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PubMedDate not supplied

[Causes of azotemia in severe cranio-cerebral injuries].

The functional state of the kidneys and the level of azotemia were studied in 51 patients with a severe craniocerebral trauma. Two groups of patients were distinguished according to the preservation of diminution of glomerular filtration. Comparison between these 2 groups showed that in normal glomerular filtration azotemia was linked with the catabolic process, while in diminished glomerular filtration azotemia was also associated with a reduced renal function. The level of azotemia has been established; a higher value is evidence of renal insufficiency.

Brain Injuries↗
PubMed1987

Effect of azotemia in dogs on the pharmacokinetics of pentamidine.

We used a new high-performance liquid-chromatography assay to study the pharmacokinetics of pentamidine isethionate given intravenously to 10 dogs before and after surgically induced renal failure. The presurgery peak serum concentration of pentamidine averaged 867 ng/ml and by 6 hr had fallen to 30 ng/ml. After surgery the peak and 6-hr concentrations were 780 ng/ml and 28 ng/ml. Mean total body clearance of pentamidine before surgery was 46.7 ml/min per kg, of which only 2.0 ml/min per kg was due to renal clearance had fallen 80%--to 0.4 ml/min per kg. Two dogs with azotemia and two control dogs received 14 daily infusions of pentamidine. Kinetic parameters measured after the last dose were not significantly different from those after the first dose, and the amount of pentamidine recovered from tissues was similar for dogs with azotemia and controls. In summary, because renal clearance of pentamidine accounted for such a small proportion of total body clearance, none of the parameters measured was affected significantly by moderate azotemia.

Amidines↗
PubMed2004

Increasing the dose of furosemide in patients with azotemia and suspected obstruction.

Diuresis renography is widely used to distinguish obstructed from nonobstructed kidneys; however, the delivery of furosemide to its site of action in the loop of Henle is impaired in patients with azotemia. Consequently, the standard adult dose of 40 mg furosemide could be insufficient to generate an adequate diuretic response. This problem is illustrated by a patient with azotemia with bilateral nephrostomies who underwent Tc-99m MAG3 (mercaptoacetyltriglycine) diuresis renography with 40 mg furosemide to determine if his bilateral ureteral obstruction had resolved. The study showed findings typical for obstruction despite the fact that the patient could not have been obstructed because the nephrostomy tubes had not been clamped. When the study was repeated 6 days later with 80 mg furosemide and clamped nephrostomy tubes, there was good drainage bilaterally excluding obstruction. The nephrostomy tubes were removed and the patient's creatinine has subsequently remained stable for 3 years. In summary, this report illustrates the rationale for increasing the dose of furosemide in patients with azotemia referred for diuresis renography and shows how increasing the dose of furosemide could improve the diuretic response and minimize false-positive or indeterminate results.

Aged↗
PubMed1992

Higher pentamidine levels in AIDS patients with hypoglycemia and azotemia during treatment of Pneumocystis carinii pneumonia.

Trimethoprim-sulfamethoxazole (TMP-SMZ) and pentamidine are both licensed for the treatment of Pneumocystis carinii pneumonia (PCP). However, their use is associated with various adverse side effects. In this prospective study, 26 AIDS patients with 32 episodes of PCP were treated with pentamidine (4 mg/kg/d). Each patient was treated for 12 to 21 days, depending on the rapidity of onset of the clinical response. During the 32 PCP episodes, hypoglycemia occurred in 16 instances, azotemia in 12, liver toxicity in 10, and leukopenia in 8. The occurrence of thrombopenia, leukopenia, and liver toxicity was not related to age, pentamidine levels, or other complications. However, patients who had hypoglycemia during pentamidine treatment had higher serum pentamidine levels than patients who did not have hypoglycemia (107 +/- 40 versus 70 +/- 26 ng/ml, p less than 0.004). In addition, we observed that patients with azotemia showed higher pentamidine levels during treatment (120 +/- 35 versus 64 +/- 22 ng/ml, p less than 0.001). In fact, 100% (11/11) of patients with serum pentamidine concentration greater than 100 ng/ml had fasting hypoglycemia and/or azotemia, while 33% (7/21) of those with pentamidine levels less than 100 ng/ml had these side effects (p less than 0.001). The relative risk of these complications with pentamidine levels greater than 100 ng/ml was 3 (95% confidence interval, 1.6 to 5.5). Fine-tuning the dose of pentamidine may eventually prove useful to avoid toxicity and optimize therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Azotemia caused by renal artery stenosis: treatment by percutaneous angioplasty.

