ISSN:1660-8151    

DOI:10.1159/000186696

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Since Mai et al. found, with the intestinal lavage technique, that the same dose of elemental calcium given as acetate (Ca Ac) complexed in the gut of uremic patients twice as much phosphate as calcium carbonate (CaCO3) while inducing a rather low calcium absorption, we wanted to see if half the dose of elemental calcium given as Ca Ac could control, on medium term, the predialysis plasma phosphate as well as CaCO3 while inducing less frequent hypercalcemia. This was evaluated in a cross-over study of 3 periods of 10 weeks according to the sequence Ca Ac, CaCO3 and Ca Ac, in 12 compliant patients on chronic dialysis previously treated by CaCO3. Because of poor tolerance of Ca Ac during the first period, 4 patients were excluded and the results were assessed only on the 8 patients who completed the study. For half the doses of elemental calcium (620 ± 250 mg versus 1,310 ± 560 mg versus 710 ± 200 mg/day), Ca Ac allowed the same control of predialytic hyperphosphatemia (1.67 ± 0.34; 1.74 ± 0.32; 1.75 ± 0.38) with paradoxically comparable normal mean plasma calcium concentration (2.61 ± 0.14; 2.56 ± 0.13; 2.55 ± 0.14 mmol/l). Plasma alkaline phosphatases and intact PTH concentrations remained also stable during the 3 periods. The frequency of hypercalcemia greater than 2.75 mmol/l (12; 9; 20%) and of hyperphosphatemia greater than 2 mmol/l (17; 22; 27%) were comparable with the 2 treatments. In conclusion, Ca Ac controls predialytic hyperphosphatemia as efficiently as CaCO3 for half the dose of elemental calcium without, however, decreasing the frequency of hypercalcemia. These results challenge the validity of extrapolating the results of the intestinal lavage technique for assessing the medium-term absoφtion of calcium. The real advantage of Ca Ac over CaCO3 as phosphate binder remains to be es

ISSN:1660-8151    

DOI:10.1159/000186697

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We have been investigating the possibility of using the renal clearance of endogenous N-1-methylnicotinamide (NMN) as a marker of renal tubular function. Sixty-three subjects (11 healthy volunteers and 52 patients with renal impairment) were used for this study. The subjects were divided into three groups according to their creatinine clearance: group 1, over 80 ml/min; group 2, between 30 and 80 ml/min, and group 3, less than 30 ml/min. The correlation between NMN and creatinine clearance was compared for each group. A good correlation (r = 0.84) was found for groups 1 and 3 (r = 0.76), whereas for group 2, a poor correlation was found (r = 0.43). For subjects with mild renal impairment (group 2), there was clear evidence of glomerulo-tubular imbalance manifest by a larger variability in NMN clearance than creatinine clearance and an essentially non-parallel decline in these two parameters for this group. When all subjects were grouped together, the relationship between the clearance of NMN and of creatinine was best described by a 3-term polynomial equation (r = 0.93). NMN clearance is a potentially useful non-invasive marker of renal tubular function in man and provides additional information to that provided by the measurement of creatinine clearance alone. This substance should be more fully evaluated as a potential diagnostic aid.

ISSN:1660-8151    

DOI:10.1159/000186698

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The vascular disturbance associated with ciclosporin (CS) nephrotoxicity is poorly defined in both the normal and transplanted human kidney. Six bone marrow transplant recipients were studied before, during and after administration of CS. By analysis of time activity curves and clearance of Tc-99m DTP A, renal blood flow (RBF), filtration fraction (FF) and GFR were shown to fall on CS (GFR: p < 0.001; RBF, FF: p < 0.01). These haemodynamic variables did not fully recover with dose reduction or after discontinuation of therapy. Plasma renin activity (PRA) aldosterone and atrial natriuretic peptide did not change although there appeared a tendency for PRA to fall on CS. There was a reversible normokalemic metabolic acidosis. CS levels stayed within the therapeutic range. The partial reversibility of GFR, RBF and FF is consistent with CS-induced functional disturbance and reflects sensitivity to microvascular and tubular injury of the normal human kidney.

