bluuebunny/crossref_metadata_2025 huggingface dataset:
Urea Reduction Ratio Considering Urea Rebound
Authors: Maduell F. , Garcia-Valdecasas J. , Garcia H. , Hdez-Jaras J. , Sigüenza F. , del Pozo C. , Giner R. , Moll R. , Garrigos E.
Published: April 2003

An American National Study shows that survival benefits from higher dialysis doses appear to be present up to a Kt/V level of 1.3 or a urea reduction ratio (URR) of 70%. The effect of increasing dialysis efficiency magnified urea rebound and the error in URR determinations. Several formulas have been developed to calculate URR considering the urea rebound (URRr). Smye and coworkers have proposed a method whereby the equilibrated blood urea nitrogen is predicted by additional intradialytic urea sample. Maduell and colleagues, based on analysis of postdialysis urea rebound, have proposed a method whereby the urea rebound is predicted. To compare measured URRr to estimated by Smye and Maduell formulas, 384 patients were studied, 211 males and 173 females, who received a dialysis session with their habitual parameters. Measurements of plasma urea concentration were obtained at the beginning, 90–100 min following the start of dialysis, at the end, and 45 min after dialysis. The postdialysis urea rebound was 22.4 ± 9.7%. The urea kinetic model Kt/V was 1.365 ± 0.26, and Kt/Vr was 1.14 ± 0.23. URR was 68.7 ± 6.6%, and when it was calculated with urea rebound, it decreased to 61.9 ± 7.4%. The URRr correlated with calculations by Smye and Maduell formulas: 60.7 ± 8.4 (r = 0.722, p < 0.001) and 61.8 ± 6.6 (r = 0.933, p < 0.001), respectively. The precision of estimated limits of agreement and percentage of error by Bland and Altman analysis show that URRr estimated Maduell formula could be used in place of the URRr. Otherwise, the degree of agreement of the Smye method was not clinically acceptable. In conclusion, our results led us to suggest that in actual dialysis, the use of URR is not adequate for delivered hemodialysis dose, and URRr should be used. URRr estimated by Maduell formula could be a simple and accurate method for use in clinical practice. The recommended dialysis dose by the American National Study of URR of 70% could correspond, considering urea rebound, to Kt/Vr 1.18 or URRr of 64%.
Dipyridamole Inhibits Human Mesangial Cell Proliferation
Authors: Hillis Graham S. , Duthie Lesley A. , MacLeod Alison M.
Published: April 2003

Background: Many glomerular diseases are associated with mesangial cell proliferation and the accumulation of extracellular matrix. At present, there are, however, few treatments which can inhibit these processes. The current study assessed the effects of the anti-platelet and putative anti-proliferative drug dipyridamole (DP) on the growth of human mesangial cells in vitro and their production of the extracellular matrix protein, fibronectin. Methods: Human mesangial cell proliferation, both intrinsic and stimulated by platelet-derived growth factor, was assessed using 3H-thymidine incorporation and an MTT proliferation assay. A sandwich enzyme-linked immunosorbent assay was used to study the effects of DP on fibronectin synthesis, again in cells stimulated by transforming growth factor beta 1 and in unstimulated cells. Results: At concentrations compatible with the serum levels found in subjects consuming standard dosages, DP significantly inhibited the growth of human mesangial cells in vitro in a dose-dependent fashion. DP also abrogated the mitogenic effects of platelet-derived growth factor. It had no significant effects on the synthesis of fibronectin by these cells (either spontaneous or induced by transforming growth factor beta 1). There was no evidence of cytotoxicity. Conclusion: These data suggest that DP may have a therapeutic role in proliferative glomerulonephritis and possibly other diseases characterized by cell proliferation.
The Proliferative Responsiveness of Mesangial Cells to Postnephrectomy Serum Declines Progressively with Time Elapsing after Contralateral Nephrectomy
Authors: Weissgarten J. , Modai D. , Cohn M. , Berman S. , Averbukh Z.
Published: April 2003

Postnephrectomy serum has been proved to enhance proliferation of mesangial cells in culture. Studies in offspring to uninephrectomized (UNx) mothers indicate that it remains active for a long period following UNx. On the other hand, postnephrectomy renal compensatory growth in vivo is known to be completed within a short period. In this study we assessed the proliferative responses of mesangial cells from single kidneys of rats which were cultured 48 h or 4 months following contralateral nephrectomy. The proliferative stimulus was provided by different postnephrectomy sera. Proliferation of both experimental cell populations was significantly greater than that of controls. Moreover, the proliferation rate of early postcontralateral nephrectomy mesangial cells was greater than those harvested 4 months after nephrectomy. We, therefore, propose that the early in vivo completion of single kidney compensatory hypertrophy, at least in part, is due to progressive blunting of renal cell responsiveness to the mitotic stimulus of the animal’s serum.
Cardiac Arrest Caused by Maprotiline in an Elderly Hemodialysis Patient
Authors: Fukunishi Isao , Kitaoka Tateki , Shirai Tetsuo , Watanabe Susumu
Published: April 2003

It is commonly known that patients with a depressive disorder often have some medical comorbidity due to antidepressant medication, although tricyclic antidepressants are associated with cardiovascular disease [1]. They are often given to cardiac patients [1–3]. In particular, amitriptyline has been reported to account for approximately 39% of the deaths due to a tricyclic overdose [2]. Several studies have demonstrated that maprotiline, a tetracyclic antidepressant with noradrenaline reuptake inhibition, produces fewer cardiovascular effects than tricyclics [4]. Recent studies, however, have shown that the cardiac effects of maprotiline do not differ either in quality or quantity from those of the tricyclic substances. We report here on an elderly depressed patient on hemodialysis who had a cardiac arrest which may have been caused by maprotiline [1, 2].
Hints for Successful Use of Subcutaneous Glofil-125
Authors: Turkel C. , Fox A.
Published: April 2003

