摘要:

ABSTRACT.Five adult patients with chronic renal failure and associated renal osteodystrophy have been treated for 6 months with 1‐alpha‐hydroxycholecalciferol (1α‐OH‐D3), a synthetic vitamin D analogue. All 5 patients had severe metabolic bone changes as estimated by bone scintigraphy. Three patients were hypocalcemic, 4 had elevated serum alkaline phosphatases, 5 had elevated serum immuno‐reactive parathyroid hormone (i‐PTH) concentration and 3 had bone pains. During treatment serum calcium increased in all patients (mean 11.4%) and 3 originally hypocalcemic patients became normo‐calcemic. Serum alkaline phosphatases decreased (mean 27.3%) and became normal in 4 patients, who initially had elevated values. A pronounced decline in the serum concentration of i‐PTH (mean 53%) was seen in all patients and 1 patient obtained normal i‐PTH levels after 4 months of treatment. The intestinal calcium absorption, which was low initially, even when calcium intake was considered, rose almost threefold (mean 273%) and reached normal values in all cases. The bone mineral content increased in all patients, but the changes were small (mean 4.9%) and insignificant. Finally, bone pain disappeared in 2 patients and improved in 1 of the 3 patients exhibiting this symptom. A linear correlation (r=0.48, p<0.001) was found between the dose of 1α‐OH‐D3and serum calcium. But in spite of this and the frequent control, all patients developed one episode of hypercalcemia. This disappeared within 48 hours after discontinuing the drug. It is concluded that treatment with 1α‐OH‐D3appears to be of therapeutic value in metabolic bone disease associated with chronic renal failure, but frequent control of blood

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1976.tb08186.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

ABSTRACT.The relation between the renal handling of phosphate, expressed as the maximal tubular reabsorption of phosphate (TmP)/glomerular filtration rate (GFR) index, and the serum concentration of immunoreactive parathyroid hormone (i‐PTH) has been investigated in 15 patients with a very wide range of GFR, TmP/GFR and i‐PTH. Seven patients had well functioning kidney allografts, with GFR ranging from 43.1 to 64.9 ml/min, while eight had varying degrees of chronic nephropathy, with GFR ranging from 26.7 to 2.3 ml/min. The TmP, the i‐PTH concentration, the51Cr EDTA clearance, the extracellular volume and the serum concentrations of calcium and standard bicarbonate were estimated during conditions where tubular reabsorption of phosphate was maximal. An inverse significant correlation was demonstrated between TmP/GFR and i‐PTH (p<0.001), while none of the other investigated factors correlated to the TmP/GFR index. It is therefore concluded that the parathyroid hormone has a key role in the regulation of the tubular handling of phosphate in patients with impaired renal f

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1976.tb08187.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

ABSTRACT.Prospective studies on kidney function have been carried out 1–14 months after transplantation in two groups of recipients of renal transplants. Both groups were characterized by immediate graft function. The first group had transplants from living donors, the second had received cadaveric kidneys. In the first group a functional maximum (as measured by125iothalamate, creatinine and131I‐hippuran clearances) was reached during the first three weeks after transplantation, approximating 70% of the donors' bilateral preoperative function. In the second group kidney function was constant during the period of study, the values being almost identical with those observed in the first group. At investigation 12–14 months after transplantation, the two groups were compared with the remaining cadaveric transplants carried out during the period of study, the latter being primarily graft anuric. Graft function in the primarily anuric grafts was found to be poorer than in those with initial function. Graft survival, too, was poorer at one year in the group characterized by primary graft anuria than in the other groups. Graft survival at one year was 68% in cadaveric kidney transplants with good initial fun

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1976.tb08188.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

ABSTRACT.Sixty‐four kidney donors have been interviewed by a psychiatrist and given the Rorschach test 6 months‐6 years after the transplantation. Twenty‐three of these donors were also interviewed before the operation. In addition, each case was studied in detail at a case conference. On the basis of the data thus obtained, an analysis was made of the central dynamics of the donors' personalities, of how they had experienced the donation, and of how they had adapted to it. No psychic trauma was observed in 20 of the subjects, and in 5 of these the operation had apparently had a beneficial effect on their psychic well‐being. That no trauma was observed in 8 additional donors was due largely to the effects of a multitude of other traumatic life experiences. Mild trauma had been experienced by 24 donors and moderate to severe by 12. In our study, the donation of a kidney to a sibling turned out to be more traumatic than the donation to a child, and a transplantation with an unsuccessful outcome was more often associated with psychic trauma to the donor than was a donation with a successful outcome. Psycho‐social factors that substantially lessened the likelihood of trauma were: good inner resources, flexible defence mechanisms, good mental health and mild compulsive traits. Factors that favoured traumatization were: poor living conditions, interpersonal problems, limited inner resources, low self‐esteem (narcissistic problems) and severe psychic deviancy. The results clearly show 1) that potential donors ought to be given adequate time not only to consider their decision but also to prepare themselves for the actual donation, and 2) that supportive help should be offered, both before and after transplantation, to donors whose psycho‐social profiles reveal them to be vulnerable to t

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1976.tb08189.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

ABSTRACT.The occurrence of late renal and extrarenal complications of primarily successful kidney transplantations is surveyed. All cases in which some surgical or clinical complication, a rejection or complication of the treatment of rejection had occurred were omitted. Primarily, 46 out of 177 transplantations (26%) were completely successful. After six months, the continued course was entirely uneventful in 21 of these cases, while in 25 some kind of complication occurred 6–72 months after the primarily successful course, 19 renal in 17 patients and 23 extrarenal in 16. The complications could not be correlated to histocompatibility, sex, age or basic disease. It may be concluded that a favourable course during the first six months gives good hope of an uneventful continuation, although even serious complications may occur occasionall

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1976.tb08190.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

ABSTRACT.Gastrointestinal iron absorption has been measured by means of whole body counting in 13 patients after renal allotransplantation. Whole body retention 14 days after oral administration of 10 μCi59Fe together with a carrier dose of 9.9 mg Fe2+was used as an expression of absorption. The percentage incorporation in the total erythrocyte mass of administered59Fe (erythrocyte incorporation) and absorbed59Fe (red cell utilization) was estimated as well. Geometric mean iron absorption was 12.4+2.5 (S.D.) % and geometric mean erythrocyte incorporation 11.1 +3.0 (S.D.) % while arithmetic mean red cell utilization was 95.6+8.6 (S.E.M.) %. None of these parameters differed significantly from those obtained in normal subjects (p>0.2,p>0.1,p>0.3, respectively). Iron absorption and erythrocyte incorporation in renal transplanted patients did not differ significantly from the values measured in non‐dialysed and dialysed patients with chronic renal failure (p>0.1). The correlation between iron absorption and erythrocyte incorporation was highly significant (r=0.96,p<0.00

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1976.tb08191.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

ABSTRACT.Fifty patients with renal glomerular diseases entered a double‐blind cross‐over study on the effect of cyclophosphamide; 38 had received neither corticosteroids nor cytostatic drugs before joining the study. Cyclophosphamide was given for 4 months in doses decreasing from 3 to 1.5 mg/kg b.wt. Cyclophosphamide caused a 46% decrease in the 24‐hour excretion of urinary protein and a decrease in serum creatinine within the normal range. Albumin, transferrin and IgA in urine, as well as albumin clearance and the sieving coefficient of albumin, changed parallel to the total urinary protein. The initial values of proteinuria and serum complement were of prognostic significance for the effect of cyclophosphamide on serum creatinine. We were unable to demonstrate a prognostic significance for the variables: clinical diagnosis, renal histology, arterial BP, initial values of serum creatinine and IgG, IgA and IgM in serum and urine. ESR appeared to be the most reliable acute phase reactant. No differences were found between the changes in renal histology during cyclophosphamide or pl

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1976.tb08192.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

ABSTRACT.Total body potassium has been estimated in 26 hypertensive patients who were hypokalaemic as a result of long‐term chlorthalidone treatment (mean 20.5 months), while they were on chlorthalidone and 4 weeks after this had been discontinued. The mean difference amounted to only 95 mEq (not significant). In 6 additional patients not previously treated with chlorthalidone, serial total body potassium estimations revealed a mean potassium deficiency of 245 mEq after 33 days and of 106 mEq after 100 days. These results suggest that the mechanism causing the initial potassium loss is partly reversed or compensated later on. In patients with uncomplicated hypertension, no significant potassium deficiency was detected during long‐term treatment. Eighteen of our patients received 39 mEq potassium chloride supplements daily for 4 weeks; this caused a mean rise in serum potassium from 3.23 mEq/1 to 3.38 mEq/1 (not significant). Total body potassium did not change at all. We conclude that potassium chloride supplements are not an effective treatment of hypokalemia in this condition. Correction of the extracellular pH by ammonium chloride in 6 patients on chlorthalidone, who demonstrated a slight metabolic alkalosis, gave rise to a mean increase in plasma potassium from 2.78 mEq/1 to 2.96 mEq/1 (not significant). The hypokalaemia in hypertensive patients on long‐term chlorthalidone treatment cannot be explained by either a potassium deficiency or the change in extracellul

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1976.tb08193.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

ABSTRACT.Two groups of railway workers (n=16 andn=17) have been followed on their place of work during a period of shifts between day and night work. Catecholamine excretion in the urine and blood levels of lipids, glucose, uric acid, potassium and calcium were followed during the different phases of shift work. Dramatic fluctuations were noted in the diurnal pattern of catecholamine excretionduringandafternight work. Significant elevations in the serum levels of cholesterol, glucose, uric acid and potassium were observed during the first week after a night shift, and these changes could not be explained on the basis of shifts in the diurnal pattern or changes in dietary or other habits.

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1976.tb08194.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY

摘要:

ABSTRACT.As part of a double‐blind randomized study, the safety and the lipid‐ and uric acid‐lowering effect of clofibrate have been evaluated in 28 patients with type II hyperlipoproteinemia (HLP). A highly significant reduction of serum cholesterol occurred in type II a and of serum triglyceride and cholesterol in type IIb HLP throughout the 60‐week observation period (p<0.01). Of the patients with types IIa and lib HLP, 65% had at least a 25% reduction of serum cholesterol. Uric acid was significantly reduced only during the first period of treatment (p<0.05). In the laboratory measurements concerning safety, a persistent, slight reduction was observed in Hb, hematocrit and alkaline phosphatase. No significant clinical side‐effects were noted. Clofibrate is considered effective as a lipid‐lowering agent in many cases of

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1976.tb08195.x

出版商:Blackwell Publishing Ltd    

年代:1976

数据来源: WILEY