ISSN:1660-8151    

DOI:10.1159/000186727

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Serum uric acid has been described as being increased in the prediabetic stage of diabetes mellitus and as being decreased in overt diabetes. In this study we compared the serum uric acid levels of patients with insulin-dependent diabetes mellitus (IDDM) to those of controls matched for sex, age and ethnic origin. Also the correlation between serum uric acid levels and the fractional excretion of uric acid in IDDM patients was investigated, as well as the correlation between glycosuria and the fractional excretion of uric acid. The mean serum uric acid was lower in IDDM patients than in normal controls (4.0 ± 1.3 vs. 4.3 ± 1.3 mg/ 100 ml; p < 0.03), mainly due to significantly lower levels in male and Ashkenazi IDDM patients, as compared to their respective controls. The fractional excretion of uric acid was found to be elevated in IDDM patients: 13.0 ± 8.6% (mean ± SD). A significant negative correlation was found between serum uric acid levels and the fractional excretion of uric acid in IDDM patients (p < 0.001), although not when the males were examined separately. We found no correlation between the fractional excretion of uric acid and the degree of glycosuria in IDDM patients. In addition, the prevalence of hypouricemia (serum uric acid < 2.5 mg%) was the same in IDDM patients and contr

ISSN:1660-8151    

DOI:10.1159/000186728

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The melatonin status of patients in end-stage chronic renal failure (CRF) was evaluated by the determination of daytime plasma melatonin levels and by the investigation of the circadian rhythmicity of melatonin secretion. A significant increase in plasma melatonin concentration was found in all CRF patient groups investigated, i.e. CRF patients on conservative treatment (CT; n = 48), CRF patients on maintenance haemodialysis treatment (HD; n = 39) and CRF patients on peritoneal dialysis (PD; n = 32). Successful transplantation led to a marked reduction in plasma melatonin levels. The circadian rhythm of melatonin secretion would appear to be suppressed in CRF as the nocturnal secretory surge was absent in all HD patients and in 80% of the posttransplantation patients studied.

ISSN:1660-8151    

DOI:10.1159/000186729

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We examined the effect of excess factor D on the alternative pathway of complement (APC). First, we demonstrated that the production of C3a is accelerated in the fluid-phase with the addition of purified factor D. Analysis by sodium dodecylsulfate polyacrylamide gel electrophoresis under reducing conditions showed that the serum iC3b level was elevated when incubated with excess factor D. Secondly, we demonstrated, by measuring the C5a-des-Arg level, that the generation of C5a was promoted in the fluid-phase with the addition of purified factor D. We then studied whether activation of APC is elevated in the blood of patients on maintenance hemodialysis whose sera contained a high concentration of factor D. First, we detected, by fluorescence activated cell sorter analysis, greater amounts of C3d on erythrocytes from the patients (mean fluorescence intensity ± SD: 7.7 ± 1.7 arbitrary units) than those from healthy individuals (5.4 ± 0.5 arbitrary units; p < 0.001). Secondly, serum C3 level was significantly lower (p < 0.001) in patients (mean ± SD: 63.3 ± 8.2 mg/dl) than in healthy individuals (84.8 ± 9.5 mg/dl), whereas there was no difference in serum C4 level between patients (32.4 ± 6.9 mg/dl) and healthy individuals (33.0 ± 7.4 mg/dl). Serum C5 level was almost the same in patients (10.5 ± 1.5 mg/dl) and in healthy individuals (11.2 ± 1.3 mg/dl). These results provide supportive evidence of elevated APC activation in patients with high serum

