ISSN:1660-8151    

DOI:10.1159/000185829

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Nine patients with biopsy-proven primary focal and segmental hyalinosis and sclerosis (FSHS) and steroid-resistant nephrotic syndrome were randomly allocated to either a period of 4–6 months of treatment (ciclosporin; (CS); 5–8 mg/kg/24 h and warfarin) or to a control period (warfarin alone) and then crossed over to the alternative for a further 4–6 months. Serum creatinine levels increased at a similar rate during treatment and control periods of observation. Serum albumin levels increased (p < 0.05) and urinary protein excretion decreased (p < 0.01) in association with the CS therapy compared to the control period of observation. No patient had complete resolution of the nephrotic syndrome. In primary FSHS, CS treatment is unlikely to produce complete resolution of nephrotic-range proteinuria but does significantly decrease urinary protein excr

ISSN:1660-8151    

DOI:10.1159/000185830

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Production of and responsiveness to interleukin 2 (IL-2) were evaluated in lymphocytes from 18 patients with nephrotic syndrome. The IL-2 production of T cells, when stimulated with autologous non-T cells separated on a polystyrene resin column, was significantly decreased in patients with minimal-change nephrotic syndrome. No significant difference in the level of IL-2 production was noted between minimal-change nephrotic syndrome patients in the nephrotic stage and those in remission. The IL-2 production was also significantly decreased in lymphocytes from patients with membranous nephropathy. The responsiveness to IL-2 was inconstant among patients with nephrotic syndrome. These results indicate that the immune system of regulating IL-2 production is impaired in patients with nephrotic syndrome.

ISSN:1660-8151    

DOI:10.1159/000185831

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Deproteinized plasma from patients with renal failure had an inhibitory effect on Na, K ATPase activity measured in vitro by a linked-enzyme assay. No inhibitory effect was observed with plasma from normal subjects or from patients undergoing chronic ambulatory peritoneal dialysis. The inhibition of Na, K ATPase whether measured by the linked-enzyme assay or by 86Rb uptake in guinea pig aortic strips was decreased acutely by a single hemodialysis treatment, but was unaffected during a time-control study or ultrafiltration. Changes in Na, K ATPase activity and in Rb uptake were correlated, indicating that the presence of the enzyme inhibitor in uremic plasma was associated with depressed Na pump activity. Change in inhibition of Na, K ATPase activity did not correlate with change in body weight. Dialysis in vitro against a membrane of molecular weight 3,500 cut-off decreased the inhibitory effect of uremic plasma on Na, K ATPase. It was concluded that a dialyzable, low-molecular-weight Na, K ATPase inhibitor circulates in uremia but has no demonstrable role in volume homeostasis.

ISSN:1660-8151    

DOI:10.1159/000185832

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Phosphatidylcholine (PC) is the predominant constituent of the surface-active material coating peritoneal mesothelium. Its effects on surgically induced adhesion formation and on peritoneal macrophage viability and superoxide production were studied in rats. Rats treated with intraperitoneal PC liposomes showed more adhesions than controls (p < 0.01). In vitro incubation with PC had no effect on macrophage viability, but significantly diminished superoxide production (p < 0.05 and less). It is concluded that PC in its insoluble form is of no value in the prophylaxis of adhesions after abdominal and pelvic surgery and that with the use of the intraperitoneal route it is probably contraindicated in patients undergoing continuous ambulatory peritoneal dialysis.

ISSN:1660-8151    

DOI:10.1159/000185833

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

We have investigated anemia in patients at different stages of the evolution of three chronic renal diseases: Balkan endemic nephropathy (BEN), chronic pyelonephritis (PN) and chronic glomerulonephritis (GN). A total of 88 patients with creatinine clearances from 9 to 118 ml/min and hemoglobin concentrations from 70 to 160 g/l were studied with regard to the relationship, if any, between erythropoietin production and the type and stage of nephropathy. Anemia in BEN was a particular focus of interest since it had been stated that in BEN, anemia precedes renal failure. Our data neither prove nor disprove this statement. A significant positive correlation between creatinine clearance and hemoglobin concentration was found in all three nephropathies, indicating that in the patients studied the severity of anemia increased with the impairment of renal function regardless of the underlying disease. Serum levels of immunoreactive erythropoietin were in the normal range in 54 patients, moderately increased in 20 and slightly decreased in 14. The erythropoietin level appears to be unrelated to the stage of renal failure or the type of nephropathy. The only exception was the subgroup where the patients with glomerulonephritis and normal renal function had increased serum erythropoietin levels and significantly higher parameters of red blood cell concentration than the patients from the same subgroup with tubulointerstitial nephropathies. In patients with severe renal failure and anemia, serum erythropoietin levels were inappropriately low for the degree of anemia, indicating that erythropoietin plays a role in the pathogenesis of the anemia.

