ISSN:1660-8151    

DOI:10.1159/000187205

出版商:S. Karger AG    

年代:1993

数据来源: Karger

ISSN:1660-8151    

DOI:10.1159/000187206

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

A previous short-term study of 10 weeks in 8 patients had shown us that with half the dose of elemental calcium, calcium acetate (CaAc) could control predialysis plasma phosphate (PPO4) as well as calcium carbonate (CaCO3) but that the incidence of hypercalcemia was not decreased. To better appreciate the value of CaAc in comparison to CaCO3, CaAc was given to 28 patients on chronic hemodialysis (6 men, 22 women, age 61 ± 14 years; dialyzate Ca: 1.5 mmol/l) for 6 months to replace CaCO3 at half the dose of elemental calcium (1,235 ± 521 versus 2,375 ± 1,470 mg/day). Because of gastrointestinal intolerance, CaAc had to be discontinued in 5 patients after 1-5 months. Magnesium hydroxide [Mg(OH)2] given in 18 of them in association with CaCO3 was discontinued and reintroduced in 6 patients in order to keep PPO4 < 2 mmol/l. Mean dosage of Mg(OH)2 was 2.09 ± 1.4 g/day with CaCO3 and 0.9 ± 0.5 with CaAc. Predialysis plasma concentrations of calcium and phosphate were monitored weekly during the 3 months of the control period under CaCO3 and during the 6-month administration of CaAc. Plasma calcium (PCa) was comparable with the 2 treatments (2.47 ± 0.11 vs. 2.5 ± 0.10 mmol/l), but PPO4 was significantly lower with CaAc (1.82 ± 0.26 vs. 1.73 ± 0.23 mmol/l). Plasma alkaline phosphatase remained constant (122 ± 66 vs. 122 ± 70; normal < 170 UI/l) as well as plasma intact PTH (121 ± 153 vs. 121 ± 146; normal 2.7 mmol/l) was present in 11 patients with CaCO3 and in 16 patients with CaAc, and its incidence did not decrease with CaAc (8.2 vs. 8%). In conclusion, this long-term study confirms that CaAc is a more efficient PO4 binder than CaCO3. However, its gastrointestinal tolerance seems poorer and the incidence of hypercalcemia is not decreased. The paradox of the unchanged incidence of hypercalcemia with acetate in spite of a reduction by half of the amount of calcium ingested may have two explanations: the very presence of a lower plasma PO4 concentration (by a physicochemical mechanism) and the possible greater bioavailability of the calcium for absorption when it i

ISSN:1660-8151    

DOI:10.1159/000187207

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

150 episodes of allograft dysfunction in 128 renal transplant recipients, 77 due to acute rejection, 32 secondary to acute-on-chronic rejection, 33 due to either prerenal factors, acute tubular necrosis, or ciclosporin A nephrotoxicity, and 8 secondary to multiple causes, were evaluated by fine-needle aspiration biopsy (FNAB), Doppler ultrasound (DUS), and radionuclide scintigraphy (RS), each performed within a 24-hour period and prior to any specific therapeutic intervention. Tests were interpreted by appropriate specialists in a large transplant center without access to clinical information. The final diagnosis was based primarily upon response to therapeutic maneuvers with histological (core biopsy) confirmation in 123 episodes. RS was the most sensitive (70%) test for the diagnosis of acute rejection during the early posttransplant period, exceeding both FNAB (52%) and DUS (43%). The predictive accuracy of either FNAB, DUS, RS, or core biopsy in the detection of a steroid-responsive component to acute rejection when superimposed upon chronic rejection was low at approximately 50%. When the underlying cause of renal dysfunction was either prerenal, acute tubular necrosis, or ciclosporin A nephrotoxicity, FNAB, DUS, and RS each gave an erroneous diagnosis of acute rejection in about 50% of the episodes. Cost analysis revealed that core biopsy was the most expensive test, but only 9% more than RS, with FNAB the least costly. In conclusion, the lack of ideal sensitivity and specificity combined with the expense of present-day FNAB, DUS, RS, and core biopsy in the diagnosis of a therapeutically reversible component to acute-on-chronic rejection and of FNAB, DUS, and RS in the diagnosis of acute rejection during the early posttransplant period should prompt research into ways to improve their diagnostic yield or alternate modalities.

