ISSN:0250-8095    

DOI:10.1159/000166764

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

20 stable hemodialysis patients were maintained on a dialysate flow rate of 300 ml/min (QD 300) to determine the safety of prolonged reductions in dialysate flow rate. After 24 months, QD 300 compared to QD 500 resulted in no change in weight, blood pressure, BUN, hematocrit, creatinine, bicarbonate, potassium, cholesterol, or calcium. Serum phosphate concentration increased between month 13 and month 17 but then stabilized. No adverse symptoms developed. EEGs and motor nerve conduction studies following 24 months at QD 300 were normal. We conclude that QD 300 does not impair dialysis efficiency for most small molecules and saves $ 1.38 per patient per dialysis.

ISSN:0250-8095    

DOI:10.1159/000166765

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

Military anti-shock trousers (MAST) are extensively used in the management of various forms of clinical shock and are presumed to produce their antihypotensive effect by the autotransfusion of blood from the lower extremities. In the present studies we documented the renal response to (1) four hours of recumbency; (2) 4 h of MAST inflation at a pressure of 45 mm Hg over the lower extremities and 15 mm Hg over the abdomen, and (3) 4 h of thermoneutral head-out water immersion in a group of salt replete normal subjects. Similar studies were performed in a group of adults with nephrotic syndrome and edema. In both normal and nephrotic subjects only water immersion produced a natriuresis that was significantly greater than during recumbency. The mean natriuresis following MAST inflation in normal subjects was somewhat greater than that during recumbency but the difference was neither consistent nor statistically significant. We conclude that MAST inflation does not lead to central translocation of more fluid than what would be expected from the assumption of recumbent posture. Thus, MAST are unlikely to be of therapeutic benefit in the relief of edema in patients with nephrotic syndrome and a critical evaluation of their mechanisms of action in the management of hypotension is required.

ISSN:0250-8095    

DOI:10.1159/000166766

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

The quantitative aspects of dialysis kinetics are poorly understood by the majority of nephrology fellows in training. For this reason, we have developed three teaching programs for use on the Apple II computer. The programs, based on the dialysis equations ofGotch et al. [1] and Gotch [2], allow the student to alter each of the dialysis variables independently, and to graphically display the resulting dialysis curves, so that the effects of changing variables can be visually compared. The three teaching programs describe intradialysis kinetics, dialysis kinetics during a single intradialytic and interdialytic period, and dialysis kinetics during a 2-week interval.

ISSN:0250-8095    

DOI:10.1159/000166767

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

Renal biopsies were performed on 91 out of 99 patients with acute intrinsic renal failure. In all these 91 cases a clinical diagnosis was suggested by an experienced nephrologist unaware of the renal biopsy findings. Most diagnoses agreed with the histopathological findings, but there were important exceptions. On clinical grounds, acute tubulointerstitial renal disease was diagnosed correctly in 77% and acute glomerulonephritis in 56%. In 15% of the patients the clinical data did not permit any certain diagnostic suggestion. In about 20% the biopsy finding definitely influenced the choice of medical treatment. In those 15 patients who needed dialysis treatment, the biopsy findings helped in determining whether this need was temporary or permanent. Our results show that renal biopsy is valuable in settling the diagnosis, in determining the prognosis, and in planning the treatment of acute intrinsic renal failure.

