摘要:

To determine whether interleukin 8 (IL-8) can be used as an index of biocompatibility of dialysis membranes, the effects of hemodialysis (HD) on plasma IL-8 levels and the expression of IL-8 mRNA in peripheral blood mononuclear cell (PBMC) were compared among regenerated cellulose (RC), polyacrylonitrile (PAN) and polymethylmethacrylate (PMMA) dialyzers. HD using RC dialyzers significantly increased plasma IL-8 levels and induced abundant expression of IL-8 mRNA in PBMC. HD using PMMA dialyzers also increased plasma IL-8 levels and induced slight expression of IL-8 mRNA. In contrast, HD using PAN dialyzers neither increased plasma IL-8 levels nor induced the expression of IL-8 mRNA. In vitro studies demonstrated that IL-8 was considerably adsorbed by PAN membranes and not at all by RC and PMMA. These studies indicate that plasma IL-8 level and expression of PBMC IL-8 mRNA can be used as indices of biocompatibility of dialysis membranes.

ISSN:0250-8095    

DOI:10.1159/000168847

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Patients with lupus nephritis frequently exhibit increasing proteinuria, hypertension and deterioration of renal function due to either active lupus nephritis, chronic lupus nephritis and/or superimposed preeclampsia during pregnancy. Percutaneous renal biopsies were therefore performed in 3 women with systemic lupus erythematosus during pregnancy and immediately postpartum in a fourth woman to evaluate their renal disease during pregnancy. Mean serum creatinine at renal biopsy was 2.9 mg/dl, with a mean creatinine clearance of 66 ml/min and protein excretion of 5.3 g/day. All patients had grade IV lupus nephritis and received pulse methylprednisolone immediately; 3 received cyclophosphamide. All 3 patients with crescent formation developed end-stage renal disease within 3 years. The fourth patient has normal renal function 3 years after biopsy. Percutaneous renal biopsies during pregnancy in women with lupus nephritis provide an accurate histopathologic diagnosis and are important in providing appropriate therapy, counseling and prognosis.

ISSN:0250-8095    

DOI:10.1159/000168848

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

There is still debate about whether continuous renal replacement therapy is superior to intermittent hemodialysis (IHD) as dialytic support for the critically ill patient with acute renal failure, mainly because of lack of comparative data. We sought to address this issue by reviewing the medical records of such patients admitted to a single surgical intensive care unit treated with either continuous arteriovenous hemodiafiltration (CAVHD) or IHD between January 1, 1986, and August 31, 1993. Of 94 consecutive patients who received dialytic support for severe acute renal failure, 34 (36%) patients were treated with IHD and 60 (64%) patients with CAVHD. The patients were comparable in terms of age or gender and represented a similar case mix. Patients treated with CAVHD were more severely ill as manifested by a lower mean arterial pressure (75 ± 3 vs. 86 ± 5 mm Hg; p < 0.05), higher Apache II score (26.5 ± 0.5 vs. 22.2 ± 0.3; p < 0.05), and a higher number of organ system failures (3.4 ± 0.2 vs. 2.6 ± 0.3; p < 0.05). Despite greater illness severity and a higher probability of death (55 ± 2.6 vs. 33 ± 2.5%; p < 0.0001), in those treated with CAVHD, no difference in outcome was observed between groups: CAVHD 26/60 (43%) vs. IHD 20/34 (59%; NS). The mean Apache II score of patients treated with CAVHD who survived was similar to that of patients treated with IHD who died (24.5 ± 0.3 vs. 24.2 ± 0.4; NS). CAVHD was associated with improved hemodynamic stability, better control of fluid balance and biochemistry, increased nutritional intake, and a shorter duration of acute renal failure (p < 0.05). Our data suggest that CAVHD offers several distinct advantages over IHD which may translate in improved survival, particularly in the more severely ill

ISSN:0250-8095    

DOI:10.1159/000168832

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Previous reports have suggested a relationship between changes in indirect immunofluorescence antineutrophil cytoplasm autoantibody (ANCA) titres and disease activity in patients with Wegener’s granulomatosis (WG). We analyzed retrospectively the data from 37 patients with biopsy-proven WG during a median follow-up period of 34 (range 8-60) months, during which 532 serial ANCA measurements had been made. A fourfold increase in ANCA titre and/ or a positive titre following a series of negative results occurred on 82 occasions, only 19 (23%) associated with clinical relapse, 25 (31%) with intercurrent infection, and 32 (38%) when patients were considered clinically well. The sensitivity of a significant increase in ANCA titre associated with clinical relapse was 43%, with a positive predictive accuracy of 23%. The combination of an increased C-reactive protein-plasma viscosity and a significant increase in ANCA titre occurred on 37 occasions, 15 (40%) with relapse and 17 (46%) with infection. The results of this study suggest that patients with WG who have significant increases in ANCA titres should be carefully monitored. Increased immunosuppression based solely on increased ANCA titres is not justified, as if this had been practiced in this study, then a large number of patients who had infective episodes would have received additional immunosuppression from which they may not have benefite

ISSN:0250-8095    

DOI:10.1159/000168833

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

It is unknown whether predialysis serum biochemical parameters may differ among chronic hemodialysis patients depending on the shift during which they are dialyzed. We studied 115 patients on chronic hemodialysis in our institution for 3 consecutive months and compared clinical and biochemical parameters based on the shift during which they were dialyzed. Predialysis serum potassium was found to be progressively higher for patients dialyzed on later as compared with earlier dialysis shifts, and phosphate was significantly higher for patients dialyzed during the evening shift as well. Regression analysis suggested that higher potassium and phosphate levels were related to the time of day of these sessions and not to patient age, amount of dialysis given or diet. By contrast, serum albumin, creatinine, sodium, and chloride levels were found to differ depending on dialysis shift, though these differences appeared to be accounted for by patient age. We conclude that the time of day of the beginning of the dialysis shift appears to mildly influence the levels of serum predialysis biochemical parameters which are important in monitoring patients on chronic hemodialysis, in particular potassium and phosphate. Further insight into the mechanism of this observed effect might improve our ability to interpret and treat derangements of these serum biochemical parameters in patients on chronic hemodialysis.

ISSN:0250-8095    

DOI:10.1159/000168834

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Human immunodeficiency virus associated nephropathy (Hivan) is a distinct renal disease described in patients infected with the human immunodeficiency virus (HIV). Hivan is characterized by a nephrotic syndrome, enlarged kidneys, a histologic finding of focal and segmental glomerulosclerosis, and a very rapid progression to end-stage renal disease (ESRD). No therapeutic intervention has been shown, in a prospective evaluation, to either alter the course of established Hivan or to influence the emergence of Hivan in HIV-infected patients. We conducted a prospective study on 23 consecutively selected patients seen between 1989 and 1992 who were infected with the HIV, 14 (61%) of whom had significant proteinuria ( > 2+). Percutaneous kidney biopsy was performed in 5 (36%) of the 14 subjects who had significant proteinuria, and histologic examination of the kidney tissue revealed focal and segmental glomerulosclerosis in all 5 cases. Of the 14 subjects with proteinuria, 8 (57%) also had azotemia (serum creatinine level > 1.3 mg/dl). Nine (39%) of 23 subjects admitted intravenous drug use, while 9 (39%) of 23 subjects have had an opportunistic infection before enrollment in the study. The known duration of HIV infection before initiation of zidovudine therapy was 10.3 ± (SD) 8 months. The mean CD4 count before zidovudine therapy was 195.9 ± 117 (range 21-654) cells/mm3. The mean dose of zidovudine administered was 543 ± 117 (range 400-800) mg daily for a period of 20.4 ± 11 (range 6-38) months. The clinical course of renal disease in the study subjects was compared to that of a control cohort of 28 HIV-infected patients with the nephrotic syndrome, presenting in ESRD for initiation of renal replacement therapy during the study period, who had never been treated with zidovudine or any other antiretroviral drug. Of 28 control patients, 14 (50%) admitted intravenous drug use; the known duration of HIV infection before onset of ESRD was 14.6 ± 8.6 months. These 28 control patients had been seen at an outpatient facility between 1989 and 1992 for anasarca and proteinuria without azotemia. The mean serum creatinine concentration of the 23 study subjects before zidovudine therapy was 1.2 ± 0.4 (range 0.8-2.1) mg/dl. By contrast, 8 (35%) of 23 subjects who stopped zidovudine due to noncompliance progressed to ESRD within a mean of 8 ± 2 (range 4-12) weeks, and each was begun on renal replacement therapy. Of these 8 patients, 2 died 10 and 12 weeks, respectively, after initiation of maintenance hemodialysis. These 8 patients had been on zidovudine therapy for a mean of 9 ± 3 months before discontinuing the drug. Reinstituted zidovudine therapy had no obvious effect on their renal function. None of the 15 zidovudine-compliant subjects developed ESRD or worsening azotemia. The mean serum creatinine concentration at the end of the study period was 0.93 ± 0.2 mg/dl. All patients initially free of proteinuria remained so. In the control patients, the interval from presentation with anasarca and proteinuria to onset of ESRD was 5.9 ± 2.3 months. None of the control group were on any medication known to cause renal failure. Fourteen (50%) of 28 control patients died within 10 months after initiation of hemodialysis at a mean time of 3.8 ± 2.1 months. We conclude that zidovudine is beneficial in HIV-associated nephropathy, and that discontinuing zidovudine treatment in HIV-infected patients with nephropathy may result in irreversible and accelerated loss of rena

