ISSN:1660-8151    

DOI:10.1159/000187849

出版商:S. Karger AG    

年代:1994

数据来源: Karger

ISSN:1660-8151    

DOI:10.1159/000187850

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

In order to clarify whether TNF inhibitory activity in the urine of glomerulonephritis (GN) patients depends on the existence of TNF inhibitors/soluble TNF receptors, we purified two types of TNF inhibitors from the urine of chronic renal failure (CRF) with GN patient. Using four steps of chromatography (anion exchange chromatography, preparative reverse phase chromatography, TNF affinity chromatography, analytical reverse phase chromatography), two types of 99% pure TNF inhibitors were purified. Amino terminal amino acid sequence revealed that one inhibitor was identical to soluble TNF receptor, p55, however, the other was homologous but not identical to soluble TNF receptor, p75. Our experiments demonstrated that TNF inhibitory activity in the urine of CRF patients depended partly on the existence of soluble TNF receptors in the urine.

ISSN:1660-8151    

DOI:10.1159/000187851

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The urinary transforming growth factor beta (TGF-β) excretion was measured in 33 patients including 10 with systemic lupus erythematosus (SLE), 8 with focal glomerular sclerosis (FGS), 9 with IgA nephropathy (IgAN), and 6 with membranous nephropathy (MN), and in 7 healthy subjects by enzyme-linked immunosorbent assay using a monoclonal antibody specific for TGF-β1+2+3. A significantly increased urinary TGF-β excretion was observed in FGS patients (555.5 ± 458.4 ng/mg Cr) as compared with normal controls (46.9 ± 43.9 ng/mg Cr) (p < 0.05) and a relative increase in SLE patients (96.4 ± 58.2 ng/mg Cr) and a decrease in MN patients (24.8 ± 13.3 ng/mg Cr). In contrast, there was no difference in TGF-β excretion between IgAN patients (54.1 ± 37.4 ng/mg Cr) and normal controls. A correlation between the amount of proteinuria and TGF-β was not found. As has been previously demonstrated in experimental studies, TGF-β may play a similar role in human glomerular diseases. The results obtained in this study raised the possibility that extracellular matrix might be produced by glomerular cells in vivo under the control of TGF-β and that TGF-β might act as a stimulator for the development of glomer

ISSN:1660-8151    

DOI:10.1159/000187852

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The influence of blood-membrane interaction on human peripheral blood monocyte tumor necrosis factor-α (TNF), interleukin-6 (IL-6), and interleukin-8 (IL-8) secretion was measured during hemodialysis of end-stage renal disease patients by in vitro stimulation of whole blood with lipopolysaccharide. Monocyte TNF and IL-6 secretion in vitro was reduced 30 min after start of dialysis session. In contrast, cellular IL-8 secretion did not change during hemodialysis. Comparison of the results of three different membranes indicates that the bioincompatibility of the dialysis membrane was reflected in both leukocytopenia and reduction of cellular TNF secretion. During treatment of normal whole blood in an ex vivo dialysis closed-loop circuit, the ability of monocytes to release TNF, IL-6, and IL-8 in vitro remained constant. This indicates that the reduced IL-6 and TNF secretion during standard hemodialysis was not due to a direct effect of contact between dialysis membranes and monocytes, but rather was a result of redistribution within the patients’ leukocyte po

ISSN:1660-8151    

DOI:10.1159/000187853

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Although the pathogenesis has yet to be fully understood, β2-microglobulin (β2m) related amyloidosis is a frequent complication in long-term hemodialysis (HD) patients. In an attempt to clarify the association of two potential candidates with amyloidogenesis from β2m in HD patients, human urine-derived β2m solution alone or combined with glycosaminoglycans: hyaluronic acid, heparan sulfate, or serum amyloid P component (SAP) were dialyzed against physiological buffered solution (pH 7.4) using a microdialyzer in vitro for 72 h at 4°C. This study demonstrates for the first time that SAP can play a crucial role in the formation of amyloid-like fibrils from β2m. This occurs by a direct influence on either the processing of a precursor protein, or protein folding, in vitro, by a short-period dialysis against a physiological buffered sol

ISSN:1660-8151    

DOI:10.1159/000187854

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A randomized, controlled trial was conducted in a pediatric unit in a teaching hospital in India to assess the efficacy of levamisole in maintaining remission in children with steroid-sensitive nephrotic syndrome. Sixty-one children with steroid-sensitive nephrotic syndrome, who had achieved remission with corticosteroids, were allocated to a treatment group (33 patients) receiving levamisole (2-3 mg/kg/day) twice a week for 12 months or to a control group (28 patients) receiving no treatment. The main outcome measure was duration of remission. Thirty months later, in the levamisole group, 21 of 33 patients were in remission as against 12 of 28 patients in the control group (χ2 = 2.54, p = 0.11, NS). The median duration of remission maintenance was 12 months in the levamisole group as compared with 10.5 months in the control group. On survival analysis, the difference in duration of remission maintenance between the two groups was not significant (p = 0.10), though there was a trend in favor of the treatment group. On stratified survival analysis, multiple relapsers in the levamisole group had longer remission maintenance than the control group though this did not reach statistical significance (p = 0.08). The clinically significant trend towards increased duration of remission maintenance in steroid-sensitive nephrotic syndrome observed with levamisole therapy, especially in patients with multiple relapses, may require a larger study with a longer follow-up for definitive confirmation

ISSN:1660-8151    

DOI:10.1159/000187855

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Thirst and hyperdipsia of anuric chronic uremics on maintenance hemodialysis and the possible dipsogenic factors were studied. Exaggerated thirst was present in 213 (86%) of the 247 studied patients. It usually started 4-6 h after the end of the dialysis session, persisted during the whole interdialytic period and often disappeared during the subsequent dialysis. Hyperdipsia, as indicated by the high body weight gain ( > 4%) in the interdialytic periods, was present in 33.6% of patients. The highest rate of increase of body weight occurred in the first hours following the end of dialysis sessions. Hypematremia, potassium depletion, increasing plasma urea levels and elevated plasma angiotensin II levels were considered as the possible dipsogenic factors of a nonpsychic nature. Sodium is certainly of paramount importance for its obliged extracellular position, and when sodium intake is elevated, hypematremia is very likely the cause of exaggerated thirst and weight gain in patients on hemodialysis. Potassium depletion may cause thirst in animals, but this condition is extremely rare in patients on maintenance hemodialysis, who often accumulate it. In these patients it is, therefore, unlikely that potassium depletion is a dipsogenic factor. Increasing serum urea levels exert an evident dipsogenic effect in anephric rats and urea, when infused into normal volunteers, stimulates thirst. The extracellular urea levels in the interdialytic period are certainly higher than the intracellular ones, as a consequence of its continuous accumulation, and this creates an osmotic gradient with a dipsogenic effect. When this gradient is reversed, following hemodialysis (which removes first the extracellular urea), the dipsogenic effect disappears. The hypothesis of a dipsogenic effect of urea operating in the interdialytic period in anuric patients on hemodialysis is therefore formulated. Angiotensin II is regarded as dipsogenic in patients on maintenance hemodialysis because of its high plasma concentrations. The following evidence is, however, against this contention: the ACE inhibitors do not prevent hyperdipsia, the body weight changes due to hyperdipsia are not correlated with the plasma levels of angiotensin II, and, finally, thirst is often absent in the hours of maximum angiotensin II plasma levels. In conclusion, hypematremia (frequently) and increasing plasma urea levels (regularly) appear to be the dipsogenic factors operating in patients on maintenance hemodialysis. The role of angiotensin II is doubtful and that of potassium depletion quite unlikely. Psychogenic factors may play an important role, however, in some patients.

ISSN:1660-8151    

DOI:10.1159/000187856

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Vitamin D metabolites 25-OH-D3 (calcifediol) and 1,25-(OH)2-D3 (calcitriol) were measured in plasma in 16 patients with advanced chronic renal failure during treatment with a protein-restricted diet for 6 months. The glomerular filtration rate (GFR) decreased only marginally, from 8.3 to 7.9 ml/min, during the study while there was a significant decrease of serum urea levels after the initiation of the protein-reduced diet. Calcitriol levels rose significantly (p < 0.05) after 3 months from 17.1 to 27.7 pg/ml but fell after another 3 months to nearly their initial values, 15.3 pg/ml. The serum phosphate levels changed during the same periods from 1.99 to 1.67 to 1.93 mmol/l. There were significant inverse correlations between the calcitriol and phosphate levels at the start and after 3 months but not after 6 months. There was also a significant correlation between the changes in calcitriol and initial GFR. A subgroup of patients with decreased or unchanged calcitriol concentrations during dietary treatment had significantly higher serum phosphate and creatinine and significantly lower standard bicarbonate concentrations. Multivariate regression analysis for the pooled set of data with calcitriol as the dependent variable showed significant values for GFR (p < 0.02), body mass index (p < 0.02), and serum phosphate concentrations (p < 0.04). These results show the importance of phosphate control and renal function for the regulation of calcitriol synthesis.

ISSN:1660-8151    

DOI:10.1159/000187857

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Renal involvement in systemic lupus erythematosus (SLE) often signifies a poor prognosis. Whilst SLE appears to be not uncommon in the racial groups of South Africa, there are few reports in the literature. Between 1984 and 1987,43 patients with SLE and nephritis were analyzed. Clinical and biochemical manifestations are described. The histological types (WHO classification) were mainly class II (15 cases) and class IV (17 cases). The ratio of black to Indian patients was 26.4% in class II and 43.4% in class IV to 42% each in class II and class IV respectively. Immunofluorescence showed a predominantly granular pattern of IgG, Cl and C3. Treatment was with combinations of prednisone and cyclophosphamide (14 cases), prednisone and azathioprine (21 cases) or pulse methylprednisolone (6 cases; total 41 cases). Two patients were not treated. There was no difference between cyclophosphamide and prednisone (14 cases) and prednisone with azathioprine (21 cases) treatment groups. The follow-up period was for 4 years. Mortality occurred in 15 patients (35%). The main cause of death was renal failure in 10 patients, infection in 1 patient and central nervous system involvement in 1 patient. The prognosis was worse in the Indian compared with the black patients. The WHO classification did not give an accurate prognosis regarding mortality in our study. Because of limited resources for the treatment of chronic renal failure in developing countries, we feel that patients with lupus nephritis should be treated with improved ancillary medical therapies and more effective immunosuppressive regimens.

ISSN:1660-8151    

DOI:10.1159/000187858

出版商:S. Karger AG    

年代:1994

数据来源: Karger