ISSN:1660-8151    

DOI:10.1159/000183688

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The parathyroid gland responsiveness to hypocalcemia induced by short-term calcium-free hemodialysis in patients with insulin-dependent diabetes mellitus was investigated in comparison with 10 nondiabetic uremic patients and compared with test results from the autonomic nervous system. Diabetic patients had lower c-terminal parathyroid hormone (cPTH) levels before hemodialysis than uremic control patients and showed a significantly smaller increase in cPTH during hypocalcemia. The neurological tests revealed severe disturbances of the autonomic functions in the diabetic group. In conclusion, the disturbances observed in the parathyroid secretory pattern are probably caused by gland dysfunction; it is hypothesized that the defective autonomic nervous system has an additional effect on the development of this hormonal dysfunction.

ISSN:1660-8151    

DOI:10.1159/000183689

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Hypercalcemia is a postrenal transplant complication. We found a high frequency of elevated plasma ionized calcium values (65.8%) in 41 normal-function renal graft recipients. In 8 patients increased free calcium was associated with high PTH levels, whereas in 19 PTH was not increased but free calcium was high. In the other 14 patients both free calcium and PTH were in the normal range. The mean transplant duration was different in the three groups: shorter in high PTH patients, longer in normal free calcium patients, intermediate in normal PTH and high free calcium patients. Our findings confirm that a condition of hyperparathyroidism persists in the first post-transplant period, and suggest that this complication evolves towards normalization of the blood chemistry values, passing through a condition of inappropriate PTH secretion with elevated plasma free calcium which in this period is the only marker of parathyroid hyperfunction.

ISSN:1660-8151    

DOI:10.1159/000183690

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Blood levels of guanidinopropionic acid (GPA), a putative uremic toxin, have been evaluated in 5 uremic patients before a dialytic session, at the end of it and during the following 68 h. GPA levels are markedly higher in uremic patients than in controls and are significantly reduced at the end of dialysis even if still higher than in controls. The clearance of GPA is similar to those of urea and creatinine, even if at the end of the dialysis session the percent decrease of GPA is significantly lower than that of urea. During the first 8 h after the end of dialysis GPA levels increase steeply; subsequently, the rate of accumulation of GPA in blood declines markedly remaining constant until the 68th hour. In conclusion GPA is markedly increased in blood of uremic patients and is significantly removed by dialysis. The evaluation of GPA increase per hour after the end of dialysis may provide an estimation of GPA production in uremic patients.

ISSN:1660-8151    

DOI:10.1159/000183691

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

In 5 patients with cirrhosis and ascites the glomerular filtration rate (GFR), free water clearance (CH2O) and urinary excretion of prostaglandin E2 (PGE2) and 6-keto-prostaglandin F1α (6-keto-PGF1α) were measured before and after a 3-day treatment with sulindac (400 mg/day). The administration of sulindac induced a marked fall of urinary excretion of PGE2 (from 24.2 ± 5.5 to 3.8 ± 1.1 ng/h; p < 0.05), 6-keto-PGF1α (from 19.9 ± 2.9 to 5.6 ± 1.1 ng/h; p < 0.02) GFR (from 111 ± 15 to 67 ± 10 ml/min; p < 0.01) and CH2O (from 7 ± 1.5 to 3.7 ± 1.3 ml/min; p < 0.02) in all patients studied. The plasma concentration of the active metabolite sulindac sulfide in cirrhotics was 400% of that found in 6 healthy volunteers (9.6 ± 1.7 vs. 2.4 ± 0.6 ng/ml). Our results indicate that sulindac, at a dose of 400 mg/day, inhibits the renal synthesis of prostaglandins and impairs renal function in cirrhotics with ascites. These effects are probably related to the marked alteration of sulindac kinetics that occurs in th

ISSN:1660-8151    

DOI:10.1159/000183692

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

We reviewed the recommendations and outcomes for all patients with diabetes mellitus and end-stage renal disease referred to the Medical Center Hospital of Vermont from 1971 through December 1983. During this period, we recommended transplantation in 53 of 73 patients evaluated. Thirty-two transplants were performed in 30 patients. Of the 30 patients, 10 had clinical vascular disease prior to transplantation, i.e., claudication, amputation, active angina, myocardial infarction, or stroke. Seven of the 10 had only claudication or amputation. These 10 patients showed a clear excess in graft failure and mortality. One- and 2- year graft survival was 37 and 13%; patient survival was 48 and 24%. By comparison, the 20 patients without evident vascular disease had 1- and 2- year graft survival rates of 83 and 75% and patient survival rates of 85% at both 1 and 2 years. The incidence of cardiovascular death in the group with vascular disease was 45% at 1 year and 63% at 2 years, as compared with none in the group without vascular disease. The high graft loss and mortality in this group after transplantation should be a major consideration when therapeutic alternatives are considered in diabetics with end-stage renal disease.

