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Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Chronic Kidney Disease IV: Nursing Management

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Chronic Kidney Disease II: Clinical Manifestations01:24

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Related Experiment Video

Updated: May 29, 2026

Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

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Published on: June 16, 2014

Ascorbic acid or L-arginine improves cutaneous microvascular function in chronic kidney disease.

Jennifer J Dupont1, William B Farquhar, Raymond R Townsend

  • 1Dept. of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.

Journal of Applied Physiology (Bethesda, Md. : 1985)
|September 3, 2011
PubMed
Summary

In chronic kidney disease (CKD), impaired skin vasodilation during heating is linked to oxidative stress and low l-arginine levels. Supplementing with ascorbic acid or l-arginine improved blood flow in CKD patients.

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Area of Science:

  • Physiology
  • Nephrology
  • Vascular Biology

Background:

  • Cutaneous vasodilation is essential for thermoregulation.
  • Chronic kidney disease (CKD) is associated with impaired vascular function.
  • Oxidative stress and altered nitric oxide (NO) bioavailability are implicated in CKD complications.

Purpose of the Study:

  • To investigate the roles of oxidative stress and l-arginine deficit in reduced cutaneous vasodilation in stage 3-4 CKD.
  • To assess the impact of local administration of ascorbic acid and l-arginine on skin blood flow during heating in CKD patients.

Main Methods:

  • Utilized microdialysis to deliver Ringer's solution, ascorbic acid (AA), l-arginine (l-Arg), or N(G)-nitro-l-arginine methyl ester (l-NAME) to the skin.
  • Measured red blood cell (RBC) flux using laser Doppler flowmetry during local heating (42°C).
  • Calculated cutaneous vascular conductance (CVC) and expressed it as a percentage of maximum CVC.

Main Results:

  • Plateau %CVC(max) was attenuated in CKD patients (76%) compared to healthy controls (91%).
  • The contribution of NO to vasodilation was lower in CKD patients.
  • Local administration of AA and l-Arg significantly increased plateau %CVC(max) in CKD patients, restoring it to levels comparable to controls.
  • Initial peak %CVC(max) was attenuated in CKD at Ringer's and l-Arg sites but not at the AA site.

Conclusions:

  • Cutaneous microvascular function is impaired in stage 3-4 CKD.
  • Oxidative stress and a relative deficit of l-arginine contribute to this impairment.
  • Targeting oxidative stress and l-arginine availability may improve vascular function in CKD.