摘要:

Recently there has been a renewed interest in the possibility that lipoprotein(a) -Lp(a) – may be important in the pathogenesis of thrombosis-related disease. In nephrotic syndrome, hyperlipidemia is a common finding, and thrombosis is a major complication. With this regard, if Lp(a) levels increase concomitantly with low-density lipoprotein and/or very-low-density lipoprotein levels in nephrotic syndrome, this may be considered a thrombogenic factor. To probe this possibility and to corroborate the relationship between Lp(a) and fibrinolytic profiles, we measured the Lp(a) levels in patients with nephrotic syndrome (n=43), in patients with chronic glomerulonephritis with less proteinuria than in nephrotic syndrome (n=28), and in healthy controls (n=50) and observed the relation between Lp(a) levels and tissue-type plasminogen activator (t-PA) activity, euglobulin fibrinolytic activity, and t-PA antigen. The Lp(a) levels were significantly higher in the patients with nephrotic syndrome as compared with both patients with chronic glomerulonephritis and healthy controls (p < 0.001). There was a direct correlation with serum cholesterol level (r=0.780; p = 0.0001), triglyceride level (r=0.445; p = 0.0001), and urine protein level (r = 0.675; p=0.0001) and a reverse correlation with serum albumin levels (r = 0.566; p = 0.0001). The Lp(a) levels showed a reverse correlation with t-pA activity (r = 0.627; p = 0.0001), total fibrinolytic activity in euglobulin fraction (r = 0.458; p = 0.0001), and t-PA activity divided by the t-PA antigen (r = 0.567; p = 0.0001), but no correlation with t-PA antigen. Our results suggest that Lp(a) may be an important thrombogenic factor in patients with nephrotic syndrom

ISSN:1660-8151    

DOI:10.1159/000188426

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

To analyze the clinical course and response to therapy 15 patients (9 male and 6 female) with the hepatosplenic form of schistosomiasis mansoni and focal segmental glomerulosclerosis (FSGS) were prospectively studied (mean follow-up=115.8 ± 93.2 months). Nephrotic syndrome was the most frequent clinical presentation, followed by abnormalities of urinalysis. The clinical course was progressive: at final evaluation 9 patients (60%) had developed renal failure. Hypertension or/and renal insufficiency at initial evaluation and persistence of the nephrotic syndrome were associated with progression toward advanced renal failure. Response to immunosuppressive therapy was recorded in 30% of the patients; all responsive patients still had normal renal function at final evaluation. The treatment of the Schisiosoma mansoni infection did not influence the clinical course of the renal disease. It is concluded that FSGS in patients with hepatosplenic schistosomiasis mansoni is a disease progressing to advanced stage independently of the presence of the parasite

ISSN:1660-8151    

DOI:10.1159/000188427

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Mean platelet survival time in patients with acute poststreptococcal glomerulonephritis (APSGN) is reduced to 50-60% of the control values, and glomerular deposits of platelet factor 4 are found in these patients. In order to investigate further systemic platelet changes of pathogenic, clinical or prognostic significance, we measured the platelet serotonin (5-HT) content and the blood platelet counts during the 1st week of the disease in 27 patients with APSGN. Platelet 5-HT was significantly reduced in patients with APSGN as compared with patients with impetigo without glomerular involvement (785 ± 54 vs. 1,329 ± 94 ng 5-HT/109 platelets; p < 0.001). Similarly, the mean blood platelet count was reduced to 247 ± 16×103 as compared with 303 ± 14×103 in the controls (p < 0.05). Thirteen (48%) of these patients had individual values of platelet 5-HT lower than the 95% confidence interval calculated in the control group. No significant correlation was observed between the concentration of 5-HT and either the severity of the disease judged by the amount of urinary protein excretion and the serum creatinine value or the presence of circulating immune complexes. Significant correction of the platelet 5-HT content (to 1,180 ± 111 ng/109 platelets; p < 0.01) and of the platelet counts (to 309 ± 21×103; p < 0.01) were observed in the longitudinal study at least 2 weeks later. Platelet activation, with secretion of granular content and increased consumption, may explain these findings. Additionally, the reduced mean age of the circulating platelets could contribute to their decreased 5-HT levels. The reduced platelet counts are not of clinical significance, but serial measurements of platelet 5-HT may be useful in predicting active glomerular infl

ISSN:1660-8151    

DOI:10.1159/000188428

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Our objective was to more precisely determine glomerular function in patients with systemic lupus erythematosus (SLE), without abnormalities in renal function, as determined by standard clinical laboratory tests. Our long-term goal is to identify patients during clinical quiescence who may be at high risk of developing progression to renal failure from lupus nephritis. We studied three groups of subjects: 8 patients with SLE and a history of nephritis, now in remission; 25 patients with SLE, without clinical evidence of nephritis, now or in the past; and 5 healthy women (normal controls). At the time of study, urinalysis, serum creatinine and 24-hour urine total protein excretion were within the normal range in each subject. We measured glomerular filtration rate (GFR) by 125I-iothalamate clearance, and albumin excretion rate (AER) by enzyme-linked immunosorbent assay (ELISA) in timed urine specimens. In addition, we compared 4-hour AER with 24-hour AER and spot urine albumin/creatinine ratio (A/C). Among patients with a history of nephritis now in remission, mean GFR was slightly but not significantly lower and mean AER was elevated (p < 0.03). Among patients with SLE without a history of nephritis, mean GFR was normal, but the variance in GFR was greater than normal (p < 0.005). Seven patients without nephritis (28%) had either hyperfiltration or hypofiltration. Mean AER was normal, but 3 other patients (12%) had elevated AER. There was no correlation of GFR and AER among patients in either group. Correlations (r) of spot urine A/C and 24-hour AER with 4-hour AER were 0.93 (p < 0.001) and 0.88 (p < 0.00l), respectively. We conclude that most patients with SLE and a history of nephritis now in remission have persistent abnormalities in glomerular function, and as many as 40% of patients without a history of nephritis also have subtle defects in glomerular function. Whether these abnormalities in glomerular function define a subset of patients at higher risk of developing renal failure, independent of disease activity, requires further study. Spot urine A/C is a valid measure of AER in SLE.

ISSN:1660-8151    

DOI:10.1159/000188429

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Patients with chronic renal failure often have low plasma zinc (Zn) levels. Some factors that may account for abnormal Zn metabolism in these patients are low dietary Zn intake, a specific Zn transport defect, or absence of intestinal Zn ligand. In this study Zn supplementation and a Zn-chelating drug, diiodohydroxyquinolein (DQ), were used to assess the effects of Zn intake and Zn transporters on Zn plasma levels in patients with chronic renal failure. To meet this objective, 20 uremic patients were randomly assigned to one of the following groups of treatment: group 1 received placebo; group 2 Zn sulfate (100 mg/day p.o.), group 3 DQ (80 mg/day p.o.), and group 4 received Zn sulfate plus DQ at the same dosages as in groups 2 and 3. The Zn plasma levels were measured in venous samples, before and after 1 and 2 weeks of treatment, by atomic absorption spectrophotometry. The Zn plasma levels increased in group 2 patients from 8 ± 0.2 to 10 ± 0.4 and 11 ± 0.9 μmol/l by the end of the 1st and 2nd weeks of treatment, respectively. In group 4 patients, the Zn plasma levels increased even more: from 9 ± 0.1 to 14 ± 1.6 and 13 ± 2.1 μmol/l respectively. The plasma Zn concentration of group 1 and 3 patients remained at basal levels. These results show that DQ, when given along with Zn sulfate supplements, causes a greater increase in plasma Zn levels than that caused by either drug give

ISSN:1660-8151    

DOI:10.1159/000188430

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Hypercholesterolemia may contribute to the pathogenesis of atherosclerosis associated with chronic renal failure (CRF). The mechanism underlying CRF-induced hypercholesterolemia, however, is still unknown. Mevalonate is the direct product of the rate-limiting step in cholesterol synthesis which is catalyzed by 3-hydroxy-3-methylglutaryl coenzyme A reductase. We studied the changes in mevalonate metabolism in a mouse model of CRF in which serum total cholesterol levels are directly correlated with the degree of severity of the disease as measured by serum urea levels. The results of these experiments indicated that in CRF mice, the urine mevalonate levels were significantly lower, while serum mevalonate and total cholesterol levels were significantly higher than in normal mice. We believe that by restricting the normal urinary excretion of mevalonate CRF results in more of this precursor being available for direct cholesterol synthesis. In addition, an increase in circulating mevalonate may upregulate the shunt pathway of mevalonate metabolism in the liver and peripheral tissues, thus providing increased levels of the substrates acetoacetate and acetyl coenzyme A for cholesterol synthesis.

ISSN:1660-8151    

DOI:10.1159/000188431

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

In the present study, we tested the hypothesis whether agmatine and spermidine, metabolites of arginine metabolism, share the pharmacological activities of argi- nine reducing collagen accumulation in the diabetic kidney. Eleven db/db mice were administered agmatine and 12 db/db mice spermidine (50 mg/kg body weight). Ten db/db mice received no treatment as negative controls and 10 db/db mice were treated with aminoguanidine (50 mg/kg body weight) as positive controls. Mean kidney OH-proline content reflecting kidney collagen content and mean CML concentration were significantly higher but acid solubility of collagen significantly lower in the untreated group than in the treated groups. Agmatine, although missing the α-amino group and the carboxyl group, and spermidine, although missing the guanidino group, thus still revealed the arginine activity. We hypothesize that the strongly nucleophilic structure of polyamines common to all active compounds is able to block reactive carbonyls

ISSN:1660-8151    

DOI:10.1159/000188432

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Hypercholesterolemic Imai rats spontaneously develop proteinuria and glomerulosclerosis, especially in males. A sex difference in glomerular injury has been recognized, but the role of sex hormones in glomerular injury remains unclear. Therefore, we investigated whether estrogen administration influences the progressive glomerular injury in male Imai rats. Estrogen produced a significant decrease in body weight. Systolic blood pressure in estrogen-treated rats was significantly lower than that in controls. Estrogen attenuated the progression of glomerular injury by significantly reducing proteinuria and glomerular sclerosis. The glomerulosclerosis index was significantly higher in controls than in estrogen-treated rats. Estrogen suppressed serum testosterone levels, whereas it increased GH levels. Results suggest that estrogen appears to play an inhibitory role on the development of glomerular injury, by itself or in association with sex-related factors regulated by estrogen and testosterone.

ISSN:1660-8151    

DOI:10.1159/000188433

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

A 64-year-old woman presenting with a history of increasing oedema was found to have nephrotic syndrome with a 24-hour urinary protein excretion of 20.7 g and renal impairment with an initial serum creatinine level of 197 μmol/l (2.16 mg/dl). A renal tumour was demonstrated by ultrasound scanning and subsequent nephrectomy revealed a renal carcinoma extending as far as the resected end of the renal vein. Histology of the kidney not involved by the tumour showed normal light microscopic appearances, with electron microscopy demonstrating foot process fusion, suggesting a diagnosis of minimal-change nephropathy. Nephrotic syndrome is a rare complication of renal cell carcinomas, and it is particularly uncommon for minimal change nephropathy to be associated with solid tumours

ISSN:1660-8151    

DOI:10.1159/000188434

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:1660-8151    

DOI:10.1159/000188435

出版商:S. Karger AG    

年代:1995

数据来源: Karger