摘要:

Although the acute nephrotoxicity of cisplatin has been well documented, long-term follow-up studies are scanty. We have evaluated the renal function in 35 patients who have had completed therapy with cisplatin at least 3 months before the study. All patients had normal serum creatinine levels before chemotherapy. Evaluation of renal function included: serum creatinine, glomerular filtration rate (inulin clearance), effective renal plasma flow (p-aminohippurate clearance), urinary β2-microglobulin and N-acetyl-β-D-glucosaminidase excretion, and renal tomography. The median cumulated dose of cisplatin was 603 ± 37 mg/m2. The mean serum creatinine level was 78 ± 21 and 88 ± 3 μmol/l before and after chemotherapy, respectively (p < 0.05). Mean glomerular filtration rate (92 ± 4 ml/min) and effective renal plasma flow (362 ± 21 ml/min) were significantly lower than in controls (110 ± 3 and 436 ± 24 ml/min). The mean enzymuria and the renal size remained within the normal range. In 12 patients who were reevaluated 12 and 24 months later, glomerular filtration rate and effective renal plasma flow remained stable. These results suggest that at usual dosages cisplatin is associated with a nonprogressive loss of renal function which is of a moderate degree.

ISSN:0250-8095    

DOI:10.1159/000168693

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Six episodes of gram-negative bacteremia and seven pyrogenic reactions occurred in 11 patients in one hemodialysis center. Gram-negative bacter-emias and/or pyrogenic reactions were not related to reuse and were more likely to occur if dialysis was performed in one unit of the center (8/13 unit 5 vs. 221/1,151 in other units, p < 0.001) and with one type of dialysis machine (10/13 vs. 581/1,151 with other machines, p = 0.05), which was preferentially used in unit 5 (p < O.Ol). Bacterial and endotoxin concentrations of water used to prepare dialysate and reprocess hemodialyzers, and of dialysate, exceeded allowable concentrations recommended by the Association for the Advancement of Medical Instrumentation (AAMI). The implicated dialysis machines were disinfected with chemicals daily, but not heat-disinfected daily as suggested by the manufacturer. Results suggest that the outbreak was caused by the use of water that did not meet AAMI standards and inadequate disinfection of one type of dialysis machine.

ISSN:0250-8095    

DOI:10.1159/000168694

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The ‘classic’ descriptions of renal histologic abnormalities in patients with hypertensive nephrosclerosis were based upon specimens obtained at autopsy or sympathectomy and were evaluated by light microscopy, without the aid of immunofiuorescence or electron microscopy. Patients with renal insufficiency accompanied by elevated blood pressure, hypertensive target organ damage (retinal disease and left-ventricular hypertrophy) and mild proteinuria are typically labelled as having hypertensive nephrosclerosis in the absence of renal biopsy material. Herein, we report the clinical summaries and renal pathology from 2 patients initially diagnosed with hypertensive nephrosclerosis. Glomeruli exhibiting focal and segmental sclerosis and interstitial scarring were present in both cases. The presence of primary renal disease in patients felt to have hypertensive nephrosclerosis is likely more common than currently appreciated. This may result from the lack of renal histologic material and the late presentation of these patients to nephrologists. Misclassifïcation of hypertensive nephrosclerosis would impact greatly on the epidemiology of end-stage renal disease and the evaluation and treatment of patients with chronic renal insufficiency.

