PubMed Health⌕ Search

Biomedical subjects

E F H van Bommel

Publications and source records attributed to E F H van Bommel.

7 recordsLinked to original sources
PubMed2003

[Salt sensitivity and hypertension].

For many years there has been ongoing controversy concerning the presumed relationship between salt intake and population blood pressure. In addition, in light of the availability of many efficient antihypertensive drugs and the frequent difficulty to motivate patients to maintain prolonged salt restriction, clinicians often doubt the importance of salt restriction in the individual treatment of hypertension. Accumulating data now underline the importance of a restriction of salt intake on a population level. This is expressed in a recent advice of the Dutch Health Council (Gezondheidsraad) and governmental intervention in some other countries. However, it is not the level of salt intake but salt sensitivity of blood pressure which predicts the effect of salt restriction in the individual treatment of essential hypertension. It should be noted that salt restriction or depletion will increase the sensitivity to other antihypertensive drugs in each form of hypertension. Recent data suggest that salt sensitivity per se should be viewed as an independent risk factor for cardiovascular morbidity and mortality. Therefore, identification and aggressive treatment of salt-sensitive hypertension, including salt restriction, is indicated. Demographic and racial characteristics as well as additional laboratory investigation may help identifying potential 'salt-sensitive' subjects, who form part of a high-risk population.

Antihypertensive Agents↗
PubMed2003

Severe rhabdomyolysis and acute renal failure following recent Coxsackie B virus infection.

Viral infections have been associated with a wide spectrum of muscle disorders, ranging from acute nonspecific myalgia to myositis. However, severe rhabdomyolysis, with or without accompanying acute renal failure (ARF), has been described only rarely. We report the fourth case in the literature of recent Coxsackie B virus infection complicated by severe rhabdomyolysis and ARF, necessitating temporary haemodialysis in a previously healthy young man. Although most Coxsackie B virus infections are asymptomatic, one should be aware of this potentially life-threatening complication of this virus. As illustrated with the present case, serological testing may reveal the diagnosis in a case of rhabdomyolysis after a viral illness.

Acute Kidney Injury↗
PubMed2003

Renal replacement therapy for acute renal failure on the intensive care unit: coming of age?

The introduction and development of continuous renal replacement therapy (CRRT) represents one of the most substantial changes in patient management on the intensive care unit (ICU). Several issues, however, are still unresolved. Adequacy of dialysis in critically ill patients involves more than simple control of urea (although considered reflective of toxic uraemic compounds). It also concerns various (other) biochemical and clinical parameters. This article addresses important questions such as the different aspects of 'adequate' dialysis and its timing and intensity ('dialysis dosing'). Dialytic treatment should now be tailored to the patient, influenced by patient characteristics, urgency of treatment, haemodynamic tolerance and vascular access. For this, intermittent haemodialysis and CRRT should be regarded as complementary techniques, to be used interchangeably in critically ill patients with acute renal failure (ARF) according to circumstances. While awaiting scientific criteria for the initiation of renal replacement therapy in ARF patients, it seems reasonable to prefer prevention of physiological derangements to their post-hoc correction. This would mean early initiation of dialytic treatment as renal support rather than its initiation as renal replacement therapy for uraemic complications. The amount of dialysis ('dialysis dose') should preferably be prescribed on an individualised basis, especially when considering that the delivered dialysis dose may make a difference. Despite its limitations, simplified urea kinetic modelling, as outlined in this article's appendix, may be used as a bedside method to establish the required dose with CRRT. If not, at least the weight-adjusted ultrafiltration (UF) flow rate should be used as a surrogate for the prescribed dialysis dose (i.e., ml/kg/h). As the prescribed dialysis dose is usually less than the delivered dose, this should also be taken into account. In addition, nutrition should be viewed as an integral part of the dialysis prescription. Continuing effort should be made to develop 'evidence-based' guidelines for the appropriate prescription and delivery of renal replacement therapy to treat ARF in the ICU. This should include efforts to determine a validated dialysis dose methodology in ARF patients to address further the dose/outcome relationship. Based on existing data, some guidelines for the prescription and delivery of adequate (C)RRT are provided.

Acute Kidney Injury↗
PubMed2002

Retroperitoneal fibrosis.

Retroperitoneal fibrosis (RPF) is an uncommon collagen vascular disease of unclear aetiology. It is characterised by a chronic non-specific inflammation of the retroperitoneum, which can entrap and obstruct retroperitoneal structures, notably the ureters. Because of the protean manifestations of RPF, awareness of the disease is important. It is still not uncommon to detect RPF only after severe renal failure is present. This comprehensive review deals with the various aspects of RPF and tries to provide a framework for the diagnosis, treatment and follow-up of this intriguing condition. Although it may have various causes, chronic periaortitis appears to be an increasingly encountered form of secondary RPF in patients with advanced atherosclerosis. Irrespective of its cause, most cases of non-malignant RPF - if in the active 'cellular' stage - will respond to treatment with corticosteroids, thereby obviating the need for surgical treatment. The clinical and radiographic improvement seen after starting steroid therapy is often impressive and reassuring as to the diagnosis. Treatment with corticosteroids may also make aneurysmectomy, if indicated, feasible in the patient who presents with perianeurysmal fibrosis and renal failure. Accumulating data suggest alternative treatment strategies for steroid-resistant cases (i.e. intensive immunosuppression) or when steroids are not feasible (i.e. other forms of immunosuppression or hormonal treatment, particularly tamoxifen). Although early diagnosis and treatment provide excellent renal and patient outcome, long-term follow-up is mandatory in all cases.

Adrenal Cortex Hormones↗
PubMed2002

Ruptured giant liver cyst: a rare cause of acute abdomen in a haemodialysis patient with autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary disorder. Although liver involvement is the most frequent extra-renal manifestation, serious complications due to liver cysts are very rare. We report the occurrence of an acute abdomen caused by massive haemoperitoneum resulting from rupture of a giant liver cyst in ADPKD. Data suggest that chronic anticoagulation therapy should be avoided where possible in the presence of a giant liver cyst.

Abdomen, Acute↗