325 research outputs found
Saint Augustine's Critical Judgment of the Pagan Writers
No full textThe following is an attempt to study Saint Augustine’s attitude toward the Greek and Latin pagan writers. An effort has been made to record all of the direct quotations of the pagan authors used by Saint Augustine in the twenty-two books of his Be Civitate Dei. |I have undertaken to emphasize the fact that the number of times an author has been quoted and the manner in which each author has been described somewhat emphasizes Augustine’s judgment of them. |Therefore, with the chart containing the above mentioned information, I have included short commentaries and recordings of those quotations to indicate Augustine’s appraisal of those who were responsible for them.ProQuest Traditional Publishing Optio
Functional renal reserve: physiology, pathophysiology and diagnostics. Application in practice = Функциональный почечный резерв: физиология, патофизиология и диагностика. Применение в практике
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Gozhenko A.I., Ivanov D.D., Nikitenko O.P., Sirman V.M.
Functional renal reserve:
physiology,
pathophysiology
and diagnostics
Application in practice
Kyiv Publisher Zaslavsky A.Yu.
2019
Machine Translated by Google
UDC 616.61-008.6-072.72.004.14
BBK 56.9+28.91
ÿ94
Authors: Gozhenko A.I., Ivanov D.D., Nikitenko O.P., Sirman V.M.
F94
Functional renal reserve: physiology, pathophysiology and diagnostics. Application in practice / Gozhenko A.I., Ivanov D.D., Nikitenko O.P. and others - K .: Publisher Zaslavsky A.Yu., 2019. - 146 p.
ISBN 978-617-632-101-9
DOI https://doi.org/10.5281/zenodo.7742367
The monograph summarizes the experience of studying the role of the functional renal reserve in the implementation of the homeostatic functions of the kidneys. The materials of our own research on the physiological substantiation of the original method for determining the functional renal reserve and the results of its study in healthy people and patients with kidney pathology are presented. The assessment of the diagnostic value of the method proposed by the authors of the study of the kidneys is given, the possibilities of determining the functional renal reserve in clinical practice and in experiments are shown.
mental studies
UDC 616.61-008.6-072.72.004.14
BBK 56.9+28.91
ISBN 978-617-632-101-9
© Gozhenko A.I., Ivanov D.D., Nikitenko O.P., Sirman V.M., 2019 © Vidavets
Zaslavskiy O.Yu., 2019
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CONTENT
List of conditional abbreviations 5
Introduction 6
Chapter
The role of glomerular filtration in the implementation of homeostatic renal functions in normal and pathological
conditions 8
Chapter
Functional renal reserve (definition, physiological significance, study
methods) 29
Chapter
Physiological rationale for the use of water-salt load to determine the functional renal
reserve 44
Physiological rationale for the ways of
determining FPR 54
Method for determining the RFP using a solution of sodium chloride 55
Chapter
Functional renal reserve in patients with
diabetes 61
The state of the functional renal reserve in patients with type 2 diabetes mellitus 76
Chapter
5
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4 Gozhenko A.I., Ivanov D.D., Nikitenko O.P., Sirman V.M. Functional renal reserve
Chapter
Functional renal reserve in patients
with AIDS 94
Chapter
Functional renal reserve in cancer
patients 105
Chapter
Functional renal reserve.
