摘要:

The renal side-effects are a major limitation of the use of cyclosporine A (CsA) following heart transplantation. In an effort to define the time course of the decline in renal function and to identify a group of patients especially prone to the nephrotoxic effects of CsA, we studied 187 orthotopic heart transplant recipients who had a follow-up of at least 1 month. All patients received oral CsA in a starting dose of 8 mg/kg and low-dose steroids. Renal function decreased steadily after transplantation. Serum creatinine was > 150 µmol/l in 52% of the patients after 2 years. After 4 years serum creatinine was > 250 µmol/l in 13% of the patients. No relation could be found between the decline in renal function (as defined by the slope of serum creatinine-1 versus time) and age, sex, creatinine levels before transplantation, blood pressure, CsA blood levels, the number of rejections or the use of calcium channel blocking drugs. We conclude that, despite reduction of CsA dosage, progressive renal insufficiency can be observed in an increasing percentage of heart tansplant recipients. We were not able to identify patients with a poor renal prognosis in an early phase after transplantatio

ISSN:0250-8095    

DOI:10.1159/000168677

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Three newborn babies with acute renal failure were started on peritoneal dialysis 3, 4 and 3 days after abdominal surgery for intestinal perforation, intestinal malrotation with volvulus and hepatic laceration, respectively. Peritoneal access was achieved by Trocath catheters in the first two and via a Jackson-Pratt peritoneal drain inserted during surgery in the third baby. Two babies survived after dialysis for 9 and 6 days. The third baby was dialysed for 16 days, had partial recovery in renal function and died of multisystem failure at the age of 35 days. Peritoneal dialysis is possible in neonates with recent major abdominal surgery. Occasionally, a peritoneal drain inserted during surgery may provide an easy access for the procedure.

ISSN:0250-8095    

DOI:10.1159/000168678

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Surveillance of 101 hemodialysis patients for Staphylococcus aureus positive nasal cultures was performed by monthly nasal swabs over a 27-month period. All positive cultures were treated with a prophylactic antibiotic regimen. Forty-seven (46.5%) patients had one or more positive cultures. The surveillance period was longer in the S. aureus nasal carriers (p = 0.004). The frequency of positive cultures correlated with the duration of surveillance (p = 0.029). The incidence of S. aureus bacteremia was greater in patients with two or more positive cultures (p = 0.030). This study suggests that continuous surveillance for S. aureus nasal colonization is essential to properly identify all patients at risk of developing S. aureus bacteremias.

ISSN:0250-8095    

DOI:10.1159/000168679

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The subcutaneous administration of recombinant human erythropoietin is effective in the treatment of anemia of end-stage renal disease. Single-dose pharmacokinetic studies suggest the possibility of less frequent dosing via the subcutaneous route. In this study, dosing once-weekly was as effective as thrice-weekly subcutaneous dosing in maintaining the corrected hematocrit in a group of children receiving continuous cycling peritoneal dialysis. This regimen was preferred by and benificial to both patients and their parents.

ISSN:0250-8095    

DOI:10.1159/000168680

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Adynamic bone is being found with increasing frequency in dialysis patients. Little is known about its aetiology, and even less about its natural history. We found 10 cases of asymptomatic adynamic bone among a group of 32 continuous ambulatory peritoneal dialysis patients, most of whom had never been exposed to aluminium-containing phosphate binders. Compared to the remaining 22 patients, they had an older mean age (54 ± 11.4 vs. 42 ± 11.8 years; p < 0.05), probably a longer pre-dialysis duration of renal failure (10.9 vs. 7.1 years), higher mean ionized calcium (1.30 ± 0.04 vs. 1.15 ± 0.02 mmol/l; p < 0.01), and lower mean intact parathyroid hormone (31.5 vs. 200.3 pg/ml; p < 0.001). The bone density was not different between the two groups, but 9 of the 10 adynamic patients had significant vascular calcification seen on plain radiology as compared with only 7 of 20 in the comparison group (p < 0.05). Follow-up of the adynamic patients showed a close association with serum intact parathyroid hormone and ionized calcium levels. With one exception, adynamic bone did not appear to be associated with lower bone density than other types of osteodystrophy, but a longer-term study is required to determine the complete natural history of this les

ISSN:0250-8095    

DOI:10.1159/000168681

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Membranous glomerulonephritis (MN) is characterized by the presence of subepithelial immune complexes and thickening of the glomerular basement membrane (GBM). Immune complexes are recognized as subepithelial electron-dense deposits (EDDs) by electron microscopy. We used immunogold electron microscopy to detect the GBM components – type IV collagen, heparan sulfate proteoglycan (HS-PG) and laminin – in thickened GBM, and studied the relationship between immune complexes and these GBM components. We demonstrate that the three major basement membrane components are distributed throughout the newly synthesized GBM. These findings suggest that type IV collagen, HS-PG, and laminin together comprise the spike-like structures and the newly synthesized GBM-like matrix in the thickened GBM of idiopathic MN and membranous lupus nephritis. The newly constructed matrix in the GBM appears to be composed of nearly normal GBM. In type IV collagen, the α1-chain was rarely present on the newly synthesized basement membrane in the lamina rara externa, while α3-chain was present on the subepithelial newly synthesized basement membrane. HS-PG was found within EDDs in membranous lupus nephritis. This suggests that anti-DNA antibody may cross-react with the HS-PG component of the GBM and thus form a subepithelial immune complex.

