摘要:

We have retrospectively examined the clinical outcomes of the 9 patients who survived for more than 10 years in our continuous ambulatory peritoneal dialysis (CAPD) program. Six were men and 3 women aged 50.8 ± (SD) 11.5 years. Three had been previously treated by hemodialysis. None of them had diabetes or neoplasms, 1 had liver cirrhosis, 3 had ischemic cardiopathy, 1 had peripheral artery disease, and all were hypertensive. The hospitalization rate ranged from 0 to 4.5 days/patient/year, the peritonitis rate was one episode every 57 months. Six patients had no peritonitis during the first 10 years of treatment. Exit-site episodes were one every 46.7 patient months. Six peritoneal catheters were removed from 4 patients. KT/V and peritoneal permeability, assessed by the peritoneal equilibration test, were within the normal range in the majority of the patients. Five patients died between the 121st and the 149th month, and 4 are still alive. Three of them are working. These results show that CAPD can be effective, peritoneal catheters can survive, and some patients can be free from peritonitis episodes for more than 10 years. After the 10-year on CAPD, the survival is poor, and the morbidity is high

ISSN:0250-8095    

DOI:10.1159/000169044

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Long-acting natriuretic peptide (LANP), vessel dilator (VSDL), and atrial natriuretic factor (ANF) consisting of amino acids 1-30, 31-67, and 99-126 of the 126 amino acid ANF prohormone, respectively, circulate in humans and have potent natriuretic properties. To determine whether these peptides have a direct relationship to serum Na and/or Cl, we examined 21 24-hour profiles of these peptides and Na and Cl in 14 healthy humans. LANP, VSDL, ANF, and Cl had significant (p < 0.001) circadian rhythms with peak concentrations at 04.00 h. The circadian rhythm of serum Na was exactly opposite. Sodium correlated negatively with LANP (p = 0.021) and ANF (p = 0.007), while Cl correlated positively with LANP (p = 0.003) and VSDL (p = 0.001). These data suggest that the atrial peptides may be important for the maintenance of serum Na and Cl within their normal ranges and in the modulation of their daily circadian rhythms.

ISSN:0250-8095    

DOI:10.1159/000169045

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Stimulation of both the systemic and local renin-angiotensin systems participates in the pathogenesis of tissue injury observed in experimental renal disease. However, substantial information demonstrating excessive activation of the renin-angiotensin system in patients with chronic renal disease is not available in spite of the well-established role of this system in the progression of renal damage. This investigation examined the plasma renin activity (PRA) and the ratio of this parameter to the simultaneously measured glomerular filtration rate (PRA/GFR) in normal volunteers (mean values 3.2 ng/ml/h and 3.0 ng/ml/h/100 ml GFR, respectively) and in patients with chronic renal disease (1.6 ng/ml/h and 28.5 ng/ml/h/100 ml GFR, respectively). A mean tenfold increase in the PRA/GFR ratio was observed in patients with chronic renal disease as compared to normal volunteers. The observed augmentation in PRA was not caused by physiologic mechanisms aimed at conserving urinary sodium since a positive correlation was found between PRA/GFR and the fractional excretion of sodium (y = 2.75+ 2.23x; r = 0.781, p < 0.01), as opposed to that of normal controls (y = 5.3- 1.46x; r = -0.640, p < 0.01). Consequently, our results support the existence of inappropriate activation of the renin-angiotensin system in humans with chronic renal disease. Such stimulation might play a critical role in the pathophysiology of advanced renal injury.

