摘要:

ABSTRACTTo evaluate the possibility that the placement of arteriovenous anastomosis (a/v a) may lead to the attenuation of glomerular hyperfiltration, we studied 5 nondiabetic patients before and after creation of vascular access for hemodialysis. Patients received no EPO and antihypertensive therapy was discontinued 24 h before each study. Cardiac output (CO) and a/v a flow rates were measured by Doppler echo, and GFR and ERPF by plasma decay curves of TC99m DTPA and131l-hippuran, respectively. Other parameters were calculated by standard formulas. Augmentation of CO and decrease in systemic vascular resistance occurred in all patients (p = 0.05), yet renal findings were less predictable since only three patients showed a decrease in renal vascular resistance and filtration fraction post a/v a. Thus, there is a discordant pattern of renal hemodynamic response to the creation of a/v a in end-stage renal disease and further studies are needed to better define the subset of patients who are prone to renal vasodilation after the placement of a/v a.

ISSN:0886-022X    

DOI:10.1080/0886022X.1995.12098270

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

ABSTRACTOver a period of 5 years, we observed 28 patients with biopsy-proven crescentic glomerulonephritis. Four of these patients were ANCA associated (pauci immune), I had anti-glomerular basement membrane antibodies (anti-GBM), and the other 23 cases had immune complex form (22 poststreptococcal and I poststaphylococcal). Acute renal failure as a main clinical feature was found in 11/28 (35.7%), all with more than 80% crescents, including all ANCA-associated cases, anti-GBM form, and the patient with poststaphylococcal form. Using“pulse”therapy with methylprednisolone, cyclophosphamide, and plasmapheresis, renal function was improved in 5/11 (45.4%), diuresis started, and end-stage renal disease was delayed. The therapy was continued orally with steroids and cyclophosphamide. The second attack of oligoanuria developed after a period of 6-12 months without improvement after the therapy used previously (during the first attack), and it was necessary to begin chronic hemodialysis treatment.

ISSN:0886-022X    

DOI:10.1080/0886022X.1995.12098271

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

During the period 1966–1989, pregnancy interruption was severely punished in Romania. However, natality rose only temporarily, while illegal abortions reached at least 3.36%year and became the main etiology of ARF. From the 653 patients hemodialyzed for ARF during 1979–1989 in Cluj, 131 (20.07%) had abortions: during 1990–1993 only 3 (1.52%) had this diagnosis. Of the women with postabortion ARF. 71.64% were oligoanutric. The average duration of oligoanuria was 18.9 days, the longest reversible oligoanuria 89 days, the mean schedule of dialysis 1/2.98 days. Hysterectomy was performed in 44.3%; chronic renal failure occurred in 8.21% of the patients. Mortality rate averaged 14.92%, being greater in hysterectomized women (18.64%) and in those with a BUN over 150 mg% at admission. The survivors had to face the menace of imprisonment and the interrogation of prosecutors already in the hospital, regardless of their health problems.

ISSN:0886-022X    

DOI:10.3109/08860229509037625

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

ISSN:0886-022X    

DOI:10.1080/0886022X.1995.12098272

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

ABSTRACTWe report a case of fulminating systemic capillary leak syndrome which temporarily responded to verapamil, a calcium channel blocker. We noted two features of the disease not previously reported: a rise in lymphocyte count 2-3 days prior to an attack, and hypogammaglobulinemia. These findings are discussed in relation to the possible etiology of this disease.

ISSN:0886-022X    

DOI:10.1080/0886022X.1995.12098273

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

ABSTRACTMucormycoses is a fungus which increasingly has been reported as a cause of opportunistic infection during the last 40 years. This infection is most commonly associated with underlying predisposing conditions, particularly diabetic ketoacidosis, hematologic and other malignancies, steroid therapy, broad-spectrum antibiotic therapy, or various acquired and hereditary immunodeficient disease states. The present report is that of a previously healthy patient with acute renal failure secondary to a postviral rhabdomyolysis syndrome, who received corticosteroids and developed unsuspected and undiagnosed systemic mucormycosis. Autopsy revealed that he died as a consequence of a massive pulmonary hemorrhage due to disseminated invasive mucormycosis, involving both the lungs and kidneys. A review of the literature reporting disseminated mucormycosis in association with renal failure is provided. Mucormycosis should be considered in immunocompromised patients with renal failure and fevers of unknown origin so that early diagnosis and prompt surgical and medical therapy may be instituted.

ISSN:0886-022X    

DOI:10.1080/0886022X.1995.12098274

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

ABSTRACTThe activity of the hypothalamic-pituitary-adrenal axis in hemodialyzed (HD) patients has been investigated, with conflicting results. Different results are reported concerning both basal ACTH and Cortisol concentration and the responses to different stimulating agents, in chronic hemodialyzed patients. The present study was performed in order to assess whether the length of the hemodialytic treatment may affect the pituitary and adrenocortical response to stimulation with ovine CRH (oCRH) and with exogenous ACTH in a group of patients on chronic HD for more than 10 years. Ten uremic patients (aged 38-71, 6 males and 4 females) on chronic hemodialysis for at least 10 years and 7 healthy subjects matched for age and sex were studied. The patients were tested on the day preceding dialysis session. Each subject received on different non-consecutive days oCRH (100μ.g i.v. in bolus) and ACTH (Synacthen 0.25 mg i.v. in bolus), and blood samples were obtained at appropriate intervals. Basal ACTH and Cortisol levels of HD patients were in the upper limit of normal range (ACTH 39.21±11.11 pg/mL in HD patients vs. 26.88±14.12 pg/mL in controls; Cortisol 19.96±5.07 in HD patients vs. 12.66±4.44 in controls); however, the means were not significantly different compared with controls. Following oCRH administration a net increase of ACTH and Cortisol was observed in every patient tested (ACTH peak 83.81±28.49 in HD vs. 78.73±22.87pg/mL in controls; Cortisol peak 30.73±19.31 in HD vs. 20.05±3.19μg/dL in controls). Comparing the ACTH and Cortisol responses to oCRH obtained in HD pts and in controls, a mild delay in the maximum response peak of ACTH (peak at 60 min vs. 30 min) and a prolonged Cortisol dismission was observed. Exogenous ACTH administration elicited a normal Cortisol response in both HD patients and control groups. In conclusion, our results show that the responsiveness of the pituitary-adrenal axis is maintained in uremic patients, even after more than 10 years of chronic hemodialysis; the delayed ACTH response to oCRH might be considered a further manifestation of the disordered hypothalamic regulation described in uremia and/or it is probably due to a maladaptative response to chronic stress.

ISSN:0886-022X    

DOI:10.1080/0886022X.1995.12098275

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

ISSN:0886-022X    

DOI:10.3109/08860229509037630

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor