ISSN:0886-022X    

DOI:10.3109/08860229609047674

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Redox cycling compounds such as daunorubicin have been assumed to be toxic because they stimulate reactive oxygen-mediated lipid peroxidation. Furthermore, both DT-diaphorase and glutathione (GSH) have been regarded as protective cellular compounds against daunorubicin cardiotoxicity, but their role in daunorubicin nephrotoxicity remains unclear. To investigate this issue, 10 adult Wistar rats were twice injected with a single dose of 20 mg/kg body weight daunorubicin into the tail vein; the interval between injections was 48 h. A control group of 10 rats were injected with normal saline. One day after the second injection, all the animals were sacrificed and their kidneys were analyzed for malondialdehyde (MDA) as an index of lipid peroxidation, DT-diaphorase activity, and GSH and glutathione disulphide (GSSG) content. A significant increase of MDA concentration (2.41 vs. 1.64 p<0.001) and DT-diaphorase activity (0.2 vs. 0.12, p<0.001) was found in the renal tissue of daunorubicin injected rats. In contrast, GSH and GSSG levels were decreased in those animals (566 vs. 1282, p<0.001 and 115 vs. 187, p<0.01, respectively). The results of this study give evidence that a high dosage of daunorubicin induces lipid peroxidation in renal tissue of rats stimulating the activation of DT-diaphorase and the detoxificative depletion of GSH.

ISSN:0886-022X    

DOI:10.3109/08860229609047675

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Lipid peroxidation is a critical pathway of reactive oxygen species inducing tissue injury in postischemic acute renal failure. In order to evaluate the effect of renal ischemia reperfusion on kidneys, renal tissue malondialdehyde (MDA, nmol/g wet weight) concentration was measured in 29 male Wistar rats subjected to a midline abdominal incision and 60 min occlusion of the left renal artery. A right nephrectomy was performed at the beginning of the ischemic period. The animals were separated in four groups. Groups 1 (n = 7) and 3 (n = 7) underwent 60 min of ischemia and 15 min of repefusion, respectively. Groups 2 (n = 8) and 4 (n = 7) were subjected to the same procedure but, in addition, they received 2.5 mg/kg TMZ into the tail vein 2 h prior to the left renal artery occlusion. A significant elevation of MDA after 60 min of ischemia (1.43 vs. 2.1, p<0.001), which was augmented after 15 min of reperfusion (1.4 vs. 3.72, p<0.001) was observed. Furthermore, there was a significant reduction of renal tissue MDA in ischemic rats treated with TMZ (group 3) (2.1 vs. 1.52, p<0.001). The maximum reduction of renal tissue MDA was observed in ischemic-reperfused rats (group 4) that had received TMZ(3.72 vs. 1.36, p<0.001). It is suggested that lipid peroxidation is a critical event in postischemic acute renal failure, and TMZ is a useful protective agent of renal damage from oxygen free radicals.

ISSN:0886-022X    

DOI:10.3109/08860229609047676

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

To study the pathological significance of circulating endothelin (ET) in ARF, we measured plasma ET in seven children (mean age 8.8±4.4 years) with ARF in the most severe phase and 3.7±3.5 months later in the recovery period. Twenty-seven healthy children were included in the study as controls. Plasma ET level was measured by highly sensitive and specific radioimmunoassay for ET-1 and ET-2 (ET-1/2, Biomedica, Vienna). Plasma ET was significantly higher in the most severe phase of ARF (4.75±4.08 fM/ml) than in the recovery period (0.78±0.24 fM/ml; p<0.01), but comparing to plasma ET in the healthy children, the difference was only of borderline statistical significance (Pf, 0.0573). Since plasma concentrations of creatinine did not correlate with plasma ET in patients, either in acute or in the recovery phase of disease, we concluded that decreased GFR is not the main factor determining an increased ET in ARF. We suggest that elevated plasma ET in ARF may be secondary to vascular endothelial dysfunction and speculate that enchancement synthesis of endothelial relaxing factor (EDRF) inhibits ET synthesis during the recovery period. We did not find any relationship between plasma ET and blood pressure (BP) in patients with ARF, so we conclude that circulating ET is not the main factor determining BP in ARF.

ISSN:0886-022X    

DOI:10.3109/08860229609047677

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

function can be achieved following the increase in PTCB with the enhanced renal perjksion therapy.

ISSN:0886-022X    

DOI:10.3109/08860229609047678

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Scleroderma renal crisis (SRC) was known as a rare and catastrophic syndrome responsible for acute renal failure (ARF) in a context of widespread microvascular disease occurring in progressive systemic sclerosis (PSS). Following pathogenetic hypoteses, angiotensin converting enzyme (ACE) inhibitors, plasma infusions (PI), and plasma-exchange (PE) have been employed in SRC with favorable results. Our purpose was to verify whether these therapies have consistently changed the fatal prognosis of SRC, even in our experience. In the last 10 years, SRC was diagnosed in eight patients (all eight with histologic data). The first five cases were treated with steroids, antihypertensive-cocktail, and PI: all five died, two within 48 hours, three after 10, 15, and 300 days, respectively. Three other patients were treated with ACE inhibitors, PI, and PE: all three died after 1, 9, and 12 months of HD. Clinical—histological correlations showed a strong relationship between the extent of glomerular involvement and the degree of renal failure, while arterial lesions seem to be more related to the past history of PSS, independently from the previous existence of hypertension. We conclude that“true”SRC diagnosed by restrictive criteria is still a rare life-threatening syndrome, and, unfortunately, no clear predictive biochemical or clinical signs could be identified; vascular renal involvement correlates to the duration of PSS independently of previous clinical evidence of renal failure or hypertension; a glomerular pattern similar to that reported for hemolytic—uremic syndrome (HUS)/thrombotic thrombocytopenic purpura (TTP) syndrome is directly related to the degree of acute renal involvement; SRC may occur even in the absence of hypertension, mainly if cardiomyopathy is present; in our experience, ACE inhibitors and plasma therapies have changed the short-time prognosis of SRC, but they may be unable to provide recovery from dialysis and do not avoid further evolution of extrarenal PSS exiting in late death.