ISSN:1660-8151    

DOI:10.1159/000186699

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A nonradioactive in situ hybridization technique was utilized for the rapid and early diagnosis of cytomegalovirus (CMV) infection in children undergoing kidney transplantation. The cellular samples were obtained directly from the organs thought to be affected on the basis of clinical findings: bronchoalveolar lavage during interstitial pneumonia (7 samples from 6 cases); fine-needle aspiration biopsy (FNAB) of the liver during acute hepatitis (1 case); kidney FNAB and peripheral blood where there was a > 25% creatinine rise with or without fever (26 episodes). Standard virus isolation procedures and an immunofluorescent technique on short-term cultures of human fibroblast cells were performed as a control. 6/23 children followed had a symptomatic CMV infection (4 had interstitial pneumonia; 1 had acute hepatitis, and there was 1 case of creatinine rise with fever). In all cases, the diagnosis was provided by in situ hybridization in less than 24 h. These results were confirmed 48 h later by immunofluorescence and after 5-25 days by standard viral cultures. In situ hybridization with a biotinylated probe proved to be a rapid and sensitive method for diagnosis of CMV disease, when performed on specimens obtained from the involved organs at an early stage of the infection. This diagnostic approach allowed a specific antiviral therapy to be undertaken promptly.

ISSN:1660-8151    

DOI:10.1159/000186700

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Following successful kidney transplantation, renal anemia is gradually corrected during the first 3-4 months. Serum erythropoietin (EPO) levels are increased after the first postoperative day following grafting. In this study, the serum EPO levels in the early posttransplant phase were investigated in 8 living-donor and 7 cadaveric-kidney transplant recipients with special emphasis on the first 24 h. Despite a considerable difference in cold ischemic time of the graft in the two groups the increase in serum EPO levels was noticed at about the same time (8 h) in both groups and the first peak of serum EPO, which was observed after 24 h, reached the same level in both groups. After 9-11 days, serum EPO reached levels which usually are observed during the first months following transplantation. The EPO response seems to be blunted in relation to the degree of anemia in the early posttransplant phase.

ISSN:1660-8151    

DOI:10.1159/000186701

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Supernatants of peripheral blood mononuclear cell culture from children with minimal change nephrotic syndrome (MCNS) and focal segmental glomerulosclerosis (FSGS) were tested for their ability to increase glomerular basement membrane (GBM) permeability and for effects on anionic sites in the GBM. Supernatants from cultures of concanavalin A-stimulated peripheral blood mononuclear cells from patients with MCNS, those with FSGS and normal controls were infused into the renal arteries of normal rats. Infusion of the supernatants from patients with MCNS and FSGS caused a significant reduction of anionic sites in the GBM (p < 0.001) and a significant increase in urinary albumin excretion (p < 0.05), whereas infusion of supernatants in control cases did not reduce anionic sites nor increase urinary albumin excretion. These findings show that stimulation of peripheral blood mononuclear cells from MCNS and FSGS with concanavalin A results in liberation of soluble substances which reduce polyanions in the GBM and increases GBM permeability.

ISSN:1660-8151    

DOI:10.1159/000186702

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We have shown that the inhibition of prostaglandin (PG) synthesis in man decreases the fractional clearance of urea (FCurea). To understand the mechanism(s) by which PG affect the renal handling of urea, 6 normal volunteers were randomly studied in maximal antidiuresis (by water deprivation and by administering 1-desamino-8-.D-arginine vasopressin) before and during PGE1 infusion, in two separate occasions: (A) after 7 days of normal protein (1 g/kg b.w./day) and water intake (10 ml/kg b.w./day), and (B) after 7 days of low protein intake (0.5 g/kg b.w./day) and high water intake (80 ml/kg b.w./day) to lower the corticomedullary osmotic gradient. During infusion of PGE1 at rates of 0.01, 0,05 and 0.1 μg/min/kg, randomly administered, the urinary fluid losses were replaced by infusing equal volumes of hypotonic NaCl (80 mmol/l). To evaluate the time effects of this protocol, control studies were performed in an other 8 subjects receiving vehicle infusion without PGE1· In study A, FCurea rose by 23% (p < 0.01) at the lowest PGE1 infusion rate (0.01 μg/min/kg), in the absence of any simultaneous change in water and salt output, Uosm, PAH and inulin clearance. Higher PGE, infusion rates (0.05 and 0.1 μg/min/kg) were associated with a progressive increase of FCurea (50%, p < 0.001 and 91%, p < 0.001, respectively), fractional clearance of water and salt output, inulin and PAH clearance and reduced Uosm from 1,005 (22 SEM; basal value) to 772 (38 SEM; minimum value) mosm/kg (p < 0.001). In study B, the basal value of Uosm was 762 (22 SEM) mosm/kg, markedly lower than the basal value of study A (p < 0.01); in this condition, the increasing infusion rates of PGE1 caused the same changes of FCurea and the other parameters as in study A. FCurea was directly related to dose infusion of PGE1 both in study A and B (p < 0.001). The slopes of these two linear regression analyses did not statistically differ. Finally, both FCurea and fractional clearance of water did not show significant changes among the several periods of the control studies. We conclude that in human subjects, the inhibition of urea tubular reabsorption, observed during PGE1 infusion, is: (1) not associated with change in tubular handling of salt and water at the lowest infusion of PGE1; (2) not mediated by passive hydrosmotic forces or by antagonism with ADH; (3) dependent on the dose of exogenous PGE1.

ISSN:1660-8151    

DOI:10.1159/000186703

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The effect of platelets on the development of immune complex glomerulonephritis (GN) was examined using bovine serum albumin (BSA) GN with platelet depletion. To clarify the role of platelets in the initial stage of BSA GN, thrombocytopenia was induced before BSA infusion. In 18 New Zealand white rabbits, BSA was intravenously injected twice after the presensitization. Eight of these BSA GN rabbits were injected daily with goat anti-rabbit platelet antiserum to induce thrombocytopenia, and platelet counts were maintained below 5 × 104/μl throughout the experiment. In the thrombocytopenic group, the degree of proteinuria was significantly decreased compared to the control group. Glomerular polymorphonuclear leukocyte infiltration, mononuclear cell proliferation, exudation and glomerular enlargement were significantly suppressed in the thrombocytopenic group. The results suggest that platelets may be quite important in the initiation and development of immune complex

ISSN:1660-8151    

DOI:10.1159/000186704

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Lipid peroxidation products, lipid hydroperoxide and malonaldehyde were measured in the serum of patients on maintenance hemodialysis and compared with values obtained from a group of healthy controls. Dialysis patients had significantly elevated levels of lipid peroxidation products (12.9 ± 1.9 vs. 9.3 ± 1.3 nmol/ml, mean ± SD, patients vs. controls, p < 0.0001). In contrast, the serum transferrin level was significantly lower in the dialysis patients (217 ± 71 vs. 290 ± 50 mg/dl, patients vs. controls, p < 0.0002). Compared to normal controls HDL cholesterol was lower (40 ± 11 vs. 53 ± 8, p < 0.0001) and triglycerides were higher (206 ± 103 vs. 142 ± 64, p < 0.007) in the patient group. The patient group was then divided on the basis of using polysulfone or cupraphane dialyzers. Patients using polysulfone dialyzers had lower levels of 2-thiobarbituric acid-reactive substances (12.3 + 0.9 vs. 13.6 ± 2.1, polysulfone vs. cupraphane, p = 0.05), and higher transferrin concentrations (248 ± 84 vs. 194 ± 37, p = 0.03). Thus, in patients on maintenance hemodialysis there was evidence for accelerated lipid peroxidation. This abnormality was more marked in patients using traditional cupraphane dialyzers. The mechanism for this observation rema

ISSN:1660-8151    

DOI:10.1159/000186705

出版商:S. Karger AG    

年代:1992

数据来源: Karger