ISSN:1660-8151    

DOI:10.1159/000189468

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Coronary artery disease is a frequent condition in dialysis patients and – probably due to the atypical symptomatology – is frequently underdiagnosed. Non-invasive tests are of limited value in establishing diagnosis, whereby arteriography is frequently necessary. Secondary prophylaxis is the same as in nondialysis patients. Due to a high reocclusion rate following PTCA bypass grafting is the preferred therapeutical option. When medical therapy is indicated, hemodialysis therapy should be adapted to coexistent coronary artery disease by avoiding dialysis hypotension and overhydration. In coronary patients renal anemia worsens coronary perfusions and should be treated targeting at least a hematocrit of 3

ISSN:1660-8151    

DOI:10.1159/000189469

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

We clarified the presence of platelet-derived growth factor (PDGF), interleukin (IL)-1β IL-6, IL-6 receptor (IL-6R) and tumor necrosis factor-α (TNF-α) in renal biopsy specimens from 62 patients with IgA nephropathy, and discuss their relationship with mesangial cell proliferation, degree of histological damage and various clinical factors. Mesangial proliferation was determined histologically by PAS staining and the positive rate of proliferating cell nuclear antigen (PCNA). Renal biopsy specimens were stained using an enzyme-antibody method to determine the presence of cytokines and the receptor. PCNA-positive cells in the glomeruli significantly increased in patients positive for PDGF, IL-6, IL-6R and TNF-α. The degree of histological damage increased with the positive rates of PDGF, IL-6 or IL-6R and the number of PCNA-positive cells in the glomeruli. In the PDGF-A-positive patients, total urinary protein (TUP), urinary 1β-microglobulin (u-β2-m) and systolic and diastolic blood pressure were significantly higher, and creatinine clearance (Ccr) was significantly lower than in the PDGF-A-negative patients. In the PDGF-B-positive patients, TUP, serum creatinine (s-Cr) and urinary and serum β2-m increased significantly and Ccr decreased significantly. IL-1β was not related to any clinical factors. In the IL-6-positive patients, TUP was significantly higher than in the IL-6-negative patients. In the IL-6R-positive patients, TUP, s-Cr, urinary β2-m and systolic blood pressure were significantly higher than in the IL-6R-negative patients. In conclusion, PDGF, IL-6 and IL-6R may be closely related to mesangial cell proliferation, histological changes and deterioration of various clinical factors in patients with IgA nep

ISSN:1660-8151    

DOI:10.1159/000189470

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The effect of the urinary calcium concentration (CaU) on erythrocyte morphology was studied by incubating erythrocytes in urine with prefixed CaUs of 5, 10, 20 and 40 mmol/l by addition of CaCl2 100 μmol/l 1-V, independent of the CaU. Dysmorphic erythrocyturia has been related to transglomerular passage even if it was sporadically observed in hypercalciuric or lithiasic patients. This work suggests a role for a high CaU in causing the formation of microcytic and warped erythrocytes. In our opinion, in hypercalciuric urine the appearance of dysmorphic or mixed hematuria does not necessarily indicate transglomerular passag

ISSN:1660-8151    

DOI:10.1159/000189471

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Sixteen patients diagnosed with an aneurysm of abdominal aorta or Leriche disease underwent elective aortic surgery involving crossclamping of infrarenal aorta (ICC). These patients were randomized into two equal groups and 8 patients were infused with nifedipine starting from the isolation of aorta until the end of surgery (group A) while another 8 patients were infused with low-dose dopamine (group B) over the same surgical course. Plasma endothelin (ET) was measured before the induction of anesthesia, at the beginning and at the end of the clamp period and at the end of the operation. Intraoperatively, creatinine clearance and urinary excretion of PGE2, 6-keto PGF1α and TxB2 were also determined before, during and after aortic crossclamping. Pre-operative GFR as well as preinduction cardiac index (CI) and pulmonary capillary wedge pressure (PCWP) of the two groups did not differ. During crossclamping plasma ET rose significantly in both groups. However, after clamp removal, plasma ET decreased in group A while it remained elevated in group B. Urinary excretion of TxB2, PGE2 and 6-keto PGF1α increased during clamp in both groups, but the ratio of PGE2 + 6-keto PGF1α/TxB2 during and after clamp was significantly higher in group A than in B. Postclamp creatinine clearance decreased in group B, and increased in group A; postoperative value of GFR was unchanged in group A and decreased significantly in group B. In conclusion, infusion of nifedipine, in contrast to dopamine, prevented the decrease of GFR in patients undergoing aortic surgery. This effect could be mediated by a nifedipine modulation of ET vascular synthesis and/or a preferential renal synthesis of vasodilating prostanoi

ISSN:1660-8151    

DOI:10.1159/000189472

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

From a review of the literature regarding kinetic models used for assessing the adequacy of hemodialysis, no definite conclusions can be drawn as to whether the classical urea kinetic model (UKM) or modified direct dialysis quantification (mDDQ) is more reliable. We compared mDDQ with classical UKM and with a modified UKM that employs an equilibrated urea value. From the theoretical viewpoint, no substantial conflict is found between the two models as regards the dialysis dose, if urea rebound is considered. From the practical viewpoint, in our opinion direct quantification lends itself better for experimental purposes whereas for routine Kt/V evaluation UKM is easier and accurate enough, provided that rebound is taken into account.

