摘要:

CAPD has stimulated much interest because of conceptual and practical developments over the last decade. The growth of CAPD also demonstrates that hemodialysis as practiced at the present time is not completely satisfactory for many patients and CAPD helps to fill a need. CAPD may not be the ultimate favorite in most patients, but may continue to offer an alternate approach to special problems. Careful controlled studies of long-term experiences with CAPD are needed. The initiation of a CAPD program should be done with extensive planning and care. CAPD is still a technique that can only be offered by specialists experienced in all of the complicated aspects of medical care in dialysis patients. Because this technique is spreading so rapidly and yet is still in its infancy, I would strongly urge cooperative studies of new devices and solution modifications to truly establish their worth and to control the spread of expensive but unproven gadgets. Also, there is an important need for a national registry of CAPD. The unfortunate demise of the hemodialysis registry and the transplant registry in this country at least took place after some years of monitoring and maturation of these techniques. The national experiences with CAPD should be shared to nurture the maturation of this promising but still evolving technique.

ISSN:0250-8095    

DOI:10.1159/000166480

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

In a retrospective study, the clinical course of 23 adult patients with documented idiopathic membranous nephropathy was reviewed. These patients included 16 men and 7 women, who were followed for a period of as long as 9 years. 22 patients (95.7%) were nephrotic (proteinuria of 3 g or more in 24 h) and 6 (26%) were hypertensive. 5 patients were treated with prednisone alone, 12 with prednisone and cyclophosphamide, 2 with prednisone and azathioprine and 4 received no treatment. 18 patients achieved complete remission (78.3%). 16 of these (88.9%) were treated with prednisone, or prednisone and cyclophosphamide or azathioprine, and the remaining remitted spontaneously. In 3 additional patients, proteinuria improved with treatment with prednisone and immunosuppression but remained in the nephrotic range in 2, and fell to 1.8 g/day in 1. Patients who failed to respond to steroids showed remarkable improvement when therapy with cyclophosphamide was added. Of the 4 patients not treated, 2 underwent spontaneous remission and 2 developed renal insufficiency. These results suggest a beneficial effect of steroids in the treatment of membranous nephropathy, and suggests further that cyclophosphamide may be effective in patients not responding to steroids alone. Finally, these results suggest that in many patients therapy may have to be prolonged before a remission can be observed.

ISSN:0250-8095    

DOI:10.1159/000166481

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

The platelet content of adenosine triphosphate (ATP), adenosine diphosphate (ADP), serotonin and ouabain-insensitive, magnesium-dependent adenosine triphosphatase (ATPase) was determined in patients with chronic renal failure, patients on chronic hemodialysis, and kidney transplant recipients. Platelet ATP content was normal in all. By contrast, ADP content, expressed in μmol/l011 platelets, was significantly lower in renal failure: 1.82 ± 0.96 compared to 2.51 ± 0.97 in normals (p < 0.05), but not in dialyzed or transplanted patients: 2.27 ± 0.96 and 1.87 ± 0.87, respectively. The mean content of serotonin was also significantly lower in renal failure patients: 0.52 μg/l09 platelets as compared to 0.90 μg/l09 platelets in normals (p < 0.05) but was not significantly different in dialyzed and transplanted patients. ATPase was significantly lower in renal failure: 3.13 ± 1.2 μmol Pi/109 platelets in whole suspension and 0.71 ± 0.22 Pi/mg protein/h in membrane preparation compared to 4.74 ± 1.1 and 1.18 ± 0.19, respectively, in normals, and was significantly lower in dialyzed and transplanted patients. Experimental azotemia (BUN 65–86 mg/l00 ml), induced by the oral ingestion of urea 2–3 g/kg body weight over 24 h, failed to induce any of these abnormalities. The abnormality in platelet ADP and serotonin content in renal failure paralleled the functional platelet defects which characterize these patients and were reversible following dialysis and

ISSN:0250-8095    

DOI:10.1159/000166482

出版商:S. Karger AG    

年代:1981

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000166483

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

Bicarbonate dialysate is claimed to be superior to acetate for both chronic and acute hemodialysis. We compared acetate and bicarbonate dialysates in 30 acute renal failure patients during 120 dialyses. 4 patients were diabetic and 2 had liver failure. Patients were dialyzed alternating acetate and bicarbonate dialysate in a double-blind cross-over manner; each patient was his own control. BUN, creatinine, Na+, K+, osmolality, Δ osmolality, % ultra-filtration, arterial blood gases, pre, post and lowest dialysis mean arterial blood pressure, dialysis with hypotensive episodes and symptoms of hypotension were recorded. The measurements obtained for each patient during dialyses with acetate and bicarbonate were compared. There was no difference in predialysis chemistries, osmolality or osmolality fall, no change in mean arterial blood pressure or hypotensive episodes and symptoms and ultrafiltration. PCO2 and pH were slightly lower for the acetate group at the 2nd h but not at the end of dialysis. 4 patients had serum acetate determinations, all metabolized acetate normally. These findings contradict recent suggestions that severely ill patients should not be dialyzed against acetate. Since acetate is technically much easier to use and has no clinical drawbacks, it does not need to be replaced with bicarbonate in acute patients. Other factors must be more important than acetate in generating hypotension during acute dialysis

ISSN:0250-8095    

DOI:10.1159/000166484

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

The presence of glomerular IgE deposits (IgE+) and its prognostic significance were examined in 241 patients with various renal diseases. 24 patients (10%) had IgE+, and nephrotic syndrome was present in 22 (92%). 17 of the 24 patients with IgE+ had lupus nephritis. These patients were compared with another group of 32 patients with lupus nephritis, but without IgE deposits (IgE-). Light and electron microscopy showed more severe pathological changes in those with IgE+ than in patients who were IgE-. The number of patients who displayed deterioration in renal function was greater in the former group than in the latter (70 vs. 31 %). Our results show that (1) nephrotic syndrome is very common among patients with IgE+; (2) the incidence of IgE deposits in lupus nephritis patients is high (35%) and the incidence of lupus nephritis among patients with IgE deposits is 71 %, and (3) the presence of IgE deposits in patients with lupus nephritis may carry a bad prognosis. It is suggested that immunofiuorescent studies of renal biopsies should include the evaluation of IgE deposition.

ISSN:0250-8095    

DOI:10.1159/000166485

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

The purpose of this study was to define the incidence of urinary tract infections (UTI) in the early post-transplant period and to determine whether or not they have any adverse influence on the severity and reversibility of rejection episodes. 166 recipients of 1st allografts (127 recipients of nonliving donor kidneys and 39 recipients of living related donor kidneys) were classified according to whether or not they had UTI during the 1 st month post-transplant. In each group, the number of subsequent rejection episodes within the 1st 6 weeks post-transplant was evaluated, and the rejections were classified as reversible or irreversible. The same evaluation was done for the 127 recipients of nonliving donor kidneys as a subgroup. The summarized results of the latter group are as follows: 52 of 127 patients had UTI for an incidence of 41 %; 40 of 52 patients (77%) with previous UTI compared to 55 of 75 patients (73%) without previous UTI developed rejection episodes. 20% of the rejection episodes were irreversible in the group with previous UTI compared to 24% in the group without previous UTI. Rejections occur with similar frequency in recipients with and without previous UTI in the early post-transplant period. No evidence was found to suggest that post-transplant UTI trigger rejection episodes or are associated with severe rejection crises. However, significantly more patients with UTI than without UTI were anergic to delayed-type hypersensitivity (DTH) skin test antigens pretransplant, had longer dialysis-dependent uremia and had received pretransplant blood transfusions. These latter three interrelated variables are thus considered to be infection-related risk factors.

ISSN:0250-8095    

DOI:10.1159/000166486

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

Most studies relating alterations in insulin receptor binding to abnormalities of glucose tolerance in humans have used peripheral blood monocytes for the in vitro assay of insulin-binding kinetics. Studies with monocytes, however, require a relatively large sample volume, whereas studies with erythrocytes can be done using much smaller volumes. Thus, investigators have recently reported results using erythrocytes instead of monocytes. In order to evaluate how accurately insulin binding to erythrocytes reflects that to monocytes in patients with end-stage kidney disease, for whom the use of erythrocytes would be advantageous because of their anemia, percent specific 125I-insulin binding to erythrocytes and to monocytes from the same blood sample was studied in 10 hemodialysis patients and 11 healthy individuals. There were no significant differences between mean ± SEM specific 125I-insulin binding to monocytes in Hepes buffer versus erythrocytes in buffer G in either patients (4.74 ± 0.80 vs. 4.70 ± 0.48) or controls (5.26 ± 0.35 vs. 5.26 ± 0.52). When the percent insulin binding to erythrocytes was compared to the percent insulin binding to monocytes within individuals, there was a significant correlation between them in patients (r = 0.63, p 0.30). These results suggest that insulin binding to erythrocytes does reflect insulin binding to monocytes in hemodialysis patients and that erythrocyte insulin binding may be a useful model for study of the ‘insulin-resistant’ glucose intolerance often found in such

ISSN:0250-8095    

DOI:10.1159/000166487

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

An association between Fanconi’s syndrome and renal transplantation has been reported. We report a patient who developed Fanconi’s syndrome coinciding with a rejection episode 4.5 years following living related donor transplantation. Recurrent disease and hyperparathyroidism were ruled out as etiologies of Fanconi’s syndrome. The presence of Fanconi’s syndrome – associated with rejection in the transplanted kidney – may signify immunologically mediated alterations in tubular function. Antitubular basement membrane antibodies have been reported in renal allograft recipients. Further study into the pathogenesis of Fanconi’s syndrome in renal transplantation may shed light on the spectrum of immunologically mediated dysfunction following renal h

ISSN:0250-8095    

DOI:10.1159/000166488

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

Histological examination of a renal biopsy specimen from a patient with acute renal failure showed the localization of Tamm-Horsfall protein in the renal interstitium. Measurement for serum anti-Tamm-Horsfall protein antibody showed a rise in the titer of this antibody in the recovery phase of the illness. It is postulated that the extravasation of Tamm-Horsfall protein into the renal interstitium may lead to immunization of the host with this antigen.

ISSN:0250-8095    

DOI:10.1159/000166489

出版商:S. Karger AG    

年代:1981

数据来源: Karger