bluuebunny/crossref_metadata_2025 huggingface dataset:
Carboxymethyllysine in Dermal Tissues of Diabetic and Nondiabetic Patients with Chronic Renal Failure: Relevance to Glycoxidation Damage
Authors: Meng Jing , Sakata Noriyuki , Imanaga Yoshinobu , Takebayashi Shigeo , Nagai Ryoji , Horiuchi Seikoh
Published: April 2003

Carboxymethyllysine (CML) is currently recognized as a major advanced glycation end product and a marker for glycoxidation. Plasma CML levels are increased in patients with chronic renal failure (CRF). However, significance and mechanism of CML accumulation in these patients are poorly understood. The objective of the present study was to analyze CML in soluble and collagen-binding fractions of the dermis to investigate CML deposition and formation and collagen damage related to CML accumulation in patients with CRF. Skin samples (among them autopsy samples) were obtained from 33 subjects: 8 nondiabetic CRF patients, 7 diabetic predialysis patients with CRF (CRF-DM), 7 hemodialysis patients, and 11 control subjects without either CRF or DM. The dermal samples were extracted sequentially by phosphate-buffered normal saline, pepsin, and collagenase. The extracts were referred to as the soluble fraction and the proteinase-extracted fraction (including pepsin-extracted and collagenase-extracted fractions). Our ELISA assay for CML in dermal collagen from predialysis patients with CRF (CRF and CRF-DM groups) demonstrated that the levels of CML in both the soluble fraction (containing soluble CML which was mainly determined by serum clearance) and the structural collagen-binding proteinase-extracted fraction (in which high CML levels could be a strong indication of in situ formation) were increased and could not be completely reduced after hemodialysis in CRF-DM and CRF groups. These results suggest that accumulation of CML may be due to both a low serum clearance and/or increased in situ CML formation in CRF. CML contents in the proteinase extracted fraction inversely correlated with the susceptibility of collagen to extraction by proteinases (n = 33, r = –0.59, p < 0.001). Our results provide the first biochemical evidence that CML level is increased in both the soluble and collagen-binding fractions and that increased CML level resulted in increased fractions of proteinase-resistant collagen in dermal extracts of patients with CRF.
Thy1 Glomerulonephritis Induced in Young Lewis Rats Accelerates Age-Related Glomerulosclerosis
Authors: Stewart Keith , Wilson Peter , Wilson Heather , Minto Andrew , Haites Neva , Whiting Paul , Macleod Alison , Brown Paul
Published: April 2003

Age-related and disease-induced glomerulosclerosis (GS) in rats have both been well defined in a number of strains and experimental models, but the inter-relationship between the two is not clear. The present study was undertaken to compare the pattern of glomerular injury in these two types of GS. One- and two-shot Thy1 glomerulonephritis (GN) was induced at 2 months of age and followed for 12 months. At 12 months histological injury in proteinuric rats was characterized by segmental hyaline lesions. Two-shot Thy1 GN resulted in accelerated, but morphologically identical injury at 8 months. Histological lesions predictive of subsequent accelerated GS were evaluated at 1, 2, 4 and 6 months. In this regard, glomerular hypercellularity, rather than hypertrophy or matrix increase, was the most consistent histological index of later accelerated disease. The profibrotic cytokines transforming growth factor (TGF)-β1 and -β3 were localized distinctly to segmental hyaline lesions, but not to areas of matrix increase within the glomerular tuft. This study reveals that GS after Thy1 GN represents acceleration of an age-related disease, presents evidence for use of prolonged glomerular hypercellularity as the best histological index of future disease progression, and correlates the key lesion of GS in these animals, the segmental hyaline lesion, with the presence of TGF-β peptides.
Prognosis of Patients with Rounded Atelectasis Undergoing Long-Term Hemodialysis
Authors: Horita Yoshio , Noguchi Mitsuru , Miyazaki Masanobu , Tadokoro Masato , Taura Kouichi , Watanabe Takashi , Nishiura Kiyoaki , Harada Takashi , Ozono Yoshiyuki , Kohno Shigeru
Published: April 2003

We present 4 patients undergoing hemodialysis in whom thoracic computed tomography (CT) suggested a diagnosis of rounded atelectasis (RA) with pleural effusion. The clinical setting and follow-up CT of all 4 patients confirmed this diagnosis. The pleural fluid of each appeared serosanguineous or hemorrhagic and predominantly consisted of lymphocytes. Biochemical analysis of this fluid revealed high levels of total protein, lactate dehydrogenase and glucose. Bacterial culture and polymerase chain reaction for Mycobacterium tuberculosis DNA was negative. Pleural biopsy specimens from 2 of the 4 patients showed evidence of fibrinous change and mesothelial cell hyperplasia. Pleural effusion from all 4 patients did not respond to either fluid restriction or aggressive hemodialysis-induced dehydration. The subsequent clinical course and thoracentesis were repeated, and in 1 patient, this was followed by tetracycline pleurodesis. However, 2 patients died during pre-pleurodesis and 1 died during post-pleurodesis, all due to respiratory failure. We propose that the clinical setting and follow-up thoracic CT and thoracentesis of patients receiving long-term hemodialysis confirmed a diagnosis of rounded atelectasis with uremic pleural effusion. We also propose that the prognosis of patients with refractory pleural effusion receiving long-term hemodialysis would be improved by early pleurodesis.
Molecular Genetics in IgA Nephropathy
Authors: Galla John H.
Published: April 2003

