Glossary

Atherosclerosis

The complex process of an artery wall thickening due to invasion and accumulation of macrophages as well as proliferation of smooth muscle cells.

Apotransferrin

Transferrin with no iron bound. Transferrin can bind two atoms of iron. Monoferric transferrin has iron bound to one of the two binding sites, while diferric transferrin (or ‘holo-transferrin’) has both binding sites occupied by iron.

Apatite

Group of phosphate minerals.

Aortic rupture

Rupture of the arota most frequently occuring due to an aortic aneurysm.

Aortic dissection

Injury to the aorta as a consequence of blood flowing between the layers of the aortic wall.

Antioxidative therapy

The use of antioxidants to reduce reactive oxygen species thereby inhibiting oxidation of other molecules.

Anticoagulation

Anticoagulants inhibit blood coagulation either directly or indirectly via blockade of coagulation factors or synthesis of coagulation factors, respectively.

Anti-nuclear antibodies (ANA)

Autoantibodies that target ‘normal’ proteins within the cell nucleus.

Angiotensin-converting enzyme (ACE)

Angiotensin-converting enzyme (ACE), a central component of the renin-angiotensin system that regulates blood pressure. It converts the hormone angiotensin I to angiotensin II. Angiotensin II is a vasoconstrictor which increases blood pressure.

Angiotensin receptor Blockers (ARB)

Medication treating high blood pressure because of the inhibition of angiotensin II. Angiotensin II is a chemical substance that causes muscles of the blood vessels to contract and therefore increases the pressure in the vessels.

Anaemia of chronic disease

Anaemia present in chronic diseases with underlying inflammation. Overproduction of pro-inflammatory cytokines and other mediators increases circulating hepcidin levels leading to blockade of iron homeostasis and (functional) iron deficiency.

Anaemia

A deficiency of haemoglobin, the oxygen-carrying protein in red blood cells. Anaemia is frequently defined as a haemoglobin concentration <12 g/dL in non-pregnant women and <13 g/dL in men. Can have various causes: e.g. iron deficiency, deficiency of vitamin B6, vitamin B12, folic acid or erythropoietin (renal anaemia) or thalassaemia (hereditary disease, particularly prevalent in those from the Mediterranean region). The most common form of iron deficiency anaemia is that treated with oral or I.V. iron replacement.

Allograft

A homograft between allogeneic individuals; individuals of the same species that are sufficiently unlike genetically to interact antigenically.

Alkalaemia

A blood disorder chracterized by a decreased concentration of hydrogen ions (pH> 7.45).

Aldosterone receptor antagonists (ARAs)

ARAs are a class of drug which inhibit the effect of aldosterone. Reabsorption of sodium is blocked and subsequently blood pressure decreases.

Aldosterone

The adrenal gland of the cortex produces aldosterone, a steroidhormone which regulates plasma sodium, extracellular potassium and blood pressure. It is part of the renin-angiotensin system.

Adynamic bone disease

Type of osteodystrophy characterized by reduced osteoblasts and osteoclasts. Adynamic bone disease is often diagnosed in patients with CKD who are treated with dialysis.

Adenosine triphosphate (ATP):

A coenzyme that transports chemical energy within cells. ATP is produced as an end-product of respiration and contains three phosphate groups. During metabolic processes, one phosphate group is broken off and energy is released, leaving behind adenosine diphosphate (ADP). ADP is usually recycled in the mitochondria to generate more ATP.

Acute phase protein

The plasma concentration of acute phase proteins increases in response to inflammation. This increase is triggered by secretion of inflammatory cytokines into the bloodstream when inflammation is present.

Action potential (AP)

An action potential is a temporary change of the membrane potential of a neuron. During an action potential the the membrane potential along the axon rises (depolarisation) and falls.

Acidosis

Acidosis is a disturbance in the acid-base metabolism. A pH value in the blood below 7.35 is defined as an acidosis.

Acetate

Acetate is a salt formed by the combination of acetic acid and an alkaline, earthy or metallic base.

