Does daily urine output really matter in renal transplantation?

2013 ◽  
Vol 18 ◽  
pp. 716-720 ◽  
Author(s):  
Arnaud Doerfler
Keyword(s):  
Renal Transplantation ◽  
Urine Output ◽  
Daily Urine ◽  
Daily Urine Output

P1097INITIATING MAINTENANCE HAEMODIALYSIS USING INCREMENTAL HAEMODIALYSIS REGIME - A SINGLE CENTRE EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Tijana Azasevac ◽  
Violeta Knezevic ◽  
Sonja Golubović ◽  
Bojana Ljubiäiä‡ ◽  
Mira Markovic ◽  
...  
Keyword(s):  
Body Composition ◽  
Urine Output ◽  
Urine Volume ◽  
Group Versus ◽  
Obstructive Nephropathy ◽  
Intradialytic Hypotension ◽  
Full Dose ◽  
Fluid Status ◽  
Daily Urine ◽  
Daily Urine Output

Abstract Background and Aims Most patients with end stage renal disease (ESRD) initiate maintenance dialysis in three times per week regime irrespectively of residual kidney function (RKF). Incremental haemodialysis (IHD) showed benefits of starting and maintaining patients on less than three times per week regime, most importantly preserving urine volume output (UVO) and RKF. The aim of this study was to assess the main differences between a group of patients initiating dialysis once-weekly (1xHD) and twice-weekly (2xHD), to evaluate time to dialysis regime change, UVO and patients volume status at the end of study period. Method Patients with ESRD who started haemodialysis through the planned IHD (once-weekly and twice-weekly) and were undergoing IHD for at least 4 months (M) were enrolled (n=44) in the study. Study was conducted from January 2016 to December 2019 at dialysis department of our hospital. Patients were divided into two groups: 1xHD (20 pts) and 2xHD (24 pts). They were excluded from the study at the end of study period or earlier if they transitioned to thrice-weekly haemodialysis or died. Patients fluid status and body composition was assessed using results derived from bioimpedance measurements performed using Body Composition Monitor device. Results The 1xHD pts were younger (66,8±11,6 versus 67,4±10 years: P>0.05) and weighed less (74,4±14,7 versus 75,5±11,9 kg, p>0,05) with lower BMI. In both groups there were more males (60% versus 62,5%: P>0,05). The most common cause of ESRD in both groups was nephrosclerosis (45% in 1xHD versus 47,1% in 2xHD, p>0,05), followed by diabetic nephropathy (30% versus 20,8%, p>0,05), obstructive nephropathy (10% versus 8,3%, p>0,05), multiple myeloma (10% versus 8,3%, p>0,05), glomerulonephritis (5% versus 8,3%, p>0,05) and others in 2xHD group (12,5%; polycystic kidney disease and chronic interstitial nephritis). The estimated glomerular filtration rate of all patients at the time of HD initiation was 7,5±2,2 ml/min/1.73m2 (8,2±2,8 in 1xHD group versus 6,9±1,48 ml/ min/1.73m2 in 2xHD group, p>0,05). Baseline daily urine output was similar, 1826,6±344,6 ml/day in 1xHD and 1772,2±343,8 ml/day in 2xHD group (p>0,05). Patients in 1xHD concluded the study after mean period of 13,4 M (min 4 M, max 35 M). At the end of study period only three patients (15%) continued receiving dialysis once-weekly (mean 14,5 M, min 7 M, max 19 M), 12 pts (60%) transitioned to twice-weekly dialysis regime after 2 to 6 M (mean 3,1 M) and continued to receive this dialysis regime until the end of study period. Four pts (20%) transitioned to full-dose dialysis (mean 18,2 M, 11-24 M). Most of the patients in 2xHD group (17; 70,8%) concluded study in the same dialysis regime (mean 20,4 M, 4-24 M), 7 pts (29%) transitioned to full-dose dialysis (mean 12,6 M, 5-21 M) and one patient transitioned to once-weekly HD (8M). At the end of study daily urine output was 1463,1±317,5 in 1xHD versus 1321,1±309,1 ml/day in 2xHD group (p>0,05). Results of assessment of fluid status and body composition at the end of study are in Table 1. We evaluated nutritional status at the end of study: total protein 57,4±8,9 g/l in 1xHD versus 62,8±5,3 g/l in 2xHD, albumin 36,9±10,6 versus 37,6±4,4 g/l, total cholesterol 4,1±1,6 versus 4,4±1,3 mmol/l, triglycerides 1,3±0,8 versus 1,7±0,7 mmol/l (p>0,05 for all parameters). At the end of the study 70% of patients treated with IHD maintained renal function that was sufficient to continue IHD regime with overall survival rate 90% in 1xHD group and 87,5% in 2xHD group. Conclusion IHD, in carefully selected patients with good compliance, provides preservation of UVO and RKF, thus delaying transition to full-dose dialysis and avoiding complications of dialysis, such as intradialytic hypotension and vascular access failure. This type of dialysis is individualized treatment that obtains easier adaptation to dialysis and better quality of life.

