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    Ureteral Reconstruction With Ileum: Long-term Follow-up of Renal Function.
    Urology 2017 Feb 22. Epub 2017 Feb 22.
    Department of Urology, Indiana University School of Medicine, Indianapolis, IN. Electronic address:
    Objective: To assess long-term renal preservation and surgical outcomes in patients undergoing ureteric substitution with ileum. This has been a mainstay of reconstruction options for lengthy ureteral defects.

    Methods: Consecutive patients aged 18 or older undergoing ileal ureters at our institution were retrospectively reviewed (from 1989 to June 2013). Read More

    Three cases of Gordon syndrome with dominant KLHL3 mutations.
    J Pediatr Endocrinol Metab 2017 Mar;30(3):361-364
    Background: Gordon syndrome (GS) is a rare form of monogenic hypertension characterized by low renin hypertension, hyperkalemia, hyperchloremic metabolic acidosis, and normal glomerular filtration rate. To date, four genes causing GS have been identified as: WNK1, WNK4, CUL3, and KLHL3.

    Case Presentation: We report three cases of GS in two families. Read More

    Hyperchloremic Metabolic Acidosis Following Total Gut Irrigation with Normal Saline in Pediatric Patients: A Rare Occurrence.
    Indian J Crit Care Med 2017 Jan;21(1):55-56
    Department of Paediatric Surgery, Post Graduate Institute and Medical Education Research, Chandigarh, India.
    Use of 0.9% sodium chloride for total gut irrigation (TGI) through nasogastric route is an effective method of bowel preparation in children undergoing colorectal surgeries. TGI with normal saline (NS) can result in nausea, vomiting, abdominal distension, and mild electrolyte imbalance; however, hyperchloremic metabolic acidosis has not been documented. Read More

    [Metabolic acidosis].
    G Ital Nefrol 2016 Nov-Dec;33(6)
    Metabolic acidosis is frequently observed in clinical practice, especially among critically ill patients and/or in the course of renal failure. Complex mechanisms are involved, in most cases identifiable by medical history, pathophysiology-based diagnostic reasoning and measure of some key acid-base parameters that are easily available or calculable. On this basis the bedside differential diagnosis of metabolic acidosis should be started from the identification of the two main subtypes of metabolic acidosis: the high anion gap metabolic acidosis and the normal anion gap (or hyperchloremic) metabolic acidosis. Read More

    Controlled trial of Hartmann's solution versus 0.9% saline for diabetic ketoacidosis.
    J Paediatr Child Health 2017 Jan;53(1):12-17
    Department of Paediatric Critical Care, Women's and Children's Hospital, Adelaide, South Australia, Australia.
    Aim: We aimed to determine whether using a balanced salt solution, Hartmann's solution (HS), in diabetic ketoacidosis (DKA) shortens the time to normalise acid-base status through the avoidance of hyperchloremic metabolic acidosis compared with 0.9% normal saline (NS).

    Methods: We conducted a double-blind, randomised controlled trial comparing HS to NS as the initial intravenous fluid in children with DKA. Read More

    A Quick Reference on Hyperchloremic Metabolic Acidosis.
    Vet Clin North Am Small Anim Pract 2017 Mar 23;47(2):201-203. Epub 2016 Dec 23.
    Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, 700 Southwest 30th Street, Corvallis, OR 97331, USA. Electronic address:
    Metabolic acidosis results from an increase in the concentration of a strong anion. Metabolic acidosis is divided into hyperchloremic metabolic acidosis and high anion gap acidosis based on the changes in the anion gap. Hyperchloremic metabolic acidosis is the result of chloride retention, excessive loss of sodium relative to chloride, or excessive gain of chloride relative to sodium. Read More

