摘要:

Acetate is used during regular hemodialysis to replace the bicarbonate lost during dialysis. The temporal changes of plasma bicarbonate and acetate concentrations and the critical role of acetate metabolism for the maintenance of plasma bicarbonate are described. We point out that the maximal rate of acetate oxidation in man is usually reached during dialysis, and we identify physiologic and pathologic factors that may modify this Vmax. A syndrome of ‘intolerance to acetate’ has been described. This syndrome is analyzed in the light of the metabolic consequences of a rapid flux of acetate oxidation in liver and muscle cells. More specifically, the effects of rapid acetate metabolism on tissue ATP, CoA, adenosine and other ATP degradation products are presented. The possible impact of dialysis-induced depletion of carnitine on optimal acetate metabolism is discussed. The potential clinical consequences produced by these changes are presented in relation to the symptoms sometimes observed during dialysis against acetate: vasodilation, hypotension and angina pectoris. The hypoxemia induced by acetate is also briefly reviewed. Different directions are proposed for future resea

ISSN:0250-8095    

DOI:10.1159/000167500

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

A 41-year-old man with combined renal and hepatic dysfunction was noted to have marked elevations in serum digoxin concentration subsequent to the discontinuation of digoxin therapy. These elevations (peak value 8.6 ng/ml), as measured by both radioimmunoassay and fluorescence polarization immunoassay, were not associated with electrocardiographic evidence of digitalis toxicity. Using a combined high-performance liquid chromatography/radioimmunoassay, accumulation and immunoassay cross-reactivity of conjugates of digoxigenin monodigitoxoside (cardioinactive metabolites of digoxin) were found to be the basis of the observed false elevation in digoxin concentration.

ISSN:0250-8095    

DOI:10.1159/000167501

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

The purpose of this study was to examine renal potassium handling in patients with low aldosterone bio-activity. The patients with a normal renal response to aldosterone were identified by finding both a low plasma aldosterone concentration during hyperkalaemia and a transtubular potassium concentration gradient (TTKG) in the cortical distal nephron of 6 or greater within 4 h after the administration of a physiologic dose of mineralocorticoid hormone. In contrast, patients with a primary renal potassium excretion defect represent a heterogenous population. In some, the TTKG rose when a pharmacologic but not a physiologic dose of mineralocorticoid was given; others had little renal response to the administration of this hormone. Furthermore, this renal response may be delayed and require more than 24 h to become manifest.

ISSN:0250-8095    

DOI:10.1159/000167502

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

A retrospective analysis of 15 renal transplant patients with end-stage renal disease (ESRD) secondary to systemic lupus erythematosus (SLE) was performed. Overall actuarial patient and graft survival at 6 years was 93 and 84%, respectively. Recipients of HLA-identical kidneys did not appear to be at increased risk of allograft failure due to rejection or recurrent disease. Two biopsy-proven cases of recurrent lupus involving the allograft were observed and are discussed. Those patients currently experiencing excellent graft function (creatinine < 2 mg/dl) had a significantly longer pretransplantation dialytic interval than the group whose most recent serum creatinine exceeds 2 mg/dl (or returned to dialysis). Posttransplantation monitoring of antinuclear antibody, antidouble-stranded DNA, C3, C4, and circulating immune complexes was not predictive of renal or extrarenal disease activity. Renal transplantation should be considered an excellent therapeutic modality for the lupus patient with ESRD, although an interim period on dialysis of at least 1 year seems warranted.

ISSN:0250-8095    

DOI:10.1159/000167615

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Autonomic nervous system dysfunction has been described frequently in uremic patients. The purpose of this study is to determine the localization of this abnormality and to study the possible relationship between autonomic dysfunction and the occurrence of dialysis hypotension. Sixteen consecutive patients participated in the study, 5 of whom had a history of dialysis-induced hypotension. These 5 patients were compared to the other 11 as regards the cardiovascular response to isoproterenol infusion, tilt test and arteriovenous (AV) fistula occlusion. None of the responses to the above mentioned stimuli was significantly different between the 2 groups. In the whole study population, an index of parasympathetic control of heart rate (variation of heart period, VHP) was reduced (31 ± 5 vs. 59 ± 9 ms in age-matched controls; p < 0.025). Heart rate and diastolic blood pressure response to isoproterenol infusion was normal (+23 ± 2 beats/min and -9 ± 3 mm Hg; p < 0.005 for both), indicating normal response of effector organs to beta-adrenergic agonist stimulation. Similarly, plasma norepinephrine increased significantly (+294 ± 51 pg/ml; p = NS from normal laboratory values) in response to head-up tilt, and heart rate increased simultaneously in all but 5 patients. Blood pressure response was within normal after 10 min of head-up tilt at 60° in all but 3 patients; only 1 of these 3 patients was in the group of dialysis hypotension. However, during AV fistula occlusion, heart rate did not change markedly, despite the significant increase in systolic blood pressure, suggesting an altered sensitivity of baroreceptor reflex arc. Since VHP was abnormal, the possibility exists that the blunted response of heart rate during AV fistula occlusion was due to impaired efferent rather than afferent vagal pathway of the baroreflex arc. The present study indicates that autonomic nervous system dysfunction in hemodialysis patients involves cardiac efferent parasympathetic pathway whereas adrenergic responses are within normal. These findings could not explain the occurrence of dialysis hypotension in this population. The latter is probably due to hemodynamic fa

ISSN:0250-8095    

DOI:10.1159/000167503

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Two cases of primary renal artery dissection in Caucasian males, aged 40 and 37 years, respectively, are presented. In both subjects, the clinical picture disclosed renal infarction with transient deterioration of renal function, microhematuria and proteinuria. In 1 patient, a slight, temporary increase in blood pressure was also observed. Both men experienced contralateral relapse 12 days and 7 years, respectively, after the first episode. The diagnosis was based on characteristic (case 1) or suggestive (case 2) arteriographic findings. In 1 subject, control arteriography suggested some progression of the lesion. Both patients were treated conservatively. A comparison with 143 cases previously reported worldwide emphasizes some aspects of this ‘not-so-rare’ ent

ISSN:0250-8095    

DOI:10.1159/000167504

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Carpal tunnel syndrome, peripheral arthropathy, erosive spondiloarthropathy and lytic bone lesions have all been associated with dialysis amyloidosis. Recent studies indicate that β2-microglobulin is the major constituent protein in this new form of amyloidosis. Dialysis amyloidosis was reported to have a local rather than a systemic involvement, although its full extent is yet to be determined. We investigated 3 patients on maintenance hemodialysis with bilateral caφal tunnel syndrome and amyloid arthropathy and found amyloid depositions in several organs. These findings suggest that, in contrast to what had been thought previously, dialysis amyloidosis could have systemic as well as visceral distribution. The amyloid deposits found were resistant against potassium permanganate treatment and reacted with anti-human β2-microglobulin antibo

ISSN:0250-8095    

DOI:10.1159/000167505

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

In 205 patients with histologically evaluated glomerulonephritis, 69 patients with essential hypertension and 12 patients with renovascular hypertension, the retina was examined and evaluated by fundus photography. Changes of the retina were classified according to the recommendations of WHO: mild to severe changes of retinal arteries were termed as mild hypertensive retinopathy, and exaggerated changes, including exudates, hemorrhages and optic disc changes, as severe hypertensive retinopathy. In spite of the short duration of renal disease and the young age of the patients in many cases, retinal changes in patients with renal hypertension were significantly more severe: especially in focal segmental sclerosis and membranoproliferative glomerulonephritis was severe hypertensive retinopathy observed. Mild hypertensive retinopathy was more prevalent in essential hypertension. When renal disease progresses the retinal findings tended to deteriorate as well. Since the 24-hour blood pressure profile was comparable in most of the groups studied, it was supposed that the vulnerability of the retina and probably other vascular beds (e.g. kidneys) was increased. We conclude that the retina of these patients should be examined even in the case of relatively mild hypertension ( > 180/100 mm Hg) and early antihypertensive treatment is an important requirement.

ISSN:0250-8095    

DOI:10.1159/000167506

出版商:S. Karger AG    

年代:1987

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000167507

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

A 47-year-old man developed Campylobacter fetus intestinalis meningitis 3 years after cadaver renal transplantation. The infection was successfully controlled with chloramphenicol followed by erythromycin. There were no relapses during the past 5 years and the allograft function remains normal. The available evidence suggests that the campylobacter sepsis was associated with nutritional therapy, the patient received in a Mexican clinic. The present case is reported because of its clinical importance and epidemiological implications.

ISSN:0250-8095    

DOI:10.1159/000167508

出版商:S. Karger AG    

年代:1987

数据来源: Karger