ISSN:0250-8095    

DOI:10.1159/000168682

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Peritonitis is a serious problem associated with continuous ambulatory peritoneal dialysis. The process can be initiated by intraluminal contamination and colonization of the peritoneal cavity as well as by bacterial adhesion to biomaterials, including catheters and exit site dressings. The aim of this study was to determine the degree to which two pathogenic organisms could adhere to three biomaterial surfaces, and the extent to which dextrose concentration influenced the binding and survival. Using a 24-hour in vitro assay, it was found that the Staphylococcus aureus strain consistently adhered significantly better than the Pseudomonas aeruginosa isolate, and only the adhesion of the latter was decreased with higher concentrations of dextrose in dialysis solutions. Electron microscopy demonstrates that within this short time period, bacterial biofilms had begun to form on the catheter surfaces.

ISSN:0250-8095    

DOI:10.1159/000168683

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Resistance to the action of PTH is encountered in chronic renal failure (CRF). This was attributed to downregulation of PTH receptor due to the state of secondary hyperparathyroidism of CRF. The present study examined whether the amount of PTH-PTH-related peptide (PTH-PTHrP) mRNA in a traditional (kidney) and a nontraditional (liver) organs for PTH action was reduced in CRF. PTH-PTHrP mRNA was measured in kidney and liver obtained from normal rats, animals with CRF of 6 weeks’ duration, normocalcemic parathyroidectomized CFR rats and from CRF and normal rats treated with verapamil. The mRNA of receptor was quantitated with Northern blot analysis of kidney RNA and liver poly A+ RNA. The relative amounts of mRNA of the PTH-PTHrP receptor to that of β-actin in both kidney and liver of CRF rats were significantly (p < 0.01) lower than in normal animals. Parathyroidec-tomy of CRF rats was followed either by significant (p < 0.01) improvement (kidney) or normalization (liver) of the receptor mRNA. Treatment of CRF rats with verapamil also significantly (p < 0.01) improved the concentration of the receptor mRNA in the kidney. The data demonstrate that CRF is associated with downregulation of the PTH-PTHrP receptor mRNA in kidney and liver. This defect is partially or completely reversed by parathyroidectomy of the CRF rats or their treatment with verapamil. The decrease in the receptor mRNA would likely result in a decrease in PTH receptor synthesis and consequently PTH receptor numbers, and hence relative resistance to the action of PTH. It is proposed that, at least, one signal that mediates the reduction in the amount of the receptor mRNA is the PTH-induced rise in cytosolic calcium in CRF. Indeed, both parathyroidectomy of CRF rats or their treatment with verapamil is associated with normalization of cytosolic calcium and significant improvement in the expression of the receptor mR

ISSN:0250-8095    

DOI:10.1159/000168684

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Ultrastructural morphometric studies of glomerular basement membrane (GBM) thickness are described in two renal biopsy specimens from a patient who presented with hemoptysis and hematuria mimicking Goodpasture’s syndrome. Significant GBM abnormality, with attenuation as the main lesion, identified in a biopsy specimen taken during active clinical disease appeared to have resolved in a second biopsy specimen taken during the recovery phase. There was no evidence of glomerulonephritis. Concurrent lung biopsy studies showed focal alveolar-capillary wall basal lamina changes of uncertain diagnostic significance. These observations suggest the alternative possibilities that GBM attenuation may be either an acquired consequence of systemic disease or may be part of an hitherto unrecognized primary multisystem abnormality of basal lamina affecting, in this case, glomerular and pulmonary laminae, resulting in hematuria and hemoptysis. The morphometric studies in this case indicate that simple-mean measurements of GBM thickness are inadequate alone for the quantitative study of this lamina because significant interand intraglomerular membrane variation, if irregularly distributed, can remain undetected.

ISSN:0250-8095    

DOI:10.1159/000168685

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Extrapulmonary tuberculosis is more common in end-stage renal disease than in normal subjects, and it frequently poses both diagnostic and therapeutic challenges. We describe 2 dialysis patients with tuberculosis of the spine (Pott’s disease). The 1st patient presented with back and left hip pain, low-grade fever, left-quadriceps weakness, hypoesthesia of the left thigh, and hypoactive left-knee jerk. X-rays of the spine showed only osteophytes. Magnetic resonance imaging showed increased signal intensity of L3 with focal expansion into the spinal canal. A computerized tomography guided biopsy revealed granulomas, and Ziehl-Neelsen stain was positive. Therapy with rifampin, isoniazid, ethambutol, and pyrazinamide caused peripheral neuropathy and optic neuritis. The 2nd patient developed bilateral proximal thigh pain and weakness that progressed to paraplegia. Magnetic resonance imaging showed destructive lesion of L3-5, involving both psoas muscles, prevertebral space, and neural foramina. Ziehl-Neelsen stain of the biopsy specimen was negative, but culture was positive for Mycobacterium tuberculosis. Paraplegia improved only partially after 1 year of therapy. Pott’s disease should be suspected in end-stage renal disease patients with back pain and/or neuromuscular complaints, particularly in those who immigrated from Asian and Latin-American countries. Treatment of tuberculosis in dialysis patients may cause significant morbid

ISSN:0250-8095    

DOI:10.1159/000168686

出版商:S. Karger AG    

年代:1994

数据来源: Karger