    Complicated pregnancies in inherited distal renal tubular acidosis: importance of acid-base balance.
    J Nephrol 2016 Dec 22. Epub 2016 Dec 22.
    Division of Nephrology, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland.
    Inherited distal renal tubular acidosis (dRTA) is caused by impaired urinary acid excretion resulting in hyperchloremic metabolic acidosis. Although the glomerular filtration rate (GFR) is usually preserved, and hypertension and overt proteinuria are absent, it has to be considered that patients with dRTA also suffer from chronic kidney disease (CKD) with an increased risk for adverse pregnancy-related outcomes. Typical complications of dRTA include severe hypokalemia leading to cardiac arrhythmias and paralysis, nephrolithiasis and nephrocalcinosis. Read More

    Review of the Diagnostic Evaluation of Renal Tubular Acidosis.
    Ochsner J 2016 ;16(4):525-530
    Department of Anaesthesia and Intensive Care Medicine, Caboolture Hospital, Caboolture, Queensland, Australia.
    Background: The term renal tubular acidosis (RTA) describes a group of uncommon kidney disorders characterized by defective acid-base regulation. Reaching the diagnosis of RTA is complex and often delayed, resulting in suboptimal treatment.

    Methods: This article provides an overview of the clinical features of RTA and diagnostic approaches in a format accessible to physicians for everyday use. Read More

    Clinical analysis of hyperkalemic renal tubular acidosis caused by calcineurin inhibitors in solid organ transplant recipients.
    J Clin Pharm Ther 2017 Feb 14;42(1):122-124. Epub 2016 Dec 14.
    Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
    What Is Known And Objective: Calcineurin inhibitor (CNI)-based immunosuppressive regimen is widely used for preventing rejection in solid organ transplantation. Hyperkalemic renal tubular acidosis (RTA) caused by CNI is uncommon and potentially underappreciated. We reported four such cases to increase awareness of this risk and to provide recommendations for its management based on our experience. Read More

    Intravenous fluids: balancing solutions.
    J Nephrol 2016 Nov 29. Epub 2016 Nov 29.
    Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, Room D-438, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
    The topic of intravenous (IV) fluids may be regarded as "reverse nephrology", because nephrologists usually treat to remove fluids rather than to infuse them. However, because nephrology is deeply rooted in fluid, electrolyte, and acid-base balance, IV fluids belong in the realm of our specialty. The field of IV fluid therapy is in motion due to the increasing use of balanced crystalloids, partly fueled by the advent of new solutions. Read More

    WNK signalling pathways in blood pressure regulation.
    Cell Mol Life Sci 2017 Apr 4;74(7):1261-1280. Epub 2016 Nov 4.
    Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK.
    Hypertension (high blood pressure) is a major public health problem affecting more than a billion people worldwide with complications, including stroke, heart failure and kidney failure. The regulation of blood pressure is multifactorial reflecting genetic susceptibility, in utero environment and external factors such as obesity and salt intake. In keeping with Arthur Guyton's hypothesis, the kidney plays a key role in blood pressure control and data from clinical studies; physiology and genetics have shown that hypertension is driven a failure of the kidney to excrete excess salt at normal levels of blood pressure. Read More

    Metabolic Acidosis Assessment in High-Risk Surgeries: Prognostic Importance.
    Anesth Analg 2016 Nov;123(5):1163-1171
    From the *Anesthesiology Department, Hospital das Clinicas-FMUSP, SP, SP/Brazil; †Anesthesiology Department, Hospital do Servidor Público Estadual-IAMSPE, SP, SP/Brazil; and ‡Intensive Care Department, Hospital do Câncer de Barretos, SP, SP/Brazil.
    Background: Metabolic acidosis frequently is present in surgical patients; however, different types of metabolic acidosis (hyperlactatemia, hyperchloremia, and others) may have different relationships to perioperative outcomes. We hypothesized that in postoperative surgical patients, distinctive types of metabolic acidosis would correlate differently with the outcomes of high-risk surgeries.

