ISSN:1660-8151    

DOI:10.1159/000185052

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Fourteen children with biopsy-proven membranous nephropathy associated with hepatitis B virus (HBV-MN) were evaluated biochemically and serologically and compared to 45 children with idiopathic nephrotic syndrome (INS). The mean ages of the two groups were similar (4.9 ± 1.6 vs. 4.6 ± 2.6 years). Serum albumin levels were similar in both groups, but serum cholesterol was significantly reduced in children with HBV-MN compared to INS. Serum C3 was also significantly depressed in children with HBV-MN compared to INS, but no differences in C4 levels were noted. Serum alanine transaminase as well as aspartate transaminase concentrations were significantly elevated in children with HBV-MN compared to those with INS, suggesting the presence of chronic hepatitis in children with HBV-MN. Hepatitis B surface and e antigens were present in serum of all children with HBV-MN, but only 54% had circulating HBV-DNA particles demonstrable in their serum. Serum C3 levels were higher in children with HBV-MN and circulating HBV-DNA, compared to those without circulating HBV-DNA. No other serological or biochemical differences occurred between these two groups. Glomerular deposition of IgG and C3 occurred in 91% of children with HBV-MN; but IgM deposition appeared to occur more frequently and with greater intensity in those children positive for circulating HBV-DNA. Antibody to delta antigen was negative in all children with HBV-MN. We conclude that biochemical and serological differences can be identified between HBV-MN and INS. We also conclude that circulating HB viral DNA does not account for immune complex formation in HBV-MN but may be related to glomerular IgM deposition and that the delta antigen is not important in HBV-M

ISSN:1660-8151    

DOI:10.1159/000185053

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Experiments were performed on 23 dogs to assess the effect of splanchnic pooling on renal hemodynamics and Na retention. When the thoracic duct pressure was raised to 40 cm H2O (HTDP), liver interstitial pressure rose from 9.0 ± 0.4 to 19.8 ± 1.1 cm H2O. Simultaneously, glomerular filtration rate (GFR) and renal plasma flow fell in the left kidney from 16.3 ± 1.7 to 9.6 ± 1.3 and from 73.7 ± 12.2 to 44.3 ± 9.8 ml · min-1, respectively (p < 0.01). UNa · V fell to 59 ± 9% of control value (p < 0.01). Plasma antidiuretic hormone (ADH) rose from 29.5 ± 7.7 to 46.9 ± 9.2 pg·ml-1 (p < 0.05). When a portocaval shunt (PCS) was opened in 10 dogs during HTDP after the first set of experimental measurements, splanchnic pressure fell from 17.2 ± 1.1 to 11.5 ± 1.2 cm H2O, attended by a return towards control of GFR. ADH fell significantly to 16.5 ± 8.1 during PCS, and to 9.7 ± 1.5 pg · ml-1 during a last, postexperimental control period. Instead, UNa V remained unchanged at the low levels measured during HTDP alone. When the HTDP was released in the 17 dogs without, and the 10 dogs with PCS, all variables became indistinguishable from control, except for UNa V, which remained reduced, even in 4 aldosterone-escaped animals. No significant change in any of these variables occurred in 6 sham-operated control animals. These data demonstrate that it is possible to increase interstitial liver pressure through the lymph duct. Renal hemodynamics is impaired and causes Na retention because of the activation of mechanisms sensitive to the fall in ‘effective’ central volume. Na retention outlives the hemodynamic effects, which are quickly reversible, suggesting that it may be either independent of the fall in GFR or maintained by mechanisms indepen

ISSN:1660-8151    

DOI:10.1159/000185054

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

A low-protein, low-phosphorus diet supplemented with essential amino acids and keto analogues was given to 12 rats, starting from the 90th day after subtotal nephrectomy. The purpose was to assess its effect on the residual renal function and on the nutritional status in rats with already established severe renal failure. Ten control rats in the same conditions, following a standard diet supplying normal amounts of protein and phosphorus were also studied. The supplemented diet exerted a well-evident protection of residual renal function and structure: lower rate of decline of creatinine clearance, lower mortality, significant decrease of proteinuria and almost total absence of histological signs of activity. The nutritional status was also well protected by the dietary therapy: increase of body weight, normal values of total serum protein, and low-constant values of urea appearance. In the control rats body weight decreased, total serum protein was lower than normal and the values of urea appearance were increasing simultaneously with a decreasing food intake and body weight.

ISSN:1660-8151    

DOI:10.1159/000185055

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

A 65-year-old woman with mild renal insufficiency had persistent hyperkalemia and hyperchloremic acidosis. Her plasma aldosterone level was relatively low for her hyperkalemia, and her urine pH was low. Fludrocortisone acetate administration corrected both hyperkalemia and acidosis by increasing urinary excretion of potassium and net acid, implicating deficient mineralocorticoid activity in the distal renal tubule in this patient. During this medication urinary ammonium excretion increased, but urine pH remained low, so that urinary titratable acid excretion did not decrease. On the other hand, correction of hyperkalemia by administration of a potassium-calcium exchange resin alone also resolved the acidosis by increasing urinary ammonium excretion. This increment exceeded the decrement of urinary titratable acid excretion, which was caused by raised urine pH secondary to increased urinary ammonium excretion, and resulted in increase of net acid excretion. Thus, in this patient, hyperkalemia appears to be a decisive causative factor in the acidosis, with deficient mineralocorticoid effect only contributing in part to the reduction of net acid excretion and the acidosis.

