摘要:

125I-iothalamate and true endogenous creatinine clearances, measured over two short collections periods of 1 and 2 h, were compared simultaneously in 70 patients with a variety of renal diseases and a wide range of renal function. Reproducibility of the iothalamate clearance was 18.5 % and that of the creatinine clearance 12.2%. The slope of the regression was not significantly different from 1 (95% confidence interval, CI, 0.964-1.155) for the whole group, nor in any subgroup chosen. The intercept at 12.6 ml/min (CI = 5.0-20.2) indicates that there is some creatinine secretion, but this was constant at all levels of GFR. It is concluded that although the clearance of true creatinine obtained during short collection periods consistently overestimates GFR by a constant proportion, it is a reproducible and accurate measure of GFR suitable for use in the clinical setting.

ISSN:0250-8095    

DOI:10.1159/000168849

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Blood urea and serum creatinine levels are important factors in deciding when to start dialysis. Recently, in the assessment of dialysis adequacy, emphasis has shifted from reliance on these parameters to use of kinetic methods. We therefore applied urea kinetic modelling (UKM) to 63 consecutive chronic renal failure (CRF) patients at the time dialysis commenced and compared the results to those obtained after 6 months of dialysis treatment. Mean normalised urea clearance (daily KT/V) at the commencement of dialysis (KTi/V) was 0.15 ± 0.05, a level indicative of underdialysis in regularly dialysed patients. After 6 months, mean daily KT/V was 0.35 ± 0.12 in patients subsequently established on CAPD, and 0.49 ± 0.08 in those subsequently haemodialysed (both p < 0.001 compared to mean KTi/V). Serum creatinine levels on commencing dialysis were similar to those after 6 months treatment by either mode. Mean age (p < 0.01) and co-morbidity index (p < 0.05) were higher, and mean KTi/V lower (p < 0.05) in the 6 patients who died during a mean follow-up period of 10 ± 4.5 months than in survivors. Hospitalisation rates during follow-up (excluding admissions for access surgery and training) correlated with age (r = 0.332, p < 0.01), co-morbidity index (r = 0.351, p < 0.01) and KTi/V (r = -0.302, p < 0.05). Blood urea and serum creatinine levels on commencing dialysis were the same in those who died and in survivors and did not correlate with hospitalisation rates. Diabetics started dialysis with a similar mean KTi/V to non-diabetics but with a lower mean serum creatinine (p < 0.005). UKM may help to define the optimum time to start dialysis, especially in diabetics, and in many patients may result in earlier treatm

ISSN:0250-8095    

DOI:10.1159/000168850

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We measured the serum levels of soluble HLA class I antigen (sHLA-I) to evaluate the immune status of uremia and following renal transplantation. Twenty-one hemodialysis (HD) patients had serum samples collected for sHLA-I analysis before and after HD and also during the initial posttransplant period. The serum sHLA-I levels in patients undergoing HD were higher than in the normal controls (574.8 ± 431.1 vs. 415.6 ± 256.1 ng/ml, p 0.05). After successful renal transplantation, the serum sHLA-I levels decreased significantly (574.8 ± 431.1 vs. 226.7 ± 202.8 ng/ml, p = 0.0001) but increased significantly during the rejection period as compared to the prerejection period (642.8 ± 296.1 vs. 305.5 ± 194.7 ng/ml, p = 0.0002). In conclusion, sHLA-I levels are stable in uremic status and can be used as a parameter for monitoring acute graft rejection in renal transpla

ISSN:0250-8095    

DOI:10.1159/000168851

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) who developed carpal tunnel syndrome (CTS) were retrospectively studied in 143 centers in Japan. Among the total 5,050 patients undergoing CAPD between 1980 and 1993 only 7 patients (0.14%) given CAPD developed CTS. Five of these 7 patients treated solely with CAPD developed CTS 12-108 months after starting CAPD. The remaining 2 patients who were initially treated with HD for 7-9 years and then switched to CAPD developed this complication 9 years after starting CAPD. All 7 patients were women, ranging in age from 32 to 70 (average 52) years. We detected the presence of amyloid deposits in 2 of 5 specimens and β2-microglobulin in 2 of 4 specimens from these patients. It was concluded that CAPD minimizes the emergence of CTS although constant surveillance is necessary to detect CTS in patients during CAPD.

