O diagnóstico de insuficiência renal crônica (IRC) inaugura para quem o experimenta uma passagem irreversível ao mundo dos doentes, alterando a relação do acometido com seu próprio corpo. Trata-se de uma doença incurável, cujo tratamento consiste em intervenções permanentes ao longo da vida do paciente, como dependência de máquinas para substituição da função renal, intervenções cirúrgicas, ingestão diária de medicamentos e adoção de restrições dietéticas. Os familiares de crianças em tratamento dialítico peritoneal domiciliar têm assumido significativa sobrecarga nos cuidados oferecidos à criança, o que resulta em desgaste emocional, vivências de culpa e estresse familiar. Nesse contexto, o objetivo deste estudo é compreender as vivências de mães de crianças portadores de insuficiência renal crônica, seus modos de existir frente ao tratamento dialítico e possibilidade de transplante renal. O estudo foi conduzido segundo a metodologia de investigação fenomenológica, que consiste na apreensão do fenômeno tal como ele se manifesta para a pessoa que o vivencia, buscando captar os significados atribuídos por ela ao seu existir. Foram entrevistadas 5 mães de crianças e adolescentes com IRC em tratamento dialítico peritoneal no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo (HC/FMRP-USP), a partir da questão norteadora: \"Como a senhora vem vivenciando esse momento na sua vida?\". As entrevistas foram analisadas segundo o método de análise da estrutura do fenômeno situado, proposto por Martins & Bicudo (1989), Giorgi (1985) e Valle (1997), revelando-se as seguintes categorias temáticas: inaugurando o existir com a doença e o tratamento do filho; integrando-se ao cotidiano de tratamento: significar para conviver; cuidando do filho: proporcionar e legitimar sua vitalidade; reconhecendo o próprio enfrentamento: buscas e conquistas, e um vislumbre sobre os vínculos - memoráveis alianças: das conquistadas às rompidas. Foi utilizado como referencial teórico algumas idéias de Martin Heidegger, bem como de outros autores que se fundamentaram nele. O estudo possibilitou compreender algumas facetas do existir dessas mães nas relações de cuidado estabelecidas com a criança doente, apreendendo os significados atribuídos por elas a uma doença incurável, ao seu tratamento e às repercussões dessa realidade em suas vidas e na vida de seus filhos. / The Chronic Renal Failure diagnosis (CRF) inaugurates in a person who experiences an irreversible crossing to the disease world, altering the relation of the sick person with his/her body. It is an incurable disease, which treatment consists in permanent interventions along the life of the patient as reliance of devices to substitute the renal function, surgical interventions, and daily ingestion of medicine and adoption of restriction dietary. The children families in ambulatory peritoneal dialysis treatment have assumed significant surcharge in the carefulness offered to the child, which results in emotional weariness, guilt experiences and familiar stress. The goal in this study, in context is to comprehend the experiences of Chronic Renal Failure holder children mother, their way to exist facing the dialysis treatment and the possibility of the renal transplant. The study was led according to the phenomenological investigation methodology, that consists in apprehension of the phenomenon such as it reveals to the person who experiences it, seeking to catch the meanings ascribed to her/him on his/her existence. Five mothers with CRF children and adolescents were interviewed in peritoneal dialysis treatment in the clinical hospital in the Faculty of Medicine of \"Ribeirão Preto\". University of São Paulo (HC/FMRP/ USP), from the question: \"How have you been experiencing this moment of your life?\" the interviews were analysed according to the method of analysis of the stated phenomenon structure, proposed by Martin & Bicudo (1989), Giorgi (1985) and Valle (1997), developing such thematic categories: inaugurating to live with the disease and the treatment of the child; integrating into the treatment everyday: to mean to \"live on\" , caring for the child: offering and recognizing his/her vitality, admitting the own coping quests and conquests, glimpsing the links memorable alliances: from the conquered to broken. Some ideas of Martin Heidegger were used as theorical references, as well as from others authors that have the same idea as him. The study enabled the comprehension of some facets of the mothers experiences on their relation of caring established with a sick child, seizing the meanings ascribed by them to an incurable sick, its treatment and repercussion of this reality on their lives and on the life of their children.

