By A. M. Davison (Auth.)
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Extra resources for A Synopsis of Renal Diseases
T h e major disadvantage is t h e possibihty o f i n t r o d u c i n g m f e c t i o n t o t h e urinary t r a c t . I t also requires considerable skill as it is possible t o overdistend t h e system a n d so give t h e impression o f h y d r o n e p h r o s i s . Arteriography. T h i s is used t o e x a m i n e t h e arterial supply t o t h e k i d n e y a n d is o f particular value i n t h e investigation o f renal artery stenosis. I t requires femoral p u n c t u r e a n d t h e i n t r o d u c t i o n o f a n arterial c a t h e t e r t o t h e level o f t h e renal arteries.
T h e h y p o v o l a e m i a r e d u c e s renal b l o o d flow a n d glomerular filtration t h e r e b y inhibiting t h e secretion of n a t r i u r e t i c factor a n d stimulating t h e secretion of renin. T h e renin increases a l d o s t e r o n e secretion from t h e adrenal. T h e h y p o v o l a e m i a also stimulates t h e secretion of A D H . T h e n e t effect of (3) and (4) is m a x i m a l conservation of s o d i u m and w a t e r b y t h e k i d n e y in an a t t e m p t t o restore t h e diminished b l o o d volume.
Care m u s t also b e t a k e n w i t h t h e a d m i n i s t r a t i o n of vasopressin in elderly p a t i e n t s o r t h o s e suspected of m y o c a r d i a l insufficiency. Normal Values 1. After 1 8 h fluid deprivation t h e u r i n e osmolality should b e 1000± 150 m o s m / k g . 2 . I n diabetes insipidus values o f less t h a n 5 0 0 m o s m / k g a r e e x p e c t e d . 3 . I n p a t i e n t s w i t h central d i a b e t e s insipidus vasopressin should r e s t o r e t h e c o n c e n t r a t i n g a b i h t y b u t it m a y t a k e several d a y s of t r e a t m e n t before a satisfactory i m p r o v e m e n t o c c u r s as it will t a k e this t i m e t o re-estabhsh t h e medullary gradient.
A Synopsis of Renal Diseases by A. M. Davison (Auth.)
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