PHYSIOLOGICAL INVESTIGATIONS ON THE EXCRETION OF KYNURENINE IN HUMANS

1955 ◽  
Vol 33 (1) ◽  
pp. 14-20 ◽  
Author(s):  
M. Špaček
Keyword(s):  
Specific Gravity ◽  
Human Urine ◽  
Urine Output ◽  
Older Persons ◽  
Average Level ◽  
Mixed Diet ◽  
Urinary Creatinine ◽  
Daily Urine ◽  
Normal Adults ◽  
Daily Urine Output

Concentration of kynurenine in human urine shows variations of about 16% during the day and approximately as much (13%) from day to day. The variations are not clearly related to daily urine output, specific gravity, urinary creatinine, and the presence of indican or diazo-reaction.Elimination of tryptophan from the diet leads to gradual decrease of kynurenine excretion in persons who have excreted large amounts on mixed diet, but not in persons excreting only traces. Concentration of kynurenine in urine rises after administration of tryptophan. The response to tryptophan varies widely from subject to subject. Nicotinamide seems to decrease excretion of kynurenine. No consistent effect of pyridoxine has been observed.Older persons tend to excrete higher concentrations of kynurenine. Normal adults of 20 years average age present an average level of 0.1 mgm. kynurenine per 100 ml. of urine, much of which is not true kynurenine. The average level in older persons (47 years average age) without physical disease has been found to be 0.21 mgm. per 100 ml.

scholarly journals The urea transporter UT-A1 plays a predominant role in a urea-dependent urine-concentrating mechanism

2020 ◽  
Vol 295 (29) ◽  
pp. 9893-9900 ◽  
Author(s):  
Xiaoqiang Geng ◽  
Shun Zhang ◽  
Jinzhao He ◽  
Ang Ma ◽  
Yingjie Li ◽  
...  
Keyword(s):  
Knockout Mice ◽  
Urine Output ◽  
Urine Osmolality ◽  
Urine Concentration ◽  
Urea Transporter ◽  
Predominant Role ◽  
Concentrating Mechanism ◽  
Daily Urine ◽  
Urine Concentrating Mechanism ◽  
Daily Urine Output

Urea transporters are a family of urea-selective channel proteins expressed in multiple tissues that play an important role in the urine-concentrating mechanism of the mammalian kidney. Previous studies have shown that knockout of urea transporter (UT)-B, UT-A1/A3, or all UTs leads to urea-selective diuresis, indicating that urea transporters have important roles in urine concentration. Here, we sought to determine the role of UT-A1 in the urine-concentrating mechanism in a newly developed UT-A1–knockout mouse model. Phenotypically, daily urine output in UT-A1–knockout mice was nearly 3-fold that of WT mice and 82% of all-UT–knockout mice, and the UT-A1–knockout mice had significantly lower urine osmolality than WT mice. After 24-h water restriction, acute urea loading, or high-protein (40%) intake, UT-A1–knockout mice were unable to increase urine-concentrating ability. Compared with all-UT–knockout mice, the UT-A1–knockout mice exhibited similarly elevated daily urine output and decreased urine osmolality, indicating impaired urea-selective urine concentration. Our experimental findings reveal that UT-A1 has a predominant role in urea-dependent urine-concentrating mechanisms, suggesting that UT-A1 represents a promising diuretic target.