ISSN:0250-8095    

DOI:10.1159/000168695

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The influence of body iron stores on the concentration of serum erythropoietin was studied in 48 hemodialyzed patients not receiving human recombinant erythropoietin, androgens or iron supplements. The serum erythropoietin concentration was 11.6 ± 10.4 mlU/ml. There was no correlation between the serum erythropoietin and the hematocrit or hemoglobin concentration; however, there was a correlation between the serum erythropoietin and the log of serum ferritin (r = -0.5699, p < 0.01). Serum erythropoietin levels were higher in the 18 ferropenic patients (serum ferritin < 50 ng/ml) than in the 30 patients with normal serum ferritin concentration (18 ± 13.8 vs. 7.8 ± 4.7 mlU/ml, p < O.01). The administration of intravenous iron to the ferropenic patients resulted in a reduction in serum erythropoietin independent of the respone of the anemia (18 ± 13.8 basal and 7.9 ± 6.5 mIU/mlat4weeks, p < 0.01). Our data would suggest that the concentration of erythropoietin in hemodialyzed patients is influenced by the serum ferritin l

ISSN:0250-8095    

DOI:10.1159/000168696

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Antineutrophil cytoplasmic autoantibodies (ANCA) have been used as markers of systemic vasculitides, including microscopic polyarteritis (MPA) and Wegener’s granulomatosis. The diagnostic potential of ANCA assays together with antibodies against the neutrophil enzymes myeloperoxidase (MPO) and proteinase 3 for detecting a systemic vasculitis was tested in a Chinese patient population. 672 sera were received for ANCA assay, and ANCA detected by indirect immunofluorescence was positive in 73 sera from 42 patients. Of the 42 patients, 3 had cytoplasmic ANCA, while 39 had a perinuclear pattern. There was no patient with Wegener’s granulomatosis. Two cytoplasmic ANCA positive patients suffered from ulcerative colitis. Another cytoplasmic ANCA positive patient was a carrier of human immunodeficiency virus. Of the 39 perinuclear ANCA positive patients, 10 had MPA. Eight of them were tested for anti-MPO antibody, and all were positive. Other immune disorders that were perinuclear ANCA positive included: 13 patients with systemic lupus erythematosus, 3 with mixed connective tissue disease, 1 with Goodpasture’s syndrome, 2 with inflammatory bowel disease, and 2 patients with IgA nephropathy. Anti-MPO antibody was not specific for MPA, and 7 out of the 13 patients with systemic lupus erythematosus were anti-MPO antibody positive. Our study suggests that ANCA and anti-MPO antibody are not specific for MPA in a Chinese population. They would alert the clinician of the possibility of vasculitis, but a clinicopathological correlation is essential in making the diag

ISSN:0250-8095    

DOI:10.1159/000168697

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

ProcoUagen type 1 is mainly synthesized by osteoblasts and, after cleavage of the N- and C-terminal extension peptides, is utilized for collagen fibril deposition in the osteoid tissue. Serum levels of C-terminal extension peptide (Pcoll-1-C) of the procoUagen molecule has been considered a useful marker for the evaluation of the rate of osteoblastic procoUagen synthesis. To appraise whether in vivo parathyroid hormone (PTH) plays a suppressive role in the synthesis of procoUagen type 1, a study has been carried out in 16 patients, 10 with severe secondary hyperparathyroidism of chronic renal failure and 6 with primary hyperparathyroidism. Following parathyroidectomy (PTX), in chronic renal failure patients a 94% fall in serum intact iPTH and a decline of serum calcium to hypocalcemic levels requiring calcitriol administration were observed. Serum Pcoll-1-C increased markedly with a peak after 7 days and a subsequent decline. Similar changes were observed for alkaline phosphatase and osteocalcin. In primary hyperparathyroidism, PTX was followed by an 88% drop in iPTH and mild hypocalcemia not requiring calcitriol administration. Also in this group serum Pcoll-1-C increased significantly with the same time course, unaccompanied by changes in alkaline phosphatase and osteocalcin. In 4 unsuccessfully neck-operated control patients no change in serum Pcoll-1-C levels was recorded during a period of 2 weeks postoperatively. In conclusion, acute withholding of parathyroid hypersecretion is accompanied by an abrupt and transitory increase of serum Pcoll-1-C, not dependent on calcitriol administration. Hypocalcemia following PTX may in part be due to uncoupling of bone formation and resorption.

