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The condition of individuals with CKD, who require either of the two types of kidney replacement therapy , is referred to as the end-stage kidney disease . Hence, the start of the ESKD is practically the irreversible conclusion of the NDD-CKD. Even though the NDD-CKD status refers to the status of persons with earlier stages of CKD , people with advanced stage of CKD , who have not yet started kidney replacement therapy, are also referred to as NDD-CKD. They have also been found to reduce the risk of major cardiovascular events such as myocardial infarction, stroke, heart failure, and death from cardiovascular disease when compared to placebo in individuals with CKD.
It starred Charlotte Wakefield as Maria, with Michael Xavier as Captain von Trapp and Caroline Keiff as Elsa. It received enthusiastic reviews and became the highest-grossing production ever at the theatre. In 2014, the show was nominated for Best Musical Revival at the Laurence Olivier Awards and Wakefield was nominated for Best Actress in a Musical. The Salzburg Marionette Theatre has toured extensively with their version that features the recorded voices of Broadway singers such as Christiane Noll as Maria.
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Apart from controlling other risk factors, the goal of therapy is to slow down or halt the progression of CKD. Control of blood pressure and treatment of the original disease are the broad principles of management. Kidney ultrasonography is useful for diagnostic and prognostic purposes in chronic kidney disease. Whether the underlying pathologic change is glomerular sclerosis, tubular atrophy, interstitial fibrosis, or inflammation, the result is often increased echogenicity of the cortex. The echogenicity of the kidney should be related to the echogenicity of either the liver or the spleen . Moreover, decreased kidney size and cortical thinning are also often seen and especially when disease progresses .
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The toxins show various cytotoxic activities in the serum and have different molecular weights, and some of them are bound to other proteins, primarily to albumin. Uremic toxins are classified into three groups as small water-soluble solutes, middle molecular-weight solutes, and protein-bound solutes. Hemodialysis with high-flux dialysis membrane, long or frequent treatment, and increased blood/dialysate flow has improved removal of water-soluble small molecular weight uremic toxins.
Measurement of kidney length on the US image is illustrated by '+' and a dashed line. Blood pressure is increased due to fluid overload and production of vasoactive hormones created by the kidney via the renin–angiotensin system, increasing the risk of developing hypertension and heart failure. People with CKD are more likely than the general population to develop atherosclerosis with consequent cardiovascular disease, an effect that may be at least partly mediated by uremic toxins.[unreliable medical source? ] People with both CKD and cardiovascular disease have significantly worse prognoses than those with only cardiovascular disease. "Anaemia management in people with chronic kidney disease ". UK National Institute for Health and Care Excellence.
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Max asks for an encore and announces that this is the von Trapp family's last chance to sing together, as the honor guard waits to escort the Captain to his new command. While the judges decide on the prizes, the von Trapps sing "So Long, Farewell", leaving the stage in small groups. Max then announces the runners-up, stalling as much as possible. When he announces that the first prize goes to the von Trapps and they do not appear, the Nazis start a search. The family hides at the Abbey, and Sister Margaretta tells them that the borders have been closed. Rolf comes upon them and calls his lieutenant, but after seeing Liesl he changes his mind and tells him they aren't there.
An Austrian production premiered in 2005 at the Volksoper Wien in German. The cast included Sandra Pires as Maria, Kurt Schreibmayer and Michael Kraus as von Trapp, with Heidi Brunner as Mother Abbess. The song "Do-Re-Mi" was rewritten as "C wie Cellophanpapier", replacing the solfège syllables with the German letter notation C through H and selecting mnemonics that begin with each letter. As of 2021, the production was still in the repertoire of the Volksoper with 12–20 performances per season. An Australian revival played in the Lyric Theatre, Sydney, New South Wales, from November 1999 to February 2000.
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It is multifactorial in cause, but includes increased inflammation, reduction in erythropoietin, and hyperuricemia leading to bone-marrow suppression. Hypoproliferative anemia occurs due to inadequate production of erythropoietin by the kidneys. Hypocalcemia results from 1,25 dihydroxyvitamin D3 deficiency (caused by high FGF-23 and reduced kidney mass) and resistance to the action of parathyroid hormone. Osteocytes are responsible for the increased production of FGF-23, which is a potent inhibitor of the enzyme 1-alpha-hydroxylase (responsible for the conversion of 25-hydroxycholecalciferol into 1,25 dihydroxyvitamin D3). Later, this progresses to secondary hyperparathyroidism, kidney osteodystrophy, and vascular calcification that further impairs cardiac function.
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Additional tests may include nuclear medicine MAG3 scan to confirm blood flow and establish the differential function between the two kidneys. Dimercaptosuccinic acid scans are also used in kidney imaging; with both MAG3 and DMSA being used chelated with the radioactive element technetium-99. Chronic pyelonephritis with reduced kidney size and focal cortical thinning.
Risk factors include a family history of chronic kidney disease. Diagnosis is by blood tests to measure the estimated glomerular filtration rate , and a urine test to measure albumin. Ultrasound or kidney biopsy may be performed to determine the underlying cause.