PHYSIOLOGICAL INVESTIGATIONS ON THE EXCRETION OF KYNURENINE IN HUMANS

1955 ◽  
Vol 33 (1) ◽  
pp. 14-20
Author(s):  
M. Špaček
Keyword(s):  
Specific Gravity ◽  
Human Urine ◽  
Urine Output ◽  
Older Persons ◽  
Average Level ◽  
Mixed Diet ◽  
Urinary Creatinine ◽  
Daily Urine ◽  
Normal Adults ◽  
Daily Urine Output

Concentration of kynurenine in human urine shows variations of about 16% during the day and approximately as much (13%) from day to day. The variations are not clearly related to daily urine output, specific gravity, urinary creatinine, and the presence of indican or diazo-reaction.Elimination of tryptophan from the diet leads to gradual decrease of kynurenine excretion in persons who have excreted large amounts on mixed diet, but not in persons excreting only traces. Concentration of kynurenine in urine rises after administration of tryptophan. The response to tryptophan varies widely from subject to subject. Nicotinamide seems to decrease excretion of kynurenine. No consistent effect of pyridoxine has been observed.Older persons tend to excrete higher concentrations of kynurenine. Normal adults of 20 years average age present an average level of 0.1 mgm. kynurenine per 100 ml. of urine, much of which is not true kynurenine. The average level in older persons (47 years average age) without physical disease has been found to be 0.21 mgm. per 100 ml.

Percutaneous nephrostomy performed on kidneys with a thin renal cortex: a retrospective study of daily urine output in 46 nephrostomy procedures

2013 ◽  
Vol 118 (6) ◽  
pp. 909-916
Author(s):  
Chia Hsing Lu ◽  
Yi-Sheng Liu ◽  
Hong-Ming Tsai ◽  
Ming-Tsung Chuang ◽  
Chiung-Yu Chen ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Urine Output ◽  
Renal Cortex ◽  
Percutaneous Nephrostomy ◽  
Daily Urine ◽  
Daily Urine Output

scholarly journals Five-year experience with donation after cardiac death kidney transplantation in a Canadian transplant program: Factors affecting outcomes

2012 ◽  
Vol 6 (6) ◽  
pp. 448 ◽  
Author(s):  
Michael Moser ◽  
Michael Sharpe ◽  
Corinne Weernink ◽  
Harrison Brown ◽  
Thomas McGregor ◽  
...  
Keyword(s):  
Renal Function ◽  
Kidney Transplantation ◽  
Creatinine Clearance ◽  
Urine Output ◽  
Cardiac Death ◽  
Donation After Cardiac Death ◽  
Ischemic Time ◽  
Transplant Program ◽  
Daily Urine ◽  
Daily Urine Output

Background: Donation after cardiac death (DCD) has led to an increase of up to 40% in the number of kidney transplants in some programs. Unfortunately, the increase in warm ischemic time results in higher rates of delayed graft function (DGF). The purpose of our study was to examine our initial 5-year experience with DCD kidney transplantation and to determine the factors involved in early postoperative function and function at 1 year.Methods: This retrospective study included a review of the recipient and donor charts of 63 DCD kidneys retrieved and transplanted by the London Multi-Organ Transplant Program between July 2006 and October 2011. Comparisons were carried out between our early (n=31, July 2006 to January 2009) and our recent experience (n=32, March 2009 to October 2011). DGF and creatinine clearance at 3, 7 and 365 days were examined with regression analyses.Results: DGF was seen in 65% of transplanted kidneys. Mean creatinine clearance (CrCl) at 1 year was 66.7 mL/min. Low pre-transplant recipient daily urine output was the most statistically significant predictor of DGF in multivariate analysis (p < 0.001). In comparisons between our early and more recent results, improvements were noted in time from asystole to flush (16.0 vs. 12.0 minutes, p = 0.003), while cold ischemic time increased (464 vs.725 minutes, p = 0.006). Experience contributed to a significant reduction in hospital length of stay (16 vs. 13 days, p = 0.035) and improved early renal function (CrCl at 3 days 7.8 vs. 11.9 mL/min, p = 0.027). The use of machine cold perfusion and higher recipient preoperative daily urine output predicted improved early renal function, while increasing donor age predicted poorer funcion at 1 year.Discussion: Despite early DGF, our results justify the continued transplantation of kidneys from DCD donors.