    Methods: A prospective, multicenter observational study was performed in 3 different tertiary care hospitals. Read More

    A comparative study of Sterofundin and Ringer lactate based infusion protocol in scoliosis correction surgery.
    Anesth Essays Res 2016 Sep-Dec;10(3):532-537
    Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
    Background: A major change in anesthesia practice as regards to intraoperative infusion therapy is the present requirement. Switching over to balanced fluids can substantially decrease the incidence of lactic acidosis and hyperchloremic acidosis. The deleterious effects of unbalanced fluids are more recognizable during major surgeries. Read More

    Effects of Different Crystalloid Solutions on Hemodynamics, Peripheral Perfusion, and the Microcirculation in Experimental Abdominal Sepsis.
    Anesthesiology 2016 Oct;125(4):744-754
    From the Department of Intensive Care, Erasme University Hospital, Unversité Libre de Bruxelles, Brussels, Belgium.
    Background: Crystalloid solutions are used to restore intravascular volume in septic patients, but each solution has limitations. The authors compared the effects of three crystalloid solutions on hemodynamics, organ function, microcirculation, and survival in a sepsis model.

    Methods: Peritonitis was induced by injection of autologous feces in 21 anesthetized, mechanically ventilated adult sheep. Read More

    The efficacy and safety of sevelamer and lanthanum versus calcium-containing and iron-based binders in treating hyperphosphatemia in patients with chronic kidney disease: a systematic review and meta-analysis.
    Nephrol Dial Transplant 2017 Jan;32(1):111-125
    Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.
    Background.: It remains unclear which phosphate binders should be preferred for hyperphosphatemia management in chronic kidney disease (CKD).

    Methods. Read More

    Hyperkalemia in young children: blood pressure checked?
    Eur J Pediatr 2016 Dec 17;175(12):2011-2013. Epub 2016 Sep 17.
    Queen Mathilde Mother and Child Care Centre, University Hospital Antwerp, Antwerp, Belgium.
    Hyperkalemia in young children is a rare phenomenon and in many cases caused by hemolysis in the specimen due to difficulties in obtaining a sample. However, hyperkalemia can also be a sign of a rare Mendelian syndrome known as familial hyperkalemic hypertension or pseudohypoaldosteronism type II. This disease is characterized by hyperkalemia, hypertension, and mild hyperchloremic metabolic acidosis (with normal anion gap) despite normal glomerular filtration. Read More

    Chloride Content of Fluids Used for Large-Volume Resuscitation Is Associated With Reduced Survival.
    Crit Care Med 2017 Feb;45(2):e146-e153
    All authors: Center for Critical Care Nephrology and CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
    Objective: We sought to investigate if the chloride content of fluids used in resuscitation was associated with short- and long-term outcomes.

    Design: We identified patients who received large-volume fluid resuscitation, defined as greater than 60 mL/kg over a 24-hour period. Chloride load was determined for each patient based on the chloride ion concentration of the fluids they received during large-volume fluid resuscitation multiplied by the volume of fluids. Read More

    [The difference and ratio between serum concentrations of natrium and chlorides in patients with hyponatremia].
    Vnitr Lek 2016 ;62(7-8):629-34
    Unlabelled: The differential diagnosis of hyponatremia is often difficult. This most frequently occurring disorder of the water and electrolyte metabolism is frequently connected with deviations relating to the acid-base balance (ABB). This survey analyzes the relationship between the changes of the volume of body fluids and ABB and infers to what extent the analysis of combinations of the two disorders can support the differential diagnosis of different forms of hyponatremia (differentiation between the dilution vs. Read More

    Chloride content of solutions used for regional citrate anticoagulation might be responsible for blunting correction of metabolic acidosis during continuous veno-venous hemofiltration.
    BMC Nephrol 2016 Aug 26;17(1):119. Epub 2016 Aug 26.
    Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090, Brussels, Belgium.
    Background: Citrate, the currently preferred anticoagulant for continuous veno-venous hemofiltration (CVVH), may influence acid-base equilibrium.

    Methods: The effect of 2 different citrate solutions on acid-base status was assessed according to the Stewart-Figge approach in two consecutive cohorts of critically ill adult patients. The first group received Prismocitrate 10/2 (PC10/2; 10 mmol citrate/L). Read More

    A randomized trial of Plasma-Lyte A and 0.9 % sodium chloride in acute pediatric gastroenteritis.
    BMC Pediatr 2016 Aug 2;16:117. Epub 2016 Aug 2.
    Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
    Background: Compare the efficacy and safety of Plasma-Lyte A (PLA) versus 0.9 % sodium chloride (NaCl) intravenous (IV) fluid replacement in children with moderate to severe dehydration secondary to acute gastroenteritis (AGE).

    Methods: Prospective, randomized, double-blind study conducted at eight pediatric emergency departments (EDs) in the US and Canada (NCT#01234883). Read More

    Hyperchloremic acidosis is associated with acute kidney injury after abdominal surgery.
    Nephrology (Carlton) 2016 Jun 16. Epub 2016 Jun 16.
    Department of Anesthesiology, Hamamatsu Rosai Hospital, Japan Organizaition of Occupational Health and Safety, Higashi-ku, Hamamatsu, Japan.
    Aim: Hyperchloremic acidosis may have an important role as a precursor of acute kidney injury (AKI) in the hyperchloremic environment induced by chloride-rich fluids, but this remains unclear. We tested the hypothesis that hyperchloremic acidosis assessed by the Stewart approach is associated with postoperative AKI.

    Methods: A historical cohort study was conducted in adult patients who had normal renal function preoperatively and required admission to the intensive care unit after elective abdominal surgery. Read More

    Mutations in ATP6V1B1 and ATP6V0A4 genes cause recessive distal renal tubular acidosis in Mexican families.
    Mol Genet Genomic Med 2016 May 14;4(3):303-11. Epub 2016 Feb 14.
    Département de Génetique Hôpital Européen Georges Pompidou Paris France.
    Background: Autosomal recessive distal renal tubular acidosis (dRTA) is a rare disease characterized by a hyperchloremic metabolic acidosis with normal anion gap, hypokalemia, hypercalciuria, hypocitraturia, nephrocalcinosis, and conserved glomerular filtration rate. In some cases, neurosensorial deafness is associated. dRTA is developed during the first months of life and the main manifestations are failure to thrive, vomiting, dehydration, and anorexia. Read More

    Management of Acute Kidney Injury and Acid-Base Balance in the Septic Patient.
    Clin Chest Med 2016 06 8;37(2):277-88. Epub 2016 Mar 8.
    Division of Critical Care Medicine, Department of Anesthesia, University of California, San Francisco, 533 Parnassus Avenue, San Francisco, CA 94143, USA. Electronic address:
    Acute kidney injury (AKI) is an abrupt decrease in kidney function that takes place over hours to days. Sepsis is the leading cause of AKI and portends a particularly high morbidity and mortality, although the severity may vary from a transient rise in serum creatinine to end-stage renal disease. With regard to acid-base management in septic AKI, caution should be used with hyperchloremic crystalloid solutions, and dialysis is often used in the setting of severe acidosis. Read More

    Fluid Management in Acute Kidney Injury.
    Contrib Nephrol 2016 8;187:84-93. Epub 2016 Feb 8.
    Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, and Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
    The goal of fluid therapy in critical care medicine is to restore hemodynamic stability and vital organ perfusion while avoiding interstitial edema. Acute kidney injury (AKI) is a common complication in critically ill patients. Decisions regarding fluid management in critically ill patients with AKI are difficult, as these patients often have accompanying oliguria as well as body fluid overload. Read More

    [VIPoma in retroperitoneum of elderly, cause of chronic diarrhea in uncommon location].
    Rev Gastroenterol Peru 2015 Oct-Dec;35(4):355-7
    Servicio de Endocrinología del Hospital Guillermo Almenara Irigoyen. EsSalud. Lima, Perú.
    Chronic secretory diarrhea is a frequent entity. Causes are multiple, that is why reaching final diagnosis can result in delay with complications that this causes in the general condition of the patient. We present the case of one older adult with chronic diarrhea, mild hypokalemia and metabolic hyperchloremic acidosis secondary to a VIPoma in retroperitoneum which is an unusual location of this type of tumor that was diagnosed by biopsy guided by tomography. Read More

