ISSN:1660-8151    

DOI:10.1159/000186796

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Anemia is already present in patients with moderate renal failure and is a major cause of the decline in exercise capacity seen in these patients. We examined the effects of erythropoietin (EPO) treatment in 12 predialytic uremic patients (EPO group: mean age 46 ± 12 years; 6 men, 6 women) with a mean glomerular filtration rate (GFR) of 10 ± 4 ml/min × 1.73 m2. These patients were compared to a control group of 8 patients (5 men, 3 women). The observation period was 3 months. The EPO group received 300 U/kg body weight i.v. once a week. The EPO group increased their total hemoglobin (THb) from 323 ± 89 to 466 ± 128 g (p < 0.001) and their hemoglobin concentration from 86 ± 8 to 117 + 11 g/l (p < 0.001). Their exercise capacity, measured by a standardized exercise test on a bicycle ergometer, increased from 128 ± 45 to 147 ± 57 W (p < 0.01). The control group did not change their THb (349 ± 124 and 357 ± 131 g), hemoglobin (93 ± 8 and 94 ± 10 g/l) or exercise capacity (98 ± 49 and 101 ± 50 W) during the observation period. There was a significant correlation between the increase in THb and the increase in exercise capacity in the EPO group (r = 0.81, p < 0.005). The GFR was unchanged in both groups (EPO group: 10 ± 4 and 10 + 6 ml/min × 1.73 m2; control group: 8 ± 3 and 8 ± 3 ml/min × 1.73 m2). The median renal plasma flow did not change significantly in either group (EPO group: 42 and 27 ml/ min × 1.73 m2; control group: 34 and 28 ml/min × 1.73 m2). The median filtration fraction, however, increased significantly in the EPO group (0.21 to 0.30; p < 0.05), while the filtration fraction in the control group was unchanged (0.22 and 0.25; NS). We conclude that erythropoietin treatment increases the THb in predialytic uremic patients, resulting in an improved exercise capacity w

ISSN:1660-8151    

DOI:10.1159/000186797

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The authors analysed CD4+ subset populations and particularly subset killing in order to evaluate the presence of antilymphocyte antibody against CD4 + subsets in patients with IgA nephropathy (IgA N). This study was performed in 45 patients with IgA N, 30 patients with other forms of glomerulonephritis and 30 healthy controls. CD4 + CD4 + CD45R- and CD4 + CD45R+ cells in the peripheral blood were counted by a flow cytometric analysis, and those cell killings were analysed by microcytotoxic assays. The percentage of circulating CD4 + CD45R + cells was significantly decreased in IgA N, and the percentage of CD4 + CD45R+ cell killing was significantly elevated in IgA N compared with other groups. There was a significant negative correlation between the percentage of CD4 + CD45R + cells present in IgA N patients’ peripheral blood lymphocytes and the killing CD4 + CD45R + cells by the same patients’ serum. Both a depletion of CD4 + CD45R+ cells in peripheral blood lymphocytes and an elevation of CD4 + CD45R+ cell killing correlated with the grade of mesangial proliferation in patients with IgA N. However, there were no correlations in other clinicopathological indices. These results suggest that low levels of antilymphocyte antibodies against CD4 + CD45R+ cells were present in patients with IgA N, who showed a depletion of CD4 + CD45R+ cells in the peripheral blood. These antibodies were strongly associated with the elimination of CD4 + CD45R+ cells and the proliferation of glomerular mesangial cells in patients with Ig

ISSN:1660-8151    

DOI:10.1159/000186798

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

CD23 is a surface marker of activated B cells as well as a low-affinity Fc receptor for IgE. In this study, we enumerated CD23-positive peripheral blood lymphocytes and evaluated their clinical significance in patients with IgA nephropathy (IgAN). Twenty-five patients with IgAN and 16 patients with non-IgA proliferative glomerulonephritis (PGN) were studied. Twenty-seven healthy adults served as controls. CD23-bearing cells were enumerated by flow cytometry, and serum IgE levels were measured by latex photometric immunoassay. Significant increases in the number of CD23-positive cells were observed in patients with IgAN (p < 0.01) and PGN (p < 0.05) compared with controls. A significant elevation of serum IgE levels was also observed in the patients with IgAN and PGN (p < 0.05). No positive correlation between the number of CD23-positive cells and serum IgE levels was observed. We also examined the induction of surface CD23 expression on peripheral lymphocytes by interleukin (IL)-2, IL-3, IL-4, IL-5, IL-6, interferon (IFN)-γ IFN-α, phytohemagglutinin, concanavalin A, pokeweed mitogen, lipopolysaccharide and phorbol myristate acetate. IL-4 was revealed to have a significantly potent effect on the induction of cell surface CD23 compared with other stimulants. It was concluded that many patients with IgAN or PGN show high serum IgE levels and/or high CD23-positive cell counts in their peripheral blood, suggesting that hyperactivation of B cells might be involved in the development of IgAN and non-IgA PGN. It appeared that IL-4 may play a significant role in the etiology of these types of glomerulonephriti

ISSN:1660-8151    

DOI:10.1159/000186799

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

To achieve a rational basis for the use of deferoxamine (DFO) in aluminum (AL) – and iron (Fe) – overloaded uremic patients, important insights may be provided by the recently available micromethods to determine DFO and its metallochelates aluminoxamine (AlA) and feroxamine (FeA). With this procedure, AlA and FeA plasma kinetics were evaluated in a pilot study in 10 uremic patients during a whole week after a single DFO infusion performed during the first hour of the first standard bicarbonate hemodialysis (HD) of the week. Patients were divided into normal (n = 6) and high (n = 4) ferritin groups (1 and 2 respectively). Baseline Al concentrations were > 2 < 6 in group 1 and 2 3.5 < 6 μmol/l), even a DFO dose as low as 10 mg/kg was sufficient to form consistent AlA amounts (from 80 to 15% of total Al). Also FeA kinetics were similar in group 1 and 2, but in this case, the peak was reached during the first HD, with an ensuing progressive decrease during all the interdialysis periods and HD times. FeA dropped in both groups from about 90-85% to 20-10% of plasma Fe at the beginning of the 2nd HD. A substantial increase in total plasma Fe differentiated group 2 from group 1. Mild differences only were observed with different DFO doses in group 2. Discrepancies between AlA and FeA on one hand, and plasma Al and Fe increase on the other, clearly showed that both circulating Al and Fe contributed to form metallochelates. The implications for clinical practice are that DFO once a week provides substantial Al mobilization and removal and sparse Fe loss in normal iron statues patients, while moderate repeated DFO doses permit Fe removal in iron-overloaded pa

ISSN:1660-8151    

DOI:10.1159/000186800

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Twenty-one familial Mediterranean fever (FMF) patients who received a kidney transplant for terminal renal failure due to amyloidosis were studied retrospectively to evaluate the prophylactic effect of colchicine on graft amyloidosis. Proteinuria, highly suggestive of kidney transplant amyloidosis, developed in 11 patients within a median of 3 years after transplantation (range 0.5-10 years). In 10 patients, repeated urinalyses for protein were negative during a median of 5 years after transplantation (range 1-13). Patients who developed proteinuria or transplant amyloidosis received smaller colchicine doses than patients without proteinuria – mean 0.69 (range 0-1) versus 1.53 (range 1-2) milligrams per day (p = 0.0002), suggesting that colchicine prevents or delays development of transplant amyloidosis. This prophylactic effect of colchicine was complete at a dose of 1.5 mg/day or more and absent at a daily dose of 0.5 mg or less. In patients who received 1 mg/day, individual variability in the response to colchicine was observed. We conclude that the development of amyloidosis of the kidney transplant in FMF is inevitable at a colchicine dose lower than 1 mg/day, unpredictable at 1 mg/day and usually preventable with 1.5 mg/day or mor

