ISSN:0250-8095    

DOI:10.1159/000168409

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The effects of increasing amounts of uremic sera (US) on the growth of erythroid progenitor cells [burst-forming unit erythroid (BFU-E)] collected from peripheral blood of normal subjects were evaluated to assess the potential role of uremic inhibitors of erythropoiesis during a treatment with recombinant human erythropoietin (r-HuEpo). US were collected from 8 patients on regular dialysis with marked anemia (Hb 6 ± 0.5 g%) before and after a treatment with high doses of r-HuEpo (from 300 to 525 U/kg/week). Standard cultures for BFU-E were performed in a-metylcellulose with fetal calf serum (FCS) and 4 U/ml of r-HuEpo (Cilag, Ortho). In successive cultures, US were added at increasing amounts to the standard culture in order to assess a possible inhibitory effect on BFU-E growth. Finally, in order to assess a possible lack of stimulatory factors, we partially substituted FCS with US. The addition of US collected either before or after therapy with r-HuEpo to the standard culture had no effect on the growth of BFU-E. Vice versa, the number of cultured BFU-E decreased when FCS was partially substituted with US collected before r-HuEpo. This effect was not evident when FCS was partially substituted with US collected after r-HuEpo. No significant differences were recorded in the tested sera collected before and after therapy considering erythropoietin levels and amino acid levels. We hypothesized that some other factors with erythropoietic stimulatory activity (burst-promoting activity?) may be deficient in uremic patients with marked anemia and can be induced during therapy with r-HuEpo

ISSN:0250-8095    

DOI:10.1159/000168410

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The normal range for whole blood serotonin levels in chronic renal failure patients has not been defined. As serotonin may be implicated in platelet abnormalities, hypo- and hypertension and itch in dialysis patients, serotonin whole blood levels were measured in a group of patients with chronic renal failure and/or who were dialysis dependent. The levels were elevated in 12 patients with moderate (mean serum creatinine 335 ± 54 µmol/l) chronic renal failure (270 ± 46 µg/l) compared to 11 normals (163 ± 17 µg/l, p < 0.05; quoted normal range < 300 µg/l) but did not correlate with serum creatinine levels. There was a marked elevation in serotonin levels in dialyzed patients, including those on hemodialysis (polysulfone, n = 6, 747 ± 234 µg/l; cuprophane membranes, n = 6, 708 ± 198 µg/l), hemodiafiltration (n = 12, 695 ± 130 µg/l) and especially peritoneal dialysis (n = 6, 1,148 ± 162 µg/l). All results were significant (p < 0.01) compared to normals and compared to the nondialyzed group (p < 0.05). The level of serotonin decreased during hemodialysis regardless of the membrane used. There was no positive correlation of serotonin levels with pruritus or hypertension, although there was a negative correlation with systolic blood pressure. The reference range for serotonin whole blood levels needs to be broadened when considering dia

ISSN:0250-8095    

DOI:10.1159/000168411

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The treatment of peritonitis in continuous ambulatory peritoneal dialysis patients is empiric until the bacteriological results are available. The Lymulus amebocyte lysate assay (LAL) is a very sensitive method for the detection of endotoxin, a structural component of gram-negative bacteria. We performed the LAL assay in a prospective study in 36 consecutive episodes of peritonitis. The LAL assay was positive in all 10 episodes of gram-negative peritonitis (100% specificity). Treatment directed specifically against gram-negative or -positive infection was started based on the LAL assay result. In 26 episodes with LAL-negative test, a gram-positive bacterium was cultured in 23 episodes, in 1 there was fungal infection and 2 were sterile. In summary: the LAL assay is a rapid (1 h) and sensitive method for the differentiation of gram-positive or -negative peritonitis and enables starting an immediate and more appropriate antibiotic therapy.

ISSN:0250-8095    

DOI:10.1159/000168412

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

In order to clarify the difference of clinical and pathological features between the IgA nephropathy patients with acute and insidious onset, 427 patients were examined in this study. Seventy-eight patients with acute onset (group 1) were often associated with mucosal system infections at the abrupt onset. This group revealed macroscopic hematuria, more severe microscopic hematuria (more than 20/hpf), higher glomerular filtration rate (p < 0.01) and lower serum levels of C3 (p < 0.01). It had also a significantly higher incidence of exudative lesions (p < 0.001). On the other hand, the onset of 349 patients (group 2) was noticed to be insidious without preceding infections. This group showed a more severe increase in mesangial cells (p < 0.01) and a significantly higher incidence of adhesion, arterial sclerosis and tubulointerstitial changes. Deposition of Clq, C4 and IgM and detachment of visceral epithelium from the basement membrane were more frequently seen in group 2. Twenty-seven of 345 patients followed for at least 1 year after the biopsy were on maintenance hemodialysis: 1 patient was in group 1 and 26 were in group 2. These results clarified that there was a difference in clinical, laboratory and histopathological findings between the patients with IgA nephropathy with acute and insidious onset.