Radio-labeled sodium iothalamate (Glofil-125) is a popular agent for the measurement of the glomerular filtration rate (GFR). The FDA-approved route of administration is by intravenous injection or continuous infusion. Israelit et al. [1], in 1973, first reported the subcutaneous route of administration. Subsequently, several investigators have validated the accuracy of this method of administration in the clinical setting [2–4]. As the pharmacist and pharmaceutical physician responsible for Glofil-125, we would like to offer the following comments from our experience in assisting with recent medical information inquiries about this product.
Renal Dysfunction Worsened by Superimposition of IgA Glomerulonephritis in a Patient with Overt Diabetic Nephropathy
Authors: Kawasaki Isao , Ishimura Eiji , Shioi Atsushi , Emoto Masanori , Kawagishi Takahiko , Goto Kiyoshi , Wakasa Kenichi , Nishizawa Yoshiki , Morii Hirotoshi
Published: April 2003

The combination of glomerulonephritis and diabetes nephropathy has been reported to occur in 1.8–22% of biopsy-proven diabetic nephropathy cases [1–6]. In these reports, however, the onset of glomerulonephritis during the course of diabetic nephropathy was not described in detail, and how the superimposition of glomerulonephritis affected renal function, particularly at the advanced stage of diabetic nephropathy. We recently encountered a patient, in whom the onset of IgA glomerulonephritis was detected clinically during the advanced stage of overt diabetic nephropathy. In this case, the onset of glomerulonephritis significantly increased the progressive deterioration of renal function.
High-Fiber Diets May Be Responsible for Hypomagnesaemia in Diabetic Patients
Authors: Mullis Primus-E. , Bianchetti Mario G.
Published: April 2003

Dietary fibre is a subject of considerable recent interest, not only with respect to diabetic diets. Water-insoluble fibres may be beneficial in treating or preventing several gastrointestinal disorders, including colon cancer, and large amounts of water-soluble fibres have a positive effect on serum lipids and may delay glucose absorption without inducing malabsorption. Therefore daily consumption of a diet containing 20–35 g (15 g/1,000 kcal) dietary fibre from a wide variety of food sources is recommended [1].
Association of Apolipoprotein E Polymorphism with Lipoprotein Glomerulopathy
Authors: Yang An Hang , Ng Yee Yung , Tarng Der-Cherng , Chen Jinn Yang , Shiao Ming Shi , Kao Jau Tsuen
Published: April 2003

Two cases of lipoprotein glomerulopathy with a new apolipoprotein E (Apo E) genotype, Ε3/Ε4, were diagnosed recently. These 2 cases, together with other cases documented in English literature made a total of 6 common isoforms of Apo E encountered in lipoprotein glomerulopathy. Although the calculated allele frequency of Ε2 is relative high in cases with lipoprotein glomerulopathy as compared with that in the general population (39.3 vs. 6.4–11.4%), the gradual emergence of Apo E isoforms other than E2/E3 in lipoprotein glomerulopathy implicates that the genetic susceptibility of certain Apo E isoforms may not be a crucial factor. An alteration in the local environment of glomerular capillaries may be more important in the pathogenesis of lipoprotein glomerulopathy.
Interleukin 12 Upregulates the Release of Vascular Permeability Factor by Peripheral Blood Mononuclear Cells from Patients with Lipoid Nephrosis
Authors: Matsumoto Koichi , Ohi Hiroyuki , Kanmatsuse Katsuo
Published: April 2003

The vascular permeability factor (VPF) is a lymphokine that has been shown to play a role in lipoid nephrosis (LN). Prior studies have shown that interleukin (IL) 12 promotes T helper type 1 differentiation and enhances production of T helper type 1 cytokines such as gamma interferon and IL-2. We, therefore, investigated the effects of recombinant human IL-12 on the release of VPF by peripheral blood mononuclear cells (PBMC) from LN patients. The VPF activity was measured according to the method of Ovary, with minor modifications. The goal of the present study was to examine the importance of IL-12 in concanavalin A induced VPF release in vitro. The levels of VPF were measured in a group of healthy subjects, LN patients with or without the nephrotic syndrome, and patients suffering from IgA nephropathy. There was a significantly increased concanavalin A induced release of VPF in LN and IgA nephropathy patients with nephrotic syndrome as compared with normal controls. Recombinant human IL-12 was found to enhance VPF release in a dose-dependent manner. Neutralization of endogenously produced IL-12 by anti-IL-12 antibody resulted in a decreased release of VPF by LN PBMC. These data indicate that endogenously produced IL-12 functions as a costimulatory molecule in vitro. Our data show that IL-12 can upregulate the release of VPF derived from LN PBMC. Thus IL-12 might be a potent adjuvant for inducing VPF. Therefore, IL-12 antagonists may interfere with newly initiated and ongoing VPF release associated with nephrotic syndrome.
Deposition of IgG Anti-Actin Antibodies on Kidneys of Glomerular Nephropathy Patients with an Enhanced Glomerular Alpha Smooth Muscle Actin Expression
Authors: Adyel Fatima Zahra , Makni Hafedh , Hachicha Jamil , Jlidi Rachid , Trigui Najib , Ayadi Hammadi
Published: April 2003

