ISSN:0250-8095    

DOI:10.1159/000166940

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

In a double-blind crossover study in 10 salt-depleted nephrotic patients the reduction of proteinuria was significantly larger during indomethacin 50 mg three times daily than during naproxen 250 or 500 mg three times daily (72 vs. 44%, p < 0.05; 77 vs. 46%, p < 0.05, respectively). Both drugs induced similar reversible intrarenal hemodynamic changes, but indomethacin had more pronounced effects than naproxen. A common pathway, such as the reduction of the glomerular filtration rate and a reduction of the glomerular transcapillary hydraulic pressure, is likely to explain the observed phenomena and is most probably mediated by inhibition of intrarenal prostaglandin synthesis. If treatment with a nonsteroidal anti-inflammatory drug is considered in patients with the idiopathic nephrotic syndrome, indomethacin appears up to now the most effective agent in reducing urinary protein loss.

ISSN:0250-8095    

DOI:10.1159/000166941

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Parathyroid hormone (PTH) is a polypeptide which in different in vitro systems raises intracellular cyclic AMP (cAMP) levels via adenyl cyclase activation and stimulates Ca2+ transport across cell membranes. We tested whether, on the basis of this mechanism, PTH would inhibit human platelet aggregation. The latter was tested in vitro by a photometric technique. Platelet aggregation induced by the calcium ionophore A 23187 was inhibited by PTH at concentrations (0.5–3 USP U/ml) similar to those effective in other in vitro systems. Higher concentrations of PTH were required to prevent aggregation initiated by adenosine-5’-diphosphate, arachidonic acid, or platelet-aggregating factor. The terminal synthetic fragment 1–34 b PTH was ineffective against all aggregation stimuli. The antiaggregating effect of PTH was potentiated by verapamil and theophylline and was additive to that of PGI2. However, PTH did not appear to increase platelet cAMP levels and was not counteracted by an inhibitor of platelet adenyl cyclase. It is therefore unlikely that PTH inhibits platelet aggregation through an adenyl cyclase stimulated increase of cAMP. Since PTH levels are markedly increased in uremic plasma, it might contribute to the defective platelet function and the bleeding tendency frequently occurring in uremic pa

ISSN:0250-8095    

DOI:10.1159/000166942

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The distribution of fibronectin (FN) and the depositions of fibrinolytic components in human renal glomeruli with a variety of pathologic disorders were examined on biopsy specimens by immunofluorescence and immunoenzymatic methods. In a majority of the cases with thickening of capillary walls and/or with fibrin deposits in the capillary walls, staining for FN along the walls of the capillary loops (capillary pattern) was noted in addition to the staining in the mesangial area. In the capillary pattern with fibrin deposition, deposits of α2-plasmin inhibitor and plasminogen, which are major components of the fibrinolytic system, were also seen along the capillary walls with a high frequency of occurrence. Plasminogen deposits, however, were found only in the glomeruli with deposits of α2-plasmin inhibitor. There was no direct relationship between the degree of proteinuria and the appearance of the capillary pattern of FN or the deposition of the fibrinolytic components. These findings suggest that the appearance of FN in the walls of the capillary loops has some causal relationship with the local activation of blood coagulation factors which is frequently followed by activation of the fibrinolytic enzyme syste

ISSN:0250-8095    

DOI:10.1159/000166943

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Electron microscopic observations of chronic uremic lungs were carried out in 6 uremic patients with special reference to histochemical and X-ray microanalytic studies on the altered alveolocapillary basement membranes. Epithelial damage varying from edematous swelling of the epithelial cells to total disruption and desquamation of the epithelium was often present. Although degenerative changes of capillary endothelium such as swelling and vacuolization of the endothehal cells were not infrequently demonstrated, total destruction of the endothelium was rarely seen. The interstitial changes included focal accumulation of edema fluid, particularly in the pericapillary spaces, patchy fibrosis, and increased cellularity. Particularly interesting were the altered alveolocapillary basement membranes which showed irregular thickening, lamination, and fragmentation. Irregular electron densities with derangement of internal ultrastructures were often observed in the matrices of isolated uremic lung basement membranes. The anionic binding sites characterized by cationized ferritins appeared to be irregularly and loosely arranged on the surfaces and in the interior of isolated basement membranes. In addition, abnormal deposition of aluminum was consistently detected in the precipitates of isolated basement membranes. From the aforementioned results we conclude that the present investigation provides the morphological data at the ultrastructural and molecular level to explain many of pulmonary physiological alterations and clinical manifestations exhibited by patients with chronic uremia.

ISSN:0250-8095    

DOI:10.1159/000166944

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

Low doses of dopamine are known to increase renal blood flow without influencing heart rate or systemic blood pressure. Indeed this effect was observed in 32 patients with IgA glomerulopathy. A concomitant increase in glomerular filtration rate (GFR), however, was only observed in patients with a baseline GFR ≥ 73 ml/min/1.73 m2. Moreover, the change in GFR during dopamine infusion increased with increasing baseline GFR. We conclude that in IgA glomerulopathy nephron loss is compensated for by a progressive utilization of the kidney’s functional reserve capacity which seems exhausted when compensated GFR falls below 73 ml/min/1.73 m2

ISSN:0250-8095    

DOI:10.1159/000166945

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

The occurrence of hypersensitivity reactions in patients dialyzed on artificial kidneys is well recognized in the dialysis community, but has received little attention in the medical literature. We report 4 cases of dialyzer hypersensitivity reactions and review the previously reported cases. Dialyzer hypersensitivity syndrome presents as an acute anaphylactoid reaction, the symptoms of which may range from mild to life threatening in severity. The cause of this syndrome is unknown, but affected patients appear to have a high incidence of positive radioallergosorbent tests to a conjugate of human serum albumin and ethylene oxide, suggesting that ethylene oxide, a substance used to dry sterilize artificial kidneys, may be an offending allergen.

ISSN:0250-8095    

DOI:10.1159/000166946

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

In 6 hypertensive patients with terminal renal failure maintained on hemodialysis, the effects of ‘salt subtraction’ and of sequential Ultrafiltrating were evaluated. Following each of 3 weekly hemodialysis sessions, salt subtraction was carried out by Ultrafiltrating 1 liter and simultaneously infusing an equal volume of 5 % dextrose. This resulted in a net sodium loss without hypovolemia. After a 2-week period of this procedure, the blood pressure prior to dialysis was lower (156/76 ± 12/5 mm Hg) than after a comparable number of sequential Ultrafiltration sessions (181/88 ± 10/6 mm Hg; mean ± SEM). This difference was not statistically significant. At the same time, body weight was comparable at 64.4 ± 3 and 64.7 ± 4 kg, respectively. Neither plasma renin activity nor plasma catecholamines responded with a clear increase to either procedure. The limited effect on blood pressure and the renin system of a marked sodium removal during salt subtraction suggests that sodium must still be present in excess in these patients. The procedure of salt subtraction appears safe and subjectively well tolerated, but it can probably not be used as the sole means of decreasing total body sodium without associating dietary measures to reduce sodiu

ISSN:0250-8095    

DOI:10.1159/000167169

出版商:S. Karger AG    

年代:1985

数据来源: Karger

摘要:

5 cases with the compatible serological criteria of mixed connective tissue disease described earlier are presented. In 1 of them with a moderate degree of proteinuria, the renal biopsy disclosed membranous nephritis. However, despite the absence of overt clinical renal disease in the other 4 cases, biopsies disclosed membranous nephritis in 1 and mild mesangial proliferative glomerulonephritis in the remaining 3 cases. In the follow-up of these 4 cases, 2 subsequently developed abnormal urinalysis. Electron microscopic examinations demonstrated electron-dense deposits in glomeruli, and 4 of these patients also had microtubular structures in the endothelial cytoplasm. Contrarily to the original concept, our findings suggest that mixed connective tissue disease also induces immune complex disease.

ISSN:0250-8095    

DOI:10.1159/000166947

出版商:S. Karger AG    

年代:1985

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000166948

出版商:S. Karger AG    

年代:1985

数据来源: Karger