摘要:

Hematologic and coagulation studies were carried out during 12 heparin-free hemodialyses in 9 maintenance hemodialysis patients. Treatment employed a C-DAK 4000 cellulose acetate membrane hemodialyzer. Both hemodialyzer and blood tubing were periodically flushed with physiologic saline. No significant clotting of the hemodialyzers was encountered in uneventful dialyses. Platelet counts, platelet aggregation with ADP and epinephrine, antithrombin III and fibrinogen/fibrin degradation products were not significantly changed compared with pre-dialysis values. Fibrinopeptide A levels, elevated pre-treatment, demonstrated additional rise during dialysis. These findings support clinical experience that this anticoagulation-free method can be used safely and effectively to dialyze patients at risk for bleeding.

ISSN:1660-8151    

DOI:10.1159/000182924

出版商:S. Karger AG    

年代:1983

数据来源: Karger

摘要:

This paper describes our initial clinical findings in a small group of patients with acute oliguric renal failure, who were resistant to extracellular volume expansion and furosemide in large doses. Based on our experience in an experimental model of acute renal failure in the dog, we administered a combination of low-dose dopamine (1–3 µg/ kg/min i.v.) and furosemide (100–200 mg every 6–8 h). This combination was uniformly effective in inducing a brisk, lasting diuresis and was associated with either stable or reduced serum creatinine levels in two-thirds of the patients. No toxicity was found. These findings would warrant extensive study of this drug combination in a larger, well-controlled, randomized group with oliguric renal f

ISSN:1660-8151    

DOI:10.1159/000182925

出版商:S. Karger AG    

年代:1983

数据来源: Karger

摘要:

43 diabetic patients on hemodialysis (n = 26) and peritoneal dialysis (n = 17) underwent nutritional assessment by weight, midarm muscle circumference (MAMC), serum albumin, transferrin, prealbumin (PA) and retinol-binding protein (RBP). Serum ferritin was measured as an index of iron stores. The mean age was 48.5 years (range 26–76 years); mean length of diabetes was 22.8 years (range 9–50 years), and mean length of dialysis was 11.6 months (range 1–48 months). At the onset of dialysis 8 subjects (19%) were below 85% ideal weight and the mean serum albumin was 3.2 ± 0.4 g/dl. By the time of nutritional assessment 11 subjects (26%) were below 85% ideal weight, 19 subjects (44%) had a MAMC less than the 5th percentile, the mean serum albumin was 3.6 ± 0.5 g/dl, the mean serum transferrin was 124 ± 36 mg/dl, the mean PA was 330 ± 100 µg/ml and the mean RBP was 142 ± 25 µg/ml. There was a significant increase in serum albumin from 3.2 ± 0.4 to 3.6 ± 0.5 g/dl (p < 0.001) during the time of dialysis. Transferrin was low in 88% of the subjects and was negatively correlated with serum ferritin, but not with change in weight or serum albumin. RBP was elevated and PA was normal or elevated in all subjects regardless of nutritional status. By conventional nutritional assessment there is widespread malnutrition in diabetic patients on dialysis with 26% below 85% ideal weight, 41% with a serum albumin less than 3.5 g/dl and 42% with a MAMC less than the 5th percentile. The usual sensitive indicators of visceral protein status, serum transferrin, PA, and RBP, are not useful in dia

ISSN:1660-8151    

DOI:10.1159/000182926

出版商:S. Karger AG    

年代:1983

数据来源: Karger

摘要:

Permanent loss of the ultrafiltration (UF) capacity of the peritoneum has been observed with an increasing frequency among our patients treated by long-term intermittent (IPD) and/or continuous ambulatory peritoneal dialysis (CAPD).The analysis of various characteristics of our PD population (patients age, dialysis techniques, peritoneal infection rate and treatment duration) indicates that the incidence of this complication increases exponentially with the duration of PD, the loss of UF capacity being observed after a shorter period in CAPD than in IPD. These observations suggest that long-term irrigation of the peritoneal cavity leads to a progressive deterioration of the peritoneum resulting in its altered permeability with loss of the ability to ultrafiltrate; the cause of this abnormality is as yet unknown.