In this study, we have attempted to evaluate by immunohistochemistry assay the glomerular alpha smooth muscle actin (ASMA) expression in 53 kidney biopsy specimens obtained from patients with glomerular nephropathy as compared with 16 histologically normal human kidneys. An enhanced mesangial ASMA expression was observed in 26 of 53 specimens of patients with glomerulonephritis. In contrast, normal glomeruli showed no ASMA-positive mesangial cells. Furthermore, we have analyzed the specificities of antibodies eluted from kidney biopsy specimens from patients and controls using an enzyme immunoassay against a panel of self antigens composed of actin, myosin, tubulin and DNA. The antibodies eluted from exclusively renal biopsy specimens of patients with an enhanced glomerular ASMA expression showed high IgG activity restricted to actin. Our results demonstrated the presence of IgG anti-actin activity in glomerular nephropathy patients with an enhanced mesangial ASMA expression.
Effect of Hemodialysis on the Dispersion of the QTc Interval
Authors: Cupisti Adamasco , Galetta Fabio , Morelli Ester , Tintori Giancarlo , Sibilia Gabriella , Meola Mario , Barsotti Giuliano
Published: April 2003

The QTc dispersion reflects the underlying regional heterogeneity of the recovery of the ventricular excitability, thereby it is considered as a novel marker of risk of ventricular arrhythmias. Because a higher incidence of ventricular arrhythmias is described during and after hemodialysis, the aim of this study has been to evaluate the QTc dispersion before and after uncomplicated hemodialysis session. Twenty chronic uremics without heart failure, ischemic heart disease or dialysis hypotension were selected. The QTc dispersion was determined as the difference between the longer and the shorter QTc interval measured on a 12-lead electrocardiogram. Following the hemodialysis session, the QTc dispersion increased from 30 ± 9 to 54 ± 17 ms (p < 0.001) associated with the expected reduction of potassium and magnesium and with the increase of extracellular calcium concentration. However, no correlation has been observed between the QTc dispersion increase and the degree of the intradialytic changes of plasma electrolytes, blood pressure or body weight. In summary, the hemodialysis treatment per se does induce an increase of the QTc dispersion, likely due to the rapid changes of electrolyte plasma concentrations. This can potentially contribute to the arrhythmogenic effect of the hemodialysis procedure, reflecting an enhanced regional heterogeneity of ventricular repolarization. The clinical importance of the increase of QTc dispersion as risk factor of ventricular arrhythmias, particularly in hemodialyzed patients suffering from ischemic or hypertrophic heart diseases, should be the matter of further investigations.
Detection of Apoptotic Cells in Glomeruli of Patients with IgA Nephropathy
Authors: Tashiro Kyoichi , Kodera Sanki , Takahashi Yutaka , Horikoshi Satoshi , Shirato Isao , Tomino Yasuhiko
Published: April 2003

The purpose of the present study was to determine the relationship between the existence of apoptotic cells in glomeruli, clinical or histopathological findings and response to treatment in patients with IgA nephropathy. Renal biopsy specimens were obtained from 23 patients with IgA nephropathy. These patients were divided into two groups: mild glomerular damage (12 patients), and severe glomerular damage (11 patients). The nick end-labelling method (TUNEL) and fluorescent staining (Hoechst 33258) were used for the detection of apoptotic cells. Five of 6 patients with apoptotic cells in the glomeruli detected by TUNEL were in the severe glomerular damage group, and only 1 patient was in the mild glomerular damage group. Apoptotic cells in glomeruli were also detected by fluorescent staining in 3 of 5 patients in the severe glomerular damage group who showed apoptotic cells in TUNEL. However, no apoptotic cells were detected in patients in the mild glomerular damage group in fluorescent staining. Mean levels of urinary protein excretion at the time of renal biopsy in the patients with apoptotic cells were significantly higher than those in patients without apoptotic cells (p < 0.01). The mean levels of creatinine clearance (Ccr) in the patients with apoptotic cells were slightly lower than those in patients without such cells. There were no significant differences in the levels of serum creatinine (s-Cr) and BUN in patients with or without apoptotic cells. In the severe glomerular damage group, urinary protein excretion after treatment in the patients with apoptotic cells was significantly improved compared with that in the patients without such cells (p < 0.01). It appears that the levels of proteinuria and renal function tests might be influenced by apoptosis in patients with IgA nephropathy. It is postulated that apoptosis may induce reduction of excess proliferative mesangial cells and/or infiltrated cells, and tissue repair. Thereafter, these histological alterations may improve proteinuria and renal function.
Urinary Soluble HLA Class I Antigen in Patients with Minimal Change Disease: A Predictor of Steroid Response
Authors: Park Cheol Whee , Song Ho Chul , Shin Young Sin , Ahn Suk Joo , Kim Yong Soo , Kim Suk Young , Choi Eui Jin , Chang Yoon Sik , Bang Byung Kee
Published: April 2003

