摘要:

The progression of renal diseases is often monitored by the serial measurement of plasma creatinine. The slope of the linear relation that is frequently found between the reciprocal of creatinine concentration and time delineates the rate of change in renal function. Minor changes in slope, perhaps indicating response to therapeutic intervention, can be difficult to identify and yet be of clinical importance. We describe the application of two-phase linear regression to identify and characterise changes in slope using a microcomputer. The method fits two intersecting lines to the data by computing a least-squares estimate of the position of the slope change and its 95% confidence limits. This avoids the potential bias of fixing the change at a preconceived time corresponding with an alteration in treatment. The program then evaluates the statistical and clinical significance of the slope change and produces a graphical output to aid interpretation.

ISSN:0250-8095    

DOI:10.1159/000167932

出版商:S. Karger AG    

年代:1989

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000168037

出版商:S. Karger AG    

年代:1989

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000167933

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Two elderly patients presented with renal failure due to pelviureteric junction (PUJ) obstruction. After dialysis, obstruction was relieved by percutaneous nephrostomy and the diagnosis was established radiologically. Differential renal function was assessed by direct measurement or isotope scanning. Surgical correction resulted in both patients remaining free of dialysis at follow-up 2 years later. PUJ obstruction is an uncommon cause of renal failure, particularly in the elderly, but is potentially correctable.

ISSN:0250-8095    

DOI:10.1159/000167934

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

We present a case of granulomatous interstitial nephritis and renal failure after a jejunoileal bypass for obesity. Improvement of the renal function occurred after reversal of the intestinal bypass. The renal biopsy showed an interstitial nephritis, oxalate crystal deposition and several aggregates of multinucleated giant cells related to the crystal material (granulomatous reaction). By ultrastructural and histochemical studies we demonstrated mitochondrial alterations in the tubular epithelial cells, and we suggested the proximal tubule origin of the giant cells. The association of the oxalate crystals with damaged tubules and giant cells suggests that the oxalate crystals are responsible for these alterations. The possibility of an associated immunological process as the cause of the interstitial nephritis cannot be excluded.

ISSN:0250-8095    

DOI:10.1159/000167935

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

A patient with ocular hypertension was treated with acetazolamide. Acute renal failure developed rapidly and renal biopsy showed mild tubular lesions and crystal formation in a tubular lumen. By immunofluorescence studies with a monoclonal antibody, Tamm-Horsfall protein, normally absent from the proximal segments of the nephron, was detected in most glomeruli. This strongly suggests that tubular obstruction plays a major part in some cases of acetazolamide-induced acute renal failure.

ISSN:0250-8095    

DOI:10.1159/000167936

出版商:S. Karger AG    

年代:1989

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000168040

出版商:S. Karger AG    

年代:1989

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000167937

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

The effects of cisplatin (5 mg/kg BW given intraperitoneal^) on renal concentration mechanism were evaluated initially by clearance studies in rats 5–7 days after cisplatin administration and compared to normal rats. During hypotonic saline infusion, cisplatin rats showed a lower inulin clearance (0.56 ± 0.07 vs. 1.12 ± 0.09 ml/min/100gBW, p < 0.01), a higher fractional distal delivery (CNa + CH20/Cin) (36.3 ± 4.4 vs. 22.8 ± 4.5%, p < 0.05), and lower CH20/CNa + CH20 (33.6 ± 5.8 vs. 56.5 ± 5.0%, p < 0.01). During hypertonic saline infusion the TcH20/Cosm was lower in cisplatin (18.3 ± 1.1%) than in normal rats (33.4 ± 3.5%, p < 0.01). These results suggest a defect in NaCl transport in the thick ascending limb of Henle and proximal tubule. In order to characterize these tubular defects, we measured Na-K-ATPase activity {\iM Pi/mg protein/h). In the renal cortex of cisplatin rats the ATPase activity was lower (18.1 ± 3.2) than in normal rats (33.4 ± 6.4, p < 0.05), also in the inner strip of the outer medulla of cisplatin rats Na-K-ATPase was reduced (26.0 ± 5.7) when compared with normal rats (67.3 ± 9.2, p < 0.01), presumably representing a decrease in enzyme activity in the thick ascending limb. In vitro measurements of diffusional water permeability (Pdw) and urea permeability (Purea) of the perfused papillary collecting duct isolated from polyuric cisplatin rats showed that vasopressin (200 uU/ml) added to the bath increased the PDw from 65.4 ± 11.2 to 104.4 ± 12.7 X 10-5cm/s(p < 0.01) and the Purea from 20.1 ± 5.7 to 30.3 ± 8.2 X 10”5cm/s(p < 0.05), as observed in the papillary collecting duct of normal rats. These findings suggest that the polyuric effect of cisplatin is due, at least in part, to impaired NaCl transport of the proximal tubule and thick ascending limb of Henle’s loop. The data rule out the possibility of ADH resistance in the papi

ISSN:0250-8095    

DOI:10.1159/000167938

出版商:S. Karger AG    

年代:1989

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000168041

出版商:S. Karger AG    

年代:1989

数据来源: Karger