ISSN:1660-8151    

DOI:10.1159/000182826

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

12 patients with the nephrotic syndrome during a phase of spontaneous sodium retention were studied on a sodium balance. When retaining sodium and gaining weight for more than 3 days, 6 patients had an elevated plasma renin activity; plasma aldosterone was elevated or at the upper range of normal, and blood volume was less than predicted in 5. The other 6 patients had a low or normal plasma renin activity and plasma aldosterone; blood volume was greater than predicted in 5 of these patients. There was a significant inverse correlation between plasma albumin and plasma renin activity (r = -0.70, p < 0.02). Thus the renin-angiotensin-aldosterone system is not stimulated in many patients with the nephrotic syndrome when spontaneously retaining sodium. In these patients, sodium retention is probably due to some other mechanism, possibly intrarenal. Stimulation of the renin-angiotensin-aldosterone system in other patients may be a compensatory mechanism to the lower plasma albumin and reduced blood volume, and may not be the underlying mechanism for sodium retention.

ISSN:1660-8151    

DOI:10.1159/000182827

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

In 11 patients suffering from nephrotic syndrome, renal phosphate handling was studied in water immersion up to the neck. There was a rapid onset of phosphate diuresis which continued to increase throughout water immersion; and an increase in fractional excretion of phosphate (FEPO4) continuing throughout immersion and decreasing in the hour after immersion. TmPO4/GFR did not change on immersion. TmPO4/Inulin clearance gave higher figures than TmPO4creatinine clearance due to secretion of creatinine in 9 of 11 patients. There was a transitory increase in PTH during immersion, but mean immersion plasma levels of PTH did not change when compared to preimmersion control values. FEPO4 was more frequently significantly correlated with FEC1 than to FENa in nephrotics.

ISSN:1660-8151    

DOI:10.1159/000182828

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

Ischemic renal failure was produced in rabbits by occluding the renal arteries for 90 min. Group 1 (n = 8) received radiocontrast media at the time of occlusion, group 2 (n = 8) 24 h after occlusion, and group 3 (n = 8) 3 days after occlusion. Group 4 (n = 12) was subjected to ischemic injury alone, group 5 (n =4) served as sham-operated controls and group 6 (n = 4) did not undergo surgery but received radiocontrast media. Serum creatinine concentration in group 1 increased to a greater degree (p < 0.001) than all other groups and did not return to normal during the 8-day observation period. Creatinine concentration in groups 2, 3, 4, and 6 were comparable and significantly increased compared to sham-operated group (p < 0.05). Urinary excretion of alanine aïninopeptidase and N-acetyl-β-glucosaminidase in group 1 was significantly greater than all other groups (p < 0.05). Microscopic analysis indicated tubular necrosis was more prominent in group 1. Radiocontrast media is nephrotoxic and in the setting of ischemic injury may prevent recovery of renal function. Toxicity was dependent on the time of administration since functional impairment was not increased if dye was given 1 or 3 days after ischemic injur

ISSN:1660-8151    

DOI:10.1159/000182829

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

Plasma prostaglandins PGE2 and PGF2α, cardiac hemodynamics, total effective vascular compliance, plasma (PV), interstitial (IFV) and extracellular fluid volumes, and renal indices were determined in 13 men with either borderline or sustained essential hypertension. PGE2 measured in the central venous blood was increased in borderline and in sustained hypertensives (p < 0.01), while PGF2α remained within normal ranges. Pulmonary degradation of both prostaglandins was decreased. In the overall population, the PGE2/PGF2α ratio was: (i) negatively correlated with central venous pressure (r=-0.68; p <0.01), and (ii) positively correlated with total effective vascular compliance (r = 0.76; p < 0.001), the PV/IFV ratio (r = 0.63; p < 0.02) and the renal plasma flow (r = 0.79; p < 0.001). The study suggests that, in hypertensive patients, prostaglandins PGE2 and PGF2α play an important role on the compliance of the venous system and on the control of renal blood flow, contributing to the autoregulatory mechanisms of the hypertensive vascular disease. Copyright © 1982 S. Karger AG,

ISSN:1660-8151    

DOI:10.1159/000182830

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

Plasma arginine-vasopressin (AVP) was measured before and after 24 h of a 26-hour renal concentration test in 47 patients treated with lithium for 6–180 months (mean 70 months). In 34 of the patients, plasma AVP was also measured before and after a 2- to 4-hour period of water loading, and in 31 of the patients, creatinine, 125iothalamate, 131I-hippuran and lithium clearances were measured. Plasma AVP values were compared to those obtained in 8 healthy controls. Baseline AVP levels were significantly higher in the lithium-treated patients than in healthy controls. During the period of water deprivation AVP values increased significantly and during oral water loading a significant decrease took place, AVP values still being significantly higher in the lithium-treated patients than in the healthy controls. During oral water loading a slight increase in lithium clearance as well as fractional lithium excretion was seen as compared to values obtained during the last 2 h of a renal concentration test. This study demonstrates that antidiuretic hormone production is neither blocked nor inhibited during lithium treatment. The hypothalamic system reacts on water deprivation as well as on water loading. This study supports the notion that the main lithium-induced renal affection is a vasopressin-resistant impairment of renal concentrating abilit

ISSN:1660-8151    

DOI:10.1159/000182831

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

During hemodialysis a decrease in pulmonary ventilation has been reported. The elimination of CO2 across the dialyzer has been suggested as the cause of the pulmonary hypoventilation. Our purpose was to analyze the factors that could have influenced the pulmonary ventilation of 7 patients with chronic renal failure during hemodialysis, performed against an acetate dialysate with constant addition of CO2, bubbling into the dialysis bath. In spite of the large volume of CO2 mainly as bicarbonate, eliminated across the dialyzer there was no significant decrease of ventilation. The values of pH in the venous line were extremely low and the values of PvCO2 were artificially maintained around 35.0 mm Hg. Thus, the total CO2 delivered to the lungs, but mainly the levels of pH and PCO2 in the venous line play an important role in the control of pulmonary ventilation of these patients.

