摘要:

Renal scarring is considered a criterion of reflux nephropathy and the end stage of pyelonephritis. Prednisolone, a strong anti-inflammatory drug, at doses of 1 or 2 mglkg prevented renal scarring in rats following infection withSerratia marcescens. Four or 8 mglkg of prednisolone, however, did not inhibit renal scar formation. In a time course experiment, renal scarring was prevented when 4-day treatment with prednisolone was initiated 2, 5, or 13 days after infection. These results show that prednisolone is effective in preventing such scarring and suggest the clinical use of this drug for preventing renal scar formation after pyelonephritis and reflux nephropathy.

ISSN:0886-022X    

DOI:10.3109/08860229309069405

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The effects of a protein-restricted diet on renal recovery following renal ischemia were studied. The renal function was assessed by measuring the inulin clearance (CiN), the p-aminohippurate clearance (CPAH), and the percent fractional sodium excretion (%FENa) 24 h after 45 min renal ischemia. In rats fed with a regular diet (containing 19.6% protein), ClNwas 10.0±2.2üL/min/100 g body weight (BW), CPAH0.08±0.02 mL/min/100 g BW, and %FENa14.8±2.0, 24 h after renal ischemia. In contrast, feeding rats with a no-protein diet (0% protein) for 1 week prior to the ischemic insult significantly improved renal recovery (CIN48.0±9.3ü/min/100g BW, CPAH0.16±0.04mL/min/100 g BW, and %FENa2.43±0.58). Feeding rats with a no-protein diet for 3 weeks prior to ischemic insult further improved the renal recovery (ClN113±30üL/min/100 g BW, CPAH0.47±0.17 mL/min/100 g BW, and %FENa1.55±0.29). When rats fed with a regular diet were exposed to 45 min of ischemia, the survival rate on day 7 was 16.7%. In rats fed with the no-protein diet for 1 week and for 3 weeks, the 7-day survival rate was 100% in each case. The survival rate of rats fed for 3 days instead of 7 days with the no-protein diet was 87.5%. When a no-protein feeding was shortened to 1 day, no beneficial effects were observed and survival rate was 14.3%. When the ischemia time was prolonged to 60 min and 75 min, the 7-day survival rate with the regular diet was 0%, while the rates for the no-protein diet for 1 week were still 100%. Even after 90 min of ischemia, the 7-day survival rate for rats with the no-protein diet was 60%. These results clearly demonstrate the beneficial effects of protein-restricted diet against postischemic acute renal failure.

ISSN:0886-022X    

DOI:10.3109/08860229309069406

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

This study evaluated renal function and histological and oxidative injury in transplanted kidneys harvested after prolonged warm ischemia in pigs. In 8 donor pigs, kidneys were perfused in situ 120 min after cardiac arrest. One of each pair of kidneys was used for histological and biochemical studies while the other was transplanted into a recipient undergoing bilateral nephrectomy. In 6 cases, renal function was satisfactory 14 days after transplantation. Histologically, a reversible acute tubular necrosis was observed with partial recovery at the 14th postoperative day. A moderate oxidation was revealed by decreased glutathione and increased malondialdehyde levels. In spite of this ischemic injury, these findings suggest that kidneys harvested after prolonged warm ischemia can still recover after transplantation, and that non-heart-beating donors may be considered as an alternative organ source for kidney transplantation.

ISSN:0886-022X    

DOI:10.3109/08860229309069407

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

We tried to study in depth the recovery process in the cortical and the medullary oxygen (O2) consumption of normal and streptozotocin diabetic rat kidneys after ischemia. It was found that the cortical and the medullary O2consumption decreased after ischemia, reaching their lowest levels at 1 day after every ischemic duration in normal and diabetic kidneys. In the period prior to ischemia to I day after ischemia, no significant difference was seen in the decrease in O2consumption between the cortex and the medulla in normal kidney, whereas the medullary O2consumption significantly decreased compared with the cortical O2consumption in diabetic kidney. From 1 day to 4 weeks after ischemia, the increase in the cortical O2consumption was significantly higher than that in the medulla of normal kidney. In contrast, the increase in the medullary O2consumption was significantly higher than that in the cortex of diabetic kidney. Consequently, up to 4 weeks after ischemia, the decrease in the cortical O2consumption was significantly lower than in the medulla of normal kidney, while there was no significant difference regarding the decrease in O2consumption between the cortex and the medulla in diabetic kidney. These results suggest that there is a clear difference in the postischemic recovery process of O2consumption between the cortex and the medulla, and also between normal and diabetic rat kidneys.