Physiological significance and its role in
the diagnosis of renal diseases 112
References 121
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LIST OF CONDITIONAL ABBREVIATIONS
ÿPNG - atrial sodium retic hormone AH - arterial hypertension BP -
blood pressure ADH - antidiuretic hormone AKF - angiotensin-converter
enzyme
ACE — angiotensin-converting enzyme ARP
— plasma renin
activity AT II — angiotensin II
ARBs - An receptor blockers
giotensin
HAART is a highly active anti- retroviral therapy
HIV - immunodeficiency virus
human
HIVAN, HIV-associated nephropathy HT, hypertension
DD, diastolic blood pressure DOXA, deoxycorticostero
for acetate
ACE inhibitors - angiotensin inhibitors
CK — creatinine clearance CF — glomerular filtration MD — minute diuresis
mRNA — messenger ribonucleic acid (synonym: messenger RNA
(mRNA)) NUF — natriuretic factor
torus
OAV - osmotic active
substances
AKI - acute renal failure
accuracy
AKI - acute injury to
check
PG — prostaglandin PC —
proximal tubules LPO — peroxidation
pids
RAAS - renin-angiotensin-al dosterone system
eGFR is the estimated glomerular filtration rate
DM - diabetes mellitus FFA - free fatty acids
lots
GFR, glomerular filtration rate HF, heart failure AIDS, acquired
immunodeficiency syndrome TIN, tubulointerstitial nephritis FPR, functional
kidney
CKD — chronic
kidney disease CRF — chronic kidney disease
cAMP sufficiency -
cyclic adenosine monophosphate cGMP - cyclic guanosine
monophosphate
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INTRODUCTION
The second half of the 20th century was a golden age for theoretical and clinical nephrology. First of all, this concerns understanding the function of the kidneys. During this period, they moved away from the idea of the excretory function of the kidneys as the leading and almost the only one. It has been established that the kidneys play a central role in the regulation of homeostasis, and primarily water-salt metabolism, in the human body due to the processes associated with urine formation. The kidneys perform excretory, osmo-, volume-, ion-regulating functions and regulate the acid-base state of the body. Along with this, the role of the kidneys in the regulation of blood pressure (BP) and hemodynamics in general, erythropoiesis and fibrinolysis, hormonal regulation and metabolism was established.
The second significant achievement was the understanding of the mechanisms of implementation of the homeostatic functions of the kidneys on the basis of a two-stage theory of urination with the establishment of the role of glomerular filtration and tubular reabsorption and secretion. Determination of the role of individual structures of the nephron in the implementation of renal functions, their mechanisms and regulation created a new understanding of physiology and served as the basis for understanding the
pathophysiology of the kidneys and clinical advances in the diagnosis and treatm
Along with this, in theoretical and clinical nephrology, an idea has developed about the leading and exclusive role of tubular reabsorption and secretion processes in the implementation of the main homeostatic functions of the kidneys. This was facilitated by data that indicated that differentiated performance of individual kidney functions is possible due to high specificity and accuracy due primarily to hormonal regulation of tubular processes of water transport (vasopressin) and sodium (aldosterone). Undoubtedly, scientific research on this topic has created a new, modern understanding of the functioning of the kidneys. Along with this, a belief has formed in nephrology that such
an important renal
process as glomerular filtration is stable, fairly constant and changes little during the regulation of renal functions.
Introduction 7
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ROLE OF THE GNUMERAL
FILTRATIONS IN IMPLEMENTATION NORMAL HOMEOSTATIC KIDNEY
FUNCTIONS
AND IN PATHOLOGY
As you know, the kidneys are an organ that plays a major role in the regulation and maintenance of body homeostasis. The main functions of the kidneys include: maintaining a constant volume of body fluids and their osmotic pressure, regulation of acid-base and ionic balance, excretion of nitrogen metabolism products, secretion of various organic substances and endocrine function (erythropoiesis, maintenance of blood pressure and the formation of an active metabolite of vitamin D ). That is, two
groups of processes occur in the kidneys that ensure the maintenance of homeostasis: the formation of urine (excretory function) and the release of hormones, enzymes, biologically active substances and compounds into the blood (endocrine function) [112, 115, 149].
Normally, the
provision of homeostasis largely depends on both the morphofunctional state of the kidneys and the systems of their regulation, especially the endocrine system.