ISSN:1660-8151    

DOI:10.1159/000183693

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

This study examines the effects of 12 months of endurance exercise training (cycling, walking and jogging) on lipid profiles, glucose metabolism, blood pressure, anemia and psychological function in 14 hemodialysis patients. Maximal aerobic capacity (Vo2max) increased 18% in the exercisers (p < 0.01), but did not change in 11 controls. This was associated with a reduction in depression, a decrease in dosages of antihypertensive medications, a significant increase in hematocrit and hemoglobin levels (red cell mass rose, plasma volume did not change), a decrease in plasma triglyceride by 23% (p < 0.05) and an increase in high-density lipoprotein cholesterol (HDL-C) levels by 21% (p < 0.01) (both HDL-C and triglyceride levels worsened in the sedentary controls), and an 18% increase in glucose disappearance rates (p < 0.05) in spite of a 52% decrease in fasting insulin levels (p < 0.01), suggesting that insulin sensitivity improved. These results demonstrate that some of the complications present in hemodialysis patients may be caused by their sedentary life-style, rather than endstage renal disease itself. This suggests that rehabilitation through exercise is possible for these patients. By reducing coronary risk factors in hemodialysis patients, exercise training may also decrease their heightened morbidity and mortality from atherosclerotic complications. These possibilities need to be examined in a longitudinal study.

ISSN:1660-8151    

DOI:10.1159/000183694

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

We have studied the role of adjustments of tissue-fluid colloid osmotic pressure (COP) in the maintenance of the blood volume in 10 patients with the nephrotic sydrome before and after diuretic treatment until dry weight. A mean weight reduction of 13.5 ± 6.4 kg was attended by a fall in blood volume in 3 patients and no change in 6, but the final blood volume was within the normal range: 84.3 ± 3.7 ml/kg (normal value: 87.6 ± 8.8 ml/kg). Albumin content and COP of tissue-fluid, obtained with subcutaneous wicks, were low before edema removal and rose slightly after it, parallel to changes in the plasma. Thus, the transcapillary gradient in COP did not change: 6.5 ± 1.5 mm Hg before and 6.2 ± 1.7 mm Hg after diuretic treatment. Considering the low plasma COP, 8.6 ± 1.6 mm Hg in edematous and 11.7 ± 3.7 mm Hg in dry conditions, this gradient was only slightly below the value of about 10 mm Hg normally found with this technique. We conclude that a lowered tissue-fluid COP is important for the preservation of blood volume in dry patients with the nephrotic syndrome. In addition, this adaptation can explain why the blood volume is often normal and not expanded despite the sometimes huge overhydration in these pa

ISSN:1660-8151    

DOI:10.1159/000183695

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Urinary excretion of lead (Pb) was measured in the basal state and following the infusion of EDTA (1 g of calcium disodium edetate) in healthy German controls and in patients with chronic renal failure with and without gout. When evaluated with Zeeman-compensated atomic absorption spectroscopy using the L’vov platform and urine pretreated with nitric acid and Triton X-100, the control basal Pb excretion (median 28, range 11–19 nmol Pb/24 h) and the postinfusion Pb increment (306, range 131–1,587 nmol/4 days/1.73 m2) were considerably lower than most values reported previously in the literature. Elevated Pb body burden was found in 7 of 8 patients who developed gout in the course of renal failure, but only in 2 of 8 patients who had gout prior to development of renal failure; this confirms that appearance of gout in patients with renal failure points to prior Pb exposure. In 7 of 19 nongouty patients with impaired renal function secondary to known renal diseases, urinary Pb excretion was above the 95th percentile of normal. All these patients had occupational Pb exposure. The high prevalence of elevated Pb body burden in patients with renal failure of known cause may not be coincidental and raises the possibility that Pb adversely affects the course of renal di

ISSN:1660-8151    

DOI:10.1159/000183696

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

We have studied the rat remnant kidney model as a tool to assess the impact of secondary oxalosis on renal failure. Although the plasma of uremic rats demonstrated increased levels of oxalic acid, deposits of oxalate crystals in tissue were not observed. The absence of such deposits in the remnant kidney, as well as other tissues, may be due to a lesser degree of hyperoxalemia observed in the rat compared to man or may reflect that uremic deaths among the experimental animals occurred prior to formation of detectable calcium oxalate deposition. We conclude that the rat remnant kidney is not a suitable model to study the impact of uremic oxalosis in man.

ISSN:1660-8151    

DOI:10.1159/000183697

出版商:S. Karger AG    

年代:1986

数据来源: Karger