In primary minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS), increased lymphocyte reactivity to renal antigens has been defined. Soluble HLA class I antigen (sHLA-I) is actively secreted by T and B lymphocytes when they are stimulated by mitogens, antigens and lymphokines. To determine if serum and urine sHLA-I levels could predict steroid response in patients with MCD and differentiate those from FSGS, we have investigated 45 healthy controls, biopsy-proven 17 patients with MCD (edema and 24-hour urine protein >3.5 g/day), 8 patients with FSGS (24-hour urine protein >1 g/day) and 10 patients with membranous nephropathy (MGN) (24-hour urine protein >1 g/day). Before and after prednisone therapy (1 mg/kg/day or 2 mg/kg/EOD for 8 weeks), the levels of serum and urinary sHLA-I were measured by ELISA (sHLA-STAT; Sangstat Co., Calif., USA). After 8 weeks of treatment, 10 patients with MCD were responders (MCD-CR) while the other 7 patients with MCD were nonresponders (MCD-NR). Three of 7 patients with MCD-NR were re-biopsied and finally diagnosed as FSGS. They were included in the data of patients with FSGS. In healthy controls, serum sHLA-I was detected (415 ± 256 ng/ml), but urinary sHLA-I was not. At entry, there were no differences in age, sex, serum Cr and 24-hour urine protein among the patients with MCD-CR, MCD-NR and FSGS, but serum albumin was significantly elevated in patients with FSGS and MGN (p < 0.05). Serum sHLA-I levels were notably elevated in MCD-CR (1,040 ± 1,066 ng/ml), in MCD-NR (668 ± 315 ng/ml) and in FSGS (713 ± 790 ng/ml), but not in patients with MGN (444 ± 86 ng/ml) when compared with controls (p < 0.05). On the other hand, urinary sHLA-I levels in MCD-NR (541 ± 239 ng/mg Cr) and in FSGS (457 ± 239 ng/mg Cr) were significantly higher than those in MGN (125 ± 28 ng/mg Cr) and in MCD-CR (100 ± 42 ng/mg Cr, p < 0.05) and these substantial differences were maintained for 8 weeks. In all patients, serum and urinary sHLA-I levels were not reduced during 8 weeks of steroid therapy. We conclude that elevated serum and urinary sHLA-I levels reflect increased cellular immune response and disease activity in patients with MCD and FSGS. In patients with MCD, urinary sHLA-I may be an easily measurable indicator of predicting steroid response, while MCD-NR with high urinary sHLA-I levels might be re-evaluated for the possibility of FSGS.
Transcription of the XRCC1 Gene in Kidneys of Radiosensitive and Radioresistant Mice following Whole-Body Irradiation
Authors: Labudova Olga , Hardmeier Rosmarie , Kitzmüller Erwin , Rink Hermann , Lubec Gert
Published: April 2003

The XRCC1 gene was described to play a role in the sensitivity of mammalian cell lines towards ionizing irradiation. Cells with a mutation of this gene present with decreased single-strand break repair and reduced recombination repair, show increased double-strand breaks, and the sister chromatid exchange is increased up to tenfold. The goal of our study was to investigate the transcription of this gene in the kidney following ionizing irradiation in the mouse, as this could be relevant to the pathogenetic mechanisms found in radiation nephropathy. Furthermore, we intended to examine whether radiation-sensitive mice would show a transcriptional pattern different from radiation-resistant mice. Radiation-sensitive BALB/c/J/Him mice and radiation-resistant C3H/He/Him mice were whole body irradiated with X-ray at 2, 4, and 6 Gy and sacrificed 5, 15, and 30 min after irradiation. mRNA was isolated from kidney cortex and hybridized with probes for XRCC1 and β-actin as a housekeeping gene control. Following irradiation at 2 Gy, radiation-resistant mice increased transcriptional levels of mRNA-XRCC1/mRNA-β-actin as early as after 5 min, and 15 and 30 min after irradiation, XRCC1 transcription was still higher than in radiation-sensitive mice. At higher radiation doses, no differences were found. This finding is the first in vivo study on XRCC1 of this kind and may in part explain the differences in the radiation sensitivity between the two strains studied.
Effect of Mizoribine on Glomerulonephritis of Early-Stage IgA Nephropathy in ddY Mice
Authors: Shimizu Masahiko , Shou Ichiyu , Tsuge Toshinao , Abe Masaaki , Tomino Yasuhiko
Published: April 2003

Immunopathological studies were performed to determine whether the glomerular injuries in ddY mice, a model for IgA nephropathy (Berger’s disease), are influenced by treatment with mizoribine, a new immunosuppressive agent. The ddY mice were treated with a low (0.05 mg/ml) or a high (0.1 mg/ml) dose of mizoribine for 35 weeks. Flow cytometry analysis showed that there was a marked decrease in the number of B cells and IgA-bearing B cells. In immunofluorescence, the deposition of IgA in the glomerular mesangial areas and capillary walls of the high-dose mizoribine-treated ddY mice was markedly decreased as compared with that of control ddY mice receiving drinking water. The glomerular mesangial expansion in the high-dose mizoribine-treated ddY mice was milder than that found in the control ddY mice. In 45-week-old ddY mice, the average number of intraglomerular cells in the high-dose and low-dose mizoribine-treated ddY mice was slightly lower than that in drinking water treated ddY mice. The levels of urinary protein excretion in the high-dose mizoribine-treated ddY mice were also lower than those in the low-dose mizoribine-treated or drinking water treated ddY mice. It appears that treatment of mizoribine might influence the proliferation of B cells, especially IgA-bearing B cells, and improve the glomerular IgA deposition and glomerular expansion in early-stage IgA nephropathy of ddY mice.
Purification, Characterization and Differentiation-Dependent Expression of a Perchloric Acid Soluble Protein from Rat Kidney
Authors: Asagi Kozo , Oka Tatsuzo , Arao Keisuke , Suzuki Isao , Thakur Mahendra Kumar , Izumi Keisuke , Natori Yasuo
Published: April 2003

We have recently reported the presence of a novel perchloric acid soluble protein in rat liver (PSP1) that inhibits cell-free protein synthesis in a rabbit reticulocyte system. While studying the perchloric acid soluble proteins from different tissues of rats, we found that the kidney protein cross-reacted with antibody against the PSP1. In this investigation, we have purified a perchloric acid soluble protein from the rat kidney and studied its characterization and expression. The protein extracted from the postmitochondrial supernatant fraction with 5% perchloric acid was purified by ammonium sulfate fractionation and CM-Sephadex chromatography. By immunoscreening with the rabbit antisera against the PSP1, we detected a cDNA that contained an open reading frame of 411 bp, encoding a 137 amino-acid protein with a molecular mass of 14,149 daltons. The deduced amino acid sequence was completely identical with that of PSP1 from rat liver. The perchloric acid soluble protein from rat kidney (K-PSP1) also inhibited cell-free protein synthesis in the rabbit reticulocyte lysate system in a different manner than RNase A. Immunohistochemistry showed that the expression of K-PSP1 increased from fetal 17th day to postnatal 4th week, and it remained almost the same until the 7th week of postnatal age. Furthermore, the expression of K-PSP1 in the kidney of the nephrotic rat model was shown to be differentiation dependent. On the other hand, the expression of K-PSP1 in renal tumor cells was downregulated as compared with intact tissue. These results suggest that the expression of K-PSP1 is regulated in a differentiation-dependent manner in the kidney.
Long-Term Enalapril Therapy in Patients with Chronic Renal Failure on a Low-Protein Diet
Authors: Shiigai Tatsuo , Hattori Koji , Iwamoto Hitoshi , Owada Akira
Published: April 2003

