摘要:

Once the decision is made to treat hyperlipidemia in a dialysis patient, several options for therapy are available. This review organizes a therapeutic approach into manipulations primarily by the patient (achievement of ideal body weight, exercise, various diets) and manipulations primarily by the physician. Dialytic options include the composition of the dialysate (buffer, glucose), peritoneal dialysis, hemodialysis and hemofiltration. The roles of dialysis efficiency and heparin are discussed in this context. Medicinal manipulations include drugs to avoid (beta adrenergic blockers, androgens, estrogens, glucocorticoids, ethyl alcohol, diuretics) and specific therapeutic agents (activated charcoal, nicotinic acid, clofibrate, L-carnitine).

ISSN:1660-8151    

DOI:10.1159/000183313

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

Intrarenal sodium handling was studied in 8 patients with essential hypertension before spironolactone treatment (200 mg/day), on the 4th day of treatment, and after 3 months of treatment. The results were compared with similar studies with chlorthalidone (50 mg/day). Renal sodium handling was assessed by simultaneous determination of the glomerular filtration rate, sodium, and potassium excretion, and maximal free-water clearance (CH2O). We took CH2O as an index of’distal’ sodium chloride reabsorption from which the proximal sodium reabsorption was calculated. During the first days of spironolactone treatment a natriuresis and increase in urinary flow rate was found. It resulted in a decrease of the extracellular fluid volume amounting to 0.9 liters and a 2.5-fold increase in the plasma renin activity. Potassium excretion showed a small but significant rise. After 3 months, virtually the same degree of volume depletion was found, which was comparable to that obtained after 3 months of chlorthalidone treatment. CH2O, as a fraction of glomerular filtration rate, decreased by 24% both after 3 days and 3 months, whereas proximal sodium reabsorption increased from 87.8 to 90.4% of the filtered load. CH2O, corrected for the ‘distal’ delivery of sodium, decreased from 85.3 to 80.7%. These changes were nearly the same as those found after 3 months of chlorthalidone treatment. It is concluded from these calculated values that spironolactone inhibits sodium chloride reabsorption in the diluting segment of the nephron and that the resulting increase in sodium delivery or urinary flow to the potassium excretory site partly counteracts the blocking effect of spironolactone on this part of the nephron, thus increasing potassium excretion during the acute administration of th

ISSN:1660-8151    

DOI:10.1159/000183314

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

Influences of essential fatty acids (EFA) and triglycerides as reasons for the progression of chronic renal failure are still in debate. We studied the outcome of four diets containing different concentrations of triglycerides and EFA in 5/6 nephrectomized rats and in NZB/W mice up to 45 weeks. The results showed no significant differences in the outcome of survival rate, proteinuria, urea, and creatinine levels as well as histological findings in the different groups of both animal models. We conclude that diets containing EFA up to C18:2 or being free of EFA or that triglyceride-enriched diets have no influence on the natural course of the renal disease in these both experimental models.

ISSN:1660-8151    

DOI:10.1159/000183315

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

9 patients were observed prospectively during 14–40 months 003continuous ambulatory peritoneal dialysis (CAPD) treatment. From start of CAPD, each patient recorded dwell time, drained ultrafiltration volume (ΔV), initial glucose concentration in dialysate, daily fluid intake, body weight and blood pressure on a special form. These data, together with monthly values for albumin, urea, creatinin, phosphate, glucose and β2-microglobulin in plasma and in instilled dialysate, were later fed into a specially designed computer program to compare changes in the monthly mean ( ± SEM) values. During 5 episodes of peritonitis, daily changes in ΔV were also computed. A long-term increase in ΔV was found in 4 and a decrease in 5 patients. In all 9 patients ΔV changed intermittently. All changes were most pronounced for long dwell times as compared to shorter dwell exchanges. The decrease in ΔV started within the first 12 months of treatment. In the daily routine we were aware of decreased ultrafiltration capacity in 3 patients only. Intermittent monthly changes in ΔV could partly be correlated to changes in daily fluid intake. No correlations were found between long-term changes in ΔV and fluid intake. All except 1 patient gained progressively in body weight, but without correlations to fluid balance, blood pressure and plasma albumin concentration. At the start of the observation period, most patients loosing ΔV during this study appeared to have a more permeable membrane with a higher absorption rate of glucose and higher equilibration ratios for creatinine and β2-microglobulin in 5-hours drained dialysate as compared with the other patients. However, this was not statistically different between the two groups of patients. During the observation period, most patients with decreased ΔV also increased transperitoneal solute transport, while the solute transport decreased in patients with increasing ΔV, but these changes were only significant for some patients. During peritonitis, ΔV decreased significantly 1 day before any other signs of peritonitis. All changes in ΔV were most pronounced for long dwell times as compared with short dwell times. It is suggested that changes in ultrafiltration can be related to altered permeability of the peritoneal membrane, which appear earlier and more frequent than suggested by others, and any loss of ΔV can be explained by a more permeable (‘open’) peritoneal membrane. It is also possible that different diseases act differently on the permeability of th

ISSN:1660-8151    

DOI:10.1159/000183316

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

In 11 patients on continuous ambulatory peritoneal dialysis 2,3-diphosphoglycerate, oxygen (O2) affinity of red cells (P50), blood gases, ventilation, and O2 consumption were studied. Contrary to patients on maintenance hemodialysis, 2,3-diphosphoglycerate and P50 were normal in patients on continuous ambulatory peritoneal dialysis; they were correlated with each other. Arterial O2 pressure was normal; under the conditions of dialysis with 35 mmol lactate per liter dialysis fluid a slight metabolic acidosis persisted; it was combined with a moderate respiratory alkalosis. Position had no influence upon pulmonary gas exchange with the exception of the alveolo-arterial gradient which was elevated when the abdominal cavity was filled with dialysis fluid and the patients assumed the supine position. Ventilation was in the normal range, whereas O2 consumption was low, possibly due to a reduction in muscle mass in some of the patients. It is concluded that pulmonary gas exchange and erythrocyte O2 transport were normal and that O2 requirements tended to be low in this group of patients on continuous ambulatory peritoneal dialysis.

ISSN:1660-8151    

DOI:10.1159/000183317

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

Captopril, an angiotensin-converting enzyme inhibitor, was used to treat 14 patients with lupus nephritis and severe hypertension. All patients had reduced renal function and were on regular immunosuppressive therapy with corticosteroids and azathioprine. The initial dosage of captopril was reduced according to the level of renal impairement. 11 patients were treated for more than 6 months. Excellent blood pressure control was achieved with captopril, from a mean of 178 ± 7/110 ± 4 to 145 ± 5/92 ± 3 mm Hg at 6 months, usually in combination with a diuretic only. In 5 cases, a β-blocker was added. In 3 patients, captopril therapy was discontinued within the 1st month of treatment. 1 patient did not respond to captopril at all; 1 patient had a rejection crisis and required dialysis; in 1 case, a general exanthema developed within 3 weeks and captopril medication was stopped. In addition to blood pressure control, renal function improved in 7 of the long-term-treated patients (mean increase in glomerular filtration rate 73 ± 34%). In 3 patients, a continued slow deterioration in renal function occurred, and in 1 patient, renal function remained unchanged. It is concluded that captopril is an effective antihypertensive drug in patients with systemic lupus erythematosus (SLE). Captopril treatment increased renal function in 64% of patients on long-term therapy. Not only optimal blood pressure control but other factors may also contribute to this beneficial effect, such as drug-induced prostaglandin release potentiating immunosuppressive treatment. Captopril may in fact be the drug of choice for the treatment of SLE patients with severe hyperte

ISSN:1660-8151    

DOI:10.1159/000183318

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

Glomerular filtration rate (GFR) is abnormally high in some, but not all, insulin-dependent diabetic patients. The potential importance of this hyperfütration lies in its possible link with later severe diabetic kidney disease. Inadequate glycaemic control is closely related to hyperfiltration but the mechanisms of the association are obscure. GFR and prevailing plasma glucose concentration were examined in a group of insulin-dependent diabetics without clinical proteinuria and in a group of non-diabetics, and their relationships observed using linear and multiple regression analysis. A positive correlation (r = 0.30, p < 0.05) is found between mean plasma glucose concentration and GFR up to a mean plasma glucose level of approximately 13.5 mmol/l. Glycaemia in excess of this degree tends to be associated with a lower GFR. Multiple regression analysis confirmed the independence of plasma glucose as a determinant of GFR (p < 0.05) at concentrations below 13.5 mmol/l. GFR declined significantly with age, but independently of diabetes duration, in the diabetic group (r = -0.48, p < 0.001). GFR in the control group showed a statistically non-significant decline with age

ISSN:1660-8151    

DOI:10.1159/000183319

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

40-mg doses of human cationic (CA) or anionic (AA) albumin were admistered intravenously to 48 normal female rats. Sodium bicarbonate (NaHCO3) was administered to 8 of these animals before CA or AA. Urine alkalinization caused increased renal CA excretion in CA-injected animals, which also showed marked reduction of the intensity of the renal changes produced by CA.

ISSN:1660-8151    

DOI:10.1159/000183320

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

Trace element concentrations in hair and fingernails and plasma of nondialyzed, hemodialyzed and hemofiltered patients with chronic renal failure and healthy volunteers were measured by atomic and nameless atomic absorption spectrophotometry and neutron activation analysis. Plasma aluminum concentrations in all three groups of patients were higher than in the controls. Aluminum levels in plasma and red blood cells were higher in hemofiltered patients than in dialyzed patients. The aluminum concentrations in the hair of both nondialyzed and dialyzed patients was higher than in the controls, while that in the hemofiltered patients it was not. These elevated aluminum concentrations appear to be mainly caused by the use of aluminum-contaminated dialysate. Calcium concentrations in the hair of nondialyzed and dialyzed patients were higher than in the controls. Plasma zinc concentrations in all the patients were lower than the controls, and the concentrations in hemofiltered patients were lower than in the dialyzed patients.

ISSN:1660-8151    

DOI:10.1159/000183321

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

The guidance of a computerized axial tomography scanner was used to locate the biopsy site in 10 instances where a previous attempt had failed to yield a satisfactory specimen. 4 of these patients were grossly obese, and the renal allograft could not be outlined by manual palpation. The scanner has facilitated the placement of the needle tip within the renal cortex, while avoiding injury to the renal pelvis, major blood vessels, and other intra-abdominal organs. Adequate tissue was obtained in each instance. There were no complications associated with this procedure. Proper use of this technique should enhance the success rate of needle biopsies and eliminate the need for open surgical biopsies in renal transplant recipients.

ISSN:1660-8151    

DOI:10.1159/000183322

出版商:S. Karger AG    

年代:1984

数据来源: Karger