A insuficiência renal crônica (IRC) pode ocasionar uma série de alterações metabólicas no organismo, das quais o comprometimento do metabolismo do cálcio pode acarretar em desmineralização óssea e mineralização de tecidos moles, inclusive renal, favorecendo a perda ainda maior de néfrons. Na rotina, a avaliação do cálcio é geralmente realizada pela mensuração do cálcio sérico total, entretanto, a única fração biologicamente ativa deste mineral é representada pelo cálcio ionizado. Assim, o presente estudo teve como objetivo avaliar o cálcio ionizado em gatos sadios e em gatos com IRC, com o intuito de se obter subsídios para o melhor entendimento da homeostase do cálcio. Foram analisados 25 gatos sadios (grupo controle) e 19 gatos com IRC (grupo de estudo) em que foram determinadas as concentrações séricas de cálcio ionizado, cálcio total, sódio, potássio, cloreto, fósforo inorgânico, albumina, como também do pH sangüíneo e das variáveis da hemogasometria. Não foram observadas diferenças significantes entre os grupos controle e estudo no que se relaciona aos valores de cálcio total (controle = 9,52 ± 0,96; IRC = 9,48 ± 0,96) e cálcio ionizado (controle = 5,24 ± 0,18; IRC = 5,29 ± 0,53). Em ambos os grupos observou-se que o valor da fração de cálcio ionizado foi superior a 50% do valor do cálcio total, dado este que difere da literatura, principalmente quando se compara com a espécie canina. Quando da avaliação individual dos dados, foi constatado nos gatos com IRC que o valor de cálcio sérico ionizado encontrava-se aumentado em 31,6% dos animais e diminuído em 15,8%; entretanto, quando foi considerado o cálcio sérico total, a hipercalcemia não foi detectada em nenhum dos animais e a hipocalcemia observada em 5,3%. Ainda, nos gatos com IRC que apresentaram normocalcemia relacionada ao cálcio ionizado, quando da mensuração do cálcio sérico total, a normocalcemia só foi constatada em 50% daqueles animais. Diferença significante também foi observada entre os dois grupos no que se refere aos valores de fósforo inorgânico e algumas variáveis da hemogasometria, caracterizando discreta hiperfosfatemia e acidose metabólica nos gatos com IRC. Apesar da presença de acidose, que poderia resultar na diminuição do cálcio ligado à albumina e assim justificar o desenvolvimento de hipercalcemia relacionada ao cálcio ionizado nos gatos com IRC, a normocalcemia e a hipocalcemia também foram detectadas, demonstrando-se, assim, a importância de se mensurar o cálcio ionizado, pois somente a mensuração do cálcio sérico total não refletiu a real condição do cálcio biologicamente ativo e, ainda, que devem ser investigados outros mecanismos que possam influenciar a fração de cálcio ionizado. / Chronic renal failure (CRF) can cause many metabolic abnormalities in the body, and one of these is represented by alteration in calcium metabolism, and the animal can develop demineralization and calcification of soft tissues, including renal parenchyma, which can facilitate the progression of renal damage. In routine, calcium is usually evaluated by measurement of total serum calcium, however, the biologically active fraction is represented by ionized calcium. Thus, the aim of the present study was to evaluate serum ionized calcium in healthy cats and in cats with chronic renal failure. Twenty-five clinically normal cats (control group) and nineteen cats with CRF were evaluated, and serum ionized calcium, total calcium, sodium, potassium, chloride, phosphorus, albumin, as well as blood pH and blood gases parameters were measured. No difference between normal cats and cats with CRF concerning total calcium (control = 9.52 ± 0.96; CRF = 9.48 ± 0.96) and ionized calcium (control = 5.24 ± 0.18; CRF = 5.29 ± 0.53) were observed. In both groups, the fraction of ionized calcium represented more than 50% of total calcium value, and the data were different from those reported in the literature, mainly concerning dogs. In cats with CRF, when the data were evaluated individually, serum ionized calcium was increased in 31.6% of the animals and decreased in 15.8%; however considering serum total calcium, hypercalcemia was not detected in any of those cats and hypocalcemia was observed in 5.3%. In addition, from the cats with CRF that presented normocalcemia related to ionized calcium, only 50% of those animals showed normocalcemia when total calcium was determined. Difference between control group and the group of cats with CRF concerning phosphorus and some parameters of blood gases were detected, observing slight phosphatemia and metabolic acidosis. The presence of acidosis can possible result in decrease of albumin bound to calcium and in consequence justify the hypercalcemia related to ionized calcium observed in cats with CRF, but normocalcemia and hypocalcemia were also observed, showing the importance of the measurement of ionized calcium, because total serum calcium did not reflect the real status of calcium that is considered the biologically active form; in addition, other mechanisms that can compromise the ionized calcium fraction should be investigated.

