Treatment of type 2 renal tubular acidosis uptodate,type 1 1 2 diabetes myth or reality summary,rzr 800 s 2 lift kit - PDF Books


Acute renal failure is the rapid  loss your kidneys’ ability to remove waste and help balance fluids and electrolytes in your body. Prerenal causes  include systemic causes, such as low blood volume, low blood pressure, heart failure, liver cirrhosis and local changes to the blood vessels supplying the kidney.
Allergic, drug induced, toxin induced, contrast media induces, Intra-renal deposition of myeloma protein and uric acid. Shock, Aminoflycosides, Radiographic contrast material,Toxemia of pregnancy, Crush injuries, Analgesic nephropathy.
Vomiting, abdominal pain, adynamic ileus, acidotic reath, kussmaul’s breathing, drowsiness, confusion, agitation, cramps, twitching, chest pain (Pericarditis), neuropathy, hypertension, dypnoea, tremor.
Renal Tubular Acidosis or RTA is a kidney disease in which the kidneys are unable to maintain the acid-base balance in the body. Increased accumulation of acid in the blood is caused by kidney failure resulting in decreased excretion of acid in urine. The disease is caused by reduced hydrogen (acid) molecules excretion in distal tubule and increased excretion of HCO3 (alkaline) molecule.
The H+ molecule is reabsorbed as acid molecule causing decreased blood pH or acidic pH resulting in metabolic acidosis.
Renal tubular acidosis is often observed in patients suffering with sickle cell disease, lupus and Sjogren syndrome.
Disease is caused by defects in proximal tubules, which results in decreased reabsorption of alkaline molecule HCO3. This condition is generally found in infants and has a close relationship with a medical disorder called as Fanconi Syndrome. The type 4 RTA is usually caused by a disorder where the cellular exchange of electrolytes such as sodium, potassium, chloride and bicarbonate are abnormal. This usually results in abundant potassium retention, which can cause problems for the heart and other vital organs of the body. The Type 4 RTA is caused by UTIs, autoimmune dysfunction, sickle cell disease and diabetes. Autoimmune4- Sjogren’s syndrome is known autoimmune disease associated with Renal Tubular Acidosis.5 Other autoimmune disease associated with Renal Tubular Acidosis are SLE and Thyroiditis.
For a confirmatory diagnosis of Renal Tubular Acidosis, the treating physician does a detailed physical examination and orders a blood test. A favorable plan of treatment is made when a diagnosis of Renal Tubular Acidosis is suspected on the tests conducted. Another form of treatment for Renal Tubular Acidosis can be alkaline medications to restore acid-base balance in the blood like sodium bicarbonate, which helps to cut down the acidic concentration in the blood. How to cite this article:Otunctemur A, Ozbek E, Cakir SS, Polat EC, Dursun M, Cekmen M, Somay A, Ozbay N. How to cite this URL:Otunctemur A, Ozbek E, Cakir SS, Polat EC, Dursun M, Cekmen M, Somay A, Ozbay N. To review and illustrate the typical ultrasound findings of renal transplant complications based on our department clinical database. Ultrasound is a noninvasive and innocuous method to depict and characterize most of the complications of renal transplantation. 2 clicks for more privacy: On the first click the button will be activated and you can then share the poster with a second click. The latter include renal artery stenosis, or the narrowing of the renal artery which supplies the kidney with blood, and renal vein thrombosis, which is the formation of a blood clot in the renal vein that drains blood from the kidney. These causes stem from the inadequate cardiac output and hypovolemia or vascular diseases causing reduced perfusion of both kidneys. The condition causes increased acidic contents in the blood and decreases excretion of acid molecules in urine.
Electrolyte imbalances and nephrocalcinosis in acute phosphate poisoning on chronic type 1 renal tubular acidosis due to Sjogren's syndrome. Mutation analysis and audiologic assessment in six Chinese children with primary distal renal tubular acidosis.
Bilateral nephrocalcinosis, distal renal tubular acidosis and interstitial nephritis in primary Sjogren's syndrome. Type IV renal tubular acidosis following resolution of acute kidney injury and disseminated intravascular coagulation due to hump-nosed viper bite.
We know that the pomegranate extract (PE) play a strong role on removal of free oxygen radicals and prevention of oxidative stress. Pomegranate extract attenuates unilateral ureteral obstruction-induced renal damage by reducing oxidative stress. It results in a progressive and permanent loss in renal function that is characterized by interstitial inflammation and tubulointerstitial fibrosis. Antioxidant expression in experimental hydronephrosis: Role of mechanical stretch and growth factors.
Cyanidin 3-O-beta-D-glucoside suppresses nitric oxide production during a zymosan treatment in rats. Beneficial effects of pomegranate juice on oxidation-sensitive genes and endothelial nitric oxide synthase activity at sites of perturbed shear stress. Pomegranate juice flavonoids inhibit low-density lipoprotein oxidation and cardiovascular diseases: studies in atherosclerotic mice and in humans.


