摘要:

Although prostacyclin has been reported to be an effective extracorporeal anticoagulant for intermittent haemofíltration and dialysis treatments, it has been suggested that it is inferior to heparin in preventing clotting in spontaneously driven continuous haemofíltration and/or dialysis circuits. We studied the effectiveness of both heparin and prostacyclin as anticoagulants in a variety of extracorporeal circuits in 17 patients with combined acute hepatic and renal failure who were at risk of haemorrhage. Although there were no differences in the pump-assisted extracorporeal circuits, prostacyclin was found superior to heparin during spontaneously driven continuous arteriovenous haemofíltration and/or dialysis. During some 2,600 h of prostacyclin therapy, there were only 3 episodes of haemorrhage that required blood transfusion compared to 8 major haemorrhages and 2 deaths from intracerebral haemorrhage during 600 h of anticoagulation with heparin. The median filter life was greater with prostacyclin, 60 h (42-72), compared to heparin, 8 h (4-16), p < 0.01. This study suggests that prostacyclin is superior to heparin in maintaining the integrity of a spontaneous arteriovenous extracorporeal circuit in patients at risk of major haemorrha

ISSN:1660-8151    

DOI:10.1159/000187859

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Twenty-three nondiabetic end-stage renal failure patients on hemodialysis were studied for adequacy of dialysis and nutritional status. Midweek predialysis blood urea nitrogen was 27.1 ± 6.4 mmol/l of urea, KT/V, according to urea kinetic modelling, was 1.21 ± 0.22 and mean normalized protein catabolic rate (nPCR) was 1.15 ± 0.23 g/kg/day. Only 1 patient had a KT/V less than 1 and 4 patients had an nPCR less than 1 g/kg/day. No correlation was found between the different nutritional parameters. All patients had normal serum albumin. However, some of the patients could be classified as severely malnourished when parameters such as body weight (2 patients), triceps skinfold (5) and total lymphocyte count (3) were taken into account. No correlation was found between adequacy of dialysis and the different nutritional parameters. Furthermore, when patients were divided into low and normal KT/V, no differences were found in their nPCR. We conclude that a global assessment of the nutritional status is required in hemodialysis patients, and at least in patients with an acceptable KT/V, nPCR is not dependent on the adequacy of dialys

ISSN:1660-8151    

DOI:10.1159/000187860

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Changes in parathyroid hormone (PTH) during hemodialysis have been explained by the influence of ionized calcium changes on PTH secretion. In this study we have investigated the influence of dialysis membranes of different permeability on PTH changes during hemodialysis. Five chronic renal failure patients underwent three consecutive hemodialysis sessions with cuprophane (CUP) polysulfone (PS) and polyacrylonitrile (PAN). Two hours of isolated ultrafiltration were followed by 3 h dialysis. A significant decrease in carboxy terminal PTH (COOH PTH) was observed with PAN (p < 0.05) but not with CUP or PS. Intact PTH decreased (p < 0.001) with all three membranes, following a significant increase in ionized calcium (p < 0.001). Sieving coefficients for COOH PTH were significantly lower with CUP than with PS (p < 0.05) or PAN (p < 0.001). Intact PTH sieving coefficients were near zero for all three membranes. COOH PTH and intact PTH clearance rates were significantly higher with PAN (p < 0.001) than with PS or CUP, either in isolated ultrafiltration or with dialysis fluid. Thus PTH changes during hemodialysis do not only depend on the increase in calcium but also on the nature of the dialysis membrane. Adsorption of PTH to the PAN membrane surface explain the high PTH clearance rates achieved with this filter.

ISSN:1660-8151    

DOI:10.1159/000187861

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

We examined the types of guanine nucleotide-binding regulatory (G) protein subunits in isolated glomeruli, cortices excluding glomeruli and medullas of rat kidneys using bacterial toxin-catalyzed adenosine 5’-diphosphate (ADP) ribosylation and specific immunoblots. ADP ribosylation catalyzed by cholera or pertussis toxin revealed the presence of stimulatory G (Gs) or inhibitory G (Gi) proteins in membranes of the 3 segments of the kidney. Immunoblots further demonstrated the existence of several G-protein subunits, two Gs-protein α-subunits (Gαs: 45 and 52 kD), Gi-protein α1, α2 and α3-sub units (Gαi1, Gαi2:40–41 kD, Gαi3: 40 kD), bacterial toxin-insensitive G-protein αq- and α11-subunits (Gαq/11: 42 kD) and G-protein β-subunits (Gβ: 35-36 kD), in membranes of the preparations. The predominant subspecies of Gαs was a 52-kD protein in glomerular membranes and a 45-kD protein in membranes of cortices and medullas. All of the G-protein subunits examined, however, were not detected in cytosolic fractions of glomeruli, cortices and medulas. Thus, we conclude that detectable quantities of several G-protein subunits including the new G-protein subunit, Gαq/11, are present in membranes of glomeruli, cortices not containing glomeruli and medullas from the rat kidney. Both the existence of Gαil and/or Gαi2 subunits in glomeruli and the presence of Gαq/11 subunits in the 3 preparations are new evidence. Moreover, the current study indicates the existence of the predominant subspecies of Gαs subunits in the 3 distinct segm

ISSN:1660-8151    

DOI:10.1159/000187862

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A controversy presently exists concerning the ability of albumin to inhibit the tubular reabsorption of low-molecular-weight (Mr) proteins in experimental renal diseases leading to massive proteinuria. We have examined the urinary excretion of albumin and of 2 low-Mr proteins, β2-microglobulin and cystatin C, in rats treated with toxins affecting primarily the glomerulus (puromycin aminonucleoside and Adriamycin) or the tubule (mercuric chloride and maleic acid). Above a threshold of 100 mg/24 h, albuminuria induced by puromycin aminonucleoside (50 mg/kg) and Adriamycin (5 mg/kg) was associated with a marked increase in the urinary excretion of β2-microglobulin and cystatin C peaking at more than 100-fold the baseline levels. These glomerulotoxins did not affect the urinary excretion of the tubular enzyme N-acetyl-β-D-glucosaminidase. This pattern of effects was completely different from that induced by mercuric chloride (2 mg/kg) and maleic acid (400 mg/kg) which increased the excretion of both N-acetyl-β-D-glucosaminidase and low-Mr proteins in rats with albuminuria values below 100 mg/24 h. These results strongly support the hypothesis that at high filtered loads, albumin decreases the tubular uptake of low-Mr proteins most likely by competition for a common transport mechan

ISSN:1660-8151    

DOI:10.1159/000187863

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A 56-year-old woman developed nephrotic syndrome in association with pulmonary sarcoidosis. Renal biopsy revealed both granulomatous interstitial nephritis and membranous nephropathy. Treatment with steroids resulted in a decrease in proteinuria and there was no deterioration in renal function over a subsequent period of 10 months. This case provides further evidence that secondary membranous nephropathy associated with sarcoidosis should be treated with steroids.

ISSN:1660-8151    

DOI:10.1159/000187864

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A 35-year-old male patient clinically characterized by massive proteinuria and hypertension without evidence of systemic diseases is reported. Histological investigation of renal biopsy specimens revealed extensive nodular formations in the mesangial areas in every glomerulus. Light-microscopic examination did not allow discrimination between the glomerular changes found in these specimens and the nodular glomerulosclerosis described in patients with diabetes mellitus. Electron-microscopic examination confirmed the presence of massive, nodular, mesangial expansions consisting of finely fibrillar substances without electron-dense deposits and circumferential mesangial interposition. Immunofluorescent examination showed the deposition of IgG, C3, fíbrinogen and kappa and lambda light chains in mesangial areas, peripheral capillary loops and a part of the nodules. Furthermore, collagen types IV, V, VI and laminin were detected in the nodules. Amyloid was not observed in these nodules. This diagnosis has not been made, and the mechanism of this nodular glomerulosclerosis remains unknown

ISSN:1660-8151    

DOI:10.1159/000187865

出版商:S. Karger AG    

年代:1994

数据来源: Karger

ISSN:1660-8151    

DOI:10.1159/000187866

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Hepatitis C virus (HCV) infection is highly prevalent in the chronic renal failure population treated in dialysis units. Transmission of HCV via blood transfusions is becoming an increasing problem, but, nevertheless, the routes by which this transmission occurs are incompletely known. We have searched for the presence of HCV RNA by the polymerase chain reaction (PCR) in serum and dialysis ultrafiltrate in 12 hemodialysis and 5 continuous ambulatory peritoneal dialysis (CAPD) patients, all of whom were HCV-antibody-positive. Serum PCR were positive for HCV RNA in all the cases, whereas PCR performed on samples of hemodialysis ultrafiltrate or peritoneal effluent were always negative for HCV RNA. In addition, 13 patients tested positive for HCV antibodies and 19 out of 32 patients sharing the dialysis monitors with 17 PCR-positive individuals remained negative. From these findings, we conclude that the dialysis ultrafiltrate or peritoneal fluid seems to be an improbable source of HCV dissemination in the dialysis setting. Moreover, a significant group of patients remained HCV-anti-body-negative although they shared the same dialysis machine with positive patients. Therefore, the importance of other sources of HCV transmission, namely blood-contaminated material, should be emphasized.

ISSN:1660-8151    

DOI:10.1159/000187867

出版商:S. Karger AG    

年代:1994

数据来源: Karger

ISSN:1660-8151    

DOI:10.1159/000187868

出版商:S. Karger AG    

年代:1994

数据来源: Karger