ISSN:0886-022X    

DOI:10.3109/08860229609047679

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

The actual disappearance of pregnancy-related acute renal failure (PR-ARF) is a common“feeling”for nephrologists. The aim of this study was to exactly quantify this event by evaluating epidemiology and the extent of renal damage in PR-ARF. From 1958 to 1994, 84 cases of PR-ARF were observed (5.8% of total number of ARF needing dialysis). In four successive periods (1956-67, 1968-77, 1978-87, 1988-94), the incidence of PR-ARF fell from 43% to 0.5% with respect to the total number of ARF, and from 1/3000 to 1/18,000 with respect to the total number of pregnancies. Maternal mortality in the past was high (31%), but no cases of death in the last period were seen. Irreversible renal damage was recorded in 11.1% of PR-ARF, and, in particular, in 18.7% of cases of preeclampsia-eclampsia (PE-E). The worst maternal and renal prognosis occurred in PE-E that was complicated by abruptio placentae (AP). Neither disseminated intravascular coagulation (DIC), microangiopathic hemolytic anemia, nor prostacyclin imbalance were significantly related to the severity of renal damage. Heparin therapy did not modify DIC evolution and renal outcome and was aggravated by severe hemorragic complications. Support therapy with plasma infusion, antithrombin III, and antiplatelet agents seems to be helpful. In conclusion, PR-ARF has become a rare occurrence and, in our experience, no cases of death or irreversible renal damage were observed in the last 7 years. The most important reasons for this favorable evolution seem to be an improved medical care and more effective measures of careful prevention, mainly regarding tempestive delivery.

ISSN:0886-022X    

DOI:10.3109/08860229609047680

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

The probability of death inpatients with acute renal failure (ARF) remains high. A valid prognostic index available on patient admission and during follow-up could be helpful for decision making. In this study, 94 ARF patients requiring dialysis (not responding to a previous single dose of furosemide 15 mg/kg) were included. On admission, patients were classified according to a Simplified Acute Physiology Score (SAPS) of≤15 or>15. The prognostic value of 11 risk factors was analyzed. Only 6 in 11 risk factors were significant by univariate analysis: age (>55 years) (0.02), mechanical ventilation (0.008), oliguria (3 risk factors showed a significantly higher mortality rate than patients with<3 risk factors (all patients disregarding SAPS) (0.001). Considering the worst combination of risk factors by univariate analysis, mortality prediction was 56% if oliguria, sepsis, and high serum bilirubin were present, and reached 80% if an older age was added (four risk factors). Ventilation increased probability of death to 92% (five risk factors). If all six risk factors were present, the probability rose to 96%. The corresponding observed mortality rate was 32% for three risk factors, 70% for four, 81% for five and 100% for six risk factors. The results suggest that probability of death in ARF requiring dialysis can be correctly estimated when more than three significant risk factors are present. If confirmed, they could avoid using a more complex severity scoring system in patients with ARF requiring dialysis.

ISSN:0886-022X    

DOI:10.3109/08860229609047681

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

ISSN:0886-022X    

DOI:10.3109/08860229609047682

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

In a retrospective study, we identified 55 elderly patients with acute renal failure (ARF) admitted to our hospital during an 8-year period from 1985 to 1993. Information about the etiology, complications, laboratory data, and treatment course were obtained from the clinical history. Of the 200 patients with ARF admitted to the hospital during this period, 28% were patients more than 60 years old (41 male and 14 female) with an average age of 68.5±7 years. The main causes of ARF were sepsis, volume depletion, low cardiac output, arterial hypotension, nephrotoxicity by antibiotics, and obstructive uropathy. The global mortality of elderly patients with ARF was 53%. The mortality rate of the different types of the ARF were: prerenal 35%, intrinsic 64% (oliguric 76%, nonoliguric 50%), and postrenal 40%. Mortality as a result of sepsis occurred in 18 patients (62%), by cardiovascular disease in 4 patients (13%), by acute respiratory failure in 2 patients (7%), and by other causes in 5 patients (18%). In the cases of sepsis, Pseudomonas was detected in 7 cases (39%), Escherichia coli in 2 cases (11%), Gram-negative nonspecific in 3 cases (17%), Klebsiella in 1 case (5%), and in 5 cases (16%), the hemoculture was negative. The patient survival rate was 47% (26 of 55 patients). Of these patients, 19 recovered their normal renal function (73%), but 7 patients remained with renal failure (27%). In conclusion, the global mortality in the elderly patients without considering the types of ARF was 53%. The oliguric form had the highest mortality rate with 76%. The main causes for mortality were sepsis with 62%, cardiovascular disease with 13%, and other causes 18%.

ISSN:0886-022X    

DOI:10.3109/08860229609047683

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor