ISSN:1660-8151    

DOI:10.1159/000188604

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

A prospective study of the evolution of serum erythropoietin level after androgen therapy was carried out in a group of 25 male patients on chronic hemodialysis treatment with nonferropenic anemia (serum ferritin > 50 ng/ml). The androgen used was nandrolone decanoate (200 mg/week intramuscularly, for 6 months). There was an increase of serum erythropoietin, that reached statistical significance in the 2nd week of treatment (8.6 ± 6.4 vs. 14.2 ± 9.8 mIU/ ml, p < 0.05), and a stabilization after 1 month (1 month: 17.8 ± 11.2 mIU/ ml, 6 months: 19.6 ± 14.9 mlU/ml). The hemoglobin also experienced a parallel increase to that observed in serum erythropoietin (basal value: 8 ± 0.9 g/ dl; at 1 month postandrogen: 9.2 ± 1.3 g/dl, p < 0.001; at 6 months: 10.7 ± 1.8 g/dl, p < 0.001). According to their response of serum erythropoietin the patients were divided into responders (15 patients) and nonresponders (10 patients). There were no differences between them concerning age, basal levels of serum erythropoietin and hemoglobin, and dose of nandrolone decanoate in relation to body weight. The evolution of hemoglobin was similar in both groups, and a correlation between serum erythropoietin and hemoglobin was not observed in the responder group. Fourteen patients were studied after androgen was discontinued. The serum erythropoietin returned to basal levels 6 weeks after the last dose of nandrolone decanoate (7.7 ± 5.4 mlU/ml). However, hemoglobin was above the basal levels 16 weeks after discontinuing androgen (9.5 ± 1.1 g/dl, p < 0.05), with no differences between the responder and nonresponder group. In conclusion, the hematopoietic effect of androgen in patients with chronic renal failure is independent of its action on the serum erythropoietin levels. The increase in the serum erythropoietin observed in 60% of patients is not the cause of the improvement in anemia and may be considered as an epiph

ISSN:1660-8151    

DOI:10.1159/000188605

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Phosphorus (Pi) retention linked to chronic renal failure (CRF) favors secondary hyperparathyroidism (HPT). Reduction of Pi and protein intake has been shown to prevent the development of HPT in CRF. The aim of the present study was to assess in patients with advanced CRF the long-term effects on phosphate and calcium metabolism of a low-Pi (5-7 mg/kg/day), low-protein (0.4 g/kg/day) diet providing 300 mg/day calcium (Ca) and supplemented with amino acids and ketoacids, Ca carbonate (400-800 mg/day) and vitamin D2 (1,000 IU/day). Twenty-nine patients with advanced CRF (glomerular filtration rate (GFR) 13.7 ± 4.5 ml/min) were selected for the study, on the basis of a follow-up of a least 2 years and a satisfactory compliance to the prescribed diet. At the start of the study, biological evidence of HPT was present with increased plasma PTH concentration (144 ± 95 pg/ml), increased plasma Pi (1.57 ± 0.33 mmol/l), an increase in alkaline phosphatase activity and plasma osteocalcin concentration. Plasma PTH concentration was positively correlated with plasma Pi and inversely with plasma Ca concentrations and GFR. Pi and protein restriction induced a significant correction of HPT within 3 months after starting the diet. After 2 years of diet, despite the diminution of GFR (11.1 ± 3.7 ml/min, p < 0.0001), plasma PTH was still lower than at the start of the diet (88 ± 57 pg/ml, p < 0.01), as was plasma Pi (1.32 ± 0.24 mmol/l, p < 0.001), total plasma Ca being higher (p < 0.01). Plasma PTH levels were correlated only to plasma Ca concentrations. However, variations in plasma PTH concentrations were correlated with changes in plasma Ca and Pi concentrations, but not with changes in GFR. Plasma calcitriol concentrations (measured in 14 patients) did not increase significantly. The results of the present study suggest that Pi and protein restriction with calcium supplementation and without calcitriol supplementation in patients with advanced CRF may induce a lasting correction of HPT, potentially mediated by the reduction of plasma Pi and the increase of plasma Ca concentrations, independently of plasma calci

ISSN:1660-8151    

DOI:10.1159/000188606

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Clinical and laboratory features and risk factors for diabetic gastroparesis (DGP) were investigated in 226 diabetics on chronic dialysis; 106 subjects (43%) had DGP diagnosed by persistent vomiting improved with the use of prokinetic agents and 120 (control group) had no clinical DGP. Type 1 diabetics had DGP more frequently than type 2 diabetics (70 vs. 37%). The DGP group had longer duration of diabetes (21 ± 8 vs. 13 ± 6 years), higher frequency of diabetic orthostatic hypotension (95 vs. 33%), enteropathy (49 vs. 5%), blindness (52 vs. 23%), myocardial infarction (86 vs. 42%), extremity gangrene (54 vs. 27%) and cerebrovascular accidents (43 vs. 25%), lower serum albumin 32.3 ± 3.9 vs. 35.4 ± 3.8 g/l), urea (24.0 ± 5.5 vs. 25.5 ± 5.5 mmol/l) and creatinine (710 ± 210 vs. 820 ± 220 μmol/l), and higher serum TCO2 (20.9 ± 3.1 vs. 19.8 ± 2.7 mmol/l) than the control group (all differences significant at p ± 0.004). Glycemic control was adequate in 24% of the DGP group subjects and 83% of the control subjects (p < 0.001). Annual hospitalization rate was 49 ± 48 days/patient in the DGP group and 16 ± 27 days/patient in the control group (p < 0.001). Median patient survival was 24 ± 2 months in the DGP group and 61 ± 9 months in the control group (p < 0.0001). Logistic regression identified long duration of diabetes and poor glycemic control as risk factors for DGP. In diabetics on dialysis, DGP is associated with high frequency of other diabetic complications, low serum albumin and creatinine, and high morbidity and mortality. Efforts to improve glycemic control in the hope of delaying DGP appear t

ISSN:1660-8151    

DOI:10.1159/000188607

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

To understand how to prevent the diffusion of hepatitis C virus (HCV) in dialysis units, 289 chronic dialysis patients treated in a renal department from the beginning of 1990 to June 30, 1993, were studied. Patients were screened monthly for alanine aminotransferase values and every 3 months for anti-HCV antibodies. At the beginning of the study the prevalence of anti-HCV antibodies was 24.7%. Two study groups were defined. In the first, anti-HCV-positive patients were treated on separate machines; in the second, 13 anti-HCV-positive and 13 negative patients shared the same machines. Patients in the study were treated with traditional dialysis, employing low-permeability membranes and disposable dialysate circuits on machines without an ultrafitration control device. The ‘universal precautions’ were rigorously applied. The use of blood transfusions was markedly reduced. Although new patients starting dialysis treatment revealed a high frequency of HCV positivity (10.8%), the overall prevalence of HCV infection in the department did not increase during the follow-up period. Furthermore, no seroconversion was found in patients on dialysis treatment, not only in the section where anti-HCV-positive patients were treated on separate machines, but also in the section where anti-HCV-positive and anti-HCV-negative patients shared the same machines. The possibility of an intradialytic diffusion of HCV appeared to be very low and the treatment of infected patients on separate machines not strictly necess

ISSN:1660-8151    

DOI:10.1159/000188608

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The prevalence of hyperuricemia was investigated in 214 kidney allograft recipients, 81 were on azathioprine and steroids and 133 on cyclosprine (CyA) and low-dose steroids or on triple therapy. All had stable renal function, serum creatinine < 2.5 mg/dl, and a follow-up between 12 and 120 months. At the time of the study, blood and urine samples were obtained to perform tests of renal function. The renal handling of urate was evaluated by a combined pyrazinamide and probenecid test in 35 selected patients (12 normouricemic on azathioprine, 9 normouricemic on CyA and 14 hyperuricemic on CyA). The prevalence of hyperuricemia was higher in the group of patients on CyA (19.7 vs. 66.9%, p < 0.001), as well as the concentration of serum urate (6.1 ± 1.9vs.7.6 ± 1.7, p < 0.001), and serum creatinine (1.2 ± 0.3 vs. 1.4 ± 0.4, p < 0.001). In patients on CyA, multivariate analysis showed that the most important predictive variables of hyperuricemia were: serum creatinine, FEurate, diuretic use and CyA blood levels (r = 0.73, p < 0.0001). Thirteen patients on CyA (9.9%) had at least one episode of gouty arthritis. Those patients were older than the hyperuricemic patients without gout (45.7 ± 6.7 vs. 37.1 ± 13.5 years, p < 0.01), had worse renal function (serum creatinine 1.9 ± 0.4 vs. 1.5 ± 0.4 mg/dl, p < 0.01), and higher prevalence of hypertension (100 vs. 63.1%, p < 0.05). The combined pyrazinamide-probenecid test showed a lower FEurate during the maximal probenecid-induced uricosuria (p < 0.05) and a lower urate secretion (p < 0.05) in hyperuricemic patients on CyA than in normouricemic on azathioprine or normouricemic on CyA. There were no differences either in the presecretory reabsorption or in the postsecretory reabsorption. According to the previous results, 20 hyperuricemic patients (11 with gouty arthritis) were treated with benziodarone (50-100 mg/day). At 1 month, there was a decrease in the serum urate (10.1 ± 1.8 vs. 5.1 ± 1.4 mg/dl, p < 0.01), and a parallel increase in FEurate (7.1 ± 2.4 vs. 25.4 ± 7.4%, p < 0.001), that persisted after 1 year of follow-up. The drug was well tolerated, and we did not observe side effects. The serum creatinine, CyA dose and CyA blood levels remained unchanged. In conclusion, hyperuricemia is a frequent complication in transplant patients on treatment with CyA. Our data suggest that the disorder could be due to an impairment of the tubular secretion of urate. Benziodarone is an alternative to allopurinol for the treatment of this complication, which does not have important s

ISSN:1660-8151    

DOI:10.1159/000188609

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The value of color Doppler ultrasound in the renal transplant follow-up has been evaluated. To do so we used a standardized protocol of analysis on a group of 86 outpatients with different transplant ages and a good and stable graft function defined as a plasma creatinine level < 105 µM/l. Renal volume increased after transplantation and averaged 198 ± 54 cm3. The graft volume was positively related to the transplant age (p = 0.04). Mean renal blood flow/ 1.73 m2 body surface area was 301 ± 98 ml/min, a value at the lower limit of normality. A statistical inverse relationship between renal blood flow and transplant age was found (p = 0.04). Renal vascular resistances increased along with the transplant age (p = 0.003). Renal function evaluated by creatinine plasma levels and creatinine clearance values did not show any statistical correlation with color Doppler findings in normal grafts. In conclusion, ultrasound measures allow us to obtain more sensitive information about the graft status and might be used for a better evaluation of the transplant follow-

ISSN:1660-8151    

DOI:10.1159/000188610

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Since 1987, we have experienced 11 children with acute renal failure (ARF) associated with Yersinia pseudotuberculosis (YP) infection. The illness began with the sudden onset of high fever, skin rash and gastrointestinal symptoms. Later in the course, periungual desquamation developed, mimicking Kawasaki disease. Elevated erythrocyte sedimentation rate, C-reactive protein and thrombocytosis were noticeable, and mild degrees of proteinuria, glycosuria and sterile pyuria were common. ARF, which typically developed about 1-3 weeks after the onset of fever, underwent a benign course with complete recovery. The renal biopsies mainly revealed findings of acute tubulointerstitial nephritis. YP should be considered as one of the causes of acute tubulointerstitial nephritis causing ARF, especially in children.

ISSN:1660-8151    

DOI:10.1159/000188611

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The serum levels of hepatocyte growth factor (HGF) were determined in chronic renal failure (CRF) patients. Nondialysis patients with renal insufficiency had significantly higher serum HGF than normal subjects (0.34 ± 0.10 ng/ml, n = 21 vs. 0.19 ± 0.05 ng/ml, n= 15; p < 0.001), and the elevated serum HGF correlated with their serum creatinine levels. Hemodialysis (HD) patients treated for 5-10 years showed higher serum HGF than those receiving HD for 1 year or less (0.45 ± 0.14ng/ml, n = 8vs. 0.33 ± 0.11ng/ml, n = 9; p < 0.05). Continuous ambulatory peritoneal dialysis patients also showed elevated serum HGF levels comparable to those of HD patients. There was no difference in serum HGF levels in HD patients with or without acquired cystic disease of kidney. Consequently, serum HGF is elevated in CRF, which may be attributed to the increased production of HGF in response to the chronic renal injury, the effect of heparin, or reduced removal of serum HGF in CRF patie

ISSN:1660-8151    

DOI:10.1159/000188612

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Binding capacity of serum IgA to jacalin in 22 patients with IgA nephropathy, 14 patients with diffuse mesangial proliferative glomerulonephritis (non-IgA nephropathy) and 20 age-matched healthy adults was examined by enzyme-linked immunoassay (ELISA) using jacalin-coated microplates. In contrast to previous findings, the binding capacity of serum IgA to jacalin in patients with IgA nephropathy measured by ELISA using jacalin-coated microplates was significantly higher than that in healthy adults. The ratio of serum IgA levels measured by this method to those obtained by single radial immunodiffusion was significantly increased in patients with IgA nephropathy. It appeared that the capacity of serum IgA binding to jacalin was marked in these patients. It is concluded that the binding capacity of serum IgA to jacalin is not ubiquitously impaired in all patients with IgA nephropathy.

ISSN:1660-8151    

DOI:10.1159/000188613

出版商:S. Karger AG    

年代:1995

数据来源: Karger