ISSN:1660-8151    

DOI:10.1159/000188899

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Renal disease patients often exhibit alterations in the lipid profile which may become an important risk of accelerated atherosclerosis and contribute to disease progression. Among such alterations, increased levels of lipoprotein(a) [Lp(a)] are common and may be related, in part, to the degree of proteinuria. Omega-3 polyunsaturated fatty acids (ω-3 FA) have been reported to decrease Lp(a) concentrations in nonrenal subjects. In addition, they have recently been shown to reduce proteinuria in patients with chronic glomerular disease. We therefore tested the hypothesis that ω-3 FA treatment in patients with chronic glomerular disease may reduce Lp(a) concentrations. Eight patients (2 with membranous glomerulonephritis, 6 with focal glomerular sclerosis) were submitted to a total of 13 six-week courses of treatment with ω-3 FA, at a dose of 3 g/day with a triglyceride preparation (n = 4) and of 7.7 g/day with an ethyl-ester preparation (n = 9). Both treatments significantly increased the proportions of ω-3 to ω-6 FA in total serum lipids, documenting compliance to treatment. Both treatments were also effective in decreasing serum thromboxane (from mean 490 ± (SEM) 70 to 325 ± 49 ng/ml, p < 0.05, in the high-dose group) and prolonging the bleeding time (from 5.8 ± 0.4 to 7.7 ± 0.5 min, p < 0.05, in the high-dose group), thus documenting the biological efficacy of treatment. However, despite a significant reduction in serum triglyceride levels (from 137 ± 20 to 104 ± 19 mg/dl in the high-dose group), Lp(a) concentrations did not change (292 ± 120 U/l before, 315 ± 130 U/l after the high-dose therapy). Treatment-related changes in proteinuria (from 2.9 ± 0.5 to 2.1 ± 0.7 g/24 h) were not related at all to changes in Lp(a) levels. We conclude that ω-3 FA do not decrease Lp(a) concentrations in renal patients with chronic glomerular diseases and that Lp(a) levels are unlikely to be related to the degree of proteinuria within the short-term modifications in

ISSN:1660-8151    

DOI:10.1159/000188900

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The binding capacity of calcium β-hydroxy-β-methylbutyrate (calcium HMB), compared to other binders, was investigated in an in vitro study. Fifty milli-equivalents of either calcium HMB, calcium acetate, calcium carbonate, aluminum hydroxide gel or non-gel aluminum hydroxide was added to a phosphate solution, titrated (HC1 or NaOH), shaken and centrifuged to four different pH levels at 37 °C (simulating the gastrointestinal milieu). The difference in phosphate concentration between that of the initial and that of the supernatant represented from the bound phosphate in the precipitate. After 4 h at a pH of 6 (representing the intestinal condition after a meal), the binding percentage was: calcium acetate = 95.6%, calcium HMB = 92.6%, calcium carbonate = 46.4%, aluminum hydroxide gel = 33.4% and non-gel aluminum hydroxide = 17.8%. There was no significant difference (p > 0.05) between calcium HMB and calcium acetate. These results suggest that calcium HMB is an efficient phosphate binder in vitro, which may predict its effective role in vi

ISSN:1660-8151    

DOI:10.1159/000188901

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Renal metabolism of C-peptide was studied in 6 patients with early insulin-dependent diabetes mellitus (IDDM) with residual beta cell activity and in 11 nondiabetic subjects by the arterial-venous difference technique both in the postabsorptive state and for 80 min after ingestion of an amino acid mixture (0.8 g/kg). Urinary C-peptide (Cp) excretion, glomerular filtration rate and renal plasma flow were also measured. In the postabsorptive state in IDDM, renal uptake of Cp is reduced, while its urinary excretion and clearance are significantly increased. As a result, net renal extraction is markedly reduced. In contrast to controls, renal uptake and net extraction of C-peptide after amino acid ingestion do not increase in patients; the peritubular uptake evident in normal subjects is not detectable. Urinary excretion and clearance of Cp remain significantly higher in IDDM patients. In both groups, renal uptake of C-peptide is directly related to its renal load: however, in IDDM, the increase in Cp uptake for each increment in renal load is 35% lower than in controls (p < 0.001). Furthermore, as opposed to controls, urinary Cp excretion is not correlated with its arterial levels. Therefore IDDM patients have marked defects in renal handling of endogenous Cp, regarding both the amount metabolized by renal tissue and that reabsorbed by tubular cells. These data indicate an early alteration in the diabetic kidney that also impairs the reliability of urinary Cp evaluation as an index of residual beta cell activity in IDDM patients.

ISSN:1660-8151    

DOI:10.1159/000188902

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The urinary enzymes alanine aminopeptidase (AAP; EC 3.4.11.2) and N-acetyl-B-D-glucosaminidase (NAG; EC 3.2.1.30) were measured daily in 35 renal transplant recipients during the early postoperative period. Each peak value of fractional excretion was corrected for its baseline value (CFE). CFE values above normal for both NAG and AAP were more frequently found in episodes of acute rejection than in cyclosporine acute nephrotoxicity episodes (76 vs. 0%; p < 0.001). Consequently, a rise in CFE levels for both NAG and AAP is strongly suggestive of acute rejection crisis.

ISSN:1660-8151    

DOI:10.1159/000188903

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Since the high rate of cardiovascular disease in renal transplant recipients, alterations of lipoprotein profile in such patients were extensively evaluated, but the HDL subclass profile was not completely clarified. Renal transplant recipients usually show normal to high plasma levels of HDL cholesterol, even if some investigations suggested a persistence of low HDL2 levels: this was not useful in terms of cardiovascular protection. We designed this study in order to evaluate HDL subfractions distribution in renal transplant recipients. We studied 55 renal transplant recipients, treated with prednisone, azathioprine and/or cyclosporine, and 34 healthy normolipidemics as controls. In all subjects cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, apolipoproteins A-I and B levels and HDL subfractions, as determined by nondenaturing polyacrylamide gradient gel electrophoresis, were assayed. Renal transplant recipients had cholesterol, triglycerides, LDL cholesterol and apolipoproteins A-I and B levels significantly higher than controls; HDL cholesterol levels were slightly, but not significantly, increased in comparison with controls (respectively 51.1 ± 15.5 and 46.1 ± 10.8 mg/dl). Multivariate analysis showed that only the time since transplantation was significantly associated with HDL cholesterol levels. When HDL subfractions were analyzed, renal transplant recipients presented significantly lower levels of HDL3a and HDL3b and, in males, higher levels of HDL2b than controls. HDL cholesterol levels were positively correlated with HDL2b levels in both renal transplant recipients and controls, and negatively correlated with HDL3b in controls. In conclusion, in renal transplant recipients, we failed to demonstrate any decrease of HDL2 particles. On the basis of a nonatherogenic HDL profile, we suggest that the increased cardiovascular risk in renal transplant recipients might be accounted for by other risk factor

ISSN:1660-8151    

DOI:10.1159/000188904

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

In the present prospective study we examined the long-term effect of intravenous supplementation with ferric saccharate (IV Fe) in the treatment of the anemia of chronic dialysis patients. All patients, 64 on chronic hemodialysis (HD) and 9 on chronic ambulatory peritoneal dialysis (CAPD), were treated intravenously with this preparation in a dose of 100 mg elemental iron twice monthly. There were five groups. Group 1:41 HD patients who were receiving erythropoietin (EPO) for at least 6 months prior to the addition of IV Fe. In this group, when IV Fe was given over 6 months, the hematocrit (Hct) increased from a mean of 28.7 to 33.7%. Over the next 6 months, the EPO dose was gradually reduced by a mean of 61.1 %, but the mean Hct remained unchanged. Group 2:11 HD patients who started IV EPO simultaneously with the IV Fe. In this group, over 6 months, the mean Hct increased from 28.1 to 34.1. Over the next 6 months, the EPO dose was gradually reduced by 75.7%, but the mean Hct remained unchanged. Group 3: 12 HD patients who received IV Fe alone for 12 months. The mean Hct increased from 30.5 to 37.9%. Group 4: 4 CAPD patients who had been receiving subcutaneous EPO for at least 6 months prior to IV Fe therapy. Over the subsequent 6 months of IV Fe, the mean Hct increased from 28.4 to 33.3%. Group 5: 5 CAPD patients not on EPO who received IV Fe for 6 months. The mean Hct increased from 27.7 to 35.6%. No adverse effects were seen in any patients throughout the study. In conclusion, adequate Fe supplementation may allow the target Hct of about 33% to be reached without, or with only very low doses of EPO. IV Fe as ferric saccharate is a new and safe form of parenteral iron therapy of the anemia of chronic dialysis patients.

ISSN:1660-8151    

DOI:10.1159/000188905

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

To investigate autonomic mechanisms underlying persistent hypotension in long-term hemodialysis patients, high-frequency (HF, > 0.15 Hz) and low-frequency (LF, 0.04-0.15 Hz) components of heart rate variability and plasma noradrenaline were analyzed in 10 persistently hypotensive hemodialysis patients (group H), 11 normotensive patients (group N) and 10 healthy controls (group C). The HF amplitude, an index of cardiac parasympathetic activity, and LF-to-HF ratio, an index of sympathetic predominance, were in the order of groups C > N > H (p < 0.01). While the HF amplitude decreased with standing in all three groups (p < 0.05 for all), the LF-to-HF ratio increased only in groups N and C (p < 0.05 for both) but not in group H. Conversely, plasma noradrenaline level was in the order of groups C < N < H (p < 0.001). Furthermore, while the LF-to-HF ratio correlated positively with the plasma noradrenaline level in group C (r = 0.73, p < 0.01), it correlated negatively in group H (r = 0.69, p < 0.05). These results indicate that an impairment in both parasympathetic and sympathetic functions exists in hemodialysis patients with persistent hypotension, and that the apparent sympathetic dysfunction could result from a reduction in cardiovascular responsiveness to sympathetic stimulation.

ISSN:1660-8151    

DOI:10.1159/000188906

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The drug therapies for hypercalcemia of malignancy have been known to be associated with either limited efficacy or cumulative toxicity in patients with advanced renal failure. To establish the guidelines for the use of dialysis and to determine its optimal prescription for hypercalcemia, calcium-free hemodialysis was performed in 6 hypercalcemic patients with renal failure not responding enough to forced saline diuresis. Calcium-free dialysate contained sodium 135, potassium 2.5, chloride 108, magnesium 0.75, bicarbonate 30 mmol/l. Mean hemodialysis time was 160 ± 27 min and mean Kt/V urea was 0.75 ± 0.2. Plasma calcium concentrations fell from a mean value of 2.92 ± 0.21 mmol/l (range 2.55-3.25) to 2.58 ± 0.16 mmol/l at 1 h of hemodialysis and to 2.16 ± 0.33 mmol/l (range 1.63-2.53) following 2-3 h of hemodialysis. The ionized calcium (n = 4) decreased from 1.44 ± 0.14 mmol/l to 0.99 ± 0.2 mmol/l. No patient showed any hypocalcemic symptoms and signs during hemodialysis. The rate of decrease in plasma calcium did not appear to produce adverse effects in any of the patients. There was a significant positive correlation between the decrease in plasma calcium concentration and the Kt/ V urea (y = 1.4x – 0.29, r = 0.92, p < 0.01). We conclude that calcium-free hemodialysis is indicated when the presence of severe renal failure prevents the administration of large volumes of intravenous fluids to hypercalcemic patients. The amount of dialysis (Kt/V urea) can be used to predict the decrease in plasma calcium concentration during calcium-free hemo

ISSN:1660-8151    

DOI:10.1159/000188907

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

To analyze O-linked oligosaccharides (O-glycans) in the hinge region of IgAl in IgA nephropathy (IgAN), the reactivity of IgA1 to jacalin, which specifically binds to O-glycans, was investigated. Initially, renal biopsy specimens from 5 patients with IgAN and 3 patients with other renal diseases were investigated in an immunofluorescence study with jacalin, monoclonal antihuman IgAl and IgA2 antibodies. All of the renal biopsy specimens of IgAN and none of other renal diseases were positively stained by both FITC-labeled jacalin and monoclonal anti-IgA1 antibody. The glomerular staining patterns of FITC-jacalin were similar to those of the monoclonal anti-IgA1 antibody. IgA2 was negative in all specimens. Based on the positive reactivity of deposited IgA1 to jacalin, the binding ability of serum IgA1 to jacalin was evaluated by inhibition assay using D-galactose in patients with IgAN (n = 58), other primary glomerulonephritides (PGN) (n = 41), and healthy controls (n = 52). The frequencies of the patients with serum IgA1 having a high affinity for jacalin were significantly greater in IgAN (19/58, 32.8%) compared with the healthy controls (2/52, 3.8%) and other PGN (4/41, 9.8%). These results suggested that the increased reactivity of O-glycan(s) in the IgAl hinge region to jacalin is due to an unusual glycosylation of serum IgA1 in IgAN.

ISSN:1660-8151    

DOI:10.1159/000188908

出版商:S. Karger AG    

年代:1996

数据来源: Karger