Showing papers in "Nephron in 1984"
308 citations
TL;DR: Renal biopsy before gestation was not predictive of the outcome of nephropathy during pregnancy, and change of histology in repeated biopsies was frequently observed.
Abstract: We describe 26 pregnancies in 19 patients with lupus nephritis. There were 4 spontaneous abortions, 2 therapeutic abortions, 4 stillbirths and 1 neonatal death. 10 deliverieswere preterm and 2 fetuses
115 citations
TL;DR: The clinical course of 123 pregnancies in 86 patients with biopsy-proven glomerular diseases have been studied and in 35 women the onset of nephropathy occurred during pregnancy.
Abstract: The clinical course of 123 pregnancies in 86 patients with biopsy-proven glomerular diseases have been studied. In 35 women the onset of nephropathy occurred during pregnancy. No complications were observed in more than half of the pregnancies. In the others, one third of the complications were obstetrical or fetal accidents, one third were renal manifestations (hypertension or deterioration of renal function) and one third were both causes. The lowest incidence of complications was observed in patients with membranous nephropathy and the highest in membranoproliferative glomerulonephritis patients. There were 6 spontaneous late abortion, 6 stillbirths and 5 neonatal deaths. 17 deliveries were preterm and 7 fetuses were small for gestational age. Hypertension appeared in 24 pregnancies, in 13 of which it was reversible and related to superimposed preeclampsia and in 11 it persisted after delivery (5 of these 11 pregnancies were in patients with IgA nephropathy). Renal function deteriorated in 10 cases during pregnancy. The deterioration was reversible in 6 and progressive in 4 (2 of whom had membranoproliferative glomerulonephritis). It is suggested that in most patients pregnancy does not change the natural history of glomerular disease.
107 citations
TL;DR: It is concluded that PV can be measured reliably in the NS with 131I-albumin, and that even after appropriate corrections are made, PV and BV are normal or increased in most patients with the NS.
Abstract: In 88 patients with the nephrotic syndrome (NS) we estimated plasma volume (PV) with 131I-albumin (RISA) and calculated blood volume (BV) from PV and whole body hematocrit (Ht). To assess whether this method gives erroneously high values in the NS, the transcapillary escape rate of albumin (TER) and large vessel Ht/whole body Ht ratio (F-cell ratio) were measured in two subsets of these patients (n = 19 and 24, respectively). Although TER appeared to be increased and F-cell ratio slightly decreased in the NS as compared to normals, it could be calculated that overestimation of PV and BV from these sources will not exceed +/- 1%. Taking these errors into account PV and BV appeared normal or increased in the NS (62.8 +/- 9.6 and 94.9 +/- 15.1 ml/kg vs. 56.0 +/- 7.1 and 88.5 +/- 10.1 ml/kg lean body mass in 51 normal controls). We conclude that PV can be measured reliably in the NS with 131I-albumin, and that even after appropriate corrections are made, PV and BV are normal or increased in most patients with the NS.
100 citations
TL;DR: It is indicated that vitamin D and PTH do influence left ventricular function in Uremic patients on chronic hemodialysis, and that a reduction in plasma PTH levels is beneficial to the uremic heart.
Abstract: 44 patients receiving regular hemodialysis therapy were investigated using M-mode echocardiography and systolic time intervals to examine the effects of parathyroid hormone (PTH) and vitamin D on left ventricular function. 12 patients were treated with 1 microgram daily of 1, alpha-hydroxycholecalciferol for 6 weeks, which produced a decrease in plasma PTH concentration from 1,883 +/- 226 to 1,123 +/- 289 ng/l. Fractional fibre shortening (FS) increased from 34.6 to 37.6% (p less than 0.025) and mean velocity of fibre shortening (Vcf) increased from 1.21 to 1.32 circ/s (p less than 0.01). A second group of 20 patients was studied before and after the plasma magnesium concentration was increased from 1.25 to 1.70 mmol/l, resulting in a fall in plasma PTH concentration from 546 to 418 ng/l (p less than 0.001). This was associated with an increase in both FS from 32.4 to 34.3%, and Vcf from 1.19 to 1.21 circ/s. A third group of 6 patients with severe hyperparathyroidism underwent total parathyroidectomy, FS increased from 34.9 to 36.3% and Vcf increased from 1.22 to 1.38 circ/s. In conclusion, our results indicate that vitamin D and PTH do influence left ventricular function in uremic patients on chronic hemodialysis, and that a reduction in plasma PTH levels is beneficial to the uremic heart.
93 citations
TL;DR: Since all patients who responded were treated within 24 h after the onset of oliguria, it appears to be crucial to administer dopamine and frusemide early, before more severe anatomical and functional damage develops.
Abstract: Into 24 oliguric patients with acute renal failure (ARF) for whom mannitol and high-dose frusemide had failed to promote a diuresis, dopamine (3 μg/kg/min) plus frusemide (10–15 mg/kg/h) were infused
90 citations
TL;DR: This phenomenon in 19 uraemic patients undergoing chronic haemodialysis was investigated by determining RBC malonyldialdehyde (MDA), a secondary product of lipid peroxidation and plasma and RBC tocopherols, which are powerful antioxidants, which were significantly decreased because of enhanced antioxidant activity.
Abstract: Some metabolic alterations of the pentose-phosphate shunt can increase susceptibility to red blood cell (RBC) lipid peroxidation in uraemic patients on maintenance haemodialysis. We investigated this phenomenon in 19 uraemic patients undergoing chronic haemodialysis by determining RBC malonyldialdehyde (MDA), a secondary product of lipid peroxidation and plasma and RBC tocopherols, which are powerful antioxidants. Evidence of RBC membrane lipid peroxidation was demonstrated by an increase of RBC MDA. RBC tocopherols were significantly decreased because of enhanced antioxidant activity. No significant variations of these parameters were found before and after dialysis.
89 citations
TL;DR: Cysts were demonstrable in the patient's own kidneys after a median follow-up of 16 months, and no correlation was noted between hematocrit and presence or extent of cystic transformation, but the 2 patients with cystic enlargement of the kidneys were polyglobulic.
Abstract: With real-time sonography, 120 nondialyzed uremic patients prior to hemodialysis, 108 patients on maintenance hemodialysis and 9 patients postdialysis after successful homotransplantation were examined for the presence of renal cysts. Even in incipient renal failure, multiple cysts were demonstrable in some patients (at a serum creatinine of 3 mg/dl in 22% of patients), particularly in patients with analgesic nephropathy. When hemodialysis was started (serum creatinine approximately 10 mg/dl), 35% of the patients had multiple cysts. On hemodialysis, the prevalence, number and size of cysts rose progressively with time. After 8 years of hemodialysis, 92% of the patients had multiple cysts. However, enlargement of the kidneys was observed in only 2/108 patients. No major clinical complications were noted with the possible exception of 1 case of renal cell carcinoma. No correlation was noted between hematocrit and presence or extent of cystic transformation, but the 2 patients with cystic enlargement of the kidneys were polyglobulic. In 8/9 patients after transplantation, cysts were demonstrable in the patient’s own kidneys after a median follow-up of 16 months. On light microscopy, cysts were lined by cuboidal or columnar epithelial cells with frequent papillary or adenomatous proliferations. The cyst lumen was filled with amorphous or lamellated organic material, which exhibited microfibrillar structure on electron microscopy. One kidney examined after ex vivo perfusion fixation showed multiple interconnected cavities on scanning electron microscopy. Ultrastructural studies showed epithelia with either the characteristics of proximal tubular cells (i.e. numerous microvilli, interdigitations and abundant lysosomes or mitochondria) or distal tubular cells (i.e. highly interdigitating processes) or finally collecting duct cells (i.e. no interdigitations and few microvilli).
84 citations
TL;DR: No explanation was found as to why patients developed arrhythmias or what differentiated the two groups of patients, and significant alkalinization occurred in all patients at the end of dialysis.
Abstract: A high incidence (40%) of cardiac arrhythmias was found in patients while on dialysis. This incidence was significantly higher than on nondialysis days. A comparison study of patients with significant
84 citations
TL;DR: It is suggested that changes in ultrafiltration can be related to altered permeability of the peritoneal membrane, which appear earlier and more frequent than suggested by others, and any loss of delta V can be explained by a more permeable ('open') peritoneale membrane.