The effect of enalapril (5–10 mg/day) on the progression of chronic renal failure (CRF) was compared with that of metoprolol (40–120 mg/day) in 28 patients for 24 months in a prospective study. Throughout the study, there was no significant difference between the 2 groups in protein intake and urinary sodium excretion. But there was a significant difference between the 2 groups in diastolic and mean arterial blood pressure at 6 months. In the serum creatinine level, there was a significant difference between the 2 groups at 6, 12, 18, and 24 months. In creatinine clearance, there was a significant difference between the 2 groups at 24 months. In addition, the progression of CRF was significantly faster in the metoprolol group than the enalapril group as estimated from the slope of creatinine clearance (p < 0.05) and the slope of glomerular filtration rate (p < 0.0005). In urinary protein excretion, there was a significant difference between the 2 groups at 6 and 18 months (p < 0.05). These findings indicate that enalapril has a suppressive effect on the progression of CRF and also has an antiproteinuric effect by a mechanism independent of its antihypertensive effect.
Effects of Extracorporeal Shock Wave Lithotripsy on Renal Function in Patients with Kidney Stone Disease
Authors: Rutz-Danielczak Aleksandra , Pupek-Musialik Danuta , Raszeja-Wanic Bożena
Published: April 2003

The effects of extracorporeal shock wave lithotripsy on glomerular and tubular renal functions were determined by serum β2-microglobulin (Sβ2m) and urinary β2-microglobulin (Uβ2m) estimations in patients with nephrolithiasis. Unilateral treatment was performed in all patients. Urinary and serum creatinine levels were determined according to the method of Yatzidis. Sβ2m and Uβ2m were measured by radioimmunoassay the day before ESWL, on the day of ESWL, and then 1, 2, 5, 7, 8, 9, 14, and 28 days after treatment. Creatinine clearance, hourly urinary β2m excretion (Uβ2m/h), and tubular reabsorption of β2m (TRβ2m) were calculated. After lithotripsy, significant increases in Uβ2m, Uβ2m/h, and TRβ2m were found (p < 0.001), whereas Sβ2m, serum creatinine, and creatinine clearance values remained unchanged. Uβ2m, Uβ2m/h, and TRβ2m reached their pretreatment values within 7–9 days after ESWL. We concluded that ESWL does not affect the glomerular filtration rate; however, it leads to a transient proximal tubular dysfunction.
Comparison of a Vegetable-Based (Soya) and an Animal-Based Low-Protein Diet in Predialysis Chronic Renal Failure Patients
Authors: Soroka N. , Silverberg D.S. , Greemland M. , Birk Y. , Blum M. , Peer G. , Iaina A.
Published: April 2003

There is some experimental evidence to suggest that progression of chronic renal failure (CRF) is slower on diets based on soya protein than on diets based on animal protein. We have compared the effect of a soya-based vegetarian low-protein diet (VPD) and an animal-based low-protein diet (APD) in 15 patients with CRF. 15 patients with CRF (51Cr-EDTA-measured glomerular filtration rate 15–50 ml/min/1.73 m2) were studied. In a randomized crossover trial, the patients were given each diet (each containing 0.75 g protein and 32 kcal per kilogram body weight) for a 6-month period. Nine patients completed the trial, 2 others dropped out because they could not tolerate the VPD, 3 because of unrelated medical complications, and 1 for technical reasons. The caloric intake was higher and the protein, phosphate and essential amino acid intake lower on the VPD than on the APD. The compliance with the suggested caloric intake was better with the VPD than with the APD (97 vs. 88% of recommended intake), as was the compliance with the suggested protein intake (94 vs. 112% of recommended intake) and with the suggested phosphate intake (102 vs. 116%). The mean glomerular filtration rate, as judged by 51Cr-EDTA, was similar after 6 months on each diet and remained unchanged throughout the entire year of the study. The rate of fall of glomerular filtration, as measured by the slope of 1/serum creatinine was slowed by 73% during the 1-year study period as compared with the prestudy period. Nutritional status (as measured by body mass index, midarm circumference, and lean body mass and percent body fat), serum transferrin, cholesterol and albumin, and total lymphocyte count were similar on the two diets. The serum albumin level on both diets, however, was significantly higher on the two diets than during the prediet period. Blood urea nitrogen, urine urea nitrogen, protein catabolic rate, and 24-hour urine creatinine and phosphate were lower on the VPD than on the APD. The 24-hour protein excretion was similar on the two diets. The two low-protein diets resulted in a slowing in the progression of CRF. A VPD is well tolerated in CRF and is associated with lower protein and phosphate intakes and a higher caloric intake than an APD and may, therefore, be used as a safe alternative or partial substitute for the usual APD in CRF.
Antioxidant Defense Potential of Rabbit Renal Tissues after ESWL: Protective Effects of Antioxidant Vitamins
Authors: Biri Hasan , Öztürk H. Serdar , Büyükkoçak Serap , Kaçmaz Murat , Çimen M.Y. Burak , Ünal Doǧan , Birey Mehmet , Bozkırlı İbrahim , Durak İlker
Published: April 2003

Antioxidant defense potential, malondialdehyde (MDA) levels, and relative hydroxyl radical (OH·) concentrations were measured in order to establish the effects of extracorporeal shock wave lithotripsy (ESWL) on free radical production and antioxidant defense potential of the rabbit kidney tissues. Electron microscopic examination was also performed to observe ultrastructural changes. The antioxidant defense potential of the ESWL-treated tissues was found to be reduced, and the MDA levels increased as compared with controls. Vitamin (vitamin E plus C combination) pretreatment ameliorated antioxidant defense potential in part, prevented increases in MDA levels in the ESWL-treated tissues, and increased the antioxidant defense potential in the control kidney tissues. After ESWL, a significant amount of OH· radical was measured in the affected tissue. This revealed the source of oxidant stress and peroxidation reactions in the ESWL-treated kidney tissue. Vitamin pretreatment caused significant reduction in the OH· radical concentration. In the electron microscopic investigation, some significant subcellular changes, such as endothelial injury, loss of foot processes, damage of glomerular basal membrane, etc., were observed in the ESWL-treated renal tissue slices. Vitamin pretreatment to a great extent prevented formation of these subcellular changes. Our results suggest that the antioxidant capacity of the kidney tissue was reduced after ESWL treatment and that the tissue was exposed to oxidant stress. Vitamin pretreatment exerted significant protection against the radical damage.
High-Protein Diet or Unilateral Nephrectomy Induces a Humoral Factor(s) that Enhances Mesangial Cell Proliferation in Culture
Authors: Weissgarten J. , Modai D. , Averbukh M. , Cohn M. , Berman S. , Averbukh Z.
Published: April 2003

Background: A high-protein diet is one of the maneuvers which produce hypertrophy of kidney mass. The underlying mechanism(s) has not been elucidated. In the present study, we investigated the possibility that a humoral factor may be involved. Methods: Twenty-eight 3-week-old Charles River rats were studied. Fourteen underwent right nephrectomy and 14 sham operation. Each of these groups was divided into two equal subgroups (n = 7 in each): one maintained on a regular diet (20% protein) and the other on a high-protein diet (60% protein) for 7 days. Following this period the animals were sacrificed. Sera from the animals were added to mesangial cell cultures from kidneys of intact 3-week-old rats, and the thymidine incorporation was assessed. Results: The parameters of kidney mass indicated that the high-protein diet indeed produced kidney hypertrophy. Sera from the sham-nephrectomized animals fed a high-protein diet produced a significantly greater proliferative effect on mesangial cells in culture than sera from the respective animals on a normal-protein diet. Sera from either nephrectomized group or from the high-protein sham-operated group all had similar magnitudes of enhancement of mesangial cell proliferation. Conclusion: We conclude that the renal hypertrophy produced by a high-protein diet is mediated, at least in part, by a humoral factor(s).
Recovery of Damaged Glomerular Capillary Network with Endothelial Cell Apoptosis in Experimental Proliferative Glomerulonephritis
Authors: Shimizu Akira , Masuda Yukinari , Kitamura Hiroshi , Ishizaki Masamichi , Sugisaki Yuichi , Yamanaka Nobuaki
Published: April 2003

Capillary repair can occur in damaged glomeruli in recovery models of glomerulonephritis (GN). In order to clarify whether capillary repair is an essential component in glomerular recovery from GN, we have examined the development of the capillary repair after inflammatory injury in both the repairing glomeruli and the segmental sclerotic scar lesions in Thy-1 GN. Mesangiolytic glomerular damage was induced in rats with anti-Thy-1.1 antibody administration. Diffuse mesangiolysis and segmental microaneurysmal ballooning developed in damaged glomeruli by day 3, with reduction of endothelial cellularity. Thereafter, histological proliferative GN developed between day 5 and week 3. Endothelial cell proliferation began on day 1 and peaked on day 5, and the number of glomerular endothelial cells increased and exceeded the level of control values on day 7. Angiogenic glomerular capillary repair occurred through the process of not only capillary regeneration from remaining endothelial cells in capillary aneurysmal lesions but also new capillary growth derived from the glomerular vascular poles by day 7. The number of glomerular capillary lumina also increased to the level of controls by week 3. Susbsequently, mesangial proliferative GN resolved, and most of the glomeruli recovered to their normal structure with the reconstruction of the capillary network by weeks 4–6. In the glomerular capillary repair, significant apoptosis of glomerular endothelial cells was present during the period of mild endothelial cell hypercellularity between day 7 and day 10 (0.06 ± 0.02 apoptotic endothelial cells/glomerular cross section vs. 0.00 ± 0.00 in controls, mean ± SEM; p < 0.05. In Thy-1 GN, most of the damaged glomeruli recovered with angiogenic capillary repair. However, segmental sclerotic scar lesions remained in 10–30% of the glomeruli with an incomplete repair of glomerular capillaries. Therefore, it is concluded that following the destruction of the glomerular capillary network in GN, angiogenic capillary repair plays an essential role in the recovery of damaged glomeruli, and incomplete capillary repair leads to sclerotic scar lesions in damaged glomeruli. Glomerular capillary repair occurs through the process of capillary regeneration from remaining endothelial cells as well as new glomerular capillary growth from the glomerular vascular poles. In glomerular capillary repair, apoptosis is necessary in regulating the number of intrinsic endothelial cells.
The Increase of Memory T Cell Subsets in Children with Idiopathic Nephrotic Syndrome
Authors: Yan Kunimasa , Nakahara Kazuhiko , Awa Shouichi , Nishibori Yukino , Nakajima Noriko , Kataoka Saeko , Maeda Motoharu , Watanabe Takashi , Matsushima Satsuki , Watanabe Nobuo
Published: April 2003