ISSN:1660-8151    

DOI:10.1159/000189473

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Ten hemodialysis patients were treated with intravenous calcitriol (1-1.5 μg 3 times per week) for 3 months and parameters reflecting cell-mediated immunity were measured before and at the end of treatment. Peripheral blood CD4+ cells increased from 33.1 ± 14.2 to 43.8 ± 5.8% (p < 0.05) causing a comparable increase in CD3+ cells (67.3 ± 14.3 vs. 77.1 ± 7.9%, p < 0.05), whereas CD8+cells did not change significantly (22.2 ± 5.4 vs. 25.5 ± 3.0%). Mitogen-induced lymphocyte stimulation responses were normal even before treatment and did not change. Antigen-induced T-cell responses were very heterogeneous before calcitriol therapy; those 5 with initially unmeasurably low serum 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) had a weaker response than the other patients (3,873 ± 1,528 vs. 22,948 ± 13,684 cpm, p < 0.05). After calcitriol treatment the patients with pretherapy unmeasurably low serum 1,25-(OH)2D3 had a comparable response to other patients (16,220 ± 9,674 vs. 22,064 ± 10,331 cpm). Our study shows that calcitriol therapy restores the depressed antigen-induced T-cell response of the hemodialysis patients most deficient in 1,25-(OH)2D

ISSN:1660-8151    

DOI:10.1159/000189474

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

We have studied serum erythropoietin (EPO) levels during 6 years after kidney transplantation in 16 patients. There was a serum EPO peak around 50 mU/ml after 5 weeks. After 3 months the serum EPO level stabilized at around 30 mU/ml. Patients with good transplant function had significantly higher serum EPO levels and normalized their hemoglobin (Hb) after a mean of 3 months. If transplant function was good, Hb was normalized even if the serum EPO was only slightly elevated. Patients with poor transplant function had lower serum EPO and Hb levels. We concluded that a good transplant function is the key to a normal erythropoiesis and that small amounts of EPO are needed to improve Hb.

ISSN:1660-8151    

DOI:10.1159/000189475

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Peritonitis is one of the most frequent complications of continuous ambulatory peritoneal dialysis (CAPD). Necrosis and exfoliation of the mesothelial cell layer of the peritoneum develop during the acute phase of peritonitis. Agents that hamper regeneration of mesothelial cells will cause delayed recovery of the peritoneal surface, which results in continuous exposure of underlying stem cells to the stimulation of growth factors and possibly leads to peritoneal fibrosis syndrome. The aim of the present study is to determine the effects of several intraperitoneal antibiotics on human peritoneal mesothelial cell (HPMC) growth at their usual loading and maintenance doses. HPMCs were isolated from human omenta. Proliferation of HPMC was evaluated by modified methyltetrazolium assay and cell membrane integrity was assessed by lactate dehydrogenase method. The results showed that most cephalosporins exert an inhibitory, even toxic, effect on HPMCs at their loading doses. Cephalothin, cephradine, cefamandole, cefoxitin, cefuroxime and cefoperazone inhibited HPMC proliferation at their maintenance doses. Vancomycin, clindamycin, aztreonam, piperacillin, imipenem, tobramycin and ceftriaxone have no effect in their usual intraperitoneal doses. From the viewpoint of peritoneal protection, not only drug sensitivity of the causative microorganisms but also effects of antibiotics on HPMC regeneration should be considered when selecting antibiotics for CAPD peritonitis.

ISSN:1660-8151    

DOI:10.1159/000189476

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

In order to study the prevalence and the clinical features of renal tuberculosis associated with AIDS, we studied the renal tissue of the necropsies made in 46 AIDS patients under light microscopy. We found renal tuberculous granuloma in 11 (23%) patients (in 3 without previous diagnosis of renal or extrarenal tuberculosis) and only 4 of them presented moderate hematuria or pyuria sterile. As subclinical renal tuberculosis was frequent in this group of AIDS patients, the urine culture for Mycobacterium tuberculosis may be useful for diagnosing tuberculosis in AIDS patients.

ISSN:1660-8151    

DOI:10.1159/000189477

出版商:S. Karger AG    

年代:1996

数据来源: Karger