摘要:

Summary1. The most specific change observed in the kidney of patients dying from multiple myeloma is tubular obstruction by dense hyaline casts, frequently leading to lesions of the tubular cells. This type of nephropathy is not accompanied by optically discernible changes within the glomeruli.2. In 8 % of myelomatous patients with uremia, renal failure is secondary to the deposition of paramyloid substance in glomerular capillaries. This type of renal lesion is not constantly accompanied by similar changes within other organs.3. Although of frequent occurrence, hypercalcaemia is a rare cause of renal failure in multiple myeloma. It constitutes probably a late event in the disease.4. There is a remarkable correlation between Bence-Jones proteinuria, specific casts and renal failure. This group of signs is frequently observed in myelomatous patients who do not show alterations in gamma-globulin fraction by paper electrophoresis. It is thus obvious that renal failure is linked to the production of abnormal globulins of low molecular weight which can cross the glomerular barrier and constitute obstructive casts within the tubular lumen.5. The abnormal serum globulins with molecular weight similar to that of normal globulins cannot leak through the glomeruli. It follows that they have no nephrotoxic properties.6. The production of abnormal globulins of low molecular weight (Bence-Jones protein) is most frequent and most active in cases where synthesis of globulins with higher molecular weight is not increased.7. Indeed, studies using tagged amino-acids have shown that urinary globulins of low molecular weight are not produced by the breakdown of abnormal serum globulins of higher molecular weight.

ISSN:1784-3286    

DOI:10.1080/17843286.1961.11717678

出版商:Taylor&Francis    

年代:1961

数据来源: Taylor

摘要:

SummaryFrom June 1960 to June 1961, one hundred and seven diabetic adults were submitted to a treatment with a French Riguanide (dimethylbiguanide, DMBG).These outpatients were carefully selected in order to fulfil the following conditions : no obesity, diabetes not controlled by diet alone, patients co-operative enough to follow a steady diet during the whole trial, to perform daily their own urine analysis and write down the results in a note book.They were submitted to an average of six periods of alternate treatment either with diet alone, diet + DMBG or diet + placebos (similar in all respects to the DMBG tablets). Most patients followed also one or more periods of sulfonamide treatment and some cases were treated with insulin. Transfer from insulin to DMBG was done progressively.Control of the diabetes was assessed by body weight, daily urine analysis and frequent titrations of glucose in the blood and urine at various moments of the day. Results of treatment with the drug were considered good when effective control of the diabetes was obtained without insulin. Thirty-five cases (>3o %) were discarded because they showed no clcarcut response to the drug or because their diabetes happened to be unexpectedly mild and had been brought under control by diet alone. Of the remaining 72 cases, 49 responded well to DMBG treatment as subsequent trials with placebo tablets conclusively proved.In many cases, Biguanide appeared to be as effective as the sulfonamides and in some cases as effective as insulin. Response to DMBG seemed to be correlated (P<0,001) with the mildness of the diabetes and with a successful response to the sufonamides (r = o,83, P<0,001) but not with either age, duration of the diabetes or a small excess of weight.No toxic or allergic effect has been observed. Gastro-intestinal discomfort occurred in one third of the cases, serious disturbances in only four cases.The effective dose extends from 2x500 mg to 3x1000 mg daily. In some cases, even with severe diabetes, DMBG induced a remission and could be dispensed with entirely. This circumstance, and the fact that even a careful selection was unable to exclude a few cases of unsuspectedly mild diabetes, emphasizes the necessity of using placebos in therapeutic trials of this type.

ISSN:1784-3286    

DOI:10.1080/17843286.1961.11717679

出版商:Taylor&Francis    

年代:1961

数据来源: Taylor

摘要:

SummaryThe indications for using the artificial kidney in 3 cases (crush syndrome, severe diabetic acidosis and chronic kidney disease) are discussed.In the patient with crush syndrome recovery followed 4 haemodialyses. It was demonstrated that prolonged dialysis drain large amounts of cellular electrolytes.In the diabetic patient, 3 hours-haemodialysis entirely corrected the marked acid-base imbalances.The use of the artificial kidney in chronic renal failure is discussed in the light of the results obtained in our case and in those previously reported in the literature.

ISSN:1784-3286    

DOI:10.1080/17843286.1961.11717680

出版商:Taylor&Francis    

年代:1961

数据来源: Taylor