摘要:

In the past 30 years steroids have been widely employed in the management of primary glomerulopathies. At variance with ‘minimal-change nephropathy’, in which glucocorticoids are of well-known value, in other forms of immune-mediated glomerulopathies and particularly in idiopathic ‘membranous glomerulopathy’ results of controlled trials are inadequate or controversial. Retrospective analysis of the data reported in the literature indicates a beneficial effect in some series but appears disappointing in others. Certainly the use of high-dose steroids for a prolonged period of time can expose the patients to serious side effects. The aim of the present review is to critically evaluate the results obtained with the use of steroids in the treatment of ‘membranous glomerulopathy’ and reexamine the rationale of their use in the light of the new information on the glucocorticoids mechanism of action on the im

ISSN:1660-8151    

DOI:10.1159/000184062

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Sixty-five patients with advanced chronic renal failure (CRF) but a normal extracellular fluid volume (ECFV), including 31 dialysis patients, were studied. Plasma volume, blood volume (BV), plasma renin activity (PRA), and mean arterial pressure were measured to examine whether hypertension (when present) is renin dependent, or whether it is related to an abnormal distribution of ECFV between the intra- and extravascular spaces. PRA was higher in dialysis than nondialysis patients, but the incidence of hypertension was the same. In both groups hypertensive patients with normal PRA and normotensive patients with elevated PRA were present. The patients were compared to 65 patients with essential hypertension (EH) and 56 normals. The BV and BV-to-interstitial fluid volume ratio were similar in these groups. We found no decreased BV in patients with EH as has previously been reported by others, possibly because we used an appropriate normalization index and matched control groups. In sum, hypertension in CRF patients with a normal ECFV cannot always be explained by elevated renin levels. In this respect, CRF patients resemble patients with EH. An abnormal extracellular fluid distribution does not seem to be involved in the maintenance of hypertension.

ISSN:1660-8151    

DOI:10.1159/000184063

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

The phosphate-binding capacities of 19 liquid and solid aluminum hydroxide gel antacids were determined in vitro under varying pH conditions. The resulting data provide a basis explaining the phosphate-binding characteristics observed when patients are treated with long-term aluminum hydroxide therapy. No antacid, liquid or solid, showed significant binding at pH 1.0. Maximum phosphate binding (expressed as phosphorus; P) was observed at pH 2.0 and 3.0 for most antacids and decreased markedly at alkaline pH. The liquid antacids showed a significantly greater phosphate-binding capacity than did tablets or capsules (p < 0.01). At pH 2.0, the liquid antacids bound a mean of 22.3 mg P/5 ml. At pH 8.0 binding was reduced to a mean of 7.3 mg P/5 ml. Significant interbrand differences were observed. At pH 2.0, the solid antacids bound a mean of 15.3 mg P/tablet or capsule. At pH 8.0, binding was reduced to a mean of 5.8 mg P/tablet or capsule. Interbrand differences, while substantial, were less than those observed among the liquid antacids. Variations in sodium and potassium content were clinically insignificant for most of the antacids in this study, while the differences in phosphate-binding properties were sufficient to warrant attention in the patient with renal failure.

ISSN:1660-8151    

DOI:10.1159/000184064

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

The prevalence of hypertension in 288 patients with primary chronic glomerulonephritis was compared with that observed in a control group of 3,477 subjects from the same geographic area. 23.3% of the patients and 12.8% of the general population were hypertensive (p < 0.01). However, if only patients with normal renal function were considered, prevalence of hypertension (12.7%) was not higher than in the control group. Hypertension was more frequent in focal segmental sclerosis (30%) and in membranous glomerulonephritis (26%) than in IgA nephropathy (9%), membranoproliferative glomerulonephritis (11%) and IgM mesangial glomerulonephritis (12%). Five years after renal biopsy, 92% of normotensive and 47% of hypertensive patients remained with normal renal function (p < 0.001). These findings suggest that the high prevalence of hypertension in chronic glomerulonephritis is related to the declining renal function. On the other hand, hypertension appears to represent a bad prognostic sign.

