摘要:

Immunosuppressive treatment in glomerulonephritis (GN) is still controversial. Most of the secondary forms of glomerulonephritis have the histologic features of one of the primary types of glomerulonephritis. Eight histologic expressions of primary glomerulonephritis can be distinguished and ordered in terms of severity of symptoms and prognosis: endocapillary GN, minimal change GN, mesangioproliferative GN, membranous GN, focal-sclerosing GN, membranoproliferative GN, focal-necrotizing GN, and rapidly progressive GN. Agreement exists only to the extent that immunosuppression is not required in endocapillary glomerulonephritis, although it is recommended in the other extreme of rapidly progressive GN. Primarily, an indication for immunosuppression is given by the severity of symptoms with a urinary protein excretion>3.5 g per day and/or serum creatinine>150μmol per liter. As for anti-GBM, the type of glomerulonephritis is more important than the severity of symptoms in guiding therapy, whereas for IgA nephropathy it is controversial whether the prospective prognosis of even inexorably deteriorating renal function justifies immunosuppression. Renal biopsy is required to identify the type of glomerulonephritis so as to establish the specific immunosuppressive concept with different intensity and duration of treatment. Immunosuppression can reduce urinary protein excretion and improve deterioration of renal function; however, the proportion of patients responding varies with and depends on the different forms of GN.

ISSN:0886-022X    

DOI:10.3109/08860229509036369

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

The mechanism of renal function abnormalities in experimental biliary cirrhosis can be partially explained by the absence of gastrointestinal bile flow, which predisposes to translocation of intestinal endotoxin, a potent renal vasoconstrictor. Since bile acids prevent the absorption of intestinal endotoxins, we aimed to evaluate the effects of ursodeoxycholic acid (UDCA) administration on renal function and hemodynamic abnormalities induced by 1 week of obstructive jaundice in rats. Methods: Fifty-two rats were used; 30 had ligation of the common bile duct, 22 were sham operated. Bile duct ligated rats were randomly and blindly assigned to receive UDCA (25 mg/kg/day, n = 14) or placebo (n = 16) during 1 week. Sham rats received no treatment. Portal pressure (PP) as well as creatinine clearance (CrCl), urinary sodium (US), and plasma renin activity (PRA) were evaluated. Results are mean±SEM, with a significant value of p<0.05. Results: Portal pressure (10.4±1.1 vs. 12.1±0.8 mm Hg) was significantly lower in UDCA than in placebo-treated rats. ALT serum levels were also significantly lower in bile duct ligated rats receiving UDCA (77.3±28 IU/L) than in placebo-treated rats (162±65 IU/L). US (1.1±0.5 vs. 2.1±0.3 mEq/24 h) was significantly lower and PRA (6.0±2.6 vs. 1.9±1.0 ng Ang 1/mL/h) higher in bile duct ligated than in sham-operated rats. No differences were found between UDCA or placebo-treated bile duct ligated rats. CrCl was similar between sham (0.39±0.12 mL/min/100 g BW) and UDCA (0.32±0.16) but significantly lower in placebo-treated (0.28±0.07) than sham-operated rats (p<0.05). Conclusion: UDCA administration had very mild effects on renal function abnormalities induced by experimental obstructive jaundice in rats. However, portal hypertension and biochemical abnormalities were partially improved.

ISSN:0886-022X    

DOI:10.3109/08860229509036370

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Rat renal cortical mitochondria were isolated from Wistar male rats weighing 80 to 120 g to investigate whether the source of oxygen free radicals was renal cortical mitochondria enhanced by gentamicin. In renal cortical mitochondria with or without the addition of gentamicin, DMSO, DFO, CAT, SOD, and MTl were added separately, then incubated at 37°C for 90 min. Superoxide anions and hydroxyl radicals were then determined. The results showed that superoxide anions and hydroxyl radicals generated in mitochondria were enhanced by the addition of in vitro gentamicin (12.4 mg/mL) when compared to those without the addition of gentamicin. Dimethylsulfoxide (DMSO), catalase (CAT), and deferoxamine (DFO) significantly inhibited hydroxyl radicals enhanced by gentamicin, but superoxide dismutase (SOD) and metallothionein-1 (MTl) did not. SOD significantly inhibited the production of superoxide anions. Our data indicated that renal cortical mitochondria are the source of oxygen free radicals and that production is enhanced by gentamicin. This provides more insight on the pathogenetic role of hydroxyl radicals and superoxide anions in gentamicin-induced nephrotoxicity in vitro.

