ISSN:0250-8095    

DOI:10.1159/000167514

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

The purpose of our study was to investigate the feasibility of using lactate as a complete or partial substitute for acetate in hemodialysis solutions. Six patients, each serving as his own control, were dialyzed once against a dialysis solution containing 40 mM acetate, once against a dialysis solution containing 40 mM DL-lactate and once against a dialysis solution containing 20 mM each of acetate and DL-lactate. Six additional patients underwent hemodialysis using acetate+lactate for a 3-week period, and the blood acid-base values during this period were compared to those obtained during periods when acetate was used. All dialysis treatments were well tolerated without hypotension or other clinical manifestations. When acetate+lactate was used, only a slight delay in the correction of acidosis during dialysis occurred and the net change in the plasma bicarbonate value appeared to be comparable to that measured with acetate. On the other hand, when lactate was used, the increase in the plasma bicarbonate level during and immediately after dialysis was reduced. With acetate+lactate, intradialytic blood D-lactate levels remained between 1 and 2 mM and returned promptly to near baseline within 1 h after dialysis. During 3 weeks of dialysis using acetate+lactate, predialysis plasma bicarbonate values were similar to those achieved when using acetate, but with acetate+lactate, the intradialytic plasma acetate levels were reduced by 50%. The results suggest that DL-lactate merits further evaluation as a potential base for hemodialysis solutions, and that both the D- and the L-lactate isomers are metabolized in maintenance hemodialysis patients.

ISSN:0250-8095    

DOI:10.1159/000167515

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Of the 244 cases of IgA nephropathy diagnosed at Necker Hospital before 1981, 9 patients (3.7%) developed spontaneous clinical remission of long duration. Three of these 9 patients presented with gross hematuria, while in the others the disease was discovered by the finding of proteinuria at routine urinalysis. During the disease course 5 patients had recurrent episodes of gross hematuria, lasting several years in 4. At the time of the first biopsy all patients had hematuria and permanent proteinuria. In 1 patient, renal biopsy showed only an increase in mesangial matrix while in the others segmentary lesions were observed, affecting less than 30% of the glomeruli in 6. Diffuse mesangial deposits of IgA were present in all. During the follow-up, proteinuria and microscopic hematuria gradually decreased and completely disappeared within 4-14 years after the onset of the disease. A repeat biopsy performed during remission in 4 patients showed, in 3, an improvement of glomerular lesions and a significant decrease in IgA mesangial deposits in parallel with clinical recovery. As in other types of’primary’ glomerulonephritis, these data indicate that the initial disorder in IgA nephropathy may be spontaneously reversible even after a long course of the dise

ISSN:0250-8095    

DOI:10.1159/000167516

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Percutaneous angioplasty was attempted in 5 patients with acute renal failure due to occlusion of the artery to a solitary functioning kidney. Angioplasty was technically successful in all patients. Renal function was completely restored in 3 and renal perfusion improved in 1 patient. In the fifth patient, renal function did not return despite ultrasound and radionuclide scan evidence of renal reperfusion. Transcatheter thrombolytic therapy was attempted in 2 patients, 1 of whom also underwent angioplasty. In this patient, perfusion was restored to most of the kidney. In the other patient an infrarenal aortic occlusion was present. During thrombolytic therapy, intrarenal microembolization occurred from lysis of the aortic thrombus, leading to irreversible renal damage.

ISSN:0250-8095    

DOI:10.1159/000167517

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

In humans, deficiency of chloride and potassium were found to perpetuate the hyperbicarbonatemia that attends metabolic alkalosis induced by gastric aspiration partly by increasing renal bicarbonate reabsorption, commensurate with the attendant increase in filtered bicarbonate load, and partly by decreasing glomerular filtration rate (GFR), which minimizes the degree of which the filtered bicarbonate load increases and thereby minimizes the requisite increase in bicarbonate reabsorption. The relative contribution of stimulated renal bicarbonate reabsorption might increase, however, if the supply of extrarenal bicarbonate is increased, in which case a greater degree of hyperbicarbonatemia would be sustained. To investigate that possibility, we reexamined the mechanism of perpetuation of gastric alkalosis in normal subjects eating a low NaCl diet supplemented with bicarbonate salts. Prior to gastric aspiration, plasma bicarbonate concentration ([HCO3]p) and pH were higher than in similarly studied subjects not receiving bicarbonate: 29.9 ± 0.6 vs. 25.3 ± 0.1 and 7.43 ± 0.008 vs. 7.41 ± 0.002 mEq/1, respectively. With continued bicarbonate supplementation, gastric aspiration induced a further significant increase (p < 0.05) in [HCO3]p of 10.8%, to values not significantly different from those in nonbicarbonate-loaded subjects with gastric alkalosis: 33.2 ± 1.2 mEq/1. GFR decreased significantly by 8.4% (from 98 ± 4 to 90 ± 3 ml/min, p < 0.025), offsetting nearly commensurately the increase in [HCO3]p so that total renal bicarbonate reabsorption was not significantly increased (2.90 ± 0.12 vs. 2.97 ± 0.19 mEq/min, p = NS). Thus, in humans ingesting a low NaCl diet, when bicarbonate availability is not rate-limiting, bicarbonate reabsorption appears to be maximal and does not increase in response to gastric aspiration; the increment in [HCO3]p induced by gastric aspiration is perpetuated predominantly by a reductio

ISSN:0250-8095    

DOI:10.1159/000167518

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

In this study, renal function of 52 workers of a primary lead smelter located in Northeast Brazil was compared to a reference group of 44 otherwise similar workers of a paper mill. Renal dysfunction, defined by a serum creatinine level ≥ 1.5 mg/dl, was found in 17 (32.7%) workers at the lead smelter, the exposed group, but in only 1 (2.3%) individual from the reference group. Workers from the exposed group also showed significantly higher mean serum uric acid levels. Renal dysfunction of workers from the exposed group was statistically associated with duration of the employment at the smelter and with age, but not with the levels of lead and zinc protoporphyrin in blood and δ-aminolevulinic acid in urine. The two groups presented similar rates of arterial hypertension. However, arterial hypertension was much more strongly associated with renal dysfunction in the lead worke

ISSN:0250-8095    

DOI:10.1159/000167519

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

The frequency of radiological changes of the bones of the hand in 142 patients on hemodialysis, 19 on CAPD, and 15 patients with advanced renal insufficiency not requiring dialysis was analyzed. Forty-seven percent of all patients had subperiostal cortical bone resorptions, 31 % periarthritis calcarea, 22 % periarticular erosions, 3 % chondrocalcinosis and 1 % aseptic necrosis. Sixty-six percent of the periarticular erosions were observed in the distal and proximal interphalangeal joints of fingers II, III, IV and V, whereas only 33% were found in the remaining joints (120 vs. 62, p < 0.001). The distal interphalangeal joints showed about 70% more often periarticular erosions than the proximal interphalangeal joints (77 vs. 43, p < 0.001). Since patients with chronic renal failure exhibit a decreasing incidence of periarticular erosions from the distal interphalangeal joints to the intercarpal joints, while patients with rheumatoid arthritis have their erosions preferentially localized in the proximal interphalangeal, meta-carpophalangeal and wrist joints, it can be concluded that renal osteodystrophy causes a distinct distribution of periarticular erosions of the bones of the hand.

ISSN:0250-8095    

DOI:10.1159/000167520

出版商:S. Karger AG    

年代:1987

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000167521

出版商:S. Karger AG    

年代:1987

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000167522

出版商:S. Karger AG    

年代:1987

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000167523

出版商:S. Karger AG    

年代:1987

数据来源: Karger