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1.
Solute and Water Transport in Peritoneal Dialysis: A Case-Based Primer.
Khanna, R
American journal of kidney diseases : the official journal of the National Kidney Foundation. 2017;(3):461-472
Abstract
Peritoneal dialysis (PD) is an effective therapy for patients with end-stage kidney disease. Dialysis solutions containing physiologic concentrations of electrolytes and base, as well as glucose often at supraphysiologic concentrations, are infused into the peritoneal cavity for solute and water exchange, and the patient's own peritoneal membrane is used for dialysis. The peritoneal membrane is dominated by small pores, which allow transport of water and small-molecular-size solutes, including electrolytes, by way of both diffusion and convection. Through small pores, diffusion allows the movement of solutes from the high-concentration compartment to a lower-concentration region. Also, through small pores, water and solutes move together by convection in response to an osmotic force. The glucose in the dialysis solution generates osmotic force to drive convection. In addition to small pores, the peritoneal membrane contains a specialized water channel, aquaporin 1, which is also present in capillaries of the peritoneal membrane. These specialized water channels, which are upregulated by glucose, allow water transport without solute (free water) in response to the osmotic force induced by glucose in the PD solution. During a PD exchange, net loss or gain of electrolytes and base is determined by both their gradient between capillary blood and dialysis solution and the net ultrafiltration volume. Developing a PD prescription, including the amount of glucose used, and changing the prescription in response to dietary changes and/or loss of residual kidney function requires a sound understanding of the peritoneal physiology. The case studies presented here help solidify the basic elements of PD prescription and how the PD prescription should be altered in response to changing clinical situations.
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2.
Aquagenic wrinkling of the palms and the potential role for genetic testing.
Park, L, Khani, C, Tamburro, J
Pediatric dermatology. 2012;(3):237-42
Abstract
Aquagenic wrinkling of the palms (AWP) is a condition characterized by excessive wrinkling, palmar edema, and whitish papules accompanied by pain, pruritus, or discomfort after brief immersion of the hands in water. It is well documented to be associated with cystic fibrosis (CF), with several theories regarding the pathogenesis having been proposed. We report a case of two sisters with AWP in whom CF has not been diagnosed and review the literature on AWP and its association with CF and CF carrier status. Because diagnosis of mild forms CF or knowledge of an underlying CF genetic mutation is frequently unknown, identification of AWP may represent the only sign of such mutations. The dermatologist plays an integral role in early detection of AWP, and the importance of genetic testing in such patients cannot be overlooked. We recommend various measures to apply in clinical practice to ensure diagnosis and decrease morbidity and mortality in patients.
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3.
Aquagenic wrinkling of the palms: A case report and literature review.
Syed, Z, Wanner, M, Ibrahimi, OA
Dermatology online journal. 2010;(7):7
Abstract
Aquagenic wrinkling of the palms (AWP) is a condition that results in pain and edema of the hands after exposure to water. We describe a 32-year-old woman who presented with a several-year history of AWP. She was unable to tolerate a 20 percent aluminum chloride solution because of irritation, but a gel formulation of 15 percent aluminum chloride controlled her symptoms without side effects.
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4.
Painful wrinkles in the bathtub: association with hyperhidrosis and cystic fibrosis.
Seitz, CS, Gaigl, Z, Bröcker, EB, Trautmann, A
Dermatology (Basel, Switzerland). 2008;(3):222-6
Abstract
Transient aquagenic palmar hyperwrinkling (TAPH) is a rarely reported cutaneous condition clinically characterized by swelling and hyperwrinkling of the palms, and associated with burning sensations after briefly immersing the hands in water. Upon the withdrawal of water, the symptoms rapidly disappear. We report on a 10-year-old boy with type I diabetes, who developed the typical symptoms of TAPH concomitantly with the onset of palmar hyperhidrosis. Determination of the sodium chloride concentration of the sweat revealed elevated levels. Subsequent screening for the most common mutations of the gene responsible for cystic fibrosis (CF) was negative. Review of the literature shows that TAPH may develop in conditions of increased water absorption due to an increased sweat quantity, such as hyperhidrosis, or an increased sweat electrolyte concentration, such as CF. In the majority of reported cases TAPH has been associated with CF; therefore, it is a cutaneous sign, which should be recognized by dermatologists, and patients should be referred for evaluation of the sodium chloride concentration of the sweat.
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5.
Transient aquagenic palmar hyperwrinkling: the first instance reported in a young boy.
Neri, I, Bianchi, F, Patrizi, A
Pediatric dermatology. 2006;(1):39-42
Abstract
Transient reactive papulotranslucent acrokeratoderma is a rare palmoplantar keratoderma seen predominantly in adolescent and young adult women. Clinically it is characterized by translucent white papules generally involving the palmar surfaces after exposure to water. The typical "hands-in-the-bucket" sign, which is not clearly visible until the hand is submerged in water, is indispensable for the diagnosis. Histologic examination shows a mild orthokeratotic hyperkeratosis and dilated eccrine ducts. We propose the term "transient aquagenic palmar hyperwrinkling" to describe this condition. Until now, a total of 12 patients have been reported in the literature, all female, with an age of onset from 9 to 33 years. We present the first reported instance of this condition in a young boy.
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6.
Familial aquagenic acrokeratoderma: case reports and review of the literature.
Saray, Y, Seçkin, D
International journal of dermatology. 2005;(11):906-9