Variables during Care of Adult Donors That Can Influence Outcomes of Kidney Transplantation

2005 ◽  
Vol 15 (3) ◽  
pp. 219-225 ◽  
Author(s):  
David J. Powner
Keyword(s):  
Blood Flow ◽  
Renal Function ◽  
Kidney Transplantation ◽  
Serum Concentration ◽  
Renal Blood Flow ◽  
Creatinine Level ◽  
Urine Output

Publications that relate characteristics of donors to renal function of recipients are reviewed. Most publications report retrospective observations that relate outcomes to donor variables that cannot be altered during donor care. Factors that can be altered in adult donors in an effort to improve recipients' outcomes include urine output and creatinine level. Increasing urine output to more than 100 mL/h, at least during the hour before explantation, and returning the creatinine level to match its serum concentration when the patient was admitted can improve outcomes. Ways of accomplishing those goals during donor care are discussed, with emphasis on support of renal blood flow.

Drug-Drug Interactions Between Lithium and Cardiovascular as Well as Anti-Inflammatory Drugs

2020 ◽  
Vol 53 (05) ◽  
pp. 229-234
Author(s):  
Maike Scherf-Clavel ◽  
Susanne Treiber ◽  
Jürgen Deckert ◽  
Stefan Unterecker ◽  
Leif Hommers
Keyword(s):  
Blood Flow ◽  
Renal Function ◽  
Serum Concentration ◽  
Drug Interactions ◽  
Renal Blood Flow ◽  
Serum Levels ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
And Function ◽  
Bipolar Affective Disorders

Abstract Introduction Lithium is the gold standard in treating bipolar affective disorders. As patients become increasingly older, drug-drug interactions leading to decreased excretion of lithium represent a key issue in lithium safety. As no study considered the effect of comedications on lithium serum concentration in combination, we aimed to quantify the impact of drugs affecting renal blood flow and function and thus potentially interacting drugs (diuretics, ACE inhibitors, AT1 antagonists, and non-steroidal anti-inflammatory drugs) on lithium serum levels in addition to age, sex, and sodium and potassium serum levels as well as renal function. Methods Retrospective data of lithium serum levels were analyzed in 501 psychiatric inpatients (2008–2015) by means of linear regression modelling. Results The number of potentially interacting drugs was significantly associated with increasing serum levels of lithium in addition to the established factors of age, renal function, and sodium concentration. Additionally, absolute lithium levels were dependent on sex, with higher values in females. However, only NSAIDs were identified to increase lithium levels independently. Discussion Routine clinical practice needs to focus on drugs affecting renal blood flow and function, especially on NSAIDs as over-the-counter medication that may lead to an increase in lithium serum concentration. To prevent intoxications, clinicians should carefully monitor the comedications, and they should inform patients about possible intoxications due to NSAIDs.

scholarly journals Value of Renal Blood Flow Measurement with Xenon-133 at the Time of Kidney Transplantation

1967 ◽  
Vol 166 (1) ◽  
pp. 65-74 ◽  
Author(s):  
D. H. LEWIS ◽  
S. -E. BERGENTZ ◽  
U. BRUNIUS ◽  
H. ERMAN ◽  
L. -E. GELIN ◽  
...  
Keyword(s):  
Blood Flow ◽  
Kidney Transplantation ◽  
Renal Blood Flow ◽  
Flow Measurement ◽  
Blood Flow Measurement ◽  
Xenon 133

scholarly journals Global REACH 2018: renal oxygen delivery is maintained during early acclimatization to 4,330 m

2020 ◽  
Vol 319 (6) ◽  
pp. F1081-F1089
Author(s):  
Andrew R. Steele ◽  
Michael M. Tymko ◽  
Victoria L. Meah ◽  
Lydia L. Simpson ◽  
Christopher Gasho ◽  
...  
Keyword(s):  
Blood Flow ◽  
Renal Function ◽  
High Altitude ◽  
Renal Blood Flow ◽  
Sea Level ◽  
Oxygen Delivery ◽  
Acid Base ◽  
Altitude Acclimatization ◽  
High Altitude Acclimatization ◽  
Renal Oxygen

