ISSN:0886-022X    

DOI:10.3109/08860228709047646

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

ISSN:0886-022X    

DOI:10.3109/08860228709047647

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

Cyclosporin A (CsA) is used widely as an immunosuppressive in organ transplantation. Although it is highly effective, acute and chronic nephrotoxicity of CsA are of continuing concern. A case of acute glomerular thrombosis secondary to CsA therapy in a renal transplant recipient is described. The course of the accompanying acute renal failure and its reversal following discontinuation of CsA and therapy with intra-arterial streptokinase is outlined. CsA-induced capillary thrombosis is rare but has been described in renal transplant recipients as well as in hepatic and bone marrow transplantation. It may give rise to diagnostic confusion in the early days following renal transplantation, where it may mimic acute rejection. The etiology of CsA-induced glomerular capillary thrombosis remains speculative.

ISSN:0886-022X    

DOI:10.3109/08860228709047648

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

We performed a meta-analysis of four randomized trials (RCTs) and one concurrent control study which addressed the following question: Does treatment with amino acid solutions and hypertonic glucose improve survival of seriously ill patients with acute renal failure who are unable to take oral or enteral feedings? Three RCTs compared outcomes with essential amino acid solutions (EAA) and hypertonic glucose against hypertonic glucose alone, and their results were pooled. Use of EAA was associated with an absolute increase in initial survival of 0.24 as compared to glucose (confidence interval: +.015 to +.446). Without weighting the data to reflect the quality of the RCTs, this effect was significant (p =. 017). Patients needing dialysis showed a significant treatment effect (p =. 015), while those not requiring dialysis did not (p =. 11). However, survival to hospital discharge was not significantly improved for the patient population as a whole (p =. 10). Using a standardized quality assessment protocol, the four RCTs received scores ranging from. 188 to. 357 out of a possible 1.00. Any statistically significant treatment effects were abolished by factoring the quality scores of the studies into the data-pooling process. Sensitivity analysis was performed to determine the effect of including the nonrandomized study. Although it had more patients than the other studies combined, the nonrandomized study was of low quality (score:. 032) and its inclusion did not change the outcome of data pooling once quality weighting was applied. We conclude that the efficacy of these parenteral nutritional regimens remains uncertain in this clinical setting.

ISSN:0886-022X    

DOI:10.3109/08860228709047649

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

The effects of dietary protein on renal function and structure, both prior to and after initiation of daily gentamicin treatment, were investigated. Male Sprague-Dawley rats were pair-fed on low-protein (LP, 5%), normal-protein (NP, 20%), or high-protein (HP, 60%) diets for 10 days prior to gentamicin treatment. Gentamicin was administered as daily subcutaneous injections (150 mg/kg) for 6 days. Immediately after beginning daily gentamicin injections some of the rats on NP diets were switched to LP or HP diets, and some of the rats on HP diets were switched to LP diets. Renal function was monitored by evaluating serum creatinine levels and 24-h urine volumes; renal histology was evaluated by light and electron microscopy; and gentamicin uptake was determined using radioimmunoassay. Our findings indicate that conditioning to higher dietary protein prior to gentamicin administration results in less uptake of gentamicin by the kidneys. If rats on HP diets are placed on LP coincident with gentamicin administration, there is a significant improvement in survival. Switching rats from NP to LP protein coincident with gentamicin administration does not improve renal function, histology, or survival. However, switching rats from NP to HP coincident with gentamicin administration significantly increases mortality. Maintaining rats on LP both prior to and after gentamicin administration results in a significant improvement in survival but does not improve renal Junction. These results indicate that dietary protein both prior to and following the administration of gentamicin can significantly affect the nephrotoxicity of gentamicin.

ISSN:0886-022X    

DOI:10.3109/08860228709047650

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor

摘要:

Previous studies of the renal kallikrein-kinin system in chronic renal failure (CRF) have given conflicting results. We have assessed activity of this vasoactive hormone system in CRF and investigated a possible relationship to hypertension in patients with CRF: 24-hour urinary kallikrein excretion (Uka) was measured in 22 patients with CRF (9 normotensive and 13 hypertensive) and 11 healthy controls. Age, sex, urine volume, and urinary sodium excretion were similar in each group. Compared with controls, Ukawas reduced in both normotensive and hypertensive patients with CRF, with no difference between CRF groups. The reduction in Ukain CRF was less than the reduction in glomerular filtration rate (GFR), as assessed by endogenous creatinine clearance (Ccr). When Ukawas divided by Ccr, Uka/mL Ccrwas therefore increased, to a similar extent, in both normotensive and hypertensive patients with CRF. This suggests that release of renal kallikrein from functioning nephrons is increased in CRF. The results do not support a role for deficient kallikrein release in the genesis of hypertension in CRF, as previously suggested; however, these abnormalities could be relevant to other aspects of renal function in CRF. The converting-enzyme inhibitor, captopril, was given to 5 patients with CRF, hypertension, and low Uka. Introduction of captopril was followed by a further reduction in Ukain all subjects. Captopril is known to inhibit kininase II, the principal enzyme involved in degradation of kinins; this potentiating effect may be counteracted by a reduction in renal kallikrein release and hence in kinin generation.

ISSN:0886-022X    

DOI:10.3109/08860228709047651

出版商:Taylor&Francis    

年代:1987

数据来源: Taylor