ISSN:0250-8095    

DOI:10.1159/000168698

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Fungal peritonitis (FP) is a serious complication of peritoneal dialysis, both in terms of morbidity and mortality. Available data on the effectiveness of fluconazole in eradicating FP without catheter removal are still controversial. We reviewed 20 FP cases that occurred among 325 patients who underwent peritoneal dialysis in our center between January 1984 and January 1992, in order to establish whether a profile of patients at risk of developing FP could be identified and to evaluate the effectiveness of fluconazole in treating FP (7 cases). Age, sex, a particular cause of end-stage renal disease, and the presence of diabetes did not correlate significantly with the development of FP. The risk of FP increased in patients on immunosuppressive treatment. Sixteen of our 20 patients had bacterial peritonitis during the month before they developed FP. Nineteen were treated with antibiotics. Neither the type of bacterial organism isolated during the bacterial peritonitis preceding FP nor modality and duration of antibiotic treatment correlated significantly with the development of FP. Patients who subsequently developed FP were more frequently treated with antibiotics while in hospital (p < 0.001). Candida species accounted for 15 of our 20 FP cases (75 %), with Candida albicans being by far the most common isolate. Treatment strategies varied among the 20 patients. The combination of intravenous or intraperitoneal administration of 5-fluoro-cytosine and oral administration of fluconazole was used in 7 cases: only 1 patient was cured without catheter removal, 1 patient died within the first 4 days of treatment, removal of peritoneal catheter was necessary in the other 5 patients. The main risk factors for the development of FP are a recent episode of bacterial peritonitis and recent exposure to antibiotics, especially when antibiotics were administered while in hospital. Under these circumstances, prophylactic administration of fluconazole should be considered. Despite initially favorable reports, fluconazole does not avoid the need for catheter removal to eradicate FP in most cases.

ISSN:0250-8095    

DOI:10.1159/000168699

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

We retrospectively evaluated the prevalence of Kaposi’s sarcoma (KS) in 820 kidney transplant recipients with a follow-up period of at least 6 months. Thirteen patients developed a KS (1.6 %): 2 were under conventional therapy and 11 under ciclosporin A. The onset of KS was 38.7 ± 38.3 (range 6-124) months after transplantation in the whole population and after 33.9 ± 19.7 months in the patients treated with ciclosporin A only. Nine were men and 4 women (male/female ratio: 2.25:1). The mean age at KS occurrence was 36.8 ± 11.1 years. The mean follow-up period since KS diagnosis was 35.9 ± 19.5 months. Clinical manifestation and severity of KS were heterogeneous: 5 patients had a KS with cutaneous involvement only, 8 patients a KS with multiple skin and mucosal and/or visceral lesions. Only 2 patients from the second group died of peritonitis due to intestinal lesions. In these 2 patients, immunosuppressive therapy had either been increased or reintroduced after a partial regression of KS. In all other patients, therapy was promptly reduced or withdrawn. In 1 patient local radiation therapy plus intralesional bleomycin administration were started and 1 patient received intralesional vincristine. Nine patients had a complete and 2 a partial remission of lesions. After therapy reduction, 4 patients lost their kidney (these patients however, had an already ongoing chronic rejection at KS diagnosis), in 2 there was an improvement of graft function, and in the other patients it remained stable. Our experience confirms that in most cases reduction or withdrawal of immunosuppression halts the evolution of both cutaneous and visceral lesions, without compromising graft function. However, in the few cases with a deteriorating renal function, the reinforcement of immunosuppression can lead to a rapid evolution

