ISSN:1660-8151    

DOI:10.1159/000182626

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

A survival analysis was applied to 1,453 patients treated between 1972 and 1978 in 33 French dialysis centers and prospectively followed up in the computerized Diaphane Dialysis Registry. 198 deaths (overall mortality = OM) were registered, of which 87 (43%) were secondary to cardiovascular complications (cardiovascular mortality = CVM). Risk factors for OM and CVM (p values < 0.05) were age, male sex, nephroangiosclerosis or diabetic nephropathy as the primary renal disease, elevated systolic and diastolic blood pressure and two weekly dialysis rather than three. In contrast with the results observed for the general population, a high body mass index and elevated cholesterol, triglycerides and uric acid were not found to be associated with significantly increased CVM or OM. On the contrary, low body mass index ( < 20 kg/m2), low cholesterol ( < 4.5 mmol/l) and low mean predialysis blood urea ( < 4.6 mmol/l) were associated with increased OM and CVM, and more especially with high stroke mortality. Results for urea but not for cholesterol remain significant after adjustment for age, sex, weekly dialysis schedule and body mass index. They suggest that, in addition to elevated blood pressure, a poor nutritional state and/or low protein intake may be important factors for explaining the high cardiovascular mortality, particularly for strokes, observed in dialyzed patients.

ISSN:1660-8151    

DOI:10.1159/000182627

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

The lactate concentration in antecubital venous blood was determined in 33 patients before and after ischemic forearm exercise. Before exercise, there was no significant difference in serum lactate level between uremic patients and controls. However, after ischemic exercise the mean serum lactate level in uremic patients was significantly lower than that of controls. The results may lead to the conclusion that uremic patients have a markedly reduced ability to form lactate with anaerobic exercise probably due to inhibition of glycolytic enzymes of skeletal muscle.

ISSN:1660-8151    

DOI:10.1159/000182628

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

Immunoreactive parathyroid hormone (iPTH) was measured in the serum of 20 patients with early renal failure (ERF) using three assays with different specificity. Half of these patients had elevated iPTH in one or more assays, up to twice the upper limit of normal. In contrast, 36 patients with a creatinine clearance below < 20 ml/min had an 80% elevated iPTH, up to 5 times the upper limit of normal. The patients with ERF and elevated iPTH had a lower serum calcium but no higher serum phosphate than those with normal iPTH. The differences in iPTH in early and end-stage renal failure can be explained by known differences in metabolism of different PTH forms in uremia.

ISSN:1660-8151    

DOI:10.1159/000182629

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

In 27 patients with end-stage chronic renal failure an elevated calcitonin (CT) and parathyroid hormone was found. On stimulation with Ca i.v. there were 9 cases in whom ΔCT proved to be higher than the maximal response of 50 pg ml-1 in controls. Supranormal CT responses were found predominantly in patients with normal alkaline phosphatase, who as a group increased their CT from 94.5 ± 61 to 142.0 ± 94 pg ml1 (p < 0.02). In contrast to this, patients with elevated alkaline phosphatase who also had a higher level of parathyroid hormone maintained unchanged CT on Ca stimulation. It is concluded that in chronic renal failure with severe secondary hyperparathyroidism, ΔCT on stimulation is normal, while an enhanced ΔCT often exists when hyperparathyroidism is of insufficient degree to cause a raised alkaline phospha

ISSN:1660-8151    

DOI:10.1159/000182630

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

A study has been made of the fluoride kinetics in man, with a series of 5 healthy subjects and 4 patients with renal insufficiency. The fluoride metabolism was found to conform to nonlinear tissue-binding kinetics. Reanalysis of findings on the rabbit reported in the literature yielded equivalent results. The tissue-binding constants elicited -probably associated with the fluoride metabolism of bone – presented no differences between healthy subjects and uremics. Uremics had a clearly lower fractional fluoride elimination rate (K) compared with the healthy controls. A significant correlation of creatinine clearance on the K value was note

ISSN:1660-8151    

DOI:10.1159/000182631

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

Ultrafiltrates from uremic patients can induce, in vitro, strong modifications of beating frequency of auricular fragments of the embryonic chick heart. According to concentration, effects increase from tachycardia to cessation of cardiac beats. Complete reversion is always observed after washing with normal medium. Only fraction 7c of middle molecules exhibits this cardiotoxicity, other fractions are without effect, even in high concentration. Uremic middle molecules strongly modify cardiac beats in vitro.

