ISSN:0250-8095    

DOI:10.1159/000167962

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

The progression of renal failure on 2 different protein and phosphate diets was evaluated in 7 patients with chronic renal failure. We decided on three study periods for each patient: period A (low-protein diet: 0.6 g/kg of protein, 600 mg of phosphate) averaged 12 months; period B (normal protein diet: 0.9 g/kg of protein, 800 mg of phosphate) lasted 9 months; period C (low-protein diet as for period A) averaged 9 months. The slopes of 1/Scr were 0.003 (period A), -0.016 (period B) and 0.009 dl/mg/month (period C). The GFR (125I-iothalamate clearance) changed from 42.6 to 45.6 ml/min/1.73 m2 in period A, from 51.9 to 40.7 in period B and from 40.5 to 44.6 in period C. The results show changes in renal function when dietary protein and phosphate intakes exceeding 0.6 g/kg and 600 mg/day, respectively, are administered to patients with GFRs ranging from 24 to 66 ml/min.

ISSN:0250-8095    

DOI:10.1159/000167963

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

We studied 21 dialysis patients who became hypercalcemic without vitamin D or calcium therapy and compared them to 28 dialysis patients who were not hypercalcemic. In the hypercalcemic group, the mean ionized-calcium level was elevated compared to normal subjects (5.4 ± 0.4 vs. 4.9 ± 0.1; p < 0.001), while the ionized-calcium level in the control dialysis patients was below normal (4.5 ± 0.4 vs. 4.9 ± 0.1; p < 0.001). Bone biopsies were performed in all patients. Two thirds of the hypercalcemic patients had low-turnover osteodystrophy (LTO, predominantly osteomalacia), a fraction significantly higher than in the control dialysis patients (13/21 vs. 8/28, respectively; p < 0.05). The hypercalcemic patients with LTO had markedly elevated surface bone aluminum (63 ± 24% of all trabecular surfaces). In contrast, the nonhypercalcemic dialysis patients with LTO and all patients with osteitis fibrosa had minimal surface bone aluminum. Hypercalcemic patients with osteitis fibrosa had a significantly lower mean N-terminal parathyroid hormone (PTH) value than did nonhypercalcemic patients with osteitis fibrosa (149 ± 81 vs. 278 ± 135 pg/ml, respectively; p < 0.005). Both mean values were markedly elevated in comparison with those obtained in normal subjects (16 ± 5 pg/ml). In contrast, patients with LTO, irrespective of the calcium level, had mean PTH values that were not significantly different from those of normal subjects. A PTH level greater than 100 pg/ml was 95% sensitive and 87% specific for osteitis fibrosa, as demonstrated by histomorphometry in nonhypercalcemic dialysis patients. However, this level was only 62% sensitive and 77% specific for a diagnosis of osteitis fibrosa in hypercalcemic dialysis patients. The hypercalcemic patients had an increased mortality at 1 year of follow-up compared to control dialysis patients, after controlling for the difference in age. Mortality at 1 year was 38% in those hypercalcemic patients who were more than 50 years of age. The majority of the deaths occurred in hypercalcemic patients with aluminum-related bone disease. In addition, this group of patients had the greatest disability.In summary, we found that hypercalcemic patients had increased disability and mortality and that aluminum-related bone disease was more common in this group of patients than was osteitis fibrosa. The N-terminal PTH level was not helpful in the differential diagnosis of the type of bone disease present in those patients who were hyperc

ISSN:0250-8095    

DOI:10.1159/000167964

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Thirty-eight peritoneal biopsies from 37 patients with normal renal function or with end-stage renal failure without replacement therapy or utilizing continuous ambulatory peritoneal dialysis (CAPD), haemodialysis (HD) or a functioning transplant were examined histologically. No abnormality in peritoneal membrane morphology was observed in uraemia in the absence of dialysis. Significant abnormalities of peritoneal membrane morphology were observed in association with CAPD, the predominant finding being the development of peritoneal fibrosis which had a deleterious effect on membrane function. Abnormal peritoneal morphology was less commonly observed in patients on maintenance HD and with functioning transplants but may have implications regarding the future use of CAPD in these patients.

