Clinical application of normalized residual activity as a semiquantitative adjunct in assessing renal emptying in pediatric diuretic scans

Background@#The most recent pediatric diuretic imaging guidelines recommend the use of normalized residual activity (NORA) as a semiquantitative index of renal tracer drainage. It is defined as the ratio of post-void renal counts to 1-2 minute post-injection renal counts, with values less than 1 indicative of good drainage. We present two instances where NORA calculation was adjunctive in the evaluation of obstructive uropathy. @*Case Presentation@#The first patient was a 3-month-old male with left-sided congenital hydronephrosis. On dynamic imaging, the diseased kidney showed adequate perfusion and parenchymal extraction; moderate to severe pelvicalyceal tracer retention exhibited good response to diuretic. The pre-diuretic NORA of 1.62 declined to 0.28 after furosemide challenge, concordant with imaging findings that were negative for obstruction. The second patient was a 7-week-old male, also with congenital hydronephrosis of the left kidney. Dynamic images showed the diseased kidney with diminished perfusion and function, as well as pelvicalyceal tracer retention which became more severe after the diuretic was given. The pre-diuretic NORA was 1.81, which became 1.18 post-diuretic. This inadequate decline supplemented imaging findings pointing to significant obstruction. Other semiquantitative parameters have preceded NORA; however, clearance half-time is not validated as a marker of obstructive uropathy in infants and children, and output efficiency requires specialized software to calculate. Standardization of NORA determination is largely provided for by the guidelines recommending a perirenal background region of interest, as well as minimizing the interval between starting camera acquisition and injecting the tracer. @*Conclusion@#Semiquantitative analysis through NORA calculation gives relevant supporting information in the reporting of renal tracer drainage among pediatric patients. Further studies are needed to ascertain its applicability among adults and its diagnostic value in a larger sample of affected Filipino children.

Connotation of Shenqi Pills based on severe cases in cardiovascular care unit and modern pathophysiological mechanism and application of Shenqi Pills for heart failure, renal failure, cardiorenal syndrome, and diuretic resistance in critical care medicine / 中国中药杂志

Shenqi Pills, first recorded in Essentials from the Golden Cabinet(Jin Kui Yao Lue) from ZHANG Zhong-jing in Han dynasty, have the effect of warming and tonifying the kidney Qi and are mainly used for the treatment of insufficiency of kidney Qi and kidney Yang. According to modern medicine, kidney Qi involves heart function, kidney function, immune function, and so on. The clinical indications of Shenqi Pills include kidney deficiency, abnormal fluid, and abnormal urination, and the last one is classified into little urine, much urine, and dysuria. In clinical settings, Shenqi Pills can be applied for the treatment of heart failure, renal failure, cardiorenal syndrome, and diuretic resistance, as well as endocrine, urological, orthopedic, and other chronic degenerative diseases. Shenqi Pills are ideal prescriptions for the weak constitution and emergency treatment. It is of great value and significance to carry out in-depth research on the connotation of the classic articles by integrating TCM and western medicine based on "pathogenesis combined with pathology and drug properties combined with pharmacology".

Comparison of Diuretic and Electrolyte Excretory Activity between Compounds of Okra Fruit (Abelmoschus esculentus) and Furosemide

@#Introduction: Hypertension takes place of being one of the most concerning health issues, leading to increasing rate of death due to its complications. Pharmacological therapy diuretic become one to intervene on hypertension’s pathological sequences through sodium and potassium regulation. Similar diuretic effect can be achieved through fruits and vegetables crop including Okra fruit (Abelmoschus esculentus). Objective: to investigate the diuretic variance of different part of Okra fruit’s (Abelmoschus esculentus). Methods: In total of 8 groups of male Rattus norvegicus rats are sorted into control and intervention groups. As control, the C- Group (negative control group) was given Na- CMC 0.5% suspension, and C+ Group (positive control group) was given furosemide. The experimental groups P1, P2, and P3 were given Okra (Abelmoschus esculentus) whole fruit ethanolic extract; P4, P5, and P6 Group are were given Okra (Abelmoschus esculentus) seedless fruit ethanolic extract within range concentration of 75-300 mg/ kg body weight. Urine volume is measured every hour for 6 hours and the 24th hour. Sodium and potassium measurements are executed towards 24-hour urine accumulation. Results: Single dose administration of Okra (Abelmoschus esculentus) fruit significantly increase 5th hour urine volume as compared to furosemide (p < 0.001). Whole fruit of Okra (Abelmoschus esculentus) compared to seedless fruit exhibit no significant increment of urine volume and electrolytes (p > 0.05). Conclusion: Ethanolic extract of Okra (Abelmoschus esculentus) fruit produce similar diuretic effect to furosemide. However, seedless Okra (Abelmoschus esculentus) fruit exerts a higher kaliuretic effect compared to whole fruit and furosemide.

Study on pharmacodynamics and pharmacokinetics of Phytolacca acinosa Roxb.And its mechanism / 中国药理学通报

Aim To explore the diuretic effect, diuretic mechanism and pharmacokinetics of Phytolacca acinosa Roxb., and clarify its "quantity-time-effect" relationship.Methods Firstly, qualified rats were modeled by water load model, given different doses of Phytolacca acinosa Roxb.aqueous extract, then the diuretic effect was investigated.Secondly, Western blot was used to detect the protein expression of aquaporins AQP2, AQP4 and the angiotensin II receptors ATGR1, ATGR2, and renin in the RAAS system in kidney tissues.Thirdly, the established LC-MS/MS biological analysis method was used to detect the esculentoside A(EsA)content in the plasma, calculate the pharmacokinetic parameters and analyze the correlation between the blood concentration and the drug effect.Results The water load model was successfully established.Compared with the model group, hydrochlorothiazide had a significant diuretic effect(P<0.01).Low, medium and high dose groups of Phytolacca acinosa Roxb.all had obvious diuretic effects(P<0.01), EsA also had a significant diuretic effect(P<0.05).Phytolacca acinosa Roxb.aqueous extract and EsA significantly down-regulated the expression of AQP2, AQP4, ATGR1 and renin protein.The pharmacokinetic results showed that the Cmax and AUC0-t of EsA in the plasma of rats in the low, medium, and high dose groups of aqueous extract increased with the increase of the dose.Conclusions Phytolacca acinosa Roxb.had a diuretic effect, which is related to inhibiting the expression of aquaporins AQP2 and AQP4 and inhibiting the expression of angiotensin II type 1 receptor and renin, thereby inhibiting the reabsorption of renal tubules and collecting ducts.

Estado del arte del síndrome cardiorrenal, ventajas y limitaciones de las terapias conocidas / State of the art of cardiorenal syndrome, advantages and limitations of known therapies

Resumen Las interacciones entre las enfermedades cardiacas y las renales se han clasificado como síndromes cardiorrenales. La clasificación actual incluye cinco subtipos: insuficiencia cardiaca aguda que conduce a insuficiencia renal aguda (tipo 1), insuficiencia cardiaca crónica que conduce a insuficiencia renal (tipo 2), lesión renal aguda que conduce a insuficiencia cardiaca (tipo 3), enfermedad renal crónica que conduce a insuficiencia cardiaca (tipo 4) y afecciones sistémicas que conducen a insuficiencia cardiaca y renal (tipo 5) (tabla 1)1,2. En esta revisión discutimos la definición, la clasificación y la fisiopatología del síndrome cardiorrenal, enfocándonos en el manejo en fases agudas y su recuperación, al exponer la evidencia actualmente disponible de los diuréticos y la ultrafiltración, con el objetivo de intervenir de manera oportuna a nuestros pacientes al conocer las ventajas y las limitaciones de cada una de las estrategias de manejo en aras de reducir el riesgo de eventos clínicos, rehospitalización y muerte.

Abstract Interactions between heart and kidney disease have been classified as cardiorenal syndromes. The current classification includes five subtypes, which are: acute heart failure leading to acute kidney failure (type 1), chronic heart failure leading to kidney failure (type 2), acute kidney injury leading to heart failure (type 3), chronic kidney disease leading to heart failure (type 4) and systemic conditions leading to heart and kidney failure (type 5) (table 1)1,2. In this review, we discuss the definition, classification, pathophysiology, focusing on acute phases treatment and its recovery, exposing the actual evidence for diuretics and ultrafiltration in order to intervene in a timely manner, pointing out the main advantages and limitations of each of the available strategies of treatment in order to reduce the risk of clinical events, re-hospitalization and death.

A hipopotassemia como efeito adverso dos diuréticos tiazídicos / Hypopotasemia as an adverse effect of thizide diuretics

O potássio tem função fisiológica fundamental no volume intracelular e na manutenção funcional de nervos e músculos. Distúrbios do potássio são comuns e estão associados a aumento na mortalidade nos portadores de doenças cardiovasculares, entre elas a hipertensão arterial. Assim a manutenção de um equilíbrio entre o potássio intra e extracelular é de fundamental importância para nervos, músculos e o sistema cardiovascular. Há décadas os diuréticos tiazídicos são uma das principais drogas utilizadas no tratamento da hipertensão arterial. Entre suas principais reações adversas relacionam-se os distúrbios eletrolíticos e metabólicos, os quais se tornaram menos frequentes com o uso de doses menores do que as habitualmente empregadas no seu início. Neste artigo os principais efeitos adversos do uso crônico dos diuréticos tiazídicos bem como suas consequências serão discutidos.

Potassium has a fundamental physiological function without intracellular volume and in the functional maintenance of nerves and muscles. Potassium disorders are common and are associated with increased mortality in patients with cardiovascular diseases, including hypertension. Thus, maintaining a balance between intracellular and extracellular potassium is of fundamental importance for the nerves, muscles and cardiovascular system. Thiazide diuretics have been one of the main drugs used in the treatment of hypertension for decades. Among its main adverse reactions are related electrolyte and metabolic disturbances, which become less frequent with the use of lower doses than those usually used at the beginning. In this article, the main adverse effects of the chronic use of thiazide diuretics as well as their consequences will be discussed.

Influence of Co-Administration of Bioflavonoid on Diuretic Activity of Furosemide

As bioflavonoids have a strong affinity to bind with albumin, it is plausible that they may have the ability to displace the diuretic furosemide bound to albumin. In this study we sought to verify this hypothesis by examining the effect of the co-administration of a bioflavonoid with furosemide on the diuretic activity of the latter. Diosmin is a bioflavonoids type of plant chemical found mainly in citrus fruits.For this purpose, we analyzed bioflavonoids by their ability to bind to human serum albumin (HAS) using an in silico method and found that diosmin had a higher affinity to albumin than furosemide. Subsequently, we investigated the effect of the co-administration of diosmin with furosemide on the diuretic activity of the latter in mice.Our results showed that the combination did not produce any significant change in the diuretic activity of furosemide; however, after 3 hours of treatment, the urine volume of the mice that received diosmin along with frusemide was greater than that of mice administered only the same dose of furosemide. There was no significant difference in urine volume between the two groups at the end of 24 hours. A similar trend of increased levels at 3 hours in the combination group and absence of any difference at 24 hours was noted in the case of the urine concentrations of Na+, K+, and 2 Cl Our findings indicate that co-administration of diosmin increased the immediate diuretic effect of furosemide for the first few hours and that this effect subsides within 24 hrs. Therefore, this combination should be used with care, especially during the first few hours of administration

Pharmacological Evaluation Of Antidiabetic And Diuretic Activity Of Hydro-Alcoholic Extract Of Anogeissus Latifolia Bark

The objective of the present investigation was to study the antidiabetic and diuretic potential of Anogeissus latifolia (A. latifolia) bark in experimental rats. The A. latifolia bark was extracted with hydro-alcoholic solvent by cold extraction method. Acute toxicity study was performed according to OECD 425 guidelines for hydro-alcoholic extracts of A. latifolia bark (ALBE). The dose of 150 mg/kg p.o. and 300 mg/kg, p.o. of ALBE was selected for further studies. Animals were prepared diabetic by administration of alloxan (120 mg/kg, i.p.). The albino rats were divided in to five groups for oral glucose tolerance test (OGTT) and alloxan induced anti diabetic model with six animals in each group. Diabetic animals were treated with hydro-alcoholic extract of A. latifolia bark for 20 days. The blood glucose level was estimated according to standard procedures. Diuretic activity hydro-alcoholic extracts of A. latifolia was evaluated by Lipshitz method. The result shows that hydro-alcoholic extract from bark of Anogeissus latifolia 300 mg/kg (ALBE-II) shown significant hypoglycemic activity as compared to glibenclamide and diabetic group. The ALBE does not exhibit significant diuretic activity which is considered as positive marker in diabetic phenomena. Hence in present study extract of A. latifolia posses antidiabetic activity. This study may be benchmark in future to use of this drug scientifically.

Hyponatremia in children with severe pneumonia and its effect on overall outcome

Background: Severe pneumonia is often associated with dyselectrolytemia, most commonly hyponatremia and the level of sodium significantly correlates to the overall outcome of the patient. The present study was conducted to identify the incidence of hyponatremia in children with Severe Pneumonia and to identify its association with Syndrome of Inappropriate secretion of Anti Diuretic Hormone (SIADH) and the effect on morbidity, mortality and duration of hospital stay.Methods: This study was conducted on 102 children between the age group of 6 months to 5 years admitted to the Upgraded Department of Pediatrics, Patna Medical College and Hospital with clinically and radiologically confirmed severe pneumonia from March 2017 to September 2018.Results: There were 33(32.4%) cases of hyponatremia out of which 26(25.5%), 5(4.9%) and 2(1.9%) had mild, moderate and severe hyponatremia respectively. 19(57.6%) cases of hyponatremia were due to SIADH out of which the duration of hospital stay was prolonged in 10(52.6%) cases, 10(52.6%) cases developed complications and 7(36.8%) patients died. The mortality of patients with hyponatremia was significantly higher (p<0.05) in the group with SIADH when compared to those without SIADH. The average duration of stay in hospital also was significantly higher (p<0.05) for the group with hyponatremia i.e. 8.2'4.5 days when compared to the group with normnatremia i.e. 7.3'1.7 days.Conclusions: Hyponatremia is commonly associated with Severe Pneumonia. Hyponatremia is usually mild and results in prolonged hospital stay, increased complications and mortality especially when associated with SIADH.

Incompatibility mechanism of Crotonis Semen Pulveratum and Glycyrrhizae Radix et Rhizoma based on diuretic effect and intestinal flora structure / 中国中药杂志

Based on the toxic characteristics caused by the compatibility between "Zaoji Suiyuan" and Glycyrrhizae Radix et Rhizoma, which was found in the previous studies, the expanded study was carried out on the incompatibility mechanism between Crotonis Semen Pulveratum(CT) and Glycyrrhizae Radix et Rhizoma(GU) with the diuretic effect and intestinal flora as the characteristic indexes. The results showed that GU could slow down the rapid diuretic effect of CT, which suggested a tendency of decreasing the efficacy. Both the high and low dose of CT could significantly induce the intestinal injury and change the intestinal bacteria structure of mice. Low dose CT combined with GU could significantly increase the levels of Streptococcus and Rikenellaceae＿ukn. The relative abundance of Desulfovibrio and Streptococcaceae＿ukn were increased after the combined application of high dose CT and GU. It also suggested that there was a risk of inflammation in the liver and intestines when combined application of these two herbs. The results revealed that the combination of CT and GU has a tendency to reduce the clinical effect and increase the toxicity from the aspects of its traditional efficacy and its effect on intestinal microflora structure, which could provide the data for the clinical use of CT.

Diuretic effect and material basis of Clematidis Armandii Caulis in rats / 中国中药杂志

To search for the active diuretic fractions of Clematidis Armandii Caulis( CAC) and determine its main active chemical components by using liquid chromatography-mass spectrometry( LC-MS) and diuretic activity evaluation. CAC 75% ethanol extracts and extracts from different polar solvents were orally administered to saline-loaded rats at different doses. 6 h urinary volume,p H and contents of electrolyte Na+,K+and Cl-were measured. The chemical components of the active fractions were separated and identified by ultra performance liquid chromatography-electrospray ionization-quadrupole time of flight-mass spectrometry( UPLC-ESI-Q-TOF-MS/MS) method. As compared with the control group,the urine volume was increased by 44%( P< 0. 01) and 34%( P < 0. 05) in CAC75% ethanol extract 57. 74 and 28. 8 mg·kg-1 groups respectively; the Na+excretion was increased by 52%( P< 0. 01) and 45%( P<0. 05),respectively; while the Cl-excretion was increased by 101%( P<0. 01) and 85%( P<0. 05),respectively. The urine volume,Na+excretion and Cl-excretion were increased by 50%( P< 0. 01),58%( P< 0. 05),and 65%( P< 0. 05) respectively in petroleum ether extract 70. 98 mg·kg-1 group as compared with the control group. While for the n-butanol extract 194. 18 mg·kg-1 group,the urine volume,Na+and Cl-excretion were increased by 42%( P<0. 01),41%( P<0. 05) and 97%( P<0. 01),respectively. The diuretic activity of other fractions was not obvious. There was no statistical difference in K+excretion in all groups. The results of LC-MS analysis showed that six compounds,including two sterols,one chromogen and three fatty acids,were identified from petroleum ether extract.Fourteen compounds,including six triterpenoid saponins,six lignin glycosides,one sterol glycoside and one phenolic glycoside,were identified from the n-butanol extract. All the results suggested that the ethanol extract of CAC had remarkable diuretic activity and its main effective components included sterol,triterpenoid saponin and lignin glycosides.

Acute Intermittent Porphyria: A rare cause of hyponatraemia

@#Introduction: Hyponatraemia is one of the most frequent laboratory findings in hospitalised patients. We present an unusual case of hyponatraemia in a 23-year-old female secondary to acute intermittent porphyria (AIP), a rare inborn error of metabolism. Case Report: The patient presented with upper respiratory tract infection, fever, seizures and abdominal pain. An initial diagnosis of encephalitis was made. In view of the unexplained abdominal pain with other clinical findings such as posterior reversible encephalopathy syndrome by CT brain, temporary blindness as well as hyponatraemia, acute intermittent porphyria was suspected. Urine delta aminolaevulinic acid (δ-ALA) and porphobilinogen were elevated confirming the diagnosis of AIP. Genetic studies were done for this patient. The patient had a complete resolution of her symptoms with carbohydrate loading and high caloric diet. Conclusion: Although rare, AIP should be considered as a cause of hyponatraemia in a patient who presents with signs and/or symptoms that are characteristic of this disease.

Research Progress in Pharmacological Effect of Mori Cortex / 中国实验方剂学杂志

Mori Cortex is the dry root bark of Moras alba L. and usually used in clinical practice. It is sweet and cold in nature, and enters the lung meridian. With effects in purging lung and relieving asthma, and inducing diuresis to reduce edema, it is mainly used to treat lung heat, asthma, cough, swelling, urine deficiency and facial skin edema. In clinic, it is mainly used for the treatment of respiratory system, urinary infection and diabetes mellitus. In recent years, great progress has been made in studies on the pharmacological effects of Mori Cortex. The literatures on the pharmacological effects of Mori Cortex in recent years were reviewed and summarized in this paper. Mori Cortex has antitussive, anti-inflammatory, hypoglycemic, cardiovascular, antiviral, anticancer, immunoregulatory, antioxidation and anti-allergy and other pharmacological effects, in addition to antitussive, expectorant, antiasthmatic and other traditional effects. Total flavones have a strong pharmacological activity. These extended studies provide valuable reference for the further development of Mori Cortex. This paper summarizes the pharmacological effects of Mori Cortex, proposes the key directions of further studies, and provides the beneficial reference for better development and utilization of Mori Cortex.

Analysis of long-term follow-up results of conservative treatment of children with unilateral UPJO / 中华泌尿外科杂志

Objective@#This study was a retrospective analysis of the efficacy of conservative treatment of unilateral renal pelvic ureteral junction obstruction with good renal function at the time of initial diagnosis.@*Methods@#The clinical data of 101 children with unilateral pelvic ureteral junction obstruction from January 2008 to December 2017 was analyzed retrospectively. All the patients underwent non-surgical treatment. There were 67 males and 34 females. The age range is from 10 days to 10 years old, with an average age of 3.4 years. 52 cases got left side obstruction and 49 cases got the right side obstrction. 14 children had abdominal pain symptoms. Among the 37 neonates: 21 male, 16 female. 15 were left, 22 were right. 10 cases were found during prenatal pregnancy, and 27 were dignosed postpartum. The indication for conservative treatment is no hydronephrosis-related symptoms or normal renal function at the initial diagnosis. The hydronephrosis did not affect the child's breathing, growth and development. The B-ultrasound was done every 1 to 6 months which depended on the different grades of hydronephrosis during a conservative observation period. The diuretic radionuclide imaging was done every 6 to 12 months. The end point of follow-up was surgery or disappear of the hydronephrosis in the affected side. Surgical indications are symptoms of hydronephrosis during follow-up which affecting growth and development, renal function reduction >10%, hydronephrosis SFU, UTDP grade progressive increase. Among them, 3 cases were raised from SFU2 to SFU3, 17 cases were raised from SFU3 to SFU4; 4 cases of neonatal UTDP2 progressed to grade 3 hydronephrosis and UTDP3 increased in 5 cases. Regression of hydronephrosis test three consecutive urinary renal ultrasound was defined as no hydronephrosis in.@*Results@#Continuous follow-up ranged from 1 year to 5 years, a median follow-up is 37 months. Of the 101 patients, 41 (40.5%) required surgery, and 60 (59.5%) kept conservative follow up. 2 cases of SFU1 children with hydronephrosis spontaneously disappeared. Of the 26 SFU class 2 children, 15 (69.2%) spontaneously resolved, 7(30.7%) improved, and 4 underwent surgery. Of the 50 children with SFU grade 3 hydronephrosis, 11(22.0%) spontaneously resolved, 19 improved or remained unchanged, and 20 patients eventually underwent surgery. Of the 23 patients with SFU grade 4 hydronephrosis, 6(26.0%) improved (to SFU 2) and 17(73.9%) underwent surgery. 37 of the 101 children were enrolled in the neonatal group for SFU grading while performing UTDP grading. Twenty-seven (70.2%) of the 37 neonates underwent conservative treat ment, including 8(100.0%) UTDP grade 1 hydronephrosis, 8(66.7%) UTDP grade 2 hydronephrosis, and UTDP grade 3 10 cases (58.8%) of hydronephrosis were effective for conservative treatment. There was a statistically significant difference between the level of hydronephrosis at the time of initial diagnosis of hydronephrosis and the efficacy of conservative treatment.@*Conclusion@#Conservative treatment of unilateral ureteral pelvic and ureteral junction obstruction is safe and effective. Severe hydronephrosis is unlikely to spontaneously resolve, often accompanied by early loss of renal function, and should be followed closely by ultrasound.

Analysis of long-term follow-up results of conservative treatment of children with unilateral UPJO / 中华泌尿外科杂志

Objective This study was a retrospective analysis of the efficacy of conservative treatment of unilateral renal pelvic ureteral junction obstruction with good renal function at the time of initial diagnosis.Methods The clinical data of 101 children with unilateral pelvic ureteral junction obstruction from January 2008 to December 2017 was analyzed retrospectively.All the patients underwent non-surgical treatment.There were 67 males and 34 females.The age range is from 10 days to 10 years old,with an average age of 3.4 years.52 cases got left side obstruction and 49 cases got the right side obstrction.14 children had abdominal pain symptoms.Among the 37 neonates:21 male,16 female.15 were left,22 were right.10 cases were found during prenatal pregnancy,and 27 were dignosed postpartum.The indication for conservative treatment is no hydronephrosis-related symptoms or normal renal function at the initial diagnosis.The hydronephrosis did not affect the child's breathing,growth and development.The B-ultrasound was done every 1 to 6 months which depended on the different grades of hydronephrosis during a conservative observation period.The diuretic radionuclide imaging was done every 6 to 12 months.The end point of follow-up was surgery or disappear of the hydronephrosis in the affected side.Surgical indications are symptoms of hydronephrosis during follow-up which affecting growth and development,renal function reduction ＞ 10％,hydronephrosis SFU,UTDP grade progressive increase.Among them,3 cases were raised from SFU2 to SFU3,17 cases were raised from SFU3 to SFU4;4 cases of neonatal UTDP2 progressed to grade 3 hydronephrosis and UTDP3 increased in 5 cases.Regression of hydronephrosis test three consecutive urinary renal ultrasound was defined as no hydronephrosis in.Results Continuous follow-up ranged from 1 year to 5 years,a median follow-up is 37 months.Of the 101 patients,41 (40.5％) required surgery,and 60 (59.5％) kept conservative follow up.2 cases of SFU1 children with hydronephrosis spontaneously disappeared.Of the 26 SFU class 2 children,15 (69.2％) spontaneously resolved,7 (30.7％) improved,and 4 underwent surgery.Of the 50 children with SFU grade 3 hydronephrosis,11 (22.0％) spontaneously resolved,19 improved or remained unchanged,and 20 patients eventually underwent surgery.Of the 23 patients with SFU grade 4 hydronephrosis,6 (26.0％) improved (to SFU 2) and 17 (73.9％) underwent surgery.37 of the 101 children were enrolled in the neonatal group for SFU grading while performing UTDP grading.Twenty-seven (70.2％) of the 37 neonates underwent conservative treat ment,including 8 (100.0％) UTDP grade 1 hydronephrosis,8(66.7％) UTDP grade 2 hydronephrosis,and UTDP grade 3 10 cases (58.8％) of hydronephrosis were effective for conservative treatment.There was a statistically significant difference between the level of hydronephrosis at the time of initial diagnosis of hydronephrosis and the efficacy of conservative treatment.Conclusion Conservative treatment of unilateral ureteral pelvic and ureteral junction obstruction is safe and effective.Severe hydronephrosis is unlikely to spontaneously resolve,often accompanied by early loss of renal function,and should be followed closely by ultrasound.

Evaluation of antimicrobial, hypotensive and diuretic effect of Eugenia uniflora extracts / Avaliação do efeito antimicrobiano, hipotensivo e diurético de extratos de Eugenia uniflora

The genus Eugenia sp. (Myrtaceae) comprises plants with reported antioxidant and antidiarrheal capability among other therapeutic potentials. The aim of this study was to evaluate the antimicrobial activity of essential oil; diuretic and hypotensive activities of aqueous extracts from leaves of Eugenia uniflora. The antimicrobial activity was evaluated . The diuretic and hypotensive activities were evaluated in normotensive Wistar rats by measuring blood pressure and urine flow after received four different concentrations of aqueous extracts (10%, 15%, 20% and 25%). Essential oil inhibited the growth of Candida parapsilosis and Candida albicans with MIC values lower than 14.41 mg/mL, equal to 57.75 mg/mL for Candida krusei. Among antibacterial effect, essential oil inhibited growth with a MIC equals to 153.93 mg/mL for all strains tested, except for Escherichia coli (MIC equals to 307.96 mg/mL. Aqueous extracts showed powerful reductions of the arterial pressure (34% and 31% lower than the control), after administration of 10% and 25% of aqueous extract, respectively. However, the animals that received the aqueous extract at the 15% and 20% concentrations presented a discrete hypotensive effect (20% and 21% lower than control group, respectively) concomitantly to powerful diuretic effect (280% and 91% higher than control group, respectively). These data confirmed the potential biological effect of this species, and represents an important step toward a depth study on the therapeutic properties of this species

O gênero Eugenia sp. (Myrtaceae) compreende plantas com capacidade antimicrobiana e antioxidante entre outros potenciais terapêuticos. O objetivo deste estudo foi avaliar a atividade antimicrobiana de óleo essencial; atividade diurética e hipotensora de extrato aquoso de folhas de Eugenia uniflora. A atividade antimicrobiana foi avaliada pela determinação da concentração inibitória mínima (MIC) e concentração mínima bactericida (MBC) de cepas bacterianas e concentração fungicida mínima (MFC) para fungos. A atividade diurética e hipotensora foi avaliada em ratos Wistar normotensos pela mensuração da pressão sanguínea e fluxo urinário após administração de quatro diferentes concentrações de extrato aquoso (10%, 15%, 20% e 25%). Óleo essencial inibiu o crescimento de Candida parapsilosis e Candida albicans com valores de MIC menores que 14,41 mg/mL, igual a 57,75 mg/mL para Candida krusei. A respeito do efeito antimicrobiano, o óleo essencial inibiu o crescimento de todas as cepas testadas, com MIC igual a 153,93 mg/mL, exceto para Escherichia coli (MIC igual a 307.96 mg/mL). O extrato aquoso mostrou redução importante da pressão arterial (34% e 31% quando comparado ao controle), após administração de 10% e 25% do extrato aquoso, respectivamente. Contudo, os animais que receberam o extrato aquoso na concentração de 15% e 20% apresentaram discreto efeito hipotensor (20% e 21% menor que o grupo controle, respectivamente) concomitantemente ao importante efeito diurético (280% e 91% maior quando comparado ao grupo controle, respectivamente). Esses achados confirmam o potencial efeito biológico dessa espécie, e representa um importante embasamento para estudos relacionados as propriedades terapêuticas da Eugenia uniflora

Predictors of contrast induced nephropathy and the applicability of the Mehran risk score in high risk patients undergoing coronary angioplasty—A study from a tertiary care center in South India

Objective To study the incidence and predictors of Contrast induced nephropathy (CIN) in high risk patients undergoing coronary angioplasty. To study the applicability of the Mehran Risk Score (MRS) in the prediction of CIN in our population. Methods This was a prospective observational study where patients with an estimated glomerular filtration rate (eGFR) between 30 and 60 ml/mt undergoing elective percutaneous coronary intervention (PCI) over a period of 15 months were evaluated prospectively for the development of CIN. The patients who developed CIN were then analysed for the presence of specific risk factors. The patients were categorized into the 4 risk groups based on the MRS. Results 100 high risk patients underwent PCI during the study period. The incidence of CIN was 29%. On multivariate analysis, the presence of anemia (p = 0.007), increased contrast volume usage (as defined by >5* B.Wt/S.cr) (p = 0.012) and usage of loop diuretics (p = 0.033) were independently found to confer a significant risk of CIN. In patients belonging to the high Mehran risk group (MRS10- 15) and very high risk group (MRS >15) the risk of CIN was 3 fold (OR: 3.055, 95% CI: 1.18–7.94, p = 0.022) and 24 fold (OR: 24, 95% CI: 2.53–228.28, p = 0.006) higher respectively when compared to intermediate and low risk patients (MRS <10). Conclusion The incidence of CIN in high risk patients undergoing PCI is substantially higher in our population compared to similar studies in the west. The MRS risk prediction is pertinent even in an Indian population.

Outpatient disease management program for heart failure:: a multidisciplinary approach with an ambulatory intravenous diuretic therapy

Aims. Heart failure (HF) is one of the most common causes of hospitalization, has high mortality and represents an economic burden. The Heart Failure Disease Management Program (HFDMP) at Health Sciences North (HSN) was designed and implemented utilizing various outpatient strategies aimed to help patients avoid emergency department (ED) visits, lower HF hospitalizations, improve outcomes, decrease mortality and lower health care costs. This study was designed to evaluate the effectiveness and safety of this program. Methods and results. 138 patients were enrolled in the HFDMP over a period of 12-months. Patient outcomes, admission, readmission and mortality rates were observed to determine the safety, efficacy and the costs associated. Of the patients treated for acute decompensated HF (ADHF) 29 patients received 79 continuous intravenous furosemide therapy (infusions). These patients were monitored for electrolyte changes, ED visits and hospitalizations to determine the safety and efficacy of the infusion clinic (IC). During the period of study NT-proBNP, eGFR and ejection fraction among other variables were analyzed. Only five readmissions within 30 days were noted over 12 months however, none of these hospitalizations was related to ADHF. The program’s mortality rate was 3%. No patient subjected to infusions required an ED visit or hospitalization. No clinical significant electrolyte changes was seen requiring hospitalization. Conclusions. The findings from our study suggests that this outpatient approach is a safe way to manage ADHF and an effective way to avoid ED visits, lower HF hospitalizations, decrease mortality, improve clinical symptoms and lower health care utilization costs.

Programa de tratamento ambulatorial para insuficiência cardíaca: uma abordagem multidisciplinar com uma terapia diurética intravenosa ambulatório Objetivos. A insuficiência Cardíaca (IC) constitui uma das maiores causas de hospitalização, apresenta uma alta taxa de mortalidade e representa um grande peso econômico para o sistema de saúde. O programa para gestão ambulatória Heart Failure Disease Management Program (HFDMP) em Health Sciences North (HSN), Sudbury, Canadá, foi estabelecido utilizando várias estratégias ambulatórias com destino a evitar a necessidade de uso de serviços de urgência (SU) e diminuir hospitalizações por episódios de insuficiência cardíaca aguda descompensada (ICAD) com o objetivo de melhorar resultados clínicos, diminuir mortalidade e baixar o custo econômico na gestão de pacientes com IC. Este estudo foi desenhado para avaliar a eficácia e segurança deste programa. Métodos e resultados. 138 pacientes entraram no programa HFDMP durante um período de 12 meses. Resultados clínicos e analíticos foram recolhidos durante este estudo, incluindo taxas de hospitalização, readmissão e mortalidade para determinar a segurança e eficácia do programa, assim como os custos associados a esta gestão. Durante o período em estudo 29 pacientes com episódios de ICAD receberam 79 infusões continuas com furosemida endovenosa em ambulatório (Infusões). Estes pacientes foram monitorizados para alterações eletrolíticas durante os procedimentos. Foi registrado a necessidade de encaminhamento para SU e hospitalizações para determinar a segurança e eficácia da clínica de infusão ambulatória. Foram analisados níveis de NT-proBNP, taxa de filtração glomerular (TFG) e fração de ejeção (EF), além de outras variáveis. Apenas 5 readmissões em 30 dias ocorreram nos pacientes do HFDMP durante o estudo, contudo, nenhuma destas hospitalizações se deveram a ICAD. A taxa de mortalidade no programa foi de 3%. Nenhum paciente submetido a Infusão ambulatória por ICAD necessitou transferências para SU ou admissão hospitalar. Nenhuma alteração eletrolítica significativa foi notada ou requereu hospitalização como resultado das infusões ambulatórias. Conclusões. Este estudo sugere que a abordagem ambulatória do programa HFDMP como resposta a ICAD é segura e representa uma forma eficaz de evitar visitas ao SU, baixando hospitalizações e a mortalidade nestes pacientes enquanto melhora indicadores clínicos e baixa custos de gestão.

Diagnóstico ecocardiográfico e tratamento de cardiomiopatia dilatada em tamanduá- bandeira ( Myrmecophaga trydactila ) mantido em cativeiro: relato de caso / Echocardiographic diagnosis and treatment of dilated cardiomyopathy in captive giant anteater (Myrmecophaga trydactila): case report

A cardiomiopatia dilatada é uma doença de caráter crônico, que compromete a função cardíaca, resultando em desequilíbrio da circulação sanguínea e da homeostase corporal do animal. Este relato apresenta a evolução do quadro clínico e o tratamento de cardiomiopatia dilatada em um exemplar cativo de tamanduá-bandeira. O animal apresentou quadro clínico de insuficiência cardíaca e foi submetido a duas baterias de exames laboratoriais e de imagem em um período de três meses. Posteriormente, foi iniciado o tratamento com pimobendan e suplementação de taurina, resultando em resposta positiva e melhora dos sinais clínicos do paciente. Os achados ecocardiográficos do caso foram compatíveis com cardiomiopatia dilatada com sinais evidentes de diminuição progressiva das frações de ejeção, bem como encurtamento e aumento expressivo das câmaras cardíacas, quando se comparou este caso ao de cães de grande porte e animais saudáveis da mesma espécie. O tratamento com inotrópico positivo, suplementação dietética de taurina e diuréticos se mostrou eficiente em controlar os sinais clínicos do animal.(AU)

The dilated cardiomyopathy it is a chronic disease that leads to a cardiac dysfunction, resulting in unstable blood circulation and specimen body homeostasis. This description shows the dilated cardiomyopathy evolution and treatment in a giant anteater captive model. The patient presented cardiac insufficient clinical condition and was submitted to two sets of laboratorial and image exams in three months. Furthermore, the treatment started with pimobendam and taurine supplementation, leading to satisfactory response to treatment and clinical improvement. The echocardiographic findings were compatible with dilated cardiomyopathy, moreover clear evidence of progressive reduction at the ejection portions and shortening and expressive increase of the cardiac chamber when compared to large dogs and healthy animals of the same species. Treatment with positive inotropic and taurine dietary supplement revealed as effective in clinical managementr.(AU)

Comparison of the diuretic effects of Descurainiae Semen, Coicis Semen and Plantaginis Semen / 中成药

AIM To compare the diuretic effects of Descurainiae Semen (DS),Coicis Semen (CS) and Plantaginis Semen (PS),and to observe their mechanical similarities and differences.METHODS Metabolic cage method was applied to investigating the diuretic effects of DS (2.34 g/kg),CS (7.00 g/kg) and PS (3.50 g/kg),whose diuretic mechanisms were studied by cryoscopic method,enzyme method,ion selective electrode method,ELISA and Western blot.RESULTS DS,CS and PS obviously increased saline-loaded rats' urine volume (P ＜ 0.05) and reduced their body weight (P ＜ 0.05) after administration for 7 h,which exhibited no significant effects on urine creatinine (Ucr),serum creatinine (Scr) and blood urea nitrogen (BUN)(P ＞ 0.05).DS showed its diuretic effect mainly by lowering the levels of serum Na +,atrial natriuretic peptide (ANP),brain natriuretic peptide (BNP),pulmonary AQP3,renal AQP1 and AQP2;CS showed its diuretic effect mainly by reducing the levels of serum Na +,Cl-,ANP,pulmonary AQP3,gastric AQP3,renal AQP1 and AQP2;PS showed its diuretic effect mainly by decreasing the levels of serum Na + and Cl-,pulmonary AQP3,gastric AQP3,renal AQP1 and AQP2.CONCLUSION Three medicinal materials have significant diuretic effects without obvious renal harm.DS categorized as a medicinal plant of lung channel and tropism has a great effect on netriuretic peptide system,CS categorized as a medicinal plant of spleen channel and tropism has a great effect on gastric AQP3,and PS categorized as a medicinal plant of renal channel and tropism has a great effect on renal AQPs.