ISSN:1660-8151    

DOI:10.1159/000184977

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

One of the more glaring paradoxes of ischemic acute renal failure is that such injury appears to be worse in the kidney as opposed to other organs, even thouth the kidney is the best oxygenated. An answer can be deduced from the anatomical and physiological background, together with a reappraisal of the role of medullary vascular damage and recent evidence of the importance of the postischemic component of ischemic injury, which is mediated by oxygen free radicals. As far as oxygenation is concerned, the kidney’s Achilles heel is the tubules of the outer strip of the outer medulla, which are also those that have the most metabolic activity. It is here that ischemic injury begins, and is maintained and exacerbated in the postischemic stage by the free radicals. These are produced by the kidney in large quantities, since it has all the necessary chemical ingredients available. It is therefore readily understandable why the kidney, being the best oxygenated organ, is so sensitive to an ischemic insult, since the damage caused in the postischemic stage is increased the greater the amount of oxygen brought in by reperfusio

ISSN:1660-8151    

DOI:10.1159/000184978

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

After influenza vaccination no statistically significant difference in antibody response was observed between patients on continuous ambulatory peritoneal dialysis (CAPD) and healthy volunteers while a large group of hemodialysis (HD) patients was found to have a significantly lower response rate. This difference remained statistically significant when CAPD patients were compared to a matched HD group. As the antibody formation after influenza vaccination is a T cell-dependent phenomenon, the normal immune response to vaccination suggests an intact humoral and cellular immunity in CAPD patients.

ISSN:1660-8151    

DOI:10.1159/000184979

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Plasma protein C (PC) antigen concentration has been shown to be normal or increased in patients with proteinuria. However, the available data concerning PC anticoagulant activity in nephrotic syndrome (NS) are limited. We measured plasma PC antigen concentration. PC anticoagulant activity, total and free protein (PS) concentrations, and antithrombin III (AT-III) antigen concentration in 21 adult patients with NS. The results were compared with those obtained in a control group of normal volunteers. PC antigen concentration and its anticoagulant activity were significantly increased in the NS group when compared with the normal control group. Likewise, plasma total and free PS values were significantly higher in the NS patients than the corresponding values found in the control group. In contrast, plasma AT-III antigen concentration was significantly reduced in patients with NS. A negative correlation was found between plasma PC and AT-III levels. These observations suggest that increased plasma PC concentration and anticoagulant activity in NS may afford some protection against the thrombotic diathesis associated with antithrombin deficiency and other coagulation abnormalities in this otherwise hypercoagulable state.

ISSN:1660-8151    

DOI:10.1159/000184980

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Total serum IgE was measured in 119 cases of primary glomerular diseases and 33 normal healthy persons. Statistically significant higher levels were noted in minimal change disease (MCD; median: 630 U/ml), IgM nephropathy (IgMN; 618 U/ml), focal glomerulosclerosis (FGS; 373 U/ml) and membranous glomerulonephritis (MGN; 144 U/ml). A higher level of serum IgE was noted in association with more frequent relapse or steroid resistance in MCD and IgMN and in FGS with nephrotic syndrome. A small group of IgA nephropathy with nephrotic range proteinuria was also noted to have extraordinarily high serum IgE. These findings suggest that IgE may play an important role in the pathogenesis of MCD, IgMN, and FGS and may serve as a prognostic indicator in terms of steroid responsiveness in MCD and IgMN.

ISSN:1660-8151    

DOI:10.1159/000184981

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

The effect of cool dialysate in hemodialysis (HD)-induced symptoms was studied in a group of 8 patients, neither diabetc nor anephric, with a high incidence of HD-induced hypotension (20–90%). Patients were studied during two consecutive periods of 6 months, the first one with dialysate at 37°C (598 sessions) and the second one at 35 °C (599 sessions). Dialysis at low temperature was associated with a decrease in symptomatic hypotension (SH) (47.4 vs. 33.9%, p < 0.001), a greater loss of weight during HD (1.52 ± 0.03 vs. 1.71 ± 0.03 kg, p < 0.001) and stabilization of predialysis systolic blood pressure (SBP) at a lower level (144 ± 0.69 vs. 139 ± 0.98 mm Hg, p < 0.001). At 37 °C, SH was associated with a higher ultrafiltration (1.71 ± 0.05 vs. 1.32 ± 0.05 kg, p < 0.001). There was an improvement of symptoms both taken as a whole (55.6 vs. 45.8%, p < 0.01) or one by one, cramps were the only exception as they increased at 35 °C (2.7 vs. 10.9%, p < 0.001) being related with a greater weight loss at both temperatures (1.47 ± 0.04 vs. 2.04 ± 0.25 kg at 37°C·p < 0.001; 1.76 ± 0.03 kg vs. 2.23 = 0.10 kg at 35°C, p < 0.001). In spite of the increase in the frequency of cramps, 7 out of 8 patients experienced some amelioration of dialysis symptoms (range between 7 and 21.4%). Dialysis at low temperature represents a simple, low-cost and partially effective method, which either by itself or associated with other procedures may contribute to the well-bei