ISSN:1660-8151    

DOI:10.1159/000186801

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We conducted a randomized unblinded parallel clinical trial to compare the effectiveness, side effects and tolerance between calcium acetate (CA) and calcium carbonate (CC) in 80 stable chronic hemodialysis patients selected on the basis of their acceptable control of serum phosphorus (P) levels with aluminum hydroxide (AH). All patients were dialyzed against the same calcium dialyzate (1.62 mmol/l). The serum analytical tests included: calcium corrected to total protein, P, PTH (intact molecule) and bicarbonate. The study was divided into the following periods: P0: baseline measurements; P1: washout (winthdrawal of AH for 15 days); P2: random allocation to CA and CC treatment at doses equivalent to 75 mEq of elemental calcium, stratified according to previous doses of AH (2 months); P3: adjustment of doses until control P (2 months). CA was poorly tolerated in 7 patients and CC in 2 (NS). The changes in serum P levels between P0 and P2 periods were lower in the CA group (1.73 ± 0.25 vs. 1.80 ± 0.50 mmol/l; p = 0.26) than in the CC group (1.77 ± 0.35 vs. 1.93 ± 0.48 mmol/l; p = 0.03, paired t test). Serum calcium was hardly modified by CA (2.42 ± 0.20 vs. 2.47 ± 0.17 mmol/l; NS) while in the CC group, it rose significantly (2.40 ± 0.12 vs. 2.55 ± 0.22 mmol/l; p = 0.0004). There were no differences in the control of PTH or bicarbonate. At the P3 period, patients on CC treatment needed higher doses of elemental calcium to control P than the CA group (99.4 ± 31 vs. 83 ± 27 mEq; p = 0.01), and at these doses, hypercalcemia ( > 2.86 mmol/l) was more frequent in the CC group (30.5 vs. 16%; NS). We conclude that CA is slightly more effective and safer than CC, albeit less well

ISSN:1660-8151    

DOI:10.1159/000186802

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Haemodialysis-related porphyria cutanea tarda is a rare, but serious and mutilating skin condition, resulting from extremely high plasma porphyrin levels because of their inadequate clearance by haemodialysis. The treatment is very difficult as chloroquine is ineffective and venesection, the conventional treatment of this disease, is not always an option because of anaemia of end-stage renal disease. We report a case of haemodialysis-related porphyria cutanea tarda and her successful management by recombinant human erythropoietin treatment.

ISSN:1660-8151    

DOI:10.1159/000186803

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Human immunoglobulin (Ig) E synthesis is regulated by T-cell-derived binding factors which include potentiating factors and suppressor factors (IgE-SFs) and B-cell-derived factors. Seventeen cases of primary glomerulonephritis (GN) with nephrotic syndrome and high serum IgE were studied for their serum IgE-SFs. These include 8 cases of minimal-change disease (MCD), 3 cases of IgM nephropathy, 4 cases of focal segmental glomerulosclerosis, and 2 cases of IgA nephropathy, aged between 20 and 60 years (mean: 37.2). A significantly lower activity of these factors was noted in the patient group as shown by a lower overall inhibition rate on in vitro IgE synthesis (median: 22.9 vs. 53.2%, p < 0.05). Some of them even exhibited an enhancing activity in their serum as shown by a negative inhibition rate. These findings suggest that there is a T cell disorder in some of the primary GNs with high serum IgE, especially in MCD, which causes an abnormal regulation of IgE synthesis.

ISSN:1660-8151    

DOI:10.1159/000186804

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A 55-year-old woman was admitted to our hospital, complaining of general malaise, muscular weakness, anorexia and weight loss. She had a history of ingesting of a certain germanium (Ge) compound over the preceding 19 months, with a total dose of 47 g as Ge element. She was found to have renal failure (blood urea nitrogen, 44 mg/dl; serum creatinine, 2.6 mg/dl) without abnormal findings in urinalysis, and muscular and nervous damage. Initially, polymyositis was diagnosed and prednisolone administered. However, no improvement was seen, and neuromuscular symptoms and signs steadily worsened, ending in death. Microscopic study of the kidney showed that lipofuscin granules increased in the cells of the thick ascending limb of Henle’s loop to the distal convoluted tubule accompanying mild tubular atrophy and that some of the tubules of these segments had vacuolar degeneration or desquamation. No apparent glomerular and vascular changes were observed. High Ge content was found in serum, urine and various tissues, e.g., spleen, liver, kidney, adrenal gland and myocardium, while in controls Ge could not be detected in sera, urine or tissues. We also review case reports about Ge toxicity, and discuss the pathogenesis of renal failure induced by Ge compound

ISSN:1660-8151    

DOI:10.1159/000186805

出版商:S. Karger AG    

年代:1992

数据来源: Karger