ISSN:1660-8151    

DOI:10.1159/000185137

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

The association between lipoprotein and apolipoprotein levels and the degree of renal failure was investigated in 72 conservatively treated patients with chronic renal disease. The progression of renal insufficiency was attended by marked increases in total triglycerides, and very-low-density (VLDL), low-density (LDL) and high-density (HDL) lipoprotein triglycerides. Total cholesterol was slightly elevated due to a rise in VLDL cholesterol. There was no change in LDL cholesterol, whereas HDL cholesterol decreased. Apo C-II and C-III showed distinct increases, their mass ratio decreasing only insignificantly. Apo B and A-I were unaffected by the degree of renal insufficiency, whereas apo A-II decreased. The findings reflect compositional changes within HDL and the accumulation to triglyceride-rich lipoproteins in chronic renal disease. The alterations in the plasma lipoprotein pattern were demonstrable even in early stages of renal failure and, therefore, may bear a serious risk for the acceleration of atherosclerosis.

ISSN:1660-8151    

DOI:10.1159/000185138

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

The kinetic parameters of high-density lipoprotein (HDL) and its major apolipoproteins (Apo) AI and Apo All were studied in 2 patients with moderate and severe proteinuria and 2 normal controls after intravenous injection of autologous 125I-HDL. The fractional catabolic rates (FCR) of HDL estimated by urine/plasma radioactivity ratio, and FCR of Apo AI and Apo All calculated from the radioactivity decay curves were higher in the patients. These results support the concept that high-density lipoproteinuria and renal parenchymal sequestration of HDL found in the nephrotic syndrome contribute to accelerated HDL catabolism.

ISSN:1660-8151    

DOI:10.1159/000185139

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Urinary protein excreted in active in situ immune complex glomerulonephritis (ICGN) was qualitatively analyzed by the comparison of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) patterns of urinary proteins from rats with Masugi GN, active Heymann GN (AHGN), and chronic serum sickness GN (CSSGN). In the SDS-PAGE analysis of urinary protein excreted in the active in situ ICGN and Masugi GN models, 200- and 145-kD macromolecules and low molecular weight components around 12 kD were excreted in large quantities at the full development stage ( > 100 mg/24 h urinary protein). These findings, however, were obscure or lacking in CSS-GN and AHGN at the peak of proteinuria. Electrophoretic patterns of urinary proteins including lower molecular weight proteins could be divided into two groups: either active in situ ICGN and Masugi GN or AHGN and CSSGN. These two groups corresponded to the differences of morphologic expression such as proliferative changes rather than degree of proteinuria. The location of immune complex formation and deposition, probably different among the experimental models, may play an important role for determining the mediation and nature of glomerular injury.

ISSN:1660-8151    

DOI:10.1159/000185140

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Nonspecific symptoms are common in dialysis patients but few methods are available to measure their severity and their response to alteration in dialysis therapy. To determine the clinical features and measure the severity of the most important symptoms in end-stage renal disease (ESRD) patients, 97 dialysis patients were interviewed, 63 of whom were reinterviewed 1 year later. For comparison 82 transplant recipients were also interviewed. The six most important symptoms in dialysis patients (using the product of the patient’s perception of severity and prevalence) were tiredness, cramps, pruritus, dyspnea, headaches and joint pain. The symptoms were long-standing, occurred frequently, with little difference in prevalence between hemo- and peritoneal dialysis patients, and were often unrelated to a hemodialysis session. For each symptom, several dimensions of severity were assessed including frequency, duration, effect on sleep, daily living, activity, subjective quality of life and necessity for drug therapy. Often these dimensions did not correlate with patient’s perception of severity. For each symptom these items were combined to give an aggregate score with a range 0–10. Interobserver reproducibility for each symptom score was > 0.7 but intraobserver reproducibility was poor for 3 symptoms, because of the fluctuating nature of the symptoms. Construct validity was demonstrated by finding a significantly worse distribution of aggregate scores for tiredness, cramps, pruritus, dyspnea and nausea/vomiting in dialysis compared to transplant patients. Aggregate scores changed little after 1 year’s follow-up in stable dialysis patients but significant improvement in the aggregate scores for tiredness, dyspnea and nausea/vomiting were observed in 14 patients after successful transplantation. Multi-dimensional aggregate scores for individual symptoms should be useful in comparing the efficacy of various dialysis regimes and in determining the etiology of different symptoms, provided account is taken of the fluctuating nature of some of these s

ISSN:1660-8151    

DOI:10.1159/000185141

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Protein-calorie malnutrition (PCMN) in patients suffering from chronic renal failure treated with a low-protein diet (LDP) is generally considered to be the major adverse effect of such a diet. One cause of PCMN might be that these protein-restricted diets do not supply enough energy, although all of them are supposed to provide at least 35 kcal/kg body weight (BW). In order to test this hypothesis, we analyzed the hypothetical protein and energy intake of a patient on different LPDs. The food intake of such a patient was simulated by analyzing the average composition of 28 complete daily menus. The daily menus simulating 9 dietary schedules (0.3 g protein/kg BW; n = 6; 0.6 g protein/kg BW; n = 3) were taken from 5 different German cookery books. Our analysis revealed that only 2 schedules supplied enough energy. All others were deficient in energy by about 500 kcal/day. The deficiency occurred to the same extent in schedules for diets providing 0.3 and 0.6 g of protein/day. Therefore we conclude that PCMN in patients on LPDs is often due to an insufficient energy supply. The use of less protein-restricted diets does not necessarily prevent PCMN, as also these diets may be low in calories. Thus the use of caloric supplements, e.g. wine or polysaccharides, and correct dietary counseling by a skilled dietitian are recommended.

