ISSN:0250-8095    

DOI:10.1159/000168264

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Acquired cystic kidney disease has been related to improvement of anemia in dialysis patients. It has been suggested that this could be due to erythropoietin production by the cysts. We studied 110 patients, 58 on hemodialysis and 52 on continuous ambulatory peritoneal dialysis, with an age of 48.6 ± 14.78 years and a time on dialysis of 44.5 ± 35.53 months. A renal echography was performed in every patient, evaluating presence and number of cysts. These findings were related to the blood levels of hemoglobin, ferritin, and erythropoietin as well as to the number of transfusions prescribed during the year of the study. The serum erythropoietin level was 18.23 ± 12.14 U/l in hemodialysis patients, 15.04 ± 12.35 in patients on continuous ambulatory peritoneal dialysis, and 12.4 ± 4.7 U/l in the control group. Hemoglobin and erythropoietin were significantly higher in patients with polycystic kidney disease. Patients without cysts had the lowest levels of hemoglobin and erythropoietin, although no significant difference was found in those with multiple bilateral cysts or in those with 1–3 isolated

ISSN:0250-8095    

DOI:10.1159/000168265

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

We prospectively studied renal tubular function during 11 consecutive exacerbations of proliferative glomerulonephritis in 8 patients with systemic lupus erythematosus (SLE). We found a rise in the fractional excretion of β2-microglobulin (p ≤ 0.05) and dimercaptosuccinic acid (DMSA; p ≤ 0.02) during the exacerbations. These changes coincided with a fall in the glomerular filtration rate (p ≤ 0.02). Since fractional excretion of β2-micro-globulin and DMSA can be considered as markers for tubular function, their rise during exacerbation and their fall (p ≤ 0.01) to control values during remission indicate that tubular dysfunction frequently occurs during active proliferative glomerulonephritis in SLE and can be influenced by immunosuppressive treatment. As no correlation was found between the different tubular function studies and the activity index of tubulointerstitial abnormalities in the renal biopsy, it is suggested that tubular function studies are probably a more sensitive indicator of tubulointerstitial disease than this activ

ISSN:0250-8095    

DOI:10.1159/000168266

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The Canadian Erythropoietin Study Group conducted a randomized, placebo-controlled trial to examine the effect of human recombinant erythropoietin on the treatment of anemia in 118 hemodialysis patients. The effectiveness of therapy on hemoglobin concentration and quality of life has been reported elsewhere. Herein is reported the effect of erythropoietin therapy on blood pressure. Patients receiving erythropoietin had a significant increase in diastolic blood pressure (DBP; p = 0.001) and required increased antihypertensive medication. There was no difference in the incidence of severe hypertension (DBP > 110 mm Hg or hypertension-related seizure) between placebo-treated patients (13%) and those receiving erythropoietin (14%). The development of severe hypertension in erythropoietin-treated patients was associated with a history of receiving antihypertensive medication or having native kidneys in situ. In the first 5 weeks of the study, there was a correlation between the change in hemoglobin concentration and the change in DBP (r = 0.42, p < 0.001). Although erythropoietin therapy was associated with a significant increase in DBP, there was no difference between placebo- and erythropoietin-treated patients with respect to severe hypertension or hypertension-related seizures.

ISSN:0250-8095    

DOI:10.1159/000168267

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

We evaluated the dialyser reprocessing agent Renalin® in a 6-month prospective study of 2,759 dialyses on 59 patients. Dialysers were withdrawn after a maximum of 6 uses, and the average number of uses achieved was 4.5. Dialyser survival varied with the type of dialyser but was unaffected by the dialysate base. In vivo clearances of urea, creatinine and phosphate were not altered by reuse, but there was a small decrease in ultrafiltration characteristics of used dialysers. No clinically significant adverse event was attributed to reuse. Blood pressure was better preserved with used dialysers, and patients experienced significantly fewer intradialytic symptoms. Savings of over $A 25,000 were achieved during the study

ISSN:0250-8095    

DOI:10.1159/000168268

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Hyperlipemia is a very frequent complication of the diabetic patient on dialysis. There is difficulty of treatment with the diet, because the dietary restriction already imposed on these patients and the secondary effects and toxicity of the available drugs in uremics aggravate the problem. We have treated 22 diabetic patients on dialysis (8 on hemodialysis and 14 on continuous ambulatory peritoneal dialysis) suffering from hyperlipemia with pantethine, a physiological substance and coenzyme A precursor in the Krebs eycle. With the administration of an oral dose of 900mg/day we obtained a reduction of total cholesterol (275 ± 72 vs. 231 ± 54mg/dl; p < 0.001), very-low-density lipoprotein (VLDL)-cholesterol (66 ± 36 vs. 46 ± 18 mg/dl; p < 0.01) and triglycerides (332 ± 182 vs. 227 ± 90 mg/dl; p < 0.01) at 2 months. High-density lipoprotein (HDL)-cholesterol did not change, but the total cholesterol/HDL-cholesterol ratio decreased significantly (p < 0.05). Total cholesterol, VLDL and triglycerides showed a progressive and significant reduction at 4 and 6 months. No changes were observed in serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, uric acid, blood glucose and glycosylated hemoglobin. Gastric discomfort in 2 patients and pruritus in another one were the secondary effects related. Pantethine was shown to be a very effective hypolipemic agent in diabetic patients on dialysis with a great tole

