ISSN:0886-022X    

DOI:10.3109/08860228709056319

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

Urinary sediment from 20 patients treated with aminoglycosides (AG) was studied using transmission electron microscopy. For the purpose of comparison, urinary sediment was also studied (control) from an additional 9 patients who had acute renal failure (ARF) but who did not receive AG (5 posttransplant, 4postsurgical). Urinary myeloid bodies and renal tubule cells were analyzed semiquantitatively. The diagnosis of AG nephrotoxicity (or ARF) was made on the basis of a rise in serum creatinine≥0.5 mg/dL from the baseline levels. Among 20 patients, 12 developed AG-ARF, and 11 of these 12 showed myeloid bodies and necrotic renal tubule cells in their urinary sediment. Of the 8 patients that did not develop AG-ARF, 5 showed myeloid bodies and 2 of these also showed renal tubule cells in their urinary sediment. This incidence of necrotic renal tubule cells in the nephrotoxic group is significantly higher than in the nonnephrotoxic group (p<0.01). Although no statistical difference was found in the incidence of myeloid bodies between the two groups, the number of myeloid bodies was significantly (p<0.05) greater in the nephrotoxic group than in the nonnephrotoxic group. Furthermore, consecutive sediment studies revealed that the appearance of necrotic renal tubule cells (and not of myeloid bodies) coincided with the increase in serum creatinine. All control patients showed necrotic renal tubule cells but no myeloid bodies in their urinary sediment. Thus this study suggests that the presence of necrotic renal tubule cells signifies ARF, and when preceded or accompanied by large numbers of myeloid bodies that it indicates AG-ARF.

ISSN:0886-022X    

DOI:10.3109/08860228709056320

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

Single injection, single blood sample, effective renal plasma flow (ERPF) estimated byl3lI-orthoiodohippurate can be performed accurately and conveniently without urine collection at the bedside. The purpose of this study was to determine if ERPF early in the course of severe acute renal failure (ARF) predicts recovery of renal function in hemodynamically stable patients. Over 18 months, ERPF was determined in 33 such patients with ARF in whom an etiologic diagnosis could be established. Eight patients died within 2 months of onset and while on dialysis, did not have an autopsy, and were not considered further. Six patients (Group A) either remained on dialysis after at least 6 months follow-up or had irreversible renal disease at autopsy. In Group B (19 patients, 13 of whom were dialyzed), serum creatinine returned to less than 2.0 mg/dL (n = 16) or was decreasing without dialysis. Peak serum creatinine (Group A 11.2±1.4; Group B 10.1±1.3 mg/dL) did not differ between groups. Oliguria was present in 75% of Group A patients and in 25% of Group B patients. Initial ERPFs differed (p<0.001) between Group A (90±11) and Group B (204±20 mL/min). Initial ERPF was greater than 125 mL/min in 15 Group B patients but in no Group A patients; the false-positive rate was 21% and the false-negative rate was 0%. We conclude that at a time when the etiology of ARF is often not established, an initial ERPF of 125 mL/min or greater predicts recovery of renal function and less than 125 mL/min suggests that renal function will not recover. Serial studies improve the diagnostic accuracy of this test.

ISSN:0886-022X    

DOI:10.3109/08860228709056321

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

Viper bites are a significant cause of mortality in India. Acute renal failure is a common finding in cases of lethal envenomization. Coagulation abnormalities and shock are other key clinical features. Some of the renal lesions appear to reflect a direct toxic effect of venom on kidney parenchyma. Glomerular, tubular, interstitial, and vascular lesions have all been described. Experimentally, viper venom causes mesangiolysis, and this may be a significant factor in the pathogenesis of viper bite-induced glomerular disease. Treatment with antivenom is commonly used but is not supported by controlled trials. Dialysis and supportive treatment appear to be the mainstay of therapy in cases complicated by renal failure.

ISSN:0886-022X    

DOI:10.3109/08860228709056322

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

The maintenance of effective therapeutic concentrations of antibiotics within the renal parenchyma is an important issue in the management of acute and chronic pyelonephritis. Available clinical data indicate that an important clinical-therapeutic correlation exists between the physiologic state of the kidney and the antibiotic concentrations that can be achieved in the medulla and papilla. Using a healthy canine model, we evaluated the influence of hydration and the state of acid-base balance upon the intrarenal distribution and urinary clearance of the semisynthetic penicillin amdinocillin. Renal physiologic activity significantly modulates the intrarenal distribution pattern of this compound. During the production of maximally acid and concentrated urine, the highest renal parenchyma levels of amdinocillin are achieved. During the latter circumstances the antibiotic undergoes distal tubular nonionic diffusion, which appears to be an important contributing factor to the high medullary and papillary concentrations of the drug. Nonetheless, at all levels of tested renal physiologic activity tissue and urine drug concentrations are adequate for the treatment of sensitive urinary pathogens.

ISSN:0886-022X    

DOI:10.3109/08860228709056323

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

Acute renal failure proved fatal in a patient with metastatic breast adenocarcinoma, complicated by the hemolytic - uremic syndrome. Low-grade hemolysis probably was ongoing prior to a third course of chemotherapy that included mitomycin. Terminal renal failure was caused by glomerular infarction and tubular necrosis. Schiztocytes in the blood smear and casts in the urine sediment may be relative contraindications to prolongation of tumor-lysis therapy. Recent advances in“rescue therapy”for hemolytic - uremic syndromes justify dialysis at least on a temporary basis.

ISSN:0886-022X    

DOI:10.3109/08860228709056324

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

Ultrafiltration was performed in 13 patients with diuretic-resistant cardiac failure. All patients had severely distressing peripheral edema and ultrafiltration was successfully completed in 12 patients, all of whom sustained symptomatic improvement. The volume of fluid removed ranged from 3. 7 to 23 L, mean 11.8L. Weight reduction produced by ultrafiltration continued over the following week, indicating an improved response to diuretic therapy. Ultrafiltration is an effective therapeutic intervention in the management of a small but well-defined group of patients with diuretic-resistant cardiac failure.

ISSN:0886-022X    

DOI:10.3109/08860228709056325

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor