ACUTE RENAL FAILURE

Acute Renal Failure and Stress and Coping How Is Relevant To Family

Acute Renal Failure and Stress and Coping How Is Relevant To Family

Mercuric Chloride (HgCl2) has been widely used to study the pathophysiology of nephrotoxic acute renal failure. Hemodynamic changes, functional alterations, and histological damage in this experimental model are well characterized and include activation of the renin-angiotensin system, profound renal vasoconstriction, reduction in glomerular filtration rate, and progressive azotemia. The renal damage is particularly severe in the proximal tubule. Treatment strategies have been mostly directed to correct the hemodynamic disturbances or the toxic effects of the metal.

Reactive oxygen species (ROS) have been increasingly implicated as mediators of damage in ischemic, toxic, and immune-mediated tissue injuries. In HgCl2-induced nephrotoxicity, the reduction in renal content of antioxidants such as glutathione (GSH), as well as the decrease of thiol groups, has been advanced as evidence of the role of ROS in this pathology. Furthermore, morphological and biochemical studies have shown that HgCl2 toxicity is associated with a substantial loss of ATP-generating mitochondrial inner membrane surfaces and important loss of activity of the free radical scavenger systems, such as superoxide dismutase and glutathione peroxidase (GSH-Px). However, the evidence for the pathogenic role of oxidant stress in this condition is conflicting. Some (4, 24, 33, 60), but not all (2, 38), studies have demonstrated increased peroxide formation in the kidney and, in addition, the administration of several antioxidants has failed to provide a consistent beneficial effect in this condition.

Melatonin (Mel) is the chief secretory product of the pineal gland and has a very potent antioxidant activity, depending mainly on its capacity to act as electron donor. In vivo and in vitro, Mel has been found to protect tissues against oxidative damage generated by a variety of toxic agents (reviewed in 7) and metabolic processes, including chemotherapy-induced toxicity and ischemia-reperfusion injury in stomach, liver, and brain. More pertinently, Mel has recently been found to protect against adriamycin-induced nephrotoxicity. Mel is widely available, relatively free of side effects, rapidly active after oral administration, and commonly used in humans in the treatment of insomnia. Therefore, we decided to investigate the effect of Mel in the course of nephrotoxic acute renal failure induced by HgCl2. Our results indicate that pretreatment with Mel improves dramatically the histological and functional damage and the lipid peroxidation in this experimental model. One of the main causes of stress is change. All human beings find change stressful - even change that we are looking forward to, like moving house, raises our stress levels. As a person with renal failure you will have to deal with more change than most people do. Not just the initial change of lifestyle that comes with the diagnosis, but ongoing change as you deal with alterations to your diet, medication and forms of treatment.

All these changes will mean you have to take in a great deal of new information, make decisions, learn new practical skills. You also have to adjust to new ways of ...