Disorders of the excretory, osmo-, volume-, ion-regulating function of the kidneys and the maintenance of acid-base metabolism may be due to impaired glomerular (glomerular) filtration, tubular reabsorption and tubular secretion. Disorders of these renal processes are associated with disturbances in water and osmotic homeostasis, electrolyte balance in the extracellular fluid, acid-base balance and chemical composition of blood plasma, which can be manifested, on the one hand, by the accumulation of metabolic end products (hyperazotemia), and on the other - loss of organic compounds necessary for the body (hypoproteinemia, hypoaminonemia, hypoglycemia). Disorders of the endocrine functions of the kidneys about
are violations of renin secretion by the juxtaglomerular apparatus of the kidneys, as well as renal depressor factors, the release of erythropoietins and inhibitors of erythropoiesis, urokinase and the formation of a hormonally active form of vitamin D. These disorders can cause the development of arterial hypertension, anemia, renal osteodystrophy and, ultimately , renal failure. Thus, with kidney damage, we can observe impaired functioning of the glomeruli (filtration) and tubules (reabsorption and secretion), which causes significant changes in homeostasis [10, 19, 33, 41, 61, 113, 209,
217, 221, 236 , 240, 264, 267]. It is known that the performance of the main homeostatic functions of the
kidneys associated with urination - excretory, ionoregulatory, acid- regulating, volume-regulating, osmoregulatory, as well as those not associated with urination, depends primarily on coordinated changes in the main renal processes - glomerular filtration, reabsorption and secretions [10, 33, 36, 52]. In the late 60s and up to the early 90s of the 20th century, a generally accepted idea developed in nephrology that the main place in the regulation
and performance of the homeostatic functions of the kidneys belongs to controlled changes in the processes of tubular reabsorption and secretion under physiological conditions, as well as that their damage mainly contributes to the disruption of homeostasis. At the same time, it was assumed that the value of glomerular filtration is a very stable indicator and, especially under physiological conditions, changes extremely little, and a decrease in glomerular filtration is observed, as a rule, only in pathological conditions [19, 21, 233].
However, it has recently become known that changes in glomerular filtration are also observed under physiological conditions associated with natural fluctuations in water, food loads, and other types of effects on the human body [17, 20, 36, 188]. A classic example is the development of physiological hyperfiltration in athletes and a mild decrease in glomerular function in vegetarians. Meanwhile, until a certain time, significant attention
was not paid to the mechanism and role of changes in glomerular filtration, since it was believed that these changes are secondary.
And only in the late 80s of the last century, for the first time, they began to pay
10 Gozhenko A.I., Ivanov D.D., Nikitenko O.P., Sirman V.M. Functional renal reserve
attention to the fact that the value of glomerular filtration in conditions of functional rest, as well as during the performance of various loads and changes in the homeostatic functions of the kidneys, can fluctuate significantly and is homeostatically significant. Moreover,
it became clear that in most cases this or that work of the kidneys is accompanied by an increase in the volume of glomerular filtration, as a result of which the idea was formed that in conditions of relative rest of the kidney, the glomerular filtration rate is at a minimum physiological level [44, 46, 49 ]. While the performance of additional functions by the kidneys, the activation of a number of adaptive reactions is accompanied by an increase in glomerular filtration. This difference between glomerular filtration rates at rest and during additional work was called the functional renal reserve (RFR) [36, 44, 60, 81, 187]. It became clear that the activation of the renal reserve during physiological reactions is a constant and obligatory component of the reaction of the kidneys to certain types of loads
and changes in homeostasis, primarily water-salt, and in pathological conditions it is an obligatory stage of compensatory reactions and can play an important role. role in the diagnosis of kidney diseases [26, 94, 97, 129, 255]. According to data on kidney physiology [2,
10, 61, 112, 113], the glomerular filtration rate (GFR) in an individual nephron is determined by
the following indicators: the amount of renal blood flow in the nephron, the hydrostatic pressure gradient, the colloid osmotic blood pressure, and the ultrafiltration coefficient. Moreover, due to the presence of mechanisms of autoregulation of the renal circulation, the latter little depends on the state of systemic hemodynamics and remains constant within the range of fluctuations in systolic blood pressure of 80–200 mm Hg. As evidenced by the data of micropuncture studies, the main factors that cause an increase in GFR are the amount of intrarenal blood flow and the increase in hydrostatic pressure in the glomerulus, which largely depend on the tone of the afferent and efferent arterioles. Most attention is paid, especially in kidney pathology, to a decrease in GFR, which is considered as a criterion for the number of functioning nephrons.
The following mechanisms for reducing filtration are possible.