Two-color and three-color flow cytometry was carried out to determine whether the memory T cells (CD45RO+ T cells) play a major role in lymphocyte dysfunction of 26 children with idiopathic nephrotic syndrome (INS). The INS patients were divided into three groups: (1) 10 patients who were not receiving glucocorticoid hormone (GCH) and were suffering from acute nephrotic state were referred to as N1; (2) 8 patients who were in remission maintained by GCH therapy alone were referred to as N2; (3) 8 patients who were free of GCH therapy for at least 4 months were referred to as N3. Group N1 demonstrated a significant increase in the percentage of CD45RO+CD4+ T cells and CD45RO+CD8+ T cells (p < 0.05) compared with 11 controls, and these subsets were noted to have a tendency to decrease to control levels in groups N2 and N3. Furthermore, interleukin-2 receptor-α expressed subsets in CD45RO+CD4+ T cells (CD45RO+CD4+CD25+ T cells) were also increased only in group N1 (p < 0.02). A similar tendency of absolute counts was observed in these subsets. These results suggest that activated memory T cells reflect lymphocyte dysfunction at initial onset or relapse in INS children.
IgA Nephropathy Complicating Diabetic Glomerulosclerosis
Authors: von Orfila Claudine , De Lepert Jean-Claude , van Modesto Anne , van Pipy Bernard , Suc Jean-Michel
Published: April 2003

A retrospective study was done on 66 diabetic patients who had renal biopsies performed during 1979–1994. This review shows 10 patients who presented IgA nephropathy associated with diabetic nephropathy. Six patients had insulin-dependent diabetes mellitus and 4 patients non-insulin-dependent diabetes mellitus. All patients presented with proteinuria and 7 had hematuria. Four patients presented with renal impairment. Histologic evaluation disclosed the presence of thickened glomerular basement membranes and increased mesangial matrix in all cases, associated with nodular sclerosis in 8 cases. By immunofluorescence, diffuse mesangial IgA deposits were observed in all cases. The high incidence of the coexistence of IgA nephropathy and diabetes seems not merely coincidental. Structural and/or functional abnormalities of the glomerular basement membranes might facilitate the development of immune complex glomerular diseases. In patients with diabetes, the appearance of urinary abnormalities and/or deterioration in renal function altered the clinical history of diabetic nephropathy. The disorders are clinically suggestive of the presence of nondiabetic renal disease and raised the possibility of another pathogenetic mechanism.
Requiring Higher Doses of Erythropoietin Suggests Pregnancy in Hemodialysis Patients
Authors: Maruyama Hiroki , Shimada Hisaki , Obayashi Hiroaki , Nakamaru Tsukasa , Miyakawa Yoshikazu , Goto Shin , Ogihara Tadahisa , Takakuwa Koichi , Tanaka Kenichi , Kishimoto Hidefumi , Yuasa Yasuko , Sakai Shinji , Okajima Hideo , Suzuki Satoru , Arakawa Masaaki
Published: April 2003

Background/Aims: Pregnancy in hemodialysis (HD) patients tends to be diagnosed late because of its infrequency and the lack of validity of urine pregnancy tests, and because these patients tend to have menstrual irregularities. The outcome is influenced by pregnancy-related anemia. We investigated the characteristics of pregnancy-related anemia and whether it is a useful diagnostic clue to pregnancy in HD patients. Methods: We retrospectively investigated six pregnancies of 5 HD patients (mean age 30 years), including 4 patients treated with recombinant human erythropoietin (rHuEpo) and a transfusion-dependent patient with two pregnancies in the pre-rHuEpo era. Results: The mean duration of HD was 6 years, the mean duration of the patients’ marriages at the time of pregnancy was 6 years, and the mean gestational age at diagnosis was 11 weeks and 4 days. The progression of anemia (an 8% decrease in the hematocrit) was detected by 8 weeks of gestation in all patients. The prepregnancy hematocrit was stable in 5 pregnancies, facilitating the detection of changes, but during one of the pregnancies of the transfusion-dependent patient the hematocrit was low and was influenced by the transfusions. The amount of rHuEpo required to attain a target hematocrit of 30% increased gradually or rapidly until delivery. Conclusions: The progression of anemia or hyporesponsiveness to rHuEpo was a useful early diagnostic clue to pregnancy in HD patients. However, the prepregnancy hematocrit should be stabilized with rHuEpo, so that decreases can be easily detected. The precise mechanisms of hyporesponsiveness to rHuEpo, which progressed during pregnancy and subsided after delivery, remain to be clarified.
Morphologic High-Risk Factors in IgA Nephropathy
Authors: Freese Poul , Nordén Gunnela , Nyberg Gudrun
Published: April 2003

Aim: Morphologic risk factors for developing end-stage renal failure (ESRD) due to IgA nephropathy may be difficult to identify in populations where the course is benign in the vast majority. Ours is a high-risk population. Methods: Protocols of 67 biopsies from native kidneys of kidney transplant patients with IgA nephropathy were reevaluated with respect to the prevalence of certain structural findings. Time points for onset of symptoms, biopsy procedure, and ESRD were recorded. Results: Features seen with more than expected frequency were: extracapillary proliferation in 49%, cellular infiltrates in the interstitium in 89%, marked tubular atrophy in 54%, and IgA deposits in the peripheral capillary loops in 71%. With extracapillary proliferation the remaining time to ESRD was 3.5 ± 3.2 versus 7.0 ± 4.2 years without (p < 0.0004). With marked tubular atrophy the remaining time was 3.5 ± 2.7 and 8.2 ± 4.2 years without (p = 0.0002). Cellular infiltrates in the interstitium also signified shorter progression (p = 0.009). Except for the presence of IgA in the periphery, no finding by immune fluorescence was more frequent than expected or correlated with progression. Conclusion: Extracapillary proliferation, interstitial cellular infiltrates, marked tubular atrophy, and IgA deposits in the peripheral capillary loops indicate risk of progressive renal failure in IgA nephropathy, but other findings by immune fluorescence do not.
Effect of Etidronate Treatment on Bone Mass of Male Nephrolithiasis Patients with Idiopathic Hypercalciuria and Osteopenia
Authors: Heilberg Ita Pfeferman , Martini Ligia Araujo , Teixeira Sergio Henrique , Szejnfeld Vera Lúcia , Carvalho Aluisio Barbosa , Lobão Rosélia , Draibe Sergio Antonio
Published: April 2003