ISSN:0250-8095    

DOI:10.1159/000168700

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Six adult patients (4 females and 2 males, age range 26-57 years) with Gitelman’s syndrome (GS) were treated with spironolactone 200-300 mg/day (n = 5) and/or amiloride 10-30 mg/day (n = 3) for 1-18 months. The patients had hypokalemia, hyperreninemia, chloride-resistant metabolic alkalosis, renal hypomagnesemia (n = 5), and hypocalciuria (n = 5). Free water clearance studies during maximal water diuresis and furosemide administration were suggestive of a solute reabsorptive defect beyond the loop of Henle. Antialdosterone therapy induced a significant increase of Pk (from 2.6 ± 0.4 to 3.4 ± 0.4 τaM\ p < 0.0001) and a decrease of Cĸ (from 21.4 ± 13.2 to 10.6 ± 4.8 ml/ min, p < 0.02) and FEK (from 21.0 ± 13.6 to 13.4 ± 5.7%; p < 0.03); PMg increased from 1.38 ± 0.38 to 1.64 ± 0.21 mg/dl (p < 0.03) with a parallel fall of CMg (from 5.5 ± 2.3 to 2.9 ± 1.5 ml/min; p < 0.02) and FEMg (from 5.7 ± 2.6 to 2.9 ± 0.6%; p < 0.05); arterial blood pH and HCO-3 did not change (P = plasma, C = clearance, FE = fractional excretion). The creatinine clearance fell (from 90.5 ± 16.8 to 65.8 ± 20.9 ml/min; p < 0.05), and Prenin rose (from 16.6 ± 8.9 to 35.3 ± 25.3 ng/ml/h;p < 0.02, as did Paldo (from 26.1 ± 12.3 to 109 ± 82.6ng/dl; p < 0.01), indicating extracellular fluid volume contraction; however no significant clinical symptoms of hypovolemia ensued. Despite increased Paldo levels, estimated transtubular K gradient in K secretory sites fell (from 8.0 ± 4.0 to 6.7 ± 3.4; p < 0.01), confirming blunted aldosterone tubular effect. At the dosages employed, spironolactone induced a greater increase of Pĸ (0.81 ± 0.52 mM) than amiloride (0.07 ± 0.41; p < 0.001). In conclusion, antialdosterone therapy is effective in ameliorating hypokalemia and hypomagnesemia in GS. Its effects appear to result mainly from a direct tubular effect on K secretion and Mg reabsorption; extracellular fluid volume contraction appears also to occur during therapy, but has no relevant clinical effects. These results confirm that hypokalemia in GS is more a consequence of increased tubular secretion in the cortical collecting tubule than of impaired tubular K reabsorption; moreover, impaired tubular Mg conservation in GS might also occur in more distal segments of the nephro

ISSN:0250-8095    

DOI:10.1159/000168701

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Immunofluorescence studies were performed to determine whether the expression of intercellular adhesion molecule 1 (ICAM-1) in ddY mice, a model for IgA nephropathy (Berger’s disease), is influenced by treatment with a rat monoclonal antibody to murine CD4 molecules. The ddY mice were initially treated with intravenous injections, followed by weekly intraperitoneal injections of monoclonal antibody CD4. Using immunofluorescence, the mean intensity of IgA deposits in renal glomerular mesangial areas and capillary walls of the treated ddY mice was significantly lower than that in saline-treated control ddY mice of comparable ages. Marked expression of ICAM-1 was observed in glomerular capillary walls and mesangial areas in both control and treated ddY mice aged 40 and 70 weeks. The glomerular mesangial expansion in the treated ddY mice was milder than that found in the control ddY mice. No significant difference in glomerular cell proliferation between the treated and control ddY mice was observed. Although the infiltration of CD4+ T cells in glomeruli was slightly decreased after the treatment, that of CD8+ T cells and macrophages/monocytes was marked in both control and treated ddY mice aged 40 and 70 weeks. Thus, it appears that CD4+ T cells modulate the amount of IgA deposits in glomeruli, and other factors may be involved in the expression of ICAM-1 in glomeruli of IgA nephropathy in ddY mic

ISSN:0250-8095    

DOI:10.1159/000168702

出版商:S. Karger AG    

年代:1994

数据来源: Karger