Early acclimatization to high altitude is characterized by various respiratory, hematological, and cardiovascular adaptations that serve to restore oxygen delivery to tissue. However, less is understood about renal function and the role of renal oxygen delivery (RDO2) during high altitude acclimatization. We hypothesized that 1) RDO2 would be reduced after 12 h of high altitude exposure (high altitude day 1) but restored to sea level values after 1 wk (high altitude day 7) and 2) RDO2 would be associated with renal reactivity, an index of acid-base compensation at high altitude. Twenty-four healthy lowlander participants were tested at sea level (344 m, Kelowna, BC, Canada) and on day 1 and day 7 at high altitude (4,330 m, Cerro de Pasco, Peru). Cardiac output, renal blood flow, and arterial and venous blood sampling for renin-angiotensin-aldosterone system hormones and NH2-terminal pro-B-type natriuretic peptides were collected at each time point. Renal reactivity was calculated as follows: (Δarterial bicarbonate)/(Δarterial Pco2) between sea level and high altitude day 1 and sea level and high altitude day 7. The main findings were that 1) RDO2 was initially decreased at high altitude compared with sea level (ΔRDO2: −22 ± 17%, P < 0.001) but was restored to sea level values on high altitude day 7 (ΔRDO2: −6 ± 14%, P = 0.36). The observed improvements in RDO2 resulted from both changes in renal blood flow (Δ from high altitude day 1: +12 ± 11%, P = 0.008) and arterial oxygen content (Δ from high altitude day 1: +44.8 ± 17.7%, P = 0.006) and 2) renal reactivity was positively correlated with RDO2 on high altitude day 7 ( r = 0.70, P < 0.001) but not high altitude day 1 ( r = 0.26, P = 0.29). These findings characterize the temporal responses of renal function during early high altitude acclimatization and the influence of RDO2 in the regulation of acid-base balance.

scholarly journals Downstream effects of splanchnic ischemia-reperfusion injury on renal function and eicosanoid release

1997 ◽  
Vol 83 (2) ◽  
pp. 530-536 ◽  
Author(s):  
Patricia Rothenbach ◽  
Richard H. Turnage ◽  
Jose Iglesias ◽  
Angela Riva ◽  
Lori Bartula ◽  
...  
Keyword(s):  
Blood Flow ◽  
Renal Function ◽  
Reperfusion Injury ◽  
Renal Blood Flow ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Inulin Clearance ◽  
Downstream Effects ◽  
Splanchnic Ischemia ◽  
Eicosanoid Release

Rothenbach, Patricia, Richard H. Turnage, Jose Iglesias, Angela Riva, Lori Bartula, and Stuart I. Myers. Downstream effects of splanchnic ischemia-reperfusion injury on renal function and eicosanoid release. J. Appl. Physiol.82(2): 530–536, 1997.—This study examines the hypothesis that intestinal ischemia-reperfusion (I/R) injury contributes to renal dysfunction by altered renal eicosanoid release. Anesthetized Sprague-Dawley rats underwent 60 min of sham or superior mesenteric artery (SMA) occlusion with 60 min of reperfusion. The I/R groups received either allopurinol, pentoxifylline, 1-benzylimidazole, or carrier before SMA occlusion. In vivo renal artery blood flow was measured by Transonic flow probes, the kidneys were then perfused in vitro for 30 min, and the effluent was analyzed for eicosanoid release and renal function. Intestinal I/R caused a twofold increase in the ratio of renal release of thromboxane B2to prostaglandin E2and to 6-ketoprostaglandin F1αcompared with the sham level, with a corresponding 25% decrease in renal sodium and inulin clearance and renal blood flow. Pentoxifylline or allopurinol pretreatment restored renal eicosanoid release and renal sodium and inulin clearance to the sham level but did not alter renal blood flow. Pretreatment with 1-benzylimidazole restored renal function, eicosanoid release, and renal blood flow to sham levels. These data suggest that severe intestinal I/R contributes to the downregulation of renal function. The decrease in renal function is due in part to toxic oxygen metabolites, which occur in the milieu of altered renal eicosanoid release, reflecting a decrease in vasodilator and an increase in vasoconstrictor eicosanoids.