ISSN:0250-8095    

DOI:10.1159/000169046

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Chronic hepatitis C is the major cause of chronic liver disease after successful cadaveric renal transplantation. The aims of this prospective, open study were to assess in such a population, firstly the prevalence of different organ-specific and nonspecific antibodies and related disorders, and secondly their outcome after inteferon-α therapy as well as the incidence of new immunologic disorders under and after this therapy. In 15 cadaveric renal transplant patients (10 men, 5 women, ages 29-65 years) with chronic hepatitis C and histological features of chronic active hepatitis, undergoing chronic immunosuppression (ciclosporine A with or without steroid and azathioprine) and treated with recombinant α2b-interferon (IFNα) (mean duration 142 ± 35 days), we assessed before and after this therapy the serum levels of cryoglobulinemia, rheumatoid factors (RF), thyroid-stimulating hormone (TSH), free thyroxine (fT4), and antinuclear (ANA), antismooth muscle (ASMA), antimitochondrial (AMA), anti-LKM1, antimicrosomal thyroid (MCA), antithyroglobulin (TGA) autoantibodies. At the start of IFNα therapy, 14 of 15 patients had detectable autoantibodies (RF: 9; ANA > 1/50: 8; ASMA > 1/50: 4; other autoantibodies: 0); 1 had cryoglobulinemia. At the end of therapy the cryoglobulinemia had disappeared, the preexisting autoantibodies remained present in all patients but 2; 3 patients had developed MCA without evidence of clinical or biological thyroid abnormalities and 3 others had developed either RF (1) or ANA (1) or ASMA (1), without any related symptoms. One patient developed transient type II diabetes mellitus without anti-Langerhans β-cell antibodies. Finally, the occurrence of autoantibodies in our patients was associated either with HLA DR3 or DR4 or DR7 phenotypes. We found that the prevalence of extrahepatic immunologic abnormalities was high in renal transplant patients with chronic hepatitis C and no exacerbation was observed during of after IFNα therapy. The most frequent autoantibody appearing after IFNα therapy was MCA although without thyroid abnorm

ISSN:0250-8095    

DOI:10.1159/000169047

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Amyloidosis due to the retention of β2-microgιobulin (β2-MG) is a frequent complication of hemodialysis (HD). Significant amounts of β2-MG can be removed from the body by highly permeable HD membranes, whereas conventional low-flux membranes are impermeable for the molecule. In a prospective and controlled study we investigated whether high-flux HD could delay the onset of dialysis-related amyloidosis (DRA). Twenty patients treated with cuprophane low-flux HD membranes were matched for age and previous time on HD either to continue their HD regimen or to receive HD treatment with high-flux polysulfone membranes. For 6 years each patient was examined for manifestations of DRA once a year or upon individual needs, additionally, serum β2-MG levels were monitored. After 6 years of follow-up no clinical signs of DRA were found in any of the patients dialyzed with high-flux polysulfone membranes, whereas 8/10 of the conventionally dialyzed patients had CTS and/or osteoarticular lesions. Serum levels of β2-MG were significantly reduced in patients treated with high-flux polysulfone memb

ISSN:0250-8095    

DOI:10.1159/000169048

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

A multicentre trial (11 nephrology centres) was carried out to test the effects of ibopamine, an orally active dopamine-like drug, on the progression of chronic renal failure. For a 2-year period 189 chronic renal failure patients (serum creatinine level 1.5-4.0 mg/dl) were observed. They were homogeneous for basic nephropathy, degree of residual renal function, blood pressure, and proteinuria. the patients were randomly divided into two groups: 96 took ibopamine at a dosage of 100 mg/day (group A) and 93 served as controls (group B). All were on a low-protein diet (mean 0.8 g/kg body weight). By the end of the observation period, the rate of decrease of the renal function indexes in time proved significantly slower (1.8 times) in group A than in group B. The survival curves for renal function (pre-established end points were creatinine level increases equal to or > 20% and equal to or > 40% of the basal values) proved significantly better (p < 0.02 and p < 0.002 respectively) in group A than in group B. The mean plasma creatinine values rose by 17% in group A and by 36% in group B. The creatinine clearance decreased by 5% in treated patients and by 14% in the controls. Statistical analysis ruled out any possible centre effect. The trial suggests that low-dosage ibopamine administration may be used as a valid and safe pharmacological adjunct for retarding the progression of renal failure in patients with mild or moderate chronic renal impairment.