ISSN:1660-8151    

DOI:10.1159/000185056

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

This study was aimed to investigate the pathogenesis of toluene-induced renal tubular acidosis (RTA). In 5 individuals addicted to toluene sniffing we documented the occurrence of hypokalemia and hyperchloremic metabolic acidosis associated with inability to lower urine pH below 5.5 (6.06 ± 0.24). Overall kidney bicarbonate reabsorption was normal or enhanced, a feature characteristic of the distal form of RTA (DRTA). These findings resemble those found during the administration of amphotericin B, a drug felt to cause DRTA by increasing hydrogen ion (H+) back-diffusion in the collecting tubule. In toluene sniffers, the urine pCO2 measured in a highly alkaline urine was reduced (47 ± 8.8 mm Hg), suggesting a decrease in the rate of collecting tubule H+ secretion rather than H+ back-diffusion. To investigate these two mechanisms of altered distal acidification more directly we studied the effect of toluene on acidification by the urinary turtle bladder, an epithelial analogue of the mammalian collecting tubule. In this preparation, toluene resulted in a decrease in the rate of H+ secretion measured by either the pH stat technique or the reverse short circuit current. When mucosal pH was progressively lowered to examine H+ secretion against an H+ gradient, toluene-treated bladders displayed a significant decrease in proton conductance but the lowest mucosal pH required to nullify H+ secretion, (MpH) JH = O, was not different from that of control bladders (4.05 ± 0.29 and 3.90 ± 0.13, respectively). In contrast, in amphotericin B-treated bladders (MpH) JH =·was 5.15 ± 0.39, a value more than 1 pH unit higher than that of control and toluene-treated bladders (p < 0.05). Thus, amphotericin B, but not toluene, reduced the pH gradient that could be generated across the turtle bladder. These findings suggest that toluene, unlike amphotericin B, does not cause H+ back-diffusion. Decreased conductance of protons through the active transport pathway is the mechanism that best explains the toluene-induced defect in distal acidific

ISSN:1660-8151    

DOI:10.1159/000185057

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

The effect on metabolic control and on intermediate metabolism of continuous ambulatory peritoneal dialysis (CAPD) was evaluated in 6 insulin-dependent diabetic uremic patients treated by CAPD, in 6 nondiabetic uremic patients in CAPD and in 6 normal subjects. During the study, 4 dialysis exchanges with 1.36 g/dl dextrose concentration were performed daily; regular insulin was added to the bags in diabetic patients. Our data show a well-controlled mean blood glucose in CAPD diabetic patients by intraperitoneal insulin administration as well as higher insulinemic levels in comparison with those of normal subjects. Plasma lactate and serum glycerol levels were higher and butyrate levels were lower reflecting a continuous ketogenesis inhibition.

ISSN:1660-8151    

DOI:10.1159/000185058

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

We examined the response of 8 patients with nephrotic syndrome (creatinine clearance 70.4 ± 16.0 ml/ min) to oral furosemide (F; 40 mg) in the absence (control) and in the presence of oral hydrochlorothiazide (HCT; 100 mg). In the 24-hour period after oral F, HCT was shown to increase urine volume and urinary sodium and chloride excretion. Increment was most significant during the 12- to 24- hour period. Enhancement of the diuresis with HCT was associated neither with a significant increase in the area under the curve of plasma F concentration nor an increase in urinary F excretion. Urinary excretion of glucuronidated F, one of the main metabolites of F, however, was decreased with HCT. In summary, HCT significantly enhanced the response to F in nephrotic patients

ISSN:1660-8151    

DOI:10.1159/000185059

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

A high mortality rate due to thromboembolic accidents has been described in patients undergoing chronic haemodialysis. This type of complications, although recognized, has not been appropriately evaluated in continous ambulatory peritoneal dialysis patients. The present study demonstrates that continuous ambulatory peritoneal dialysis patients present in vivo platelet hyperreactivity, as evidenced by enhanced platelet responses to epinephrine ex vivo and an increased MDA/MDAa index which traduces a decreased threshold for activation of the arachidonate pathway and subsequent thromboxane production. Since the etiopathogeny of this platelet abnormality seems to be related to abnormalities in lipid metabolism, compounds such as fish oil must be beneficial in the management of this risk factor.

ISSN:1660-8151    

DOI:10.1159/000185060

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Insulin induced hypoglycemia was produced in 5 chronic hemodialysis patients and 5 normal controls. Normally, several counterregulatory hormones (cortisol, growth hormone, glucagon and epinephrine) are secreted. Although we did not measure glucagon in our study, the other hormones were found to respond normally to the hypoglycemia in the control subjects. In the dialysis patients plasma epinephrine response was normal, but no responses of plasma ACTH, cortisol and growth hormone were found. Failure of the other counterregulatory hormones to respond to hypoglycemia indicates that dialysis patients probably maintain their euglycemic state by increasing plasma glucagon and epinephrine concentrations. We were unable to confirm the expected decrease of catecholamines that has been reported during hemodialysis.

ISSN:1660-8151    

DOI:10.1159/000185061

出版商:S. Karger AG    

年代:1988

数据来源: Karger