ISSN:1660-8151    

DOI:10.1159/000183363

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

We measured the serum concentration of alpha-1-acid glycoprotein (AAG) in 30 healthy subjects (controls), in 54 patients with various degrees of residual renal function (group I), and in 98 patients in the terminal phase of chronic renal failure (CRF) on both conservative and dialytic therapy (group II). A positive correlation between the logarithm of serum AAG and serum creatinine levels was found in group I. Serum AAG increased significantly when serum creatinine rose above 10 mg/dl. This fact would indicate that a retention of the substance occurs as the renal function falls. The mean serum concentration of AAG was significantly higher in group II patients, with no difference between those on conservative therapy and those on maintenance hemodialysis. However, levels above normal were present in only a minority of cases. We conclude that the serum AAG measurement maintains its diagnostic value as an acute phase reactant also in the terminal phase of CRF.

ISSN:1660-8151    

DOI:10.1159/000183364

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Hypouricemia seen with hyponatremia related to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) results from an increase in uric acid renal clearance. We studied the mechanism of the increase of uric acid excretion in 6 SIADH patients through pyrazinamide (PZA), which decreases tubular secretion of uric acid, and sulfinpyrazone (SPZ) which decreases post-secretory reabsorption of uric acid. 3 g of PZA decreased the absolute uric acid excretion from 428 ± 244 to 105 ± 47 μg/min (mean ± SD, p < 0.01), and 300 mg of SPZ increased the uric acid to creatinine clearance ratio from 0.31 ± 0.05 to 0.52 ± 0.05 mg/dl glomerular filtration rate (mean ± SEM, p < 0.001), which represent an increment about half of that observed in the control group. The increase of uric acid clearance in SIADH seems to result from a decrease in the post-secretory reabsorption of uric acid. After SPZ, we saw a decrease of natriuresis from 5.6 ± 1.4 to 1.8 ± 0.3 mmol/h (p < 0.001), without any change of urinary flow or urinary potassium e

ISSN:1660-8151    

DOI:10.1159/000183365

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Uremia causes major increases in the erythrocyte (RBC) purine nucleotides, presumably secondary to phosphate retention, but no previous study has been made of the pyrimidine nucleotides, normally absent from RBC. This investigation was prompted by demonstration of the abnormal presence of RBC pyrimidine nucleotides, primarily cytidine triphosphate (CTP) plus cytidine diphosphate-choline (CDP-C) and cytidine diphosphate-ethanolamine (CDP-E), in two types of congenital hemolytic anemia as well as in lead poisoning. These observations suggested an analogy to the RBC membrane dysfunction of uremia. This is a report of the identification of CDP-C and CDP-E as the predominant abnormal pyrimidine nucleotides in the RBC hemolysates of uremic subjects. High-performance liquid chromatography of hemolysates from uremic adults showed a 50% increase in purine nucleotides and the abnormal presence of pyrimidine nucleotides and diesters at approximately 10% of the concentration of the purine nucleotides. By means of UV spectra and 31P nuclear magnetic resonance, these were identified as CDP-C and CDP-E. The increased purine and abnormal pyrimidine nucleotides of uremic RBC were unrelated to the pre- or posthemodialysis state, allopurinol, levels of blood lead, copper and zinc, or RBC pyrimidine 5’-nucleotidase, the cytosolic enzyme that specifically dephosphorylates the pyrimidine nucleotides. Although the accumulation of CTP, CDP-C and CDP-E may be an epiphenomenon of phosphate retention, it also suggests a common pathway to the accelerated hemolysis of chronic renal insufficienc

ISSN:1660-8151    

DOI:10.1159/000183366

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Propranolol-induced hypoglycemia in hemodialysis patients has been increasingly recognized. We studied the effects of a nonselective β-blocker (propranolol) and a β1-selective-blocker (metoprolol) on glucose metabolism during pharmacologic hyperglucagonemia in these patients. cAMP and insulin responses to glucagon were noted to be significantly higher in all patients after dialysis. This may possibly be due to the removal of a dialyzable factor suppressing these responses. However, despite a similar cAMP response, patients on propranolol had significantly lower glucose response than those not receiving β-blocker before and after dialysis. While patients on metoprolol also had impaired glucose response before dialysis, this significantly improved after dialysis possibly due to the removal of active metabolite(s). Results suggest that metoprolol has less interference on glucose response to glucagon than propranolol in hemodialys

