ISSN:1660-8151    

DOI:10.1159/000181774

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

Over a 4-year period, 94 of 248 patients with end-stage renal disease were evaluated echocardiographically because of clinically suspected pericarditis. The clinical diagnosis was established in 39 patients based on the development of a friction rub at some time during their course. 15 of the 55 patients, in whom the diagnosis of pericarditis could not be established, had a small pericardial effusion. The rest had no pericardial fluid. 15 patients developed pericarditis prior to the initiation of dialysis and all responded to dialysis alone. 4 had no effusions, 3 had small effusions and 8 had moderate or large effusions. In 9 of 24 dialysis patients with pericarditis, a presumptive etiology other than uremia was identified. In these 24 patients, 9 had no effusions, 2 had small effusion and 13 had moderate or large effusions. Only 9 patients, all with moderate or large effusions, required operation. The data suggest that: (1) pericarditis present at the initiation of dialysis regularly resolves with dialysis; (2) specific etiologies are common; (3) small pericardial effusions are common in dialysis patients without pericarditis; (4) pericardial effusions are frequently not present in uremic patients with pericarditis and, (5) the size of the pericardial effusion is of some value in predicting which patients may subsequently require operative intervention.

ISSN:1660-8151    

DOI:10.1159/000181775

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

The effect of an intravenous infusion of saralasin in a rising dosage on blood pressure, central haemodynamics, forearm blood flow and venous distensibility was tested in 11 subjects with chronic non-uraemic renal disease. Only 1 subject had an elevated resting plasma renin activity, and in him saralasin produced a drop in systolic and diastolic blood pressures due to a decrease of the total peripheral vascular resistance whereas the plasma renin activity markedly rose. Among the remaining 10 subjects, whose plasma renin activity was within the normotensive range, blood pressure rose transiently in 3, with the lowest dose of saralasin, due to an increase in the total peripheral vascular resistance. Both these parameters returned to the control level when continuing the infusion and increasing its dosage. Excluding this initial period from the analysis, no relevant change, even with a more than tenfold increase in the saralasin dosage and a duration of the infusion of 1 h, was found in the following: blood pressure, cardiac and stroke index, heart rate, total peripheral vascular resistance, central and peripheral venous pressures, forearm blood flow and vascular resistance, forearm blood volume and venous distensibility. The haemodynamic response to the Valsalva manœuvre remained unaffected by saralasin. It is concluded that angiotensin plays an active role in changing the haemodynamics and in elevating the blood pressure in subjects with chronic non-uraemic renal disease only in those cases where plasma renin activity is raised

ISSN:1660-8151    

DOI:10.1159/000181776

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

Serum thyroxine (T4), triiodothyronine (T3), the T3 resin uptake test (T3RU) and TSH were measured in 85 clinically euthyroid patients on regular haemodialysis; sera were collected immediately before dialysis. 32% of patients had goitres. Serum T3 was below the normal range in 34% and T4 in 39%; the T3RU was in the high normal range in most. Serum TSH was slightly elevated in 13 patients. In 20 patients dialysed for 3 months or less the serum T4 was normal in 18 and the free thyroxine index (FTI) was normal in every case; mean T4 and FTI values were significantly lower in patients dialysed for more than 3 months. 16 patients were studied prospectively on two occasions 14 months apart; those initially dialysed for less than 1 year showed a significant fall in mean T4 and FTI values after a further 14 months of dialysis, while levels were unchanged in those dialysed initially for more than a year. Thyroid hormone levels were measured before and immediately after a single dialysis in 57 patients. Dialysis caused significant acute elevations of T3, T4, and FTI, but had no consistent effect on TSH. The TSH and prolactin responses to TRH were investigated in 18 male patients: the mean maximal TSH increment was significantly lower than in controls and peak responses were subnormal in 5 patients. Basal serum prolactin levels were elevated but peak responses were normal. It is concluded that, in patients on regular haemodialysis: (1) goitre may be frequent; (2) in vitro thyroid function tests were often subnormal just before a period of dialysis, but were usually normal immediately after the dialysis; (3) serum T4 levels fall rapidly in the first year of dialysis; (4) the pituitary responsiveness to low serum thyroid hormone levels and to exogenous TRH is often abnormal in dialysed patients, although they appear to be euthyroid.