Osteopenia is frequently found among calcium stone forming (CSF) patients with hypercalciuria. We investigated the effect of a 2-year therapeutic course of etidronate, a bone-sparing agent, in 7 young male CSF patients. The treatment consisted of a cyclic intermittent administration of phosphate followed by sodium etidronate and calcium supplementation every 74 days. Bone mineral density (BMD) measured at 12-month intervals and bone biopsies performed at baseline and after 2 years were the primary efficacy parameters. Mean lumbar spine BMD increased significantly after the 1st year by 2.6 ± 1.0% (mean ± SE, p < 0.05) and nonsignificantly after the 2nd year by 5.6 ± 2.6%. Nonsignificant changes were observed for femoral neck mean BMD after either the 1st or the 2nd year (decrease of 2.0 ± 1.0% and 2.0 ± 3.0%, respectively). Mean histomorphometric parameters showed that bone volume, osteoid volume, and eroded surfaces did not differ from baseline (13.9 ± 2.2 vs. 12.2 ± 1.1%, 1.2 ± 0.7 vs. 2.6 ± 0.7%, and 20.7 ± 6.2 vs. 13.7 ± 1.3%, respectively). Osteoid surface was significantly lower than baseline values (9.5 ± 5.2 vs. 18.8 ± 5.3%, p < 0.05). These data suggest that etidronate given to young male CSF patients presenting with hypercalciuria and osteopenia led to a significant amelioration of BMD, evident only in the lumbar spine after 1 year of treatment. There was no histological evidence of long-term improvement in bone remodeling.
Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism and Diabetic Albuminuria in Patients with NIDDM Followed Up for 9 Years
Authors: Huang Xiao-Hong , Rantalaiho Vappu , Wirta Ole , Pasternack Amos , Hiltunen Timo P. , Koivula Timo , Malminiemi Kimmo , Nikkari Tapio , Lehtimäki Terho
Published: April 2003

Nephropathy is a major cause of premature morbidity and mortality in patients with non-insulin-dependent diabetes mellitus (NIDDM). The insertion/deletion (I/D) polymorphism of angiotensin-converting enzyme (ACE) is a genetic determinant of plasma ACE levels. Recent studies have found I/D polymorphism of the ACE gene to be associated with nephropathy in NIDDM. This association has not been evaluated in prospective studies. We, therefore, studied the relationship between ACE gene I/D polymorphism and diabetic albuminuria and glomerular filtration rate (GFR) in 83 NIDDM patients followed up for 9 years. At baseline, 29% (24 of 83) of the diabetic patients had an increased (>30 mg/24 h) urinary albumin excretion rate (UAER) and the prevalence of albuminuria at the 9-year examination was 35% (29 of 83). During the follow-up period, systolic blood pressure (p = 0.044), prevalence of hypertension (p < 0.01), and fasting blood glucose levels (p < 0.01) increased, while high-density lipoprotein cholesterol (p < 0.01) decreased. The declines of GFR during the follow-up period were 8.5, 14.1, and 16.3% within genotype groups of II, ID, and DD, respectively (p values for decreases: NS for II, <0.001 for ID, and <0.001 for DD). Patients with the DD genotype tended to have a steeper decrease of GFR, but the change was not statistically significant between the genotype groups. The increases of UAER during the follow-up period were 35.1, 8.3, and 122.4% within genotype groups of II, ID, and DD, respectively, but p values for all increases were not significant. Parallel to GFR, patients with the DD genotype tended to have a steeper increase of UAER, but the change was not statistically significant between the genotype groups. There were no differences in the ACE genotype distribution and allele frequencies between the patients with or without albuminuria either at follow-up or in cross-sectional settings. In conclusion, this 9-year follow-up study does not support the hypothesis that the ACE I/D polymorphism is a major genetic marker of diabetic nephropathy in NIDDM patients.
Serum Leptin Concentrations in Patients on Hemodialysis
Authors: Nakazono Hiroshi , Nagake Yoshio , Ichikawa Haruo , Makino Hirofumi
Published: April 2003

Serum leptin concentrations in normal humans have been reported to correlate with the body mass index (BMI) as well as with the body fat mass. In this study, we measured serum leptin concentrations in 107 patients on hemodialysis, 30 of whom had diabetes mellitus as the cause, and examined the clinical significance. Furthermore, we evaluated the effects of high-flux dialysis membranes on serum leptin levels. Serum leptin concentrations had a linear correlation with BMI as well as with the percentage of body fat in patients on hemodialysis. The serum leptin concentrations showed a positive correlation with the serum concentrations of total cholesterol, low-density lipoprotein cholesterol, and triglyceride, the body weight, the BMI, and the percentage of body fat. The serum leptin levels were not different between the diabetic and the nondiabetic groups. The serum leptin levels in the nondiabetic group were nearly fourfold higher in women than in men. We investigated the differences in the rate of reduction in serum leptin after dialysis with polysulfone membrane dialyzers (PS-N and PS-UW) in comparison with a cellulose membrane dialyzer (AM-SD), and as a result, we found that the polysulfone membrane dialyzers removed serum leptin, while the cellulose membrane dialyzer did not. We conclude that in patients on hemodialysis, the serum leptin concentration is a valuable clinical marker of the body fat content and may also contribute to the evaluation of hyperlipidemia.