Made available in DSpace on 2014-06-11T19:22:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-20Bitstream added on 2014-06-13T19:07:29Z : No. of bitstreams: 1 suman_p_me_botfm.pdf: 1196436 bytes, checksum: 8dcde5816493bed62c06995c961056df (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A relação entre a doença renal crônica (DRC) e a deficiência auditiva (DA) vem sendo estabelecida através de estudos na área. Apesar de a hipertensão arterial e diabetes mellitus estarem frequentemente relacionados às duas patologias, poucos estudos levam em consideração seus efeitos sobre os achados audiológicos dessa população. O efeito do tipo de tratamento para DRC sobre a audição, bem como a localização da perda auditiva ainda são inconclusivos. O objetivo deste trabalho foi de verificar o efeito da DRC e dos tratamentos conservador, diálise peritoneal e hemodiálise, sobre a cóclea e nervo auditivo, levando-se em consideração o efeito das variáveis hipertensão arterial e diabetes mellitus. Sujeitos com idade acima de 60 anos, deficiência auditiva congênita, síndromes genéticas e/ou submetidos a transplante renal foram excluídos. Foram realizados Audiometria Tonal Limiar (ATL), Timpanometria, Emissões Otoacústicas Evocadas Transientes (EOAET) e Potencial Evocado Auditivo de Tronco Encefálico (PEATE) em 101 sujeitos com DRC, subdivididos em 03 grupos, de acordo com o tipo de tratamento (A1: hemodiálise/ n=35; A2: diálise peritoneal/ n=15 e A3: conservador/ n=51) e um grupo controle foi formado por 27 sujeitos saudáveis (B). Entre os portadores de DRC, a hipertensão esteve presente em 86,1% dos sujeitos e o diabetes em 29,7%. A idade média dos doentes foi 46,7 (±12,3) anos enquanto que a do controle foi 36,6 (±12). Apresentaram DA uni ou bilateral 32,7% dos sujeitos do grupo A e não houve diferença estatisticamente significante da sua frequência entre os subgrupos A. Quanto ao tipo da perda, 92% das orelhas (n=45) foi neurossensorial e 8% mista (n=4). Quanto ao grau, 67% das orelhas (n=33) apresentaram perda leve, 20% (n=10) moderada, 5% (n=2) grave e 8% (n=4) profunda e não houve diferença significante do grau entre os subgrupos A. / The relation between chronic renal disease (CRD) and hearing loss (HL) has been determined by studies in the field. Despite arterial hypertension (AH) and diabetes melitius (DM) are frequently associated to both conditions, few studies considered their effects on the audiological findings in this population. The effects of the type of treatment for CRD on the hearing as well as on the site of the hearing loss are still inconclusive. The aim of this study was to verify the effect of the CRD, of different treatments: conservative, peritoneal dialysis and hemodialysis on the cochlea and on the auditory nerve, considering the effects of AH and DM. Subjects over 60 years, with born hearing deficiency, genetic syndromes and/or submitted to renal transplant were excluded. The 101 subjects with CRD were tested with Pure Tone Audiometry (PTA), Tympanometry, Transitory Evoked Otoacoustic Emissions (TEOE) and Auditory Brainstem Response (ABR). Subjects were divided in 3 groups according to the type of treatment (A1: hemodialysis/ N=35; A2: peritoneal dialysis/ N=15; A3: conservative/ N=51). The control group constituted of 27 health individuals (B). Among the individuals with CRD, 86.1% presented AH and 29.7% presented DM. The mean age was 46.7 y (± 12.3) in the group with CRD and 36.6 y (± 12) in the control group. In group A 32.7% of the subjects presented uni- or bilateral HL with no statistical difference between sub-groups. In what refers to the type of hearing loss, in 92% of the ears (N=45) it was neuro-sensorial and in 8% (N=4) it was mixed. The degree was mild in 63% (N=33) of the ears, moderate in 20% (N=10), severe in 5% (N=2) and profound in 8% (N=4), without significant differences between subgroups. When compared to group B, the group A presented significantly lower hearing thresholds on the PTA, smaller amplitude on the TEOE and more alterations on the ABR (10.4%/ N = 21 ears).

No description available.

No description available.

