ISSN:1660-8151    

DOI:10.1159/000185909

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

While it is known that angiotensin-converting enzyme (ACE) in the kidney is concentrated at the brush borders of the proximal tubule, the role of tubular ACE in renal physiology is not well understood. The active site of tubular ACE is exposed on the luminal surface of the brush borders and may hydrolyze peptides in the glomerular filtrate. However, a positive correlation between blood pressure and renal ACE activity was observed in spontaneously hypertensive rats, as well as in cases of ACE inhibition. Determination of ACE activity in different renal zones and immunohistochemistry demonstrated that ACE predominates in the inner cortex and that the proximal tubule in the outer cortex contains less ACE. Perhaps the inner cortex is the area responsible for alteration of renal ACE activity, since only ACE activity in the inner cortex increased following administration of the ACE inhibitor captopril. This would suggest that the induction of ACE occurs in the inner cortex. Renal ACE activity is also affected by oxidation. Thus, the activity increased when diamide, an oxidizing agent, was added to the crude extract of renal cortex and when oxygen was introduced into the extract. Therefore, tissue oxidation may be one factor affecting renal ACE activity.

ISSN:1660-8151    

DOI:10.1159/000186027

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Patients with uremia have excess levels of parathyroid hormone (PTH). It has been reported that excess PTH is associated with bone marrow fibrosis. The present study was undertaken to examine the in vitro effect of intact 1–34 PTH and the active 1–34 N-terminal fragment on human bone-marrow-derived fibroblasts. Proliferation of fibroblasts was not stimulated by PTH in concentrations present in uremia (5–30 U/ml) nor by uremic sera which contained either high or low PTH levels. The lack of stimulation contrasted with the activity of both PTH preparations in other systems, i.e., inhibitory to erythroid colonies and stimulatory to heart muscle

ISSN:1660-8151    

DOI:10.1159/000185910

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Somatic symptoms are common in patients on dialysis. Their causes are largely unknown and their therapy is unsatisfactory. To examine the relationship of psychological and clinical factors to these symptoms, 191 interviews were done in patients on hemo- and peritoneal dialysis. The severity of 8 somatic symptoms (tiredness, sleep disturbance, cramps, pruritus, headache, nausea, dyspnea, joint pain) of importance in dialysis patients was measured using previously validated scales. Indices of affect and quality of life were obtained, as was demographic, clinical and laboratory information. The severity of each symptom was significantly related to the indices of affect and quality of life. Using multiple logistic regression, poor affect score was the strongest correlate of each of the following somatic symptoms, tiredness, pruritus, sleep disturbance and cramps. It was ahead of any clinical or demographic variable and was also significantly correlated with the severity of the other smptoms. Indices of hyperparathyroidism were significantly associated with headache, joint pain, dyspnea and nausea. We conclude that the strongest correlate of common somatic symptoms in dialysis patients is affect disturbance, and that therapy aimed at improving the affect may improve the symptoms.

ISSN:1660-8151    

DOI:10.1159/000185911

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

We investigated the effect of long-term i.v. administration of L-carnitine on human muscle fibers using morphometric parameters. We administered 2 g/day L-carnitine to patients undergoing hemodialysis for at least 12 months. At the end of this period a marked increase in serum and muscle carnitine levels was observed in all patients, together with hypertrophy and predominance of type 1 fibers, L-carnitine was withheld for 4 months, during which time serum and muscle levels gradually decreased and no changes were observed in muscle fibers. Subsequent addition of L-carnitine to dialysis fluid for another 4 months stabilized lower levels. At the end of this period reduction of diameter of type 1 fibers was observed. Type 2 fibers remained unchanged. Moreover, type 1 fibers remained predominant in all cases. Hence, we suggest that carnitine has a specific trophic effect on type 1 fibers which are characterized by an oxidative metabolism.