Percutaneous angioplasty of the renal artery was performed in 79 patients who had stable or climbing serum creatinine levels greater than 1.7 mg/dl and hemodynamically significant stenosis of the renal artery. Patients who had nonrenal causes of azotemia, nephropathy caused by iodinated contrast material, or serum creatinine levels that were declining while the patients were receiving medical therapy before angioplasty were excluded from the study. Angioplasty resulted in a significant (greater than 20%) decline in the level of serum creatinine (average, 2.7 mg/dl before to 1.7 mg/dl after) in 43% of these patients during an average follow-up period of 16 months. A significant decrease in the level of serum creatinine was seen in 61% of patients with bilateral stenosis, 38% of patients with unilateral stenosis with absent contralateral renal blood flow, and 38% of patients with unilateral stenosis and normal contralateral renal blood flow. Recapture of lost nephron function was least successful in patients whose levels of serum creatinine were greater than 4.0 mg/dl (14%); this included one (11%) of nine patients who were already on hemodialysis. We conclude that angioplasty of the renal artery can play a major role in the treatment of patients who have mild azotemia and bilateral stenosis of the renal artery. It is less successful in treatment of patients who have severe azotemia and those who have unilateral disease.

Angioplasty, Balloon↗
PubMed1978

Digoxin disposition kinetics in dogs before and during azotemia.

The purpose of this study was to evaluate the disposition kinetics of digoxin after the administration of a single intravenous dose to the same dogs before and during azotemia. The digoxin plasma concentration-time data were fitted to a multicompartment model using nonlinear regression analysis. During azotemia, the biological half-life of digoxin was prolonged in six of seven dogs, while digoxin renal clearance, body clearance and apparent volume of distribution were significantly decreased. There was a corresponding increase in the apparent volume of the "central" compartment of digoxin. Approximately 45% of a digoxin dose was excreted by the kidney in these animals indicating a substantial nonrenal component to digoxin elimination in the dog. This nonrenal elimination did not change during azotemia, despite a decrease in renal clearance by 61%.

Animals↗
PubMed1995

Azotemia control by extracorporeal therapy in patients with acute renal failure.

The mortality rate for patients with acute renal failure (ARF) requiring renal replacement therapy remains unacceptably high. The cause of death in these patients has been thought to relate primarily to the nature of the condition that precipitated renal failure. However, recent investigations challenge that notion and suggest that the characteristics of the renal replacement procedure itself may influence outcome. The major considerations for the clinician prescribing renal replacement therapy to the patient with ARF are the therapy mode, the type of membrane used, and the dose of delivered therapy. The first two considerations have been discussed extensively in the medical literature and are reviewed elsewhere in this issue. However, the determination of the amount of delivered therapy, although standard practice in patients with end-stage renal disease, has not been assessed routinely in patients with ARF. Furthermore, the influence on patient outcome of the level of azotemia control achieved by the delivered therapy is unknown. The purpose of this review is to provide some insight into quantifying the amount of renal replacement therapy delivered to patients with ARF treated with either continuous or intermittent therapies. The expected level of azotemia control that can be achieved with each of these therapies is discussed. We suggest that quantification of the amount of delivered therapy and the level of azotemia control are important variables to be obtained and evaluated in future investigations seeking to understand the high mortality rate of patients with ARF.

Acute Kidney Injury↗
PubMed1996

Case-control study of the association between intraoperative administration of nafcillin and acute postoperative development of azotemia.

OBJECTIVE: To describe 7 cases of acute postoperative azotemia in dogs and to examine by use of a case-control study the possible association between this complication and administration of nafcillin. DESIGN: Retrospective and case-control study. ANIMALS: 7 case dogs and 28 matched control dogs. PROCEDURE: Cases of acute renal failure or acute renal insufficiency were identified by retrospective study of records of dogs treated between July 1, 1992, and Feb 28, 1995, and from information received from a practitioner. A random sample of records of dogs undergoing invasive procedures between Dec 1, 1992, and Nov 30, 1993, was examined to determine the prevalence of nafcillin use. Each case dog was matched with 4 control dogs, and data were subjected to logistic regression analysis, employing exact conditional inference on the parameter estimates. RESULTS: Case dogs were between 1 and 9 years old and weighed between 21 and 60 kg. Preoperatively, none of the dogs had a history of renal disease, and BUN concentrations, hematocrit, and plasma protein concentrations were within reference ranges. Postoperatively, each dog became azotemic and had clinical signs consistent with uremia. Hyponatremia was recorded in 6 case dogs. One dog did not respond to treatment and was euthanatized. Two dogs had persistent isosthenuria, and 4 dogs recovered. Nafcillin was used in approximately 502 of 2,184 (23%) dogs that underwent invasive procedures between Dec 1, 1992, and Nov 30, 1993. The use of nafcillin ceased on Nov 30, 1993, and no further cases were recorded in the following 15 months. In the case-control study, the only factor that was significantly associated with the occurrence of acute postoperative azotemia was administration of nafcillin. CLINICAL IMPLICATIONS: Intraoperative use of nafcillin maybe associated with development of acute postoperative azotemia in dogs.

Acute Disease↗
PubMed1986

Computer-assisted diagnosis of acute azotemia.

We designed a computer program to make diagnostic suggestions in cases of acute azotemia. The performance of the program was tested in a retrospective manner on 63 patients with acute azotemia. The program correctly identified 90 of 94 diagnoses and made 20 false positive diagnostic suggestions. A revised version of the program correctly identified 94 of 94 diagnoses and made 4 false negative suggestions. The justification for this kind of diagnostic aid is discussed.

Artificial Intelligence↗
PubMed1992

High pentamidine levels associated with hypoglycemia and azotemia in a patient with Pneumocystis carinii pneumonia.

We report on a patient who presented with a Pneumocystis carinii pneumonia. Intravenous pentamidine (4 mg/kg/day) was given for 14 days without the occurrence of adverse effects. During this treatment, the mean (+/- SD) serum pentamidine trough concentration was 94 +/- 16 ng/ml. Three days later, the patient was admitted because of fever, and pentamidine (4 mg/kg/day) was again started. Fasting hypoglycemia and azotemia then occurred; the mean serum trough pentamidine level was 190 +/- 10 ng/ml during this week of treatment. We conclude that the occurrence of hypoglycemia and azotemia during pentamidine therapy may not be idiosyncrasic, but seemed associated in our patient with high levels of serum pentamidine.

AIDS-Related Opportunistic Infections↗
PubMed2000

Differential diagnosis of prerenal azotemia from acute tubular necrosis and prediction of recovery by Doppler ultrasound.

Acute renal failure (ARF) is a life-threatening disease that often causes multiple organ dysfunction. The accurate and rapid diagnosis of the cause of ARF is particularly important for selecting the appropriate therapy. Ultrasound Doppler is a noninvasive diagnostic method that has recently been introduced to clinical nephrology. We report the diagnostic value of Doppler ultrasound in differentiating acute tubular necrosis (ATN) from prerenal azotemia by comparing this study with the fractional excretion of sodium (FENa), renal failure index (RFI), and urinary/serum creatinine (Cr) ratio. Doppler ultrasound was able to differentiate prerenal azotemia from ATN, equivalent to FENa, RFI, and the urinary/serum Cr ratio. Doppler ultrasound does not require blood or urine samples and can be performed at the bedside. Of note, Doppler is unaffected by changes in Na or Cr in urine or serum after diuretics or hemodialysis. Furthermore, one can predict recovery from ATN by Doppler findings. Thus, we consider Doppler ultrasound an effective diagnostic tool in ARF.

Adult↗
PubMed1978

Familial azotemia. Impaired urea excretion despite normal renal function.

We performed detailed studies of renal function in two of five related patients with normal serum creatinine levels to determine the mechanism of their chronic azotemia. Inulin and para-amino-hippurate clearances, maximum tubular transport of para-aminohippurate, and renal acidification were within normal limits. In addition, renal concentrating and diluting abilities of these patients were similar to those of four normal controls. Urea clearances of both patients during maximum water diuresis (27.6 and 40.8 ml per minute per 1.73 m2) and antidiuresis (5.3 and 4.0), however, were much lower than mean (+/- S.E.M.) values in the normal controls (70.4 +/- 3.7 and 30.0 +/- 3.42 ml per minute per 1.73 m2, respectively). Thus decreased urea excretion despite otherwise normal renal function was responsible for the chronic azotemia of these patients. The genetic defect in renal urea clearance appeared to be inherited as an autosomal dominant trait.

Adult↗
PubMed1976

Effects of azotemia on renal extraction and clearance of PAH and TEA.

Dogs were made azotemic by bilateral ureteral-venous anastomosis. Subsequently, the left ureter, a systemic artery, and the left renal vein were cannulated. Left renal blood flow (RBF) was measured by an electromagnetic flowmeter. Left renal clearances and extractions of [14C]tetraethylammonium ([14C]TEA) and p-aminohippuric acid (PAH) were determined at five 40-min intervals after administraiton of loading doses and institution of a maintenance infusion containing PAH and [14C]TEA. The renal extraction of TEA was independent of blood urea nitrogen (BUN), whereas the extraction of PAH correlated inversely with BUN. Renal plasma flows calculated from urinary clearances and renal extractions agreed with renal plasma flows calculated from flowmeter data. The extraction of TEA remained constant over the 200-min experimental period, whereas the extraction of PAH increases progressively as a function of time. It is probable that those organic acids which accumulate in azotemia, and interfered with renal tubular secretion of PAH, were themselves eliminated after opening the ureteral-venous anastomosis. Thus, TEA is superior to PAH for evaluation of the renal circulation in azotemia.

Aminohippuric Acids↗
PubMed1995

Carbamylated hemoglobin in prerenal azotemia.

UNLABELLED: Carbamylated hemoglobin (Carb Hb) levels were measured in 16 patients with a documented transient rise in BUN due to prerenal azotemia, in whom BUN levels before and after the episode were normal. They were compared with 13 controls. Carb Hb was expressed as carbamyl valine concentrations, which were significantly higher in the patients (166 micrograms/g Hb) than in controls (95.3 micrograms/g Hb, p < 0.01). The mean maximum BUN level in the patients was 51.8 +/- 23.9 mg/dl. There was a significant correlation between the product of mean BUN level times the number of days of BUN elevation, and the Carb Hb level (r = 0.5197; p < 0.05). There was no correlation between Carb Hb and either mean BUN level or maximum BUN level. Elevated Carb Hb was seen after a minimum of 4 days' BUN elevation. Four patients had no elevation of Carb Hb despite elevated BUN levels. CONCLUSION: Carb Hb may be elevated after a minimum of 4 days' transient BUN elevation; Carb Hb is not useful in differentiating between mild acute renal failure and prerenal azotemia.

Aged↗
PubMed1994

Possible gliclazide-induced water retention with azotemia.

An 80-year-old woman with diabetes mellitus was treated with gliclazide. Prior to the gliclazide administration, her urinary excretion of albumin, serum urea nitrogen and serum creatinine were normal. After the medication, oliguria, edema and azotemia developed. On the twenty-fourth day when the edema was severe and generalized, gliclazide administration was terminated. On the following day urinary volume increased suddenly (5,740 ml/day). Polyuria persisted for five days. Edema improved and urea nitrogen and creatinine were normalized thereafter. Though the mechanism is not known, the clinical course suggests that gliclazide is the principal causative factor in the water retention and azotemia in this patient.

Aged↗
PubMed1998

Can fingernail creatinine concentrations be used to predict duration of azotemia?

Clinical use of fingernail creatinine estimation to predict duration of azotemia is yet to be validated. We studied the fingernail creatinine concentrations in 48 subjects: seven controls, nine with acute renal failure, five with rapidly progressive glomerulonephritis, 12 with chronic renal failure and 15 with end-stage renal failure on maintenance hemodialysis. The creatinine concentration in aqueous eluates of powdered nail clippings was determined by the alkaline picrate reaction. The mean fingernail creatinine concentration was significantly higher in patients with chronic renal failure (93.7 +/- 83.7 micrograms/g) and end-stage renal disease on maintenance hemodialysis (118.4 +/- 46.8 micrograms/g) as compared to those with acute renal failure (36.6 +/- 23.7 micrograms/g) and rapidly progressive glomerulonephritis (35.8 +/- 20.6 micrograms/g). The creatinine concentrations did not differ significantly between normal subjects (27.2 +/- 28.7 micrograms/g) and those with acute renal failure and rapidly progressive glomerulonephritis. However because of large variability in the values of fingernail creatinine concentrations within each group, the test lacked specificity. Therefore, this investigation is an unreliable indicator of duration of azotemia in individual patients and is not likely to be of much clinical use.

Acute Kidney Injury↗
PubMed1984

Effects of azotemia on results of the boronate-agarose affinity and ion-exchange methods for glycated hemoglobin.

We evaluated the effect of azotemia on results for glycated hemoglobin as measured by a boronate-agarose affinity method and an ion-exchange chromatographic procedure with saline preincubation and found a good correlation. However, values for glycated hemoglobin in samples from nondiabetic patients with various degrees of azotemia were consistently higher with the ion-exchange column procedure (mean, 8.5%) than with the boronate affinity method (mean, 6.2%). The latter method may thus be preferred for monitoring glycated hemoglobin in diabetic patients with impaired renal function.

Boronic Acids↗
PubMed1978

Azotemia in cattle.

Blood biochemical studies were performed on 21 azotemic cattle with various disease conditions. The cattle were greater than or equal to 4 months old. Blood urea nitrogen concentrations ranged from 41 to 346 mg/dl. The azotemia was determined to be of prerenal origin in 10 cattle and of renal or postrenal origin in 11 cattle. The most consistent biochemical finding was that of hypochloremia. Sixteen cattle had lower than normal concentrations of serum calcium, and 15 had serum inorganic phosphorus concentrations greater than normal. In 17 cattle, the serum concentration of inorganic phosphorus was greater than that of calcium. Plasma sodium content was lower than normal in 9 of the 21 cattle, and plasma potassium concentrations were quite variable. Most of the cattle tended to maintain a normal acid-base status or had metabolic alkalosis. It was concluded that evaluation of biochemical data does not make it possible to determine whether azotemia is prerenal, renal, or postrenal in origin.

Animals↗