Chapter 1. The role of glomerular filtration in the implementation of homeostatic renal functions ... 11
Decreased hydrostatic pressure on the capillary wall. This, in turn, may be due to a drop in blood pressure below 10.4 kPa (80 mm Hg) due to shock and collapse, cardiovascular insufficiency, and a decrease in circulating blood volume.
An increase in oncotic blood pressure (over 3.25-3.9 kPa - 25-30 mm Hg) due to hemoconcentration during dehydration of the body, transfusion of large volumes of protein blood substitutes, as well as
in some diseases that occur with hyperproteinemia e.g. in multiple myeloma. 3. An increase in pressure in the glomerular capsule (more than 2.6 kPa
- 20 mm Hg), which is observed with delayed reabsorption of fluid in the proximal part of the nephron tubules, blockage of the lumen of the tubules by cylinders, necrotic masses, in case of obstructions to excretion urine in the urinary tract (not crosis, blood clots, stones, swelling). 4. Change in the state of the glomerular filter - a decrease in the total filtration surface (normally
about 1.5 m2 ), the number, area and diameter of pores (normally up to 5 nm); an increase in the thickness of the glomerular membrane (normally 80-120 nm), a change in its physico-chemical properties, for example, a decrease in the anionic charge. Such disorders are observed primarily in inflammatory processes that directly affect the glomerular membrane (glomerulonephritis, pyelonephritis) and aging [2, 52, 81, 98, 127, 221, 233, 294].
5. A decrease in the number of functioning glomeruli (normally about 2 million in two kidneys), which is the main reason for the decrease in glomerular filtration and is considered as a consequence of a decrease in the number of functioning nephrons. The main
mechanism for increasing the filtration rate is an increase in hydrostatic pressure in the capillaries of the glomerulus. An increase in the
hydrostatic pressure gradient and the development of intraglomerular hypertension results in the expansion of the afferent (bringing) and narrowing of the efferent (efferent) arteriole. With the maximum expansion of the afferent arteriole and a sharp narrowing of the efferent arteriole, the hydrostatic pressure gradient is maximum, intraglomerular pressure increases and hyperfiltration develops [19].
12 Gozhenko A.I., Ivanov D.D., Nikitenko O.P., Sirman V.M. Functional renal reserve
Factors such as an increase in hydrostatic pressure on the glomerular capillary wall due to hemodynamic changes and a decrease in blood oncotic pressure due to the redistribution of blood protein fractions towards the predominance of coarse globulins (in hepatitis, liver cirrhosis) also
play a role in increasing filtration.
A change, and especially a decrease, in GFR is accompanied by
other consequences of changes in their regulation.
Thus, the cardinal sign of increased glomerular membrane permeability is albuminuria/proteinuria — the excretion of plasma proteins in the urine more than the physiologically acceptable (20–30 mg/day) amount, as
well as the appearance in the urine of proteins with a large molecular weight (more than 70,000 Da). Therefore, the mechanism of proteinuria caused by an increase in the permeability of the glomerular filter is associated, on the one hand, with an increase in filtration due to pore expansion, and, on the other hand, with physicochemical changes in the basement membrane that facilitate diffusion or reduce the electrostatic barrier to filtration. Damage to the glomerular membrane, in particular the walls of the capillaries, may be accompanied by hematuria - the release of erythrocytes into the primary urine and the lumen of the tubules and their appearance in the urine (renal glomerular hematuria), where they are often detected in the form of shadows due to hemolysis. Such erythrocyturia is one of the manifestations of the urinary syndrome of glomerulonephritis [10, 21, 25, 38, 180, 181,164, 200, 262]. The most important pathophysiological consequence of impaired filtration in
the glomeruli is a delay in the excretion of nitrogen metabolism products from the body and an increase in their concentration in the blood
- hyperazotemia. The latter is mainly due to the accumulation in the blood of urea, uric acid, creatinine, other end products of metabolism, to a lesser extent amino acids, as well as toxic products formed during decay in the intestines - indican, phenols, indole, skatole. The determining factor of hyperazotemia is the degree of decrease in glomerular filtration, the criterion of which is an increase in the content of creatinine in the blood.