scholarly journals Polyuria in a Patient With a Pituitary Mass

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A602-A603
Author(s):  
Sowjanya Naha ◽  
Joseph Theressa Nehu Parimi ◽  
Rajani Gundluru ◽  
John Chen Liu ◽  
Hasan Syed ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Urine Output ◽  
Laboratory Evaluation ◽  
Secondary Adrenal Insufficiency ◽  
Pituitary Mass ◽  
Maximum Serum ◽  
Water Excretion ◽  
Daily Urine ◽  
Daily Urine Output

Abstract Background: Hypocortisolism can develop in patients with a pituitary mass because of hypopituitarism and is appropriately managed with steroid replacement. However, these patients often have co-existing endocrine derangements that can become clinically evident after administration of steroids. Clinical Case: A sixty-year-old Caucasian female with known non-small cell lung cancer on chemoimmunotherapy was admitted for management of an enlarging suprasellar mass. Her symptoms included nausea, vomiting and multiple syncopal episodes over the preceding three weeks. At the time of admission, physical examination was unremarkable. She was noted to be hypotensive with systolic blood pressure in the high 70s and was treated with intravenous fluids. Laboratory evaluation showed low random cortisol (0.99 ug/dL, n: 0.4-22.6 ug/dL), undetectable ACTH (&lt;5 pg/mL, n: 7.2-63 pg/mL), low free thyroxine (1.01 ug/dL, n: 0.93-1.7 ug/dL), low free T3 (1.6 pg/mL, n: 2-4.4 pg/mL) and low TSH (0.023 ug/dL, n: 0.27-4.2 ug/dL), consistent with central hypothyroidism and secondary adrenal insufficiency. Importantly, she was normonatremic and normokalemic at admission. She was started on stress dose hydrocortisone (100 mg IV q8h) for presumed adrenal crisis. Following institution of steroid replacement therapy, the patient rapidly became polyuric while simultaneously developing hypernatremia. Her daily urine output peaked at 4400 mL corresponding temporally to a maximum serum sodium of 160 mmol/L. A single dose of 0.5 mg of desmopressin resulted in immediate lowering of daily urine output to 750 mL and appropriate improvement in urine osmolality from 147 mOsm/kg to 565 mOsm/kg, confirming a diagnosis of central diabetes insipidus (cDI). Conclusion: Hypocortisolism is known to impair free water excretion by stimulating arginine vasopressin (AVP) secretion through renal sodium loss and consequent volume depletion as well as direct feedback stimulation of corticotrophin releasing hormone (CRH) and AVP within the hypothalamus. Conversely steroid replacement leads to loss of feedback stimulation, unmasking cDI. This unique convergence of cDI with hypocortisolism is most often encountered in patients with hypopituitarism. Hence patients with secondary adrenal insufficiency should be carefully monitored for cDI after initiation of steroid replacement therapy.

Merkusal with cardiac edema and ascites

1938 ◽  
Vol 34 (1) ◽  
pp. 80-87
Author(s):  
V. N. Smirnov
Keyword(s):  
Acetic Acid ◽  
Chemical Composition ◽  
Pharmaceutical Industry ◽  
Complex Compound ◽  
Sodium Salt ◽  
Urine Output ◽  
Intramuscular Injections ◽  
Cardiac Edema ◽  
Daily Urine ◽  
Daily Urine Output

Of the drugs released in recent years by our Soviet pharmaceutical industry, merkuzal, an analogue of the German drug salirgan, attracts attention. According to its chemical composition, it is a complex compound of mercury acetic acid and sodium salt of allylamidosalicylic acid; soluble in water. This drug, released for sale in ampoules in the form of a 10% solution containing 0.036 grams of mercury in 1 cm3, belongs to the group of the strongest diuretics and is used intramuscularly, intravenously and intraperitoneally at intervals of 2-3 days. With intramuscular injections, according to our data, approximately 75% of daily urine output falls in the first 7-8 hours after injection.

Coping with Fluid Restriction and the Quality of Life in Hemodialysis Patients with Very Low or no Daily Urine Output

2014 ◽  
Vol 37 (6) ◽  
pp. 427-435 ◽  
Author(s):  
Luciana F. Silva ◽  
Gildete B. Lopes ◽  
Taline O. Cunha ◽  
Bruno M. Protásio ◽  
Ronald L. Pisoni ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Urine Output ◽  
Hemodialysis Patients ◽  
Fluid Restriction ◽  
Daily Urine ◽  
Daily Urine Output
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