ISSN:1660-8151    

DOI:10.1159/000185834

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

In 24 patients with a kidney transplant and in 10 healthy subjects the test meal response of immunoreactive insulin (IRI), glucagon (IR-G), pancreatic polypeptide (IR-PP) and gastrin (IR-Ga) was studied. Patients with a kidney transplant showed significantly elevated basal plasma glucagon levels but normal levels of plasma IRI, IR-PP and IR-Ga. After administration of a test meal a significantly suppressed response of IRI, IR-PP and IR-Ga secretion was observed both in the patients treated with azathioprine as well as those treated with ciclosporin. In patients of the ciclosporin group the compromised response of IR-Ga and IRI secretion was significantly more marked than in subjects in the azathioprine group. From the results obtained in this paper it follows that the type of immunosuppressive drugs (azathioprine or ciclosporin) seems to be of minor importance in the pathogenesis of the described endocrine abnormalities.

ISSN:1660-8151    

DOI:10.1159/000185835

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

The purpose of the present study was to assess the plasma levels of atrial natriuretic peptide (ANP) in chronically uremic patients not submitted to dialysis and to determine the predialysis plasma concentration of ANP, the effect of ultrafiltration on plasma levels of ANP (hemodialysis, (HD), and the HD clearance of ANP in a population of adult patients treated with maintenance HD. The mean plasma ANP concentration (pg/ml) in HD was 370.2 ± 35.5 pg/ml (mean ± SEM) before HD and decreased to 165.3 ± 15.2 after HD (p < 0.01). Both value were significantly higher than in controls (28 ± 2; n = 39). The changes in plasma ANP levels correlated inversely with those in plasma protein concentration (r = -0.53; p < 0.03; y = 48.6 ± 0.8 x). ANP clearance across the cuprophan membrane averaged 13 ± 6.4 ml/mn. Resting plasma ANP values in the 16 uremic patients ranged between 16 and 227 pg/ml (124 ± 11 pg/ml). These levels were significantly higher than those observed in controls (p < 0.01). In these patients there was a highly significant correlation between serum creatinine and plasma ANP concentrations (p < 0.01; r = 0.75; y = 0.2 x + 3). Furthermore we report the results of the determination of the renal clearance of ANP in normal dogs. In all dogs a fall in plasma ANP concentration was recorded between the aorta (28.6 ± 4.5 pg/ml) and the renal vein (14.2 ± 2.7 pg/ml). The renal extraction ratio averaged 51.3 ± 3.7%. Mean ANP renal clearance was 38.2 ± 5.2 ml/ mn. These data support the hypothesis that in hemodialyzed patients high circulating concentrations of the natriuretic peptide are due to sodium and water loading. Furthermore, in patients with renal failure an altered rate of ANP metabolism may contribute to the raised plasma ANP levels that are observed. In fact in normal dog our data indicate that the kidney contributes to the clearance of endo

ISSN:1660-8151    

DOI:10.1159/000185836

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

We studied angiographically the access route 1–27 months after the insertion of temporary dialysis catheters in 52 patients: 32 subclavian and 20 internal jugular. The two groups were statistically similar with respect to age, sex and race. The subclavian catheters were left in for a mean of 11.5 days (2–22) while the internal jugular ones were inserted for 15.8 days (5–25; p = 0.0015). One hundred percent of the internal jugular patients were free of any venogram abnormalities in their venous access return. In marked contrast, 50% of the subclavian sites had mild to severe strictures with 90% having 70–100% occlusion of the subclavian vein. Six patients had bilateral severe strictures. The long-term stricture rate of subclavian catheters in the subclavian vein was unacceptably high compared to the internal jugula

ISSN:1660-8151    

DOI:10.1159/000185837

出版商:S. Karger AG    

年代:1990

数据来源: Karger

摘要:

Changes of macro- and microcirculation during haemodialysis and fluid removal are probably dependent on ultimate fluid status and on the efficacy of various regulation mechanisms, especially the catecholamines. This was studied in 20 chronic dialysis patients. Pre- and postdialysis stroke volume, mean arterial pressure, heart rate and systemic vascular resistance were measured. Furthermore, microcirculation was studied by Laser Doppler flow and by intravital microscopy of finger nail fold, measuring red blood cell velocity and capillary density. Pre- and postdialysis noradrenaline and adrenaline were measured. Nine patients proved to be hypovolaemic after dialysis (group I) and 11 patients proved to be normovolaemic or less hypervolaemic (group II) according to vena cava inferior parameters. There was a significant decrease of mean arterial pressure and stroke volume in group I, and an increase of heart rate, whereas in group II there was only a decrease of mean arterial pressure. Systemic vascular resistance did not change in both groups. Noradrenaline decreased although not significantly in both groups, whereas in group I adrenaline increased significantly. There was a significant decrease of skin perfusion in group I, whereas in group II there was a significant increase. Capillary density increased significantly in group II after reaching normovolaemia. Underhydration was leading to a decrease of skin microcirculation on the basis of a decrease of stroke volume and an increase of adrenaline levels. In hypervolaemic patients, who were ultrafiltrated to normovolaemia, skin microcirculation improved on the basis of a decrease of arterial and venous pressure and consequently a decrease of the myogenic response as a local autoregulatory effect.

ISSN:1660-8151    

DOI:10.1159/000185838

出版商:S. Karger AG    

年代:1990

数据来源: Karger