摘要:

Peritoneal dialysis has been increasingly employed to treat patients with end-stage renal failure. Solute transport can be enhanced by increasing ultrafiltration with hypertonic dialysate, infusing intraperitoneal vasodilators to increase the effective surface area for exchange, and by employing new methods of dialysate delivery which may improve dialysate mixing and decrease the effective membrane resistance to solute flux. While infection remains a major complication of peritoneal dialysis, techniques to prevent and treat infections have been effectively employed. Progress has also been made in the treatment of diabetic patients with peritoneal dialysis. Continuous ambulatory peritoneal dialysis, a relatively new technique with fast growing clinical application, may be the therapy of choice for many patients with end-stage renal failure.

ISSN:1660-8151    

DOI:10.1159/000182056

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

The high blood flow rate/gram of kidney tissue supplies mainly the renal cortex. The net effect of the interaction of the renin-angiotensin system, the kallikrein-kinin system and prostaglandins is to autoregulate renal blood flow within a narrow range. Drugs and neurogenic factors also influence renal hemodynamics. The renal circulation responds to changes in extracellular fluid volume, and in cardiac output. Renal ischemia occurs readily as these parameters decrease and prompt correction of circulatory dynamics can restore renal blood flow and prevent tubular necrosis. With hypovolemia or heart failure, angiotensin II is a mediator of efferent arteriolar constriction promoting a proportionately greater fall in renal plasma flow than in glomerular filtration rate, thereby augmenting sodium reabsorption. With renal failure, glomerulotubular balance is affected conversely promoting sodium loss. Appreciating these distinctions allows recognition of inappropriate sodium retention or loss. With such data, prognosis can be estimated more accurately and attempts to restore circulatory dynamics can be guided.

ISSN:1660-8151    

DOI:10.1159/000182057

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

Multiple use of dialyzers has been studied in a single hospital and by survey of all Australian dialysis units. An annual saving of $84,000 was achieved in a 46-patient unit. No significant patient morbidity or mortality occurred. In Australia 43% of all haemodialysis patients are on a multiple use regime. The 1-year patient cummulative survival for units with a reuse policy is 92.8% and for those with a single use policy is 87.1%. Anti-N-like antibodies are being found in low but with increasing frequency as the reuse program continues.

ISSN:1660-8151    

DOI:10.1159/000182058

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

Continuous ambulatory peritoneal dialysis has been demonstrated to be a successful dialysis therapy for those patients who are emotionally, socially, and intellectually capable of safely performing the self-dialysis technique. Rapid expansion of the procedure, modification of the technique to reduce the incidence of peritonitis, development of experienced personnel and adequate funding by the government can serve to increase the home dialysis population, save tax dollars and free patients from the requirement of machine dialysis.

ISSN:1660-8151    

DOI:10.1159/000182059

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

Different facets of hepatitis B infections are encountered in a renal unit. The viral antigens are implicated in the pathogenesis of some cases of glomerulonephritis. Hepatitis B surface (HBS) antigenaemia frequently persists in dialysis patients who contract the virus and presents a significant health hazard to the attendant staff. Persistent HBs antigenaemia does not jeopardise renal allograft survival. The effect of antiHBs antibodies is not clear. Transplantation can reactivate latent hepatitis B infections and render patients HBS antigen (HBSAg)-positive. Hepatic malignancies have been observed and increased patient mortality reported in HBSAg-positive renal allograft recipients. The effect of immunosuppression and maternal viral infection on the fetus is open to speculation.

ISSN:1660-8151    

DOI:10.1159/000182060

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

It has been generally accepted that acidosis results in hyperkalemia because of shifts of potassium from the intracellular to the extracellular compartment. There is ample clinical and experimental evidence, however, to support the conclusion that uncomplicated organic acidemias do not produce hyperkalemia. In acidosis associated with mineral acids (respiratory acidosis, end-stage uremic acidosis, NH4CI- or CaCl2-induced acidosis), acidemia per se, results in predictable increases in serum potassium concentration. In acidosis associated with nonmineral organic acids (diabetic and alcoholic acidosis, lactic acidosis, methanol and the less common forms of organic acidemias secondary to methylmalonic and isovaleric acids, and ethylene glycol, paraldehyde and salicylate intoxications), serum potassium concentration usually remains within the normal range in uncomplicated cases. A number of factors, however, may be responsible for hyperkalemia in some of these patients other than the acidemia per se. These include dehydration and renal hypoperfusion, preexisting renal disease, hypercatabolism, diabetes mellitus, hypoaldosteronism, the status of potassium balance, and therapy. The mechanism(s) of this differing effect of mineral and organic acidemias on transmembrane movement of potassium remains undefined. The prevalent hypothesis, however, favors the free penetrance of the organic anion into cells without creating a gradient for the hydrogen ions and, thus, obviating the efflux of intracellular potassium. The importance of the presence of hyperkalemia in clinical states of organic acidemias is obvious. A search for the complicating factors reviewed above should be undertaken since organic acidemias per se, should not be expected to be accompanied by elevations of serum potassium concentration. Moreover, the classical teaching that the absence of hyperkalemia during severe acidosis is indicative of severe potassium deficiency, may not be universally valid in patients with uncomplicated organic acidemias.

ISSN:1660-8151    

DOI:10.1159/000182061

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

Intramitochondrial glutamate removal through deamination may regulate renal ammoniagenesis from glutamine. However, little information is available to determine if there is a strong association between glutamine deamidation and the removal within mitochondria of the glutamate subsequently formed after deamidation. Using rat renal mitochondria, we found that ammonia production, glutamate appearance, and amide nitrogen disappearance were near equal aerobically and anaerobically, when no ADP-generating system was present. Whan an ADP-generating system was added (ATP alone, ATP + malonate, or ATP+ 2,4 DNP), more ammonia was formed aerobically from glutamine. Additionally, less glutamate appeared even though more amide nitrogen disappeared. Intramitochondrial concentrations of glutamate decreased. When pyruvate and α-ketoglutarate were added to the system, ammoniagenesis, deamidation, and deamination decreased; while glutamate built up in both the medium and mitochondria. In our mitochondrial system, we found a significantly positive correlation between glutamate deamination and glutamine deamidation, between glutamate accumulation and intramitochondrial glutamate concentrations; and a significantly negative correlation between glutamate deamination and glutamate accumulation, between glutamine deamidation and intramitochondrial glutamate concentrations, and between glutamate deamination and glutamate accumulation. We conclude that there is a biochemical relationship between glutamine deamidation and deamination of the glutamate subsequently formed. We propose that increased deamination lowers mitochondrial concentrations of glutamate and increases deamidation. In contrast, slowing deamination increases mitochondrial concentrations of glutamate and decreases deamidation

ISSN:1660-8151    

DOI:10.1159/000182062

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

Ribonuclease isolated from human urine is a glycoprotein of molecular weight 33,000. The purified enzyme inhibits: (1) the stimulation of 3H-thymidine uptake into lymphocytes by phytohemagglutinin, pokeweed, and concanavalin A; (2) the growth of pancreatic fibroblastoid cells in in vitro cell culture, and (3) the growth of colonies in bone marrow cell cultures. Ribonuclease levels in the uremic patient vary from 9,500 to 35,000 U/ml (normal 1,041 ± 247). Serum ribonuclease levels are unaffected by dialytic procedures. It is suggested that the ribonuclease glycoprotein may represent a large number of nondialyzable high molecular weight uremic ‘toxin

ISSN:1660-8151    

DOI:10.1159/000182063

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

Serum and urinary concentrations of β2-microglobulin were measured for the first 21 days after renal transplantation to aid in diagnosis of acute rejection. Criteria developed after study of 15 patients were applied to the entire group of 31 consecutive cases. 29 instances meeting our criteria were identified in 651 days at risk and were associated with a mean maximal increase of serum creatinine of 74.8%. β2-Microglobulin methods may make possible detection of what is now subclinical rejection. β2-Microglobulin methods, however, are an adjunct to, not a replacement for classical methods for detecting acute rejecti

ISSN:1660-8151    

DOI:10.1159/000182064

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

Nephrotoxicity was evaluated in 37 patients receiving aminoglycosides by serial urinary measurements of the low-molecular weight protein β2-microglobulin (β2m), and the proximal tubular enzymes N 20% of the baseline value, was diagnosed in 15 of 30 evaluable patients. The laboratory diagnosis of nephrotoxicity, defined as a two-fold increase in β2m, N-acetyl-glucosaminidase and β-glucuronidase, was confirmed in 11/15 patients. Additionally, there were 3 patients in whom there was definitive laboratory nephrotoxicity in the absence of a rise in serum creatinine. The laboratory diagnosis of nephrotoxicity could be made 4.1–5.5 days prior to significant elevation in serum creatinine. The data suggest that β2m and enzyme studies are predictors of nephrot

ISSN:1660-8151    

DOI:10.1159/000182065

出版商:S. Karger AG    

年代:1981

数据来源: Karger