摘要:

9 patients with primary glomerulopathies and slowly progressive renal failure were treated by regular plasma exchanges without immunosuppressive drug therapy. All 3 patients with the subendothelial type of mesangiocapillary glomerulonephritis (MCGN-I) had no progression of their renal failure while undergoing plasma exchanges. The creatinine rose when treatment was stopped and fell again in 2 pagients who restarted plasma exchange. 2 patients with hypocomplementaemia and dense deposit disease (MCGN-II) and all 3 patients with idiopathic membranous nephropathy (IMN) did not benefit. 1 patient with normo-complementaemic MCGN-II had some improvement in renal function which lasted 18 months. Proteinuria fell or was unchanged during the 1st month of plasma exchange in the 4 who improved and increased in the 5 who did not. The response to plasma exchanges could not be attributed to removal of circulatory complexes or changes in reticulo-endothelial function. Regular 2.8-litre plasma exchanges using 4.3% immunoalbumin proved to be safe for periods up to 44 months. Regular plasma exchange appears to prevent progression to renal failure in patients with MCGN-I.

ISSN:1660-8151    

DOI:10.1159/000183504

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

To find out why most patients with the nephrotic syndrome maintain a normal blood volume despite a reduced plasma colloid osmotic pressure (COP), we measured the transcapillary (plasma-tissue fluid) COP difference in 12 patients with the nephrotic syndrome, as well as in 6 patients during complete (n = 3) and partial (n = 3) recovery. Subcutaneous nylon wicks were used to collect tissue fluid. The albumin content was also measured. The albumin content and COP were lowered in both plasma and tissue fluid in the nephrotic phase, and rose gradually during recovery. During these changes the transcapillary COP difference only rose slightly: from 6.2 ± 1.7 mm Hg when the plasma COP was below 10 mm Hg (n = 11) to 8.7 ± 1.5 mm Hg when the plasma COP exceeded 20 mm Hg (n = 12). These observations indicate that in hypoproteinemia preservation of the intravascular volume is strongly dependent on maintenance of the difference in oncotic pressure across the capillary wal

ISSN:1660-8151    

DOI:10.1159/000183505

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

An improved purification method for isolating an immunosuppressive fraction from uremic ultrafiltrates was described. Lyophilized ultrafiltrates were fractionated on Sephadex G-15 and the active fraction was further purified using high-performance liquid chromatography. The inhibitory effect of eluates on in vitro lymphocyte proliferation was assessed at the different steps of purification. Results obtained after enzyme treatment suggested that the substance(s) responsible for the immunosuppressive activity is (are) of peptidic nature. This peptide appears to be different from the other peptides previously reported, which have a much lesser activity in the lymphocyte proliferation assay.

ISSN:1660-8151    

DOI:10.1159/000183506

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

A simplified method of renal scintigraphy carried out with 1311-Hippuran and 99mTc-DTPA diethylenetriaminopentacetate is described in man. Results were expressed as tubular clearance (with Hippuran) and glomerular clearance (with DTPA) per kidney, and compared to PAH and inulin clearances measured in the same patients. There was a close positive correlation between clearances calculated by means of renal scintigraphy and those measured by standard procedure for studying renal function. This study showed that a simple calculation allowed to express scintigraphical findings in terms of clearance.

ISSN:1660-8151    

DOI:10.1159/000183507

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

We determined carbamylated plasma protein (CPP) according to the method of Hunninghake in patients with renal failure and normal subjects. CPP values were significantly higher in patients with renal failure than in normal subjects. In patients with renal failure, a significant correlation was found between CPP levels and blood urea nitrogen. Thus, CPP appears to be a new indicator of the status of renal failure, irrespective of hemodialysis.

ISSN:1660-8151    

DOI:10.1159/000183508

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

After the discovery of sleep apnea in 2 patients receiving chronic maintenance hemodialysis, we decided to survey all 29 male patients undergoing outpatient dialysis for symptoms suggestive of sleep apnea. 12 of 29 (41%) had positive clinical histories. 8 of these patients consented to undergo all-night polysomnography. 6 were found to have sleep apnea which was primarily obstructive in type. Recent information has implicated testosterone administration in the development of obstructive sleep apnea. Therefore, polysomnography was performed in 5 of the patients both on and off weekly testosterone injections which they were receiving to stimulate erythropoiesis. There was no change in sleep complaints or a decrease in the number of apneas and hypopneas off therapy. Sleep apnea should be considered in symptomatic male dialysis patients. Its causation is presently unknown but it does not appear to be solely related to the administration of testosterone.

