ISSN:1660-8151    

DOI:10.1159/000185770

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

During the last 4 years, the Permcath Quinton double-lumen silicone catheter was inserted into the internal jugular vein of 57 uraemic patients with difficulty for creating conventional vascular access for haemodialysis. In 4 patients, with definitive contraindication of conventional vascular access, this catheter still permits haemodialysis after a duration of 8–25 months. In 25 further patients with terminal uraemia, but poor vein system, it allowed the maturation of an arteriovenous fistula after 2–14 months of use. In 17 patients already on chronic haemodialysis, but who lost abruptly their vascular access (15 grafts and 2 arteriovenous fistulae), it allowed a new arteriovenous fistula to mature in 16 cases after a mean duration of 7.3 ± months. In 5 patients with short life expectancy because of neoplasia, it allowed to dialyse them until their death which occured after 6.5 ± 2.2 months. In 6 patients with acute renal failure and haemostasis problems, it allowed to perform not only dialysis, but also plasmapheresis in 3 and parenteral nutrition in 3 other cases. The complications were the following: sepsis (n = 3); episodes of hypocoagulability due to inadvertent injection of heparin stored in the lumen (n = 2), thrombosis of the lumen (n = 3), and insufficient flow (n = 6). In no case these complications prevented continuation of haemodialysis. The catheter had to be removed in 2 cases because of septis and in 1 case because of insufficient flow. In 3 cases the catheter had to be replaced because of thrombosis and in 1 case because of laceration. These complication rates are, however, fewer than those reported in the literature for arteriovenous shunts or rigid subclavian and femoral catheters. The Permcath catheter seems, therefore to be the method of choice for immediated vascular access in patients in whom the creation of conventional vascular access is diff

ISSN:1660-8151    

DOI:10.1159/000185771

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

From July 1984 to December 1987,9 patients with lupus nephritis did not respond to the administration of two courses of methylprednisolone pulse therapy and cyclophosphamide treatment for 56 days. Therefore, high-dose intravenous human γ-globulin (IVIG) was administrated. Before IVIG therapy, renal biopsy showed class IV lupus nephritis in 5 cases, class V in 2 cases, and class IV with V in 2 cases. Immunofiuorescence of the renal biopsy showed heavy IgG deposits along the glomerular capillary walls. These heavy glomerular IgG deposits were dissociated after in vitro incubation of the cryostat kidney sections with plasmin-treated, PEG-treated, sulfonated human γ-globulin and a human Fc fragment, as evidenced by a dramatic decrease or even absence of fluorescent intensity. After high-dose IVIG treatment, 3 out of 5 cases of class IV lupus nephritis had a good response with decreased proteinuria and creatinine; serum C3, C4 levels and CH50 hemolytic activity also increased. The glomerular IgG deposits decreased in the follow-up biopsy. Pathologically, 2 of them transformed into class lib. The capacity to synthesize immunoglobulin after pokeweed mitogen stimulation was reduced and the circulating immune complexes (CIC) lowered after high-dose IVIG treatment. In the others there was partial response. These clinical and immunological improvements after high-dose IVIG therapy are probably related to the modulation of macrophage-T cell function and enhancement of suppressor T cell function. The toxicity of high dose IVIG was minimal, but the cost is high, search for an optimal dosage is warrante

ISSN:1660-8151    

DOI:10.1159/000185772

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

The distribution of the von Willebrand factor (vWF) as the factor-VIII-related antigen in glomeruli was examined by immunoelectron microscopy in 10 patients with idiopathic membranous nephropathy (MN), 8 patients with minimal-change nephrotic syndrome (MCNS), and 11 patients with IgA nephropathy (IgA-N). Electron-dense reaction products of vWF were observed in the endothelium and mesangium in all specimens examined. However, they were not detected in subepithelial electron-dense deposits of MN. The amount of electron-dense reaction products of vWF in the endothelium was significantly higher in MN than that in MCNS or IgA-N. This finding suggests that the glomerular endothelium in MN is the site of the local activation of coagulation and platelet aggregation system in glomerular capillary wall lesions.

ISSN:1660-8151    

DOI:10.1159/000185773

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Of 103 patients with the acquired immunodeficiency syndrome (AIDS) admitted for acute opportunistic infections, 36 had serum sodium less than or equal to 130 mEq/l (130 mmol/l). In 12 the hyponatremia was associated with volume depletion and corrected with saline replacement therapy. In 23 it was associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). One patient had adrenal insufficiency and the serum sodium corrected after steroid replacement. We conclude that hyponatremia is a common electrolyte abnormality in AIDS patients suffering acutely from opportunistic infections and that SIADH and volume depletion are important contributing factors.