ACE inhibitor

A class of drugs used primarily for the treatment of hypertension and chronic heart failure (CHF) that inhibit angiotensin-converting enzyme (ACE), a component of the renin-angiotensin system that regulates blood pressure.

Absolute iron deficiency

A condition where the body’s iron stores are depleted. Absolute iron deficiency is generally defined as low serum ferritin (e.g. <100 ng/mL in the absence of inflammation) and low TSAT (<20%). See iron deficiency.

Bone Mineral Density (BMD)

A test that measures the density of minerals (such as calcium) in the bones.

Bone Mineral Density (BMD)
Blood pressure (systolic and diastolic)

A measurement indicating how much pressure the blood is exerting against artery walls while the heart beats (systolic) or while the heart is resting in between beats (diastolic).

Bioavailability

The fraction of an administered dose of a drug that is present in the circulation.

Bicarbonate

Salt of carbonic acid.

Cytokines

Small proteins (e.g. interleukins, tumour necrosis factor, interferons) that are released by cells and have specific effects on the behaviour and interactions of cells. Different cytokines can trigger inflammation in response to infections (pro-inflammatory cytokines) or tone down inflammatory reactions (anti-inflammatory cytokines).

Crossmatch

Crossmatching is used before a kidney or pancreas transplantation to determine if the receivers tissue is compatible to the donors tissue. Blood serum of the receiver is checked for antibodies against donor cells.

Creatinine clearance rate

The precipitation rate of creatinin used to assess the function of the kindeys. If the kidneys are damaged, less creatinine is released in the urine.

Creatinine

Creatinine is a breakdown product of creatine phosphate in muscle and it is primarily eliminated by the kidneys.

Coronary revascularization

Treatment to restore blood flow in vessels of the heart eather by bypass operation redirecting the blood flow or stent operation opening the blocked vessels.

Continuous ambulatory peritoneal dialysis (CAPD)

Type of peritoneal dialysis (see peritoneal dialysis) where the fluid inside the abdomen is changed manually.

Chronic kidney disease (CKD)

Progressive loss of renal function over a period of months or years. Guidelines classify the severity of CKD in five stages, with stage 1 being the mildest and usually causing few symptoms, and stage 5 being a severe illness with poor life expectancy if untreated.

Chronic kidney disease – mineral and bone disorder (CKD-MBD)

Indication induced by disturbed calcium and phosphorus levels in CKD patients which may affect bones, heart and vessels.

Chronic heart failure

Indication where the heart is not able to pump properly. Caused by damage which occured to the heart muscle by a heart attack, high blood pressure, diabetes or other heart diseases.

CHr

Reticulocyte haemoglobin content; measures haemoglobin content per reticulocyte (mean reticulocyte cell volume x mean reticulocyte haemoglobin concentration). CHr is an early marker of iron deficiency or response to anaemia therapy, as reticulocytes exist in the circulation for only 1–2 days.

Cholesterol

An essential part of the human cell membrane used to synthesize hormones, bile acid and vitamin D3. Cholesterol is transported by two forms of lipoproteins, LDL (low density lipoprotein) and HDL (high density lipoprotein).

Cholecalciferol

A form of vitamin D (vitamin D3) which plays a major role in calcium regulation of the body.

Chlorophyll

Photosynthetic pigment found in plant, algae and a type of bacteria.

Catecholamine

Most important substances included in this group are dopamin, adrenalin and noradrenalin, which are neurotransmitters in the central nervous system. Adrenalin and Noradrenalin are hormones, too.

Catalase

A red crystalline enzyme that consists of a protein complex with haematin groups and catalyzes the decomposition of hydrogen peroxide into water and oxygen.

Cardiac arrhytmia

A disorder in the rhythm of the heartbeat. The heart may beat too fast, too slow or irregular.

Calcitriol

Active form of vitamin D which is found in the human body and produced in the kidney. As a medication Calcitriol is used to treat hypocalcemia or osteoporosis.

Calcineurin

A phosphatase that plays a crucial role in T cell activation. Dephosphorylation of the nuclear factors of activated T cells by calcineurin is essential for activating the immune response.

C-reactive protein (CRP)

Acute-phase protein. The plasma concentration of CRP increases during inflammatory disorders, reflecting the presence and intensity of inflammation.

Dual-energy X-ray Absorptiometry (DXA)

Commonly used method to measure bone loss and diagnose osteoporosis. Pictures of the bone structure are produced using two photon energies to show calcium and thereby bone mineral.

Dual energy X-Ray absorptiometry (DEXA)

Medical examination designed to measure bone density by two X-ray beams with different energy levels. DEXA is used to diagnose osteoporosis.

DMT1 transporter

Divalent metal transporter 1; DMT1 functions in transport of ferrous iron, and some, but not all divalent metal ions across the plasma membrane and/or out of the endosomal compartment.

Divalent iron

Iron ion that carries two positive charges, i.e. it can gain two negatively charged electrons; Fe2+.

Diuretics

Medication to treat high blood pressure which makes the kidneys release more sodium into the urine. Because of the higher sodium amounts more water will be transported out of the body and the amount of fluid in the vessels is reduced.

Direct renin inhibitors (DRIs)

Medication to treat high blood pressure which blocks the enzyme renin and causes blood vessel muscles to relax.

Diffusion

Transport of substances by random movement of particles in fluids under the influence of concentration gradients

Dialysate

Fluid used in hemodialysis which absorbs waste products from the blood.

Dextran

A polysaccharide made up of (1→6) linked glucose molecules with chains of varying lengths (from 1 to 2000 kilodaltons). Dextrans are of bacterial origin and may, depending on their size, invoke anaphylactic reactions.

Extracellular fluid

Bodily fluid outside the cell found e.g. in blood, lymph or brain which contains proteins and electrolytes.

ESA therapy – erythropoiesis-stimulating agent

ESAs are drugs that are structurally similar to the naturally occurring protein erythropoietin (EPO). They mimic the action of erythropoeitin to stimulate red blood cell production in the bone marrow.

ESA hyporesponsiveness

Term describing a lower reaction to the intake of ESAs (see ESA therapy). Patients with ESA hyporesponsiveness may not achieve desired haemoglobin concentration even if treated with higher ESA dose than normal.

Erythropoietin (EPO)

Glycoprotein (protein with a carbohydrate component), which is formed in the kidney and stimulates erythrocyte formation. The EPO level in the blood is reduced in various kidney diseases and can therefore lead to renal anaemia.

Erythropoiesis

The process by which red blood cells (erythrocytes) are produced.

Erythroid

The process by which red blood cells (erythrocytes) are produced.

Erythrocytes

Red blood cells; in humans, they are disc-shaped blood cells, with a central depression on the top and bottom. They contain haemoglobin, with whose help oxygen transport in the blood takes place. Their life cycle is approximately 100 to 120 days. In iron deficiency, either too few erythrocytes are produced or those that are produced do not function fully (hypochromic microcytic erythrocytes; i.e. erythrocytes whose haemoglobin content and volume is too low).

Erythroblasts

A polychromatic nucleated cell of the bone marrow that synthesises haemoglobin and is an intermediate in the initial stage of red blood cell formation.

Ergocalciferol

A form of vitamin D (vitamin D2) used in the body to absorb calcium and phosphorus.

Enterocytes

The absorptive cells that line the wall of the gut.

Electrolyte

Ions which are electrically charged negative (cathode) or positive (anode). Electrolytes like sodium or chloride control important cell functions like muscle contraction or hydration.

Electrocardiography (ECG)

A method that measures and visualizes the activity of the heart muscle triggered by electric impulses to show the rhythm of the heartbeat. Electrodes are applied to the patients legs, arms and chest.

eGFR

Mathematically estimated Glomerular Filtration Rate to indicate the renal function. GFR is estimated considering patients serum creatinine level, age, gender and race.

Echocardiogram

Imaging technique that shows structures of the heart and its bloodflow using ultrasound.

