Light microscopic study of striated muscle in uremia

Summary Gastrocnemius muscle biopsies from 28 patients with chronic renal failure were analyzed with a light microscope after staining with Gomori trichrome stain and after histochemical reactions for ATPase and NADH diaphorase. Nineteen (68%) of the biopsies were pathological. Uremic myopathy was seen in eleven (39%) of the biopsies, eight of which were obtained from subjects on regular hemodialysis. Pure myopathic muscle damage was observed in three (11%), both myopathic and neuropathic muscle damage in eight (29%) and pure neuropathic muscle damage in eight (29%) of the biopsies. Fiber type atrophy and hypertrophy of both types were seen. The most common quantitative findings were Type II atrophy, small mean size and type grouping of Type II fibers, and Type I hypertrophy.     

尿毒症性心脏损害的超声心动图研究

本文应用超声心动图对５０例慢性透析治疗的尿毒症患者心脏损害进行观察，结果显示：心包积液１６例（３２％），心包膜增厚６例（１２％）。心脏各腔室内径与正常对照组比较，除女性右室无差异外，其余均有扩大（Ｐ＜０．０５～Ｐ＜０．０１），以左室、左房扩大为著。室间隔和左室后壁明显增厚，左心室重量和重量指数显著增加，左室容积／重量比值减小。心肌回声分为三型：Ⅰ型１４例（２８％），Ⅱ型２０例（４０％），Ⅲ型１６例（３２％）。左室功能主要为舒张功能显著降低     

Ultrastructure of the Rat Testis in Experimental Uremia

Ulstrastruktur des Rattenhodens bei experimenteller Uraemie
Die Feinstruktur des Hodens normaler und hCG-behandelter normaler Ratten wurde untersucht und mit der urämischer und hCG-behandelter urämischer Tiere verglichen. Bei den urämischen Tieren enthielten die Samenkanälchen zahlreiche nekrotische Spermatocyten und Spermatiden mit akrosomalen Fehlbildungen. Die Sertolizellen erschienen funktionell beeinträchtigt, mit wenig endoplasmischem Retikulum und zahlreichen großen Lipidtropfen. Die Feinstruktur der Leydigzellen war recht unterschiedlich. Viele enthielten nur spärlich glattes endoplasmisches Retikulum, einen kleinen Golgi-Apparat und keine Lipidtropfen, während andere unverändert waren. HCG-Behandlung während der Urämie verhinderte den Keimzellverlust nicht, obwohl sie deutliche Veränderungen in der Feinstruktur der Leydig-Zellen gegenüber der der urämischen Tiere bedingte. Die meisten Leydig-Zellen enthielten zahlreiche Mitochondrien und viel rauhes endoplasmatisches Retikulum, wohingegen glattes endoplasmatisches Retikulum, Lipidtropfen, Lysosomen und der Golgi-Apparat unauffällig waren.     

Role of parathyroid hormone in the pathogenesis of the uremic manifestations

Summary A multitude of clinical and experimental data points toward the role of the elevated blood levels of parathyroid in the pathogenesis of the uremic syndrome. The possible pathways through which parathyroid hormone may exert its deleterious effects and evidence for its toxicity are discussed.This work is supported by Contract NO1-AM-7-2218 with the Chronic Uremia Program of the NIAMDD     

尿毒症患者左室重构及相关因素分析

目的探讨尿毒症患者左室重构的相关因素。方法对120例尿毒症患者的临床资料及心脏超声的检测结果进行了统计学分析。结果左室肥厚、扩大为临床中普遍存在的病理结构变化。收缩压、舒张压与左室肥厚、扩大呈明显正相关(P<0.05),而血红蛋白浓度与左室肥厚、扩大呈明显负相关(P<0.05)。血清白蛋白浓度仅与左室扩大呈负相关(P<0.05)。同时左室扩大与左房、右房、右室的扩大也存在明显正相关(P<0.05),左室肥厚与此无明显相关性(P>0.05)。结论血压越高、贫血越重,意味着左室肥厚、扩大越明显。营养不良可能加重左室扩大。左室结构的变化与左房、右房、右室的结构变化呈一致性。     

