with hypoalbuminemia or proteinuria (both of which are related to resistance to loop diuretics) has not been clarified...
October 23, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/29043393/characterization-of-a-set-of-abdominal-neuroendocrine-cells-that-regulate-stress-physiology-using-colocalized-diuretic-peptides-in-drosophila
#19
Meet Zandawala, Richard Marley, Shireen A Davies, Dick R Nässel
Multiple neuropeptides are known to regulate water and ion balance in Drosophila melanogaster. Several of these peptides also have other functions in physiology and behavior. Examples are corticotropin-releasing factor-like diuretic hormone (diuretic hormone 44; DH44) and leucokinin (LK), both of which induce fluid secretion by Malpighian tubules (MTs), but also regulate stress responses, feeding, circadian activity and other behaviors. Here, we investigated the functional relations between the LK and DH44 signaling systems...
October 17, 2017: Cellular and Molecular Life Sciences: CMLS
https://www.readbyqxmd.com/read/29034321/refractory-versus-resistant-hypertension-novel-distinctive-phenotypes
#20
Tanja Dudenbostel, Mohammed Siddiqui, Nitin Gharpure, David A Calhoun
Resistant hypertension (RHTN) is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is defined as blood pressure (BP) >140/90 mmHg treated with ≥3 antihypertensive medications, including a diuretic, if tolerated. Refractory hypertension is a novel phenotype of severe antihypertensive treatment failure. The proposed definition for refractory hypertension, i.e. BP >140/90 mmHg with use of ≥5 different antihypertensive medications, including a diuretic and a mineralocorticoid receptor antagonist (MRA) has been applied inconsistently...
September 2017: Journal of Nature and Science
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