ISSN:1660-8151    

DOI:10.1159/000182632

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

Previous reports on the nephritogenic and immunological enhancing capacity of posttransplant circulating immune complexes (CICs) are conflicting and have been confined to the study of acute rejection episode (AR). This study was undertaken to assess the nephritogenicity of CICs in patients undergoing accelerated acute rejection (AAR) and chronic rejection (CR) episodes. We also assessed the possible role of CICs as mediators of immunological enhancement by assessing CIC levels in long-term-stable allograft recipients. To assess the nephritogenic role of CICs, 98 CIC determinations were performed on 49 serum samples from 41 pediatric renal transplant recipients using the Clq solid-phase assay (Clq-SPA) and the Raji cell radioimmunoassay (Raji-RIA). Serum samples from normal subjects served as controls. No recipient undergoing AAR had evidence of CICs by either assay. 5 of 21 (23.8%) recipients undergoing CR had positive CIC levels in the Raji-RIA, while 4 of 21 (19%) recipients had positive CICs in the Clq-SPA. There was no statistically significant correlation of CIC levels with long-term allograft function. In addition, there was no evidence supporting antithymocyte globulin as an immunogen in patients demonstrating posttransplant CICs. In summary, CICs do not appear to be an important mediator of AAR or CR episodes, and CICs were not routinely detected in patients with good long-term allograft function.

ISSN:1660-8151    

DOI:10.1159/000182633

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

30 patients on hemodialysis or peritoneal dialysis have been investigated by computerized tomographic (CT) scan. To evaluate possible cerebral alterations induced by dialysis, CT examinations were carried out before, immediately after and 6 h after the end of dialysis with an Evaluskop, which provides an objective precise evaluation of even slight variations in brain density. No morphological variations were noted after dialysis, while the brain density fell significantly during and after the treatment. A decrease in density was not observed in normal subjects or in patients on continuous peritoneal dialysis. The changes in the densitometric values of brain tissue suggest that there is a postdialysis gain in cerebral water linked to the intermittent treatment. CT may represent a simple reliable method for studying uremic encephalopathy and investigating the pathogenesis of the dialysis disequilibrium syndrome.

ISSN:1660-8151    

DOI:10.1159/000182634

出版商:S. Karger AG    

年代:1982

数据来源: Karger

摘要:

In order to assess the effects of sodium depletion on tubular Na and H2O transport in man, renal clearance studies were performed under control conditions and after sodium depletion in 7 normal subjects. The control diet contained 250 mEq of Na daily. Sodium depletion was induced by placing subjects on a 20-mEq/day Na diet and administering furosemide (40 mg) daily for 3 days. Balance studies revealed that the subjects were in Na balance under control conditions, and that after sodium depletion had been established they were in a sodium-retaining state. Subjects were studied under both conditions, after H2O hydration and during a subsequent hypotonic mannitol infusion. After H2O hydration the minimal urinary osmolality averaged 61 and 67 mosm/kg in the sodium depletion and control states, respectively. Sodium depletion was associated with a significant reduction in C inulin, sodium clearance (CNa), urine flow (V), fractional urine flow (V/GFR), free water (CH2O), and fractional free water clearance (CH2O/GFR). During hypotonic mannitol infusion indices of absolute and fractional delivery of Na from the proximal tubule (CH2O + CNa; CH2O/GFR + CNa/GFR) were consistently reduced after sodium depletion and rose more slowly as absolute and fractional fluid delivery to the loop of Henle (V; V/GFR) were increased. Indices of absolute and fractional sodium chloride transport in the distal tubule (CH2O; CH2O/GFR) rose at a significantly sharper rate after sodium depletion as absolute and fractional distal sodium chloride supply (CH2O + CNa; CH2O/GFR + CNa/GFR) were increased. These data are consistent with the view that modest sodium depletion in man provokes an increase in fractional sodium chloride reabsorption in both the proximal and distal tubules.

ISSN:1660-8151    

DOI:10.1159/000182635

出版商:S. Karger AG    

年代:1982

数据来源: Karger