ISSN:0886-022X    

DOI:10.3109/08860229309069408

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

To compare and contrast the clinical outcomes in critically ill patients with acute renal failure managed with either acute continuous hemodiafiltration or conventional dialytic therapies.Design: Retrospective review of the medical records of 167 consecutive cases of acute renal failure treated at a single center (July 1982-July 1991). Scoring for illness severity (APACHE II, number of failing organs) and assessment of outcome in terms of biochemical control ofazo-temia, ARF therapy-related morbidity, and overall morbidity and mortality. Setting: Tertiary institution.Patients: 767 consecutive critically ill patients with multiorgan failure and acute renal failure.Measurements and Main Results: 84 patients received conventional dialytic therapy (CDT) (1982–1988) and 83 acute continuous hemodiafiltration (ACHD) (1988–1991). The etiology of ARF and illness severity indices were similar in both groups (organ failure scores: CDT 3.9 vs. ACHD 4.1; NS). All patients were critically ill, with more severely ill patients within the ACHD groups (mean APACHE II score: CDT 25.8 vs. ACHD 28.1; p<. 01). There were no significant differences in pretreatment serum creatinine, glucose, bicarbonate and phosphate, white cell and platelet counts, incidence of disseminated intravascular coagulation, prevalence of sepsis, or evidence of pulmonary and/or peripheral edema. Overall survival was 29.8% for the CDT groups and 41% for the ACHD group (NS). When patients were stratified by severity of illness, survival in those with 2 to 4 failing organs was significantly greater in the ACHD group (CDT 31.1% vs. ACHD 53.8%; p<. 025). Similarly, overall survival in patients with intermediate APACHE II scores (24 to 29) was significantly better in those treated with ACHD (CDT 12.5%vs. ACHD 46.4%; p<. 025). During the course of ARF, in comparison to CDT, ACHD was associated with greater overall reductions in serum creatinine, and in phosphate and plasma urea, and an increased net nutritional intake. Conclusions: ACHD provided biochemical and outcome indicator advantages over conventional dialytic therapy. In patients with 2 to 4 failing organs or an intermediate APACHE II score (24 to 29) a significant survival advantage was demonstrated for ACHD over CDT. Although this study is a retrospective analysis, with all the inherent limitations of such studies, it suggests that ACHD is the treatment of choice for ARF in the critically ill, with maximum benefits seen in those with 2 to 4 failing organs and/or intermediate APACHE II scores.

ISSN:0886-022X    

DOI:10.3109/08860229309069409

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

One hundred and twenty patients with a mean age of 38 years (range 12–85 years; M 91, F 37) were studied over a period of 5 years in a teaching hospital in Dhaka. Sixty-two patients presented with probable anuria with 1–4 days 1 duration, 63 patients presented with oliguria, and 3 were nonoliguric. The causes of acute renal failure were medical (94), surgical (22), obstetrical (13). Of the medical cases, the causes were gastroenteritis in 42 cases, gastroentertitis with CNS involvement in 11 cases, rapidly progressive glomerulonephritis in 10 cases, acute viral hepatitis in 8 cases, and septicemia in 8 cases. Of 22 surgical cases, postoperative acute renal failure was the cause in 9, road traffic accident in 6, and renal calculus disease in 7. There were 13 cases in the obstetrics group, of whom 9 were due to abortion, 2 were due to preeclampsia, and the other 2 were postoperative. The mean blood urea of all cases was 35 mmollL and serum creatinine was 988ümollL. Dialysis was required in 105 cases; of these, 72 were medical cases, 21 were surgical cases, and 12 were obstetric cases. The overall survival rate was 75%. The improved survival is probably due to timely referral and prompt medical management.