ISSN:0250-8095    

DOI:10.1159/000168835

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Although atrial natriuretic peptide (ANP) levels are often elevated in low-renin hypertensives, the renal and hormonal effects of ANP infusion have never been evaluated in these patients. To address this topic, 27 lean nondiabetic men affected by uncomplicated essential hypertension were studied. Low-renin patients (n = 9, age 42 ± 3 years) were defined as those individuals in balance on a low NaCl intake (10 mmol NaCl/day for 1 week) who had a plasma renin activity < 0.30 ng angiotensin I/l/s, in both the supine and the upright positions. The remaining hypertensives (n = 18, age 41 ± 4 years) were classified into the normal-renin group. Six age-matched healthy men (age 40 ± 2 years) served as controls. After plasma renin activity determinations, both patients and controls were replaced on a normal NaCl intake (120 mmol NaCl/day). After 1 week, either ANP (99-126), at a dose (0.7 pmol/kg/min for 3 h) which is known to induce changes in plasma ANP confined to the range of normality, or its vehicle were infused at 1-week intervals, according to a randomized double-blind crossover design. At time 0, low-renin patients had significantly higher (p < 0.05) levels of plasma ANP (12.4 ± 2.5 fmol/ml) than normal-renin patients (7.2 ± 2.4 fmol/ml) and normotensives (7.4 ± 3.3 fmol/ml). The ANP-related aldosterone decrement was more rapid (p < 0.05 at 30 min) and evident in low-renin patients (from 325.3 ± 12.3 pmol/l at time 0 to 207.7 ± 8.3 at 180 min; p < 0.001) than in normal-renin patients (from 352.6 ± 4.5 pmol/l at time 0 to 282.6 ± 11.3 at 180 min; p < 0.01) and control subjects (from 300.5 ± 10.3 pmol/l to 270.6 ± 12.8 at 180 min; p < 0.05). As compared with placebo, ANP significantly increased renal sodium excretion in all groups, but low-renin patients had a greater ANP-induced increase in natriuresis (p < 0.05 at 120 min) than normal-renin hypertensives (NS) and control subjects (NS). The glomemlar filtration rate increased during ANP infusion in low-renin patients (p < 0.05 at 60 min), while no significant changes were observed in normal-renin hypertensives and normotensives. In conclusion, at variance with other conditions, such as cardiac failure and liver cirrhosis, in hypertensive patients the presence of increased levels of plasma ANP does not imply a reduction in the renal and endocrine responses to A

ISSN:0250-8095    

DOI:10.1159/000168836

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

A prospective study with 65 maintenance hemodialysis (MHD) patients on recombinant human erythropoietin (rHuEPO) therapy was conducted to assess the effect of iron balance on responsiveness. An attempt to define the predictors of erythropoietin (EPO) response and identify the specific causes of EPO resistance was undertaken in the present study. The treatment protocol consisted of two stages, the first was rHuEPO therapy for 6 months and the second was iron supplementation plus rHuEPO therapy in patients without response to EPO for the next 6 months. According to the hemoglobin (Hb) changes (increment exceeded 30% of baseline or did not exceed 15% of baseline for 3 consecutive months) and whether or not there was an achievement of target Hb level ( > 10.5 g/dl), all patients (n = 65) were divided into EPO-responsive (n = 20) and EPO-resistant (n = 45) groups. The EPO-resistant patients were then further stratified into iron-responsive (n = 29) and iron-irresponsive (n = 16) groups. Iron metabolism and red cell indices were analyzed prior to and following rHuEPO therapy and iron supplementation. We found the following: (1) only serum ferritin (SF) was a reliable discriminator between the EPO-responsive (SF > 300 µg/l) and EPO-resistant (SF < 300µg/l) groups; (2) similarly, transferrin saturation (TFS) 25% was quoted as the best cut-off value between the iron-responsive (TFS 25%) groups; (3) EPO-resistant patients with TFS < 2 5 % regained proper EPO response (Hb before and 6 months after therapy: 7.8 ± 0.9 vs. 10.6 ± 0.8 g/dl, p < 0.01) and the mean TFS increased significantly (initial TFS and peak level after therapy: 18.9 ± 4.7 vs. 34.5 ± 10.8%, p < 0.01) following iron therapy; (4) the cumulative incidence of TFS < 25% elevated to 44.5% 6 months following initial rHuEPO therapy, and (5) there was a strong inverse relationship between initial TFS and the changes of Hb following iron therapy in EPO-resistant patients (r = -0.75, p 300 µg/l equates adequate or increased body iron stores and seems to exclude iron deficiency in MHD patients. On the contrary, SF < 300 µg/l appears to be an insufficient diagnostic threshold for iron deficiency. Once resistance occurs during the rHuEPO therapy, in our opinion only patients with TFS 25% and resistance to EPO, further investigations are necessary before increasing the dose of rHuEPO to explore other possible conditions, such as aluminum overload, severe hyperparathyroidism, occult blood loss or hemolysis, and episodes of infection or inflammatory pr

ISSN:0250-8095    

DOI:10.1159/000168837

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Persistent hyperparathyroidism and impaired tubular reabsorption of phosphate (P) are common after kidney transplantation. In order to assess the suppressibility of these abnormalities, we studied the effects of a single oral calcium (Ca) load (1 g) in 7 healthy subjects (HS) and in 14 normocalcemic long-term renal transplant recipients with good renal function (RT). In HS and RT, serum and urinary Ca were similar at baseline, and increased (p < 0.001) to the same extent after Ca ingestion. Serum parathyroid hormone (PTH) and nephrogenic cAMP (NcAMP) levels were higher at baseline in RT than HS (mean ± SEM; respectively, PTH 7.8 ± 0.8 vs. 3.5 ± 0.6 pmol/l, p < 0.001, and NcAMP 24.8 ± 2.3 vs. 13.9 ± 2.3 nmol/lGFRp < 0.01). After Ca, PTH (p < 0.001) and NcAMP (p < 0.01) decreased markedly in both RT and HS. Maximal changes in PTH and NcAMP were larger in RT than HS (PTH -3.3 ± 0.4 vs. -2.1 ± 0.03 pmol/l, p < 0.01, and NcAMP -18.2 ± 3.3 vs. -8.1 ± 2.6 nmol/l GFR, p < 0.05). Although PTH levels remained significantly higher in RT than HS from baseline to the end of the study (p < 0.001), PTH decreased to the normal range in RT after Ca load. Moreover, NcAMP reached similar values in RT and HS after Ca (16.0 ± 3.2 vs. 13.2 ± 2.8 nmol/l GFR at the end of the survey, NS). At baseline, RT had higher phosphaturia than HS (246 ± 25 vs. 127 ± 19 µmol/l, p < 0.01), and Ca ingestion lowered phosphaturia to similar values in both RT and HS (116 ± 13 vs. 95 ± 7 µmol/l GFR, NS). Renal P threshold expressed as TmP/GFR and tubular reabsorption rate of P were lower in RT than HS at baseline, and resumed normal values after Ca. To summarize, in normocalcemic long-term kidney transplant recipients, a single oral Ca intake acutely blunted the excessive PTH secretion and increased tubular reabsorption of P up to a normal range. We conclude therefore, that PTH is a main factor of tubular P loss i

ISSN:0250-8095    

DOI:10.1159/000168838

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The acid-base balance of 199 patients with cystic fibrosis, seen from 1987 through 1992 at the Bern Outpatient Clinic, were evaluated. Simple metabolic alkalosis was demonstrated in 16 and mixed metabolic alkalosis and respiratory acidosis in 9 patients. When compared with 10 patients with simple respiratory acidosis and 16 with normal hydrogen ion balance, those with simple metabolic alkalosis were significantly younger. The need for pancreatic enzymes was significantly higher and the relative underweight significantly more severe in patients with either simple or mixed metabolic alkalosis and respiratory acidosis. The results indicate the rather common occurrence of chronic metabolic alkalosis in cystic fibrosis. It is observed in young patients, in patients who need high doses of pancreatic enzymes and in those with poor nutritional status.

ISSN:0250-8095    

DOI:10.1159/000168839

出版商:S. Karger AG    

年代:1995

数据来源: Karger