摘要:

The present comparative evaluation aims at establishing whether the basic structure of dialysis membrane is able to predict long-term clinical outcome. From a population of 1,256 patients on renal dialysis treatment, treated by the Institute of Nephrology and Dialysis of the St. Orsola University Hospital of Bologna from 1963 to 1993, 122 patients were retrospectively selected for the present study. Patients were divided into two different groups according to the kind of dialysis membrane used – cellulose-based (64 patients) and synthetic-based (58 patients) membranes. The parameters considered were: intradialytic biology, long-term biocompatibility, survival and morbidity, and cost/benefit. The results obtained demonstrate that cellulosic membranes can be said to cause a greater acute intradialytic biological response than synthetics, though not to a significant degree. There are, however, no significant differences in the biological changes from group to group. Nonsignificant differences were noted in long-term survival general morbidity. In terms of sheer cost, synthetic membrane treatment is anything up to 200% dearer than cellulosi

ISSN:0250-8095    

DOI:10.1159/000168886

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Furancarboxylic acid (3-carboxy-4-methyl-5-propyl-2-furanpropionic acid, CMPF), an inhibitor of erythropoiesis, cannot be removed by conventional hemodialysis due to its strong albumin binding, resulting in its accumulation in uremic serum. We used protein-leaking hemodialysis with BK-F dialyzers in 8 uremic patients for 4 months to determine its effect on the serum levels of CMPF. Pre-hemodialysis serum levels of CMPF significantly decreased to about 50% after 4 months by protein-leaking hemodialysis, while those of BUN and serum creatinine did not change significantly. Pre-hemodialysis hematocrit and hemoglobin levels significantly increased by protein-leaking hemodialysis. These results indicate that protein-leaking hemodialysis reduces serum levels of albumin-bound CMPF and improves anemia.

ISSN:0250-8095    

DOI:10.1159/000168887

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Serum CA-12 5 an ovarian tumor marker, is used to screen and follow up patients with ovarian cancer. Normal values ( < 35 U/ml) have been reported in patients with end-stage renal disease and patients maintained on chronic hemodialysis (HD). Non-malignant ascites has been associated with high serum levels of CA-125, suggesting that the presence of fluid in the peritoneal cavity may stimulate its release. We studied 38 HD and 43 chronic ambulatory peritoneal dialysis (CAPD) patients with regard to serum CA-125 levels. In the HD patients, the mean ± SE serum CA-125 level was 10.1 ± 1.7 U/ml (range 35 U/ml. In the CAPD patients, the mean serum CA-125 level in all samples collected (n = 68) was 17.7 ± 2.7 U/ml (range < 5-101, p 35 U/ml. The high serum CA-125 levels in the CAPD patients were from sera obtained within 2 months of diagnosis of peritonitis, peritoneal dialysis (PD) catheter implantation, or intra-abdominal surgery. When serum samples from this 2-month period were excluded, the mean serum CA-125 level was 8.9 ± 1.5 U/ml (p = NS vs. HD) and only 1 patient had an abnormal level. Peritoneal dialysate CA-125 levels during an episode of peritonitis were significantly higher than at the baseline (69.1 ± 14.2 vs. 21 ± 2.5, p = 0.004) and both were significantly higher than the serum levels (p < 0.0001). Serum CA-125 levels were also the same in both sexes and races. In conclusion, it was found that while the serum CA-125 level is within normal limits in the majority of HD and stable CAPD patients, it is not uncommon that it is elevated in CAPD patients within 2 months of peritonitis, PD catheter placement, or intra-abdominal surgery, particularly when peritoneal exchanges are temporarily on hold in the latter two. The serum CA-125 level should be interpreted with caution in the CAPD patients as it may be a non-specific marker of peritoneal irritation. It was also found that there was a significant removal of CA-125 by the peritoneal fluid which markedly increased during episodes of perito

ISSN:0250-8095    

DOI:10.1159/000168888

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

To assess the prevalence, risk factors, clinical causes and outcome of acute renal failure (ARF) following bone marrow transplantation (BMT), a retrospective analysis of 275 patients was undertaken. ARF was diagnosed in 72 patients (26%) and occurred in 81.9% within the first month. The three main clinical causes were multifactorial (36%), nephrotoxic (29%), and veno-occlusive disease of the liver (VOD) 15%. The prevalence was higher in allogeneic BMT (36%) than in autologous BMT (6.5%). Risk factors related to the development of ARF were preexisting VOD and age older than 25 years. Logistic regression in allogeneic BMT confirmed this association (VOD, odds ratio 3.8; age ofer than 25, odds ratio 1.9). Underlying disease, graft-versus-host disease, sepsis, conditioning therapy, and sex were not associated with ARF. Seventeen cases of ARF required hemodialysis (24%) mainly in association with VOD (70.5%). The overall mortality from ARF was 45.8%, the dialyzed group having the highest mortality (88%). Survival in the ARF group was continuously worse up to 3 months and the actuarial survival at 10 years was 29.7 versus 53.2%. We conclude that ARF is a common complication mainly in allogeneic BMT and carries a grave prognosis. VOD and age were risk factors for ARF.

