ISSN:1660-8151    

DOI:10.1159/000185031

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

This paper discusses the possible pathogenesis of the cerebral atrophy (CA) observed in a large percentage of uraemic patients, taking the form of prevalently cortical damage (cortical atrophy) and/or subcortical enlargement of ventricular cavities (subcortical atrophy). This central nervous system pathology seems to share very little either with the better known ‘dialysis encephalopathy’ or with the ‘acute encephalopathy syndrome’, even though sporadic cases of both these forms have shown concomitant CA. Histopathologically it offers the picture of loss of neurons and nerve fibres and can thus be compared with uraemic peripheral nervous system damage. CA is unquestionably important because of its implications in terms of impairment of superior cortical functions, just as in CA of non-uraemic aetiology. A first aetiopathogenic hypothesis might include endogenous uraemic intoxication to the nerve tissue, believed responsible for peripheral uraemic neuropathy, but other possibilities merit consideration: vascular calcification secondary to hyperparathyroidism, blood lipid disorders, and systemic hypertension – factors that contribute to impairing the brain vasculature, with cascade effects on brain tissue oxygenation, neuronal metabolism, and energy exchanges. Tissue oxygenation is already jeopardized in the uraemic patient by the concomitant chronic anaemia and by cardiac insufficiency in cases with hypertensive heart disease. In dialysis patients with volume-dependent hypertension the brain may be further damaged by abrupt pressure changes produced by dialytic ultrafiltration; these constitute a severe challenge to cerebral blood flow autoregulation. Cyclic variations of brain tissue hydration connected with regular dialysis treatment may have adverse effects on neurotransmitter functions, particularly those mediated by neuropeptidergic systems. Chronic intoxication may result from oral A1(OH)3 of phosphorus-chelating agents: in animal studies and clinical observations in non-uraemic populations the neurotoxic potential of A1 is indicated by a significant correlation between histological neuronal damage, impaired function, and A1 concentration in brain tissues. In addition, a concausal role of malnutrition in central nervous system damage in the uraemic patient cannot be overlooked, since malnutrition is known to give rise to functional and structural alterations in non-uraemic human pathology. In the light of these clinical observations and experimental findings, it would appear that the prevention of CA in uraemia is today

ISSN:1660-8151    

DOI:10.1159/000185032

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Measurement of IgA circulating immune complexes (IgA-CIC) in sera from patients with IgA nephropathy after a gluten-poor diet, an unrestricted diet and a gluten-rich diet is described. High levels of IgA-CIC in sera were detected in patients after these diets. However, the levels of IgA-CIC in sera 2 weeks after the gluten-rich diet were not significantly increased compared with those after the other diets. It is suggested that, for a short duration, the gluten-rich diet might not increase the levels of IgA-CIC in sera from Japanese patients with IgA nephropathy.

ISSN:1660-8151    

DOI:10.1159/000185033

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

We studied metabolic and hormonal patterns in 11 patients on hemodialysis for over 10 years (group A) to determine whether some metabolic abnormalities worsen with long-term dialysis or whether a particular endocrine-metabolic pattern discriminates long-term hemodialysis survivors. Data were compared to those of 14 subjects of similar age and sex on dialysis for 1 -3 years (group B) and to those measured in the same patients during the 1 st year of dialytic treatment. As to glucose metabolism, group A showed elevation of fasting plasma glucose and a decrease of glucose constant decay (K) and insulin production (IIG) values as compared to the 1 st year of dialysis. No difference was found between group A now and group B. However in the 1 st year of dialysis group A showed significantly higher K values than group B. As regards lipid metabolism, group A presented higher α-lipoprotein values and high-density lipoprotein-cholesterol/cholesterol, high-density lipoprotein-cholesterol/apoprotein A, and apoprotein A/apoprotein B ratios, while low-density lipoprotein-cholesterol and apoprotein B values and β/α-lipoprotein ratio were lower. These data demonstrate less vascular risk in group A. We explain these results as depending on natural selection. Multivariate analysis of survival confirmed that survival in hemodialysis patients is influenced negatively by glucose and lipid metabolism abnormalities. As to Ca-P metabolism, group A showed higher carboxy-terminal parathyroid hormone and alkaline phosphatase values than group B. However, these data may be superimposed to those determined in the same patients in 1981, when we began the regular use of 1α,25-(OH)2-vitamin D3. X-ray-evidenced bone disease showed a progressive worsening correlated to plasma carboxy-terminal parathyroid hormone rates. In iron metabolism only the serum ferritin level was higher in group A patients. No difference between the two groups was found in basal thyroid, gonadal, and adrenal hormones and related pituitary tropins. We conclude that long-term dialysis affects the endocrine-metabolic pattern of hemodialysis patient only in a limited way. However, metabolic and endocrine abnormalities of uremia, if uncorrected by dialysis, continue to affect target organs with increased morbidity and mortal

