Browsing by Subject Kidney Diseases

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Nephrocare - a quality of care development programme for renal medicine : report on a WHO meeting, Copenhagen, Denmark 15-16 April 1999
World Health Organization. Regional Office for Europe ( 1999 )

As part of a joint quality development project between the WHO Regional Office for Europe and the renal societies of Denmark, Finland, Iceland, Norway and Sweden, representatives of the societies and WHO have developed a core data set for quality of care development in renal medicine. In April 1999, representatives of 18 renal centres in the five countries met to discuss the results of an evaluation of care based on the analysis of random samples of chronic renal patients collected from 1673 patients in the centres. In an anonymous comparison of selected indicators ("bench-marking") of participating centres, there was a marked difference between centres in indicators of referral/acceptance patterns and diagnostic activity. Despite a significant improvement in blood pressure from time of first referral to follow-up, under half the patients had blood pressure below 140/90 at follow-up, the proportion varying twofold between centres. Analysis of the application of common renal therapeutic principles showed a marked variation across the centres, sug-gesting that guidelines may have little effect on clinical nephrological practice. Participants concluded that the demon-strable differences between centres were unwanted, unnecessary and possibly inequitable, and recommended that: nephrologists should assume a greater responsibility in the organization of early renal care from a secondary and tertiary prevention perspective to reduce morbidity and cost; anonymous comparison of selected indicators with feedback to centres may be a feasible method for reducing differences in quality of treatment and care for persons with renal disease; the NEPHROCARE data set is a feasible tool for quality of care development in all kinds of renal treatment and care; information on renal patients is particularly complex and should be made more easily accessible to nephrologists through the use of compatible electronic patient records incorporating the NEPHROCARE data set; the NEPHROCARE project should continue

Principles and methods for the assessment of nephrotoxicity associated with exposure to chemicals / published under the joint sponsorship of the United Nations Environment Programme, the International Labour Organisation, and the World Health Organization, and on behalf of the Commission of the European Communities
World Health Organization; International Programme on Chemical Safety; Commission of the European Communities ( 1991 )

Establishes detailed guiding principles for the planning of studies designed to investigate the nephrotoxic effects of exposure to chemicals, whether medicinal, industrial, or environmental. Close to 800 recent reports are cited in order to provide state-of-the-art advice on the design of studies, the interpretation of results, and the extrapolation of data from animals to man. As early renal injury is often masked by the kidneys considerable functional reserve and capacity for repair, the book places special emphasis on the need for improved screening tools and markers that can aid the timely diagnosis of chemically induced renal dysfunction. The book also cites evidence that exposure to chemicals may have a much greater influence on the incidence of nephropathy and chronic renal failure than previously suspected. The book opens with a thorough discussion of the many factors that must be considered when investigating nephrotoxicity due to chemicals. The second chapter discusses the special features of kidney structure and function, including the mechanisms by which xenobiotic molecules are metabolized, that can affect the interpretation of toxicological data. Other chapters summarize current knowledge on the molecular basis of renal injury, identify specific therapeutic agents and chemicals that can induce nephrotoxicity, and outline the multiplicity of questions that must be asked in order to identify nephrotoxic chemicals and understand their potencies, sites, and mechanisms of toxicity. The concluding chapter evaluates the predictive value and diagnostic validity of new biochemical and immunochemical markers of early renal changes in humans

Принципы и методы оценки нефротоксичности, связанной с воздействием химических веществ.
Всемирная организация здравоохранения; Программа ООН по окружающей среде; Международная организация труда; Международная программа по химической безопасности ( 1994 )

Публикации серии «Гигиенические критерии состояния окружающей среды», как правило, посвящены химическим соединениям, применяемым в различных отраслях промышленности, однако следует иметь в виду, что в настоящее время большая часть информации о нефротоксичности у лабораторных животных и человека касается лекарственных средств. Эти данные особенно полезны тем, что, используя точно документированные сведения об уровнях воздействия и нефротоксических последствиях, с их помощью можно сравнивать влияние определенных соединений на животных и человека. На основании таких данных удалось составить определенное представление о механизмах первичного повреждения, долгосрочных последствиях и значимости проблемы нефротоксичности для здравоохранения. Поскольку эти соединения обычно хорошо изучены, более рациональное представление о механизме их нефротоксичности у животных и человека создает основу для проверки обоснованности экстраполяции результатов, полученных на разных видах, и более точной оценки степени риска.

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