ISSN:1660-8151    

DOI:10.1159/000185774

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

A rapid assay is described for detection of cytomegalovirus in peripheral blood lymphocytes. It consists of an indirect immunofluorescence technique for detection of cytomegalovirus antigens by means of a monoclonal antibody directed against early viral coded proteins. This assay was compared with the conventional cell culture system. Patients transplanted between December 1986 and May 1988 were studied, and of 27 patients identified, two were excluded due to early graft failure. A total of 320 blood specimens obtained were studied, and from 12 patients cytomegalovirus was isolated in at least one specimen by conventional cell culture (in total 25 specimens). Results were available with the new technique within 6 h, whereas the cell culture took an average of 13 days to develop the typical cytopathic effect changes. Sensitivity and specificity compared with that of viral isolation in conventional cell culture was 92 % and 95 %, respectively. This technique provides an accurate and rapid diagnosis of cytomegalovirus infections, and allows specific antiviral therapy to be started earlier.

ISSN:1660-8151    

DOI:10.1159/000185775

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Serum lipid abnormalities are a common feature of the nephrotic syndrome. It is suggested that this may influence the membrane lipid composition of red cells, which on the other hand may result in an abnormal sensitivity of red cells to lipid peroxidation. Therefore, lipids of plasma and red cell membranes from 7 patients with nephrotic syndrome and from 31 healthy control subjects were examined. In addition, the consequences for the hydrogen-peroxide-induced lipid peroxidation of red cells as an index for their capacity to compensate for oxidant stress was measured. All patients were anemic. Their red cells exhibited a significantly increased susceptibility to lipid peroxidation. Fatty acid analysis revealed a decreased proportion of linoleic acid in plasma and red cell membrane. The content of cholesterol in patients’red cell membranes was clearly diminished. It is shown that this abnormality was related to the enhanced sensitivity of their red cells for peroxidative stress. The present study shows that in addition to an impairment of red cells’ antioxidant enzymes, abnormalities of the membrane lipid composition should be considered investigating the cause for an increased susceptibility to lipid peroxidat

ISSN:1660-8151    

DOI:10.1159/000185776

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Glomerular morphological changes produced by 5-hour intravenous infusion of endotoxin (40 μg/kg/h) were studied in 57 rabbits. During endotoxin infusion all animals developed signs of endotoxemia, anemia, and transient leukopenia and thrombocytopenia. Acute renal failure also developed in all animals. By light microscopy a marked polymorphonuclear cell infiltration was the prominent finding within 1 h from the beginning of the infusion. At hour 5 fibrin deposits and thrombi were detected in most animals. The abnormalities were reversible. By electron microscopy endothelial damage was detected few minutes after the beginning of endotoxin infusion followed by leukocyte and platelet infiltration in glomerular capillaries. Fibrin appeared at hour 5 as free strands into the lumens or in large clumps along the luminal surface of endothelial layer. Occasionally, occlusive fibrin thrombi were seen. At hour 48 only mild endothelial damage was seen, associated with few polymorphonuclear cells in the glomerular capillary lumens. These results document the sequence of renal changes in the best available animal model of hemolytic uremic syndrome. Beside endothelial damage, leukocyte infiltration in glomerular capillaries is a prominent finding suggesting a role of inflammatory cells in the development of microvascular thrombosis

ISSN:1660-8151    

DOI:10.1159/000185777

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Complementary DNA (cDNA) probes were used to investigate the extrahepatic production of the major histocompatibility complex (MHC)-linked complement components C4, factor B and C2 in various normal human tissues. The presence of the corresponding messenger RNA (mRNA) was tested by Northern blot analysis. Complement C4 mRNA was found in liver, and with high intensity also in normal kidneys. In contrast, no C2 mRNA and only very low amounts of factor B mRNA could be detected in the kidney. Slot blot hybridization was performed to quantitate the amount of C4 mRNA, and the intensity of C4 mRNA hybridization in the kidney samples was about 25% compared with liver RNA. C4-specific transcripts were not present in isolated glomeruli but in the renal interstitium. Other human tissues, such as tonsil, spleen, thymus, brain, lung and peripheral mononuclear cells, contained no C4 mRNA. Low amounts of C4 mRNA were found in colon, thyroid gland, lymph node and breast carcinoma. The results obtained with lung, where C2 mRNA was found but no C4 mRNA, further indicate an independent, tissue-specific regulation of the class III gene expression. The results, showing that the complement C4 genes are transcribed very efficiently in normal human kidney, suggest a direct role of complement C4 in renal pathogenesis.

ISSN:1660-8151    

DOI:10.1159/000185778

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

This preliminary study concerns murine monoclonal antibodies (Mabs) against tubular basement membranes (TBM) of human kidney which were produced by the classical hybridization technique. One of these Mabs (PP8–1) specifically recognized an antigen present in the tubular basement membranes of various portions of tubule and in the Bowman’s capsule. By immunocytochemical techniques, this Mab was used to study the presence and the distribution of the related antigen in urinary sediment from 12 normal healthy subjects. This TBM and Bowman’s capsule antigen was demonstrated along hyaline urinary cast surface and, in some cases, in free extracellular fibrillar structures morphologically unrelated to the casts. This suggests that, in some normal conditions, catabolism of TBM and/or Bowman’s capsule could release material in urine, as it has been described for glomerular basement membrane (GBM) constituents. Such an immunocytochemical approach could be useful to detect components from tubular renal basement membranes in urinary sediment during pathological con

ISSN:1660-8151    

DOI:10.1159/000185779

出版商:S. Karger AG    

年代:1989

数据来源: Karger