Showing papers in "Nephron in 1990"

Superiority of the internal jugular over the subclavian access for temporary dialysis.

Abstract: We studied angiographically the access route 1–27 months after the insertion of temporary dialysis catheters in 52 patients: 32 subclavian and 20 internal jugular. The two groups were statistically si

Acute and Chronic Renal Failure in Liver Transplantation

Abstract: We have performed a retrospective review of the incidence and etiologies of acute renal failure (ARF) in 105 adult patients receiving liver transplants. The prevalence of chronic renal failure was als

The clinical course of left ventricular hypertrophy in dialysis patients.

Abstract: To determine the clinical and echocardiographic outcome of left ventricular hypertrophy a prospective study was undertaken of 104 nondiabetic dialysis patients without dilated cardiomyopathy, who were

The crush syndrome revisited (1940-1990).

Abstract: This article reviews the local and systemic effects of crush injury. Within minutes to hours after extrication of survivors trapped under fallen masonry (and immediately following decompression of lim

Acute Renal Failure of Leptospirosis: Nonoliguric and Hypokalemic Forms

Abstract: Acute renal failure induced by leptospirosis was studied in 56 patients. A higher frequency of nonoliguric renal failure was observed with lower morbidity and mortality rates than in oliguric forms. In addition, 45% of the patients in this series were hypokalemic, and no hyperkalemic patients were seen. A prospective study in 11 patients showed an initially elevated urinary fractional potassium excretion that fell simultaneously with the high urinary fractional sodium excretion and the urinary K/Na ratio, suggesting an increased distal potassium secretion due to an increased distal sodium delivery consequent to functional impairment of the proximal reabsorption of sodium.

Randomised prospective study on renal effects of two different contrast media in humans: protective role of a calcium channel blocker.

Abstract: Contrast media affect renal hemodynamics Hyperosmolality is regarded as the major factor responsible for renal hemodynamic changes In this study, the role of osmolality was evaluated in 30 hospitalized patients without risk factors during intravenous pyelography Contrast media with low and high osmolality were used In addition, nifedipine was administered before infusion of high-osmolality contrast to evaluate the role of calcium ions in radiocontrast-induced changes of renal hemodynamics Hyperosmolar contrast reduced renal plasma flow and glomerular filtration rate Calcium channel blocker prevented changes of renal hemodynamics Hyperosmolality appears the most likely factor affecting renal hemodynamics during hyperosmolar radiocontrast infusion Calcium channel blocker may prevent renal changes due to hyperosmolar medium

Efficient removal of albumin-bound furancarboxylic acid, an inhibitor of erythropoiesis, by continuous ambulatory peritoneal dialysis.

Abstract: 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid, which cannot be removed by conventional hemodialysis due to its strong albumin binding, was found to be efficiently removed by continuous ambulatory peritoneal dialysis (CAPD), resulting in a lower serum level in uremic patients on CAPD than in those on hemodialysis. 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid was demonstrated in vitro to inhibit erythroid colony formation. The anemia in patients on CAPD was significantly less severe than in those on hemodialysis. These results suggest that the efficient removal by CAPD of 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid, an inhibitor of erythropoiesis, is related to an improvement of anemia in patients on CAPD.

Intraperitoneal Secretion of Interleukin-6 during Continuous Ambulatory Peritoneal Dialysis.

Abstract: Interleukin-6 (IL-6) was determined in serum and peritoneal dialysis effluent (PDE) of patients on chronic ambulatory peritoneal dialysis (CAPD) by a biological assay measuring the proliferation of the IL-6-dependent 7TD1 cell line. Six patients free of peritonitis displayed low but significant levels of IL-6 (mean +/- 42 pg/ml) in PDE, while IL-6 was undetectable in serum. In 6 patients with staphylococcal peritonitis, a tremendous increase in PDE levels of IL-6 was noted (range: 5,832-37,491 pg/ml), while serum IL-6 remained either undetectable or on a low level except in one case. After 5 days of antibiotic treatment, IL-6 levels in PDE returned to basal values. We conclude that CAPD results in an intraperitoneal secretion of IL-6 which is markedly but transiently increased during peritonitis episodes.

Clinical and psychological correlates of somatic symptoms in patients on dialysis.

Abstract: Somatic symptoms are common in patients on dialysis. Their causes are largely unknown and their therapy is unsatisfactory. To examine the relationship of psychological and clinical factors to these sy

The therapeutic dilemma of the usage of corticosteroid in patients with membranous nephropathy and persistent hepatitis B virus surface antigenaemia.

Abstract: The therapeutic benefits and risks of short-term corticosteroid were investigated in 8 patients with membranous nephropathy and hepatitis B surface antigenaemia. Seven patients presented with nephrotic syndrome, and the remaining patient had significant proteinuria. Their liver function tests were normal on repeated examination. Their sera demonstrated the persistent presence of hepatitis B virus surface antigen and high titres of antibody to hepatitis B virus core antigen. Hepatitis B virus e antigens were present in the sera of 4 patients at initial presentation. Their clinical responses were compared with 7 similar patients previously treated with diuretic therapy alone and acting as historic controls. Short-term corticosteroid (6 months) with stepwise reduction resulted in an early regression of the nephrotic syndrome in 3 patients. Five patients had persistent but reduced proteinuria. Transient liver impairment was observed in 3 patients. Corticosteroid therapy induced transient viral replication with increased serum concentration of hepatitis B virus e antigen and hepatitis B virus DNA. Two of the 7 patients receiving diuretics developed spontaneous remission though apparently later than those receiving corticosteroid. Yet complications such as liver dysfunction and hypertension were not observed in the patients treated with diuretics. Our findings suggest that corticosteroid therapy could be harmful in membranous nephropathy related to hepatitis B surface antigenaemia, as activation of viral replication could occur with corticosteroid therapy.

Elevated serum levels of C-reactive protein in hemodialysis patients

Abstract: Serum C-reactive protein (CRP) levels were measured by nephelometry in 30 healthy subjects (controls) and in 99 patients with uncomplicated terminal uremia on conservative therapy (group 1, n = 30) or chronic hemodialysis (group 2, n = 69). Whereas there was no difference between controls and group 1, both the mean concentration of CRP and the incidence of elevated levels were significantly higher in group 2 in comparison with both controls and group 1. Moreover, the degree of increase in these patients was directly correlated with the duration of hemodialysis. The abnormality, therefore, is somehow related to chronic hemodialysis per se. From a practical standpoint, we concluded that this test cannot be recommended as an acute-phase reactant in this clinical setting.

Increased Intestinal Permeability to Differently Sized Polyethylene Glycols in Uremic Rats: Effects of Low- and High-Protein Diets

Abstract: Intestinal mucosa forms an important barrier towards harmful agents in the intestinal lumen, besides being the site for absorption of nutrients. Little is known about the intestinal permeability prope

Renal function in the elderly.

Abstract: Etude chez des vieillards des fonctions renales. Comparaison du volume urinaire, de l'excretion urinaire et de la clairance de la creatinine, ainsi que de la creatinine plasmatique (CP) avec les valeurs obtenues avec de jeunes insuffisants renaux. Etude des correlations entre les clairances de la creatine mesurees, calculees, la CP et la vitesse de filtration glomerulaire

Long-term prognosis of membranoproliferative glomerulonephritis type I. Significance of clinical and morphological parameters: an investigation of 220 cases.

Abstract: We carried out a retrospective investigation in 220 patients to assess the influence of various parameters on the long-term course of membranoproliferative glomerulonephritis (MPGN) type I. 50 patients (23%) died during the follow-up period of 59 months on average, in another 57 (26%) end-stage renal failure developed. 54 patients (24%) suffered from chronic renal failure, stable renal function (creatinine below 1.3 mg/dl) was preserved in 59 patients (27%). 5 years after biopsy 49% of the patients had already died or needed regular dialysis treatment; after 10 years this proportion increased to 64%. Morphological findings: The outcome was--with the exception of focal crescent formations--not determined by the severity of glomerular changes; the survival rate, however, decreased significantly, if tubulointerstitial lesions were present as defined by acute renal failure, interstitial fibrosis or a combination of both. Clinical parameters: A progressive deterioration of renal function and an increasing number of renal deaths was noticed, when elevated serum creatinine levels at the time of biopsy and high blood pressure values during the follow-up period were observed. 26 patients died from hypertension, 18 of whom before reaching end-stage renal failure. Nephrotic syndrome and the degree of proteinuria as well as antiphlogistic and immunosuppressive treatment did not influence the prognosis of MPGN type I.

Destructive Spondyloarthropathy in Dialysis Patients: An Overview

Abstract: Destructive spondyloarthropathy has been increasingly recognized in dialysis patients. We have reviewed 39 observations published in the literature and added 11 personal cases in order to define the clinical and radiological presentation of the disease. The many hypotheses that have been proposed for its pathogenesis are discussed, including secondary hyperparathyroidism, microcrystal deposition, β2-microglobulin-associated amyloidosis and aluminum intoxication.

Trace elements and complications in patients undergoing chronic hemodialysis

Abstract: Abnormalities of trace elements such as aluminum, silicon, zinc, manganese and nickel were found in chronic hemodialysis (HD) patients. The relationship between serum concentration of trace elements and complications such as anemia bone disease, neurological disorder and nutritional disorder in 100 chronic HD patients was examined. Serum Al and Si levels were very high in these patients, and were negatively correlated with indicators of anemia such as RBC, hemoglobin and hematocrit values. Serum Al and Si levels in the HD patients with peripheral neurological disorder (excluding encephalopathy) and with bone disease were significantly high. The levels of serum Zn, Mn and Ni were low, and were correlated with total serum protein levels. In summary, in order to prevent some complications in chronic HD patients, it is very important to regulate levels of trace elements.

Elimination of iohexol, a low osmolar nonionic contrast medium, by hemodialysis in patients with chronic renal failure.

Abstract: The dialyzability of iohexol was examined in patients with chronic renal failure on long-term hemodialysis treatment. Eight patients had iohexol (Omnipaque 240 or 350 mg I/ml) injected in doses between 98 and 1,493 mg I/kg body weight (BW) 25 h (mean time) before start of hemodialysis. Dialysance of iohexol was 81 +/- 15 ml/min (mean +/- SD) compared to 120 +/- 16.8 ml/min for creatinine. Elimination half-life for iohexol during hemodialysis was 3.9 +/- 1.1 h while plasma clearance was 64 +/- 17 ml/min. The distribution volume calculated (0.25 +/- 0.05 liters/kg BW) confirms previous observations with distribution in the extracellular fluid only. Before the start of hemodialysis 36 +/- 28% of the dose injected was eliminated, indicating some extrarenal elimination. After 4 h of hemodialysis 72 +/- 11% of the dose was removed.

Mechanism of Normochloremic and Hyperchloremic Acidosis in Diabetic Ketoacidosis

Abstract: The present communication seeks to resolve the mechanism of metabolic acidosis that persists after ketonemia has cleared; the reason for the approximate equality of excess anion gap and reduction in serum bicarbonate at the time of admission despite substantial prior urinary loss of ketone anions; the mechanism of transformation of normochloremic acidosis to hyperchloremic acidosis during the recovery phase of DKA

Morphometric evidence of the trophic effect of L-carnitine on human skeletal muscle

Abstract: We investigated the effect of long-term i.v. administration of L-carnitine on human muscle fibers using morphometric parameters. We administered 2g/day L-carnitine to patients undergoing hemodialysis for at least 12 months. At the end of this period a marked increase in serum and muscle carnitine levels was observed in all patients, together with hypertrophy and predominance of type 1 fibers. L-carnitine was withheld for 4 months, during which time serum and muscle levels gradually decreased and no changes were observed in muscle fibers. Subsequent addition of L-carnitine to dialysis fluid for another 4 months stabilized lower levels. At the end of this period reduction of diameter of type 1 fibers was observed. Type 2 fibers remained unchanged. Moreover, type 1 fibers remained predominant in all cases. Hence, we suggest that carnitine has a specific trophic effect on type 1 fibers which are characterized by an oxidative metabolism.

Prevalence of Chronic Renal Insufficiency in the Course of Idiopathic Recurrent Calcium Stone Disease: Risk Factors and Patterns of Progression

Abstract: The occurrence of chronic renal insufficiency was investigated in 171 patients with severe idiopathic calcium stone disease. Ninety healthy subjects matched for age and sex were used as controls. The patients were thereafter subclassified into two subgroups, assuming a GFR of 80 ml/min/1.73 m2 body surface area as a cut-off value: the normal GFR, 141 patients, and the impaired GFR, 30 patients. The normal GFR group included more males and the patients were younger both at onset and at presentation. In the impaired GFR group the disease lasted longer, but the overall stones and the stone recurrence rate were as high as those of the normal GFR patients. The single stone episodes were more severe in the former group as suggested by the occurrence of more surgery and complications. The GFR level was in part predicted by the age of patients; however, stone disease was shown to induce a clear-cut influence in accelerating the natural worsening of GFR with age. The onset of renal insufficiency causes multiple changes in renal pathophysiology, which result in a sharp decrease in the urine saturation with respect to calcium salts. These changes account for the decrease in the stone recurrence rate in the impaired GFR group. Thus, unless factors independent of or complicating the calcium stone disease supervene, the renal insufficiency of treated patients remains mild and relently progressive.

Germanium dioxide-induced nephropathy: a new type of renal disease.

Abstract: Chronic renal failure developed in 5 patients who were taking germanium dioxide (GeO2)-containing compounds. Renal functional deterioration was slow but progressive and dialysis treatment was necessitated temporarily in 2 patients. After the discontinuation of GeO2, the impaired renal function tended to improve but remained abnormal for an observation period of 10-40 months. The lack of proteinuria and hematuria was characterized as the clinical manifestations. Renal biopsy specimens revealed the tubular epithelial cell degeneration containing hematoxylin-positive fine granules on light microscopy, and electron-dense inclusions in the swollen mitochondria on electron microscopy. These findings localized mainly in distal segment of the tubules. In the rats given GeO2 orally for 10 weeks, similar histological lesions were evident, as manifested by marked weight loss, anemia, azotemia, and negative proteinuria. In the rats given carboxyethylgermanium sesquioxide, these changes were not observed and Ge concentration of kidney was significantly lower than in the rats given GeO2. The present study indicates that chronic GeO2 intake causes progressive renal dysfunction characterized by the degeneration of distal tubules.

Phenylacetylglutamine and hippuric acid in uremic and healthy subjects.

Abstract: Phenylacetyglutamine (PAG) and hippuric acid (HA) were determined in protein-free filtrates of plasma and urine from patients with chronic renal failure and healthy subjects, using reverse phase high performance liquid chromatography. Plasma accumulation of the metabolites was detected when the creatinine clearance was below 15 ml/min. Protein-binding studies showed that PAG was not bound to plasma proteins but that HA was partly bound. Concentrations of PAG and free HA in plasma did not correlate with values of serum urea or creatinine. Hemodialysis decreased the plasma concentration of PAG and free HA to about the same extent as that of urea and creatinine. The average renal clearances of PAG and HA were about 1.4 and 5 times higher, respectively, than the creatinine clearance. The daily excretion rates of PAG, HA, urea, and creatinine were similar in non-dialysis patients with a creatinine clearance higher than 15 ml/min and in healthy subjects, whereas patients with a creatinine clearance below 15 ml/min had lower excretion rates of urea, creatinine, and HA. However, the average excretion rate of PAG was in the same range in uremic and healthy subjects. The excretion rate of HA, but not of PAG, correlated with that of urea and creatinine.

Refinements of assays for low concentrations of inulin in serum.

Abstract: Dans le but de mesurer la vitesse de filtration glomerulaire en calculant la clairance a partir de la courbe de disparation de l'inuline (I) plasmatique apres une simple injection, deux methodes conventionnelles de dosage de l'I sont affinees pour augmenter leurs sensibilites. Etude de la correlation des resultats obtenus par ces deux methodes, l'une enzymatique (de determination du rapport glucose/fructose) et l'autre chimique (par determination avec l'anthrone du fructose apres hydrolyse acide de l'I.)

Use of angiotensin-converting enzyme inhibitors for the preservation of kidney function. A retrospective study.

Abstract: To investigate the effects of angiotensin-converting enzyme (ACE) inhibitors on renal outcome in patients with renal insufficiency, a 2-part study was conducted. Part A consisted of a retrospective 1-year analysis of 80 hypertensive outpatients with serum creatinine levels of 1.5-6 mg/dl, 39 of whom received ACE inhibitors and other antihypertensive agents and 41 of whom received only other antihypertensive agents. Median serum creatinine levels in the ACE group rose acutely from 2.33 to 2.7 mg/dl after 1 month of therapy and remained stable thereafter. Serum creatinine levels more than doubled in 2 patients. In controls, median serum creatinine levels rose gradually over 12 months from 2.39 to 3.45 mg/dl, and serum creatinine more than doubled in 9 patients. Part B consisted of a prospective follow-up of patients for a second year; 34 patients in the treatment group and 32 controls were then analyzed; median serum creatinine level was 3.0 vs. 4.4 mg/dl after 2 years; 2 of 34 vs. 6 of 32 patients were on dialysis; serum creatinine level had more than doubled in 4 of 34 vs. 8 of 32. These results suggest that ACE inhibitors are more effective than other antihypertensive agents in reducing the progression of renal failure.

Hepatitis B virus-associated membraneous nephropathy: clinical features, immunological profiles and outcome.

Abstract: To evaluate the clinical features, immunological profiles and the prognosis of hepatitis B virus-associated membraneous nephropathy (HBVMN), 34 patients (25 boys and 9 girls) were studied from April 1

Reduced Superoxide Dismutase Activity in Erythrocytes of Dialysis Patients: A Possible Factor in the Etiology of Uremic Anemia

Abstract: Superoxide dismutase (SOD) plays a major part in the destruction of oxygen-free radicals in the body. SOD activity is impaired by several trace elements including aluminium and silicon which are found in increased levels in plasma and tissues of uremic man. SOD activity was investigated in the erythrocytes of normal controls and of dialysis patients to determine if lack of SOD-protective activity could be a contributory cause to the increased hemolysis of uremia. It was found that SOD levels in red cell hemolysate were significantly lower in dialysis patients (41.4 +/- 9.1 units/100 ml) compared to control (49.3 +/- 7.2 units/100 ml) (U = 7.3; p less than 0.005). When expressed per 100 ml of whole blood SOD levels were 3.25 +/- 0.93 units/100 ml in dialysis patients and 6.46 +/- 0.99 units/100 ml in controls (U = 96; p less than 0.001). It is concluded that inhibition of SOD activity in the erythrocytes of dialysis patients may contribute to their anemia.

Macroglossia and Amyloidoma of the Buttock: Evidence of Systemic Involvement in Dialysis Amyloid

Abstract: A 48-year-old male on cuprophane haemodialysis for 18 years, with a history of dialysis arthropathy and recurrent carpal tunnel syndrome developed macroglossia and bilateral buttock tumoral masses. The tongue and buttock masses were biopsied. Histology of both biopsies showed amyloid deposits of the beta 2-microglobulin (B2M) variety. Amyloidomas in the gluteal region and macroglossia have not been previously described in amyloid derived from B2M. These findings suggest that systemic B2M amyloidosis can have a similar tissue distribution to AL amyloidosis. This case also stresses the importance of inspection of the tongue, and palpation of the gluteal region for masses, in the assessment of patients with dialysis arthropathy.

Toxic acute renal failure and hepatitis after ingestion of raw carp bile.

Abstract: The raw carp bile has both nephrotoxic and hepatotoxic effects which are not well known. Recently, we studied 13 patients who had toxic acute renal failure and toxic hepatitis after ingestion of raw bile of carp in 3, grass carp in 8 and silver carp in 2 cases. The purpose of this report is to alert physicians to this very rare cause of toxic acute renal failure and hepatitis. All patients presented initially with gastrointestinal upset after eating. These symptoms were followed by oliguria in 7 patients (54%), hematuria was noted in 10 (77%) and jaundice in 8 patients (62%). Elevation of blood urea nitrogen, creatinine and transaminases lasted for about 3 weeks. The severity of the symptoms depended on the amount of bile ingested. All the patients recovered with conservative therapy and hemodialysis. Biopsy of the kidney revealed findings compatible with acute tubular necrosis similar to that produced by other nephrotoxins. Biopsy of the liver revealed findings consistent with acute toxic hepatitis. Both suggest toxic effects of carp bile as a cause of toxic acute renal failure and hepatitis.

Circadian variations of urinary dopamine, norepinephrine, epinephrine and sodium in normotensive and hypertensive subjects.

Abstract: Under standardized conditions, we determined circadian urinary excretion of sodium (Na) and free dopamine (DA), norepinephrine (NE) and epinephrine (E) in 20 normotensive, 20 borderline hypertensive and 10 mild hypertensive middle-aged men. The 24-hour excretions of water, Na, DA, NE and E were comparable between the normotensives and the hypertensives. In the total study population, these parameters showed significant time-related changes: high excretion during the daytime and low excretion in the night. The circadian variations of urinary DA, NE and E were similar among the 3 groups. The circadian curve of urinary DA was similar to those of Na and water excretion. In the total study population, 24-hour water and Na excretion correlated positively with urinary DA, but not with NE or E. These results suggest that endogenous DA may play a role in the circadian variation of water and sodium metabolism. The circadian excretion of urinary catecholamines may not be altered in middle-aged subjects with borderline or mild hypertension.