摘要:

Thyroid function tests were evaluated in 38 patients on regular hemodialysis (HD), in 36 on continuous ambulatory peritoneal dialysis (CAPD) and in 39 healthy controls. A significant reduction in total thyroxine (TT4), total triiodothyronine (TT3), reverse (rT3), and free T4 (fT4) mean levels and normal TSH, free T3, TBG and albumin concentrations was found in both HD and CAPD patients. A ‘low-T4 syndrome’ (serum T4 < 5 μg/dl) was found in 9 CAPD (25%) and 20 HD (53%) patients, but none of them had fT4 levels below the normal laboratory range. The only striking difference between low-T4 HD and low-T4 CAPD patients was the significantly lower TBG and albumin serum levels in CAPD group. Low-T4 HD displayed normal TBG levels but enhanced fT4/TT4 and TT4/TT4 × TBG ratios. We concluded that: (1) the abnormalities in thyroid function tests in patients on long-term dialysis (HD and CAPD) do not express the existence of a true hypothyroidism; (2) a different pathogenesis of the low-T4 syndrome in the CAPD and HD groups may be hypothesized: in the former it could be attributed to a reduction in serum-binding capacity for thyroid hormones, in the latter the relative increase in fT4 percentage despite normal TBG levels suggests either the presence of T4-TBG-binding inhibitor (s), or structural abnormalities of thyroid-hormone-binding pro

ISSN:1660-8151    

DOI:10.1159/000184359

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Patients who undergo extensive plasma exchanges using albumin replacement may be more susceptible to infection because they develop significant hypogammaglobulinemia. Substitution of IgG in these patients could be beneficial. A model to calculate the individual amount of IgG required is described. The course of IgG during chronic intermittent membrane plasma separation (MPS) therapy was simulated using an one-pool model. Three modes of substitution were considered for their efficacy: (A) infusion after MPS (B) infusion after discarding an equivalent plasma quantity after termination of MPS, and (C) plasma exchange at the end of MPS against an IgG solution. Mode B was shown to be most economical and was subsequently used to check the validity of the substitution model in a prospective test. The difference between predicted and measured IgG levels was 5% both for simulations from one MPS to the next and for the long-term prediction. The data prove that replacement of IgG after plasma separation is practicable. The substitution model allows to fix in advance any plasma limit value for indication and target of the substitution therapy. Thus it permits to give therapeutic recommendations for individual IgG substitution therapy of secondary antibody deficiency after MPS.

ISSN:1660-8151    

DOI:10.1159/000184360

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Accumulation of aluminum (Al) of the skin of end-stage renal failure (ESRF) patients was analysed by means of an energy dispersive X-ray spectrometer (Kevex 7000 series). The Al detecting ratio was higher in the hemodialysis (HD) groups than in the non-dialysis ESRF group (p < 0.025) and the normal volunteer group (p < 0.01). There were no significant differences between the duration of HD (group I and group II), and between the non-dialysis ESRF and the normal volunteer groups. High Al accumulation detected in the skin of the HD groups may be attributed to the dosing of aluminum hydroxide gel (Al-gel), judging from the fact that all cases in the HD groups had been dosed with Al-gel (0.75–4.5 g/day). High Al detections were observed in 2 cases each of the HD and nondialysis ESRF groups responding HBs-antigen positiv

ISSN:1660-8151    

DOI:10.1159/000184361

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

We studied the effect of an immuno-stimulating agent, isoprinosine, which is being marketed as an antiviral drug, on some immune functions in vitro in 14 uremic patients treated by hemodialysis and in 10 healthy controls. PHA and PPD induced stimulations of DNA synthesis and interleukin-2 (11–2) production and NK cell activity were measured from peripheral blood mononuclear cells cultured with and without isoprinosine. PHA responses were enhanced by isoprinosine (100 μg/ml) both in the patient group (p < 0.001) and in the control group (p < 0.05) but PPD responses in neither. The enhancement of PHA responses was not due to an increased production of 11–2 (T-cell growth factor). Isoprinosine augmented NK activity in those patients whose NK activity was initially low. No enhancement could be seen in the controls or in those patients whose NK activity was comparable to that of the controls. Our results motivate a clinical study with isoprinosine in uremic patients at the risk of virus infec

ISSN:1660-8151    

DOI:10.1159/000184362

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Urine alkalinization favours the formation of calcium phosphate (CaP) and struvite stones. In this retrospective study we analyze the effect of chronic urinary acidification on phosphatic stone recurrence. Twenty-four patients with CaP-struvite recurrent stones and persistently high urinary pH were divided in two groups: group A, 11 patients who failed to lower the urinary pH below 5.5 during a standard acid load test; group B, 13 patients with preserved acidification power. Ammonium sulfate 2–3 g/day was given for 4.7 and 6.5 years to groups A and B, respectively. A persistent reduction in urinary pH, relative saturation for CaP and stone formation rate was observed in both groups. The treatment did not cause systemic acidosis as long as renal function remained normal. Urinary daily excretion of Ca and P as well as their renal tubular handlings did not change with time. Results suggest acidifying agents might be useful in preventing recurrence of Ca P-struvite stones even in the presence of a mild acidification defect and encourage undertaking properly controlled prospective trial

