HANDBOOK OF DIALYSIS FIFTH EDITION PDF
Handbook of Dialysis Fifth Edition by Daugirdas, John T., Blake, Peter G. and Ing, Todd S.. Philadelphia, PA: Lippincott Williams & Wilkins. Handbook of dialysis / [edited by] John T. Daugirdas, Peter G. Blake, Todd S. Ing. — Fifth edition. p. ; cm. Includes bibliographical references and index. Request PDF on ResearchGate | On Feb 5, , John T Daugirdas and others published Handbook of Dialysis 5th Edition.
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Handbook of Dialysis Fifth Edition by myavr.info - Ebook download as PDF File .pdf), Text File .txt) or read book online. The updated 5th edition of the Handbook of Dialysis is full of evidence-based, practical information on all aspects of dialysis training and therapy. Authored by. Handbook of Dialysis 5th Edition PDF Diálisis Peritoneal, Peritoneal Dialysis, 28 MB Format: PDF Length: pages Publisher: Wolters Kluwer Health; edition .
Normal creatinine concentrations range from 0. Measurement of the serum creatinine concentration is one way to obtain a rough estimate of the level of renal function, because as re- nal function falls, creatinine will continue to be produced, and the serum levels will rise. Serum creatinine levels are influenced by muscle mass, recent dietary intake, especially of cooked meat, and concomitant drug therapy e.
In patients with cirrhosis and ascites, estima- tion of renal function from serum creatinine is particularly difficult.
There can be a very low creatinine production rate due to extremely low muscle mass low creatinine produc- tion rate , plus it often is difficult to determine ascites-free body weight for normalization.
In such patients, serum cre- atinine levels in the 0. For ex- ample, a serum creatinine of 1.
Handbook of Dialysis
In the United States and many other countries, laboratories are now normal- izing their measurement methods to IDMS, and the nor- malized values tend to be lower than those obtained using other methods. Creatinine clearance by timed urine collection.
A timed usu- ally 24 hours urine collection of creatinine excretion can be used to calculate the creatinine clearance CCr , which is defined as the volume of serum cleared of creatinine per minute.
Patients are instructed to urinate Daugirdasch Next they are to pass all of their urine into a container during the ensuing day and night.
The following morning, the patients are to urinate into the container one last time, and to note this time as the end of the collection period. By dividing the amount of creati- nine in the collected urine by the number of minutes in the collection period start time to finish time , the laboratory can calculate the per minute rate of creatinine excretion.
A sample of blood must be drawn at some point during the urine collection period in which the serum creatinine level is measured. To calculate creatinine clearance, one simply divides the per minute creatinine excretion rate by the se- rum value.
For example, if the per minute creatinine excretion rate is 1. Despite the technical challenge of collecting urine properly, timed urine collections are a very useful means of estimating kidney function in cachec- tic patients, including those with cirrhosis and ascites, as well as markedly obese patients.
The completeness of the urine collection for creatinine can be estimated by com- paring the amount of creatinine recovered per day based on the expected daily creatinine excretion rate for a given patient based on sex and body weight.
A more exact estimate of daily creatinine excretion rate can be obtained from the use of an equation incorpo- rating body weight, gender, age, and race, such as that de- veloped by Ix , and which is detailed as a nomogram in Appendix A.
A creatinine excretion rate that is signifi- cantly less than expected usually indicates an incomplete urine collection. Because creatinine is cleared by the renal tubules in addition to being filtered at the glomerulus, the creatinine clearance is greater than GFR.
To get a more reliable estimate of GFR when GFR is low, one can measure the amounts of both creatinine and urea in the timed urine sample, and measure the serum urea level as well as the creatinine level during the collection period.
Handbook of Dialysis: Fifth Edition
The per minute clearance of urea is calculated in the same way as for creatinine. Urea is filtered at the glomerulus, but then some urea is reabsorbed by the renal tubules, so with urea, the situation is opposite to that with creatinine; due to tubular reabsorption, the urea clearance will be less than Daugirdasch Estimated creatinine clearance. To avoid the inaccuracies and inconvenience of timed urine collections, creatinine clear- ance CCr can be estimated by using equations that esti- mate the per minute creatinine excretion rate based on age, body size, gender, and in some equations, race.
This equation provides a quick and reasonably accurate estimate of renal function at the bedside.
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The more recently developed Ix equation Ix, , described in Appendix A, also can be used. The Ix equation was developed and validated in a much larger sample of individuals, including blacks, and was based on modern, IDMS-calibrated laboratory measures of creati- nine. Neither equation is very accurate in markedly obese or cachectic patients.
Some have suggested that the ac- curacy of the Cockcroft—Gault equation can be increased by using actual body weight for cachectic patients, ideal body weight for normal weight patients, and adjusted body weight for markedly obese patients Brown, Estimated GFR a. Raimann http: First published: Read the full text. Tools Request permission Export citation Add to favorites Track citation.
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No abstract is available for this article. Citing Literature Number of times cited according to CrossRef: A comprehensive review and analysis , Journal of Scleroderma and Related Disorders , 3 , 2 , , Volume 19 , Issue 4 October Pages Related Information.
Handbook of Dialysis: Fifth Edition
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Old Password.In patients with cirrhosis and ascites, estima- tion of renal function from serum creatinine is particularly difficult. First, it was developed from data that measured GFR by iothalamate, a substance which is not secreted by the re- nal tubules, and so it predicts GFR rather than creatinine clearance. Finally, it addresses common psychosocial and medical conditions afflicting dialysis patients.
Master Techniques The GFR, usually expressed in terms of milliliters per minute, is the volume of serum cleared by the kidneys per unit of time.
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