ISSN:0250-8095    

DOI:10.1159/000168852

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Mesangial cell migration is a feature of certain renal diseases such as mesan-giocapillary glomemlonephritis, a disorder which responds to treatment with cyclo-oxygenase inhibitors. We undertook the present study to determine whether prostaglandin E2 (PGE2) might have a direct effect on mesangial cell migration. PGE2 (10–8M) treated cells migrated a mean percent area of 16.8 ± 0.5 during 24 h when compared to control cells which migrated only a mean percent area of 10.3 ± 0.8 (p < 0.001). At 48 h, PGE2-treated cells migrated a mean percent area of 21.7 ± 1.1 when compared to control cells which migrated only a mean percent area of 14.7 ± 1.4 (p < 0.01). Meclofenamate (10-5M), a cyclo-oxygenase inhibitor, significantly (p < 0.02) inhibited migration of mesangial cells (at 48 h controls 13.4 ± 0.5 vs. meclofenamate-treated cells 3.2 ± 0.8). Since meclofenamate attenuates basal production of PGE2 by mesangial cells, inhibition of migration by mesangial cells by meclofenamate indicates that the basal production of PGE2 by mesangial cells also significantly contributes to the migration of mesangial cells. 3-Isobutyl-l-methylxanthine (IBMX, 10–3M), a phosphodiesterase inhibitor, also significantly (p < 0.001) enhanced migration of mesangial cells (controls 13.4 ± 0.5 vs. IBMX-treated cells 20.8 ± 0.5). These results suggest that mesangial cell migration is directly enhanced by PGE2. The present study provides a rationale for the use of cyclo-oxygenase therapy in patients with mesangiocapillary glomem

ISSN:0250-8095    

DOI:10.1159/000168853

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

This study examines whether there is a relationship between aluminum overload and the accumulation of lipofuscin products (aging pigments) and lipid peroxides in red blood cells (RBC) of hemodialyzed patients. Lipid peroxides levels were assessed by the thiobarbituric acid reactivity; lipofuscin products were assessed by determining fluorescence in the lipid extracts at excitation 360 nm and emission 440 nm. Aluminum was measured by atomic absorption spectrophotometry. Controls were age-matched normal volunteers. Data show that there was a significant increase in the lipid peroxides and lipofuscin products in hemodialyzed patients compared with controls even after normalization with hemoglobin or phospholipids in RBC. Further, the increase in the lipid peroxides and lipofuscin products significantly correlated with the levels of aluminum accumulation in RBC of hemodialyzed patients. This study suggests that aluminum overload has a role in increased membrane peroxidation, which in turn can cause reduced RBC life span and contribute to anemia in chronic renal failure patients.

ISSN:0250-8095    

DOI:10.1159/000168854

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

This study was performed to investigate the factors that influence intraperitoneal absorption of recombinant human erythropoietin (rHuEPO) and to evaluate the differences of the pharmacokinetics of intraperitoneally administered rHuEPO before peritonitis and after recovery. First, the pharmacokinetics in different groups of continuous ambulatory peritoneal dialysis (CAPD) patients was studied. Thirty-six CAPD patients were enrolled and divided into four groups. Group 1 included 20 patients who were either just placed on CAPD therapy or had been on CAPD for 55kg). Group 2, patients who had received CAPD treatment for more than 1 year, was further divided into group 2a and group 2b according to a low or a high frequency of peritonitis episodes, respectively. rHuEPO (100 U/kg) was administered as a single bolus of intravenous, subcutaneous, or intraperitoneal injection. Intraperitoneal rHuEPO was retained for 10 h. The results showed no significant differences between subcutaneous and intraperitoneal administration in group 1 patients. However, peak concentration, time to reach peak serum level, area under the curves, and bioavailability were substantially lower after intraperitoneal than after subcutaneous administration in group 2a and group 2b patients. There was no influence of body size on peak concentration and area under the curve in group 1 patients. Second, comparison of the pharmacokinetics of intraperitoneal administration before and after recovery from peritonitis in group 1 patients revealed that the serum levels of rHuEPO became lower after the occurrence of peritonitis. Third, with intraperitoneal administration of 100 U rHuEPO/kg three times a week for 6 months, only group 1 patients had a statistically significant increase in hemoglobin. These results indicate that the therapeutic effect of intraperitoneal or subcutaneous administration of rHuEPO is similar in patients just on CAPD therapy or on CAPD < 1 year but with a low peritonitis rate. CAPD treatment itself and peritonitis both can decrease the peritoneal absorption of rHuEPO.

ISSN:0250-8095    

DOI:10.1159/000168855

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Angiotensin-converting enzyme (ACE) inhibitor therapy has recently been shown to be effective in the treatment of post-renal transplant erythrocytosis (PTE). In an attempt to assess the effect of drug treatment on serum erythropoietin level, glomerular filtration rate, and urinary protein excretion, we prospectively evaluated 8 consecutive cadaveric renal transplant recipients with PTE treated with ACE inhibitor therapy for 3 months. In response to ACE inhibition, the mean hematocrit (HCT) value decreased from 53.7 ± 0.6% before treatment to 42.7 ± 2.2% at the conclusion of the study (p = 0.03). However, 1 patient failed to respond to ACE inhibition (HCT > 50%), and 2 patients with PTE developed anemia (HCT < 35%) while maintained on drug treatment. Although the mean serum erythropoietin level decreased during ACE inhibition (from 22.8 ± 8.4 to 9.4 ± 5.3 mU/ml; p = 0.06), a consistent change in individual erythropoietin levels was not identified. At the conclusion of the study, the serum erythropoietin levels were undetectable in 4 patients, decreased in 1 unchanged in 2, and increased in the only patient with PTE who failed to respond to drug treatment. All patients tolerated the ACE inhibitor therapy without developing cough or hyperkalemia. In addition, serum creatinine levels, 125I-iothalamate clearances, and mean arterial blood pressures were unchanged throughout the study. Microalbuminuria (spot urinary albumin/creatinine ratio between 30 and 200 mg/g) developed in 5 patients with PTE and coincided with the onset of erythrocytosis (25.2 ± 7 mg/g before PTE and 76.3 ± 36.7 mg/g at the time of PTE detection). At the conclusion of the study, the urinary albumin excretion had normalized in all 5 patients (17.3 ± 12 mg/g). Improvement in microalbuminuria occurred in the absence of significant changes in mean arterial blood pressure or glomerular filtration rate. In addition, neither microalbuminuria nor PTE recurred in the 2 anemic patients who required discontinuation of ACE inhibitor therapy. We conclude that (1) ACE inhibitor therapy is an effective treatment for PTE and is not associated with a significant alteration in 125I-iothalamate clearances over a 3-month period; (2) changes in erythropoietin levels are not solely responsible for the improvement in HCT seen in our patients during treatment with an ACE inhibitor; (3) PTE is associated with the development of microalbuminuria, and (4) ACE inhibitor therapy significantly reduces PTE-associated microalbuminuria.

ISSN:0250-8095    

DOI:10.1159/000168856

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

A dialysis arteriovenous fistula caused life-threatening high-output cardiac failure in a 66-year-old patient. Excessive shunting through the dialysis fistula was demonstrated by invasive measurement of cardiac output, systemic arterial blood pressure, systemic vascular resistance, and oxygen consumption before and after temporary occlusion of the dialysis fistula. Noninvasive echo-cardiographic evaluation of the influence of fistula compression on cardiac output and noninvasive duplex measurement of the fistula flow also confirmed the diagnosis. Following surgical closure of the fistula, the patient’s condition improved, and signs of congestive heart failure subsided. High-output cardiac failure is a rare complication of dialysis arteriovenous fistulas. The diagnosis may remain unrecognized for longer periods. Noninvasive methods for estimation of the hemodynamic importance of a fistula may be of help in the establishment of the proper diagnosi

ISSN:0250-8095    

DOI:10.1159/000168857

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Flucytosine is effective in the treatment of serious fungal infections. Some of the patients might have acute renal failure requiring continuous hemofiltration as renal replacement therapy. We evaluated the removal of flucytosine in a patient who received the drug for systemic Candida infection while undergoing continuous hemofiltration for acute renal failure. Arterial, venous, and ultrafiltrate sample pairs were collected to evaluate flucytosine removal. Ultrafiltrate/arterial drug concentration ratios and sieving coefficients obtained with the polysulfone membrane were higher than those obtained with the polyacrylonitrile membrane. Between 2.54 and 22.56 mg of flucytosine was removed from the patient per hour when the serum drug concentrations were 21.1-126.5 mg/l. The amount of hemofiltration flucytosine removal was related to ultrafiltration flow rate, serum drug concentration, and hemofilter type. The mean continuous arteriovenous hemofiltration flucytosine clearance for the polysulfone membrane was 77.0 ± (SD) 15.6% of the ultrafiltrate flow rate, while the clearance for the polyacrylonitrile membrane was 51.0 ± (SD) 5.7%. In patients with renal failure, continuous hemofiltration can remove an appreciable quantity of flucytosine when the ultrafiltrate flow rate is high. Serum drug concentration determination is necessary to devise an optimal dosage regimen for the patien

ISSN:0250-8095    

DOI:10.1159/000168858

出版商:S. Karger AG    

年代:1995

数据来源: Karger