Functional iron deficiency

Functional iron deficiency arises when the demand for iron is higher than availability. This most frequently occurs in patients with increased erythropoietin-stimulated erythropoiesis (e.g. following substantial blood loss) or during treatment with erythropoiesis stimulating agents (ESAs), when the demand for iron is greatly increased, or during inflammation, when iron is sequestered within macrophages and enterocytes.

Free radical

An atom, ion or molecule that contains an unpaired electron and is therefore unstable and highly reactive.

Fibronolysis

The usually enzymatic breakdown of fibrin.

Ferrous ion

Iron(II) or Fe2+.

Ferroportin

A protein that is present in the membrane of cells, such as liver cells and macrophages of the reticuloendothelial system. Ferroportin transports iron from the inside of the cell to the outside of the cell across the cell membrane.

Ferritin

Storage form of iron in the cell; consists of the protein apoferritin, which binds up to 4,500 iron ions to itself and thus becomes the storage molecule, ferritin. <Serum ferritin>: biological marker reflecting iron stores in the body.

Ferric ion

Iron(III) or Fe3+. This is the form in which iron is bound to transferrin for transport.

Ferric citrate

Iron(III) citrate or FeC6H5O7. Substance used to lower blood phosphate levels in patients with kidney diseases.

Fatigue

Symptom occuring in a lot of physical or psychological indications described as the lack of energy and motivation.

Growth hormone

Hormone produced by the pituitary gland regulating growth of tissues and metabolism.

Growth differentiation factor-1 (GDF1)

A protein that plays a role in left-right patterning and mesoderm induction during embryonic development.

Granulocytes

A polymorphonuclear white blood cell (basophil, eosinophil, or neutrophil) with granule-containing cytoplasm.

Glycaemia

The presence of glucose in blood. If there is a high blood glucose level it is named hyperglycemia. A low blood glucose level is called hypoglycemia.

Glomerulus

Bundle of capillaries in the kidney within the Bowman’s capsule which is able to filter waste products from the blood.

Glomerular filtration rate (GFR)

The volume of fluid filtered through the glomeruli of the nephrons in the kidney per unit time.

Gastrointestinal

Term describing things relating to intestines and the stomach.

Hypochromic red cells (%HYPO)

Proportion of hypochromic red blood cells; provides an evaluation of the bone marrow activity, reflecting the balance between available iron and erythropoiesis.

Hypochromic

General meaning: with a reduced pigment content; in haematology (science of the blood and its diseases) it describes a reduced haemoglobin content of a red blood cell.

Hypertension

Also known as High Blood Pressure. Blood is pushing against the arteries with a higher force than normal.

Hypersensitivity

Exaggerated reaction of the immune system as seen in allergies and autoimmune diseases.

Hyperphosphataemia/Hyperphosphatemia

Higher levels of phosphate in the blood.

Hyperkalaemia/Hyperkalemia

Higher levels of potassium in the blood.

Hyperferritinemia

Higher levels of ferritin levels in the blood.

Hydroxyvitamin D

Form of vitamin D also known as Calcifediol transformed from cholecalciferol in the liver.

HIF-PHI (Hypoxia-Induced Factor Prolyl Hydroxylase Inhibitors)

Medication to treat anemia in CKD which inhibits the prolyl hydroxylase thereby stabilizing HIF. Inhibition therfore stimulates the endegenous erythropoietin production in patients.

HFrEF (Heart Failure with reduced ejection fraction)

An indication where the heart muscle does not contract normally and less oxygen-containing blood is pumped into the body.

Heterogeneity

The quality or state of being heterogeneous.

Hepcidin

Small, liver-derived peptide (25 amino acids) that is the key regulator of iron homeostasis. Hepcidin synthesis is stimulated during inflammation and reduces utilisation of dietary and storage iron by blocking the release of iron from enterocytes or macrophages.

Hepatocytes

Cells in the main tissue of the liver that perform critical metabolic functions.

Heparin

Polysaccharides which are used as anticoagulants to treat blood clots or work as blood thinners to prevent blood clots.

Hemochromatosis

Indication with excessive accumulation of iron in the body.

HCP1 transporter:

Haem carrier protein 1 (HCP1); mediates haem uptake into intestinal cells.

HbA1c

Glycated hemoglobin used in a blood test to measure the average levels of blood glucose over the past 3 months.

Haemosiderin

Storage form of iron in cases of iron overload.

Haemojuvelin

A membrane protein in mammals that is responsible for the iron overload condition known as juvenile haemochromatosis, a severe form of haemochromatosis.

Haemoglobin

Red pigment of the red blood cells, whose principal task is oxygen transport; consists of four protein chains.

Haemodialysis chronic kidney disease (HD-CKD)

Stage of chronic kidney disease where haemodialysis is needed as a treatment.

Haemodialysis

A repeated process to remove waste products from the blood used in patients with disturbed to no renal function. The blood is filtered outside of the body.

Haemochromatosis

Iron storage disease. Disease in which iron overload occurs in the organs. In idiopathic haemochromatosis, the cause is unknown. Acquired haemochromatosis is usually due to an alcohol-related disease, prolonged, high-dose iron replacement therapy or frequent blood transfusions.

Haematopoiesis

The production of all types of blood cells (e.g. neutrophils, platelets and red blood cells) generated by a self-regulated system that is responsive to the demands put upon it.

Haematocrit (HCT)

Part of the volume of all red blood cells in the total blood; is given as a percentage.

Haem

Pigment unit of the red blood pigment haemoglobin in the red blood cells. Each haemoglobin molecule carries 4 haem molecules. Each haem carries one iron ion as the central atom, to which oxygen is bound.

Ischemia

Condition in which a part of the body is supplied with an insufficient amount of blood.

Iron therapy

Treatment against iron deficiency anemia where iron is given orally.

Iron deficiency

Insufficient iron stores or iron availability for normal physiological functions. Iron deficiency may be associated with impaired physical function, weakness and fatigue.

Intravenous (IV)

Inside of a vein or something entering a vein e.g. an intravenous infection.

Intracellular

The inside of a cell.

Insulin

Hormone produced by the pancreas which controls blood sugar levels.

Inorganic phosphorous

Substance added to foods which is absorbed in the blood as phosphate ions. An increased amount of phosphate may be found in patients with kidney or glandular diseases. Decreased amounts indicate vitamine deficiency.

Inflammatory cytokines

Chemicals produced by cells within the immune system in response to inflammation. The most notable inflammatory cytokines are the interleukins IL-1, IL-6 and IL-8 and tumour necrosis factor-alpha (TNF-α).

Immunosuppression

Inhibition of the immune system which suppresses its ability to recognize infections. Immunosuppression occures in diseases like AIDS.

Kinetics

Part of sciences that studies time dependence of chemical reactions like the reaction rate.

Lymphocyte

A type of white blood cells in the immune system. There are different types of Lymphocytes. Natural killer cells which kill infected cells, B cells which produce antibodies for the immune response and T cells which destroy infected or mutated cells of the body.

Lipoprotein

A protein which is able to transport the water-insoluble substances cholesterol and tryglycerides inside of the body.

Lipid peroxidation

Oxidative degradation of lipids in the cell membrane, produced by a free radical reaction. Lipid peroxidation is a process that often leads to cell damage and death.

Lanthanum carbonate

Medication used to lower high phosphate levels in patients with CKD and hyperphosphatemia which works by preventing phosphate from being absorbed by the intestine.

Myoglobin

Muscle haemoglobin; a protein found in muscle, which is related to haemoglobin and which is responsible for the oxygen supply to the muscle; consists of only a single protein chain, which is bound to haem; iron content 0.338%; binds oxygen 6 times more strongly than haemoglobin.

Myocardium

Part of the heart located in the middle layer which consist of cardiac muscle. Cardiac muscle combines characteristics of the two other muscle types skeletal muscels and smooth muscles.

Myocardial infarction

Condition in which a continuos cardiac ischemia causes damage to the heart tissue. Also known as a heart attack.

Mitochondria

Organelles that are found within most cells of the body and which act as “cellular power plants”. They generate most of the cell’s supply of adenosine triphosphate (ATP).

Mineralocorticoid receptor antagonist (MRAs)

Medication to inhibit the action of the hormon aldosteron which is released from the adrenal gland. The inhibition is associated with possible deterioration of heart failure.

Mineralization

A process in which inorganic substances precipitate in organic structures like bones.

Microcytosis

Increased occurrence of microcytes in the blood, i.e. of red blood cells with a diameter of less than 7 µm.

Meta-analysis

Statistical method to determine the significance of several related studies.

Membrane potential

Difference in the electric potential on the intracellular and the extracellular side.

Mean corpuscular volume (MCV)

Volume of one red blood cell; it is determined electronically or calculated from the haematocrit and the total number of red blood cells.

Mean corpuscular haemoglobin concentration (MCHC)

Mean corpuscular haemoglobin concentration of a single red blood cell; it is calculated using a formula obtained from the haemoglobin value and the haematocrit.

Mean corpuscular haemoglobin (MCH)

Haemoglobin amount per red blood cell; it is calculated using a formula obtained from the haemoglobin value and red blood cell count.

Mammalian target of rapamycin (mTOR)

An evolutionarily conserved serine/threonine protein kinase implicated in a wide array of cellular processes such as cell growth, proliferation, and survival.

Malnutrition-inflammation-cachexia (MICS)

A syndrome occuring in patients who are treated with haemodialysis. Patients often suffer from protein energy malnutrition and inflammation simultaneously.

Magnetic resonance imaging (MRI)

A medical imaging technique employed to visualise detailed internal structures. It uses magnetic and radio waves, so the patient is not exposed to X-rays.

Macrophages

White blood cells that engulf and then digest cellular debris and pathogens, and which also stimulate other elements of the immune system to respond to pathogens. Macrophages in the reticuloendothelial system break down red blood cells that have reached the end of their life span. The Hb from the red blood cells is further digested and its iron content is released. The iron is either stored within the macrophages as ferritin if there is no immediate need for iron, or transported via ferroportin into the plasma, where it is bound to transferrin to be delivered to cells that require iron.

NSAID

Nonsteroidal antiinflammatory drugs are able to reduce inflammation, fever and pain.

Non-transferrin bound iron (NTBI)

Plasma iron species, not bound to transferrin, which appear in conditions of iron overload and ineffective erythropoiesis.

Non-dialysis chronic kidney disease (ND-CKD)

Early stage of chronic kidney disease in which dialysis is not yet needed and the patient is still treated with special nutrition and hydration plans.

Nephrectomy

Operative removal of the kidneys. Types of nephrectomy are radical nephrectomy where the kidney, the fat around the kidney, the ureter, the adrenal gland and surrounding lymph nodes are removed entirely, partial nephrectomy where only a part of the kidney is removed and simple nephrectomy where only the kidney is removed.

Natriuresis

Excessive excretion of sodium in the urine. Natriuretic peptides induce natriuresis.

Oxyhaemoglobin

Oxygen-laden haemoglobin in the red blood cells.

Oxidative stress

Occurs when the production of reactive oxygen species exceeds the body’s capacity to detoxify them. Reactive oxygen species can cause toxic effects, for example through the process of peroxidation, on various cell components of the cell including proteins, lipids, and DNA.

Osteoporosis

A condition leading to fragility and decreased density of bones. Without treatment osteoporosis may cause fractures commonly in the hip or wrists.

Osteogenic differentiation

Change in the structure of human mesenchymal stem cells which are able to differentiate in diverse cell types including adipocytes, chondrocytes and osteocytes.

Osteodystrophy

Bone disease often occuring in patients with kidney diseases where the kidneys are not able to maintain calcium and phosphorus levels in the blood. Osteodystrophy is shown by symptoms like bone and joint pain and weak fractures.

Osmosis

Diffusion of water and solvents trough a semipermeable membrane from an area with low concetration of the solvent to an area with a high solvent concentration.

Organic phosphorous

Phosphorous which is naturally contained in food. 40-60% of it is absorbed after eating.

Protein oxidation

Modification of a protein induced by reactive oxygen species or secondary by-products of oxidative stress.

Proportion of hypochromic red cells (%HRC)

This measures the concentration of Hb in red blood cells, as opposed to CHr, which measures the absolute amount of Hb. %HRC takes into account both the absolute amount of Hb and the size of the cell. However, since red blood cells expand when they are stored, the test must be performed quickly at a local laboratory. See hypochromic red cells (%HYPO).

Proliferation

Growth of tissues by cell multiplication.

Progenitor cell

A ‘primitive’ cell that can differentiate into different cell types depending on exposure to different growth factors or signalling molecules (e.g. cytokines).

Proerythroblast

A haemocytoblast that gives rise to erythroblasts.

Porphyrin

Any of various compounds with a structure that consists essentially of four pyrrole rings joined by four =CH− groups; especially: one (as chlorophyll or haemoglobin) containing a central metal atom and usually having biological activity.

Pleiotropic

Producing more than one effect; especially: having multiple phenotypic expressions <a pleiotropic gene>.

Piper Fatigue Scale

A scale used to measure a person’s level of fatigue. It is used in cancer treatment to help HCPs assess the causes and intensity of their patients’ fatigue as a rational basis for treatment.

PHRC

See hypochromic red cells (%HYPO).

Phosphate binders

Medication used to decrease the absorption of phosphorus in the gastrointestinal tract.

Pharmacokinetic

Effects the body has on a drug including processes like absorption, distribution, metabolism and excretion.

Phagosome

A membrane-bound vesicle that encloses particulate matter taken into the cell by phagocytosis.

Phagolysosome

A digestive vesicle formed within a cell by the fusion of a phagosome containing ingested material and a lysosome containing hydrolytic enzymes.

Peritoneal dialysis

A repeated process to replace kidney functions like removing waste products from the blood in patients with no or restricted kidney function. In comparison to heamodialysis no blood is taken and cleaned directly but the peritoneal membrane lining the abdomen is bathed into a fluid. Waste products pass from capillary blood into the fluid which removes them from the blood. Types of peritoneal dialysis are CAPD (see continuous ambulatory peritoneal dialysis) and automated peritoneal dialysis where a machine is used to change the fluid in the abdomen.

Peripheral oedema

Indication with an increased amount of fluid in the interstitial space causing extremities to swell.

Parathyroidectomy

Surgical treatment removing the parathyroid gland or parathyroid gland tumors.

Parathyroid hormone (PTH)

A hormone of the parathyroid gland that regulates the metabolism of calcium and phosphorus in the body.

Ribonucleotide reductase

An enzyme that catalyses the formation of deoxyribonucleotides from ribonucleotides.

Reticuloendothelial system (RES)

Complex, multi-organ system consisting of phagocytes and storage cells, which are mainly found in the liver, spleen and bone marrow.

Reticulocytes

Immature red blood cells in the bloodstream. They exist for only 1-2 days before becoming mature red blood cells.

Reticulocyte haemoglobin content

See CHr

Renin

An enzyme regulating blood pressure which is secreted by the kidney.

Renal replacement therapy (RRT)

A term used to describe treatments that support renal function e.g. peritoneal- and haemodialysis, haemofiltration and renal transplantation.

Renal anaemia

As a result of a chronic renal disease, sufficient quantities of erythropoietin, which stimulates erythrocyte formation, can no longer be formed, so that anaemia develops over time. In addition, such patients usually also suffer from iron deficiency, particularly if they require dialysis, i.e. they regularly have to undergo “blood washing”, where a lot of blood is lost.

Red cell distribution width (RDW)

A parameter that measures variation in red blood cell volume. Can be used in conjunction with MCV to assess anaemia type.

Reactive oxygen species

Molecules or free radicals derived from molecular oxygen that are highly reactive.

RAASi

Renin-angiotensin-aldosteron system inhibitor used as therapy for chronic kidney disease paired with hypertension, diabetes or heart failure. The RAAS regulates electrolyte balance and circulating blood volume of the body and may cause hypertension if it is overreactive. In patients treated with RAASi extracellular potassium levels are often elevated what may cause hyperkalemia.

System lupus erythematosus (SLE)

An autoimmune disease resulting in chronic inflammation.

Superconducting quantum interference device (SQUID)

Allows indirect assessment of liver iron.

Sucroferric oxyhydroxide

Synthetic substance used to lower blood phosphate levels in patients with CKD.

Stroke

Condition caused by interruption of the blood flow in the brain eather caused by a vessel breaking and bleeding into the brain or by blood clots.

Soluble transferrin receptor (sTfR) in serum

This receptor mediates the uptake of iron by cells. The amount of transferrin receptor expressed on a cell increases in proportion to the cell’s need for iron. It thus provides an index of erythropoiesis activity. sTfR levels are not affected by inflammation, and can be a sensitive indictor of iron deficiency in the presence of chronic inflammation, when serum ferritin levels may be raised.

Serum transferrin receptor concentration (sTfR)

A marker of the amount of iron uptake into cell. It is a sensitive method of detecting iron deficiency in the presence of inflammatory states (e.g. infection or chronic inflammatory states such as kidney disease) because it is not affected by the acute phase response.

Serum iron

A medical laboratory test that measures the amount of circulating iron that is bound to transferrin.

Serum ferritin

Small amounts of ferritin, which can be measured by a laboratory immunoassay and used as an indicator of body iron stores in healthy individuals. Serum ferritin levels correlate with body iron stores and an elevated value indicates full iron stores. However, serum ferritin levels can become elevated independently of the body iron as part of the general pattern of the systemic effects of inflammation.

Senescence

The state of being old; the process of becoming old.

Secondary hyperparathyroidism (SHPT)

Indication usually caused by kidney failure which leads to parathyroid glands becoming enlarged. Increasing phorphorus levels generate low levels of calcium in the blood which stimulates parathyroid glands to produce a growth hormone.

Trivalent iron

Iron ion that carries three positive charges, i.e. it can gain three negatively charged electrons; Fe3+.

Transferrin saturation (TSAT)

The ratio of serum iron and total iron binding capacity, multiplied by 100 (TSAT is expressed as a percentage). In conditions of normal iron status, transferrin in the serum is saturated to about one third of its total iron binding capacity, such that there is a mixture of apotransferrin, the two monomeric forms and diferric transferrin. Higher values of TSAT indicate greater availability of iron for cellular functions, including production of red blood cells in the bone marrow.

Transferrin

Transporting molecule in the blood, to which iron is bound and can thus be transported to the cells that need iron in order to perform their functions.

Total iron binding capacity (TIBC)

A medical laboratory test that measures the blood’s capacity to bind iron.

Ureotelic

Excreting nitrogen in form of urea.

Urea metabolism

Chain of reactions building urea to excrete toxic ammonia which derives from the synthesis of amino acids. Urea metbolism takes place in the liver and to a lesser extinct in the kidneys.

Vitamin D receptor activator (VDRA)

Activators of Vitamin D receptor, subseuqently leading to a reduction in parathyroid hormone levels, which is associated with a lower risk of hypercalcemia and hyperphosphatemia.

Vitamin D

A Vitamin which can be synthesized by UVB-radiation or ingested from the diet. Its active form Calcitriol binds to the Vitamin D receptor (VDR) and regulates calcium and phosphate levels in blood and bone growth.

Vascular calcification

A process when calcium accumulates in the vasculature leading to reduced aortic and arterial elastance.

Zinc protoporphyrin (ZnPP)

A compound  formed in red blood cells when haem production is inhibited by iron deficiency or lead poisoning

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