ISSN:1660-8151    

DOI:10.1159/000183509

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

5 cases of sarcoidosis with normocalcemic granulomatous nephritis and renal impairment are described. 24 earlier reported cases with normocalcemic granulomatous nephritis of sarcoidosis were extracted from the literature and reviewed together with the present cases. GFR was normal ( > 80 ml/min) in 2 of the patients, slightly to moderately decreased (80–20 ml/min) in 14 patients, and severely decreased ( < 20 ml/min) in 13 patients. The patients (19 males and 10 females) were 12–68 (median 45) years old. All patients with GFR less than 10 ml/min were more than 43 years old. 1 patient died in terminal uremia on admittance. All but 1 of the patients treated with corticosteroids improved (22 patients) or stabilized (5 patients) at least initially. 1 patient treated with a relatively low dose of a corticosteroid progressed to terminal uremia. 8 patients had a relapse when the corticosteroids were tapered or discontinued. 12 of the patients had residual renal impairment after initial successful treatment and in 4 cases the impairment worsened after a corticosteroid-sensitive relapse. It could be concluded from the study that an initial corticosteroid dosage of 1 mg prednisolone/kg B W or more should be used in granulomatous nephritis of sarcoido

ISSN:1660-8151    

DOI:10.1159/000183510

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Acute renal failure due to tubulo-interstitial nephritis developed in a 15-year-old girl. The disease was accompanied by uveitis and an inflammatory syndrome, consisting of a markedly increased erythrocyte sedimentation rate and high serum gamma globulin levels. The nephropathy as well as the inflammatory syndrome subsided spontaneously. A topical antiphlogistic treatment healed the ocular disease, which has not relapsed so far. The association of acute tubulo-interstitial nephritis and acute uveitis observed in several patients has led to the identification of a specific syndrome with a very particular symptomatology and course, the so-called TINU syndrome, the interest of which resides in the predictability of the complete reversibility of the nephropathy either spontaneously or after steroid treatment, contrasting with the marked tendency towards relapse of the uveitis. The demonstration of circulating immune complexes in the serum during the acute phase of the illness, as in our patient, further points to the involvement of immune processes in the syndrome, but the origin and pathogenesis remain as yet unknown.

ISSN:1660-8151    

DOI:10.1159/000183511

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

To further define the platelet abnormality responsible for uremic bleeding, we studied platelet aggregation with adenosine diphosphate, ristocetin, and collagen in serum fractions obtained by Sephadex G-15 chromatography. We found that uremic patients had considerable inhibition in several peaks of middle molecular range, but the findings were inconsistent and not clearly related to the degree of uremia.

ISSN:1660-8151    

DOI:10.1159/000183512

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Plasma renin activity (PRA), plasma aldosterone (PA), blood uric acid (BUA), plasma concentrations of catecholamines (Peat) and plasma volume (PV) were measured simultaneously in 24 patients with pregnancy-induced hypertension. This hypertensive group was divided into labile (LH) and permanent hypertension (PH) groups according to the response of their blood pressure to home bed rest. As compared to normal theoretical values, PV was decreased in both hypertensive groups (LH = -7%; PH = -14%). As compared to a control group of 16 normotensive pregnant women, PRA was higher in LH and lower in PH whereas PA was lower in both hypertensive groups. In both hypertensive groups, BUA was higher than in the control group. No difference in Peat was found between the three groups. In the PH group negative correlations were found between BUA and PRA, as well as between BUA and PV, but no correlation between PRA and PV nor between Peat and BUA were found. Conclusions: (1) LH and PH are two pathophysiologically different entities in pregnancy-induced hypertension. (2) In PH, renin secretion is not appropriate to hypovolemia and therefore not primarily involved in the pathogenesis of hypertension. (3) The role of hypovolemia in the increase of BUA may be discussed.

ISSN:1660-8151    

DOI:10.1159/000183513

出版商:S. Karger AG    

年代:1985

数据来源: Karger