ISSN:0250-8095    

DOI:10.1159/000166768

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

We have determined the level of persisting pneumococcal antibody in a group of nephrotic children vaccinated by us 5 years ago. Of the 19 vaccinated children, 2 have died and 1 has moved away. Sera from the remaining 16 patients were examined by radioimmunoassay to determine the antibody response to 11 of the 14 types contained in the polyvalent pneumococcal vaccine. The lowest protective level of geometric mean titre (GMT) of antibody in our laboratory is 300 ng antibody nitrogen per millilitre. 56% (9/16) of the patients showed adequate GMT 5 years after vaccination. All 9 patients had minimal change nephrotic syndrome. 44% (7/16) of the children had a GMT less than 300 ng antibody nitrogen per millilitre. 3 of these patients had focal sclerosis, 3 had membranoproliferative glomerulonephritis, and 1 patient had IgM nephropathy. Of these 7 patients, 1 with the lowest GMT (23 ng antibody nitrogen per millilitre) developed pneumococcal peritonitis. During this same period, in 20 other unvaccinated nephrotic patients followed continuously from 1976 to 1981, 7 cases of pneumococcal peritonitis occurred (p < 0.05). Additionally, 1 unvaccinated child died of pneumococcal sepsis. Our study indicates that patients with minimal change nephrotic syndrome continue to maintain adequate amounts of antibody, but those with disease other than minimal change nephrotic syndrome are unable to maintain an adequate level of antibody.

ISSN:0250-8095    

DOI:10.1159/000166769

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

Clindamycin phosphate (C-PO4) must be hydrolyzed to the active antibiotic, but whether this occurs within the peritoneal cavity during peritoneal dialysis is unknown. Therapeutic peritoneal levels are difficult to achieve after intravenous administration, so direct intraperitoneal instillation is preferred in treating dialysis-associated peritonitis. Therefore, the activation of C-PO4 in peritoneal dialysate was investigated. Fresh and ‘uremic’ peritoneal dialysates of 1.5 and 4.25% dextrose concentrations at pHs of 5.1 and 7.4 did not activate C-PO4. Clindamycin hydrochloride in this same fluid was active, ruling out uremic deactivators. A patient with peritonitis was treated with intraperitoneal C-PO4 5 μg/ml) serum and peritoneal levels were achieved. Infected (exudative) peritoneal dialysate drained from another patient with peritonitis activated C-PO4 in vitro. Commercial alkaline phosphatase added to uremic dialysate also activated C-PO4in vitro. C-PO4 was instilled into the peritoneal cavities of 10 noninfected patients. Exposure to the peritoneal membrane at two concentrations resulted in a 3% activation of C-PO4. From these observations it is clear that C-PO4 is only partially activated intraperitoneally. Uremia or uremic products in the dialysate do not deactivate the antibiotic. Exudative material (bacteria, white blood cells and proteins) in infected dialysate contribute to activation of C-PO4. The peritoneal membrane further assists in activation. We recommend that C-P04 be administered at a concentration of 167 mg/l of dialysate to ensure therapeutic peritoneal levels of the active antibiotic, especially after the exudative phase cl

ISSN:0250-8095    

DOI:10.1159/000166770

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

A noninvasive method for diagnosing thrombosis in the nephrotic syndrome could be useful clinically. We measured hematocrit, fibrinogen, creatinine, antithrombin III, plasminogen, and alpha-2-plasmin inhibitor levels in 20 patients with nephrotic syndrome objectively studied for the presence of thrombosis, and found that by using combinations of three or more of these variables good discrimination could be obtained between those patients with and without thrombosis. We conclude that it is possible to predict risk of thrombosis in nephrotic syndrome using relatively simple noninvasive laboratory tests.

ISSN:0250-8095    

DOI:10.1159/000166771

出版商:S. Karger AG    

年代:1984

数据来源: Karger

ISSN:0250-8095    

DOI:10.1159/000166772

出版商:S. Karger AG    

年代:1984

数据来源: Karger

摘要:

The treatment of the bleeding diathesis of renal failure remains unsatisfactory. 1-Deamino-8-D-arginine vasopressin (DDAVP) has recently been shown to shorten the prolonged bleeding time of renal failure and may as a result diminish the risk of clinical hemorrhage. We describe 2 cases where DDAVP was used successfully in the management of hemorrhage in the setting of renal insufficiency.

ISSN:0250-8095    

DOI:10.1159/000166773

出版商:S. Karger AG    

年代:1984

数据来源: Karger