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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
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
https://www.readbyqxmd.com/read/29034087/spironolactone-in-cardiovascular-disease-an-expanding-universe
#14
REVIEW
John W Funder
Spironolactone has been marketed for over half a century as a 'potassium-sparing diuretic', used primarily in patients with ascites. With the realization that primary aldosteronism is the most common (5-13%) form of secondary hypertension, it has become widely used as a mineralocorticoid receptor antagonist. More recently, in the wake of the RALES trial, spironolactone in addition to standard therapy has been shown to be very beneficial in heart failure with a reduced ejection fraction. Despite the failure of the TOPCAT trial, spironolactone is being increasingly used in diastolic heart failure (i...
2017: F1000Research
https://www.readbyqxmd.com/read/29033430/the-prevalence-of-japanese-outpatients-with-hypertension-who-meet-the-definition-of-treatment-resistant-hypertension-and-are-eligible-for-enrolment-in-clinical-trials-of-endovascular-ultrasound-renal-denervation
#15
Keisuke Okamura, Kazuyuki Shirai, Tetsu Okuda, Hidenori Urata
Objective A clinical trial (REQUIRE) was started to investigate the use of an ultrasound renal denervation system in the treatment of resistant hypertension (RHT). We analyzed the prevalence of patients who were eligible for inclusion in this cross-sectional study at the time of screening. Methods Nine-hundred ninety-nine consecutive hypertension (HT) patients who were treated in our hospital as outpatients were classified into the following categories: patients treated with at least 3 types of antihypertensive drugs including diuretic agents who were eligible for enrolment in SYMPLICITY HTN-Japan (SH-J) with an office systolic blood pressure (SBP) of ≥160 mmHg, who were ≤80 years of age, and an eGFR of ≥45 mL/min/1...
October 16, 2017: Internal Medicine
https://www.readbyqxmd.com/read/29018014/elizabethkingia-meningoseptica-emerging-multidrug-resistance-in-a-nosocomial-pathogen
#16
Sairam Raghavan, Biji Thomas, B A Shastry
A 46-year-old male patient presented with complaints of burning micturition for 2 days. Initial history, physical examination and laboratory investigations were consistent with the diagnosis of congestive cardiac failure (CCF) and concomitant urinary tract infection. CCF was treated with diuretics and a urine culture/sensitivity (C/S) was sent which returned growing Elizabethkingia meningoseptica resistant to all tested drugs. Intravenous cefotaxime which had been started empirically 3 days earlier was withheld at this point, and a repeat urine C/S was sent revealing resistance to all tested drugs (including reserved drugs) barring minocycline...
October 10, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28980452/rationale-and-study-design-of-intravenous-loop-diuretic-administration-in-acute-heart-failure-diur-ahf
#17
Alberto Palazzuoli, Gaetano Ruocco, Giorgio Vescovo, Roberto Valle, Salvatore Di Somma, Ranuccio Nuti
AIMS: Although loop diuretics are the most commonly used drugs in acute heart failure (AHF) treatment, their short-term and long-term effects are relatively unknown. The significance of worsening renal function occurrence during intravenous treatment is not clear enough. This trial aims to clarify all these features and contemplate whether continuous infusion is better than an intermittent strategy in terms of decongestion efficacy, diuretic efficiency, renal function, and long-term prognosis...
October 4, 2017: ESC Heart Failure
https://www.readbyqxmd.com/read/28977099/fluid-overload-in-children-undergoing-mechanical-ventilation
#18
Clarice Laroque Sinott Lopes, Jefferson Pedro Piva
Patients admitted to an intensive care unit are prone to cumulated fluid overload and receive intravenous volumes through the aggressive resuscitation recommended for septic shock treatment, as well as other fluid sources related to medications and nutritional support. The liberal liquid supply strategy has been associated with higher morbidity and mortality. Although there are few prospective pediatric studies, new strategies are being proposed. This non-systematic review discusses the pathophysiology of fluid overload, its consequences, and the available therapeutic strategies...
July 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28959123/ultrasound-assessment-of-kidney-volume-in-patients-with-acute-decompensated-heart-failure-a-predictor-of-diuretic-resistance
#19
Shinobu Sugihara, Yoshiharu Kinugasa, Tomoaki Takata, Takaaki Sugihara, Keiko Hosho, Chitose Imai, Hiromi Ito, Kensaku Yamada, Masahiko Kato, Kazuhiro Yamamoto
BACKGROUND: Diuretics are essential for treating acute decompensated heart failure (ADHF), but the response is inconsistent. This study aimed to clarify whether kidney volume as assessed by ultrasound (US) predicts diuretic resistance in patients with ADHF. METHODS: We enrolled 29 patients with ADHF and 32 controls. Height-adjusted kidney volume was assessed by US. We divided patients into two groups based on the median value of total daily use of furosemide (intravenous dose plus 0...
September 2017: Yonago Acta Medica
https://www.readbyqxmd.com/read/28948051/persistent-unexplained-dyspnea-a-case-of-hepatopulmonary-syndrome
#20
Alfonso Campanile, Alessandro Colombo, Maurizio Del Pinto, Claudio Cavallini
Regarding a patient with dyspnea, the history and physical examination often lead to the correct diagnosis. In some circumstances, when more than one underlying disease is present, the diagnostic process can be more challenging. We describe an unusual case of dyspnea and persistent hypoxemia related to a hepatopulmonary syndrome in a 53-year-old patient with known heart failure and chronic liver disease. Initially managed with intravenous diuretic therapy, due to signs of lung and peripheral congestion, our patient did not improve as expected; therefore we performed more advanced studies with a chest-abdomen CT scan and a right heart catheterization...
2017: Case Reports in Cardiology
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