The renal origin of hyperazotemia is indicated by a simultaneous increase in the concentration of urea and creatinine in the blood [1, 2, 10, 27, 32,
48, 81, 114, 115].
As a result of dysfunction of the glomeruli, the excretion of phosphates, sulfates and organic acids is delayed and
Chapter 1. The role of glomerular filtration in the implementation of homeostatic renal functions ... 13
their concentration in the blood - hyperphosphatemia, hypersulfatemia, hyperacidemia. These anions in the extracellular fluid displace bicarbonates, reduce the alkaline reserve of the blood (up to 18–13.5 mmol/l, normally 25–31 mmol/l), which causes the development of acidosis (renal azothemic acidosis). Delay in the excretion of electrolytes from the body (potassium, sodium, magnesium and chlorine ions) and their redistribution between the extracellular and intracellular space - the accumulation of magnesium and potassium ions in the extracellular space, including in the blood (hyperkalemia, hypermagnesemia), and sodium and chlorine - in intracellular with a decrease in their concentration in the blood plasma (hyponatremia
and hypochloremia) are the result of kidney losses or impaired functioning of the sodium-potassium pump in the cells of the body. This is accompanied by a violation of volemic homeostasis — an increase in the fluid content in the intracellular and extracellular space, followed by the development of edema [21, 22, 24, 32, 94,
124, 139, 149, 179].
Changes in GFR, especially in kidney pathology, are always accompanied by changes in the functional state of nephron tubules, both adaptive and pathological. Disorders of tubular
processes, which are accompanied by changes in the constancy of the internal environment of the body or a selective violation of the partial functions of the tubules, are called tubular insufficiency (tubular syndrome). According to the literature [135, 136, 147, 156, 174, 176], tubular lesions are manifested by the following
morphological changes: a) damage with degeneration and coagulation necrosis of tubular epithelial cells (loss of nuclei with partial preservation of the cell contour), karyorrhexis and/or or karyopyknosis)
b) swelling of the tubular epithelium (which is typical for the action of many nephrotoxins and pathological processes that lead to prolonged hypokalemia); c) lag of tubular epitheliocytes from the main membrane of the tubules; d) destruction or loss of the border of tubular epithelial cells; e) dilatation of the tubules; e) interstitial edema with separation of tubules from each other; g) the presence of casts (hyaline, pigmented, eosinophilic, cellular or from granular detritus) (heavily pigmented casts may indicate the deposition of hemoglobin or myoglobin); h) the presence in the tubular lumen of living and dead epithelial cells, leukocytes and products
14 Gozhenko A.I., Ivanov D.D., Nikitenko O.P., Sirman V.M. Functional renal reserve
cell breakdown; i) destruction of the basement membrane (tubulorexis);
j) later, at the stage of repair and regeneration - basophilic staining of the cytoplasm of tubular epithelial cells, an increase in hyperchromic nuclei, mitotic figures, etc. Tubular dysfunction is
manifested by damage to those or
other parts of the tubular apparatus and, accordingly, a violation of the reabsorption of substances, the transport of which is carried out by the affected parts of the tubular apparatus. In the tubules, the processes of reabsorption and secretion take place. Glucose, proteins, amino acids, electrolytes (K+, Na+, Ca++, Cl–, Mg++), sulfates, phosphates, water, osmotically active substances (OSA) are reabsorbed [5, 7, 18, 21, 32, 41,
76 , 96, 135]. In primary urine (filtrate), as well as in blood, album
The Alcott Home in Louisa May Alcott’s Little Women
No full textTime and again writers of fiction have divulged the sources of their story material. Even a cursory glance at these occasional confessions reveals that authors utilize a surprising amount of their personal experiences. Especially do they treat successfully in fictional presentation the happenings of their early life. Indeed, some of the best stories and novels and poems are end-products of childhood activities, thoughts, and imaginative flights. One case in point is that perennial favorite of children and adults alike--Louisa May Alcott’s Little Women. Here if ever is an instance where the author first lived all that she later transmuted into a narrative of irresistible and unfading charm. |The impact of the Alcott family life was strong upon every one of its members. But we are here mainly concerned with the impressionability of Louisa May. We are furthermore interested not only in how she received impressions but in how she used them for artistic purposes, For this reason we need a survey of the beginning and growth of the whole Alcott family. More specifically, consideration shall be given to the family in general, to the Alcott parents and daughters in particular, to the emergence and development of literary talent in Louisa May, to the manifestation of this talent in Little Women, and finally to a critical evaluation of the famous hook as the synthesis and exemplification of wholesome family living. |ProQuest Traditional Publishing Optio
ПОНЯТТЯ РЕАЛІЗАЦІЇ КОНСТИТУЦІЙНОЇ СВОБОДИ ОСОБИ НА ПІДПРИЄМНИЦЬКУ ДІЯЛЬНІСТЬ В УКРАЇНІ. The concept of realization of the person’s constitutional freedom for business activity in Ukraine
No full textУ статті розглянуто поняття реалізації конституційної свободи особи на підприємницьку діяльність. Проаналізовано праці таких авторів, як С.С. Банковский, М.В. Вітрук, О.П. Віхров, С.І. Іщук, А.В. Ковач, Л.О. Нікітенко, А.Ю. Олійник, В.Ф. Попондопуло, О.В. Пушкіна, С.В. Різник та ін. The article deals with the concept of realization of a person’s constitutional freedom for entrepreneurial activity. The works of such authors as S.S. Vitruk, O.P. Vihrov, S.I. Ischuk, A.V. Kovach, L.O. Nikitenko, A.Yu. Oliynyk, V.F. Popondopulo, O.V. Pushkin, S.V. Butcher and others
Some aspects of Lactantius's credibility as seen in the De Mortibus Persecutorum
No full textThe purpose of the present work is to determine through a comparative study of the works of other men the historical accuracy of Lactantius in his De Mortibus Persecutorum. I shall first set forth a biographical sketch of the author, then consider the following questions: What factors may have influenced the thinking of Lactantius? In what points and to what extent does Lactantius agree with other historians? Where does he differ? Along this procedure, I shall follow Lactantius in his treatment of the persecution and the death of the Roman emperors -- Nero, Domitian, Decius, Valerian, Aurelian, and Diocletian with his associates. The Diocletian persecution, however, I shall treat at a greater length.RAL Thesis 1951 S3
Special Order no. 23 (28 January 1864)
No full textMajor O.P. Chaffie\u27s release of duty and order to reporthttps://egrove.olemiss.edu/ciwar_milrec/1014/thumbnail.jp
March Of Medicine
No full textDistribution Of First Lesions In Leprosy. Horton,R.J. & Povey, S
Chronic Ill Health From Unrecognised Malaria. Wills, N.E., Turner,P.P. , Somers, K. & Markandya, O.P.
Infant Mortality Due To Congenital Malformations. Landtman, B. and Wallgren, E.
Intertemporal Non-Separability or Borrowing Restrictions? : A Disaggregate Analysis Using the US Cex Panel
No full textTime Measurements of Software Cryptographic Algorithms for Real-time Transmission of Information
No full textAbstract—In recent years, much of the information exchange is done with the use of PC’s. This increase in PC usage leads to an increase in illegal information leakage and eavesdropping. To protect the information (data) measures must be taken to ensure security. A way to enforce protection is by the application of cryptography. We have used DES and RSA as cryptographic algorithms. We have focused on software programs of these algorithms. These cryptographic algorithms are programmed in C++ and Matlab.Electrical Engineering, Mathematics and Computer ScienceTelecommunicatie- en Verkeersbegeleidingssysteme
About the author
No full textIheanyi M. Enwerem, o.P., who was ordained a Catholic priest on July 8, 1978, is a member of the well known Catholic religious order, the Order of Preachers (Dominicans). He holds a B.A. (Hons) degree in Philosophy (University of Leuven, Belgium), M.A. in Theology (University of Toronto, Canada), and M.A. and Ph.D. in Social and Political Thought (York University, Toronto, Canada). After teaching in the Division of Social Science in his alma mater, York University, and in the Department of Hi..
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