Acute renal failure related to rhabdomyolysis: pathophysiology, diagnosis, and collaborative management.

Acute renal failure related to exertional rhabdomyolysis is a medical condition that, if not diagnosed correctly and treated aggressively, can lead to serious dysfunction and may result in death. Although the history is invaluable in diagnosing this condition, it must be confirmed by laboratory testing. The sometimes subtle manifestations of exertional (non-traumatic) rhabdomyolysis make it mandatory that the health care team is able to recognize the signs and symptoms and understand the pathophysiology for prompt treatment and referral.     

有关非创伤性横纹肌溶解症致急性肾功能衰竭的八个问题

结合9例非创伤性横纹肌溶解症致急性肾功能衰竭的临床分析,作者认为非创伤性横纹肌溶解症并非罕见,对有病因者,检查血清磷酸肌酸激酶,尿肌红蛋白以及必要的肌肉活检等多可诊断,应预防和警惕急性肾衰。特别是非少尿性急性肾衰的发生,对已发生急性肾衰者,经病因处理,支持疗法和必要的透析,病人多可痊愈。文章着重讨论了非创伤性横纹肌溶解症致急性肾衰的发生机制,诊断及治疗问题等。     

Acute respiratory failure: an approach to diagnosis and management.

Acute respiratory failure can be diagnosed using clinical judgment and simple bedside measurement of physiologic function. Respiratory support is based on the pathophysiology of the disorder. Initial therapy is directed at correcting life-threatening hypercapnia, hypoxia, and acidosis. The final outcome is positively influenced by skillful intensive care and a team approach.     

Acute pancreatitis: pathophysiology, nursing diagnoses, and collaborative problems

Acute pancreatitis affects one per 10,000 people annually. Among the alcoholic population this number rises to one per 100. Etiologic factors are numerous, but the main causative agents are biliary tract disease and excessive alcohol intake. The exact mechanism of injury is unknown, but is believed to be either bile reflux into the pancreatic duct or stricture of the sphincter of Oddi. Through either of these pathways the pancreatic enzymes, normally inactive within the gland, are activated and begin digesting pancreatic tissue. Using the knowledge of major collaborative problems, nursing diagnoses, pathophysiology, appropriate assessment parameters, and nursing interventions discussed above, the nurse can develop an effective plan of care for managing the patient with acute pancreatitis.     

Acute renal failure: definitions, diagnosis, pathogenesis, and therapy

Acute renal failure (ARF), characterized by sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, conserve electrolytes, and maintain fluid balance, is a frequent clinical problem, particularly in the intensive care unit, where it is associated with a mortality of between 50% and 80%. In this review, the epidemiology and pathophysiology of ARF are discussed, including the vascular, tubular, and inflammatory perturbations. The clinical evaluation of ARF and implications for potential future therapies to decrease the high mortality are described.     

Mechanism, pathophysiology, diagnosis, and management of renal transplant rejection

In recent years, there has been a steady progress in basic research (immunogenetics and cellular immunology) that helped us in understanding the mechanisms underlying allograft rejection. Several laboratory tests were developed, and the results were shown to correlate with clinical rejection. However, most of these studies have not found a place in clinical practice because of their nonspecificity, lack of sensitivity, time lag, added expense, and inconvenience. The commonly employed diagnostic tests (i.e., renal transplant ultrasound and 131I hippuran scintigram) are helpful in differentiating rejection from other causes of graft malfunction. The specific renal parenchymal disease, such as acute or chronic rejection or de novo or recurrent glomerular disease, contributing to graft malfunction can only be diagnosed by renal histopathologic study. Because hyperacute and accelerated acute rejections are irreversible and necessitate graft nephrectomy, measures should be taken to prevent this problem. High-dose corticosteroids still remain the mainstay of therapy for acute cellular rejection. In the case of steroid-resistant rejections, treatment with ALG or OKT3 appears promising. As there is no effective therapy for chronic allograft rejection, usual measures of delaying the progression of chronic renal failure should be employed, and patients should be advised to return to maintenance dialysis before they develop uremic symptoms. If current experiments demonstrating selective immunosuppression with monoclonal antibodies are found successful in human trials, one can expect further improvement in the outcome of renal transplantation.     

Asthma: pathophysiology, diagnosis and management

This article provides an overview of asthma in adults, includin pathophysiology, risk factors and triggers. Assessment, diagn pharmacological therapies are considered. The importance of in partnership with the patient and encouraging supported self-care are highlighted.     

Acute stroke: pathophysiology, diagnosis, and treatment

Stroke, a neurologic event due to altered cerebral circulation, is the third leading cause of death in the United States. Risk factors for stroke include hypertension, family history, and diabetes mellitus. The subtypes of stroke are ischemia, infarction, and hemorrhage. Ischemia and infarction are the result of atherosclerotic development of thrombi and emboli. Decreased and/or absent cerebral circulation causes neuronal cellular injury and death. Intracerebral hemorrhage occurs from rupture of cerebral vessels often as the result of hypertension. Patient assessment and diagnosis include the use of computed tomography scans, magnetic resonance imaging, and the National Institute of Health Stroke Scale, and treatment depends on the etiology of the stroke. Thrombolytic therapy is the mainstay of treatment for thrombotic and embolic events. Current recommendations for future stroke care include the development of designated stroke centers. Directions for research in stroke treatment includes examining neuroprotective therapies.     

横纹肌溶解综合征致急性肾衰竭23例诊治分析

目的 :总结横纹肌溶解综合征 (RM)合并急性肾衰竭 (RM ARF)的发生率以及治疗效果和临床转归。方法 :2 3例 RM ARF患者中男 17例 ,女 6例 ;平均年龄 (38.0 0± 17.13)岁。所有患者均检测血清肌酶、血肌红蛋白 (Mb)、白蛋白 (Alb)以及血生化指标检测 ,包括电解质、肝功能、肾功能、血尿酸 (UA)、血红蛋白(Hb)、血气分析等。3例患者行肾活检术 ,并做肾小管 Mb免疫组织化学 En Vision法检测。结果 :RM ARF发生率占同期 ARF的 5 .96 % (2 3/ 386 ) ,占急性小管间质病变的 9.75 % (2 3/ 2 36 )。血肌酸磷酸激酶 (CPK)78.2 6 %升高 (>16 .6 7μmol· s- 1 · L- 1 ) ,血 P3+ 、U A、K+ 分别为 78.2 6 %、95 .6 5 %、86 .96 %升高 ,血 Ca2 +86 .96 %下降 ,代谢性酸中毒 91.30 % ,高分解代谢 82 .6 1%。 3例肾脏病理显示急性肾小管坏死 (ATN) ,肾小管Mb免疫组织化学全部阳性。 8例患者有肌肉损伤 ,但未行肌电图检查和肌肉活检。 18例行血液净化 ,其中 5例血液透析 (HD) ,7例腹膜透析 (CAPD) ,6例连续性静静脉血液滤过 (CVVH)。经综合治疗 ,RM ARF病死率34.78% ,存活率 6 5 .2 2 % ,其中 12例肾功能完全恢复正常。结论 :RM大多为非创伤性 ;血清肌酶和血生化检测可提高 RM ARF诊断率 ;肾脏病理活检有助于确诊 RM AR     

Cocaine-associated rhabdomyolysis and acute renal failure

We have described four male patients, aged 21 to 39 years, who had rhabdomyolysis and acute renal failure during parenteral cocaine use. This complication has only recently been attributed to cocaine. Their illnesses behaved clinically like nonoliguric acute tubular necrosis, though renal biopsies were not done. No permanent nerve, muscle, or kidney damage resulted.     

Hereditary hemochromatosis: pathophysiology, diagnosis, and management

Hereditary hemochromatosis (HH) is an autosomal recessive genetic disease resulting in inappropriate intestinal iron absorption leading to iron overload and end-organ disease. The disease is most prevalent in white individuals of European descent. The C282Y mutation on the HFE gene accounts for most cases of HH; however, other genetic mutations have been identified. End-organ damage results in cirrhosis, diabetes mellitus, and cardiomyopathy. Therapeutic phlebotomy to deplete excessive iron stores is the standard treatment of HH and results in normal longevity if therapy is initiated before end-organ disease occurs.     

Acute renal failure: diagnosis, choice of treatment method, prognosis and outcomes

Main aspects of clinical and laboratory diagnosis of various forms of acute renal failure (ARF) are presented. Special attention is paid to choice of therapy with due consideration for the etiology, form, and stage of ARF. Indications for the use of different methods of hemodialysis and hemofiltration are defined. Complications of extracorporeal methods of treatment are discussed and approaches to preventing them outlined.     

Clinical acute renal failure diagnosis and management

Acute renal failure (ARF)_is frequently encountered in the hospitalized setting. In this article, we discuss the etiology, pathogenesis, preventative therapies, and renal replacement strategies in patients with acute tubular necrosis, the most common form of hospitalized ARF. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors do discuss the use of generic medications.