Evidence from both genotypic and phenotypic perspectives is considered that patients may be genetically predisposed to IgA nephropathy (IgAN) or Henoch-Schönlein purpura (HSP) or that a factor(s) might exclusively contribute to their progression to chronic renal failure. In contrast to most other renal diseases, both IgAN and HSP are uncommon in blacks; this is unexplained but is not due to their low frequency of the A2m(1) allotype. The association of these diseases or their progression with a variety of abnormalities of IgA immunobiology in patients and their families has not been linked to any genotype; similarly, no HLA antigen has been positively or negatively associated in any consistent way. Although complement factor 3 universally accompanies IgA glomerular deposition, complement pathway abnormalities are only sporadically reported with either IgA deposition or disease progression. Whether angiotensin-related polymorphism including the converting enzyme alleles have a specific predictable role, particularly in the progression of renal failure in IgAN, remains problematic. The promising possibility that a structural defect in IgA1 due to an as yet unidentified genetic defect accounts for the deposition of IgA is considered in some detail. Nevertheless, the genetic mechanism(s) of progressive renal failure, whether exclusive to IgAN or to glomerular diseases generally, is of paramount importance.
Elevated Interleukin-18 Levels in the Urine of Nephrotic Patients
Authors: Matsumoto Koichi , Kanmatsuse Katsuo
Published: April 2003

Background/Aim: The etiology of minimal-change nephritic syndrome (MCNS) is obscure. It has been speculated that T cells play a role in the pathogenesis of MCNS. Interleukin (IL)-18, a novel immunoregulatory cytokine with potent inferon-γ-inducing activities, may play an important role in T-helper type 1-mediated immune responses. To examine further the possible role of IL-18 in nephrotic syndrome (NS), in the present study we measured IL-18 levels in the urine in different clinical stages of MCNS. The aim of this study was to investigate the involvement of IL-18 in MCNS. Methods: Urine samples were obtained from 20 MCNS patients. The disease controls included 20 patients with IgA nephropathy. The samples were assayed for IL-18 protein by a sandwich enzyme-linked immunosorbent assay. Results: Compared with normal controls, significantly increased urinary levels of IL-18 were detected in MCNS patients with the NS. The urinary IL-18 (uIL-18) levels correlated with the degree of proteinuria in MCNS patients. Moreover, when individual MCNS patients were followed through their clinical illness, uIL-18 levels were increased during the active phase and decreased as the patients went into remission. Conclusions: These results indicate that uIL- 18 is detectable in a subgroup of patients with active NS and correlates to their disease activity in patients with MCNS. Our findings support the notion that IL-18 may play a role in the pathophysiology of NS.
Biochemical, Histological and Behavioral Consequences of Nephrectomy in Young and Aged Mice
Authors: Al Banchaabouchi M. , Marescau B. , D’Hooge R. , van Marck E. , De Deyn P.P.
Published: April 2003

Background: This study investigates the effect of nephrectomy in young and aged mice on some biochemical, histological and behavioural aspects. Methods: Each age group, 2- and 12-months-old, comprised a sham-operated group, a unilaterally nephrectomized group and a subtotally nephrectomized group. Consequences of nephrectomy were examined 10 days postsurgery on urea and guanidino compound levels in body fluids and brain; the remaining kidney by light-microscopic examination; and learning and memory abilities using the Morris water maze task. Results: Effect of nephrectomy on urea and guanidino compound levels in plasma, urine and brain was significantly more pronounced in the young age group. Some guanidino compounds show a tendency to decrease with aging in the sham-operated group and the two nephrectomized groups. Higher compensatory kidney hypertrophy was found in younger nephrectomized mice whereas in older mice glomerular mesangial expansion was a common feature. Finally, young mice with subtotal nephrectomy displayed a slight but significant impairment in memory and learning; whilst old nephrectomized mice manifested no impairment. Conclusions: Nephrectomy induces more changes in younger mice than in older mice as observed in higher variation of urea and guanidino compound levels, glomerular volume and kidney hypertrophy and decline in spatial learning and memory.
Persistent Post-Transplant Autonomous Hyperparathyroidism despite 23 Years of Excellent Renal Allograft Function
Authors: Goldsmith David , Owen William J.
Published: April 2003

Hyperparathyroidism is a common problem for patients on renal replacement therapy programs. Many long-term dialysis patients require parathyroidectomy while on dialysis. Some patients, however, despite severe renal osteodystrophy, are transplanted, and in these a large proportion show a slow resolution of bony problems, in the context of the removal of the uremic stimulus to abnormal bone metabolism. A proportion of these patients become hypercalcaemic after renal transplantation, sometimes with symptoms. There is not a consensus on how these patients should be managed, with opinions varying from early parathyroidectomy to later parathyroidectomy and to conservative treatment. We present the case of a lady who underwent 23 years of conservative management of her post-transplant hyperparathyroidism. She was hypercalcaemic for almost all of that period, despite excellent renal transplant function. Finally, after 23 years she underwent surgical parathyroidectomy with autografting with prompt sustained resolution of her symptomatic hypercalcaemia.
Possible Site of Decreased Intestinal Zinc Absorption in Chronic Uremic Rats
Authors: Wang Shu-Chi , Chen Yeong-Shiuh , Chen Shu-Ming , Young Tze-Kong
Published: April 2003

Background/Aims: Previous zinc tolerance tests in uremic patients indicated decreased intestinal zinc absorption. In the present study, a zinc tolerance test was initially applied to a uremic rat model and subsequently the possible site of malabsorption investigated. Methods: Chronic uremia was induced by five-sixths nephrectomy. Both control and nephrectomized rats were divided into three groups including animals with intact intestine, removal of the jejunum, and removal of the ileum. Each rat was orally loaded with zinc sulfate (80 mg/kg) in conscious state. Blood samples were drawn before and after zinc load at different intervals during 6 h for zinc analysis. The area under the plasma zinc curve (AUC) and the maximal increase of plasma zinc level (Cmax) were calculated. Results: Jejunectomy decreased both AUC and Cmax in control and nephrectomized rats, whereas ileectomized animals remained, interestingly, unchanged with regard to these two parameters. Significant decreases in both AUC and Cmax were observed in nephrectomized rats as compared with the control rats. Conclusions: The jejunum is the main site of zinc absorption in response to a large oral load of zinc sulfate in both normal and uremic rats. The data further suggest that five-sixths nephrectomy reduces gastrointestinal zinc absorption in rats predominantly by the ileum.
Potential Value of CML-Hb in Predicting the Progression of Bone Cysts in Dialysis-Related Amyloidosis
Authors: Motomiya Yoshihiro , Iwamoto Hisahiko , Uji Yoshinori , Higashi Takuya , Uchimura Tomonori , Maruyama Ikuro
Published: April 2003

Background/Aim: Carboxymethyllysine is one of the common advanced glycation end products in vivo. In a previous report, we were the first to describe the increase of circulating carboxymethyllysine-hemoglobin (CML-Hb) levels in hemodialysis patients, particularly in patients with dialysis-related amyloidosis (DRA). The aim of this study was to investigate the predictive value of CML-Hb in the progression of DRA using computed tomography images of 2-year or 3-year follow-up periods of patients with amyloid bone cysts at the hip joint. Methods: Circulating CML-Hb levels were measured as previously reported, and computed tomography scanning was conducted from 1996 to 1998 or 1999 in 57 hemodialysis patients whose original renal disease had been confirmed to be nondiabetic. Patients who showed a new growth of cysts or a growth rate of 30% or more were classified as progressive cases, while the other patients were classified as nonprogressive cases. Results: (1) The circulating CML-Hb levels showed a strong correlation with the DRA score by multiple regression analysis, and (2) patients with progression of amyloid cysts showed a significantly higher circulating CML-Hb level than patients without progression. Conclusion: Based upon these results, we conclude that measurement of circulating CML-Hb levels has a potential value in both judgment of the clinical state and prediction of progression of DRA in hemodialysis patients.
Evolution Pattern of Auto-Antibodies against Oxidized Low-Density Lipoproteins in Renal Transplant Recipients
Authors: Kandoussi Abdel-Mejid , Glowacki François , Duriez Patrick , Tacquet Albert , Fruchart Jean-Charles , Noël Christian
Published: April 2003

An increased degree of oxidative stress in renal transplant recipients and a possible role of ciclosporin A (Cs-A) immunosuppressive therapy in this process have already been described. However, prospective data using in vivo markers and the influence of Cs-A in the oxidizability of low-density lipoprotein (LDL) are scarce. We aimed at investigating in this prospective study the evolution pattern of auto-antibodies directed against malondialdehyde-modified LDL (MDA-LDL) and Cu2+-oxidized LDL in 28 stable renal transplant recipients on Cs-A immunosuppressive therapy before and after 3 successive years of renal transplantation. Also, the effect of enrichment of LDL with Cs-A on the susceptibility of LDL to in vitro oxidation was tested. The results showed a significant increase of both auto-antibody titres (MDA-LDL and Cu2+-oxidized LDL) after 1 year, and the values remained high during the 2nd and the 3rd year following transplantation. The yearly mean relative variations of auto-antibodies against MDA-LDL and Cu2+-oxidized LDL during the follow-up period were 133, 149, and 137%, and 111, 115, and 117%, respectively. A significant correlation was observed during the 1st year between Cs-A trough blood level and Cu2+-oxidized LDL auto-antibody: r = 0.04 (p = 0.046). Incorporation of Cs-A into LDL from healthy volunteers showed no changes during the lag phase in comparison with Cs-A-free LDL, indicating that Cs-A had no effect on in vitro LDL oxidizability. Our results suggest that Cs-A may be involved earlier in the LDL oxidation, but the mechanism by which it acts is still unclear.
Crescent-Forming Mechanism in an Irreversible Thy-1 Model in Rats
Authors: Oyanagi Akihisa , Orikasa Michiaki , Kawachi Hiroshi , Ito Yumi , Koike Hiroko , Gejo Fumitake , Shimizu Fujio
Published: April 2003

Background: The crescent-forming mechanism has not yet been fully clarified and a cell which constitutes a crescent still remains controversial. This study was undertaken to analyze the crescent-forming mechanism in an irreversible Thy-1 model by applying a new marker-recognizing monoclonal antibody (mAb) OS-3. Methods: An irreversible Thy-1 model was induced by an intravenous injection of 500 µg of anti-Thy-1 mAb 1-22-3 to unilaterally nephrectomized Wistar rats. Seven rats were sacrificed 3, 7 and 14 days after the mAb injection respectively and the renal tissues were examined histologically and immunohistochemically. Results: Inflammatory cells were demonstrated mostly in the interstitium, but they were located within advanced cellular crescents in later stages. OS-3, which stained parietal glomerular epithelial cell (PGEC) only partly in a normal rat kidney section, reacted to PGEC more extensively at day 3 and also with cellular crescents at day 7. During the course of this model the podocytes lost their characteristic to be stained by anti-podocalyxcin Ab and obtained a new marker of a diseased state, i.e. to be positively stained by OS-3. Conclusion: Glomerular epithelial cells, but not inflammatory cells, are suggested to directly participate in the crescent formation in early stages, and podocytes with phenotypic changes might be partly involved in the formation of the crescents.
Somatostatin Analogue Attenuates Estrogen-Induced Augmentation of Glomerular Injury in Spontaneous Hypercholesterolemic Female Imai Rats
Authors: Nakamura Megumi , Ikeda Yuji , Mine Makoto , Tomiyoshi Yoshiyuki , Sakemi Takanobu
Published: April 2003

Background: Aggravating effect of estrogen replacement therapy on glomerular injury associated with an elevation of growth hormone (GH) levels has been reported. Therefore, in the present study, to clarify an association between GH elevation and the aggravating effect of estrogen on glomerular injury, we investigated the effect of somatostatin, an inhibitor of GH secretion, on glomerular injury in estrogen-treated hypercholesterolemic female Imai rats. Method: Control female rats were assigned to group 1 (Cont, n = 10). Group 2 (Cont-E, n = 10) received estrogen, and groups 3 (Cont-E-LS, n = 10) and 4 (Cont-E-HS) received estrogen and either a low dose of somatostatin analogue or a high dose of somatostatin analogue. Body weight, urinary protein, serum albumin, total cholesterol, triglycerides, blood urea nitrogen and serum creatinine were investigated every 4 weeks from 10 weeks through 30 weeks of age. At 30 weeks of age, rats were studied morphologically. Results: Estrogen administration resulted in an increase in urinary protein excretion rates and serum total cholesterol levels, and aggravated glomerular injury associated with an increase in GH. In contrast, somatostatin treatment reduced both urinary protein excretion rates and total cholesterol levels and attenuated glomerular injury to levels close to those of controls associated with a reduction of GH levels. Conclusion: The results suggest that increased GH levels may contribute to an enhancing effect of estrogen administration on glomerular injury.
Primary Tuberculosis in the Gluteal Muscle of a Patient with Chronic Renal Failure
Authors: Ergin Funda , Arslan Hande , Bilezikçi Banu , Ağildere A. Muhteşem , Özdemir Nurhan
Published: April 2003

Patients suffering from chronic renal failure (CRF) are at increased risk for contracting tuberculosis (TB) due to their impaired immunity. In this patient group, extrapulmonary involvement is more common than the pulmonary form of TB, and symptoms tend to be milder and less distinctive than those seen in the general population. Pyomyositis secondary to TB is relatively rare. We report a case of TB pyomyositis in the setting of CRF. The nonspecific symptoms that are typical of CRF patients with TB make it particularly difficult to establish the diagnosis in this patient group. In order to avoid diagnostic delays, which may increase the risk of complications and mortality, TB should be kept in mind in any case of ongoing fever and infection that does not respond to seemingly appropriate therapy. In addition, TB should always be suspected in endemic areas, even in the absence of osseous involvement.
Consonant Length, Stød and Morae in Standard Danish
Authors: Grønnum Nina , Basbøll Hans
Published: April 2003

After a brief summary of Hans Basbøll''s mora analysis of Danish stød, the results of an acoustic analysis of – primarily – consonant duration are reported. In natural running speech postvocalic stød bearing (moraic) sonorant consonants are not – as might be expected from previous investigations – systematically longer across positions than the corresponding stødless (non-moraic) consonants; therefore, in modern standard Copenhagen Danish, the moraic/non-moraic distinction in consonants is qualitative, not straightforwardly quantitative, as it is in vowels. Further, the results of an analysis of consonant duration in schwa assimilation are reported. The importance of citation form speech material versus more natural running speech is discussed.
Use of Pulsed-Field Gel Electrophoresis in the Analysis of Recurrent Staphylococcus aureus Infections in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Chang Horng-Rong , Lian Jong-Da , Shu Kuo-Hsiung , Cheng Chi-Hung , Wu Ming-Ju , Chen Cheng-Hsu , Lau Yeu-Jun , Hu Bor-Shen
Published: April 2003

Background/Aim: The purpose of this study was to evaluate pusled-field gel electrophoresis (PFGE) for distinguishing between relapse and reinfection of Staphylococcus aureus infections in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods: Between July 1993 and May 1997, 4 patients with recurrent CAPD-associated infections caused by S. aureus we enrolled in this study. There were nine episodes of peritonitis, one episode of temporary double lumen catheter infection, and one episode of Hickman catheter infection. A total of eleven S. aureus isolates were collected from peritoneal fluid (n = 9) and blood (n = 2). PFGE typing was applied. Results: In our study, from PFGE typing, the 11 S. aureus isolates were classified into seven patterns. Antibiogram profiling classified only four patterns. Patient A had a reinfection by another strain of S. aureus, and patient B had three episodes of peritonitis caused by the same strain of S. aureus due to exit site infections. Patient C had two episodes of CAPD peritonitis caused by two different strains, respectively. Patient D had four episodes of S. aureus infection (three CAPD peritonitis and one bacteremia); the first two episodes of peritonitis were caused by an identical strain of S. aureus, whereas the subsequent two infections were caused by other organisms. Conclusion: PFGE has a high discriminatory power and can be an assistant method to antibiogram profiling for distinguishing relapse from reinfection in CAPD-associated peritonitis.
Comparison of Blood Loss with Different High-Flux and High-Efficiency Hemodialysis Membranes
Authors: Otti Theodore , Khajehdehi Parviz , Fawzy Ahmed , Gellens Mary , Bastani Bahar
Published: April 2003

Iron deficiency is a common problem in patients on chronic HD. Earlier studies have shown significant blood loss per HD session. To identify whether the new more biocompatible high-flux or high-efficiency membranes are also responsible for significant blood loss during HD, we quantitated the amount of blood loss associated with 4 commonly used membranes (F-50, F-80, CA-210, and CT-190). The residual blood in each compartment of extracorporeal circuit was quantitated after total lysis of the red blood cells (RBC), hemoglobin assay, and calculation of the RBC volume using the patient’s hemoglobin and hematocrit concentrations just prior to the study. The average residual RBC volume in different membranes was 0.2–0.3 ml. The residual RBC volume in the dialysis lines (arterial or venous) was 0.1–0.2 ml and did not correlate with the residual RBC volume in the dialysis membranes. The residual RBC volume in the whole extracorporeal circuit (HD membrane, arterial and venous lines) ranged from 0.5 to 0.6 ml. It was significantly higher with F-50 vs. CA-210. The residual RBC volume in the dialysis membrane was significantly higher in the F-80 vs. CA-210 and CT-190 dialyzers. There was also significant difference in the residual RBC volume in the arterial lines of F-50 vs. CT-190, and F-50 vs. F-80 dialyzers. Conclusion: Our results demonstrate for the first time that the total RBC loss per HD session is minimal in chronic HD patients.
Kimura’s Disease in a Chronic Hemodialysis Patient
Authors: Lee Chien-Te , Huang Chao-Cheng , Lam King-Kwan , Chen Jin-Bor
Published: April 2003

Eosinophilia is not an uncommon finding in chronic dialysis patients. It is usually benign in nature although definite pathogenesis is unknown. We have encountered a young uremic Chinese adult who developed Kimura’s disease after being on maintenance hemodialysis for about 3 years. Asymptomatic eosinophilia had been noted for 1 year and 8 months prior to the development of progressively enlarged neck masses, which leads to the diagnosis of Kimura’s disease. In contrast to most cases, eosinophilia was first noticed before the neck masses appeared. There is often a close correlation between Kimura’s disease and glomerular disease, where renal involvement is considered as a systemic manifestation. However, we do not have strong evidence to support this relationship between terminal renal failure and Kimura’s disease in this patient. To our knowledge, our patient is the first reported case of Kimura’s disease occurring in chronic hemodialysis patients. Eosinophilia persisted for nearly 2 years before the neck mass developed and recurred after the excision. Besides, our patient also demonstrated a chronic and recurrent course typical of Kimura’s disease.
A Case of Partial Carnitine Palmitoyltransferase Deficiency in a Patient Undergoing Chronic Hemodialysis
Authors: Soejima Akinori , Waku Masayuki , Kamiya Yasushi , Kaneda Fumika , Ishizuka Shunji , Nagasawa Toshihiko
Published: April 2003

A 71-year-old male undergoing hemodialysis for chronic renal failure presented with proximal muscle weakness. He had normal levels of serum creatine phosphokinase. The results of nerve conduction velocity studies and a needle-exploration electromyogram were normal. Ultrasonography revealed adenomatous enlargement of the parathyroid glands, and he had marked elevation of the serum parathormone level. The level of serum free carnitine before hemodialysis was significantly lower than normal, while the acyl/free ratio was high. However, the muscle carnitine content was within the normal range. Interestingly, partial inactivation of carnitine palmitoyltransferase activity in the muscle was observed in association with the elevation of the serum parathormone level. Uremic myopathy in this case may be caused not only by abnormal carnitine metabolism but could also be attributable to the partial carnitine palmitoyltransferase deficiency associated with secondary hyperparathyroidism.
Renoprotective Effect of Angiotensin II Receptor Antagonists in Experimental Chronic Renal Failure
Authors: Eliahou Haskel , Avinoach Ilana , Shahmurov Mark , Ben-David Aharon , Shahar Clarissa , Matas Zippora , Zimlichman Reuben
Published: April 2003

We compared the antihypertensive and renoprotective effects of the angiotensin II receptor antagonist losartan and the calcium channel blocker verapamil in the rat with chronic renal failure. One month after five-sixths nephrectomy, male WKY rats were treated for 2 months with either losartan or verapamil. Both resulted in a similar reduction in blood pressure: from 147.1 to 112 mm Hg in losartan-treated and from 155 to 118 mm Hg (p = NS) in verapamil-treated rats. Losartan improved the creatinine clearance (difference +17.1% as compared with +6.6% for verapamil, p = 0.039) and prevented the increase in proteinuria: 12.26 ± (SE) 2.33 mg/day before and 18.48 ± 2.19 mg/day (p = NS) after therapy in the losartan-treated and 17.27 ± 2.73 mg/day before and 32.27 ± 10.29 mg/day after therapy (p = 0.0484) in the verapamil-treated group. In addition, losartan resulted in minimal mesangial proliferation and significantly less glomerular sclerosis and thickening of the small arterial and arteriolar walls. The changes in interstitial fibrosis and tubular hypertrophy, however, were similar in both the verapamil- and losartan-treated groups. Treatment with losartan 1 month after five-sixths nephrectomy in male WKY rats resulted in reduced blood pressure, similar to that of the verapamil-treated group. However, despite similar antihypertensive properties, losartan improved creatinine clearance and reduced proteinuria. The losartan-treated group also had a marked reduction in mesangial proliferation and less glomerular sclerosis and less reduced vascular wall thickness in renal small arteries and arterioles. However, losartan did not totally eliminate nephrosclerosis. The tubular and interstitial changes were fewer in the losartan-treated group. Thus losartan has an additional, although only partial, renoprotective effect when compared with verapamil.
Circulating Sodium in Acute Meningitis
Authors: von Vigier Rodo O. , Colombo Silvia M. , Stoffel Peter B. , Meregalli Paolo , Truttmann Anita C. , Bianchetti Mario G.
Published: April 2003

Background: In acute meningitis hyponatremia is common and traditionally attributed exclusively to inappropriate water retention. However, the exact mechanisms underlying hyponatremia are unknown. Methods: The files of 300 pediatric patients with acute bacterial (n = 190) or aseptic (n = 110) meningitides were retrospectively analyzed. Results: The plasma sodium level ranged from 122 to 148 mmol/l and was low (<133 mmol/l) in 97 patients. Fluid volume contraction was significantly more pronounced in hyponatremia (median 6.0 · 10–2) than in normonatremia (median 2.0 · 10–2). The fractional sodium excretion was less than 1.00 · 10–2 in the 26 hyponatremic children with this measurement. Conclusion: In acute meningitis hyponatremia is not exclusively brought about by inappropriate water retention.
Treatment of Henoch-Schönlein Purpura Glomerulonephritis in Children with High-Dose Corticosteroids plus Oral Cyclophosphamide
Authors: Flynn Joseph T. , Smoyer William E. , Bunchman Timothy E. , Kershaw David B. , Sedman Aileen B.
Published: April 2003

Background: Henoch-Schönlein Purpura (HSP) is a common childhood vasculitis with manifestations in numerous organ systems, including glomerulonephritis. Patients with more severe HSP-associated glomerulonephritis may develop chronic renal failure. Currently, no widely accepted treatment protocols exist for patients with significant renal involvement. Methods: We retrospectively reviewed the clinical courses of 12 children (mean age 9 years) with HSP glomerulonephritis treated with high-dose corticosteroids plus oral cyclophosphamide. All patients had nephrotic-range proteinuria, and all had significant histopathologic changes on biopsy, including crescentic nephritis in 10 patients. Treatment consisted of either intravenous pulse methylprednisolone or oral prednisone followed by oral cyclophosphamide (2 mg/kg/day) for 12 weeks, along with either daily or alternate-day oral prednisone. Prednisone was tapered following completion of cyclophsophamide. Results: Serum albumin rose significantly after treatment from 2.8 ± (SD) 0.5 to 3.7 ± 0.4 g/dl (p < 0.001), and there was a concurrent reduction in proteinuria, as reflected by decreasing serial protein-to-creatinine ratios: from 6.3 ± 4.4 to 0.8 ± 0.8 (p = 0.002). Renal function remained normal in all patients. Hypertension developed during treatment in 10 patients, all but 1 of whom were normotensive at last follow-up, 35 ± 17 months following biopsy. Conclusions: We conclude that treatment of children with HSP nephritis with high-dose corticosteroids plus oral cyclophosphamide is safe and, as in nephrotic syndrome, appears to significantly reduce proteinuria which is a known risk factor for the development of renal insufficiency in HSP. Further studies with larger numbers of patients should be conducted to confirm this finding.
Neurotoxicity of Valacyclovir in Peritoneal Dialysis: A Pharmacokinetic Study
Authors: Izzedine Hassane , Mercadal Lucile , Aymard Guy , Launay-Vacher Vincent , Martinez Valérie , Issad Belkassem , Deray Gilbert
Published: April 2003

Valacyclovir is an effective oral agent for the treatment of herpes virus infection, however, the pharmacokinetics of the drug are altered in renal failure. It is increasingly recognized that dose adjustment of oral valacyclovir in renal failure is necessary to avoid neurotoxicity. We studied this drug in a continuous ambulatory peritoneal dialysis (CAPD) and immunocompromised patient. She developed neurotoxicity with an adjustment dosage of valacyclovir for a cutaneous zoster infection. The elimination half-time (15 h) was similar to that reported for end-stage renal disease patients, while the steady-state volume of distribution (85 l) and the area under the curve concentration (127 mg/l·h) were greater. The mean CAPD dialysance was only 5.27 ml/min with less than 1% of an administered dose being recovered in the 24-hour dialysate. 48 h after interrupting treatment, she recovered normal neurological status and 500 mg of valacyclovir every 2 days was effective and well tolerated.
Peritoneal Sodium Mass Removal in Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis: Influence on Blood Pressure Control
Authors: Ortega Olimpia , Gallar Paloma , Carreño Agustin , Gutierrez Magdalena , Rodriguez Isabel , Oliet Aniana , Vigil Ana , Gimenez Elena
Published: April 2003

Background/Aim: Sodium and water retention is common in peritoneal dialysis patients and contributes to cardiovascular disease. As peritoneal sodium removal depends partly on dwell time, and automated peritoneal dialysis (APD) often uses short dwell time exchanges, the aim of this study was to compare the 24-hour peritoneal sodium removal in APD and standard continuous ambulatory peritoneal dialysis (CAPD) patients and to analyze its possible influence on blood pressure control. Methods: A total of 53 sodium balance studies (30 in APD and 23 in CAPD) were performed in 36 stable peritoneal dialysis patients. The 24-hour net removal of sodium was calculated as follows: M = ViCi – VdCd, where Vd is the 24-hour drained volume, Cd is the solute sodium concentration in Vd, Vi is the amount of solution used during a 24-hour period, and Ci is the sodium concentration in Vi. Peritoneal sodium removal was compared between APD and CAPD patients. Residual renal function, serum sodium concentration, daily urinary sodium losses, weekly peritoneal Kt/V and creatinine clearance, 4-hour dialysate/plasma creatinine ratio, proportion of hypertonic solutions, net ultrafiltration, systolic and diastolic blood pressures, and need for antihypertensive therapy were also compared between the groups. Results: Peritoneal sodium removal was higher (p < 0.001) in CAPD than in APD patients. There were no significant differences in residual renal function, serum sodium concentration, urinary sodium losses, peritoneal urea or creatinine clearances, 4-hour dialysate/plasma creatinine ratio, or proportion of hypertonic solutions between groups. The net ultrafiltration was higher in CAPD patients and correlated strongly (r = 0.82; p < 0.001) with peritoneal sodium removal. In APD patients, peritoneal sodium removal increased significantly only in those patients with a second daytime exchange. The systolic blood pressure was higher (p < 0.05) in APD patients, and the proportion of patients with antihypertensive therapy was also higher in APD patients, although no significant relationship between blood pressure values and amount of peritoneal sodium removal was found. Conclusions: The 24-hour sodium removal is higher in CAPD than in APD patients, and there is a trend towards better hypertension control in CAPD patients. As hypertension control and volume status are important indices of peritoneal dialysis adequacy, our results have to be considered in the choice of the peritoneal dialysis modality.
Lack of Effect of Chronic Hepatitis C Virus Infection on T-Cell Cytokine Production in Chronic Hemodialysis Patients
Authors: Rostaing Lionel , Borde Jean Sébastien , Hasle Catherine , Bories Pierre , Allal Asma , Abbal Michel , Durand Dominique
Published: April 2003

It has been shown that chronic hemodialysis modifies, to some extent, the normal immune response by both T and B lymphocytes elicited by antigenic stimulation, e.g. by impairing the T-cell-dependent response after vaccination. A new technique, i.e. flow cytometry, enables to assess intracytoplasmically, at the single cell level, the production of a given cytokine. By using it, we studied in healthy volunteers (HV) and in chronic hemodialysis (CHD) patients, with respect to their hepatitis C virus (HCV) status, the production by the T lymphocytes of type 1, and type 2 cytokines. We studied the following cytokines (CK): IL-2, IL-4, IL-5, IL-6, IL-10, IFN-γ and TNF-α in the T-cell lymphocytes (whole, CD4+ and CD8+). There were 13 HV and 59 CHD patients (36 HCV(–) and 23 HCV(+)). Amongst the latter, there were 32 men and 27 women, aged 59.5 ± 2 years, undergoing CHD since 70 ± 9.4 months. We found that: (1) the total number of lymphocytes as well as those expressing CD3, CD4, or CD19 were significantly decreased in CHD patients as compared to those from HV; (2) the total number of lymphocytes as well as their different subsets were similar in HCV(+) and in HCV(–) CHD patients; (3) the frequency of T-cell-expressing IL-5 or IL-10 was always low (<1%) in both HV and CHD groups; (4) overall in CHD patients, the mean percentages of T lymphocytes expressing IL-2, IL-4, IFN-γ or TNF-α were respectively 31 ± 13, 2.5 ± 1.3, 28 ± 12 and 34 ± 11% and were not statistically different between HCV(+) and HCV(–) patients; (5) IL-2 was mainly produced by CD4+ T cells, whereas IFN-γ was produced by CD8+ T cells, in both HV and CHD groups, and (6) the lymphocytes of CHD patients produced significantly more IL-2 and IL-4 than those from HV, suggesting an activation of their T lymphocytes. We conclude that using the cytokine flow cytometry assay, our study demonstrated that in HCV(+) CHD patients, as opposed to what has been described for HCV(+) patients with normal renal function, there was no impairment in the production of type 1 cytokines by peripheral blood mononuclear cells when compared to HCV(–) CHD patients. Conversely to HV, T lymphocytes from CHD patients are activated.
Recurrence of Light Chain Nephropathy in a Renal Allograft
Authors: Short A.K. , O’Donoghue D.J. , Riad H.N. , Short C.D. , Roberts I.S.D.
Published: April 2003

Myeloma and monoclonal gammopathies can affect the kidney in many ways with cast nephropathy and light chain deposition disease being the most commonly recognised histological entities. Renal transplantation in these patients remains controversial both because of the risk of recurrent disease affecting the graft and also because of concerns around the possibility of disease relapse within the patient. We suggest that the histological pattern of disease within the native kidneys is crucial in the overall assessment of these patients for renal transplantation. Those patients in whom renal deposition of light chains is associated with a proliferative glomerulonephritis have a considerably worse graft survival than those presenting with cast nephropathy.
Severe Hypertension and Massive Osteoporosis as Presenting Symptoms of Cushing’s Syndrome
Authors: Endemann D.H. , Fischereder M. , Leingärtner T. , Stubanus M. , Zietz B. , Riegger G.A.J. , Krämer B.K.
Published: April 2003

Though Cushing’s syndrome is a well-known clinical problem in terms of side effects of steroid therapy, endogenous Cushing’s syndrome is a relatively rare diagnosis. We treated a 27-year-old patient who presented with severe hypertension and massive osteoporosis. We could diagnose a central Cushing syndrome by endocrinological function tests which, in retrospect, existed undiagnosed for more than 5 years. However, magnetic resonance imaging did not display an adenoma neither of the hypophysis nor of the adrenal glands. During explorative surgery, a cylindric microadenoma of the pituary gland was found and excised. After surgery, the blood pressure returned to normal, making further antihypertensive treatment unnecessary.
Two Enlarged Kidneys: A Manifestation of Erdheim-Chester Disease
Authors: André Marc , Delèvaux Isabelle , de Fraissinette Bruno , Ponsonnaille Jean , Costes Chalret Nicole , Wechsler Bertrand , Piette Jean-Charles , Aumaître Olivier
Published: April 2003

Erdheim-Chester disease is a rare form of non-Langerhans’ cell histiocytosis. This disorder is characterized by a bone involvement and several extraskeletal manifestations. We describe the case of a patient with a pleural and pericardial effusion leading to tamponade. Pathological examination of pericardium and mediastinal adenopathy was normal. The abdominal computed tomography scan showed two enlarged kidneys suggestive of Erdheim-Chester disease. Bone scan scintigraphy demonstrated symmetrical increased labeling of the long bones. The biopsy of perirenal soft tissue confirmed the diagnosis of Erdheim-Chester disease.
The Role of Autonomic Neuropathy in the Genesis of Intradialytic Hypotension
Authors: Chang Ming-Hong , Chou Kang-Ju
Published: April 2003

