ISSN:1660-8151    

DOI:10.1159/000188389

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

There is accumulating evidence that leukocyte-endothelial adhesion molecules are important in inflammatory injury in being involved in the primary step of entrapment and migration of leukocytes to the site of inflammation. We have used an antigen capture ELISA to measure the levels of circulating intercellular adhesion molecule-1 (cVCAM-1), vascular cell adhesion molecule-1 (cVCAM-1) and E selectin (cE selectin) in the peripheral blood of 33 patients with IgA nephropathy (IgAN) during clinical quiescence and 24 healthy controls. The serum levels of cICAM-1 and E selectin in IgA-nephritic patients were not different from that of healthy controls but the cVCAM-1 level was significantly elevated in IgAN despite a lack of clinical activity (p=0.008). The differential rise of circulating leukocyte-endothelial adhesion molecules in IgAN probably reflects the origins and nature of these molecules as well as the specific immunological profile of IgAN. There was no correlation between the levels of these three circulating adhesion molecules. When the patients with IgA nephropathy were stratified according to the severity of their glomerular and interstitial lesions, there was an apparent increase in cE selectin and cVCAM-1 associated with increased histopathologic grading. The changes in endothelial adhesion molecules during clinical exacerbation were studied in 10 patients. Coinciding with synpharyngitic macrohematuria, there was a significant rise of cVCAM-1 and cE selectin (p=0.046 and p=0.016, respectively) but no similar rise was observed in cICAM-1. Though probably of limited diagnostic significance, our findings tend to support the role of T lymphocyte in the immunopathogenesis in IgAN and also indirectly reflect the active interaction between neutrophils/lymphocytes and vascular endothelial cells during the clinical exacerbation in IgAN.

ISSN:1660-8151    

DOI:10.1159/000188390

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The potential role of atrial natriuretic factor (ANF) in blood pressure (BP) drops during hemodialysis (HD) has been examined in 30 patients with end-stage chronic renal failure. Echocardiographic measurements and evaluation of cardiac parasympathetic function were performed prior to HD sessions, simultaneously with hormonal determinations. The plasma ANF level was correlated with the peak value of the E wave and the Doppler index of the left ventricular preload and was more elevated in ‘denervated’ than in intact patients. During the HD sessions, the BP fell in 18 patients (group 1) and remained stable in 12 others (group 2), despite similar weight losses. Both groups differed by the basal values of plasma ANF, greater in group 1 than in group 2 (100.0 ± 13.3 vs. 65.7 ± 3.4 fmol/ml; p < 0.05). The magnitude of plasma ANF decrease was identical in both groups despite the BP decrease in group 1 at the end of the session. These results suggest that the ANF release depends not only on hemodynamics but also on cardiac innervation in dialyzed patients and that high plasma ANF levels are implied in the BP drops during HD se

ISSN:1660-8151    

DOI:10.1159/000188391

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

To investigate the pathogenetic mechanisms of mesangial interposition (MI) in IgA nephropathy, we examined renal biopsy samples from 20 patients with IgA nephropathy. Electron microscopic morphometric analysis showed that cytoplasmic protrusion of mesangial cells (MCs) into endothelial cells (ECs) or capillary lumina, and widening of the lamina rara interna (LRI) were significantly more prominent in glomeruli with MI than in those without. Immunoelectron microscopy revealed that the ratio of positive endothelial staining with a polyclonal antibody against human platelet-derived growth factor (PDGF) BB was significantly higher in capillary loops with MI than in those without. Enhanced capillary staining of fibronectin related to MI was not recognized. These results suggest that MI in IgA nephropathy is caused by factors such as enhancement of cytoplasmic extensibility of the MCs, widening of the LRI and chemotactic influence of PDGF-BB located in the glomerular ECs.

ISSN:1660-8151    

DOI:10.1159/000188392

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Gram-negative particles, found in ‘normal’ urine by an improved microscopic technique, become excessive (often > 105/ml) in many systemic diseases. In these diseases they are accompanied by sparse, usually fastidious, gram-positive cocci. Antibiotics at moderate doses usually have little effect. Larger doses of antibiotics suppress, or temporarily eliminate, the particles. In this report, the particles are characterized by light microscopy for better identification. Then, by detection of muramic acid in a hydrolysate and by transmission electron microscopy, they are identified as decomposed (‘exploded’) gram-positive cocci. Since explodeds cannot be external contaminants, and their precursors cannot proliferate sufficiently in urine, they must have crossed renal membranes to come from within the body. They are demonstrated in tissue fluids and in synovial fluids by optical microscopy, by their muramic acid, and by transmission electron microscopy. Thus, they cross other membranes. Explodeds are excessive in several rheumatic diseases, in renal diseases, in diseases in which a coccal cause has been sought, and in some in which cocci have never been considered. There is no precedent for explodeds. Their appearance and numbers are compatible with the literature on natural and experimental systemic streptococcal diseases and with the experimental illnesses following injection of streptococcal cell walls. Urinary explodeds are likely to be the end result of the ‘almost physiological’ entry of streptococci into the circulation which necessitates predental antibiotic prophylaxis in mitral disease. Increased numbers of urinary explodeds probably represent excessive entry of precursors or proliferation of precursors within the host. Urinary explodeds serve as a marker for diverse systemic diseases, systemic coc

ISSN:1660-8151    

DOI:10.1159/000188393

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Catheter function was retrospectively analysed after surgical placement in 21 children requiring peritoneal dialysis for acute renal failure due to haemolytic uraemic syndrome. Substantial benefits were shown to have accrued from partial omentectomy which resulted in reliable access and trouble-free drainage in the 11 patients in whom it was carried out. Conversely 4 of 10 patients in whom partial omentectomy was not done experienced total catheter blockage whilst the other 6 experienced intermittent poor drainage. Partial omentectomy should be considered as integral to the surgical technique of peritoneal catheter placement for both short-term and long-term dialysis in children.

ISSN:1660-8151    

DOI:10.1159/000188394

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Considering that PAI-1 is an important factor modulating the systemic fibrinolytic activity, the abnormal insulin metabolism frequently seen in end-stage renal disease (ESRD) may cause decreased fibrinolytic activity in concert with PAI-1. To study this possibility, we measured insulin levels and compared it with the fibrinolytic profiles in ESRD patients. Fasting blood sugar, insulin, and C peptide levels were higher in ESRD patients than in the control group. In the ESRD patients, the insulin levels showed a positive correlation with C peptide (r=0.612, p=0.0001), fasting blood sugar (r=0.334, p=0.044), and PAI-1 antigen (r=0.474, p=0.0001) and a reverse correlation with euglobulin fibrinolytic activity (r=0.5, p=0.005), but no correlation with t-PA antigen. The euglobulin fibrinolytic activity showed a reverse correlation with PAI-1 antigen (r=0.289, p=0.0144), but no correlation with t-PA antigen. Our results suggest that abnormal insulin metabolism and/or insulin resistance, which occur frequently in ESRD, may play an important role in the decrease in systemic fibrinolytic activity by the regulation of the PAI-1 concentration.

ISSN:1660-8151    

DOI:10.1159/000188395

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Fifteen laparoscopic abdominal operations were performed in 14 patients treated by continuous ambulatory peritoneal dialysis for chronic renal failure. Celioscopic exploration of the abdomen and subsequent operation displayed several advantages specific to the method: identification of the etiology of scrotal dialysate outflow was achieved in 4 cases, peritoneal dialysis catheter salvage during laparoscopic cholecystectomy in 1 case, abdominal exploration during occurrence of peritonitis in 3 cases, and catheter dysfunction or abdominal examination before catheter implantation in 7 cases. The laparoscopic procedure allows early resumption of peritoneal dialysis after surgery, hence avoiding the need for transient hemodialysis. Nevertheless, it seemed unable to offer a salvage capability of infected catheters through extensive abdominal washing. Laparoscopy has been reported to decrease postoperative pain and disorders of ventilation, allowing for rapid recovery of social and professional activities following this minimal invasive surgical technique. Laparoscopy is a novel technique which enables precise diagnosis and surgical operations in patients treated by continuous ambulatory peritoneal dialysis.

ISSN:1660-8151    

DOI:10.1159/000188396

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

We studied the in vitro effects of peritoneal dialysis fluids (PDF) containing 1 and 1.5% amino acids (AA) as compared to approximately equiosmolar glucose (GLU)-based PDF (1.5 and 4.25%) and control buffer, respectively, on peritoneal macrophage (PMØ) function. The media were tested at original pH (5.3-5.5) and after pH adjustment to 7.4. PMØ were isolated from the effluents of 10 on continuous ambulatory peritoneal dialysis (CAPD) patients and tested for luminol- and lucigenin-enhanced chemiluminescence (CL), superoxide generation measured by cytochrome c reduction, killing capacity and phagocytosis after incubation (30 min, 37°C) in the PDF used. All AA-based PDF exhibited a statistically significant depressive effect on integral CL response, O-2 production and bacterial killing of PMØ at pH 7.4 in comparison with pH-adjusted GLU-based PDF of similar osmolality and buffer. Exposure of PMØ to acidic AA-based media did not result in a significantly different suppression of the oxidative metabolism and the killing capacity as compared to fresh GLU-based fluids. Phagocytosis of PMØ did not show significant differences after incubation in the solutions studied. Thus, the AA-based PDF employed compromise the oxidative metabolism and the killing capacity of PMØ at pH 7.4 in vitro significantly more than GLU-based fluids. Since pH-identical and almost equiosmolar PDF were compared, the specific composition of the AA-based fluids, especially the high content of lactate and several essential AA, could be responsible for this detrimental

ISSN:1660-8151    

DOI:10.1159/000188397

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The effect of d-α -tocopherol on the progression of renal dysfunction was investigated in rats injected with adriamycin (ADR), a model of progressive glomerulosclerosis associated with the nephrotic syndrome. Treatment with d-α -tocopherol was started 1 day before or 1 day after ADR injections (BE-TOC or AF-TOC rats). When compared to rats without d-α -tocopherol treatment (ADR-CON rats), the serum total cholesterol and triglyceride levels were significantly lower in the BE-TOC and AF-TOC groups. In week 16, the LDL cholesterol level and the atherogenic index were both significantly lower in BE-TOC and AF-TOC rats than in ADR-CON rats. The urinary protein, serum creatinine, blood urea nitrogen, malondialdehyde, and systolic blood pressure levels as well as the glomerulosclerosis score were high in ADR-CON rats, and reduced in BE-TOC or AF-TOC rats. There were no significant differences in body weight and serum albumin between the three groups in week 16. It is concluded that d-α -tocopherol can improve hyperlipidemia and ameliorate glomerulosclerosis in rats with ADR-induced progressive renal failure. Thus, d-α -tocopherol may have the potential for clinical application to treat focal glomeruloscler

ISSN:1660-8151    

DOI:10.1159/000188398

出版商:S. Karger AG    

年代:1994

数据来源: Karger