ISSN:1660-8151    

DOI:10.1159/000183391

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

There is increasing evidence that the sodium retention of nephrotic syndrome is directly due to an intrarenal mechanism and not to a low blood volume stimulating the renin-angiotensin-aldosterone system. However the mechanism of the natriuresis that occurs during remission is not known. Patients with nephrotic syndrome were therefore studied during steroid-induced remission. At the onset of natriuresis, blood volume and plasma albumin were low and did not change. Plasma renin activity and plasma aldosterone were initially high and both fell during the natriuresis. At the end of the natriuresis when patients had lost their oedema, plasma renin activity and plasma aldosterone rose to high levels, plasma albumin and blood volume remained low, and yet the patients were no longer retaining sodium and were in sodium balance. These observations suggest that the natriuresis of remission is due to the correction of an intrarenal mechanism causing the sodium retention. This study raises two major unanswered questions. Firstly, when the presumed intrarenal mechanism is corrected, what tells the kidney to excrete large amounts of sodium when the blood volume remains low? Secondly, why do the patients come back into sodium balance when the blood volume is low, and plasma renin activity and plasma aldosterone are elevated?

ISSN:1660-8151    

DOI:10.1159/000183392

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The present study was undertaken to determine the prevalence of asymptomatic pericardial effusion in a population with end-stage renal failure just prior to the initiation of chronic dialysis, and to determine the effect of long-term dialysis on these effusions. We prospectively studied 50 uremic patients with M-mode echocardiograms prior to initiation of chronic dialysis and followed 33 of these patients after 10 months of intense dialytic therapy. Predialysis effusion was present in 18/50(36%) patients. Only 3/50 patients had clinical evidence of pericarditis (none of these individuals had an effusion). The incidence of clinical congestion and radiological evidence of volume overload was significantly higher in the patients with an asymptomatic pericardial effusion. Of these, the effusion disappeared on improved in 6 (43%), remained unchanged in 6 (43%), and worsened in 2 (14%). No patients developed new pericardise effusions during chronic dialysis. Changes in effusion size were related to changes in body weight between dialysis treatments (r ≈ 0.39; p < 0.05). Our data show that (1) asymptomatic pericardial effusions are frequent in uremic patients prior to initiation of dialysis, (2) the etiology of asymptomatic pericardial effusions in these patients appears to be related to volume overload, (3) only 43% of the patients improved their effusions with chronic dialysi

ISSN:1660-8151    

DOI:10.1159/000183393

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

A retrospective study was undertaken to evaluate the significance of anatomic variants in living-related donor kidneys, when used in renal transplantation. 301 arteriograms were performed in the evaluation of such potential living donors over an 8-year period. 51 (16.9%) were found to have one or more radiographic abnormalities. 20 of the 51 patients (39%) were judged as not suitable for transplantation because of radiographic abnormalities. 7 of 31 patients who were accepted as organ donors declined for personal reasons. The remaining 24 patients underwent donor nephrectomy with the abnormal kidney utilized as the donor organ. In follow-up, none of the kidneys were lost because of their primary radiographic abnormality, and allograft survival of abnormal kidneys was the same as for normal kidneys transplanted under parallel circumstances. We conclude, in properly selected living donors, kidneys with anatomic variants without pathological significance can be used safely in renal allotransplantation. We do not recommend, however, transplanting kidneys with the potential for the development of progressive disease.

ISSN:1660-8151    

DOI:10.1159/000183394

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Anuria is a frequent complication during the immediate post-transplantation period in kidney transplant recipients. Radioisotopic studies with 13lI-Hippuran and 99mTc-pertechnetate allow correct differentiation between viable and non-viable grafts.

ISSN:1660-8151    

DOI:10.1159/000183395

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

27 patients on hemodialysis (dialysate aluminium < 0.7 μmol/l for 2 years, and 2 μmol/l before) whose plasma Ca and PO4 were adequately controlled for already 6 months by high doses of CaCO3 alone (mean ± SD: 9 ± 5 g/day), were randomly divided into 2 groups, a control group (c group) which was kept on the same treatment, and a group in which CaCO3 was reduced to 3 g/day but in which plasma Ca was kept normal due to 1α-OH-vitamin D3 administration (1 μg/day at the beginning, 0.3 μg/day after 6 months; 1α group) whereas plasma phosphate was kept below 6.0 mg/dl because of A1(OH)3 (2.7–5 g/day). Initially, the 2 groups were comparable as regards the plasma concentrations of total and ionized Ca, phosphate, alkaline phosphatases, medium and C-terminal parathyroid hormone (PTH) and aluminium, but the control group had lower plasma 25-OH-vitamin D (25-OHD.) After 6 months, the same difference in plasma 25-OHD was found with comparable plasma concentrations of total and ionized calcium as well as of medium and C-terminal PTH (beta error 1%). However, plasma concentration of phosphate and the plasma Ca phosphate product, as well as the plasma aluminium were higher in the 1α group whereas their PCO3H was lower. Although the alkaline phosphatase values were not significantly different between the 2 groups, they increased only in the control group because of 1 patient who developed a vitamin-D-deficient osteomalacia (plasma 25-OHD 3 ng/ml), which was subsequently cured by physiological doses of 25-OHD3. The incidence of transient hypercalcemia (15 vs. 21 episodes) and worsening of soft tissue calcifications (3 in each group) was the same in th