    Evidence-based fluid management in the ICU.
    Curr Opin Anaesthesiol 2016 Apr;29(2):158-65
    Department of Intensive Care Medicine University Hospital, Aachen, Germany.
    Purpose Of Review: Evidence-based fluid therapy is complicated by blurred boundaries toward other fields of therapy and the majority of trials not focusing on patient-relevant outcomes. Additionally, recent trials unsettled the faith in traditional concepts on fluid therapy. The article reviews the evidence on diagnosis and treatment of hypovolemia and discusses the use of balanced solutions and early goal-directed therapy (EGDT) in septic shock resuscitation. Read More

    Severity and Duration of Metabolic Acidosis After Deep Hypothermic Circulatory Arrest for Thoracic Aortic Surgery.
    J Cardiothorac Vasc Anesth 2015 Dec 29;29(6):1432-40. Epub 2015 Jul 29.
    Anesthesiology and Critical Care.
    Objective: To determine the severity, duration, and contributing factors for metabolic acidosis after deep hypothermic circulatory arrest (DHCA).

    Design: Retrospective observational study.

    Setting: University hospital. Read More

    [Half-molar sodium-lactate: The osmotic agent we are looking for?].
    Med Intensiva 2016 Mar 3;40(2):113-7. Epub 2015 Dec 3.
    Cátedra de Medicina Intensiva, Centro de Tratamiento Intensivo, Hospital de Clínicas Dr. Manuel Quintela, Facultad de Medicina, Universidad de la República (UdeLaR), Montevideo, Uruguay.
    Intracranial hypertension (ICH) is the most important modifiable factor with predictive negative value in brain injury patients. Osmotherapy is the most important first level specific measure in the treatment of ICH. Mannitol 20%, and 3, 7. Read More

    [Is physiological saline really physiological? Hyponatreamia treatment--small deviations from the rules of appropriate therapy create serious complications and side effects].
    Pol Merkur Lekarski 2015 Oct;39(232):237-40
    Professor emeritus Department of Medical Rehabilitation Shalgren's Hospital Goethenburg University, Sweden.
    Physiological saline can hardly be treated as physiological as it contains qualitatively and quantitatively different amounts of electrolytes. In particular, it contains 50% more chlorine ions than serum. Physiological saline can cause metabolic acidosis and in diabetic patients hyperchloremic acidosis. Read More

    Intravenous balanced solutions: from physiology to clinical evidence.
    Anaesthesiol Intensive Ther 2015 20;47 Spec No:s78-88. Epub 2015 Nov 20.
    Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
    "Balanced" solutions are commonly defined as intravenous fluids having an electrolyte composition close to that of plasma. As such, they should minimally affect acid-base equilibrium, as compared to the commonly reported 0.9% NaCl-related hyperchloremic metabolic acidosis. Read More

    Long-term Outcome of Ileal Ureteric Replacement With an Iliopsoas Muscle Tunnel Antirefluxing Technique for the Treatment of Long-segment Ureteric Strictures.
    Urology 2016 Feb 11;88:201-6. Epub 2015 Nov 11.
    Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China.
    Objective: To investigate the long-term outcome of ileal ureteric replacement using a proximal antirefluxing technique for the treatment of long-segment ureteric strictures.

