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Homeostasis

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39 papers 100 to 500 followers
By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
https://www.readbyqxmd.com/read/29029808/potassium-homeostasis-in-health-and-disease-a-scientific-workshop-cosponsored-by-the-national-kidney-foundation-and-the-american-society-of-hypertension
#1
Csaba P Kovesdy, Lawrence J Appel, Morgan E Grams, Lisa Gutekunst, Peter A McCullough, Biff F Palmer, Bertram Pitt, Dominic A Sica, Raymond R Townsend
While much emphasis, and some controversy, centers on recommendations for sodium intake, there has been considerably less interest in recommendations for dietary potassium intake, in both the general population and patients with medical conditions, particularly acute and chronic kidney disease. Physiology literature and cohort studies have noted that the relative balance in sodium and potassium intakes is an important determinant of many of the sodium-related outcomes. A noteworthy characteristic of potassium in clinical medicine is the extreme concern shared by many practitioners when confronted by a patient with hyperkalemia...
September 29, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29030153/potassium-homeostasis-in-health-and-disease-a-scientific-workshop-cosponsored-by-the-national-kidney-foundation-and-the-american-society-of-hypertension
#2
Csaba P Kovesdy, Lawrence J Appel, Morgan E Grams, Lisa Gutekunst, Peter A McCullough, Biff F Palmer, Bertram Pitt, Dominic A Sica, Raymond R Townsend
While much emphasis, and some controversy, centers on recommendations for sodium intake, there has been considerably less interest in recommendations for dietary potassium intake, in both the general population and patients with medical conditions, particularly acute and chronic kidney disease. Physiology literature and cohort studies have noted that the relative balance in sodium and potassium intakes is an important determinant of many of the sodium-related outcomes. A noteworthy characteristic of potassium in clinical medicine is the extreme concern shared by many practitioners when confronted by a patient with hyperkalemia...
October 6, 2017: Journal of the American Society of Hypertension: JASH
https://www.readbyqxmd.com/read/29102372/renal-potassium-physiology-integration-of-the-renal-response-to-dietary-potassium-depletion
#3
REVIEW
Kamel S Kamel, Martin Schreiber, Mitchell L Halperin
We summarize the current understanding of the physiology of the renal handling of potassium (K(+)), and present an integrative view of the renal response to K(+) depletion caused by dietary K(+) restriction. This renal response involves contributions from different nephron segments, and aims to diminish the rate of excretion of K(+) as a result of: decreasing the rate of electrogenic (and increasing the rate of electroneutral) reabsorption of sodium in the aldosterone-sensitive distal nephron (ASDN), decreasing the abundance of renal outer medullary K(+) channels in the luminal membrane of principal cells in the ASDN, decreasing the flow rate in the ASDN, and increasing the reabsorption of K(+) in the cortical and medullary collecting ducts...
November 1, 2017: Kidney International
https://www.readbyqxmd.com/read/29063671/magnesium-supplementation-a-consideration-in-dialysis-patients
#4
EDITORIAL
Mugurel Apetrii, Adrian Covic, Ziad A Massy
Even though disorders of magnesium (Mg) balance are common in dialyzed patients, this cation is often neglected. Many factors interfere with serum magnesium including diet, medications (eg, antacids or phosphate binders), and the dialysis prescription. Mg supplementation may help reduce serum phosphate concentration, PTH, and interfere with vascular calcification and bone mineralization. It could also decrease the all-cause and cardiovascular mortalities, although the results of current studies are conflicting...
October 23, 2017: Seminars in Dialysis
https://www.readbyqxmd.com/read/29031355/adverse-effects-of-the-metabolic-acidosis-of-chronic-kidney-disease
#5
REVIEW
Jeffrey A Kraut, Nicolaos E Madias
The kidney has the principal role in the maintenance of acid-base balance, and therefore, a fall in renal net acid excretion and positive H(+) balance often leading to reduced serum [HCO3(-)] are observed in the course of CKD. This metabolic acidosis can be associated with muscle wasting, development or exacerbation of bone disease, hypoalbuminemia, increased inflammation, progression of CKD, protein malnutrition, alterations in insulin, leptin, and growth hormone, and increased mortality. Importantly, some of the adverse effects can be observed even in the absence of overt hypobicarbonatemia...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29031353/regulation-of-acid-base-balance-in-chronic-kidney-disease
#6
REVIEW
Glenn T Nagami, L Lee Hamm
The kidneys play a major role in the regulation of acid-base balance by reabsorbing bicarbonate filtered by the glomeruli and excreting titratable acids and ammonia into the urine. In CKD, with declining kidney function, acid retention and metabolic acidosis occur, but the extent of acid retention depends not only on the degree of kidney impairment but also on the dietary acid load. Acid retention can occur even when the serum bicarbonate level is apparently normal. With reduced kidney function, acid transport processes in the surviving nephrons are augmented but as disease progresses ammonia excretion and, in some individuals, the ability to reabsorb bicarbonate falls, whereas titratable acid excretion is preserved until kidney function is severely impaired...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29030467/metabolic-acidosis-and-subclinical-metabolic-acidosis-in-ckd
#7
Kalani L Raphael
Metabolic acidosis is not uncommon in CKD and is linked with bone demineralization, muscle catabolism, and higher risks of CKD progression and mortality. Clinical practice guidelines recommend maintaining serum total CO2 at ≥22 mEq/L to help prevent these complications. Although a definitive trial testing whether correcting metabolic acidosis improves clinical outcomes has not been conducted, results from small, single-center studies support this notion. Furthermore, biologic plausibility supports the notion that a subset of patients with CKD have acid-mediated organ injury despite having a normal serum total CO2 and might benefit from oral alkali before overt acidosis develops...
October 13, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28899602/an-increasingly-complex-relationship-between-salt-and-water
#8
EDITORIAL
Evan C Ray, Thomas R Kleyman
No abstract text is available yet for this article.
November 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28879535/hypercalcemia-a-consultant-s-approach
#9
Ari Auron, Uri S Alon
Due to their daily involvement in mineral metabolism, nephrologists are often asked to consult on children with hypercalcemia. This might become even more pertinent when the hypercalcemia is associated with acute kidney injury and/or hypercalciuria and renal calcifications. The best way to assess the severity of hypercalcemia is by measurement of plasma ionized calcium, and if not available by adjusting serum total calcium to albumin concentration. The differential diagnosis of the possible etiologies of the disturbance in the mineral homeostasis starts with the assessment of serum parathyroid hormone concentration, followed by that of vitamin D metabolites in search of both genetic and acquired etiologies...
September 6, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28729033/metabolic-acidosis-is-common-and-associates-with-disease-progression-in-children-with-chronic-kidney-disease
#10
Jérôme Harambat, Kevin Kunzmann, Karolis Azukaitis, Aysun K Bayazit, Nur Canpolat, Anke Doyon, Ali Duzova, Anna Niemirska, Betul Sözeri, Daniela Thurn-Valsassina, Ali Anarat, Lucie Bessenay, Cengiz Candan, Amira Peco-Antic, Alev Yilmaz, Sibylle Tschumi, Sara Testa, Augustina Jankauskiene, Hakan Erdogan, Alejandra Rosales, Harika Alpay, Francesca Lugani, Klaus Arbeiter, Francesca Mencarelli, Aysel Kiyak, Osman Dönmez, Dorota Drozdz, Anette Melk, Uwe Querfeld, Franz Schaefer
Recent studies in adult chronic kidney disease (CKD) suggest that metabolic acidosis is associated with faster decline in estimated glomerular filtration rate (eGFR). Alkali therapies improve the course of kidney disease. Here we investigated the prevalence and determinants of abnormal serum bicarbonate values and whether metabolic acidosis may be deleterious to children with CKD. Associations between follow-up serum bicarbonate levels categorized as under 18, 18 to under 22, and 22 or more mmol/l and CKD outcomes in 704 children in the Cardiovascular Comorbidity in Children with CKD Study, a prospective cohort of pediatric patients with CKD stages 3-5, were studied...
July 17, 2017: Kidney International
https://www.readbyqxmd.com/read/28692217/-magnesium-in-daily-practice
#11
Dany Minetto, Jacques Serratrice, Jérôme Stirnemann
The magnesium is the 4th cation in the human body behind sodium, potassium and calcium. It is often referred to as the forgotten cation of modern medicine because of a lack of knowledge about its physiology and its potential medical use. Recent medical literature has shown renewed interest for the magnesium with publications about its role in diversified fields from prevention of muscular cramps, cardiovascular risk factors prevention trough to neuroprotection in stroke. However, we cannot recommend the use of magnesium in adults in our clinical practice, beyond the simple correction of hypomagnesemia, pre-eclampsia and possibly the treatment of torsades de pointes...
October 19, 2016: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28599903/metabolic-acidosis-or-respiratory-alkalosis-evaluation-of-a-low-plasma-bicarbonate-using-the-urine-anion-gap
#12
Daniel Batlle, Jamie Chin-Theodorou, Bryan M Tucker
Hypobicarbonatemia, or a reduced bicarbonate concentration in plasma, is a finding seen in 3 acid-base disorders: metabolic acidosis, chronic respiratory alkalosis and mixed metabolic acidosis and chronic respiratory alkalosis. Hypobicarbonatemia due to chronic respiratory alkalosis is often misdiagnosed as a metabolic acidosis and mistreated with the administration of alkali therapy. Proper diagnosis of the cause of hypobicarbonatemia requires integration of the laboratory values, arterial blood gas, and clinical history...
September 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28450695/hyperphosphatemia-a-cause-of-high-anion-gap-metabolic-acidosis-report-of-a-case-and-review-of-the-literature
#13
Seyed Ali Sadjadi, Alexander Pi
BACKGROUND Hyperphosphatemia is a common problem in patients with kidney failure. It is usually mild and rarely severe enough to cause metabolic acidosis on its own. Besides kidney failure, use of phosphate containing enemas, rhabdomyolysis, and tumor lysis syndrome are common causes of severe hyperphosphatemia. CASE REPORT A 74-year-old man with a history of diabetes mellitus type II, arterial hypertension, and end stage renal disease, who was on hemodialysis and who had undergone hemicolectomy for ischemic bowel disease, and had not eaten for several days, developed severe metabolic acidosis, with an anion gap (AG) of 31 meq/L, -uncorrected for serum albumin...
April 28, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/27590096/assessing-acid-base-status-physiologic-versus-physicochemical-approach
#14
Horacio J Adrogué, Nicolaos E Madias
The physiologic approach has long been used in assessing acid-base status. This approach considers acids as hydrogen ion donors and bases as hydrogen ion acceptors and the acid-base status of the organism as reflecting the interaction of net hydrogen ion balance with body buffers. In the physiologic approach, the carbonic acid/bicarbonate buffer pair is used for assessing acid-base status and blood pH is determined by carbonic acid (ie, Paco2) and serum bicarbonate levels. More recently, the physicochemical approach was introduced, which has gained popularity, particularly among intensivists and anesthesiologists...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/26901864/osmoregulation-during-long-term-fasting-in-lungfish-and-elephant-seal-old-and-new-lessons-for-the-nephrologist
#15
REVIEW
Bernard C Rossier
Vertebrates control the osmolality of their extra- and intra-cellular compartments despite large variations in salt and water intake. Aldosterone-dependent sodium reabsorption and vasopressin-dependent water transport in the distal nephron and collecting duct play a critical role in the final control of sodium and water balance. Long-term fasting (no eating, no drinking) represents an osmotic challenge for survival. Evolution has found very different solutions to meet this challenge. To illustrate this point, I will discuss osmoregulation of a mammal (elephant seal pup) and of a fish (lungfish) that are able to survive long-term fasting for months or even years...
2016: Nephron
https://www.readbyqxmd.com/read/26854262/the-importance-of-the-gastrorenal-axis-in-the-control-of-body-sodium-homeostasis
#16
REVIEW
Pedro A Jose, Zhiwei Yang, Chunyu Zeng, Robin A Felder
What is the topic of this review? Sensing the amount of ingested sodium is one mechanism by which sodium balance is regulated. This review describes the role of gastrin in the cross-talk between the stomach and the kidney following the ingestion of sodium. What advances does it highlight? Neural mechanisms and several gut hormones, including cholecystokinin and uroguanylin, have been suggested to mediate the natriuresis after an oral sodium load. It is proposed that gastrin produced by G-cells via its receptor, cholecystokinin B receptor, interacts with renal D1 -like dopamine receptors to increase renal sodium excretion...
April 2016: Experimental Physiology
https://www.readbyqxmd.com/read/26854277/the-pharmacokinetics-of-potassium-in-humans-is-unusual
#17
REVIEW
Peter H Hinderling
Potassium is critical for maintaining cellular tonicity, propagation of nerve impulses, contraction of cardiac, skeletal, and smooth muscles, and normal renal function. The focus of this review is on the pharmacokinetics of potassium, K(+) , after administration of liquid and solid formulations of potassium chloride, KCl, to healthy subjects. Potassium can be considered an endogenous and exogenous compound. The amounts of endogenous K(+) are kept constant by balancing intake and loss of exogenous K(+) . Food and ingestion of KCl-containing medicines are sources for exogenous K(+) ...
October 2016: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/26880451/treatment-of-hyperkalemia-something-old-something-new
#18
REVIEW
Richard H Sterns, Marvin Grieff, Paul L Bernstein
Treatment options for hyperkalemia have not changed much since the introduction of the cation exchange resin, sodium polystyrene sulfonate (Kayexalate, Covis Pharmaceuticals, Cary, NC), over 50 years ago. Although clinicians of that era did not have ready access to hemodialysis or loop diuretics, the other tools that we use today-calcium, insulin, and bicarbonate-were well known to them. Currently recommended insulin regimens provide too little insulin to achieve blood levels with a maximal kalemic effect and too little glucose to avoid hypoglycemia...
March 2016: Kidney International
https://www.readbyqxmd.com/read/26772188/low-blood-levels-of-bicarbonate-are-linked-to-premature-death-in-healthy-older-people-study-shows
#19
COMMENT
Susan Mayor
No abstract text is available yet for this article.
January 14, 2016: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/26687922/evaluation-of-polyuria-the-roles-of-solute-loading-and-water-diuresis
#20
Bhavna Bhasin, Juan Carlos Q Velez
Polyuria, defined as daily urine output in excess of 3.0 to 3.5L/d, can occur due to solute or water diuresis. Solute-induced polyuria can be seen in hospitalized patients after a high solute load from exogenous protein administration or following relief of urinary obstruction. Similar clinical scenarios are rarely encountered in the outpatient setting. We describe a case of polyuria due to high solute ingestion and excessive water intake leading to a mixed picture of solute and water diuresis. Restriction of the daily solute load and water intake resulted in complete resolution of polyuria...
March 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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