Background: Intradialytic hypotension is a frequent complication of hemodialysis. Some authors have pointed to autonomic neuropathy as a major cause of intradialytic hypotension. However, other authors have found no such association. Methods: Tilt-table test and time-domain measures of heart rate variation were used to determine autonomic function. Conventional nerve conduction studies (NCS) were also performed to assess whether intradialytic hypotension is associated with polyneuropathy and autonomic neuropathy. Results: The indidences of polyneuropathy confirmed by standard NCS were similar for the intradialytic hypotensive and normotensive subjects, implying that polyneuropathy is not strongly related to intradialytic hypotension. However, heart rate variation decreased significantly in intradialytic hypotensive subjects, suggesting that isolated autonomic neuropathy plays a major role in the pathogenesis of intradialytic hypotension. One of 9 intradialytic hypotensive subjects had normal autonomic tests and 2 of 18 normotensive subjects had abnormal autonomic function, implying that intradialytic hypotension is not caused by autonomic neuropathy alone. Conclusion: Autonomic neuropathy plays an important role in the genesis of intradialytic neuropathy. Tilt-table is easily performed and time-domain measures for heart rate variation are easily determined. Tilt-table test and time-domain measures provide useful information concerning autonomic function.
Intradialytic Hypercapnic Respiratory Failure Managed by Noninvasive Assisted Ventilation
Authors: Tovbin David , Heimer Dov , Mashal Abdallah , Degtyar Pinchas , Avnon Lone Solling
Published: April 2003

We report a hemodialysis patient with acute hypercapnic respiratory failure managed on noninvasive intermittent positive pressure ventilation and progressive metabolic acidosis. Dialysate bicarbonate concentration of 25 mEq/l was associated with exacerbation of metabolic acidosis, while higher dialysate bicarbonate concentration of 30 mEq/l induced a dangerous increase in PCO2 level. Excessive bicarbonate buffering and CO2 production induced by severe metabolic acidosis, malnourishment and tissue hypoxia, could explain inadequate correction of metabolic acidosis and worsening of hypercapnia in this patient. Our findings suggest the need for close monitoring of blood gases and cautious modulation of dialysate bicarbonate concentration in the presence of progressive metabolic acidosis in hypercapnic hemodialysis patients.
The Inevitability of Renal Function Loss in Patients with Hypercreatinemia
Authors: Fink Jeffrey C. , Salmanullah Muhammad , Blahut Steven A. , Weir Matthew R. , Sawyer Robert , Henrich William L. , Hise Michael K.
Published: April 2003

Although it is anticipated that most patients with renal insufficiency will progress towards end-stage renal disease (ESRD) there have been few population-based studies to validate this assumption. We examined serial creatinines from 3,874 anonymous patients at an urban VA medical center who had a baseline creatinine of 1.4 mg/dl or greater to estimate the frequency of deterioration in renal function (DRF). DRF was defined as the first Cr (1stCr) value being lower than the last Cr (LCr) for each patient. The median follow-up was 48.3 ± 0.5 months with 18 ± 0.5 creatinine values per patient. The median 1stCr was 1.6 ± 0.1 mg/dl with 32.2% of the patients having a 1stCr greater than or equal to 1.7 mg/dl. In the study group, 1,723 (44.4%) had DRF including 1,089 (41.4%) of those patients with a 1stCr of 1.4–1.7 mg/dl. However, 45 (36.6%) of those with a 1stCr value 3.0–5.0 mg/dl did not have DRF, the percent with stable creatinine in this group did not vary with length of follow-up. Over the study period, 299 (7.7%) of all the patients had a creatinine rise to 7.0 mg/dl, with 104 (4%) of those with a 1stCr of 1.4–1.7 mg/dl reaching this endpoint. Conclusion: A majority, but not all, patients with renal insufficiency lose renal function over time and those with even mild hypercreatinemia are at risk for deterioration in renal function. Hypercreatinemia, however, does not accurately discriminate between those renal insufficiency patients who are stable versus those at high risk for ESRD.
Diagnosis of Unexplained Bleeding from Tunneled Dialysis Catheter
Authors: Huang Emily Y. , Cohen Steven , Lee Jean , Ranganna Karthik , Quinn Thomas J. , Weiss Jeffery , Ahmed Ziauddin
Published: April 2003

Bleeding after hemodialysis catheter placement is commonly seen and can happen because of anticoagulation, poor platelet function in dialysis patients, and trauma to the vessel and tunnel tract during placement. We wish to present here two cases of prolonged exist site bleeding with tunneled dialysis catheters (SchonCath dialysis catheter, Angio-Dynamics, Queensbury, N.Y.) due to unsuspected catheter leak within the tunneled portion of the catheter, which was identified with angiogram.
Immunoglobulin A Nephropathy and Ulcerative Colitis
Authors: Trimarchi Hernán M. , Iotti Alejandro , Iotti Roberto , Freixas Emilio A.R. , Peters Richard
Published: April 2003

The immune response has largely been implicated in the pathogenesis of inflammatory bowel disease (ulcerative colitis and Crohn’s disease) and immunoglobulin A nephropathy. We present a 26-year-old woman with a long past history of asymptomatic macroscopic hematuria who later developed several episodes of bloody stools and abdominal pain. A colonic biopsy disclosed ulcerative colitis and a renal biopsy was consistent with immunoglobulin A nephropathy. Immunoglobulin A nephropathy is the most common glomerulonephritis, being end-stage renal disease a rare but the most serious complication. It can be primary or secondary, but the association between both entities is unusually observed. We discuss the possible immunologic mechanisms involved and believe the initial immunologic derangement originates in the bone marrow. We suggest both conditions must be considered when either a patient with ulcerative colitis and micro- or macrohematuria or with renal involvement and a past history of diarrhea or abdominal pain presents.