ISSN:0886-022X    

DOI:10.3109/08860229309069410

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Between 1982 and 1992, 18 cases of pregnancy-related acute renal failure (PR-ARF) were observed (9% of the total number of ARF). Mean age of the women was 32 years (22–40 years). Uterine hemorrhage andpreeclampsialeclampsia were the major causes of ARF, accounting for 61% of the cases. Patchy renal cortical necrosis was suspected in 2 cases whereas signs of disseminated intravascular coagulation (DIC) or microangiopathic hemolytic anemia were present in 6 (33%) and 9 (50%) cases, respectively. Ten women required hemodialysis; and 6 of them, additional plasma exchange sessions. Five patients (28%) died during the acute phase of the illness, mainly due to brain damage, hepatic failure, and sepsis. Among the survivors, a complete (61.5%) or partial recovery (23.1%) was usually seen, but irreversible renal failure was recorded in 2 cases with postpartum hemolytic uremic syndrome (HUS). Short-lasting oligoanuria (<3 days) represents a good prognostic index. However, the presence of vascular injury (cortical necrosis, HUS) seems to carry a poor prognosis. In conclusion, PR-ARF is still a critical occurrence, associated with serious prognosis for both women and kidneys. So far, the most effective measures remain the careful prevention and the aggressive management of the obstetric complications.

ISSN:0886-022X    

DOI:10.3109/08860229309069411

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Captopril's short-term effects on clinical and biochemical parameters were studied in 21 diabetic nephropathic patients. Their mean age was 57.50±2.28 years; 16 of them were women and 5 were men. Eleven patients had been regulated with insulin and 10 of them had been regulated with oral antidiabetics. Fifteen patients were microalbuminuric (200 mg/daily and below albuminuria) and their mean diabetes mellitus history was 14.86±1.44 years. Six patients had advanced diabetic nephropathy (400 mg/ daily and above albuminuria). Their mean diabetes mellitus history was 4.50±2.87 years. Captopril in a low dose (37.5 mgldaily p.o., three separated doses) was given during 20 days. In the microalbuminuria group there were insignificant alterations in renal function, blood glucose levels, and systolic blood pressure. Diastolic blood pressure decreased significantly in this group (p<. 05). Microalbuminuria increased significantly after the therapy in this group (p. 05), while serum BUN and creatinine levels increased significantly (p<. 05), and GFR decreased significantly in this group (p<. 05). Albuminuria decreased after the therapy in this group (p<. 05). In all study groups, serum potassium levels increased significantly while serum total protein and albumin levels did not change significantly. We concluded that in the microalbuminuria group, increasing microalbuminuria may be related to a captopril-induced increase in renal plasma flow rate and single nephron glomerular filtration rate. This increase in microalbuminuria cannot be related with blood glucose levels, renal functions, and systemic blood pressure allterations. The decrease in albuminuria in the advanced diabetic nephropathy group may be related to a captopril-induced decrease in single nephron glomerular filtration rate due to nephrotoxic, or to unknown, effects of captopril, especially in patients with renal dysfunction. This decrease cannot be related with blood glucose levels and systemic blood pressure factors.

ISSN:0886-022X    

DOI:10.3109/08860229309069412

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

During the last 9 years, 32 cases of hemorrhagic fever with renal syndrome (HFRS) have been diagnosed in our institution. Seven patients died. Twenty-three patients were discharged healthy while in another 2 some degree of renal dysfunction, which remained stable 12–15 months later, was evident. In 12 out of the 23 healthy individuals thorough examination of renal function was performed 1–5 years after their discharge. Three out of the 12 had renal tubular acidosis (RTA) type I (distal), complete or incomplete, and 2 (1 of whom also had incomplete RTA) had reduced urine concentrating ability. The development of chronic renal dysfunction was independent of the clinical severity of the acute illness.

ISSN:0886-022X    

DOI:10.3109/08860229309069413

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Renal transplantation therapy performed for amyloid nephropathy is controversial because of the fatal effects of the disease. Amyloidosis is a relatively frequent disease and is generally associated with familial Mediterranean fever (FMF) in Turkey. Renal transplantation in the treatment of amyloid nephropathy started in January 1985. Till now, 18 (3.2%) renal transplantations have been performed on patients who had amyloid nephropathy. The mean followup period was 34.6 months. Fourteen renal grafts still function well (creatinine: 1–3.2 mgldL). The overall 1-year patient and graft survival rates were 88.9% and 83.0%, respectively. These rates are not statistically different from renal transplantations done for other cases of renal failure. Therefore, patients with end-stage renal failure due to amyloidosis can be considered as appropriate candidates for renal transplantation.

ISSN:0886-022X    

DOI:10.3109/08860229309069414

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor