摘要:

Six chronic hemodialysis patients acquired bloodstream infections (BSIs) with Klebsiella pneumoniae of the same serotype and similar plasmid profile during an 11-day period. The 6 case-patients were more likely than noncase-patients to have received dialysis during the fourth shift (p < 0.05) and to have their dialyzers reprocessed for reuse after those of the noncase-patients (p = 0.05). Investigation identified a patient during the same shift with an arteriovenous fistula infected with K pneumoniae. The dialyzer reprocessing technician did not change gloves between contacting patients and their dialyzers in the treatment area and reprocessing the case-patients’ dialyzers at the end of the fourth shift. We conclude that the outbreak of BSIs was caused by cross-contamination of the case-patients’ dialyzers with bacteria from the gloves of the reprocessing technician and by inadequate dialyzer disinfection. After revised dialyzer reprocessing techniques and glove-changing policies were instituted, no further clusters of BSIs occur

ISSN:0250-8095    

DOI:10.1159/000168793

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

During a period of 1 year we observed 12 African American patients who had smoked or sniffed cocaine for several years and presented to inner city hospitals with accelerated hypertension and renal insufficiency. Ten required maintenance dialysis; 1 recovered partially after a brief period of dialysis, and 1 had moderate renal insufficiency. In the absence of striking proteinuria, cardiomegaly or renal shrinkage, the probable diagnosis in most of the patients was primary accelerated hypertension. The clinical history suggested that the habitual use of cocaine had worsened the hypertension, made it more difficult to control or triggered an accelerated phase resulting in renal shutdown. At a time when billions of dollars are being spent on the treatment of end-stage renal disease, the harmful role of cocaine in susceptible individuals requires due attention.

ISSN:0250-8095    

DOI:10.1159/000168794

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

This paper reports a study on the treatment of predialysis patients with recombinant human erythropoietin (r-HuEPO). The haematocrit, haemoglobin, reticulocyte and platelet values as well as creatinine and creatinine clearance evaluated by standard and radio-isotopic methods before, during and after r-HuEPO treatment were determined. The slope of the inverse creatinine versus time curves was studied too. The authors did not observe any variation of the renal function parameters during and after study and suggest their protocol of r-HuEPO administration for predialysis patients.

ISSN:0250-8095    

DOI:10.1159/000168795

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Gallstones are quite prevalent in western countries (10-20% of adult population), but there are very few data about the prevalence of cholecystolithiasis in haemodialysis (HD) patients. In our study, we found – with real-time ultrasound – a prevalence of gallstones of 16% in patients with end-stage renal disease (ESRD) treated with HD which is similar to the prevalence in a non-uraemic control group matched for age and sex. In most of our HD patients, cholecystolithiasis was asymptomatic. HD patients with cholecystolithiasis were statistically significantly older than patients without gallstones. We found no differences in sex or duration of HD treatment in patients with and without cholecystolithiasis. The prevalence of cholecystolithiasis in patients with ESRD on HD is similar to that of a normal population though some data suggested a higher prevalence in HD patie

ISSN:0250-8095    

DOI:10.1159/000168796

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Since it was first discovered in the early 1980s, the role of atrial natriuretic peptide (ANP) in the control of fluid and electrolyte balance and blood pressure has been extensively studied in both health and disease. We report here a study of ANP and its relationship to corresponding changes in right atrial pressure (RAP) in patients with chronic renal failure (CRF) on haemodialysis compared to healthy controls. Although there was a positive correlation between RAP and ANP in both groups, the changes in ANP following changes in RAP between the two groups were not statistically significant. A unique observation was the response of RAP to changes in posture, with RAP falling significantly as expected in healthy controls in contrast to the exceptional absence of a significant fall in patients with CRF. Healthy controls demonstrated appropriate postural changes in plasma renin activity (PRA) despite marked suppression of PRA levels due to salt loading, in complete contrast to patients with CRF who, despite chronic fluid overload and elevated levels of ANP, continued to have grossly elevated PRA levels that failed to change significantly in response to changes in posture.

ISSN:0250-8095    

DOI:10.1159/000168797

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We have evaluated intracellular pH (pHi) and Na+/H+ exchanger activity in peripheral lymphocytes from 16 patients on regular acetate hemodialysis. All the patients were taking oral NaHCO3 supplementation (30 mmol/day), to maintain predialysis arterial blood acid-base status within normal range (pH 7.36 ± 0.02, PHCO3- 23.3 ± 1.2 mM, pC02 40.9 ± 1.4 mm Hg). pHi was measured, using the fluorescent probe BCECF (2’,7’-bis-carboxyethyl-5,6-carboxyfluorescein), both in nominal absence of bicarbonate (Hepes solution, pH 7.4; n = 10) and in the presence of HCO3-/CO2 buffer system (pH 7.4, [HCO3-] 25 mM, PCO2 40 mm Hg; n = 6). Predialysis pHi did not differ from controls when measured in the presence of HCO3-/CO2 (7.28 ± 0.04 vs. 7.29 ± 0.04, p = NS), but was lower in dialysis patients than in normal subjects (7.11 ± 0.04 and 7.20 ± 0.02, respectively; p < 0.05) when measured in Hepes solution. This suggested that bicarbonate-independent pHi regulation was abnormal in dialysis patients. To further characterize this abnormality of pHi regulation, lymphocytes were exposed to ethylisopropylamiloride, a specific Na+/H+ antiporter inhibitor, in Hepes solution; this maneuver induced a significantly lower decrement in pHi (0.04 ± 0.04 vs. 0.15 ± 0.03, p < 0.05) in dialysis patients than in controls, indicating reduced Na+/H+ exchanger activity in the patients. The rate of pHi recovery during the first 30 s after induction of various degrees of cell acidification (pHi range 6.2-7.0), which in the absence of HCO3-/CO2 is dependent on Na+/H+exchanger activity, was also reduced in the patients as compared to controls (p < 0.001). These findings demonstrate depressed Na+/H+ exchanger activity in lymphocytes from patients on chronic maintenance hemodialysis; accounting for the lower pHi in Hepes solution. However, this abnormality does not prevent pHi to be mainteined in the normal range in the presence of the physiological buffer HCO3-/CO2 and poss

ISSN:0250-8095    

DOI:10.1159/000168798

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Patients with gouty arthritis were examined at Veterans General Hospital to evaluate whether their renal function is impaired and to define the factor(s), if any, of renal function deterioration. A total of 152 cases were included in the study, and the patients were divided into two groups. One group (n = 80) exhibited pure gout without any associated medical problems or preexisting renal disorders. The second group (n = 72) included patients with gout and hypertension. The group with pure gout was further stratified into patients with tophi (n = 21) and those without (n = 59). Seventy-two sex- and age-matched normal adults served as the control group. We found (l)that the renal function was impaired in the pure-gout group when compared with sex-and age-matched normal individuals (serum creatinine 1.56 ± 0.64 vs. 0.90 ± 0.16mg/dl, p = 0.0001; creatinine clearance 59.91 ± 30.90 vs. 97.10 ± 27.19 ml/min, p = 0.0001); (2) that the renal function was significantly more aggravated in patients with clinically visible tophi than in those without (gout with tophi vs. gout without tophi: serum creatinine 1.89 ± 0.90 vs. 1.44 ± 0.48 mg/dl p = 0.040; creatinine clearance 47.27 ± 31.90 vs. 64.40 ± 29.53 ml/min, p = 0.030), and (3) that a further significant decline of the renal function was noted in gouty patients with an associated medical illness, i.e., hypertension (gout with hypertension vs. pure gout: serum creatinine 2.10 ± 0.97 vs. 1.56 ± 0.64 mg/dl, p = 0.0001; creatinine clearance 45.06 ± 24.69 vs. 59.91 ± 30.90 ml/min, p = 0.0029). From image studies, i.e., renal sonogram and KUB film, it was determined that 19 out of 21 cases with tophaceous gout had highly echogenic and radiolucent lesions scattered over the corticomedullary junctions of both shrunken kidneys. Renal biopsy was performed in 4 such patients with tophaceous gout and impaired renal function, and pathological investigation disclosed a mixture of tubular, interstitial, and vascular lesions. Most importantly, the presence of urate deposits with giant cell reaction in the medullary interstitium was characteristic in all our patients. A fairly satisfactory association could be found with clinically visible tophi, with radiolucent and highly echogenic lesions in the kidneys, and with the distinctive presence of urate deposits in the renal medulla. This paper draws attention to the importance that gouty kidney, lead poisoning, or genetic factors may play a role in the pathogenesis of renal disorder of gou

ISSN:0250-8095    

DOI:10.1159/000168799

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Renin-angiotensin-aldosterone system, plasma atrial natriuretic peptide (PANP), and blood volume (BV) have been investigated in 20 nephrotic patients with normal renal function and with (group 1; n = 12) or without (group 2; n = 8) sodium retention. Patients of group 1 had a plasma albumin (PALB) concentration 1.7 g/dl, and the other parameters were normal. The spontaneous intake of dietary sodium was lower in group 1 than in group 2. In all patients the BV was directly correlated with PALB, and the plasma renin activity (PRA) was inversely correlated with both BV and PALB. A nonlinear inverse relationship was present between plasma aldosterone (PALD) levels and fractional excretion of sodium (FENa). The acute expansion of the BV in patients of group 1 normalized PRA, PALD, PAII, FENa, and FELi and increased PANP. The administration of spironolactone to the patients of both groups had variable effects on FENa, did not modify PRA and PALD, and reduced body weight, PANP, and FELi, thus suggesting that the reduction of BV induced by the drug increased the proximal reabsorption of sodium. Three additional patients who had sodium retention, PALB of 2.3-2.4 g/dl, normal PRA and PALD, elevated urinary excretion of aldosterone, and a slightly low PANP showed a spontaneous normalization of urinary aldosterone and PANP associated with natriuresis and weight loss, but thereafter urinary aldosterone increased, PANP decreased, and the sodium retention began again. Our data suggest that in nephrotic patients with severe hypoalbuminemia, contraction of BV plays a major role in promoting the sodium retention through the activation of compensatory hormonal mechanisms. On the other hand, when PALB is not severely reduced, the patients have normal BV, but they are very sensitive to small changes of BV which are better evidenced by modifications of the urinary excretion of aldosterone and PANP rather than by the profiles of PRA and PALD.

ISSN:0250-8095    

DOI:10.1159/000168800

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Rheumatic disorders are common complications in patients on long-term hemodialysis (HD), and abnormalities of collagen metabolism in the musculoskeletal system have been suggested in these patients. Since collagenase, which catalyzes the initial step in the proteolytic degradation of collagen, plays an important role in the metabolism of collagen, the present study investigated whether factor(s) present in the sera from patients on long-term HD stimulates collagenase gene expression in synovial cells. The addition of sera from 8 patients on long-term HD resulted in 1.5- to 4.0-fold increases in the collagenase mRNA level in human synovial cells as compared with that of sera from normal subjects. The collagenase-inducing factor(s) in uremic sera is more than 3,000 D in molecular mass and shows no binding to heparin. Uremic sera also increased stromelysin mRNA, but failed to exert any effect on mRNAs for tissue inhibitor of metalloproteinases and proαl(I)collagen. Our findings suggest that there exists a factor(s) to enhance degradation of synovial collagen in sera from long-term HD patients

ISSN:0250-8095    

DOI:10.1159/000168801

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Immune cell subsets, when measured by two-color flow cytometry in a population of 129 hemodialysis patients, showed significant variance from normal values. Lymphopenia, decreased absolute counts, and altered percentage values of immune cells were found. Increased proportions of CD3+, T cell receptor (TCR) αβ+ cells and CD4+ T lymphocytes were present. An abnormally high percentage of a subset of activated TCR αβ+ cells (αβ+ DR+) was also seen in hemodialysis patients. The proportion of B lymphocytes was found to be significantly lower as compared with controls. Relative values for TCR γδ+ cells, both for activated (γδ+ DR+) and nonactivated (γδ+ DR-) subsets, as well as for CD8+ lymphocytes and natural killer cells did not vary from those of normal controls. Also, the CD4+/CD8+ ratio showed no significant change. Analysis of absolute counts of the investigated immune cell populations revealed significantly decreased numbers for the majority of subsets, as a result of the preexisting lymphocytopenia, characteristic of end-stage renal disease. We conclude that profound quantitative alterations of immune cells, including TCR+ T cells subsets, exist in hemodialysis patients. These account, at least in part, for the immune dysregulation associated with chronic re

ISSN:0250-8095    

DOI:10.1159/000168802

出版商:S. Karger AG    

年代:1995

数据来源: Karger