摘要:

Clinically overt glomerular disease was detected in 6 (1.1%) of 543 patients with HIV infection followed at a Brazilian National Referral Center for AIDS. In 4 cases, glomerulosclerosis was present (focal and segmental in 3, diffuse and global in 1) and rapid progression to terminal renal failure was observed 1-10 months after clinical presentation. The other 2 patients died with normal renal function, and autopsy studies suggested the diagnosis of minimal change disease. Clinically overt glomerular disease was significantly more common among Black patients, whether all the cases with glomerulopathy (p < 0.001) or just the cases with glomerular sclerosis were considered (p = 0.011). Autopsy study of renal fragments from patients without clinical evidence of glomerular disease was additionally performed and revealed the presence of focal and segmental glomerulosclerosis in 3 cases (7.5 %). We concluded that a glomerulopathy with clinicopathological features which match the definition of HIV nephropathy can be found among Brazilian patients with HIV infection. Accordingly to what has been described in American series, Brazilian Black patients seem to be at increased risk of the development of that nephropathy.

ISSN:0250-8095    

DOI:10.1159/000168461

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The occurrence of hepatitis C virus (HCV) infection amongst chronic renal failure (CRF) patients in our Nephrology Unit was investigated over a period of 1 year. A total of 71 patients was studied comprising 26 chronic haemodialysis (CHD) patients, 6 acute haemodialysis patients, 4 peritoneal dialysis patients and 35 CRF patients not on dialysis. Patients were screened before and after haemodialysis, and their baseline and postdialysis values of liver enzymes were determined. Eleven (15.5%) of the total 71 patients were HCV antibody positive. Analysis of the individual patient groups showed that 8 (30.7%) of the 26 CHD patients were positive for HCV. Our data showed a statistically significant relationship between seroconversion and duration of dialysis (p < 0.05). A high statistically significant (p < 0.0001) correlation was observed between the HCV antibodies and CRF. The relative risk of hepatitis C was about 22 times greater for those with CRF compared with the normal controls, which makes CRF an important risk factor. A high proportion of the HCV seroconverters had elevated liver enzyme (serum glutamic pyruvic transaminase). The data presented show a positive correlation between HCV seroconversion, CRF, duration on dialysis and elevated serum liver enzymes.

ISSN:0250-8095    

DOI:10.1159/000168462

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We investigated insulin-like growth factor (IGF)-I and -II mRNA expression in peripheral blood mononuclear cells (PBMC) and T cells obtained from 31 patients with IgA nephropathy (IgAN), 43 patients with other types of glomerulonephritis and 16 healthy age-matched controls. The majority of patients with IgAN showed elevated IGF-I and -II mRNA expression in PBMC, while no IGF-I and -II mRNA expression was detected in PBMC obtained from patients with other types of glomerulonephritis or normal controls. In T cells obtained from IgAN, other types of glomerulonephritis and normal controls, however, IGF-I and -II mRNA expression was not detected. A positive correlation was noted between IGF-I and -II mRNA levels and urinary protein excretion. IGF-I and -II mRNA expression also correlated with the histopath-ological findings in the renal tissue of patients with IgAN. Sixty-nine percent of patients with more than 1.0 g/day proteinuria showed strong [more than (++)] IGF-I and -II mRNA expression in their PBMC. Eighty-one and 76% of patients with grade III and IV histopathological findings, respectively, showed strong IGF-I and -II gene expression in their PBMC. We also studied the clinical course of 11 patients with IgAN during hospitalization. The IGF-I and -II mRNA levels in these patients decreased gradually, as did proteinuria, after treatment. These studies suggest that abnormal regulation of IGF-I and -II gene expression in PBMC may be associated with the progression of IgAN and may be useful as an indicator of disease activity.