ISSN:1660-8151    

DOI:10.1159/000184982

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Plasma levels of pancreatic secretory trypsin inhibitor (PSTI), lipase and amylase were measured in patients with chronic renal failure (CRF), patients undergoing regular hemodialysis treatment (RDT) or continuous ambulatory peritoneal dialysis (CAPD), patients with acute renal failure (ARF) and patients following successful cadaveric kidney transplantation. Plasma PSTI values were 9.2 ± 0.8 ng/ml in controls (CO), 156.9 ± 16.2 ng/ml in CRF patients, 257.6 ± 22.3 ng/ml in RDT patients, 376.8 ± 57.5 ng/ml in CAPD patients and 2,300 ± 276.9 ng/ml in patients with posttraumatic ARF. RDT patients with malignant diseases displayed significantly higher PSTI values (1,014 ± 148.7 ng/ml; p < 0.01) than RDT patients without malignancy. Transplant patients with normal kidney function (creatinine 1.25 ± 0.1 mg/dl) showed significantly lower PSTI values (16.7 ± 2.1 ng/ml) than transplant patients with impaired renal function (creatinine 4.7 ± 0.5 mg/dl; PSTI 72.8 ± 11.8 ng/ml; p < 0.01). Daily urinary excretion of PSTI increased from 26.7 ± 3.1 μg (CO) to 551.8 ± 54.8 μg in CRF patients. In CAPD patients, daily peritoneal loss of PSTI was 164.3 ± 58.4 μg. Plasma PSTI values increased during hemodialysis with dialyzers made of cuprophan (317.0 ± 32.6 vs. 422.0 ± 46.2 ng/ml; p < 0.05) and decreased with polysulfone dialyzers (226.6 ± 19.9 vs. 86.6 ± 18.1 ng/ml). There was no correlation between PSTI and urea, creatinine, lipase or amylase in each tested group. Our results document markedly elevated plasma PSTI values in all forms of renal insufficiency, suggesting extrapancreatic PSTI production and/or reduce

ISSN:1660-8151    

DOI:10.1159/000184983

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Lupus-like anticoagulant is diagnosed by a prolonged activated plasma thromboplastin time not corrected after incubation with normal plasma, prolongation of diluted tissue thromboplastin time and of diluted Russel’viper venom time, excluding factor deficiencies or specific coagulation inhibitors. We studied the presence of this ‘lupus-like anticoagulant’ in 100 patients with end-stage renal disease, 56 on hemodialysis and 44 on conservative treatment. ‘Lupus-like anticoagulant’ activity was found in vitro in the blood of 22 patients (22%) being a significantly higher prevalence than that found in 125 patients with systemiuc lupus erythematosus (15%) and in 50 healthy controls (0%). Hemodialysis patients showed ‘lupus-like anticoagulant’ activity in 30% cases, compared to 11% patients on conservative treatment. The presence of ‘lupus-like anticoagulant’ was unrelated with primary disease or medication received. The incidence of thrombosis in patients with this in vitro anticoagulant was higher than in patients without it (23 vs. 13%), although this difference is not significant. We conclude that prevalence of ‘lupus-like anticoagulant’ is high in patients with end-stage renal disease, a previously unreported observation. Its clinical and pathogenetic significance shou

ISSN:1660-8151    

DOI:10.1159/000184984

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Seven patients with acute renal failure after ingestion of analgesic drug combinations including paracetamol were seen. They presented with oliguric renal failure and restitution of renal function was complete. Only 2 patients had severe liver damage and 2 patients had no signs of liver abnormality. Renal biopsies, studied by light and electron microscopy, in 3 patients showed focal tubular epithelial cell necrosis. Focal vascular damage, predominantly of endothelial cells, was also present in all specimens. This vascular injury was found in various locations in the kidney, including the glomerular and peritubular capillaries and small arterioles. This suggests that microvascular damage is an important mechanism for the renal injury after analgesic drugs.

ISSN:1660-8151    

DOI:10.1159/000184985

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

The IgG subclass distribution of autoantibodies to glomerular basement membrane (anti-GBM antibodies) was investigated and compared to the distribution of liver-kidney microsomal (LKM) autoantibodies in chronic active hepatitis, to antimitochondrial autoantibodies (AMA) in primary biliary cirrhosis, and to the subclass distribution of total serum IgG within a healthy population. Solid phase assays for the demonstration of these autoantibodies were performed with four mouse monoclonal antibodies specific for each human subclass to provide quantitative data for the autoantibodies. In addition, the subclass distribution of total IgG in these sera was analyzed. IgGl accounted for 75% of the total antibody activity in anti-GBM antibodies. In LKM antibodies a more homogeneous distribution was observed between the different subclasses with a relative high proportion of IgG4 autoantibodies (21.2%). In AMA a high proportion of IgG3 subclass autoantibodies was found (anti-p-48 = 28.7%, anti-p-62 = 29.9%). In these patients a high proportion of IgG3 (23 vs. 27.2%) could also be demonstrated in the subclass distribution of total IgG, whereas in patients with anti-GBM antibodies and LKM antibodies the subclass distribution of total IgG was comparable to a population of healthy volunteers. We conclude that the subclass distribution in anti-GBM antibodies differs from the distribution in other autoimmune diseases and from a healthy population and that these differences may be of pathogenetic relevance.

ISSN:1660-8151    

DOI:10.1159/000184986

出版商:S. Karger AG    

年代:1988

数据来源: Karger