ISSN:1660-8151    

DOI:10.1159/000183396

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Skeletal muscle water, Cl, Na and K were studied in 24 patients with predialysis chronic renal failure (CRF) and in 16 patients under regular dialysis treatment (RDT) for 8–16 years; 35 healthy controls were also examined. Total Cl, Na and water (Clm, Nam, TW) were high in both CRF and RDT groups (p < 0.001); high TW in CRF was due to both extra (ECW) and intracellular (ICW) fractions, which were calculated from Cl space; in RDT only ECW was increased and ICW was normal. Muscle K was diminished in CRF, in reference to both muscle fat free dry solids and ICW, and it was slightly but significantly higher than normal in RDT. The findings demonstrate that high cell volume and low intracellular K observed in CRF are fully corrected by long-term hemodialysis, probably because these abnormalities are mainly related to cell function disturbances due to uremic state. On the contrary, the persistence of high total Cl, Na and muscle ECW seems to be an expression of expanded extracellular fluid volum

ISSN:1660-8151    

DOI:10.1159/000183397

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The probability of being a stone former (PSF) was calculated in 3 groups of idiopathic calcium stone formers [with normocalciuria (NC), dietary hypercalciuria (DH) and idiopathic hypercalciuria (IH)] in 4 conditions: while (1) on a free diet; (2) on a calcium- and oxalate-restricted diet during 4 days; (3) after an oxalate load, while on a 1.5-gram calcium diet, and (4) after an oxalate load while on a calcium-restricted diet. Combined calcium and oxalate restriction significantly decreased PSF only in NC and DH whereas the decrease was not significant in IH because of a concomitant significant increase in oxalate excretion. Increase of PSF with the oxalate load was significantly greater during a calcium-restricted diet than during the 1.5-gram calcium diet in all groups of patients (4,6 and 12 times greater in NC, DH and IH, respectively). These data show the critical role of oxalate restriction when calcium is restricted in order to decrease the PSF. This combined restriction is however not sufficient in idiopathic hypercalciuric patients to decrease their PSF.

ISSN:1660-8151    

DOI:10.1159/000183398

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Venous and arterial thromboembolism frequently complicate the nephrotic syndrome. Increased platelet aggregation, high levels of fibrinogen and other procoagulants, and depressed levels of antithrombin III and plasminogen are commonly cited as reasons. Less attention has been paid to changes in the hemostatic system which might protect against thrombosis. We found a high frequency of reduced α2-antiplasmin levels in 40 patients with nephrotic syndrome, correlating with serum albumin and with antithrombin III levels. Since α2-antiplasmin is a major determinant of the sensitivity of fibrin thrombi to lysis, and since reduced levels would be expected to promote fibrinolysis, we conclude that in many patients with nephrotic syndrome depressed antiplasmin levels may help reduce the risk of thrombosis posed by diminished antithrombin III level

ISSN:1660-8151    

DOI:10.1159/000183399

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Rheumatoid factors (RF), autoantibodies to IgG, have been postulated to have some pathogenetic role in the development of some types of glomerulonephritis. A simple and sensitive solid-phase fluorescence immunoassay was employed to determine whether IgG, IgA and IgM RF were detectable in sera from patients with various types of glomerulonephritis, rheumatoid arthritis (RA) and those with various streptococcal infections. IgG, IgA and IgM RF were significantly increased in the majority of patients with RA, lupus nephritis (SLE), acute poststreptococcal glomerulonephritis (APSGN) and various streptococcal infections. The titers of IgG and IgA RF were significantly higher in patients with APSGN than in those with simple pharyngitis. IgM RF was increated in patients with IgA nephropathy (IgA-N) and in those with membranoproliferative glomerulonephritis type I (MPGN). No significantly high RF was observed in membranous nephropathy (MN) or chronic mesangial proliferative glomerulonephritis without IgA deposition (PGN). It is suggested that some autologous immune mechanisms may be involved in the pathogenesis of some types of glomerulonephritis.

ISSN:1660-8151    

DOI:10.1159/000183400

出版商:S. Karger AG    

年代:1985

数据来源: Karger