    Patients And Methods: Between January 1997 and December 2013, 41 patients with a long ureteral stricture or defect and 3 patients with unilateral mid-lower ureteral cancer (20 bilateral and 24 unilateral, 28 males and 16 females) were treated by ureteral substitution using a proximal antirefluxing technique. The distal part of the upper ureter (4 cm) was fixed between the psoas muscle and the ileal segment (the iliopsoas tunnel technique). Read More

    Mutant neurogenin-3 in a Turkish boy with congenital malabsorptive diarrhea.
    Pediatr Int 2016 May 6;58(5):379-382. Epub 2015 Nov 6.
    Department of Pediatric Gastroenterology, Gazi University Medical School, Ankara, Turkey.
    Congenital diarrheal disorders are caused by disruption in nutrient digestion, absorption, or transport, enterocyte development and functioning, or enteroendocrine functioning. Many additional rare forms of congenital diarrhea are expected to be linked to genes associated with appropriate intestinal fluid and electrolyte balance. Neurogenin-3 mutation, a very rare form of congenital diarrhea, disrupts enteroendocrine cell differentiation and is characterized by malabsorption and the absence of pancreatic islet cells. Read More

    A Rare Case of Acquired Fanconi's Syndrome With Monoclonal Gammopathy in an Infant.
    J Clin Lab Anal 2016 Sep 29;30(5):510-2. Epub 2015 Oct 29.
    Department of Pathology and Laboratory Medicine, University of Texas at Houston, Houston, Texas.
    Background: Monoclonal gammopathies associated with acquired Fanconi's syndrome (AFS) have been reported in the adult population. AFS is characterized by renal dysfunction resulting in proteinuria, aminoaciduria, hypophosphatemia, glucosuria, and hyperchloremic metabolic acidosis. In this case report, we document the clinical and laboratory findings of a preterm infant with features of both AFS and monoclonal gammopathy in the urine. Read More

    Hyperchloremic Metabolic Acidosis due to Cholestyramine: A Case Report and Literature Review.
    Case Rep Nephrol 2015 3;2015:309791. Epub 2015 Sep 3.
    University of Toronto and University Health Network, Toronto General Hospital, Room 8N-842, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
    Cholestyramine is a bile acid sequestrant that has been used in the treatment of hypercholesterolemia, pruritus due to elevated bile acid levels, and diarrhea due to bile acid malabsorption. This medication can rarely cause hyperchloremic nonanion gap metabolic acidosis, a complication featured in this report of an adult male with concomitant acute kidney injury. This case emphasizes the caution that must be taken in prescribing cholestyramine to patients who may also be volume depleted, in renal failure, or taking spironolactone. Read More

    Deferasirox-induced serious adverse reaction in a pediatric patient: pharmacokinetic and pharmacogenetic analysis.
    Eur J Clin Pharmacol 2016 Feb 24;72(2):247-8. Epub 2015 Sep 24.
    Department of Biomedical and Clinical Sciences, Unit of Clinical Pharmacology, "Luigi Sacco" University Hospital, University of Milano, Milan, Italy.

    Hyperchloremic metabolic acidosis following plasma exchange during myasthenia gravis crisis.
    J Clin Apher 2016 Oct 22;31(5):479-80. Epub 2015 Sep 22.
    Service De Réanimation Neurologique, Hospices Civils De Lyon, Lyon, France.
    Background: Therapeutic plasma exchanges are increasingly used, notably during myasthenia gravis crisis. Repeated exchanges may induce severe adverse events.

    Case: We reported a case of symptomatic hyperchloremic metabolic acidosis following a therapeutic plasma exchange. Read More

    Using Zero Balance Ultrafiltration with Dialysate as a Replacement Fluid for Hyperkalemia during Cardiopulmonary Bypass.
    J Extra Corpor Technol 2014 Sep;46(3):262-6
    Avoiding or managing hyperkalemia during cardiac surgery, especially in a patient with chronic renal insufficiency, can be challenging. Hyperkalemic cardioplegia solution is usually administered to achieve and maintain an electrical arrest of the heart. This solution eventually mixes in with the systemic circulation, contributing to elevated systemic potassium levels. Read More

