ISSN:0250-8095    

DOI:10.1159/000168282

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

We compared cell-mediated immune responses in two groups of patients on hemodialysis. One group of patients were chronic carriers of hepatitis B virus (HBV), and the patients of the other group were HBV antigen negative. Our results show that despite the presence of normal numbers of T cells and an increased CD4/CD8 ratio in both groups of patients compared to healthy controls (p < 0.0001), only the group of patients who were chronic HBV carriers showed depressed lymphoproliferative responses to phytohemagglutinin (p < 0.001) and concanavalin A (p < 0.0001). In contrast, a control group of healthy adult HBV carriers showed normal T cell subsets and lymphoproliferative responses to mitogens, indicating that HBV infection per se did not result in depressed lymphoproliferative responses. These results further substantiate the notion that depressed cell-mediated immunity in chronic renal failure is an important factor in predisposing patients to HBV infection with subsequent development of the chronic carrier state.

ISSN:0250-8095    

DOI:10.1159/000168283

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Dialysis patients have increased susceptibility to infection and this is, in part, due to impaired phagocytic and bactericidal activities of polymorphonuclear leukocytes (PMNL). The mechanisms responsible for the reduced phagocytosis are not known. Dialysis patients have elevated blood levels of parathyroid hormone (PTH), and available data indicate that PMNL is a target cell for PTH. Chronic exposure to excess PTH may cause accumulation of calcium in PMNL which in turn could adversely affect cellular events leading to their dysfunction. We studied phagocytosis, resting levels of cytosolic calcium ([Ca2+]i), ATP content and the rise in [Ca2+]i in response to ligation of Fcγ RIII receptors with 3G8 monoclonal antibody in PMNL from 37 dialysis patients and 48 normal subjects. The PMNL from the dialysis patients displayed impaired phagocytosis, elevated resting levels of [Ca2+]i, decreased ATP content and a smaller rise in [Ca2+]i in response to various doses of 3G8 monoclonal antibody as compared to values obtained in PMNL of normal subjects. Our results suggest that derangements in cellular metabolism and possibly an abnormality in Fcγ RIII interaction with antibody and/or the consequences of such interaction are responsible, at least in part, for the impaired phagocytosis of PMNL of dialysis patients. Our data are consistent with the notion that excess PTH may play an important role in the processes leading to impaired phagocytosi

ISSN:0250-8095    

DOI:10.1159/000168284

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The clinical and pathologic features of progressive renal disease in 4 patients with Down’s syndrome are described. All patients were male, between 20 and 30 years of age at the time of clinical presentation. Three out of 4 had proteinuria, and 2 had hematuria. Serologic tests for hepatitis B virus infection and antinuclear antibodies performed in 2 patients were negative. Examination of renal tissue from biopsy and/or from autopsy revealed mesangiocapillary glomerulonephritis (MCGN), type 1. While an increased incidence of congenital heart disease and acute leukemias has been documented in Down’s syndrome, an association with MCGN has not been reported previously to our knowledge. This probably represents a form of idiopathic MCGN and may be related to the long survival of these individu

ISSN:0250-8095    

DOI:10.1159/000168285

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Liposomal amphotericin B without prior administration of Fungizone® was found to be an effective treatment in 4 patients with urinary tract infections caused by Candida albicans. Urine typically became culture negative after 1–4 days of dosing at 50mg/day, demonstrating that therapeutic levels of amphotericin B were reached in the urine at conventional doses given in liposomal form. The low incidence of toxicity with this preparation was particularly useful in patients with impaired renal function, including renal transplant patients on cyclosporin immunosuppressi

ISSN:0250-8095    

DOI:10.1159/000168286

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Studies were conducted in 9 dialysis patients with volume-nonresponsive hypotension, 6 dialysis patients with volume-responsive hypotension and in 10 normal subjects in an effort to evaluate the role of dysfunction of the autonomic nervous system (ANS) in the genesis of volume-nonresponsive hypotension. ANS function was evaluated by the Valsalva maneuver, handgrip exercise, and by the response of heart rate and blood pressure to change of posture from a supine to a standing position. Patients with volume-nonresponsive hypotension displayed significant derangements in the function of ANS as compared to normal subjects and to patients with volume-responsive hypotension. Data show that dysfunction of ANS plays an important role in the genesis of volume-nonresponsive hypotension in dialysis patients.

ISSN:0250-8095    

DOI:10.1159/000168287

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Information on persisting renal sequelae after cisplatin in children and adolescents is limited. Twelve patients aged 4–20 years had been treated with cisplatin and were healthy 4–43 months after stopping chemotherapy. Plasma creatinine, calcium, albumin and hydrogen ion concentration, plasma and urinary sodium, chloride, phosphate and urate, and urinary magnesium and potassium were comparable in patients and controls. However, mean calciuria, magnesemia and potassemia were significantly reduced and bicarbonatemia increased in the patients. Calciuria, magnesemia, potassemia and bicarbonatemia were normal in 3 patients only, calciuria was below – 2 SD control in 9 patients, renal magnesium deficiency was demonstrated in 5 patients (all with hypocalciuria as well), and 4 patients presented with hypokalemic metabolic alkalosis (all with magnesium deficiency and hypocalciuria). Conclusions: (1) Renotubular dysfunctions persist very often after cisplatin; (2) hypocalciuria is more frequent than hypomagnesemia; (3) the most severe tubulopathy after cisplatin includes hypocalciuria, renal magnesium deficiency and hypokalemic metabolic alka

ISSN:0250-8095    

DOI:10.1159/000168288

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The long-term effects of converting enzyme inhibitors and calcium channel blockers on proteinuria and the progression of renal disease in patients with hypertension and chronic renal insufficiency are not well established. We have studied the long-term effects of treating hypertension with an angiotensin-converting enzyme inhibitor, enalapril, and a calcium channel blocker, nicardipine, on urinary albumin excretion (UAE) and on renal function in 16 patients with hypertension and chronic renal insufficiency (creatinine clearance ranging between 17 and 62 ml/ min). After 1 year of treatment, these agents caused a similar decrease in blood pressure. Only enalapril, however, caused a significant decrease in UAE (from 641 ± 98 to 292 ± 47 mg/24 h, p < 0.01), whereas UAE did not change in the group treated with nicardipine (675 ± 78 vs. 601 ± 75 mg/24 h). Creatinine clearance at the beginning of the study was similar in the group treated with enalapril and in the group treated with nicardipine (35 ± 3.6 vs. 40 ± 4.1 ml/min). After 1 year of follow-up, creatinine clearance remained unchanged in both groups of patients. These studies demonstrate that both enalapril and nicardipine can effectively reduce blood pressure in patients with hypertension and chronic renal insufficiency. Enalapril but not nicardipine, however, appears to reduce urinary albumin excretion in these patients. Whether the reduction in UAE has any significant impact on the progression of renal disease remains to be establ

ISSN:0250-8095    

DOI:10.1159/000168289

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Interleukin-1 (IL-1) is a pleiotropic factor, eliciting a broad set of immunologic and inflammatory events. We have previously shown that IL-1 is present in inflamed glomeruli. To evaluate factors that might regulate of IL-1 production, we tested the effects of substances accessible to mesangial cells (MC): immune complexes (IC) are known to modulate MC function. We have attempted to assess the ability of soluble IC derived from rat glomerular basement membrane to induce the production of IL-1. When isolated MC were incubated with the soluble IC, substantial amount of IL-1 could be detected in the supernatants as measured by the mouse thymocyte assay. To block the effect of prostaglandins on the IL-1 assay, we cultured the MC with the addition of indomethacin and assayed IL-1 activity in the culture supernatants. The use of indomethacin resulted in a further increase in IL-1 production. These biological activities were neutralized by a specific antibody to IL-1. In the present report, we show that IC represent important sources of stimulation of MC for the production of IL-1. We speculate that IC could augment local inflammatory responses in the kidney partly due to their capacity to induce the production of IL-1.

ISSN:0250-8095    

DOI:10.1159/000168290

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

We report a case of biopsy-proven acute tubulointerstitial nephritis associated with a second course of flurbiprofen, a nonsteroidal anti-inflammatory drug of the propionic acid class. The clinical presentation and course was consistent with acute tubulointerstitial nephritis due to these agents.

ISSN:0250-8095    

DOI:10.1159/000168291

出版商:S. Karger AG    

年代:1991

数据来源: Karger