ISSN:0886-022X    

DOI:10.3109/08860229509036371

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

In Wistar rats just after weaning, 5/6 of renal parenchyma were removed surgically. Thereafter, the rats were fed either a“high-protein”(21%) or two types of a“low-protein”(6%) diet; in one of the latter the lack of protein was substituted by saccharide, in the other by fat, making the substitution“isocaloric”in either case. In all three diet groups, subgroups were formed drinking either tap water or water containing either the ACE inhibitor enalapril (Ena) or the calcium antagonist diltiazem (Dil), or both (Ena + Dil). In the high-protein diet group, increases in the weight of kidney remnants, in proteinuria and in systolic blood pressure (SBP) were seen. This was prevented by feeding either type of the low-protein diet but also by Ena and Ena + Dil. Ena and Ena + Dil not only prevented the increase in SBP but actually lowered it significantly. Dil alone also had a SBP-lowering action but offered no protection from kidney hypertrophy and proteinuria. No additive protective action of Ena + Dil or Ena + low protein or Ena + Dil + low protein was seen, suggesting that a bottom limit of these protective action was reached by the low-protein diet alone. There was no substantial difference between either type of the low-protein diet except a small and transient decrease in body weight in the first week of fat-rich diet administration.

ISSN:0886-022X    

DOI:10.3109/08860229509036372

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Atrial natriuretic peptide (ANP) levels were studied in young (2-week-old) and old (age 20 months) rats following acute (20 mL/kg bolus of normal saline i.v.) vs. chronic sodium loading (high-salt diet for 21 days). In both groups serum ANP rose significantly 1 h post i.v. loading. However, the increment was greater in the old animals. On chronic sodium load, in the young group, ANP rose significantly on days 3 and 7, subsequently declining to baseline. In the old animals, no increase in ANP was noted throughout the chronic experiment. Twenty-four-hour urinary sodium excretion was similar in the two groups following acute or chronic salt load. The results suggest that: (1) The old kidney requires a greater ANP stimulus to excrete a given acute i.v. sodium load. (2) The relatively diminished elasticity of the old heart plays a major role in the exaggerated ANP release in response to a bolus i.v. load of saline. (3) The role of ANP in maintaining homeostatic renal sodium excretion during short-term sodium oral loading is different in the two age groups.

ISSN:0886-022X    

DOI:10.3109/08860229509036373

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Tubular damage as suggested by enzymuria and tubular proteinuria is a recognized feature of glomerulonephritis (GN) with clinical proteinuria and both incipient and overt diabetic nephropathy (DN). However, little is known about the presence of tubulopathy in patients with primary GN, microalbuminuria [albumin excretion (AER) 30–300 mg/d] and microhematuria. Three groups were studied. The GN group comprised 17 (2 F) patients with biopsyproven GN with microalbuminuria. The DN group comprised 35 (14 F) patients with incipient diabetic nephropathy with AER 30–300 mg/d. and controls comprised 38 (15 F) normal subjects with normal AER<30 mg/d. Serum creatinine, albuminurinuria, transferrinuria, and markers of tubular damage such as urinary excretion of N-acetyl-glucosaminidase (NAG), leucine aminopeptidase (LAP),γ-glutamyl transferase (gGT), and retinol binding protein (RBP) were measured. GN and DN had comparable degrees of albuminuria, transferrinuria, and LAP excretion, and these were significantly higher than controls. Serum creatinine was significantly higher in GN than DN and controls. DN had significantly higher NAG and RBP, and lower gGT than GN and controls. In both GN and DN groups, both glomerular proteins correlated with each other and NAG correlated significantly to LAP and gGT. Albuminuria correlated to tubular enzymuria in GN group but not in patients with DN. The results suggest that tubular damage is less marked in microalbuminuric patients with GN than those with DN despite similar degree of glomerular proteinuria. The pattern of tubulopathy is also different in the two groups, indicating differences in the pathogenesis of tubular damage in these two clinical settings.

ISSN:0886-022X    

DOI:10.3109/08860229509036374

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Thirty-one infants and children with acute renal failure were treated with peritoneal dialysis using a surgically placed Tenckhoff catheter. In 10 patients a peritoneal dialysis cycler was used, and 21 were dialyzed by the manual method. Initially, hourly exchanges were given for 24 to 48 h and, as the patients stabilized, 10 exchanges per day at 1-h intervals were given. The mean stabilization period was 36±8 h. The predialysis mean serum creatinine was 5.8±1.8 mg% and the serum creatinine while on daily dialysis was 2.8±1.1 mg%. Peritoneal dialysis succeeded in controlling metabolic abnormalities and improving fluid balance. All the catheters except one functioned immediately following insertion. Median duration of catheter placement for dialysis was 18 days (range 2 to 90). The incidence of peritonitis was 12.8%, and exit site infection was 6.4%. The infection rate was decreased when a cycler was used compared with the manual method (23.8% vs. 10.0%), though not statistically significant. Two patients developed hypothermia while being dialyzed via the manual method. To conclude, 10 daily peritoneal dialysis exchanges performed at 1-h intervals after initial stabilization using a surgically placed Tenckhoff catheter is an effective and safe mode of dialytic therapy for children with acute renal failure. Complications (infection and hypothermia) are reduced with the use of a cycler.

ISSN:0886-022X    

DOI:10.3109/08860229509036375

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

The activities of five lysosomal hydrolases—namelyβ-glucuronidase,β-hexosaminidase,β-galactosidase,α-galactosidase, andα-mannosidase—were measured in the plasma and urine of children (ages, 7 to 15 years) with sickle cell anemia (n = 11) and controls (n = 11) from Jos, Nigeria. The presence of SS hemoglobin was confirmed by electrophoresis of red cell hemolysates. Albuminuria was absent in all of the patients with sickle cell anemia. The creatinine-indexed urinary activity level (units of enzyme activity/milligrams creatinine) and the fractional enzyme excretion (FEE) value, which is defined as the ratio of enzyme clearance to creatinine clearance, were determined for each of the five lysosomal enzymes and compared between the two groups. The mean FEE values forβ-glucuronidase andα-galactosidase in the sickle cell patients were 10- and 3.5-fold lower, respectively, than the corresponding control values, and these differences were statistically significant (p<. 03) for both enzymes; however,β-hexosaminidase,β-galactosidase, andα-mannosidase levels in urine were not different between the two groups. When indexed to creatinine, a comparison of the urinary enzyme levels of control and sickle cell patients showed significant differences forβ-glucuronidase (p<. 01) andα-galactosidase (p<. 05) but not for the other three enzymes. Differences in level of plasma enzyme activity between control and sickle cell patients were not significant, except forα-galactosidase (p<. 05), which was increased slightly (25%) in the sickle cell group. These data indicate that there may be abnormalities in the metabolism of lysosomal enzymes in the kidneys of patients with sickle cell anemia.

ISSN:0886-022X    

DOI:10.3109/08860229509036376

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Many patients with end-stage renal disease (ESRD) have signs and symptoms of easy fatigability, fluctuating weakness, apathy, dry mouth, and blurring of vision. These symptoms can be confused with disorders of neuromuscular transmission. When present, the physician may want to determine whether the patient has myasthenia gravis—the commonest of all neuromuscular disorders—and administer the edrophonium (Tensilon) test. An unequivocally positive response to the test must be interpreted with caution in ESRD. However, the exact mechanism of a positive response is unclear but may be explained by metabolic abnormalities related to end-stage renal disease, i.e., uremic toxins, disordered calcium metabolism, abnormal neuromuscular mechanism, associated neurological disorders, or myopathic processes in uremia, all of which can affect neuromuscular transmission.

ISSN:0886-022X    

DOI:10.3109/08860229509036377

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

ISSN:0886-022X    

DOI:10.3109/08860229509036378

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor