ABSTRACT
Toxic substances, known as uremic toxins, accumulate in body fluids during the course of progressive, chronic kidney disease. This article will briefly summarize current views on the definition, physico-chemical characteristics, pathobiological mechanisms for generation and retention, and cellular pathophysiology of uremic toxins. In addition, this article will attempt to integrate these disparate phenomena into a systems biology approach as to how such toxins lead to the diverse clinical manifestations so characteristic of the uremic state.
Subject(s)
Anthracenes/toxicity , Kidney Failure, Chronic/etiology , Propane/analogs & derivatives , Toxins, Biological , Uremia/classification , Uremia/physiopathology , Humans , Molecular Weight , Propane/toxicity , Toxins, Biological/classification , Uremia/chemically induced , Uremia/pathologyABSTRACT
BACKGROUND: Quality of life (QOL) is suboptimal in end-stage renal disease. However, studies indicate that QOL is already impaired prior to the initiation of renal replacement therapy, implying that the initial decline originates in the chronic kidney disease (CKD) phase of the renal disease trajectory. Given the significance of QOL as a clinical outcome, there is a paucity of QOL research in CKD. AIMS: To measure QOL at three distinct phases (based on creatinine clearance-Ccr) of the disease trajectory in CKD: normal renal function (NRF) with underlying renal disease, moderate CKD, and advanced CKD (Ccr > or = 75, 40-60, and < or = 30 ml/minute, respectively), and to establish if QOL is different between these groups. METHODS: Data was collected from 25 patients from each of the Ccr bands (N = 75). We measured self-reported QOL (Schedule for the Evaluation of Individual Quality of Life-SEIQOL), uraemic symptoms (Leicester Uraemic Symptom Scale-LUSS), and laboratory variables. RESULTS: SEIQOL was significantly lower (p < 0.001), and symptom number, frequency, and intrusiveness significantly higher (all p < 0.001) in the advanced CKD group when compared to the NRF group. Although SEIQOL and symptom intrusiveness did not differ between the advanced and moderate CKD groups, SEIQOL was significantly lower (p < 0.05) and symptom intrusiveness significantly higher (p < 0.05) in the moderate CKD group when compared to the NRF group. CONCLUSION: QOL is already impaired in moderate CKD. The significant difference in QOL and symptom intrusiveness between the moderate CKD and NRF groups may denote a causal relationship between symptom intrusiveness and QOL early in CKD.
Subject(s)
Kidney Diseases , Quality of Life , Uremia/diagnosis , Aged , Chronic Disease , Disease Progression , Female , Health Status , Humans , Interviews as Topic , Kidney Diseases/diagnosis , Kidney Function Tests , Male , Middle Aged , Surveys and Questionnaires , Uremia/classificationSubject(s)
Uremia , Acute Kidney Injury , Adult , Humans , Male , Peritoneal Dialysis, Continuous Ambulatory , Renal Dialysis , Terminology as Topic , Uremia/classification , Uremia/therapyABSTRACT
In the suggested classification of affections of the kidneys in diabetes mellitus the main attention is paid to the vascular genesis of the appearing disturbances. The terms used formerly ("diabetic glomerulosclerosis", "diabetic nephropathy") failed to reflect the primary affections of the vessels. The following new terms are suggested: "diabetic microangionephropathy" (affection of the small vessels), "macroangiography" (affection of the large vessels), "diabetic angionephropathy" (complex affection of the renal vessels). "Pyelonephritis" (acute and chronic) was also introduced into the classification due to its exceedingly frequent occurrence in diabetes. The term "diabetic nephropathy" is suggested for complex affection including diabetic angionephropathy and pyelonephritis. Diabetic microangionephropathy should be divided into four clinico-laboratory stages; their characteristics are presented. Particular attention was paid to the accessibility of their diagnosis in medical institutions.