    Distal Renal Tubular Acidosis Screening by Urinary Acidification Testing in Mexican Children.
    Rev Invest Clin 2015 May-Jun;67(3):191-8
    Department of Pediatric Nephrology, Hospital Universitario "Nuestra Señora de La Candelaria", Santa Cruz de Tenerife, Spain.
    Background: Primary distal renal tubular acidosis is a clinical disorder characterized by hyperchloremic metabolic acidosis, hypercalciuria, hypocitraturia, urinary acidification impairment, hypokalemia, metabolic bone disease, and nephrocalcinosis. Urinary acidification ability may be evaluated by an acidification test or maximum urinary pCO2 assessment with alkaline urine. The maximum urinary pCO2 test using acetazolamide and sodium bicarbonate is an easy test to confirm the lack of urine acidification in distal renal tubular acidosis in children. Read More

    Biological Impact of Recent Guidelines on Parenteral Nutrition in Preterm Infants.
    J Pediatr Gastroenterol Nutr 2015 Dec;61(6):605-9
    *Neonatal and Pediatric Intensive Care Unit, CHU Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris †Neonatal Intensive Care Unit, CHU Angers, Angers ‡Neonatal Intensive Care Unit, Pôle Médico-Chirurgical de Pédiatrie et de Génétique Clinique, CHU Rennes, Rennes §Division of Neonatology, AP-HM, Aix-Marseille University, Marseille ||Neonatal Intensive Care Unit, Pôle Femme Couple Enfant, CHU Amiens, Amiens ¶Neonatal and Pediatric Intensive Care Unit, CHU Félix Guyon, La Réunion #Neonatal Intensive Care Unit Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris **Neonatal Intensive Care Unit, Groupe Hospitalier Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France.
    Objectives: Recent guidelines for preterm neonates recommend early initiation of parenteral nutrition (PN) with high protein and relatively high caloric intake. This review considers whether these changes could influence homeostasis in very preterm infants during the first few postnatal weeks.

    Methods: This systematic review of relevant literature from searches of PubMed and recent guidelines was reviewed by investigators from several perinatal centers in France. Read More

    The effect of 0.9% saline versus plasmalyte on coagulation in patients undergoing lumbar spinal surgery; a randomized controlled trial.
    Int J Surg 2015 Aug 27;20:128-34. Epub 2015 Jun 27.
    Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea. Electronic address:
    Introduction: In multi-level lumbar spinal fusion surgery yielding a large amount of blood loss, choice of fluid for volume resuscitation is an important issue since it can influence acid-base status, coagulation, and patients' outcome. This study compared the effect of plasmalyte to 0.9% saline on coagulation assessed by rotation thromboelastometry (ROTEM) and acid-base balance in the aforementioned patients. Read More

    [NaCl 0.9 % for volume substitution : blessing or curse?].
    Internist (Berl) 2015 Jul;56(7):773-8
    Medizinische Klinik D, Abteilung für Allg. Innere Medizin, Nephrologie und Rheumatologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland,
    The nonphysiological high chloride content of 0.9 % saline causes hyperchloremic acidosis and rapidly reduces renal perfusion in healthy volunteers-negative affects not seen with balanced crystalloids with low chloride content. Evidence from recently published studies strongly suggests that 0. Read More

    Deficient acid handling with distal RTA in the NBCe2 knockout mouse.
    Am J Physiol Renal Physiol 2015 Sep 24;309(6):F523-30. Epub 2015 Jun 24.
    Department of Cellular/Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska; and
    In many circumstances, the pathogenesis of distal renal tubular acidosis (dRTA) is not understood. In the present study, we report that a mouse model lacking the electrogenic Na(+)-HCO3 (-) cotransporter [NBCe2/Slc4a5; NBCe2 knockout (KO) mice] developed dRTA after an oral acid challenge. NBCe2 expression was identified in the connecting tubule (CNT) of wild-type mice, and its expression was significantly increased after acid loading. Read More

    The great fluid debate: saline or so-called "balanced" salt solutions?
    Ital J Pediatr 2015 Jun 25;41:47. Epub 2015 Jun 25.
    Department of Internal Medicine, Ospedale San Giovanni, 6500 Bellinzona, Switzerland.
    Background: Intravenous fluids are commonly prescribed in childhood. 0.9 % saline is the most-used fluid in pediatrics as resuscitation or maintenance solution. Read More

