Clinical investigation of renal disease

2020 ◽  
pp. 4781-4806
Author(s):  
Andrew Davenport
Keyword(s):  
Renal Impairment ◽  
Renal Disease ◽  
Clinical Investigation ◽  
Multislice Ct ◽  
Clinical Information ◽  
Distal Tubule ◽  
Ct Scanning ◽  
Careful Examination ◽  
Positron Emission ◽  
Retrograde Ureteropyelography

An accurate history and careful examination will determine the sequence and spectrum of clinical investigations required to make a diagnosis or decide on prognosis or treatment for renal disease. Midstream urine (MSU) sample—this standard investigation requires consideration of (1) macroscopic appearance, (2) stick testing, and (3) microscopy. Quantification of proteinuria—this is important because the risk for progression of underlying kidney disease to endstage renal failure is related to the amount of protein in the urine. Low molecular weight proteinuria is caused by proximal tubular injury and can be detected with markers. Knowledge of the glomerular filtration rate (GFR) is of crucial importance in the management of patients, not only for detecting the presence of renal impairment, but also in the monitoring of all patients with or at risk of renal impairment, and in determining appropriate dosing of those drugs cleared by the kidney. Measurement of plasma creatinine remains the standard biochemical test used to assess renal function. The simplified Modification of Diet in Renal Disease (sMDRD) formula is explained, along with a revised version (CKD-EPI). Investigations of tubular function, including the proximal tubule, distal tubule, and renal-induced electrolyte and acid–base imbalances are discussed in this chapter. Renal imaging covered in this chapter includes ultrasonography, ultrafast multislice CT scanning, magnetic resonance imaging, nuclear medicine scanning, and fluorodeoxyglucose positron emission tomography. Invasive techniques including antegrade or retrograde ureteropyelography and angiography are discussed. A renal biopsy should be considered in any patient with disease affecting the kidney when the clinical information and other laboratory investigations have failed to establish a definitive diagnosis or prognosis, or when there is doubt as to the optimal therapy.

Clinical investigation of renal disease

2010 ◽  
pp. 3863-3884
Author(s):  
A. Davenport
Keyword(s):  
Specific Gravity ◽  
Renal Disease ◽  
Clinical Investigation ◽  
Early Morning ◽  
Red Cells ◽  
Careful Examination ◽  
Macroscopic Appearance ◽  
Heavy Proteinuria ◽  
Clinical Investigations ◽  
Standard Investigation

An accurate history and careful examination will determine the sequence and spectrum of clinical investigations required to make a diagnosis or decide on prognosis or treatment. Midstream urine (MSU) sample—this standard investigation requires consideration of: (1) macroscopic appearance—this may be suggestive of a diagnosis, e.g. frothy urine suggests heavy proteinuria; (2) stick testing—including for pH (<5.3 in an early-morning specimen makes a renal acidification defect unlikely), glycosuria, specific gravity (should be >1.024 in an early-morning or concentrated sample), nitrite (>90% of common urinary pathogens produce nitrite) and leucocyte esterase; and (3) microscopy—for cellular elements (in particular red cells, with the presence of dysmorphic red cells detected by experienced observers indicative of glomerular bleeding), casts (cellular casts indicate renal inflammation), and crystals....

scholarly journals Ultrasonic image analysis and image-guided interventions

2011 ◽  
Vol 1 (4) ◽  
pp. 673-685 ◽  
Author(s):  
J. Alison Noble ◽  
Nassir Navab ◽  
H. Becher
Keyword(s):  
Image Analysis ◽  
Imaging Modality ◽  
Medical Image Analysis ◽  
Three Dimensional ◽  
Clinical Information ◽  
Image Guided ◽  
Software Algorithms ◽  
Positron Emission ◽  
Imaging Research ◽  
Magnetic Resonance Imaging Mri

The fields of medical image analysis and computer-aided interventions deal with reducing the large volume of digital images (X-ray, computed tomography, magnetic resonance imaging (MRI), positron emission tomography and ultrasound (US)) to more meaningful clinical information using software algorithms. US is a core imaging modality employed in these areas, both in its own right and used in conjunction with the other imaging modalities. It is receiving increased interest owing to the recent introduction of three-dimensional US, significant improvements in US image quality, and better understanding of how to design algorithms which exploit the unique strengths and properties of this real-time imaging modality. This article reviews the current state of art in US image analysis and its application in image-guided interventions. The article concludes by giving a perspective from clinical cardiology which is one of the most advanced areas of clinical application of US image analysis and describing some probable future trends in this important area of ultrasonic imaging research.