ISSN:0250-8095    

DOI:10.1159/000167965

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Six patients with progressive chronic renal failure not yet requiring dialysis and not consuming supplemental calcium or vitamin D developed hypercalcemia. Three had proven and 1 suspected tertiary hyperparathyroidism, 1 parathyroid carcinoma and 1 aplastic bone. None of the 3 patients who underwent bone biopsy had heavy bone aluminum staining. The patients with proven parathyroid-mediated hypercalcemia had marked elevation of C-terminal parathyroid hormone and alkaline phosphatase values and, when performed, radiographs consistent with osteitis fibrosa. When these findings are absent or the diagnosis is otherwise uncertain, a bone biopsy may provide a definitive diagnosis and guide management.

ISSN:0250-8095    

DOI:10.1159/000167966

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

We assessed blood volume (BV) in 20 edematous patients with nephrotic syndrome and in 32 subjects without renal or other disease liable to induce BV variation. Two methods were chosen, one using 131I-albumin and the other 51Cr red blood cells. Among the 20 patients, 11 presented minimal-change lesions, and 9 had histological glomerular impairment. The BV was significantly higher when measured with 131I-albumin in both nephrotic patients and in controls. However, in patients with nephrotic syndrome, the values obtained from the measurement of BV by 131I-albumin showed an increase of only 1 %. Comparison of BV values of nephrotic patients and controls showed that BV is equal or higher in two thirds and lower in one third, respectively. The same incidence of histological glomerular lesions was observed in both groups. In conclusion, this study demonstrates that the method using l31I-albumin to measure BV in nephrotic syndrome is reliable. BV is decreased in one third of the patients and is not related to the presence or absence of histological glomerular lesions.

ISSN:0250-8095    

DOI:10.1159/000167967

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

To investigate possible abnormalities of the hypothalamic-pituitary axis in patients with chronic renal failure on dialysis, we have examined the effects of insulin-induced hypoglycemia on the adrenal steroid responses. In normal subjects, plasma aldosterone and Cortisol concentrations increase significantly in response to hypoglycemia, with good correlation. In the patients with end-stage renal disease (ESRD) however, insulin-induced hypoglycemia fails to elicit significant increases in the plasma Cortisol and aldosterone levels. To test the adrenal responsiveness to adrenocorticotropin (ACTH), we administered ACTH to both groups. Plasma Cortisol and aldosterone responses are similar in both groups suggesting that the adrenal responsiveness to ACTH is not impaired. We also investigated the responsiveness of the renin-angiotensin-aldosterone system in response to volume contraction by hemofiltration in patients with ESRD. Neither plasma renin activity nor plasma aldosterone concentration change significantly following such contrived volume contraction. These results reveal several endocrinologic abnormalities in the patients with ESRD on chronic hemodialysis.

ISSN:0250-8095    

DOI:10.1159/000167968

出版商:S. Karger AG    

年代:1989

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000167969

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

A 57-year-old male with mild impairment of renal function secondary to diabetic glomerulosclerosis developed acute renal failure (creatinine 32.4 mg/dl) associated with a generalized desquamative skin rash and peripheral eosinophilia shortly after initiation of antihypertensive therapy with captopril. An acute interstitial nephritis was demonstrated on renal biopsy, and improvement was temporally related to initiation of therapy with prednisone. A review of the literature revealed 5 similar cases in whom acute deterioration of renal function occurred following initiation of captopril and in whom there were features of a hypersensitivity reaction, including skin rash, fever, eosinophilia, azotemia, eosinophiluria, and a Coombs-positive hemolytic anemia. Renal biopsy, where available, revealed an acute interstitial nephritis. Observations from these cases suggest that, of the angiotensin-converting enzyme inhibitors, this syndrome appears to be specific for captopril, begins within the 1 st month of therapy, is not dose-dependent, and generally resolves on cessation of therapy. Steroids may hasten recovery, but sufficient data are not available to confirm their efficacy.

ISSN:0250-8095    

DOI:10.1159/000167970

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

We report two cases of acute interstitial nephritis associated with Yersinia pseudotuberculosis infection. The patients had fever, abdominal pain, vomiting and acute renal failure coinciding with elevated agglutination antibody titer for Y. pseudotuberculosis. Renal biopsy revealed interstitial nephritis in both patients. Although it is well known that yersiniosis sometimes affects glomeruli, this is the first report to demonstrate acute interstitial nephritis in patients with Y. pseudotuberculosis infection.

ISSN:0250-8095    

DOI:10.1159/000167971

出版商:S. Karger AG    

年代:1989

数据来源: Karger