摘要:

Over the last 16 years we have treated 40 patients with a renal pathological diagnosis of anti-glomerular basement membrane (anti-GBM) disease. The age of presentation ranged from 18 years to 76. Males and females were equally affected. The most common presenting symptoms were anorexia and uremia. Fifty percent of the patients were oliguric at presentation and required dialysis within 24 h, while the mean serum creatinine (Cr) at presentation was 5.1±6.8 mg/dL. Sixty-two percent of the patients demonstrated evidence of pulmonary involvement. Hematuria was universally present and was macroscopic in 35% of cases. Eight-two percent of the biopsies demonstrated greater than 80% crescents. Eight patients retained independent renal function after immunosuppression with cyclophosphamide, prednisone, and plasmapheresis. No patient who presented with a Cr greater than 5 mg/dL retained renal function. Using a logistic regression model the only clinical, biochemical, or pathological factors at presentation that significantly predicted eventual need for dialysis were the serum creatinine and percentage of glomeruli with crescents. Ten patients underwent cadaveric renal transplantation, and 7 have a functioning graft for a mean of 8.2 years. None have shown evidence of recurrence of anti-GBM disease in the graft. We conclude that anti-GBM disease is an important cause of renal failure and that its prognosis is directly related to the degree of renal failure at presentation. Efforts need to be made to diagnose this condition earlier in its natural history if its prognosis is to be improved.

ISSN:0886-022X    

DOI:10.3109/08860229609052780

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

The mechanisms of free-radical injury include reactions with proteins, nucleic acids, and polysaccharides; and covalent binding to membrane components and initiation of lipid peroxidation. Cells have developed antioxidant defense to prevent free-radical injury including superoxide dismutase (SOD) and glutathione peroxidase (GPx). Significantly higher concentrations of total malondialdehyde (MDA) in plasma (1.22±0.42 vs. 0.64±0.22μimol/L, p<0.0001) as well as erythrocytes (2.56±1.28 vs. 1.03±0.44μmol/L, p<0.0001) of the CAPD patients were found when compared to the control group. The free MDA in plasma and the erythrocytes do not differ significantly in continuous ambulatory peritoneal dialysis (CAPD) patients and the control group. A significantly lower activity of GPx in erythrocytes of CAPD patients (17.85±2.63 U/g Hb vs. 23.26±3.61 U/g Hb, p<0.0001) was found when compdred to the control group, but the SOD activity in erythrocytes is not different (2272.36±579.92 U/g Hb vs. 2347.13±502.51 U/g Hg, NS). Our results show an increase of total MDA in erythrocytes and plasma. MDA is the product of lipid peroxidation with decreasing activity of GPx, which is capable of detoxifying peroxides. The activity of SOD did not change in CAPD patients. These results propose a possible role of free radicals with reduced antioxidant activity of GPx in CAPD patients and indicate that they could play some role in other pathological conditions such as atherogenesis and hemolysis.

ISSN:0886-022X    

DOI:10.3109/08860229609052781

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Over the last 16 years the evolution of 24 pregnancies in 17 women with biopsy-proven glomerular disease was analyzed. The underlying renal histology was IgA nephropathy in 8 cases, lupus nephritis in 7, mesangiocapillary glomerulonephritis type I in 1, and focal segmental glomerulosclerosis in 1. All but 2 had normal renal function before conception and 3 were hypertensive. Fetal survival rate was 75%. There were 6 preterm deliveries (33.3%), 3 newborns small for gestational age (17%), 1 stillbirth, and 5 therapeutic abortions. The perinatal mortality was 5.5%. De novo hypertension occurred in 8 pregnancies (33.3%). In 11 pregnancies (46%) increased proteinuria was diagnosed and in 6 (25%) a decline in maternal renal function was recorded. Permanent impairment of renal function was seen in 2 women with renal insufficiency before conception. Maternal hypertension and renal function impairment were associated more frequently with obstetric complications. In conclusion, pregnancy is safe for normotensive mothers with glomerular diseases and normal renal function. Hypertension and impaired renal function at conception seem to carry increased risk for mothers and fetuses. Low-dose immunosuppressive treatment during pregnancy is not harmful for the fetus.

ISSN:0886-022X    

DOI:10.3109/08860229609052782

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Abnormal glucose metabolism in uremia may result from a complex interplay between decreased insulin secretion and insulin resistance. Recent studies report beneficial effect of biotin administration in glucose metabolism in diabetic animals and in a small number of patients with diabetes mellitus. The aim of the present study was to evaluate the response of oral glucose tolerance test (OGTT) to the i.v. administration of large doses of biotin in hemodialysis patients. Eleven hemodialysis patients aged 56.90±11.20 (32–76) years on regular hemodialysis thrice a week for 2.72±1.79 (1–7) years were studied. Fasting venous plasma glucose, glucosylated hemoglobin (%GH), and plasma glucose concentration 2 h after the administration of a 75-g glucose load were measured before, and 2 weeks and 2 months after administration of 50 mg of biotin i.v. postdialysis, and after a 2-month washout period. During the study, dialysis schedule and patients' medication, diet, and dry weight were kept unchanged. OGTT was abnormal in 4 patients before biotin administration and became normal in 3 patients (75%). Our results offer support to the findings of other studies about the beneficial effect of biotin in experimental or clinical diabetes mellitus, and argue for the involvement of biotin in glucose metabolism.

ISSN:0886-022X    

DOI:10.3109/08860229609052783

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Baseline renal function and the renal reserve capacity were examined in 60 patients with multiple myeloma (MM). The factors leading to the development of chronic renal insufficiency (CRI) were explored through a series of conventional studies which included renal ultrasonography. In these patients, the main cause of CRI was hyper(para)proteinemia and paraproteinuria. Ultrasonography was important in determining kidney size, in evaluating the size of the renal parenchyma and calyces, and in detecting abnormalities in the urodynamics of the upper urinary tract. Plasmapheresis was shown to be an effective method for the treatment of established CRI. In addition, plasmapheresis was employed as the prophylactic therapy when abnormalities were seen on renal ultrasonography even in the absence of overt functional impairment. Plasmapheresis may be an efficient measure to protect against tubular injury and to improve the glomerular filtration rate.

ISSN:0886-022X    

DOI:10.3109/08860229609052784

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

A 71-year-old woman with a solitary kidney who developed acute renal failure with anuria secondary to a spontaneous perirenal hematoma is described. Serum creatinine peaked at 335.9μmol/L and BUN at 26.4 mmol/L, but neither surgery nor dialysis treatment was performed because renal function gradually improved. In this syndrome, first described by Wunderlich in 1856, anuria was not previously reported. Conservative management must always be considered rather than emergency surgery, which usually results in nephrectomy.

ISSN:0886-022X    

DOI:10.3109/08860229609052785

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor