ISSN:0250-8095    

DOI:10.1159/000166530

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

The present study evaluated thyroid hormone indices of patients with acute renal failure without other systemic illnesses (n = 12), as compared to patients with critical illnesses in the presence (n = 16) and absence (n = 6) of acute renal failure. Abnormalities in the group with acute renal failure alone included decreased serum levels of total T4 and T3, and elevated levels of free rT3. Serum levels of free T4 by equilibrium dialysis and the enzyme immunoassay, T3 uptake ratios, TSH and total rT3 were normal. These findings are consistent with the presence of decreased binding of T4 and rT3 to their serum carrier proteins. Critically ill patients with acute renal failure differed in that they had lower total T4 and T3 levels and elevated T3 uptake ratio values. As in the group with acute renal failure alone, total rT3 levels were normal and free rT3 values were elevated. The group with critical illness alone differed only in that the total rT3 concentrations were elevated in all patients. The alterations of thyroid hormone indices in acute renal failure are similar to those of other nonthyroidal illnesses with the exception of the normal total rT3 levels. This suggests that the failing kidney or the metabolic consequences of uremia specifically affect rT3 metabolism.

ISSN:0250-8095    

DOI:10.1159/000166531

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

5 (group 1) of 9 patients with systemic lupus erythematosus (SLE) who underwent a kidney biopsy during a 1 -year period had a noninflammatory renal microangiopathy which significantly narrowed or occluded the lumens of arterioles and terminal segments of interlobular arteries. Though these lesions resemble those of malignant hypertension and the thrombotic microangiopathies, their distinctive features, revealed by light, immunofluorescence and electron microscopy, differentiate them from the others. 4 of these 5 (group 1) patients developed hypertension; in 3 the microangiopathy predated the hypertension. None of the remaining 4 (group 2) patients without these lesions has become hypertensive. One group-1 patient with extensive lesions involving 40 % of intrarenal arterioles at biopsy developed renal failure shortly thereafter with increasing arteriolar involvement but unchanged glomerular histology.

ISSN:0250-8095    

DOI:10.1159/000166532

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

Hyperkalemia usually does not develop in chronic renal insufficiency until the glomerular filtration rate is very low. We studied 25 hyperkalemic patients with glomerular filtration rate ranging between 105 and 10 ml/min. 16 patients were unable to raise plasma aldosterone in response to hyperkalemia whereas the remainder of the patients increased plasma aldosterone to normal levels. Plasma cortisol levels were normal in both groups: At any given level of glomerular filtration rate, fractional potassium excretion, during baseline conditions, was significantly lower in both groups of patients than in controls. During stimulation of potassium excretion by NaHCO3, acetazolamide or Na2SO4 administration fractional potassium excretion was also lower in patients than in controls. Hyperchloremic metabolic acidosis was recognized in all but 2 patients of each group. These data indicate that hyperkalemia in patients with renal insufficiency, can arise either as a consequence of aldosterone deficiency or tubular unresponsiveness to this hormone.

ISSN:0250-8095    

DOI:10.1159/000166533

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

Presented is a unique case of accelerated hypertension in a 26-year-old black man. Clinically, the patient was found to have a left renal artery lesion and lateralizing renal vein renins. At surgery, a stenosing lesion was found in the artery supplying the upper pole of the left kidney. This was caused by a densely fibrotic mass involving the main renal artery. Microscopy revealed a necrotizing arteritis with no other arteries involved. This case of primary necrotizing arteritis of the main renal artery appears to represent a new entity because of its pathological and clinical differences with the known forms of large vessel arteritis. It is possible that this may represent a particularly acute and necrotizing stage of Takayasu’s aortitis, or an extremely rare case of classical periarteritis nodosa confined solely to the main renal artery. The renin tissue assays document the hyperreninemia produced by arterial stenosis. The differential diagnosis of the lesion is considered, and the pathophysiology of hypertension due to large vessel arteritis is discusse

ISSN:0250-8095    

DOI:10.1159/000166534

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

A patient with advanced chronic renal failure secondary to polycystic kidney disease suffered an episode of volume contraction during which his urinary sodium concentration fell to less than 5 mEq daily. Urine sodium excretion remained at this level when later in his course he became clinically volume expanded. The patient also suffered from Crohn’s disease and had an ileostomy from which he excreted from 100 to 150 mEq sodium daily. We propose that this patient’s capacity to produce urine virtually free of sodium despite advanced renal failure was a result of the persistent loss of sodium from his ileostomy. This sodium loss obviated the development of the adaptive natriuresis that usually occurs in the functioning nephrons of the diseased kidney and prevented the development of a ‘salt-losing’ t

ISSN:0250-8095    

DOI:10.1159/000166535

出版商:S. Karger AG    

年代:1981

数据来源: Karger

摘要:

A syndrome characterized by rapidly progressive ischemic necrosis involving large areas of the skin and muscle, and by peripheral gangrene associated with extensive vascular calcifications was observed in a patient with end-stage renal failure on chronic hemodialysis. In an effort to control the disease, parathyroidectomy was performed which resulted in rapid improvement of tissue perfusion. However, the patient eventually died from sepsis within 2 months after admission. This case presents the typical features of the syndrome of systemic calciphylaxis. The literature is reviewed searching for similar cases of this poorly recognized, but life-threatening, clinical syndrome. The pathogenesis, clinical manifestations, and therapy of this unusual and rapidly progressive, but potentially reversible, condition are reviewed with emphasis on its prompt recognition and appropriate management.

ISSN:0250-8095    

DOI:10.1159/000166536

出版商:S. Karger AG    

年代:1981

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000166537

出版商:S. Karger AG    

年代:1981

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000166538

出版商:S. Karger AG    

年代:1981

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000166539

出版商:S. Karger AG    

年代:1981

数据来源: Karger