Abstract: 9 patients were observed prospectively during 14–40 months 003continuous ambulatory peritoneal dialysis (CAPD) treatment. From start of CAPD, each patient recorded dwell time, drained ultrafiltration volume (ΔV), initial glucose concentration in dialysate, daily fluid intake, body weight and blood pressure on a special form. These data, together with monthly values for albumin, urea, creatinin, phosphate, glucose and β2-microglobulin in plasma and in instilled dialysate, were later fed into a specially designed computer program to compare changes in the monthly mean ( ± SEM) values. During 5 episodes of peritonitis, daily changes in ΔV were also computed. A long-term increase in ΔV was found in 4 and a decrease in 5 patients. In all 9 patients ΔV changed intermittently. All changes were most pronounced for long dwell times as compared to shorter dwell exchanges. The decrease in ΔV started within the first 12 months of treatment. In the daily routine we were aware of decreased ultrafiltration capacity in 3 patients only. Intermittent monthly changes in ΔV could partly be correlated to changes in daily fluid intake. No correlations were found between long-term changes in ΔV and fluid intake. All except 1 patient gained progressively in body weight, but without correlations to fluid balance, blood pressure and plasma albumin concentration. At the start of the observation period, most patients loosing ΔV during this study appeared to have a more permeable membrane with a higher absorption rate of glucose and higher equilibration ratios for creatinine and β2-microglobulin in 5-hours drained dialysate as compared with the other patients. However, this was not statistically different between the two groups of patients. During the observation period, most patients with decreased ΔV also increased transperitoneal solute transport, while the solute transport decreased in patients with increasing ΔV, but these changes were only significant for some patients. During peritonitis, ΔV decreased significantly 1 day before any other signs of peritonitis. All changes in ΔV were most pronounced for long dwell times as compared with short dwell times. It is suggested that changes in ultrafiltration can be related to altered permeability of the peritoneal membrane, which appear earlier and more frequent than suggested by others, and any loss of ΔV can be explained by a more permeable (‘open’) peritoneal membrane. It is also possible that different diseases act differently on the permeability of the peritoneal membrane.
70 citations
TL;DR: By univariate analysis of patients with membraneous nephropathy, terminal renal failure was associated with male sex, a large amount of proteinuria, low serum albumin concentration, low Creatinine clearance rate, high serum creatinine concentration, and high systolic blood pressure, but was not associated with age or prednisone treatment.
Abstract: By univariate analysis of patients with membranous nephropathy, terminal renal failure was associated with male sex, a large amount of proteinuria, low serum albumin concentration, low creatinine clea
TL;DR: It is concluded that several parameters of immune function are improved with pyridoxine supplementation, even though some patients who responded had no evidence for vitamin B6 deficiency before therapy, as indicated by a normal erythrocyte glumatic-pyruvic transaminase index.
Abstract: 8 male patients undergoing maintenance hemodialysis were studied to determine the effect of administering supplements of pyridoxine hydrochloride, 50 mg/day for 3–5 weeks, on tests of immune function.
TL;DR: The combined effect of cholemia may lead to redistribution of cardiac output away from the kidney and the brain, and the tendency to arterial hypotension is aggravated when parenchymal liver damage complicates obstructive jaundice.
Abstract: (Fig. 1) Cholemia per se (i.e. independent of parenchymal liver damage) causes a profound disturbance of systemic hemodynamics. This includes decrease in total peripheral vascular resistance, and possible impairment of left ventricular performance. These, in turn, lead to a decrease in effective blood volume, a tendency to hemorrhagic shock and prerenal failure. Early in the course of cholemia , the natriuretic effects of bile salts in the circulation may aggravate the hypovolemia. In marked contrast to the decrease in total peripheral vascular resistance, the regional vascular beds of the kidney and the brain constrict during cholemia . The combined effect of cholemia may thus lead to redistribution of cardiac output away from the kidney and the brain. When parenchymal liver damage complicates obstructive jaundice, the tendency to arterial hypotension is aggravated. The overall interrelationship between jaundice and circulatory homeostasis is depicted in figure 1.
TL;DR: A harmful effect of L-carnitine replacement therapy when given in high doses is suggested, causing aggravation of uremic hypertriglyceridemia and increased platelet aggregation in patients predisposed to thromboembolic phenomena.
Abstract: Uremic patients undergoing chronic hemodialysis demonstrate a secondary systemic carnitine deficiency. We studied the effect of carnitine replacement with high doses ( L -carnitine, 3
TL;DR: Glomerular filtration rate declined significantly with age, but independently of diabetes duration, in the diabetic group, while GFR in the control group showed a statistically non-significant decline with age.
Abstract: Glomerular filtration rate (GFR) is abnormally high in some, but not all, insulin-dependent diabetic patients. The potential importance of this hyperfutration lies in its possible link with later seve
TL;DR: It is concluded that captopril is an effective antihypertensive drug in patients with systemic lupus erythematosus (SLE) and increased renal function in 64% of patients on long-term therapy.
Abstract: Captopril, an angiotensin-converting enzyme inhibitor, was used to treat 14 patients with lupus nephritis and severe hypertension. All patients had reduced renal function and were on regular immunosup
TL;DR: Since signs of an absolute magnesium excess were not detected, a combination of low dialysate magnesium and the use of an oral magnesium compound as a phosphate binder might be a way to decrease aluminium exposition in hemodialysis patients.
Abstract: The magnesium status of 22 hemodialysis patients was studied by analyses of serum, skeletal muscle and peripheral blood lymphocyte levels of magnesium. Despite elevated serum magnesium, normal magnesium levels were noted in skeletal muscle and lymphocytes. 12 patients were exposed to a low dialysate magnesium concentration, resulting in normalization of serum magnesium but no changes in muscle or lymphocyte magnesium, which might indicate slow exchange between these intracellular stores and the extracellular fluid. Normalization of serum magnesium was followed by a slight rise in circulating parathyroid hormone levels without noticeable changes in serum calcium or phosphate levels. Since signs of an absolute magnesium excess were not detected, a combination of low dialysate magnesium and the use of an oral magnesium compound as a phosphate binder might be a way to decrease aluminium exposition in hemodialysis patients.
TL;DR: Present long-term results show that 5 years after the acute episode, chronic renal failure may be expected to occur in about 50% of cases with acute renal failure due to glomerular and vascular injuries.
Abstract: A long-term clinicomorphological study in 227 patients with acute renal failure due to intrinsic renal damage shows the clinical value of renal biopsy for assessing treatment and predicting prognosis.
TL;DR: The findings suggest that the infusion of 2 liters of dialysis fluid into the peritoneal cavity induces not only a restrictive effect, but also an increase in the strength of the respiratory muscles, the latter effect being probably due to increased diaphragmatic contractility.
Abstract: The increasingly frequent use of continuous ambulatory peritoneal dialysis (CAPD) as substitutive therapy in terminal renal failure has induced the investigation of the advantages and disadvantages of
TL;DR: Although acute interstitial nephritis associated with the use of nonsteroidal anti-inflammatory drugs has long been recognized, only recently has its association with ‘minimal change’ nephrotic syndro been recognized.
Abstract: Although acute interstitial nephritis associated with the use of nonsteroidal anti-inflammatory drugs has long been recognized, only recently has its association with ‘minimal change’ nephrotic syndro
TL;DR: It is demonstrated that the sodium retention of nephrotic syndrome is not due to stimulation of the renin-angiotensin-aldosterone system, but must be due to some other mechanism, which is probably intrarenal.
Abstract: The mechanism of sodium retention in the nephrotic syndrome remains controversial, though the classic pathophysiological explanation is stimulation of the renin-angiotensin-aldosterone system. Recent
TL;DR: Assessment of sympathetic nerve function and acute and chronic administrations of clonidine suggest that abnormalities in the function of the sympathetic nervous system are already evident in patients with mild to moderate renal failure and suggest that the sympathetic nerve system may participate in the maintenance of the hypertension in these patients.
Abstract: Plasma catecholamines, hand-grip exercise and orthostatic stress were used to assess sympathetic nerve function in 14 hypertensive patients with mild to moderate renal failure and, for comparison, in
TL;DR: It thus appears that the presence of a functioning renal allograft somehow retards the evolution of cystic changes in the diseased native kidneys.
Abstract: End-stage kidneys are known to undergo cystic transformation in patients treated with long-term hemodialysis. Little has been published, however, on the occurrence of acquired renal cystic disease (ACD) in renal transplant recipients. The available clinical and histopathological data were gathered on 22 renal transplant recipients who had undergone either necropsy or nephrectomy. None of our patients exhibited cystic changes in their donor kidneys. However, 11 patients (50%) had ACD of the native kidneys while the remaining patients lacked ACD. The duration of dialysis prior to transplantation was significantly longer and the life of the functional transplant kidney was significantly shorter in the ACD group as compared to the noncystic group. The combined duration of ESRD (dialysis + transplantation), however, was comparable in the two groups. It thus appears that the presence of a functioning renal allograft somehow retards the evolution of cystic changes in the diseased native kidneys. 1 of the patients in the ACD group exhibited superimposed multifocal clear cell carcinoma of the affected kidney, while none of the patients in the noncystic group exhibited renal neoplasm.
TL;DR: The results of this study confirm earlier reports on extrarenal synthesis of 24,25-dihydroxyvitamin D and suggest that there may beextrarenal production of 1, 25-dhydroxy vitamin D as well.
Abstract: Circulating concentrations of 1,25-dihydroxyvitamin D, 24,25-dihydroxyvitamin D and 25-hydroxyvitamin D were measured in 21 anephric subjects. 13 subjects had no therapy with vitamin D, dihydrotachyst
TL;DR: The results indicate the need for increased replacement doses of vitamin D metabolites in CAPD patients, with losses of both metabolites in peritoneal fluid averaging approximately 6-8% of the plasma pool per day.
Abstract: We measured peritoneal losses of the active vitamin D metabolites 1,25(OH)2D3 and 24,25(OH)2D3 in patients receiving continuous ambulatory peritoneal dialysis (CAPD). The serum concentration of 24,25(OH)2D3 was considerably lower than in hemodialysis patients. The serum concentration of 1,25(OH)2D3 was undetectable and rose to levels similar to those in hemodialysis patients only after loading with much higher oral doses of 1-α-vitamin D3 than those received by hemodialysis patients. Losses of both metabolites in peritoneal fluid were considerable, averaging approximately 6–8% of the plasma pool per day. These losses lead to low serum levels of these active vitamin D metabolites in CAPD patients, which may be an important factor in exacerbating renal osteodystrophy. Our results indicate the need for increased replacement doses of vitamin D metabolites in CAPD patients.
TL;DR: The contention that IgA immune complexes, especially those composed of polymeric IgA, may have a role in the pathogenesis of IgA nephropathy is supported, as the high serum levels of polymer IgA observed in these patients could contribute to the slow clearance and long persistence in the circulation of IgC immune complexes with their subsequent deposition at the glomerular mesangium.
Abstract: The presence of circulating immune complexes in 54 patients with IgA nephropathy has been studied by two different techniques. 64% of the patients had IgG immune complexes and 37% had IgA immune compl
TL;DR: It is shown that treatment of the hematologic disorder can be followed by a dramatic improvement of renal function, and b-cell dyscrasia should be considered a possible etiology in a patient with crescentic glomerulonephritis.
Abstract: In 3 patients rapidly progressive glomerulonephritis revealed plasma cell dyscrasia in 2 cases and Waldenstrom's macroglobulinemia in the 3rd. Renal biopsy showed proliferative glomerulonephritis with marked endo- and extracapillary (crescentic) proliferation. In case 1, corticosteroids and cyclophosphamide favorably influenced the course of the disease. The 2nd patient was not treated and went on to maintenance hemodialysis. In the 3rd case, plasma exchange and cytotoxic drugs allowed discontinuation of hemodialysis. Thirteen other cases of proliferative glomerulonephritis associated with monoclonal gammapathies have been described in the literature, including 3 with crescents. B-cell dyscrasia should be considered a possible etiology in a patient with crescentic glomerulonephritis. In such case we show that treatment of the hematologic disorder can be followed by a dramatic improvement of renal function.
TL;DR: Chronic HD per se did not enhance the risk of malignant arrhythmias in patients with end-stage kidney disease, and the HR demonstrated a typical, well-known circadian pattern with remarkable increase of the HR during each HD.
Abstract: Patients with end-stage kidney disease untergoing chronic maintenance dialysis (HD) are a high risk group for sudden death due to cardiovascular complications. It was the aim of the study to investiga