ISSN:1660-8151    

DOI:10.1159/000183902

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

A combination of a real time phased array sector scanner and a range-gated 16-channel pulsed Doppler system was used for the evaluation of renal artery flow patterns in 25 echogenic subjects. Eight of these had renal artery stenosis, 5 an increased peripheral resistance in the kidney, and 12 showed normal renal flow patterns with consistent forward flow during the entire heart cycle. In normals, the ratio of end systolic (S2) versus early peak systolic (S1) velocity was 0.52 ± 0.11 (range 0.37–0.84). In the patients with renal artery stenosis S2/S1 ranged from 0 to 0.30. Five of the 8 patients with renal artery stenosis could be evaluated before and after percutaneous transluminal dilatation (PTA). After successful PTA (diameter reduction < 50% and pressure gradient < 20 mm Hg) S2/S1 returned to normal. The patients with increased peripheral resistance due to an angiographically proven small kidney exhibited a variety of flow patterns with S2/S1 ranging from 0 to 0.29, similar to the ones with renal artery stenosis. The results suggest that the noninvasive determination of the ratio S2/S1 with the aid of ultrasound Doppler measurements permits a differentiation between normal and abnormal flow patterns and can be applied for the follow-up of patients after PTA. In utilizing the described method, neither the angle between the Doppler beam and the vessel axis, nor the vessel diameter must be evaluat

ISSN:1660-8151    

DOI:10.1159/000184035

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

In this paper several aspects of the evaluation of renal perfusion by means of the xenon-133 washout technique are reviewed. Although the method requires arterial catheterization, and is difficult to carry out in the face of far-advanced renal artery stenosis, in many patients it may provide useful information on the intrarenal hemodynamic pattern. In patients with renal artery stenosis the percentage of total flow perfusing the rapid compartment ( = outer cortex) is maintained, but absolute flow in that compartment is reduced to a variable degree. It is suggested that this reflects recruitment of fast-flow nephrons in response to a fall in perfusion pressure.

ISSN:1660-8151    

DOI:10.1159/000184036

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Serum parathyroid hormone (PTH) levels in 6 patients who had received parathyroid tissue autografts were studied. Samples were taken from graft and non-graft arms both pre- and post-dialysis. Each sample was analysed using two PTH assays, one measuring C-terminal PTH and the other measuring the intact PTH molecule. For both pre- and post-dialysis samples an appreciably greater difference was seen between the graft and non-graft arms using the intact assay. A patient with suspected ectopic PTH production showed a very much reduced differential between the two sampling sites with both assays. We suggest that the intact PTH assay is of greater clinical utility in the localisation of ectopic glands and monitoring of graft function than the commonly used C-terminal assays.

ISSN:1660-8151    

DOI:10.1159/000183903

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

We have examined the interstitial cellular infiltrate using monoclonal antibodies against T cells (Cris 1), helper/inducer T cells (OKT4) and suppressor/cytotoxic T cells (OKT8) by indirect immunofluorescence in renal biopsies taken from 14 transplanted patients during clinical episodes suggestive of acute (n = 9), chronic (n = 2) and no rejection (n = 3). Infiltrating T cells and T cell subsets were found to be significantly increased during all types of rejection (n = 11) as compared to no rejection (n = 3). Two types of biopsies could be distinguished according to the predominance of T cell subsets. In some biopsies (n = 6), OKT8+ cells were significantly more numerous that OKT4+ cells. In the remaining biopsies (n = 5), OKT4+ cells were more common that OKT8+ cells, the OKT4/OKT8 ratio being significantly higher. No association was observed between HLA mismatch and predominating T cell subset, neither for type nor outcome of graft rejection. Our results suggest that the OKT4+ cells may play a more important role than previously reported in renal graft rejection.

ISSN:1660-8151    

DOI:10.1159/000183904

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

A retrospective analysis of renal vein renin results has been done in 96 patients with renal artery stenosis and hypertension studied in two Italian centers (Sassari and Pisa) with respect to the outcome of either surgery or percutaneous transluminal angioplasty (PTA). In all patients the renal vein renin ratio and the V-A/A ratios for the affected and unaffected kidney were calculated. Each patient underwent surgery (75) of PTA (21) : 71 subjects were cured, 17 improved whereas the arterial pressure did not vary after revascularisation procedure in 8 patients. In the Pisa series all 54 patients showed a lateralisation with contralateral renin suppression and 95% of them benefitted from surgery. In the Sassari series 42 patients were submitted to PTA or surgery, not only on the basis of a positive renal vein renin study but taking into account a complete clinical evaluation: 8 of them were cured or improved in spite of negative renal vein renin criteria. In the two series, the better predictive index appeared to be the suppression of the renin secretion from the contralateral kidney while the high/low renin ratio showed a consistent amount of false-positive and false-negative results. Our retrospective study demonstrates that the renal vein test in hypertensive patients with renal artery stenosis is highly predictive of the curability of the disease, particularly when contralateral suppression of renin secretion is present. On the other hand, since patients with negative renin indexes can also take benefit from surgery of PTA, the renin parameters cannot be adopted as the sole criterion in making the decision to operate.