ISSN:0250-8095    

DOI:10.1159/000168889

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Overestimation of creatinine measurement using the Jaffé kinetic method in peritoneal dialysis solutions, due to glucose interference, has been quantified and corrected through the elaboration of linear formulas obtained from 110 recovery and 301 biological tests. The added pure powdered creatinine and enzymatic method were considered as references after proven accuracy. Considering creatinine as well as glucose concentration interference, we obtained correction formulas from multiple regression application. All the computed formulas gave satisfactory corrections but different accuracy levels. The best model in biological samples was: Corrected CR = K1JafféCr + K2Glucose (all values in mg/dl) where K1 = 0.973 and K2 = -0.00035 (Rsq = 0.987, F ratio = 10,945, p = 0.00001). Applying formulas to biological samples there was a drop in accuracy, possibly explained by the presence of numerous unidentified substances in peritoneal dialysis biological samples that can amplify scatter. Every laboratory can reduce the error of the Jaffé kinetic assay by calculating their own correction formula in relation to the method and instrument used, because Jaffé kinetic assay gives different results with different kinetic windows. So, especially when applied to peritoneal dialysis fluid measurements, if a creatinine assay reference method is not available, the correction formula can be applied directly as given. Otherwise the method we have described can be followed with a well-structured creatinine recovery fest to identify and quantify assay interferen

ISSN:0250-8095    

DOI:10.1159/000168890

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Fifty-four patients with noninsulin-dependent diabetes mellitus, who had established nephropathy, were examined to evaluate the risk factors for the progression of diabetic nephropathy. Time-averaged values of blood pressure, serum total cholesterol and fasting plasma glucose concentrations, and the degree of proteinuria during their follow-up period (4.2 ± 0.5 years) were calculated. The correlation between these values and the slope of the regression line for the reciprocal of serum creatinine concentration over time, as an index of the speed of the progression of nephropathy, was examined. Age (61 ± 1 years), mean arterial pressure (109 ± 1 mm Hg), and the degree of the proteinureia (2.1 ± 0.1 in dipstick test) were correlated with the slope. Effects of hypercholesterolemia and smoking on the slope were also examined. Mean arterial pressure was correlated with the slope significantly in patients without hypercholesterolemia (p < 0.05) and there was a tendency bewteen these two in smokers (p < 0.06), while was no correlation found in patients with hypercholesterolemia or in nonsmokers. In addition, the relation between the slope and mean arterial pressure was relatively stronger in smokers without hypercholesterolemia than in nonsmokers with hypercholesterolemia. Our data suggest that blood pressure control as well as smoking avoidance may be important in preventing the progression of noninsulin-dependent diabetic nephropa

ISSN:0250-8095    

DOI:10.1159/000168891

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

In this work, 100 living related donor kidney transplant recipients under cyclosporin (CsA) therapy were randomly distributed to two groups. Group 1 were administered ketoconazole, with group 2 serving as the control. Ketoconazole was given orally, 100 mg/day, while the dose of CsA was adjusted for a CsA whole blood trough level of 100-150 ng/ml. Patients and controls were assessed regularly in an outpatient clinic for 12 months and compared statistically for CsA dose, graft and liver functions, cholesterol, blood sugar, CsA nephrotoxicity, acute rejection episodes, chronic rejection and fungal skin infections. Statistical analysis showed a significant reduction in the CsA dose in the ketoconazole-treated group (73-76%), along with significantly lower alanine aminotransferase, aspartate aminotransferase, bilirubin, and serum creatinine values. CsA chronic nephrotoxicity and chronic rejections were also significantly lower in the ketoconazole-treated group, as was fungal skin infection (6.6 vs 63.2%). From this study, we conclude that addition of a low dose of ketoconazole to CsA-treated kidney transplant recipients not only saves costs, but may also have a favorable effect on graft function, chronic CsA nephrotoxicity, chronic rejection and fungal skin infection.

ISSN:0250-8095    

DOI:10.1159/000168892

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Among the symptoms of systemic vasculitis, purulent rhinorrhea with painful sinusitis is thought to be relatively specific to Wegener’s granulomatosis (WG). Sixteen patients with rapidly progressive glomerulonephritis (GN), arteritis and extensive crescents in renal biopsy were studied by head indium-111 (111In)-granulocyte scanning. They included 8 WG, 5 microscopic polyarteritis, 2 necrotizing and crescentic GN and 1 classic polyarthritis nodosa. Autologous granulocytes labeled with 12.3 MBq of 111In-oxine were administered intravenously. Scintigraphic studies were performed at 4 and 24 h post-injection. Compared to the non-WG cases, considered as a whole, significant accumulation of tracer in sinuses was observed in WG patients (Fisher’s p = 0.02). Substantial scintigraphic amelioration was obtained in a WG case treated with methylprednisolone pulses and, in another WG case, after high doses of intravenous γ-globulins. The complete disappearance of facial uptake was obtained after 2 months of intensive therapy (i.e., steroid, cyclophosphamide and plasma exchange) in another WG patient. 111In-oxine granulocyte imaging may be useful in clinical practice as an additional marker of disease activity and a tool of identification of upper respiratory tract involve

ISSN:0250-8095    

DOI:10.1159/000168894

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Secondary hyperparathyroidism in patients with end-stage renal disease is characterised by elevated circulating levels of parathyroid hormone, due to inadequate synthesis of calcitriol, the active metabolite of vitamin D. Recent studies suggest that administration of calctriol may directly suppress parathyroid (PTH) secretion independent of changes in serum calcium. We have studied the effect of intravenous calcitriol administration on the PTH level in 14 patients on maintenance haemodialysis with serum PTH levels above 2,000 pmol/l over a 16-week period. There was a significant reduction in the PTH level (65%) and a rise of serum calcium to the normal range. There was a significant reduction in serum PTH levels before the serum calcium concentrations increased, suggesting that calcitriol directly inhibits PTH release. In conclusion, intravenous treatment with calcitriol is of clinical importance, because it suppresses hypersecretion of PTH in uraemic patients, with minimal side effects.

ISSN:0250-8095    

DOI:10.1159/000168896

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000168897

出版商:S. Karger AG    

年代:1995

数据来源: Karger