ISSN:0250-8095    

DOI:10.1159/000168463

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

While recombinant human erythropoietin (rHuEPO) is an effective therapy for anemia in renal failure, most published studies concern benefits in relatively healthy hemodialysis patients. The present study compares intravenous and subcutaneous administration of rHuEPO in an unselected group of 128 hemodialysis patients who were randomized to receive rHuEPO in an initial dose of 150 U/kg/week in three divided doses by subcutaneous or intravenous injection. Following a 4-week placebo run-in period, patients received rHuEPO until their hemoglobin was stable between 105 and 125 g/l for 4 weeks and then followed for a further 24 weeks. Eighty-three patients completed the study, 45 in the subcutaneous and 38 in the intravenous group. There was no difference in mean hemoglobin at any stage between subcutaneous and intravenous patients. Mean rHuEPO dose at the time of stabilization was significantly lower in the subcutaneous group compared to the intravenous (205.9 ± 135.4 vs. 274.1 ± 142.4 U/kg/week; p = 0.019), mean time to hemoglobin target was 9.9 ± 4.5 weeks for the subcutaneous group and 11.9 ± 4.9 weeks for the intravenous group (p = 0.037). Time to stabilization was 14.9 ± 4.7 weeks for the subcutaneous compared to 17.3 ± 3.9 weeks for the intravenous group (p = 0.006). Diabetic patients had higher dose requirements for rHuEPO at all time points and required a longer time to reach stabilization than nondiabetics (18.6 ± 4.6 vs. 15.6 ± 4.3 weeks; p = 0.016). Quality of life estimated by a disease-specific Kidney Disease Questionnaire improved significantly during rHuEPO therapy in both groups. There was no significant change in dialysis prescription throughout the study. No significant changes were seen in the index of removal of urea and protein catabolic rate during the study in either group. Urea generation rate was significantly higher in the intravenous group at 24 weeks of follow-up. Serious adverse events were rare. Seizures occurred in 4.1 % of patients during the study. Episodes of significant hypertension occurred in 40 patients. Thrombotic events related to access and dialysis circuit occurred in 39% of subcutaneous patients and 48% of intravenous patients. Access failure occurred in 23.1 % of subcutaneous and 17.7% of intravenous patients. Access failure was more common in patients with grafts compared to arteriovenous fistulae (p = 0.002). In conclusion, rHuEPO therapy was associated with similar hematologic effects and quality of life benefits in this unselected patient population compared to more selected patients. The adverse event profile was also similar with access failure, particularly for implanted access, occurring more fequently during rHuEPO therapy. Subcutaneous administration appeared at least equivalent to intravenous administration of rHuEPO, and the lower induction dose and shorter induction period might confer some clinical advantages and redu

ISSN:0250-8095    

DOI:10.1159/000168464

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The effect of intravenous 1α-hydroxyvitamin D3 [1α(OH)D3] on circulating levels of intact parathyroid hormone (PTH 1-84) and COOH-terminal immunoreactive PTH (PTH 53-84) was examined in 13 patients on chronic hemodialysis. Thirteen patients were treated for 300 days (10 months), 9 patients for 520 days (14 months) and 6 patients for 720 days (2 years) with increasing doses of 1α(OH)D3 intravenously under careful control of plasma Ca2+. Blood samples were obtained 1 week before start of treatment and then at every 2nd week. None of the patients had previously been treated with oral vitamin D metabolites. Intact PTH levels were maximally suppressed after 27-33 weeks of treatment by approximately 73 %. At the end of the study periods, PTH 1-84 was still suppressed by 78 ± 4.3% after 300 days, 78 ± 8.8% after 520 days and 85 ± 6.5% after 720 days. Plasma Ca2+ was kept within normal levels, but showed an initial increase from 1.14 ± 0.03 to 1.27 ± 0.15 mmol/l, and an adjustment of the doses of lα(OH)D3 was necessary. The present investigation demonstrated (1) that intravenous administration of the 1-hydroxylated vitamin D metabolite lα(OH)D3 induced a significant decrease in circulating levels of biologically active intact PTH, and (2) that it was possible to maintain the marked suppression of PTH secretion by intravenous treatment of 1α(OH)D3 for up to 2 years. Hypercalcemia could be avoided by careful monitoring of plasma Ca2+ and adjustment of the doses of 1α(OH)D3.

ISSN:0250-8095    

DOI:10.1159/000168465

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

In order to evaluate the changes in causes and outcome of acute renal failure (ARF) during the years 1975-1989, 710 patients treated in our dialysis center were analyzed. We compared the etiology, the severity and catabolic state of ARF, the techniques of renal replacement therapy, which were employed and the ages and mortality rates of these patients, who received dialysis therapy during the years 1975-79 (n = 227), 1980-84 (n = 240) and 1985-89 (n = 243). The number of postoperative, posttraumatic and non-traumatic cases of ARF was approximately the same in all three 5-year periods, only the frequency of postrenal failure decreased from 7% in the years 1975-79 to 3% in the years 1985-89. The incidence of sepsis as a major cause of ARF and the most important risk factor was comparably high in the surgical and medical patients during all of the periods, but it increased in the traumatic patients from 7 % in the years 1975-79 to 28 % during the last 5-year period. The prevalence of respiratory failure and jaundice as additional organ failures, the severity of ARF (oligonanuric-nonoliguric) and the metabolic state were not different in the three patient groups. The magnitude of rise in serum creatinine before the start of renal replacement therapy was significant lower in the last 5-year period in comparison to the years 1975-79 (p < 0.05). Hemodialysis was the treatment in choice of 98 and 93 % of the cases during the first two periods, respectively. Since 1980, bicarbonate was employed in the dialysis instead of acetate in the most cases. In the years 1985-89, hemodialysis was only performed in 51 % of the patients, intermittent or continuous hemofiltration was used in 49%. The mortality of all the patients was reduced from 69% in the years 1975-79 to 54 and 48%, respectively, in the last two 5-year periods (p < 0.01), though the mean age of the patients has increased from 44 (9-84) to 57 (10-84) and 58 years (15-90), respectively. This improvement in outcome has been demonstrated in surgical and traumatic as well as nontraumatic and postrenal failure.

ISSN:0250-8095    

DOI:10.1159/000168466

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

In order to verify if, in essential hypertension (EH), the microalbuminuria (AER) increase could be due to hemodynamic modifications or to glomerular structural changes, in 15 essential hypertensives (EHs) with 24-hour AER > 16 µg/min and in 15 EHs with 24-hour AER ≤ 16 µg/min, the day- and nighttime behavior of creatinine clearance (Ccr), as well as AER clearance (AER-C) and fractional clearance (AER-FC), and behavior of blood pressure (BP) was evaluated. Patients with 24-hour AER > 16 µg/min showed significantly higher values of 24-hour and daytime Ccr than the other group of EHs, while during the night period, there were no significant differences between the two groups. On the contrary, AER and both AER-C and AER-FC resulted markedly and significantly higher in the EHs with 24-hour AER > 16 µg/min not only in the 24-hour evaluation, but also during the nighttime study, notwithstanding the significant decrease in BP and in Ccr observed during the night. These data, in the absence of correlations between BP and AER-FC seem to demonstrate the existence in EHs with 24-hour AER > 16 µg/min of an altered glomerular permselectivity, due to changes of the glomerular me

ISSN:0250-8095    

DOI:10.1159/000168467

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

These studies were designed to track the cutaneous deposition of beta2-micro-globulin (β2M) in patients on chronic hemodialysis, patients with chronic renal insufficiency and patients with successful renal transplants. Immunoperoxidase staining of skin biopsies from dialysis patients demonstrated significantly increased amounts of β2M compared to controls (p < 0.01). There was a strong positive correlation between the skin β2M content and the years of dialysis treatment. Renal transplant recipients had decreased skin content of β2M compared to hemodialysis patients. There was no difference in the skin β2M content in patients with chronic renal insufficiency not on hemodialysis and controls. No dialysis patient had amyloid in the skin by Congo red stain. We conclude that β2M accumulates in the skin of patients on chronic hemodialysis. This β2M is not in the form of amyloid. Successful renal transplantation allows for the removal of β2M from the skin indicating that β2M not in the form of amyloid can be mobilized from tiss

ISSN:0250-8095    

DOI:10.1159/000168468

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

This study was designed to determine the incidence, etiology and consequences of severe hypermagnesemia. We retrospectively reviewed all hospital admissions over a 5-year period from 1984 to 1989 and identified 8 cases of severe hypermagnesemia (serum Mg ≧ 6.0 mg/dl) due to magnesium ingestion. All but 1 patient were elderly (mean age 70 ± 6 years). The etiology when identified was due to magnesium-containing cathartics (n = 3) or antacids (n = 3). The total amount of magnesium ingested was not excessive, but bowel disorders that may have enhanced absorption (such as active ulcer disease, gastritis, colitis, perforated viscus, massive gastric dilatation) were present in 7 of the 8 patients. Unexpectedly, only 1 had preexisting renal failure. Renal function was found to be normal in 1, only mildly to moderately impaired in 5 (creatinine < 3.6 mg/dl) and severely impaired in 2 (creatinine 7.6, 15.7 mg/dl). Clinical sequelae of hypermagnesemia were hypotension (n = 7), bradycardia (n = 2), respiratory depression (n = 3), EKG abnormalities (n = 6), depressed mental status (n = 5). Hypocalcemia (range 5.7-7.4 mg/dl) more severe than could be attributed to either hypoalbuminemia or acute renal failure was present in 7. A low anion gap (range -2 to 9) was present in 5. Most striking was the fact that despite clinical sequelae, the hypermagnesemia was unsuspected in 6 of the 8 cases. Hypermagnesemia can occur without severe renal insufficiency in association with bowel disease, particularly in elderly individuals, and may be a clinically unrecognized cause of cardiovascular dysfunction, hypocalcemia and neurologic or respiratory depressi

ISSN:0250-8095    

DOI:10.1159/000168469

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We prospectively followed the course of eye disease in patients with diabetic end-stage nephropathy from the time of initial referral by the renal unit. A total of 31 patients (62 eyes) – 9 of whom had functioning renal transplants and 22 of whom were on maintenance dialysis – were consecutively evaluated for 6-24 months (mean follow-up of 18 months). Visual acuity and diabetic retinopathy stabilized or improved in all 18 eyes of the transplant patients and in 41 of 44 (93%) eyes of the dialysis patients. When first evaluated, economically useful vision (20/200 or better) was present in 11 of 18 (61 %) eyes in the transplant group and in 25 of 44 (57%) eyes in the dialysis group. At the most recent evaluation, economically useful vision was present in 13 of 18 eyes (72%) in the transplant group versus 28 of 44 eyes (64%) in the dialysis group. Ambulatory vision (counting fingers or better) was present in 15 of 18 eyes (83%) in the transplant group versus 37 of 44 eyes (84%) in the dialysis gr

ISSN:0250-8095    

DOI:10.1159/000168470

出版商:S. Karger AG    

年代:1992

数据来源: Karger