ISSN:1660-8151    

DOI:10.1159/000182832

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

Fibrinogen fragments (X, Y, D and E) and fibrin fragments (D-dimer and E) were examined in the urine of 52 patients with various types of renal diseases. One or more of the fibrinogen fragments were detectable in all the urine specimens. D-Dimer together with fibrinogen fragments was found in 38 of the 52 patients. The clearance ratio of D-dimer to IgG, which indicates D-dimer generated in the kidney, was lower than 1 in all the patients with the minimal changes nephrotic syndrome, and was greater than 1 in the majority of patients with acute glomerulonephritis, rapidly progressive glomerulonephritis, mesangial proliferative glomerulonephritis and membranoproliferative glomerulonephritis. Our results suggest that urinary fibrin/fibrinogen degradation products (FDP) in renal diseases are derived primarily from increased filtration of FDP from the plasma through a damaged glomerular basement membrane, and that the mechanism of lysis of cross-linked fibrin deposited in the glomeruli occurs simultaneously in some types of glomerulonephritis. It seems that the determination of the clearance ratio of D-dimer to IgG may be useful in assessing the activation of the coagulation and fibrinolysis systems in the kidney in patients with renal diseases.

ISSN:1660-8151    

DOI:10.1159/000182833

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

The site of reduced electrolyte transport in Bartter’s syndrome (BS) was studied with a new technique whereby resorption can be separately measured as equivalent volumes of free water generated along the ascending limb of Henle’s loop (CH2O-HL) and cortical distal tubule (CH2O-DT): the fractional proximal resorption (FPR) and the volume of free water dissipated along collecting ducts (CD) by back diffusion (CH2O-BD) in the absence of ADH are also measured during maximal water diuresis. Data are expressed as ml · min-1 GFR-1 · 100. The studies were performed on 2 brothers with all clinical and laboratory features of BS. They achieved external Na balance within 3 days when placed on either 10, 100, or 230 mEq Na daily. With the 100-mEq-Na diet indomethacin caused a stable 1.5 kg weight gain. FPR was 0.69 in normal controls (NC), 0.77 in BS; CH2O-HL 16.7 vs. 16.4; CH2O-DT 9.7 vs. 3.9; CH2O-BD 13.8 vs. 13.8; CH2O (free water excretion) 12.5 vs. 6.1; urine flow rate (V) 17.6 vs. 9.9. Thus, BS is characterized by a slight fall in proximal delivery, normal HLNa transport, a striking impairment of DTNa transport and preserved interstitial hypertonicity which drives a normal osmotic flow of CH2O-BD. Aspirin injected intravenously during water load affected CH2O and Y in proportion to the change in GFR, which fell from 145 ± 19 to 114 ± 12 ml · min-1, p < 0.01). Thus, the primary abnormality of BS is impaired Na transport along the early portion of the distal tubule. This is compensated by volume contraction attended by reduced proximal delivery and full activation of renin-angiotensin-aldosterone system. Consequently, more distal cation exchange sites reclaim Na+ at the expenses of excessive K+ and H+ losses, trapping NH4Cl within tubular lumen and generating hypokalemic metabolic alkalosis. The excess angiotensin is counterbalanced by increased prostaglandin (PG) secretion, which brings renal vascular resistances toward normal and causes tachyphylaxis to angiotensin. Inhibition of PG synthesis leads to a fall in GFR and proximal delivery: this causes distal delivery to fall below reabsorptive capacity for Na: therefore both Na and K retention ensues causing partial volume reexpansion till a new balance is established. PGs do not affect either Na or Cl resorption in BS except by a purely hemodynami

ISSN:1660-8151    

DOI:10.1159/000182834

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

We compared ionized serum calcium and parathyroid hormone (PTH) responses to the β-adrenergic agents, isoproterenol and propranolol, in 14 patients with hyperparathyroidism following renal transplantation and 8 normal volunteers. Following isoproterenol, PTH rose in normal subjects concurrent with a significant (p < 0.01) fall in ionized but not total, calcium. In the hyperparathyroid patients the PTH concentration decreased (p < 0.001) coincident with a significant (p < 0.01) increase in ionized, but not total, calcium. Changes in both PTH (p < 0.05) and ionized calcium (p < 0.05) were significantly different in hyperparathyroid patients compared to normal subjects. Propranolol did not affect PTH, ionized or total calcium in either group. We conclude that β-adrenergic stimulation of PTH secretion may be mediated, in part, by antecedent changes in ionized calcium and not solely a direct effect of the agonist. Concurrent assessment of changes in ionized calcium is necessary for proper interpretation of investigations involving the sympathetic nervous system’s regulation of PTH secret

ISSN:1660-8151    

DOI:10.1159/000182835

出版商:S. Karger AG    

年代:1982

数据来源: Karger