    A role for VAX2 in correct retinal function revealed by a novel genomic deletion at 2p13.3 causing distal Renal Tubular Acidosis: case report.
    BMC Med Genet 2015 Jun 13;16:38. Epub 2015 Jun 13.
    Departments of Medical Genetics, Renal Medicine and Ophthalmology, University of Cambridge, Cambridge, UK.
    Background: Distal Renal Tubular Acidosis is a disorder of acid-base regulation caused by functional failure of α-intercalated cells in the distal nephron. The recessive form of the disease (which is usually associated with sensorineural deafness) is attributable to mutations in ATP6V1B1 or ATP6V0A4, which encode the tissue-restricted B1 and a4 subunits of the renal apical H(+)-ATPase. ATP6V1B1 lies adjacent to the gene encoding the homeobox domain protein VAX2, at 2p13. Read More

    Quick note on tissue engineering-based surgical measures to treat patients with neurogenic bladder-due detrusor/sphincter dyssynergia.
    Ann Ital Chir 2015 May-Jun;86(3):252-7
    To treat the neurogenic bladder-due detrusor/urethral rhabdosphincter dyssynergia, early combined clean intermittent catheterization/ pharmacotherapy (anticholinergic-, β3-adrenoceptor agonist drugs) management may be at times crowned with success of preserving an adequate bladder compliance and renal safe conditions.The persistence, instead, of elevated bladder filling pressure levels with high voiding pressure/uroflow values, together with aberrant urethral rhabdosphincter electromyographic findings, make necessary the resort to surgery strategies, among which - a part from rhabdosphincterotomy or alternatively intrasphincteric botulinum A toxin injection or urethral stent insertion - the bladder augmentation cystoplasty, with either reconfigurated bowel- or gastric segment, is today the most efficacious surgical measure to increase the bladder urinary storage meanwhile lowering bladder filling pressure. Given the enterocistoplasty-dependent both potential systemic metabolic imbalances - such as hyperchloremic acidosis/hypokaliemia, hyperoxaluria, bone demineralization, chologenic diarrhoea/steatorrhoea, vit B12 deficiency - together with bowel prosthetic mucus overproduction-due recurrent stone formation, and, sometimes, malignant complications particularly at the intestinal-urinary tract suture line, tissue engineering techniques have been taken into consideration, more than twenty years ago, as alternative measure for bladder augmentation cystoplasty, until to reach successful clinical validation just in patients suffering from either congenital dysraphism- or acquired spinal cord injury-dependent neurogenic bladder. Read More

    An unrecognised case of metabolic acidosis following neobladder augmentation cystoplasty.
    Int J Surg Case Rep 2015 25;11:129-31. Epub 2015 Mar 25.
    Department of Urology, Darent Valley Hospital, Dartford, Kent DA2 8DA, United Kingdom. Electronic address:
    Introduction: We present a case where there was a delay in the diagnosis of severe metabolic acidosis in a patient with an orthotopic neobladder. There are a growing number of patients with orthotopic neobladders and a wider range of clinicians are encountering these patients. A delay in the diagnosis can lead to significant morbidity but if identified early it can be easily treated. Read More

    Comprehensive clinical approach to renal tubular acidosis.
    Clin Exp Nephrol 2015 Aug 9;19(4):556-61. Epub 2015 May 9.
    PSRI Hospital, Sheikh Sarai, Saket, New Delhi, India,
    Renal tubular acidosis (RTA) is essentially characterized by normal anion gap and hyperchloremic metabolic acidosis. It is important to understand that despite knowing the disease for 60-70 years, complexities in the laboratory tests and their interpretation still make clinicians cautious to diagnose and label types of tubular disorder. Hence, we are writing this mini-review to emphasize on the step wise approach to RTA with some understanding on its basic etiopathogenesis. Read More

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