ISSN:0250-8095    

DOI:10.1159/000169049

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Intestinal permeability was investigated by using 51Cr-EDTA as a probe molecule in 29 patients with immunoglobulin A nephropathy (IgA NP) and 20 healthy controls in 1990. Intestinal permeability was significantly higher in the IgA NP patients than in the controls (IgA NP, 3.86 ± 0.29%; controls, 2.72 ± 0.23%, p < 0.005). There was a significant relation between the manifestations of the disease (proteinuria and/or microhematuria) and the increased intestinal permeability (p < 0.05). By 1994, after an interval of 4 years, average intestinal permeability in the 21 patients available for study had not changed (3.80 ± 0.36 vs. 4.57 ± 0.63%) and was significantly higher than in the controls (p 3.2 g/l; n = 15) there was a significant correlation between serum IgA levels and the degree of intestinal permeability (p < 0.02). During the 4-year period, the patients’ kidney function deteriorated (n = 25; creatinine clearance in 1990, 92.4 ± 6.1 ml/min; in 1994,73.9 ± 7.6 ml/min; p < 0.0002), the deterioration being greater in patients with increased intestinal permeability. There was no relation between the histologic grade of the biopsy specimen, hypertension and intestinal permeability. These data collected over a 4-year period suggest that in IgA NP increased intestinal permeability may play a role in the pathogenesis of the disease and adversely influence its prog

ISSN:0250-8095    

DOI:10.1159/000169050

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Objective: To determine whether T1- or T2*-weighted sequences are more informative and practical in dynamic Gd-DTPA-enhanced MR imaging for the evaluation of renal blood flow and function. Materials and Methods: Dynamic Gd-DTPA-enhanced MR imaging of the kidney was performed in 7 patients by either Tl-weighted TurboFLASH (TR/TE/TI/FA = 9/4/27/8) or T2*-weighted FLASH (TR/TE/FA = 32/22/10) sequences for comparison of the enhancement pattern. None of the subjects had a suspicion of renal dysfunction from laboratory data, and the absence of renal artery stenosis was confirmed by conventional angiography. Results: During the early phase, the marked signal increase in T1-weighted imaging in the renal cortex corresponded to a similar marked decrease in signal intensity in T2*-weighted imaging. During the middle and late phases, the medulla was dramatically decreased in intensity on the T2*-weighted imaging resulting in a good contrast between the cortex and medulla. Conclusion: Both sequences may provide almost similar information about the renal cortical blood flow. However, T2*-weighted dynamic MR imaging may be more informative than T1-weighted dynamic MR imaging about the concentrating ability in the renal medulla. A high concentration of Gd-DTPA in the tubular structure was suspected to cause a dramatic decrease in intensity in the medulla in T2*-weighted imaging.

ISSN:0250-8095    

DOI:10.1159/000169051

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Renal and systemic hemodynamics, plasma arginine vasopressin, plasma renin activity, plasma norepinephrine, blood volume and water loading test were studied in 10 patients with falciparum malaria without renal failure. Six patients responded to water load normally, while 4 patients had a decreased response to water load. The patients with a normal water load response had normal renal and systemic hemodynamics and a normal hormonal profile. The patients with a decreased response to water load had hyponatremia, hypervolemia, high cardiac index, low systemic vascular resistance, high plasma arginine vasopressin, high plasma renin activity, high plasma norepinephrine, low creatinine and p·aminohippurate clearances, low urine sodium and high urine osmolality. They had a lower mean arterial pressure during the acute phase of the disease than during the recovery phase. The findings suggest that a decreased response to water load is due to peripheral vasodilatation which results in a decreased effective blood volume leading to the release of vasopressin and norepinephrine, increased renin activity and decreased renal hemodynamics

ISSN:0250-8095    

DOI:10.1159/000169042

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

A 69-year-old diabetic woman with diffuse atherosclerosis presented with acute renal failure due to contrast nephropathy and severe metformin-induced lactic acidosis. There was a discrepancy between the patient’s elevated serum creatinine level, indicative of severe renal insufficiency, and her very low blood urea nitrogen content. It is postulated that the patient’s extremely severe acidosis interfered with her hepatic urea generation, contributing to this unusual biochemical abnormal

ISSN:0250-8095    

DOI:10.1159/000169052

出版商:S. Karger AG    

年代:1996

数据来源: Karger