ISSN:1660-8151    

DOI:10.1159/000185034

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Increased levels of urinary β2-microglobulin (β2M) have been used as a marker of proximal tubular dysfunction in human neonates. To assess the value of β2M in the detection of early stages of tubular damage caused by gentamicin, renal handling of β2M was studied sequentially in 18 gentamicin-treated neonates with idiopathic respiratory distress syndrome (mean birth weight 1,781 g, mean gestational age 33.7 weeks) during the first 7 days of life. These data were compared with those obtained from 10 control infants matched for gestational and postnatal ages. In addition, follow-up studies of renal function were conducted in 14 of 18 study infants 1 week after termination of therapy, on day 14 postpartum. The ( ± SD) fractional tubular excretion of β2M (FEβ2M) tended to decrease significantly in the control infants from 10.3 ± 1% on day 1 to 6.5 ± 0.8% on day 7 postpartum (p < 0.05). In infants treated with gentamicin, the mean FEβ2M rose from 10.5 ± 2% on day 1 to 17.1 ± 1%on day 7 (p < 0.01), followed by a decrease to 8.2 ± 0.5% over the next 7 days (p < 0.001). Compared with the control infants, values for the infants receiving gentamicin were significantly higher on postpartum days 3,5, and 7 (p < 0.001). No significant differences in serum creatinine, creatinine clearance, or fractional tubular excretion of sodium were observed between the two groups during the study period. These results suggest that administration of gentamicin with a penicillin antibiotic to preterm infants with idiopathic respiratory distress syndrome is associated with increased FEβ2M and that the FEβ2M may serve as a useful indicator of tubular dysfunction in infants treated w

ISSN:1660-8151    

DOI:10.1159/000185035

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

A review of 85 patients aged 60 years or more, treated in a southern Indian hospital for conditions requiring renal biopsy, showed that diffuse poliferative glomerulonephritis was the most frequent diagnosis, being present in 24 cases of whom 11 had elevated serum streptococcal antibody titres. Infections were also important in 2 patients with amyloidosis secondary to tuberculosis, in 3 patients with acute tubular necrosis following infectious gastroenteritis and in a patient with acute pyaemic interstitial nephritis with septicaemia. Drugs including indigenous medicines were the other important cause of renal disease, being implicated in 11 cases.

ISSN:1660-8151    

DOI:10.1159/000185036

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

The murine monoclonal antibody Ki67 recognizes a nuclear antigen present in all phases of the cell cycle except G0 and can be used with a simple indirect immunohistochemical technique to demonstrate cell proliferation in tissue sections. This antibody was applied to 37 unselected renal biopsies showing a wide variety of histological appearences. Ki67-positive nuclei were seen most frequently in tubular epithelium in acute tubulo-interstitial pathology, particularly in renal allograft rejection. Tubular epithelial staining ranged from 0 to 10% of cells. In chronic nephropathies few tubular cells were stained. Staining was seen in glomerular crescents, but was rare in glomerular tufts except those that showed mesangial proliferation where occasional cells stained. This study demonstrates that information regarding cellular proliferation in renal biopsies can be easily obtained using Ki67 immunostaining. This is likely to be a useful investigative tool and may provide clinically useful information.

ISSN:1660-8151    

DOI:10.1159/000185037

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

This study was performed to test the effect of dialysis-induced acute modifications of plasma volume and sodium pool on red blood cell (RBC) ion transport in patients with end-stage renal disease. This approach confirmed the presence of an Na-K pump inhibitor in the plasma of uremic patients with extracellular fluid volume expansion. This factor cross-reacts with digoxin antibodies, and its concentration decreases during dialysis; this explains the increased activity of the RBC Na-K pump that is consistently observed during dialysis.

ISSN:1660-8151    

DOI:10.1159/000185038

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Identification of crescent-forming cells in rapidly progressive glomerulonephritis (RPGN) is very difficult, and controversial results on the participation of different epithelia as well as of monocytes have been reported. In the present study different monoclonal antibodies were used to analyze cellular infiltrates of crescents and the interstitium as well as the distribution of well-defined renal antigens and major histocompatibility complex (MHC) encoded antigens along the human nephron in cryostat sections of renal biopsies from patients with RPGN. The results demonstrate that monocytes/macrophages infiltrate Bowman’s space and that cellular components of crescents present with phenotypes of parietal glomerular and proximal tubular cells. T lymphocytes are significantly found in glomeruli and also in interstitium with predominance for CD4+ lymphocytes. Reduction of MHC class-II antigens within diseased glomeruli correlates with changes in renal antigen expression. Tubular cells, however, often presented an abnormal expression of MHC class-II antigens. Differences of renal and MHC-encoded antigen expression may be due to rapid regeneration episodes of renal parenchymal cells in RPG

ISSN:1660-8151    

DOI:10.1159/000185039

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Atrial natriuretic peptide (ANP) and arginine vasopressin concentrations were measured in 9 patients with pregnancy-induced hypertension. The results were compared to those found in 7 normal pregnant women matched for age, duration of pregnancy, and parity. Plasma ANP levels were significantly higher in the pregnancy-induced hypertension patients than in the control group. Plasma arginine vasopressin concentrations, however, were not significantly different in the two populations. The mechanism of the observed rise in ANP concentrations in the patients with pregnancy-induced hypertension is not known. However, it may be related to a rise in intra-atrial pressures secondary to hypertension, an increase in baroreceptor discharge as a result of hypertension, or, less likely, the ANP may be released from extracardiac sites.

ISSN:1660-8151    

DOI:10.1159/000185040

出版商:S. Karger AG    

年代:1988

数据来源: Karger