ISSN:0250-8095    

DOI:10.1159/000168413

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The peracetic acid-based sterilant Renalin® is increasingly being used for reprocessing hemodialyzers. In order to evaluate the effects of reprocessing on (32-microglobulin (β2M) kinetics and complement activation in chronic hemodialysis patients, we compared 4 dialyzer membranes on 1st, 2nd and 4th use of the membrane. Dialysis with new cuprammonium rayon dialyzers (0.8 m2) for 4 h resulted in a nonsignificant increase in serum β2M concentrations of 10.7% (corrected for changes in extracellular volume) and significant generation of the complement component C3a des Arg. On reuse, minimal changes in serum β2M levels were noted and complement activation was absent. Dialysis with new cellulose acetate (CA, 1.5 m2), polyacrylonitrile (AN69 HF, 1.6 m2) or polymethylmethacrylate (PMMA, 1.6 m2) membranes resulted in significant decreases in serum β2M levels (19.5, 31.7 and 50.8%, respectively). Reprocessing had negligible effects on the removal of β2M by CA and AN69, but by the 4th use halved the effectiveness of PMMA. Reprocessing reduced the significant generation of C3a des Arg observed with new CA and PMMA membranes. We conclude that, except for PMMA, Renalin reprocessing has minor effects on the ability of the membranes to remove β2M and improves the biocompatibility of all membranes s

ISSN:0250-8095    

DOI:10.1159/000168414

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Increased blood viscosity has been previously noted in a subgroup of patients with essential hypertension with concomitant high plasma renin activity (PRA). It has been suggested that the cause of hyperviscosity in hypertensives is the presence of circulating red blood cells (RBCs) that were rendered less deformable by significant alterations in their cationic milieu, namely an increase in intracellular concentration of calcium and sodium. The relation between RBC deformability and PRA however is not clear. Our study was conducted to examine this issue. RBC deformability was reduced experimentally, and its effects on renal blood flow, renal artery resistance, glomerular filtration rate and PRA were investigated in experimental (n = 8) and control (n = 4) groups of dogs. Blood was collected from the animals before the experiments and incubated with 0.025% glutaraldehyde. These hardened RBCs were administered to the animals through exchange transfusions. Following the exchange transfusion with the hardened RBCs, there were no changes in renal blood flow, renal artery resistance, and the creatinine clearance. The only change observed was an increase in PRA. In the control group, all parameters that were determined remained unchanged. The data are consistent with the notion that the presence of circulating hardened RBCs may by itself increase PRA, and this effect can be important in some types of hypertension and some other disorders in which impaired deformability of RBCs have been reported.

ISSN:0250-8095    

DOI:10.1159/000168415

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Volumetric analysis of urinary red blood cells (RBCs) was performed in two groups of patients: (a) 91 with glomerulonephritis (GN), 158 with non-glomer-ular diseases (non-GN) and 53 controls without haematuria; (b) 97 with GN and 41 with non-GN diagnoses and ≧ 2+ haematuria, analysed after modified sample preparation (isotonic dilution and haemolysis to eliminate non-RBC debris). In group A, diagnostic ranges were established for modal, mean and differential (urinary-peripheral blood modal) RBC volumes to differentiate GN from non-GN sources of blood loss according to RBC size. 54% (135/249) of modal volumes and 68% (124/183) with ≧2+ haematuria were within a diagnostic range of values, i.e. 40-180 fl (sensitivity ), and the source of haematuria was correctly identified in 85% (115/135) and 87% (108/124) of these, respectively (specificity). Of the remainder, with modal volumes 180 fl, 45% (51/114) were from GN and 55% (63/114) from non-GN specimens, along with 94% (48/53) controls without haematuria (non-diagnostic analyses). In contrast, whilst 90% (74/82) of mean volumes ≧ 110 fl and 94% (62/66) of differential volumes ≧ 0 fl were from non-GN specimens, values below these were common to both diagnostic groups so that diagnostic sensitivities were reduced to 38% (82/219) and 34% (66/193), respectively. In group B, haemolysis enabled extension of the diagnostic range of GN modal volumes down to 30 fl, whilst specificity of the test was enhanced with the modified sample preparation to 100% (86/86) versus 87% for those with ≧ 2+ haematuria from group A (p < 0.001). These findings illustrate the value of a standardized methodology for the assessment of urinary RBC volumes in the investigation of patients with unexplained urinary blood loss: diagnostic accuracy is enhanced with a classification of modal volumes and modified sample preparation in specimens with ≧ 2+ dipstick

ISSN:0250-8095    

DOI:10.1159/000168416

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The use of fractional excretion of sodium as a guide to renal perfusion is hampered by the prior use of natriuretic agents. The fractional excretion of urea (FEUr) has been shown to be affected by volume status. We, therefore, determined the value of the FEUr as a guide to renal perfusion. In 6 patients evaluated prospectively and in 87 patients evaluated retrospectively, a low FEUr (≤ 35 %) was found to be a sensitive index to renal perfusion, despite the prior administration of furosemid

ISSN:0250-8095    

DOI:10.1159/000168417

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Optimal route and frequency of administration of recombinant human erythropoietin (rHuEPO) have not yet been determined. There is some evidence to suggest that subcutaneous administration of rHuEPO may be more effective than the intravenous route in reversing renal anaemia. It is also unclear whether rHuEPO is more effective when given by a large intermittent dose or by more frequent multiple divided doses. We have compared the effect of twice weekly versus once weekly subcutaneous administration of rHuEPO in two groups of haemodialysis patients. At the end of 12 weeks of treatment with rHuEPO, the mean haemoglobin levels had risen from 6.9 ± (SD) 0.7 to 8.9 ± 1.3 g/dl in the once weekly group and from 7.2 ± 1.0 to 9.3 ± 1.6g/dlin the twice weekly group. The average doses of rHuEPO used during the study were 127 + 6 and 115 ± 18 U/kg body weight/week for the once weekly and twice weekly groups, respectively. Subcutaneous administration of low-dose rHuEPO is effective in reversing renal anaemia. Similar responses were obtained with once weekly and twice weekly regi

ISSN:0250-8095    

DOI:10.1159/000168418

出版商:S. Karger AG    

年代:1992

数据来源: Karger