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      Changes in Osmolal Gap and Osmolality in Children with Chronic and End-Stage Renal Failure

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          Most cited references 7

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          Brain swelling after dialysis: old urea or new osmoles?

          The pathogenesis of brain swelling and neurological deterioration after rapid hemodialysis (dialysis disequilibrium syndrome) is controversial. The "reverse urea hypothesis" suggests that hemodialysis removes urea more slowly from the brain than from the plasma, creating an osmotic gradient that results in cerebral edema. The "idiogenic osmole hypothesis" proposes that an osmotic gradient between brain and plasma develops during rapid dialysis because of newly formed brain osmoles. In this review, the experimental basis for the two hypotheses are critically examined. Based on what is known about the physiology of urea and water diffusion across the blood-brain barrier, and empiric observations of brain solute composition after experimental hemodialysis, we conclude that the "reverse urea hypothesis" remains a viable explanation for dialysis disequilibrium and that rapid reduction of a high urea level in and of itself predisposes to this condition.
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            Osmol gaps revisited: Normal values and limitations

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              Inter-dialytic variations in blood volume and total body water in uraemic patients treated by dialysis


                Author and article information

                Nephron Physiol
                Nephron Physiology
                S. Karger AG
                January 2007
                30 November 2006
                : 105
                : 2
                : p19-p21
                Departments of aPediatric Nephrology, cBiochemistry and dBiostatistics, Çukurova University School of Medicine, and bDepartment of Pediatric Nephrology, Adana Teaching and Medical Research Center, Baskent University School of Medicine, Adana, Turkey
                97604 Nephron Physiol 2007;105:p19–p21
                © 2006 S. Karger AG, Basel

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                Page count
                Tables: 1, References: 12, Pages: 1
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                Cardiovascular Medicine, Nephrology

                Osmolality, Chronic renal failure, Osmolal gap


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