Pomegranate juice supplementation to atherosclerotic mice reduces macrophage lipid peroxidation, cellular cholesterol accumulation and development of atherosclerosis. Vascular endothelial growth factor gene polymorphism is associated with calcium oxalate stone disease. The effects of citrate, polyphosphates and pridoxin on intratubular crystallization in hyperoxaluric rats.
Preventive effects of green tea on renal stone formation and the role of oxidative stress in nephrolithiasis. Melatonin attenuates unilateral ureteral obstruction-induced renal injury by reducing oxidative stress, iNOS, MAPK, and NF-kB expression. Pomegranate juice consumption reduces oxidative stress, atherogenic modifications to LDL, and platelet aggregation: Studies in humans and in atherosclerotic apolipoprotein E-deficient mice. A novel mechanism for the inhibition of NF-kappaB activation in vascular endothelial cells by natural antioxidants. Rosiglitazone, an agonist of peroxisome proliferator-activated receptor c, protects against gastric ischemia-reperfusion damage in rats: Role of oxygen free radicals generation.
Optimized steps in fluorometric determination of thiobarbituric acid-reactive substances in serum: importance of extraction pH and influence of sample preservation and storage. Prevention of renal interstitial fibrosis via histone deacetylase inhibition in rats with unilateral ureteral obstruction.
Turmeric-based diet can delay apoptosis without modulating NF-kappaB in unilateral ureteral obstruction in rats. Preclinical evaluation of pharmacokinetics and safety of melatonin in propylene glycol for intravenous administration. Melatonin is a safe and effective treatment for chronic pulmonary and extrapulmonary sarcoidosis. Effect of Spirulina, a blue green algae, on gentamicin-induced oxidative stress and renal dysfunction in rats.
Atorvastatin prevents gentamicin-induced renal damage in rats through the inhibition of p38-MAPK and NF-kappaB pathways.
Carvedilol: A beta blocker with antioxidant property protects against gentamicin-induced nephrotoxicity in rats. Protective effect of human ulinastatin against gentamicin-induced acute renal failure in rats.
Both kidneys need to be affected as one kidney is still more than adequate for normal kidney function. In this article, we will read about the different causes, symptoms, and treatments for Renal Tubular Acidosis.
In the current study study, we evaluated the effect of PE on kidney damage after unilateral ureteral obstruction (UUO). The acute phase of obstructed kidney in unilateral ureteral obstruction (UUO) is characterized by dramatic changes in glomerular filtration rate, renal blood flow, and interstitial edema.
After 14 days, rats were killed and their kidneys were taken and blood analysis was performed. It has been shown that oxidative stress in UUO contributes to the development of tubulointerstitial lesions and renal fibrosis. Statistical Analysis Used: Statistical analyses were performed by the Chi-square test and one-way analysis of variance.
Various factors with complex cellular and molecular interactions have also been proposed as possible causes that lead to tubulointerstitial lesions and renal fibrosis. Edible parts of pomegranate fruit represent 52% of total fruit weight, comprising 78% juice and 22% seeds. Anthocyanins were shown to be effective inhibitors of LPO, production of nitric oxide (NO), and inducible nitric oxide synthase activity in different model systems. Many investigators have reported that pomegranate and it's derivatives have free radical scavenger and potent antioxidant activity. NO has an important role in the elimination of pathogens and tumor cells; however, overproduced NO is oxidized to ROS, resulting in the disruption of cell signaling and uncontrolled systemic inflammation. Glutathione (GSH) is the major intracellular antioxidant with multiple biological functions, including the maintenance of the thiol moieties of proteins and the reduced from of many other biologically active molecules.
The use of animals and the experimental protocol were approved by the Institutional Animal Care and Use Committee and animals were treated in accordance with the Guide for the Care and Use of Laboratory Animals of Research Council.Experimental designOne week after acclimatization, UUO was induced. After 15 days, rats were killed and their kidneys were taken and blood analysis was performed. Tubular necrosis, mononuclear cell infiltration and interstitial fibrosis scoring were determined histopathologically in a part of kidneys; NO, MDA and reduced glutathione (GSH) levels were determined in the other part of kidneys.
Urea, creatinine levels were investigated in a blood analysis.Biochemical assaysTwenty-four hours after the administration of last doses of PE, on 15 th day, rats were anesthetized by intraperitoneal injection of ketamine and sacrificed.
Renal cortical tissues were separated into two parts for biochemical analysis and light microscopic examination. Blood samples were also taken by cardiac puncture to assess the serum levels of urea and creatinine concentrations. In frozen tissues biochemically MDA, end product of LPO, reduced glutathione (GSH), nonenzymatic antioxidant, and total nitrite, a stable product of NO, were evaluated as a means of oxidative stress.Renal impairment was assessed by serum urea and creatinine levels, as well as by the kidney histology.
Serum urea and creatinine levels were determined with an autoanalyzer (Beckman Coulter Synchron L × 20, Ireland) by using commercial Becman Coulter diagnostic kits.


Kidney tissue (300 mg) was homogenized in icecold tamponade containing 150 mM KCL for determination of MDA. MDA referred to as thiobarbituric acid reactive substance, was measured with thiobarbituric acid at 532 nm using a spectrofluorometer, as described previously.
Paraffin-embedded specimens were cut into 6-μm thickness and stained with hematoxylin and eosin stain for light microscopic examination using a conventional protocol [26] (Olympus, BH-2, Tokyo, Japan).
A semi-quantitative evaluation of renal tissues was accomplished by scoring the degree of severity according to previously published criteria.
Briefly, minimum of 50 proximal tubules associated with 50 glomeruli were examined for each slide and an average score was obtained.
Severity of lesion was graded from 0 to 3 according to the percentage of the tubular involvement. Paraffin-embedded specimens were cut into 5-mm thick sections and stained with hematoxylin and eosin and Masson's trichrome for examination under a light microscope (BH-2; Olympus, Tokyo, Japan). To evaluate leukocyte infiltration, the widening of interstitial spaces with focal leukocyte infiltration was assessed in five randomly chosen sections prepared from each kidney sample. For each section, interstitial space widening with focal leukocyte infiltration and interstitial fibrosis was assessed in high-power fields (×400) to quantify the results.
The Banff classification of kidney pathology was used for scoring the degree of mononuclear cell infiltration and interstitial fibrosis. The score was graded from 0 to 3, depending on the severity of histological characteristics.
Statistical analyses of the histopathologic evaluation of the groups were carried out by the Chi-square test and biochemical data were analyzed by the one-way analysis of variance. Rats with PE administration (Group 4) showed reduced levels of LPO as measured by MDA levels [Table 2]. UUO also induced a significant increase in the tissue NO levels that have been prevented by PE [Table 2]. In rats with UUO, there were mild and severe tubular necrosis in the proximal tubules compared control and sham groups [Figure 1]b and c.
Severe leukocyte infiltration was observed in the periglomerular and peritubular interstitium of the kidneys of the rats in Group 3 with UUO [Figure 2]a and b. Quantitative analysis of the focal leukocyte infiltration area in the interstitium showed that leukocyte infiltration was significantly reduced in rats that received UUO + PE (Group 4) [Figure 2]c.
UUO caused a significant interstitial fibrosis in rats that received no treatment (Group 3), and the percentage area of interstitial fibrosis in the kidney of rats with UUO that received no treatment was significantly greater than that of rats with UUO that received PE (Group 4) [Figure 3]a-c. Our results showed that the obstructed kidney had significantly higher tissue MDA, NO levels, and lower GSH levels along with more fibrosis.
The current data demonstrate that UUO structural and functional alterations in the kidney with a concomitant increase in proinflammatory cytokines in the blood.
PE, on the other hand, reduced the severity of injury, depressed the concentration of these cytokines and increased the antioxidative capacity.Pomegranate extract is rich in antioxidants of the polyphenolic class that includes tannins and anthocyanins. These antioxidants are more potent, on a molar basis, than many other antioxidants, including Vitamins C and E, coenzyme Q-10, and lipoic acid. The antioxidant levels in PE were found higher than levels in other natural juices, such as blueberry, cranberry, and orange, as well as in red wine. The present study demonstrated ameliorative effects of PE, a phenolic antioxidant, on UUO-induced nephrotoxicity, in line with the consideration that oxygen-free radicals are important mediators of UUO-induced acute renal failure.Apoptotic cell death has been reported to play an important role in UUO-induced renal damages. However, in a recent study, curcumin and melatonine which is an antioxidant and anti-inflammatory agent like PE, has been reported to prevent UUO-mediated apoptotic cell death and reduce the UUO related renal damage. Although we believe that PE can reduce the UUO-induced renal damage by a similar mechanism that prevents apoptosis-related cell death, there is a need for further study on that subject for verifications.The pathogenesis of renal fibrosis caused by UUO involves infiltration of the kidney by inflammatory cells including monocytes, activation, and possible transformation of intrinsic renal cells, and interactions between infiltrating and resident cells. ROS are a recently recognized mechanism in the pathogenesis of UUO in experimental studies.
Our findings corroborate those of earlier studies demonstrating that an enhanced endogenous oxidative stress has a major role in the severity of UUO-induced acute renal failure. GSH has a very important role in protecting against oxygen-free radical damage by providing reducing equivalents for several enzymes, as well as scavenging hydroxyl radicals and singlet oxygen. Its depletion is a common consequence of increased formation of ROS [35] like UUO-induced nephrotoxicity. However, our study shown that PE effect NO levels protectively in similar to some previous studies with different antioxidant agents.
This could be due to the formation of highly reactive radicals as a consequence of oxidative stress caused by UUO.
The kidneys of the control group showed normal histological features, but the UUO group revealed more extensive and marked tubular necrosis.
On the other hand, the tubules from rats of the UUO + PE group were nearly normal in histological appearance except for a slight desquamation and atrophy of the tubular epithelial cells.
Similar changes were also reported by some studies who demonstrated structural changes in renal tissue of gentamicin-treated animals and its reversal by various agents.
We therefore propose that PE supplementation therapy can be used for kidney protection in patients with UUO, such as ureteral stones.



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