ISSN:1660-8151    

DOI:10.1159/000184065

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Maximum urine concentration capacity was studied in healthy adults using different routes and doses of administration of 1-deamino-8-d-arginine vasopressin (DDAVP) – desmopressin. Plasma levels of DDAVP showed a dose-dependent increase after the subcutaneous but not after the intranasal administration. The effect on urine osmolality was similar but more prolonged after the subcutaneous as compared to the intranasal route. We conclude that subcutaneous injection is a simple and reliable way of administering DDAVP. A dose of 4 μg in adults is optimum diagnostically and it corresponds to 20–40 μg administered intrana

ISSN:1660-8151    

DOI:10.1159/000184066

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

A 45-year-old woman had hypouricemia (serum uric acid, 1.0–2.3 mg/dl) with increased uric acid clearance (29.8 ± 9.3 ml/min/1.73 m2). Uric acid clearance to creatinine clearance ratio (Cua/Ccr) was suppressed markedly by pyrazinamide to 2.3% and surprisingly enhanced by probenecid to 227.8%. No other renal tubular or metabolic abnormalities were detected. This previously unreported high postprobenecid Cua/Ccr suggests that markedly increased urate secretion by the renal tubule is responsible for hypouricemia in this patie

ISSN:1660-8151    

DOI:10.1159/000184067

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

In a pediatric and in an adult group of patients with hematuria and normal creatinine clearance overnight urine examination was carried out on 2 nonconsecutive days by means of phase contrast microscopy by two independent observers working in two different institutions. In this way it was possible to distinguish between patients on the basis of dysmorphic (glomerular) and isomorphic (nonglomerular) red cells in urine and to correlate the findings with the final diagnosis. A clear-cut indication (more than 80% of isomorphic and/or dysmorphic red cells) was obtained in 163 patients (102 of pediatric age) and final diagnosis of hematuria correlated with red-cell microscopy findings in 96.4% of glomerular diseases and in all cases of nonglomerular origin. Mixed hematuria (50–75% of dysmorphic red cells) was found in 2 cases of renal tuberculosis, 2 cases of polycystic kidney disease and in 1 child with viral meningoencephalitis with a bladder stone. The data indicate that the method is safe and accurate but further experience must be gathered for the many etiologies of glomerular and nonglomerular diseases hitherto not studie

ISSN:1660-8151    

DOI:10.1159/000184068

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

Three patients with renal hypouricemia in the same family are described. Serum urate levels in the mother were in the low normal range and were below normal in her 2 sons. In all 3 patients, the ratios of renal urate clearance to creatinine clearance were abnormally elevated. Clear responses to either pyrazinamide or probenecid administration were observed in these ratios. These results suggest that these 3 patients had renal hypouricemia with normal reabsorption of urate as judged by the criteria for differentiating abnormalities in renal urate handling. This corresponds to the previously postulated mechanism as renal urate hypersecretion. Possible limitations to the diagnostic use of probenecid and pyrazinamide are also discussed.

ISSN:1660-8151    

DOI:10.1159/000184069

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

The effect of cyclosporin A (CYA) on the respiration and phosphorylation in rat kidney mitochondria was studied. When CYA (50 mg/kg/day) was subcutaneously administered to rats for 4 days, the state 3 respiration and uncoupled respiration of succinate and glutamate/malate respiration was decreased. The respiratory control index was decreased in glutamate/malate respiration. These ex vivo effects of mitochondrial dysfunction are discussed as CYA effects on kidney mitochondria occuring in the intact cell. The nephrotoxic effect of CYA could be demonstrated by increased excretions of urinary enzymes.

ISSN:1660-8151    

DOI:10.1159/000184070

出版商:S. Karger AG    

年代:1987

数据来源: Karger

摘要:

The long-term effects of parathyroidectomy (PTX) on blood pressure, intravascular volume, pressor hormones, and on acute vascular effects of intravenous parathyroid hormone (PTH) were evaluated in spontaneously hypertensive (SH) and normotensive Wistar-Kyoto (WK) rats. PTX or sham operation (CO) were done at 4–5 weeks of age, and a high calcium diet was offered to PTX rats to study them at eucalcemic calcium levels. The cardiovascular effects of PTX, determined after 11–13 weeks, were qualitatively similar in SH and WK rats: mean arterial blood pressure (concious unrestrained rats) was lower, intravascular volume was higher, total body sodium was slightly higher, and plasma angiotensin II or norepinephrine levels were not different from CO groups. The acute hypotensive and chronotrophic effect of intravenous PTH was unchanged in PTX groups. When parathyroid intact SH rats and PTX SH rats were both examined on an 1.6% Ca diet, blood pressure was significantly lower in PTX than in parathyroid-intact SH rats. The results are compatible with the hypothesis that PTH has a permissive action on blood pressure maintenance in eucalcemic SH and WK rats by mechanisms unrelated to volume status or circulating pressor hormone concentrati

ISSN:1660-8151    

DOI:10.1159/000184071

出版商:S. Karger AG    

年代:1987

数据来源: Karger