ISSN:1660-8151    

DOI:10.1159/000185912

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Longitudinal data were obtained on 131 diabetic subjects enrolled in a study designed to evaluate the impact of persistent elevation of the blood pressure (BP) upon progression of renal damage in diabetes mellitus. For both insulin-dependent and non-insulin-dependent diabetes, serum creatinine exhibited a more rapid rise in those individuals whose BP remained elevated above 140 mm Hg despite therapy. Since no significant difference in age, duration of diabetes, diabetic control, or renal function at entry in the study could be identified as possible explanations for these differences, the findings support the conclusion that persistent elevation of the BP adds significantly to the risk of renal damage in both insulin-dependent and non-insulin-dependent diabetes, with more rapid decline occurring in non-insulin-dependent diabetes. Hypertensive subjects exhibited higher levels of plasma angiotensin II during the follow-up period.

ISSN:1660-8151    

DOI:10.1159/000186030

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Our experience of peritonitis in 156 patients over an 8-year period represents 186 episodes of peritonitis and 4,964 patient-months of CAPD. The incidence of peritonitis was significantly greater (1 episode every 8.6 patient-months) when the Oreopoulos technique was used and dropped to 1 episode every 43.3 patient-months when the Y set system was used. Of the 109 patients using the Y set system, 88 (80.7%) never had episodes of peritonitis, whereas only 7 (16.7%) of the 42 patients using the Oreopoulos technique were free of peritonitis. For 23 patients shifted from the Oreopoulos to the Y set technique, the incidence of peritonitis dropped from 1/9.8 to 1/35.2 episodes/patient-months.

ISSN:1660-8151    

DOI:10.1159/000185913

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Continuous therapy with an angiotensin-converting enzyme (ACE) inhibitor has been shown to have a glomerular vasodepressor effect in the newly diabetic rat and to largely prevent subsequent development of severe sclerosing glomerular injury. Preliminary studies in humans with established diabetic glomerular injury reveal that ACE inhibitor therapy has an antiproteinuric effect and may also slow the decline in glomerular filtration rate that usually attends this disorder. Although promising, the human studies are inconclusive because of short duration and other limitations in experimental technique and study design. Additional trials are required to confirm more positively this amelioration of human diabetic glomerular injury by ACE inhibitor therapy.

ISSN:1660-8151    

DOI:10.1159/000186031

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

It has been reported that treatment with L-carnitine at a daily dose of 3 g orally may cause a rise in platelet aggregation and serum triglyceride concentration in hemodialyzed patients. The present double-blind cross-over study has been performed to evaluate the influence of L-carnitine when compared with placebo on platelet aggregation and plasma concentrations of various factors involved in platelet activation. In addition, the concentration of triglycerides, cholesterol and HDL-cholesterol has been evaluated. 18 uremic patients on maintenance hemodialysis for at least 1 year were randomly allocated either to a control group receiving placebo or to a group treated with L-carnitine. Statistical analysis performed by means of ANOVA did not show any significant change in the serum concentration of cholesterol, HDL-cholesterol and triglycerides. Furthermore, platelet aggregation tests (performed with adenosine 5’-diphosphate, epinephrine, thrombin and collagen) and plasma β-thromboglobulin concentration did not show any statistically significant difference. In addition, the plasma concentration of several coagulation markers, such as factor VIIIc, antithrombin III, α2-antiplasmin, and fibrinopeptide A, did not show any significant variation. The results suggest that under our experimental conditions L-carnitine neither increases the risk of thromboembolism nor alters the serum lipid content in uremic patients on chronic hemodialy

ISSN:1660-8151    

DOI:10.1159/000185914

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Nonsteroidal anti-inflammatory drugs, especially indomethacin, have variable effects on proteinuria when used alone, but can dramatically reduce proteinuria if combined with diuretics and sodium restriction. Reduction of angiotensin II concentrations in plasma and kidney following angiotensin-converting enzyme inhibition also reduces proteinuria, not only in nephrotic conditions but also in diverse diseases, including diabetes mellitus, glomerulosclerosis following subtotal nephrectomy, and membranous nephropathy. The reduction of proteinuria appears independent of decrements in blood pressure since other hypotensive agents do not alter proteinuria in these conditions.

ISSN:1660-8151    

DOI:10.1159/000186032

出版商:S. Karger AG    

年代:1990

数据来源: Karger