ISSN:1660-8151    

DOI:10.1159/000181777

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

The behavior of coagulation factor XIII (fibrin-stabilizing factor, FSF) was studied in patients with renal disease. Specific antiserum against the active subunit (FSFA) was employed to set up a method for the direct measurement of the active fraction in plasma, according to the electroimmunodiffusion technique. The plasma FSFa levels were measured in the following patients: (I) 31 patients with chronic renal disease and serum creatinine not higher than 1.5 mg/dl; (II) 41 patients with chronic renal failure on conservative therapy; (III) 53 uremic patients on maintenance hemodialysis; (IV) 10 patients with acute renal failure. FSFA concentration (93.3 ± 17.6% of a reference plasma in a group of 15 healthy controls) was found to be significantly higher than normal in the patients with chronic renal disease and serum creatinine lower than 1.5 mg/dl (127 ± 39.8%, p < 0.005). The FSFa levels were similarly increased in the 41 patients with chronic renal failure on conservative management (134.9 ± 35.8%, p < 0.001), and in the 53 end-stage uremics on maintenance hemodialysis (132.8 ± 29.5%), p < 0.001). Whereas, FSFa concentration was found to be markedly reduced in the 10 patients with acute renal failure (35.8 ± 14.6%, p < 0.001). In the patients with chronic renal disease (groups I, II, and III) plasmatic FSFA was higher in those patients with serum triglycerides above the upper normal limit, and a significant positive correlation was found between serum triglycerides and FSFA plasma le

ISSN:1660-8151    

DOI:10.1159/000181784

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

Plasma and erythrocyte potassium (K) concentrations were measured in uremics on chronic dialysis and in a control group composed of healthy persons and of patients with anemia due to causes other than renal failure. The behavior of the erythrocyte K content in uremics did not differ from that of the control group and in both cases a close inverse relationship was present between hematocrit and erythrocyte K concentration, irrespective of its plasma level. These findings suggest that the red blood cell count, rather than renal failure, may affect the erythrocyte K content.

ISSN:1660-8151    

DOI:10.1159/000181778

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

The angiotensin II analogue 1-sar-8-ala-angiotensin II (saralasin) was infused i. v. into 6 patients with stable nephrotic syndrome on a 110–120 mEq/day sodium intake. After two 60-min control periods (C+) saralasin was infused during two 30-min periods at a rate of 2 and 5 µg/kg/min, respectively, followed by 10 µg/kg/min for an additional 60 min and a subsequent control period of 60 min. Saralasin increased arterial blood pressure in a dose-dependent fashion from a mean of 126/88 (C+) to 145/109 mm Hg (10 µg/kg/min), while glomerular filtration rate fell from a mean of 145 ± 17 (C+) to 118 ± 21 ml/min (10 µg/kg/min). Urinary Na+ and K+ excretion was unchanged during the 2 and 5 µg/kg/min infusion rate, but fell by a mean of 31 and 21%, respectively, during the 10 µg/kg/min infusion dose of saralasin. Control ‘recumbent’ plasma renin activity and plasma aldosterone concentration were within the normal range for the established sodium intake. Mean PRA decreased dose-dependently from 1.86 ± 0.43 (C+) to 1.27 ± 0.40 ng/ml/3 h (10 µg/kg/min). However, plasma aldosterone concentration was unaffected during the low dose of saralasin, increased during the 5 µg/ kg/min dose (C+: 43.7 ± 8.5; 5 µg/kg/min: 78.4 ± 13.7 pg/ml), and returned into the control range during the 10 µg/kg/min infusion dose. Thus, saralasin at lower doses exhibited an angiotensin II agonistic effect on all receptor systems studied. Our findings exclude a major role of the renin-angiotensin-aldosterone system in the pathophysiology of impaired sodium balance in patients with nephrotic syndrome. They do, however, further support the hypothesis of functional differences between the vascular and adrenocortical ang

ISSN:1660-8151    

DOI:10.1159/000181779

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

Renal sodium wasting has been observed in both proximal and distal renal tubular acidosis (RTA), although few studies have been reported indicating the tubular localization of such a defect. The use of clearance methodology during hypotonic saline diuresis may give an indirect estimate of proximal tubular reabsorption of sodium, sodium reabsorption at the diluting segments and proportion of sodium load reabsorbed distally. This study was carried out in 17 normal children, in 9 children with proximal RTA, associated in all but one with the Fanconi syndrome, and in 5 children with primary distal RTA. Patients with proximal RTA presented mainly an impaired reabsorption of sodium in the proximal tubule, which was in great part but not completely compensated by an absolute increase in distal sodium reabsorption. Patients with distal RTA showed normal reabsorption of sodium in the proximal tubule but they were unable to reabsorb completely the load of sodium escaping proximal reabsorption due to a defect of sodium reabsorption in the distal diluting segments. These results indicate that the classification of RTA in proximal and distal types is also valid according to the differences found in the tubular handling of water and sodium.

ISSN:1660-8151    

DOI:10.1159/000181780

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

The natural history of renal allograft in recipients who have sickle cell disease or trait has not been widely studied. This survey attempted to collect all the case histories known at present and to assess the relationship of sickle cell disease or trait to the natural history of renal allograft. A questionnaire was sent to 120 transplant centers in North America. 106 centers responded to the study, compliance rate being 88%. 88 centers reported not having any experience with such a case, whereas 18 centers transplanted 34 kidneys in 30 patients with this disease or trait. 9 of these had sickle cell disease and 21 had the trait. Graft survival at 1 year was 23 of 34, i.e., 67%. Mortality was 4 of 30, i.e., 13% in the first year. Sickle cell crisis was noted in 8 patients during the first year, 7 of whom had sickle cell disease. Thus, sickle cell crisis is very common in sickle cell transplant patients. From the points of view of patient survival and graft survival, recipients of kidneys who have the disease or the trait do just as well after transplant as the remaining patient population.

ISSN:1660-8151    

DOI:10.1159/000181781

出版商:S. Karger AG    

年代:1980

数据来源: Karger

摘要:

Rat sera, 10–30 h after unilateral nephrectomy (UNI), enhance 3H-thymidine (3H-Tdr) incorporation into DNA of incubating renal tissue from control rats. Stimulation is even greater when extracts from remaining growing kidneys 20 h after UNI are combined with sera from rats after UNI. UNI extracts, i. e., extracts from the kidney remaining after uninephrectomy, are nonstimulatory alone. UNI sera and UNI sera plus UNI extracts could theoretically augment 3H-Tdr incorporation into renal DNA via dilutional means rather than enhanced DNA synthesis. To determine if our results were secondary to enhanced DNA synthesis, we performed our in vitro assay using the labelling of nuclei via autoradiography as another index. The addition of UNI sera compared to sera from sham-operated rats (SHAM) in seven paired experiments enhanced incorporation of 3H-Tdr into DNA by 30% (p < 0.02) and the addition of both UNI sera and UNI extracts compared to SHAM sera and SHAM extracts enhanced incorporation by 48% (p < 0.001). Unlike a dilutional effect, nuclear labelling also increased in these same seven experiments: UNI sera versus SHAM sera increased 25% (p < 0.05) and UNI sera + UNI extracts versus SHAM sera + SHAM extracts increased 37% (p < 0.01). We conclude that UNI sera and UNI sera + UNI extracts enhance 3H-Tdr incorporation into DNA by augmenting DNA synthesis, driving cells into the ‘S’ phase. The use of 3H-Tdr incorporation into DNA in our assay does estimate DNA synt

ISSN:1660-8151    

DOI:10.1159/000181782

出版商:S. Karger AG    

年代:1980

数据来源: Karger