ISSN:1660-8151    

DOI:10.1159/000184039

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

To assess the diagnostic and prognostic value of renal venous renin levels in renovascular hypertension, 95 patients with severe unilateral renal artery stenosis were studied. Surgery (n = 52) or percutaneous transluminal dilation (n = 43) were done irrespective of renal venous renin levels. Lateralization of renin secretion as assessed by the PRA ratio and the renin secretion index was found in the majority of patients (66% and 88%, respectively). Patients with fibromuscular hyperplasia had more frequently PRA ratios < 1.5 than those with arteriosclerotic stenosis (p < 0.05). The renin secretion index proved to have a higher sensitivity (92%) and predictive value (92%) for a successful outcome of both surgery and PTA than the PRA ratio (69% and 89%, respectively), while the specificity was the same with both parameters (42% and 43%, respectively). The contralateral suppression index was most specific in predicting an unfavorable outcome. However, with all ratios used, a considerable number of false-negative and false-positive tests were observed both with surgery and PTA, a finding limiting the value of the method in selecting patients for these interventions. Other factors, such as age of the patient, kidney function and the underlying arterial disease turned out to be equally important prognostic factors. Thus, although cure after both surgery and PTA is more likely in the presence of lateralized renin secretion and contralateral suppression, the method does not allow to exclude patients with severe renal artery stenosis, hypertension and negative renal venous renin tests from these interventions. Therapeutic decisions in renovascular hypertension therefore should not depend on a single test, but rather on various clinical, radiological and laboratory findings together.

ISSN:1660-8151    

DOI:10.1159/000184040

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

Gentamicin removal during intermittent peritoneal dialysis was studied in 13 uremic patients. The peak serum level after 80 mg of gentamicin intravenous drip was 6.00 ± 1.3 μg/ml with a serum half-life of 13.6 ± 4.07 h. The gentamicin dialysate level did not correlate with the corresponding serum concentration. The peritoneal gentamicin clearance (10.0 + 3.65 ml/min) correlated with the rate of protein loss, but not with the peritoneal clearances of urea and creatinine. When 4% glucose dialysate was used, the clearance of the drug increased considerably along with the ultrafiltration rate. Adding gentamicin (5 μg/ml) to the dialysate resulted in a sustained serum drug level. The mechanism of gentamicin transport through the peritoneal membrane is discussed. The study demonstrated significant removal of gentamicin during intermittent peritoneal dialy

ISSN:1660-8151    

DOI:10.1159/000183905

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

A 58-year-old woman was hospitalized with acute renal failure and unilateral pulmonary consolitation. Ten days later she developed massive pulmonary haemorrhage with diffuse pulmonary consolidation. Renal biopsy revealed 100% crescentic nephritis without immunofluorescence (IF) or electron microscopic evidence of immune-reactant deposition. Circulating anti-glomerular basement membrane (antiGBM) antibody was not detectable by radioimmunoassay. Despite aggressive therapy pulmonary haemorrhage eventually proved fatal. IF of lung tissue revealed no immune-reactant deposition. This report represents a case of idiopathic Goodpasture’s syndrome, both from an aetiological and an immunopathological viewpoint. It emphasizes that Goodpasture’s syndrome (i.e. pulmonary haemorrhage and glomerulonephritis) occurs in a variety of situations which are not mediated by antiGBM antibody deposition and that alveolar haemorrhage should be considered in the differential diagnosis of all radiological pulmonary infiltrates, including unilateral opacities, when abnormalities of renal function coex

ISSN:1660-8151    

DOI:10.1159/000183906

出版商:S. Karger AG    

年代:1986

数据来源: Karger

摘要:

The ability of renal venous renin ratio (RVRR) to predict the blood pressure response to nephrectomy was studied in 45 hypertensive patients followed for at least 1 year after nephrectomy. Twenty patients had unilateral chronic parenchymal renal disease (UCPR) and 25 patients had unilateral renal artery stenosis (RAS). The RVRR procedure was performed according to a strict protocol which included sodium restricted diet (40 mmol daily) and hospital admission, with one set of unstimulated samples collected after overnight recumbency, and at least one further set collected after sympathetic nervous system stimulation induced by tilting or i.v. diazoxide. In only 3 of 12 patients with serum creatinine 0.15 mmol/l or higher and presumed bilateral renal disease was hypertension improved. If these 12 patients are excluded, RVRR was a good predictor of outcome, but only if the question of unstimulated and stimulated ratios was considered. Whereas inclusion of stimulated ratios increased the predictive accuracy to 81% in RAS, and avoided two false-negatives, in UCPR the stimulated ratio created four false-positives. Since there were no false-negatives and six true-negatives in UCPR, overnight recumbent RVRR was a perfect predictor of outcome in this sub-group. It appears that RVRR without sympathetic stimulation is most reliable in UCPR, and RVRR during sympathetic stimulation in RAS, raising the question that renin regulation may be different in these two conditions.

ISSN:1660-8151    

DOI:10.1159/000184041

出版商:S. Karger AG    

年代:1986

数据来源: Karger