ISSN:1660-8151    

DOI:10.1159/000187208

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

We measured plasma parameters of the prothrombotic state, namely thrombin-antithrombin III complex (TAT), fíbrinopeptide A (FPA). D-dimer (DD), von Willebrand factor (vWF), tissue-type plasminogen activator (tPA), β-thrombo-globulin (βTG), platelet factor 4 (PF4) and serotonin (5HT) in a series of 51 adult patients with chronic uremia: 22 were on maintenance hemodialysis (MHD) and 29 on conservative dietary treatment. Serum tumor necrosis factor α (TNF) was determined as well. Uremics presented significantly higher levels of TAT, FPA, DD, vWF, TNF, βTG and 5HT than normal controls. Patients on conservative treatment showed lower levels of TAT, DD, TNF and βTG than patients on MHD. Our results provide evidence that a prothrombotic state exists in chronic uremia and that MHD patients have a higher degree of hypercoagulation. Both hemodialysis procedure and uremia-related factors are likely to contribute to the hemostatic derang

ISSN:1660-8151    

DOI:10.1159/000187209

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Hyperlipidemia is associated with accelerated glomerular sclerosis in experimental renal insufficiency. To investigate whether the dyslipoproteinemia seen in human renal failure also influences the future course of renal insufficiency, we have correlated plasma levels of lipids and apolipoproteins at start of follow-up with the subsequent change in renal function in 34 adult patients with chronic renal disease. Nineteen patients had primary renal disease, and 15 patients had diabetic nephropathy. Except for antihypertensive therapy no specific treatment to modify the progression of the disease was given during the follow-up. The rate of progression was determined by repeated measurements of the glomerular filtration rate (GFR). The time of follow-up ranged from 12 to 91 months with an average of 39.7 ± 16.7 months. The mean initial GFR was 34.7 ± 13.9 ml/min× 1.73 m2 body surface area and the average decline in renal function was -0.27 ± 0.26 ml/min/month. The entry levels of triglycerides (TG; p = 0.04), very-low-density lipoprotein cholesterol (p = 0.03), apolipoprotein-B (ApoB; p = 0.008) and systolic blood pressure (SBP; p = 0.04) were significantly correlated with the rate of progression. Among lipoprotein variables, ApoB showed the strongest correlation with the decline in GFR. Patients with a progressive course of their disease also tended to have initially higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (NS), whereas the initial plasma concentration of high-density lipoprotein cholesterol did not show an association with the progression of renal insufficiency. The rate of progression was shown to be much higher in patients with initially high levels of both ApoB and SBP than in patients with initially low levels of these variables. There was no difference between diabetic and nondiabetic patients with respect to initial ApoB and BP levels and the rate of progression. The results of this study suggest that altered lipoprotein metabolism has a significant effect on the progression of renal failure. In particular, increased plasma concentrations of ApoB-containing lipoproteins seem to be linked to a more rapid development of renal insufficiency, and the combination of dyslipoproteinemia and hypertension may act synergistically to promote the progression of chronic renal fail

ISSN:1660-8151    

DOI:10.1159/000187210

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

To study the specificity of gut hyperpermeability in primary glomerulonephritis, we investigated intestinal permeability by means of 51Cr-EDTA testing in 20 healthy individuals and in 30 patients with Immunoglobulin A nephropathy (IgA GN), 25 with idiopathic nephrotic syndrome (INS) and 20 with immune complex glomerulonephritis (IC-GN; membranous + membranoproliferative glomerulonephritis). Gut permeability was statistically increased in each patient group versus the controls [controls: 2% (0.4-3.9); IgA GN: 3.25% (0.7-17.70); INS: 3.71% (0.82-10); IC-GN: 3.40% (0.30-16); results are median (range); p < 0.005, nonparametric Mann-Whitney test]. An increase in intestinal permeability exceeding the upper limit of control values (95th percentile) was observed in 36% of IgA GN, 60% of INS and 50% of IC-GN patients. We conclude that intestinal permeability is frequently increased in primary glomerulonephritis and may also be increased in types of glomerulonephritis other than IgA GN.

ISSN:1660-8151    

DOI:10.1159/000187211

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

To study the influence of cardiovascular damage on plasma endothelin in chronic renal failure, we have measured the plasma concentration of this peptide in 32 uremic patients (7 undialyzed uremics, 8 CAPD patients and 16 hemodialysis patients) and in 9 healthy subjects. Sixteen patients had severe cardiovascular damage while the other 16 had no cardiovascular involvement. Endothelin was markedly raised (p < 0.01) in the uremic group as a whole (13.9 ± 2.6 pmol/l) in comparison with the group of healthy subjects (8.6 ± 1.6 pmol/l). Hemodialysis patients displayed endothelin levels much higher (p < 0.01) than CAPD patients and undialyzed uremics. Endothelin was directely related with BUN (r = 0.37) and with serum creatinine (r = 0.52) in dialysis patients. Similar correlations were also found in undialyzed uremics. Plasma endothelin was almost identical in patients with severe cardiovascular damage (15.5 ± 1.6 pmol/l) and in those without cardiovascular involvement (15.9 ± 2.6 pmol/l). There was no relationship between arterial pressure and plasma endothelin. Residual renal function is an important determinant of circulating endothelin even at very advanced stages of renal insufficiency. It appears unlikely that atherosclerosis plays a major role in the pathogenesis of high plasma concentration of this peptide in uremic patie

ISSN:1660-8151    

DOI:10.1159/000187212

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

Evidence that an increase in plasma atrial natriuretic peptide (ANP) concentrations mediates, at least in part, glomerular hyperfiltration in diabetic rats prompted us to study the relationship between ANP and renal haemodynamics in hyperfiltering type 2 diabetic patients in association with other hormones implicated in the control of glomerular filtration rate (GFR) (catecholamines, vasopressin, renin) and in sodium tubular transport (aldosterone, ouabain-dis-placing factor, ODF). Since hyperglycaemia is also associated to hyperfiltration, diabetic patients who presented with secondary drug failure were studied both in hyperglycaemic and in normoglycaemic condition. For this purpose, 11 normo-tensive non-macroproteinuric hyperfiltering patients with type 2 diabetes were treated with an 8-day continuous insulin infusion (days 0-7). Dehydration was prevented or corrected and natriuresis was on day 0 above 100 mmol/day. The following parameters were determined on days 0 and 7: GFR and renal plasma flow (RPF) by 99mTc-DTPA and 131I-hippuran clearances; the extracellular volume, assimilated to the DTPA diffusion volume; urinary ODF by receptor-binding assay and urinary as well as plasma catecholamines by HPLC after extraction on alumin. Plasma ANP and antidiuretic hormone (ADH) were measured by radioimmunoassay after extraction on phenyl-silylsilica (ANP) and with ether (ADH). Unextracted plasma was used for radioimmunological measurement of plasma renin activity and aldosterone. When correcting hyperglycaemia to normoglycaemia GFR decreased from high to normal mean value (138 ± 27 and 115 ± 6 ml/min, p < 0.001), RPF followed the same trend, and the DTPA diffusion volume did not change. Hormone concentrations remained unchanged in the normal range, with the exception of plasma adrenaline and natriuretic hormones: the urinary ODF/creatinine ratio decreased from 7.05 ± 0.86 to 4.89 ± 0.77 nmol/mmol while plasma ANP increased (both p < 0.05). There was no correlation between GFR and hormonal concentrations neither on day 0 nor on day 7 and no correlation was found between their respective changes after insulin infusion. In conclusion, at least on the basis on plasma measurements, ANP does not seem to be involved in the pathogenesis of glomerular hyperfiltration or in the decrease of GFR with correction of hyperglycaemia in human type 2 diabe

ISSN:1660-8151    

DOI:10.1159/000187213

出版商:S. Karger AG    

年代:1993

数据来源: Karger

摘要:

During bicarbonate hemodialysis, there is an increase in peripheral vascular resistance of nonadrenergic origin, counteracting the hypotensive effect of fluid removal during the course of the dialysis. In this study, the plasma levels of vasoactive regulatory peptides, noradrenaline and renin, were investigated in 11 patients with chronic renal failure during standard bicarbonate hemodialysis (STHD) for 270 min. As regards vasoconstrictors, an increase in γ2-melanocyte-stimulating hormone (γ2-MSH), neuropeptide Y (NPY) and plasma renin activity (PRA) occurred. However, arginine vasopressin and noradrenaline were unchanged. With respect to vasodilators, calcitonin gene-related peptide was not changed. An initial increase in β-endorphin (β-END) occurred, followed by a decrease during the remaining part of the treatment. Motilin decreased during the first part of the treatment but increased to the baseline level during the latter part. An increase in substance P was observed while vasoactive intestinal peptide decreased. We conclude that an increase in vasoconstricting substances (γ2-MSH, NPY, PRA) occurs during STHD, probably owing to the decrease in plasma volume. With the exception of β-END, the changes in vasodilators were fairly small. The data suggest that vasoactive substances might participate in the hemodynamic response to hemodia

ISSN:1660-8151    

DOI:10.1159/000187214

出版商:S. Karger AG    

年代:1993

数据来源: Karger