ISSN:1660-8151    

DOI:10.1159/000185142

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Uremic patients are at high risk of hepatitis B virus (HBV) infection and, despite the availability and efficacy of hepatitis B vaccine, a high rate of non responders has been reported. Forty uremic patients undergoing maintenance hemodialysis who failed to produce any measurable anti-HBs antibody response after 4 administrations of 5 μg of Hevac B Pasteur vaccine were admitted to a randomized controlled clinical trial. Group A (14 patients) received 3 doses of 5 μg s.c. each of vaccine at monthly intervals and 12 doses of 50 mg s.c. of thymopentin on alternate days between the first and the second vaccination. Group B (11 patients) received 3 doses of 5 μgs.c. each of vaccine at monthly intervals. Group C (15 patients) received 3 doses of 10 μg s.c. each of vaccine at monthly intervals. Immunization rates were 86% in group A (on both 1-month and 6-month checks), 36% on the 1-month and 27% on the 6-month check in group B, 53% on the 1-month and 47% on the 6-month check in group C. Anti-HBs antibody titers were similar in group A and C but notably lower in group B. Thymopentin seems as useful therapeutical tool for non responder patients. As it promotes T cell maturation and responsiveness, which are impaired in uremia, it could play a major part in the management of uremic immunodeficie

ISSN:1660-8151    

DOI:10.1159/000185143

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

IgA nephropathy besides exhibiting a characteristic geographical distribution has been noted to have a low incidence in the blacks of the USA. There is a paucity of data on IgA nephropathy in the blacks of Africa. We report our findings among the blacks and compare these with Indians. An analysis of the primary glomerular diseases of 252 blacks and 75 Indians over 6 years (1981–1986) was done. Mesangiocapillary glomerulonephritis was the commonest type in the black (35.7%), whereas mesangial proliferative glomerulonephritis was the commonest in Indians (26.7%). IgA nephropathy occurred in 2 blacks (1 male, 1 female), whereas there were 10 Indians (8 males, 2 females). Available data among whites in Natal show that IgA nephropathy is not uncommon. HLA studies done in blacks with IgA nephropathy did not reveal the HLAB35 or the DR4 antigen. HLAB35 in our blacks is less common compared to Indians and whites of Durban. Thus, although glomerulonephritis is common in blacks, IgA nephropathy is rare. This suggests that infection which is common in our black population may not be responsible for the aetiology of IgA nephropathy. A dietary factor in the form of a high-fibre diet may protect the black population from IgA nephropathy. However, a genetic factor cannot be exclude

ISSN:1660-8151    

DOI:10.1159/000185144

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

A model of hematuria was established in rabbits. An accelerated form of unilateral Masugi nephritis was induced in 10 New Zealand white rabbits by an intravenous injection of duck antirabbit kidney serum and by ligating the left renal artery immediately after the injection of the antibody. All 10 rabbits became hematuric 1–2 weeks after the injection of the antibody and red blood cell (RBC) casts were found in the urinary sediment of all these animals. An ultrastructural examination of renal glomeruli by transmission electron microscopy revealed the transcapillary passage of polymorphonuclear leukocytes through the gaps of the glomerular basement membrane (GBM). RBC were found in the urinary space in 50% of the glomeruli observed by scanning electron microscopy (SEM) and the passage of leukocytes and RBCs through the glomerular capillary wall was also observed. Gaps in the GBM became clearer after the removal of cellular components by detergents. In control rabbits, no RBCs could be observed in the urinary space, and isolated GBM were intact by SEM. These data further support the hypothesis that in rabbit Masugi nephritis hematuria is a result of the passage of RBCs through gaps in the GB

ISSN:1660-8151    

DOI:10.1159/000185145

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

End-stage renal failure is a severe and relatively frequent complication of insulin-dependent diabetes, also representing the only growing cause of uremia requiring replacement therapy in Western countries. Five principal pathogenic factors are to be considered: genetic, immunologic, hemorheologic, biochemic, and hemodynamic; of these, nonenzymatic glycosylation of proteins and glomerular hyperfiltration appear to be most important. In the last few years, a better understanding of the natural history of type I diabetes has been gained, with particular significance attributed to the stage of the disease defined as incipient diabetic nephropathy which is characterized by microalbuminuria. However, advances in pathophysiologic notions have not always been followed by corresponding results in the prevention and therapy of diabetic nephropathy; possible reasons for this are briefly discussed. In spite of these uncertainties, the importance of achieving the best possible correction of glycemic homeostasis and of albeit initial elevations in the arterial pressure appears to be well established.

ISSN:1660-8151    

DOI:10.1159/000185146

出版商:S. Karger AG    

年代:1988

数据来源: Karger