ISSN:1660-8151    

DOI:10.1159/000183367

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

24 renal biopsies from 23 patients with IgA nephropathy (Berger’s disease) were examined. This retrospective ultrastructural study focused on extraglomerular vascular structures since information about these structures in IgA nephropathy is lacking. Electron-dense deposits were observed in arterioles in 8 out of 18 biopsies (44%), in which arterioles were available for electron microscopic examination. Deposits were absent in peritubular capillaries and in all arteries. The presence of deposits had no correlation with the patient’s blood pressure. The electron-dense deposits represent additional evidence that IgA nephropathy is a monosymptomatic form of a systemic disease that is mediated by circulating immune complexes of heterogenous ori

ISSN:1660-8151    

DOI:10.1159/000183368

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

We evaluated 9 patients with transplant renal artery stenosis. Captopril treatment always resulted in a dramatic decrease in renal function. Moreover, only in patients (n = 2) with a stenosis in one out of more renal arteries a satisfying fall in blood pressure was achieved. Surgical reconstruction of the stenosis was successful in 4 out of 5 patients. Angiotensin I-converting enzyme inhibition in transplant renal artery stenosis often leads to loss of graft function, probably due to efferent vasodilation.

ISSN:1660-8151    

DOI:10.1159/000183369

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Effect of hemodialysis on phenylalanine distribution between the intracellular water of erythrocytes and the plasma obtained from patients with end-stage kidney was studied by fluorimetric measurements of phenylalanine concentration according to the method of Mc Caman and Robins. The measurements were performed twice: before and after 4 h of hemodialysis. It was found that the nondialyzed patients with end-stage kidney had higher than normal phenylalanine concentrations both in plasma and in the intracellular water of erythrocytes. Hemodialysis brought about a decrease in plasma phenylalanine level without influencing the erythrocyte concentration of the studied amino acid and without altering the function of the erythrocyte cell membrane, as far as the phenylalanine transport was concerned.

ISSN:1660-8151    

DOI:10.1159/000183370

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Extensive metabolic studies were performed in a 14-year-old boy suffering from the rare clinical entity known as childhood idiopathic hypercalciuria associated with dwarfism, renal tubular abnormalities and bone lesions. The salient features were: hyperphosphaturia with hypophosphatemia, hypercalciuria with normocalcemia, elevated serum 1,25-dihydroxycholecalciferol [1,25(OH)2D3] levels, marked intestinal hyperabsorption of calcium and phosphorus, with low serum parathyroid hormone (PTH) and urinary adenosine 3’:5’-cyclic monophosphate (c-AMP). Bone biopsy confirmed the clinical and radiological diagnosis of rickets. It appears that the following pathophysiological sequence is operating: primary renal phosphate leak with hypophosphatemia, increased 1,25(OH)2D3 synthesis, enhanced intestinal calcium absorption which in turn inhibits release of PTH and c-AMP. Hypercalciuria is seen to be secondary to both avid intestinal calcium absorption and depressed PTH activity, and rickets the result of phosphate depletion. Treatment with oral phosphorus only resulted in an acceleration of growth rate, cure of rickets, and return of urinary calcium excretion to normal val

ISSN:1660-8151    

DOI:10.1159/000183371

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

A 32-year-old male with renal retinal dysplasia is presented. He also showed hearing loss and growth retardation. Laboratory data showed mild proteinuria, renal dysfunction and type-1 renal tubular acidosis. Computed tomography showed multiple cysts at the corticomeduUary junction of both kidneys. Ocular examinations disclosed retinitis pigmentosa. On light microscopy of renal biopsy specimens, diffuse cystic dilatation of Bowman’s space as well as dilated tubules with interstitial fibrosis and cellular infiltration were noted. Electron microscopy revealed a peculiar chromatin condensation of epithelial cell nuclei in Bowman’s capsules, glomeruli and tubules. The association of renal retinal dysplasia with diffuse glomerular cysts has not, to our knowledge, been previously repor

ISSN:1660-8151    

DOI:10.1159/000183372

出版商:S. Karger AG    

年代:1985

数据来源: Karger