ISSN:0250-8095    

DOI:10.1159/000168269

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

In order to ascertain whether there are abnormalities of nonenzymatic glycosylation in uremia, the levels of nonenzymatically glycosylated hemoglobin (GHb), and total plasmatic glycosylated proteins (PGP) were studied using the thiobarbituric acid (TBA) method, a procedure not interfered with by carbamylation. Total hemoglobin A1 (HbA1) and the A1c fraction were also determined by ion exchange chromatographic methods. Sixty-six end-stage renal disease patients (29 nondiabetic and 8 diabetic uremic patients on conservative treatment, 29 non-diabetic hemodialysis patients) and 56 controls (32 nonuremic diabetic patients and 24 healthy controls) were studied. High levels of GHb and total PGP were found in the nondiabetic uremic group on conservative treatment with all the methods used, but the persistence of high chromatographically determined HbA1 levels in hemodialysis patients contrasts with the results obtained with the other techniques, which showed lower values on hemodialysis. Nondiabetic uremic patients with abnormal oral glucose tolerance curves had significantly higher levels of TBA-determined GHb and PGP. Uremic diabetic patients had the highest glycosylation levels of all the studied groups. We conclude that there is an abnormal nonenzymatic glycosylation of proteins in uremia, independent of carbamylation reactions and partially corrected by hemodialysis.

ISSN:0250-8095    

DOI:10.1159/000168270

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The survival rate of critically ill patients who develop acute renal failure is extremely low, in spite of the sophisticated support systems, including dialysis. Therefore, it would be advantageous to identify, early in the disease course, those few survivors. We reviewed the clinical course of 43 consecutive critically ill patients who developed acute renal failure and were first dialyzed in an intensive-care unit setting to define comorbid conditions, present at the time of first dialysis, that were predictive of outcome. Mortality rate was 88%. Adult respiratory distress syndrome (p < 0.05), requirement for antibiotics (p < 0.01) and ventilatory failure (p < 0.01) impacted negatively on recovery of renal function. The most powerful predictor of mortality was the need for ventilatory support (p < 0.001). The presence of ventilatory failure at the initiation of dialysis predicted a 100% mortality (89–100%;,95% confidence limits). The initiation of dialysis in intensive-care unit patients with acute renal failure requiring ventilatory support did not alter the uniformly fatal outcom

ISSN:0250-8095    

DOI:10.1159/000168271

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The effect of the methylprednisolone (MP) pulse therapy on renal function was examined in 15 patients with renal or collagen disease. Three nephrotic patients who had reduced renal function and active renal disease with progressive deterioration of renal function prior to the use of MP developed transient renal failure following an MP pulse therapy. The renal failure in each case was reversed by discontinuation of MP and/or by forced diuresis using albumin and furosemide. We examined the correlations between the individual changes in serum creatinine (Scr), body weight (BW) and urine volume (UV) before and after the pulse therapy and other laboratory data such as Scr, total serum protein and albumin. There were significant correlations between a change in Scr on the one hand and changes in BW and UV, Scr and serum albumin on the other. These findings mean that the effect of the MP pulse therapy on renal function depends on the clinical state of the patient and that renal deterioration after the pulse therapy may be more marked in patients who are more nephrotic and more impaired in renal function and suggest that increasing sodium and water retention during an MP therapy and the associated renal interstitial edema, proposed as one of the mechanisms of acute renal failure occurring in patients with minimal-change nephrotic syndrome, may be responsible for the MP-induced transient renal failure.

ISSN:0250-8095    

DOI:10.1159/000168272

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The substitution of recombinant human erythropoietin (rhEPO) in chronic hemodialysis patients is often associated with the development of severe hypertension. In the present study, a systematical echocardiographic analysis was performed in 25 patients on maintenance hemodialysis during rhEPO therapy for at least 4 months. Referred to the total group, indices of left ventricular size decreased significantly. Left ventricular total volume and left ventricular mass were reduced considerably. Fractional fiber shortening and ejection fraction showed an impressing improvement. At a constant heart rate, stroke volume and cardiac output were reduced. Myocardial thickness did not alter under chronic rhEPO therapy. When subgroups were formed with respect to changes in blood pressure, all parameters investigated behaved very similar to the total group, irrespective of changes in blood pressure. Five patients with coronary heart disease and clinical signs of myocardial insufficiency were evaluated separately. These patients showed a decrease in left ventricular size and no evidence of a deterioration of myocardial function. We conclude from our results that rhEPO therapy in patients on maintenance renal replacement therapy has beneficial effects on left ventricular size and function; these effects are not significantly counteracted by the development of hypertension.

ISSN:0250-8095    

DOI:10.1159/000168273

出版商:S. Karger AG    

年代:1991

数据来源: Karger