Skin Examination: An Important Diagnostic Tool in Renal Failure Patients

2018 ◽  
Vol 45 (1-3) ◽  
pp. 187-193 ◽  
Author(s):  
Karen M. Van de Velde-Kossmann
Keyword(s):  
Renal Failure ◽  
Renal Disease ◽  
Genetic Disorders ◽  
The United States ◽  
Underlying Disease ◽  
Careful Examination ◽  
Common Skin ◽  
Important Diagnostic Tool ◽  
Stage Renal Disease ◽  
End Stage

Renal failure is common in the United States with an estimated prevalence of 660,000 treated end-stage renal disease patients in 2015 [<xref ref-type="bibr" rid="ref1">1</xref>]. Causes of renal failure are many, and complications from renal failure, underlying disease, and treatment are not infrequent. Examples of common skin manifestations include xerosis, pigmentary change, and nail dystrophies. Frequent disease-specific skin changes may be helpful in the diagnosis of primary disorders leading to renal disease or severity of disease including bullosis diabeticorum, sclerodactyly, or leukoctoclastic vasculitis. Some cutaneous changes, such as the multiple angiokeratomas of Fabry disease or the plexiform neurofibromas of neurofibromatosis, are pathognomonic of genetic disorders, which often lead to renal failure. Careful examination of the skin can provide crucial clues to diagnosis of renal failure causation and aid in monitoring complications.

Multislice CT Scanning with the SOMATOM Volume Zoom

2001 ◽  
pp. 7-21 ◽  
Author(s):  
Thomas H. Flohr ◽  
Klaus Klingenbeck-Regn ◽  
Bernd Ohnesorge ◽  
Stefan Schaller
Keyword(s):  
Multislice Ct ◽  
Ct Scanning

scholarly journals Haematological Aspects of Renal Disease

1983 ◽  
Vol 11 (4) ◽  
pp. 361-368 ◽  
Author(s):  
Anthony Dodds ◽  
Maryann Nicholls
Keyword(s):  
Renal Transplantation ◽  
Renal Impairment ◽  
Renal Disease ◽  
Renal Diseases ◽  
Red Cell ◽  
Fibrin Deposition ◽  
Platelet Dysfunction ◽  
Red Cell Survival ◽  
Active Investigation ◽  
Is Failure

Renal diseases are associated with a variety of haemopoietic changes. Anaemia parallels the degree of renal impairment and its most important cause is failure of renal erythropoietin secretion. Other factors include depressed red cell production and reduced red cell survival. Purpura and bleeding are predominantly due to platelet dysfunction and usually respond to dialysis. Cryoprecipitate and 1-deamino-8-d-arginine vasopressin may be of value in the bleeding patient. Abnormal coagulation with fibrin deposition in the microcirculation is now recognised as a mechanism of renal impairment. Plasma infusion and anticoagulants may be useful in the therapy of conditions in which this occurs. Plasma exchange is now used in the investigation and management of some varieties of immunologically mediated renal disease. Blood transfusion has been found to improve graft survival if given prior to renal transplantation and this effect is currently under active investigation.

The patient with vasculitis

2015 ◽  
Author(s):  
Lorraine Harper ◽  
David Jayne
Keyword(s):  
Renal Impairment ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Drug Toxicity ◽  
Response To Therapy ◽  
Renal Outcome ◽  
Remission Induction ◽  
Renal Vasculitis ◽  
Stage Renal Disease ◽  
End Stage

The goals of treatment in renal vasculitis are to stop vasculitic activity and recover renal function. Subsequent strategies are required to prevent vasculitis returning and to address longer-term co-morbidities caused by tissue damage, drug toxicity, and increased cardiovascular and malignancy risk.Cyclophosphamide and high-dose glucocorticoids remain the standard induction therapy with alternative immunosuppressives, such as azathioprine, to prevent relapse. Plasma exchange improves renal recovery in severe presentations. Refractory disease resulting from a failure of induction or remission maintenance therapy requires alternative agents and rituximab has been particularly effective. Replacement of cyclophosphamide by rituximab for remission induction is supported by recent evidence. Methotrexate is effective in non-renal vasculitis but difficult to use in patients with renal impairment. Mycophenolate mofetil seems to be effective but there is less long-term evidence.Drug toxicity contributes to co-morbidity and mortality and has led to newer regimens with reduced cyclophosphamide exposure. Glucocorticoid toxicity remains a major problem with controversy over the rapidity with which glucocorticoids can be reduced or withdrawn.Disease relapse occurs in about 50% of patients. Early detection is less likely to lead to an adverse affect on outcomes. Rates of cardiovascular disease and malignancy are higher than in control populations but strategies to reduce their risk, apart from cyclophosphamide-sparing regimens, have not been developed. Thromboembolic events occur in 10% and may be linked to the recently identified autoantibodies to plasminogen and tissue plasminogen activator.Renal impairment at diagnosis is a strong predictor of patient survival and renal outcome. Other predictors include patient age, antineutrophil cytoplasmic antibody subtype, disease extent and response to therapy. Chronic kidney disease can stabilize for many years but the risks of end-stage renal disease are increased by acute kidney injury at presentation or renal relapse. Renal transplantation is successful with similar outcomes to other causes of end-stage renal disease.

The patient with sarcoidosis

2015 ◽  
Author(s):  
Ravindra Rajakariar ◽  
Muhammad M. Yaqoob
Keyword(s):  
Acute Kidney Injury ◽  
Renal Impairment ◽  
Renal Disease ◽  
Low Dose ◽  
Clinical Presentation ◽  
Tubulointerstitial Nephritis ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Chronic Renal Impairment

Renal involvement in sarcoidosis is common and often under-recognized. The most frequent manifestation is acute kidney injury secondary to hypercalcaemia and granulomatous tubulointerstitial nephritis. The latter can lead to both acute kidney injury and to slowly progressive chronic renal impairment with concomitant chronic damage seen on histology. This chapter describes the types of renal disease that may occur in sarcoidosis and the pathogenesis, clinical presentation, diagnosis, and treatment of the patient with sarcoidosis. Corticosteroid therapy is the cornerstone of therapy. In patients with granulomatous tubulointerstitial nephritis, the authors recommend long-term, low-dose maintenance steroids.

Pulmonary Airways: 3-D Reconstruction From Multislice CT and Clinical Investigation

2004 ◽  
Vol 23 (11) ◽  
pp. 1353-1364 ◽  
Author(s):  
C.I. Fetita ◽  
F. Preteux ◽  
C. Beigelman-Aubry ◽  
P. Grenier
Keyword(s):  
Clinical Investigation ◽  
Multislice Ct ◽  
Pulmonary Airways

Renal Insufficiency and Failure

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 431-436 ◽  
Author(s):  
Meletios A. Dimopoulos ◽  
Evangelos Terpos
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Renal Impairment ◽  
Renal Disease ◽  
Renal Injury ◽  
Filtration Rate ◽  
Acute Renal Injury ◽  
Sustained Improvement ◽  
Definition Of

Abstract Renal impairment is a common complication of multiple myeloma. Chronic renal failure is classified according to glomerular filtration rate as estimated by the MDRD (modification of diet in renal disease) formula, while RIFLE (risk, injury, failure, loss and end-stage renal disease) and AKIN (acute renal injury network) criteria may be used for the definition of the severity of acute renal injury. Novel criteria based on estimated glomerular filtration rate measurements are proposed for the definition of the reversibility of renal impairment. Renal complete response (CRrenal) is defined as sustained (i.e., lasting at least 2 months) improvement of creatinine clearance (CRCL) from under 50 mL/min at baseline to 60 mL/min or above. Renal partial response (PRrenal) is defined as sustained improvement of CRCL from under 15 mL/min at baseline to 30 to 59 mL/min. Renal minor response (MRrenal) is defined as sustained improvement of the baseline CRCL of under 15 mL/min to 15 to 29 mL/min or, if baseline CRCL was 15 to 29 mL/min, improvement to 30 to 59 mL/min. Bortezomib with high-dose dexamethasone is considered the treatment of choice for myeloma patients with renal impairment and improves renal function in most patients. Although there is limited experience with thalidomide, this agent can be administered at the standard dosage to patients with renal failure. Lenalidomide, when administered at reduced doses according to renal function, is effective and can reverse renal impairment in a subset of myeloma patients.

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