ISSN:1660-8151    

DOI:10.1159/000184363

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

In order to separate the effect of oxalate retention in primary hyperoxaluria with renal failure from that of excessive oxalate synthesis and to determine the optimum time for renal transplantation in primary hyperoxaluria, we have studied a series of patients with different degrees of renal failure due to other causes. The results were compared with those obtained in studies on 8 patients with primary hyperoxaluria at different levels of residual overall renal function. In the patients with renal failure unrelated to primary hyperoxaluria, oxalate retention increases rapidly when the glomerular filtration rate (GFR) decreases below about 20 ml·min-1 These results suggest that the reduced renal excretory contribution to oxalate accumulation in primary hyperoxaluria would be expected to be particularly important in this range of GFR. In primary hyperoxaluria, oxalate retention occurs when GFR is only a little below the reference range and measures to remove oxalate from the body should be considered when the GFR falls below 40ml min-1 1.73 m-2, with a view to their introduction when the GFR is in the range 20–25 ml · min--11.73 m-2

ISSN:1660-8151    

DOI:10.1159/000184364

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Patients on chronic hemodialysis were divided into two groups: normotensive patients (group I) and renal hypertensive patients treated with antihypertensives (group II). The sodium and potassium contents in red blood cells ([Na+]i, [K+]i, ouabain-resistant net sodium uptake (ORNa+ uptake, φNa), the relative ORNa+ uptake (k), the mean cell hemoglobin concentration (MCHC), and acid-base status were examined just before and after dialysis. The results indicate that (1) in treated renal hypertensive patients k is stimulated and causes lower red blood cell sodium content. The reason for this increase remains obscure; (2) the pattern of alterations of the sodium transport components during dialysis is similar in all patients; (3) [Na+]i and φNa increase significantly during dialysis, and (4) the increases in [Na+]i are closely related to increases in pH and bicarbonat

ISSN:1660-8151    

DOI:10.1159/000184365

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

The techniques of bonding of anionic antibiotics by treatment with cationic surfactants were applied to continuous ambulatory peritoneal dialysis (CAPD) catheters. The elution of 14C-penicillin from tridodecylmethylammonium chloride (TDMAC) treated silicone elastomer catheters in dialysis solution was biphasic, with 95% dissociated from the catheter by 48 h. Forty percent of the TDMAC left the catheter surface during the initial 2 days. The ability of the surfactant TDMAC to bind antibiotics after incubation in dialysis solution correlated directly with the amount of surfactant remaining. Rats with intraperitoneal dialysis catheters were inoculated with exit site and intraluminal bacterial challenges. Intraperitoneal catheter tips treated with TDMAC-penicillin were rendered more resistant to colonization after exit site and intraluminal bacterial challenges.

ISSN:1660-8151    

DOI:10.1159/000184366

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

To investigate various factors that possibly affect oxygen affinity of hemoglobin (Hb-O2 affinity) in chronic hemodialysis (HD) patients, we determined P50 at standard condition (P50std), 2,3-diphosphoglycerate (2,3-DPG) content in red blood cells, serum inorganic phosphorus (S-Pi), Hb, and arterial blood gas analysis in 55 HD patients. P50std in HD patients was higher than that in normal controls (26.6 ± 1.6 vs. 25.4 ± 1.4 mm Hg; p < 0.001). We could find neither an effect of alkalizating agents for HD (acetate vs. bicarbonate) nor an effect of the underlying disease (diabetics vs. nondiabetics) on Hb-O2 affinity. There were significant positive correlations between P50std and the duration of HD therapy (r = 0.598; p < 0.001) and between P50std and SPi (r = 0.476; p < 0.001), contrasting with the absence of correlation between P50std and Hb. Forward stepwise multiple-regression analysis demonstrated that the duration of HD therapy played the most important roles in determining P50std, followed by SPi and PO2. These data suggest that the major factor influencing Hb-O2 affinity in chronic HD therapy is the duration of the therapy and that the minor factors are SPi and PO2

ISSN:1660-8151    

DOI:10.1159/000184367

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

The tubular transport of urate was studied in 47 uremic patients and in 20 normal subjects using probenecid and pyrazinamide tests. There was a marked increase in urate excretion per nephron as the renal function deteriorated. Presecretory reabsorption of urate per nephron, which was almost complete in normal subjects, showed a diminution with increasing severity of chronic renal failure. Until the creatinine clearance had decreased to less than 10 ml/min, the secreted urate per nephron remained almost constant, while in the end stage of renal failure it was markedly decreased. With the progression of renal disease, the postsecretory reabsorption of urate per nephron diminished. In patients with a creatinine clearance less than 10 ml/min, it was 4 times lower than in normal subjects. These findings indicate that urate secretion does not contribute to the increase of urate excretion per nephron at any level of renal failure, whereas the impairment of both reabsorptive components accounts for the augmented urate excretion per nephron in uremic patients.

ISSN:1660-8151    

DOI:10.1159/000184368

出版商:S. Karger AG    

年代:1987

数据来源: Karger