scholarly journals ACUTE AND CHRONIC EFFECTS OF THE INSECTICIDE ENDRIN ON RENAL FUNCTION AND RENAL HEMODYNAMICS

1964 ◽  
Vol 42 (5) ◽  
pp. 599-608 ◽  
Author(s):  
D. A. Reins ◽  
D. D. Holmes ◽  
L. B. Hinshaw
Keyword(s):  
Blood Flow ◽  
Renal Function ◽  
Renal Blood Flow ◽  
Systemic Hypertension ◽  
Adrenergic Agents ◽  
Renal Vasoconstriction ◽  
Chronic Effects ◽  
Renal Vascular ◽  
Acute And Chronic Effects ◽  
Marked Drop

Variable effects of chlorinated hydrocarbon insecticides on the kidney have been reported. The purpose of the present study was to determine the acute and chronic effects of the insecticide endrin on renal function and hemodynamics in dogs. Dogs were exposed to endrin acutely by intravenous infusion, and chronically by intramuscular injection. In acute experiments, dogs developed systemic hypertension and increased renal vascular resistance attributable to a sympatho-adrenal action. Acute effects of endrin were predominantly afferent arteriolar vasoconstriction as evidenced by decreases in renal blood flow, glomerular filtration rate, and urine flow. Phentolamine and phenoxybenzamine increased renal blood flow after endrin, providing evidence for humorally induced renal vasoconstriction due to adrenergic agents. Adrenalectomy partially offset the marked drop in renal blood flow after endrin although systemic hypertension and bradycardia were unaffected. Results from renal denervation experiments were variable. Changes in renal function in chronic studies were minimal and appeared to be due to secondary alterations in systemic hemodynamics. Results from this investigation provide no evidence for renal failure attributable to the direct effects of endrin.

Effects of synthetic atrial natriuretic factor on renal function and renin release

1984 ◽  
Vol 247 (5) ◽  
pp. F863-F866 ◽  
Author(s):  
J. C. Burnett ◽  
J. P. Granger ◽  
T. J. Opgenorth
Keyword(s):  
Blood Flow ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Renal Blood Flow ◽  
Atrial Natriuretic Factor ◽  
Filtration Rate ◽  
Renin Secretion ◽  
Natriuretic Factor ◽  
Atrial Natriuretic

Studies were performed in anesthetized dogs (n = 5) to determine the effects of synthetic atrial natriuretic factor on renal function and renin release. Intrarenal infusion of synthetic atrial natriuretic factor (ANF) (0.3 microgram X kg-1 X min-1) resulted in a transient increase in renal blood flow (126 +/- 8 to 148 +/- 11 ml/min). The duration of this transient vasodilation was 3.1 +/- 0.4 min. Continued infusion was followed by a slight decrease in renal blood flow (126 +/- 8 to 117 +/- 8 ml/min) and an increase in glomerular filtration rate (23.1 +/- 3.5 to 30.7 +/- 1.9 ml/min), with filtration fraction thus being increased (0.19 +/- 0.04 to 0.27 +/- 0.03). These hemodynamic alterations were associated with increases in fractional sodium excretion (0.6 +/- 0.2 to 5.8 +/- 0.8%), fractional potassium excretion (30.8 +/- 9.4 to 56.3 +/- 7.4%), fractional lithium excretion (32.2 +/- 7.1 to 60.3 +/- 5.7%), and fractional phosphate excretion (8.7 +/- 3.5 to 41.6 +/- 11.7%). Intrarenal infusion of synthetic ANF markedly suppressed renin secretion rate (295.5 +/- 84.6 to 17.2 +/- 10.6 ng/min) despite a slight reduction in arterial pressure (123 +/- 9 to 118 +/- 9 mmHg). Our studies demonstrate that synthetic ANF results in a marked natriuretic response that is in part mediated by an increase in glomerular filtration rate. The increase in fractional lithium and phosphate excretion suggests that this factor may also have an action on proximal tubule reabsorption. Further, these studies demonstrate that synthetic ANF markedly inhibits renin secretion.

scholarly journals Hypoxia-inducible factor-1α activation improves renal oxygenation and mitochondrial function in early chronic kidney disease

2017 ◽  
Vol 313 (2) ◽  
pp. F282-F290 ◽  
Author(s):  
Joanna L. Thomas ◽  
Hai Pham ◽  
Ying Li ◽  
Elanore Hall ◽  
Guy A. Perkins ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Blood Flow ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Blood Flow ◽  
Mitochondrial Function ◽  
Hypoxia Inducible Factor ◽  
Volume Density ◽  
Mitochondrial Morphology ◽  
Hypoxia Inducible Factor 1Α

The pathophysiology of chronic kidney disease (CKD) is driven by alterations in surviving nephrons to sustain renal function with ongoing nephron loss. Oxygen supply-demand mismatch, due to hemodynamic adaptations, with resultant hypoxia, plays an important role in the pathophysiology in early CKD. We sought to investigate the underlying mechanisms of this mismatch. We utilized the subtotal nephrectomy (STN) model of CKD to investigate the alterations in renal oxygenation linked to sodium (Na) transport and mitochondrial function in the surviving nephrons. Oxygen delivery was significantly reduced in STN kidneys because of lower renal blood flow. Fractional oxygen extraction was significantly higher in STN. Tubular Na reabsorption was significantly lower per mole of oxygen consumed in STN. We hypothesized that decreased mitochondrial bioenergetic capacity may account for this and uncovered significant mitochondrial dysfunction in the early STN kidney: higher oxidative metabolism without an attendant increase in ATP levels, elevated superoxide levels, and alterations in mitochondrial morphology. We further investigated the effect of activation of hypoxia-inducible factor-1α (HIF-1α), a master regulator of cellular hypoxia response. We observed significant improvement in renal blood flow, glomerular filtration rate, and tubular Na reabsorption per mole of oxygen consumed with HIF-1α activation. Importantly, HIF-1α activation significantly lowered mitochondrial oxygen consumption and superoxide production and increased mitochondrial volume density. In conclusion, we report significant impairment of renal oxygenation and mitochondrial function at the early stages of CKD and demonstrate the beneficial role of HIF-1α activation on renal function and metabolism.

scholarly journals Short-Time Intermittent Preexposure of Living Human Donors to Hyperoxia Improves Renal Function in Early Posttransplant Period: A Double-Blind Randomized Clinical Trial

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Kamran Montazeri ◽  
Mohammadali Vakily ◽  
Azim Honarmand ◽  
Parviz Kashefi ◽  
Mohammadreza Safavi ◽  
...  
Keyword(s):  
Renal Function ◽  
Kidney Transplantation ◽  
Hospital Stay ◽  
Urine Output ◽  
Human Study ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Duration Of Hospital Stay ◽  
Group I ◽  
Group Ii

The purpose of this human study was to investigate the effect of oxygen pretreatment in living kidney donors on early renal function of transplanted kidney. Sixty living kidney donor individuals were assigned to receive either 8–10 L/min oxygen (Group I) by a non-rebreather mask with reservoir bag intermittently for one hour at four times (20, 16, 12, and 1 hours before transplantation) or air (Group II). After kidney transplantation, urine output, blood urea nitrogen (BUN), serum creatinine, need to additional diuretics (NTADs) in the first 24 hours after transplantation, delayed graft function (DGF), the creatinine clearance (CrCL) on 10th day, and duration of hospital stay from the first posttransplant day till normalization of renal function was recorded and compared in two groups. Mean CrCL in posttransplant day 10, NTAD after 24 hours of transplantation, and urine output during 6 hours after operation were significantly better in Group I compared with Group II (). Also, DGF during the first week after operation and duration of hospital stay was less in Group I compared with Group II. Intermittent exposure of human living kidney donor to hyperoxic environment may improve renal function following kidney transplantation.

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