ISSN:1660-8151    

DOI:10.1159/000182927

出版商:S. Karger AG    

年代:1983

数据来源: Karger

摘要:

To evaluate early pathological changes in autosomal dominant polycystic kidney disease (PKD), percutaneous renal biopsy specimens from 14 subjects at risk for PKD were analyzed. The subjects represented 5 unrelated families, ranged in age from 11 to 26 years and had normal excretory urograms. One additional renal tissue specimen was obtained at the time of nephrectomy from a patient with PKD and end-stage renal failure. In renal biopsy specimens from 5 subjects, light microscopy findings of dilated distal and collecting tubules suggested early manifestation of PKD. In 3 of these 5 subjects, PKD was documented 3 years later by repeated excretory urography. Polypoid and papillary hyperplasia of tubular epithelium was not seen in biopsy specimens but was present in the nephrectomy specimen. Electron microscopy revealed splitting of the lamina densa of the glomerular capillary basement membrane in the nephrectomy specimen and in two biopsy specimens with light microscopic changes of tubular dilatation, from subjects with PKD documented 3 years later. In three biopsy specimens without light microscopic changes of tubular dilatation from subjects without PKD documented 3 years later and in the nephrectomy specimen, multilayering of the tubular basement membrane was seen on electron microscopy. These data indicate that structural abnormalities of the basement membranes may be the primary cause in cyst formation in autosomal dominant PKD. Evidence of tubular obstruction was not present.

ISSN:1660-8151    

DOI:10.1159/000182928

出版商:S. Karger AG    

年代:1983

数据来源: Karger

摘要:

From this study of 163 males and 57 females on maintenance dialysis, evidence is presented that lipid levels, except for cholesterol in females, remain stable for the first 5 years. Thus, baseline lipid classifications are valid through this time period.

ISSN:1660-8151    

DOI:10.1159/000182929

出版商:S. Karger AG    

年代:1983

数据来源: Karger

摘要:

Withdrawal of azathioprine in renal transplant recipients with chronic active hepatitis and persisting HBs antigenemia was recommended for its beneficial effect on the course of liver disease. We report here three cases in which azathioprine treatment was stopped for this reason. One of these patients lost his graft due to irreversible vascular rejection 6 years after successful transplantation. Decrease of graft function paralleled azathioprine withdrawal in a second patient. Data from other reports indicate that cessation of azathioprine treatment may be followed by decreased graft function or even graft loss. We conclude that the risk of altered graft function is substantial and this is too high a price to pay for a procedure that may not prevent chronic active hepatitis from progressing to cirrhosis.

ISSN:1660-8151    

DOI:10.1159/000182930

出版商:S. Karger AG    

年代:1983

数据来源: Karger

摘要:

As indicated by changes in microsphere distribution in the rat, acute bilateral carotid artery occlusion (CAO) was found to cause a small but significant increase in outer cortical flow fraction. When renal perfusion pressure was kept constant, no redistribution occurred upon CAO. In denervated kidneys the redistribution induced by CAO did not differ from that observed in contralateral control kidneys. Animals pretreated with prostaglandin inhibitors showed a significant redistribution in the ‘unprotected’ right kidney and a minor increase in outer cortical flow fraction in the normotensive kidney. It is concluded that: (1) the increase in outer cortical flow fraction induced by CAO in the rat is due to an increase in perfusion pressure, and (2) that this redistribution is independent of sympathetic vasoconstrictor stimuli, catecholamines and prostagland

ISSN:1660-8151    

DOI:10.1159/000182931

出版商:S. Karger AG    

年代:1983

数据来源: Karger

ISSN:1660-8151    

DOI:10.1159/000182932

出版商:S. Karger AG    

年代:1983

数据来源: Karger

ISSN:1660-8151    

DOI:10.1159/000182933

出版商:S. Karger AG    

年代:1983

数据来源: Karger