This dissertation describes how to apply pharmacokinetic simulations and modeling in a clinical setting to monitor and adjust drug dosing in special patient populations. Pharmacokinetic simulations were used to investigate efficacy and risk of drug toxicity of a new dosing regimen for aminoglycoside antibiotics when administered to renal failure patients. The current method of administering aminoglycosides to renal failure patients is to dose the drug during the last half hour of dialysis sessions. The new proposed method suggests dosing the drug during the first half hour of the dialysis session. Using one-compartment model infusion equations, both methods were simulated to predict drug peaks, troughs and area under the curves. These parameters were used to compare both dosing regimens to find out if the proposed dosing regimen can be suggested in a clinical setting to obtain the same efficacy and lower risk of drug toxicity. The dissertation then describes a prospective clinical study in chronic renal failure patients who received the same tobramycin dose using current and proposed dosing regimens. Results from the clinical study confirm pharmacokinetic simulations and modeling outcomes. Results suggest that both regimens have the same efficacy, but the new proposed method is expected to have lower risk of drug toxicity. The dissertation also describes a retrospective study for vancomycin dosing in renal failure patients. The objective was to confirm that pharmacokinetic modeling could be used to predict and adjust vancomycin dosing for this special population. Vancomycin trough concentrations obtained from patient medical records were compared to predictions obtained using a pharmacokinetic model. It was concluded that there was no statistically significant difference between actual and predicted vancomycin trough concentrations. These results suggest that the pharmacokinetic model can be used to predict and adjust vancomycin dosing to chronic renal failure population. The last part of this dissertation describes evaluation of insulin glargine effect on glycemic control and weight change in a diabetic population. Glycemic control and weight of patients before and after initiation of insulin glargine were evaluated retrospectively. Results showed that initiation of insulin glargine improved glycemic control while weight remained relatively stable. / Graduation date: 2005

Thesis (M. Nurs.)--University of Hong Kong, 2006.

No description available.

To identify those with kidney disease early and thus facilitate earlier instigation of disease-progression slowing treatments, new definitions of chronic kidney disease (CKD) were introduced in 2002 (KDOQI). After this, the worldwide introduction of estimated glomerular filtration rate (eGFR) reporting (2006 onwards), also facilitated more widespread identification of those with CKD. Prognosis in those with CKD identified in this way was not known and the numbers with CKD appeared higher than originally expected. This thesis aimed to improve understanding of outcomes in those who met the definition of chronic kidney disease and facilitate better directed care. Data-linkage of several healthcare datasets including to laboratory, morbidity and mortality healthcare data for individuals in the Grampian region with measures of renal function in 2003 allowed those aims to be addressed. Patterns in the testing of kidney function over time were also described. Mortality and RRT initiation during the GLOMMS-I cohort's 6.5 years of follow-up were described, as were variables that were associated with these outcomes. Other measures of decline of kidney function over time (progression), were explored and compared to the ultimate measure of progression - the initiation of RRT. Various models to predict outcomes (RRT initiation, mortality and survival) were explored. Measures of model performance including discrimination, calibration, goodness of model fit and predictive performance were described. Overall the aim of this thesis was met - to improve the understanding of the prognosis of those currently labelled with chronic kidney disease. The work in this thesis has also provided the necessary information to plan and start a much wider population based study of outcome in those both with and without CKD (GLOMMS-II).

The purpose of this cross-sectional, descriptive, correlational study was to describe the relationships among demographic factors (age, gender, education, income), perceived severity of illness, perceived barriers to action, perceived self-efficacy, and interpersonal influences (social support) and health-promoting behaviors (HPB) and to identify predictors of HPB. A nonprobability sample of 110 participants with Chronic Renal Failure (CRF) was recruited from the outpatient clinic of Burirum hospital and Surin hospital located in north-eastern Thailand. All participants were individually interviewed by the principal investigator in a private area within an outpatient clinic. Six variables were significantly correlated with the HPB. They were age, education, perceived severity of illness, perceived barriers to action, perceived self-efficacy and social support. According to the results from the analyses of demographic data and HPB, participants who were younger and had higher educational levels practiced more HPB. From the analyses of perceived severity of illness, perceived barriers to action, perceived self-efficacy, and social support and HPB, the results showed that participants with lower levels of perceived severity of illness and lower levels of perceived barriers to action reported better HPB. In contrast, the participants with higher levels of perceived self-efficacy and social support reported better HPB. By using a stepwise multiple regression analysis, two predictors were identified from 8 predictor variables, and those two accounted for 78.2% (p < 0.01) of the variance in HPB. Two variables that contributed significantly to the variance in the HPB were perceived self-efficacy ([beta] =.769, p < 0.01), and social support ([beta] = .162, p < 0.01); whereas age, gender, income, educational level, perceived severity of illness, and perceived barriers did not contribute to the variance in the HPB. The study found that participants who experienced better perceived self-efficacy and social support reported better HPB. In contrast age, gender, income, educational level, perceived severity of illness, and perceived barriers did not enter as predictors in this stepwise regression equation. / text