ISSN:1660-8151    

DOI:10.1159/000186730

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Sixteen of 110 hemodialysis (HD) patients fulfilling criteria of non-A, non B hepatitis (NANBH), i.e. alanine aminotransferase (ALT) > 50 U/ml in the absence of both serologic markers for acute HBV and HAV infections and clinical evidence of another cause of hepatitis, were tested for the presence of antibodies against hepatitis C virus (anti-HCV) by enzyme immunoassay (Ortho, Diagnostics). All (100%) were anti-HCV-positive. There were 5 patients with a monophasic (M) rise pattern (1 or 2 ALT rises), and 11 cases demonstrated a polyphasic (P) rise elevation pattern (more than 2). The mean ALT value of the M group was 202.3 ± 209 U/ml and that of the P group was 116.6 ± 39.1 U/ml. The patients received a mean of 19.1 ± 16.2 units of packed red cells during the follow-up period (69.9 months). Only 1 patient received no blood transfusion. Six patients had a past HBV infection and 3 became HIV-infected in the course of this study. The high rate of infection of hemodialysis patients with hepatitis C virus in our setting points to the need for improved control measur

ISSN:1660-8151    

DOI:10.1159/000186731

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The purpose of this study is to evaluate the place of intravenous 1α-hydroxyvitamin D3 (1α-OH-D3) in the prevention of radiologically obvious hyperparathyroidism (HPT) in patients on maintenance dialysis while excluding aluminium phosphate binder and using a dialysate calcium concentration of 1.62 mmol which keeps the intradialytic calcium balance neutral. Therefore, 47 patients without subperiosteal resorption and previously treated by oral CaCO3 and if necessary Mg(OH)2 as phosphate binder while their dialysate calcium had a Ca level of 1.62 and a Mg level of 0.2 mmol/l were randomized into a control group of 24 who were maintained on the same treatment and an experimental group of 23. This group discontinued CaCO3 and received intravenous 1α-OH-D3 after each dialysis at increasing doses up to 4 μg and increased Mg(OH)2 as their sole phosphate binder. When plasma Ca increased above 2.7 mmol/l, the dose of 1α-OH-D3 was decreased. When plasma P04 increased above 2 mmol/l, the dose of Mg(OH)2 was increased to the highest dose not inducing diarrhea, hypermagnesemia ( < 2 mmol/l) or hyperkalemia ( < 6 mmol/l). In case of persistent hyperphosphatemia, the dose of 1α-OH-D3 was decreased. Since mean plasma alcaline phosphatase was normal, HPT was monitored on the plasma concentration of 1-84 PTH for which a previous histological study showed that frank osteitis fíbrosa was present only when they were above 70 pg/ml, i.e. (about twice the upper limit of the normal value). Before the study, plasma PTH was below this limit in 16 patients of the CaCO3 group and in 14 patients of the 1α-OH-D3 group. After 6 months, they remained below this limit in all patients except 2 of each group. Plasma PTH was initially above 70 pg/ml in 8 of the CaCO3 and did not change significantly throughout the study, 2 patients having at 6 months a PTH level below 70 pg/ml. In contrast with intravenous 1α-OH-D3, all the 9 patients with initial frank HPT decreased their PTH levels after 2 months, the levels being below 70 pg/ml in 6 cases. However, because of hypercalcemia and/or of hyperphosphatemia in spite of a highest tolerable dose of Mg(OH)2, 1α-OH-D3 doses had to be decreased down to 0.4 μg per dialysis at the 6th month so that at 6 months 6 of 9 patients had their PTH levels above 70 pg/ml, a number comparable to that of patients treated with CaCO3 (6 of 8). Conclusion: (l) CaCO3 and intravenous 1α-OH-D3 are comparably capable of preventing HPT in two thirds of the dialyzed patients; (2) only intravenous 1α-OH-D3 is able to correct an established frank HPT but this correction is only transient when Mg(OH)2 is the sole phosphate binder. As a matter of fact, the highest tolerable doses of Mg(OH)2 cannot prevent the hyperphosphatemia worsening induced by intravenous 1α-OH-D3, which leads to a decrease of the dose of 1α-OH

ISSN:1660-8151    

DOI:10.1159/000186732

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We investigated the incidence of painless (silent) myocardial ischemia, manifested as S-T segment deviation, by Holier ECG monitoring in patients with chronic renal failure undergoing regular hemodialysis. Forty-five patients underwent Holier ECG monitoring for a continuous 48-hour period covering dialysis and the intermediate period of everyday activity at home. ECG criteria for ischemia were found in 15.5% of patients mainly during and immediately after dialysis with a simultaneous increase of R, S, R+ S amplitude. There was no correlation of S-T segment deviation with the existence of cardiac dysfunction and coronary artery disease proved by hemodynamic and angiographic studies. It is concluded that hemodialysis itself seems to play an important role in the genesis of the above ECG findings, possibly by means of serum K and Mg changes.

ISSN:1660-8151    

DOI:10.1159/000186733

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

In order to clarify the minimum requirements for renal biopsy size for a more accurate interpretation of renal biopsy information by light microscopy, we reanalyzed 92 open renal biopsy specimens in 92 patients with IgA nephropathy retrospectively. The mean number of functioning glomeruli per square millimeter in open renal biopsy specimens from 38 patients with a poor outcome was 1.2 ± 0.4. In contrast, the mean number in 54 biopsy specimens from 54 patients with stable conditions for 10 years was 3.0 ± 0.6. Therefore, there was a significant reduction (p < 0.0001) in the numbers of functioning glomeruli in patients with a poor outcome. We found that the most important point in predicting the severity of tissue damage was detection not of the total numbers of glomeruli but of the density of glomeruli in given specimens in patients with IgA nephropathy. A biopsy sample of 1 mm × 7 mm in size of cortical origin is the minimum necessary to confidently interpret biopsy specimens from patients with IgA nephropat

ISSN:1660-8151    

DOI:10.1159/000186734

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Heparin cofactor II (HCII) is a thrombin inhibitor in human plasma which displays similarities with antithrombin III (ATIII). Hereditary HCII deficiency was recently reported to be associated with thrombophilia. Since thromboembolism constitutes one of the main complications of the nephrotic syndrome (NS), both activities and antigen concentrations of HCII and ATIII were measured in the plasma and urine of 33 adult patients with nephrotic syndrome. The mean HCII plasma level was significantly increased whereas the ATIII level was decreased. Plasma HCII was significantly correlated with proteinuria and with the fibrinogen level, suggesting that HCII could act as an acute phase reactant in patients with NS. HCII antigen was detectable in 16 of the 24 available urine samples, whereas ATIII antigen was present in all of them. In addition, functionally active HCII was detected in most of the urine samples containing HCII antigen, while ATIII was only present in the inactive form. In conclusion, these findings suggest that HCII is submitted to a metabolic pathway different from that of ATIII in patients with NS.

ISSN:1660-8151    

DOI:10.1159/000186735

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

To elucidate the relationship between localization of β2-microglobulin (β2-MG) and renal lesions or dysfunction, 119 patients with various renal diseases and various degrees of renal injuries were examined: patients with β2-MG deposition (group 1, n = 69), and patients without renal β2-MG deposition (group 2, n = 50). β2-MG was found mainly in the tubular epithelium and tubular casts. No significant difference in the degree of proteinuria and hematuria were found between the two groups. Group 1 had a significant decrease in glomerular filtration rate (GFR; p < 0.01): the average values of GFR in group 1 and 2 were 61.1 ± 35.7 and 95.4 ± 34.5 ml/min. Group 1 had a significant decrease in the phenolsulfonphthalein excretion test (p < 0.01) and the maximum urine specific gravity in Fishberg’s concentration test (p < 0.02). Group 1 had a significant high incidence of glomerular sclerotic lesions (p < 0.001), arteriolar elastosis (p < 0.01), tubulo-interstitial changes (p < 0.001) and renal deposition of lysozyme (p < 0.001). The present study demonstrates that the immunohistological study of renal β2-MG deposition is a reliable method to identify renal dysfunction and renal injuries, especially the presence of tubulo-interstitial changes, in various renal

ISSN:1660-8151    

DOI:10.1159/000186736

出版商:S. Karger AG    

年代:1992

数据来源: Karger