Daily but not pulse calcitriol therapy improves growth in experimental uremia

Calcitriol (C) pulse therapy is widely used to suppress secondary renal hyperparathyroidism. However, high C serum concentrations may have an antiproliferative effect on growth cartilage cells and may suppress growth rate. The study was designed to evaluate whether daily C and pulse C therapy have differential effects on growth in uremic rats. Female Sprague-Dawley rats (150 g, n=5–10 per group) underwent two-stage subtotal nephrectomy (U). The duration of uremia was 14–18 days. The animals were fed a standard diet or a diet with a low-calcium content. Rats on a low-calcium diet were randomized for recombinant human growth hormone (rhGH) treatment (2.5 IU/kg per day) or solvent. C was injected subcutaneous twice daily (15 pmol/day) or intraperitoneal (105 pmol) twice per week. Weight gain and length gain was determined weekly. After sacrifice, total body calcium was determined by total body neutron activation analysis. Bone micromorphometric analysis of third lumbar vertebra and double staining with tetracycline for determination of mineralization rate were performed. Whereas daily C significantly increased total body length gain within 2 weeks, pulse C did not (U solvent 4.0±0.3 cm, UC bolus 4.3±0.4 cm, UC daily 5.3±0.3 cm, P<0.05). A low-calcium diet reduced and rhGH increased basal length gain and weight gain; regardless of these preconditions, daily but not bolus C increased length gain significantly. C both daily and in bolus form reduced bone osteoid content, but daily C improved mineral apposition rate more than C bolus. Total body calcium corrected for body weight decreased with a low-calcium diet, was lowest with concomitant rhGH treatment, and was not improved by C. In conclusion, daily but not bolus C treatment improves growth in uremic rats. Received: 5 October 1999 / Revised: 1 February 2000 / Accepted: 10 February 2000     

尿毒症患者血液透析前后的甲襞微循环

观察１８例慢性肾功能不全尿毒症终末期患者甲襞微循环的改变及其中１１例用血液透析治疗的患者第一次血透前与血透４～８次（平均５．９次）后甲襞微循环的变化，结果表明，尿毒症患者甲襞微循环加权积分综合判断，中度异常者占８３．３％，重度异常者占１６．７％。其中１１例作血透的患者在治疗前与治疗后总积分值分别为６．９０±０．７２与５．１０±０．７０，二者有非常显著差异。提示尿毒症患者甲襞微循环障碍经血透治疗后可有明显改善，但仍在中度异常范围。给尿毒症患者进行甲襞微循环检查，对其病情的估价有着一定的临床意义。     

Growth hormone and insulin-like growth factor-I and mesangial matrix in uremic rats

Combined growth hormone (GH) and insulin-like growth factor-I (IGF-I) therapy has been advocated for clinical use to minimize the diabetogenic effect of GH and enhance their anabolic effects. However, GH has been shown to accelerate the development of glomerular sclerosis in experimental animals and IGF-I mediates the renal effects of GH. The purpose of this study was therefore to examine morphometrically the effects of GH (1 mg intraperitoneally three times a week), IGF-I (50 g/kg body weight subcutaneously twice a day), and combined GH/IGF-I treatments in vivo on mesangial matrix at 3–20 days after 5/6 nephrectomy in 140- to 150-g rats. There were no significant changes in growth and renal function after GH and/or IGF-I treatment. The effects of GH and IGF-I on glomerular size were additive, which were more prominent in juxtamedullary glomeruli. GH induced proportional increases in mesangial area (MA) and glomerular area (GA), whereas IGF-I induced a similar increase in GA without a corresponding change in MA. When compared with GH treatment alone, combined GH/IGF-I treatment resulted in a lesser degree of mesangial expansion despite an enhanced glomerular size. While additional studies are needed to examine the long-term effects of these findings, our results suggest a potentially beneficial effect of combined GH/IGF-I therapy during uremia.     

Renal transplantation in infants, a therapeutic option?

Renal transplantation is widely accepted as the treatment of choice for endstage renal failure in childhood. Since dialysis is regularly applied to infants with renal failure, the question logically arises, can infants also receive renal transplants and what are the outcomes? A review of the literature and the clinical experience at the University of Minnesota supports the performance of renal transplantation in infancy. Present patient and graft survival rates for infants are indistinguishable from those of older children. While living adult donors are preferred, adult cadaveric kidneys have also been successfully transplanted. Following successful transplantation, the infants have generally enjoyed catch-up growth and accelerated psychomotor development. While there may be problems related to fluid and electrolyte balance in these smallest patients, the majority of the problems encountered mirror those seen in any child undergoing transplantation. Renal transplantation is regularly successful in infancy and should be considered an integral component of the therapy for any child with chronic renal failure.     

Is Vecuronium Toxicity Abolished by Hemodialysis? A Case Report

Vecuronium is a curaric agent, largely used in anesthesia. Indications as to its employ in uremic patients appear to be debated because of partial renal elimination of the drug. A 52-year-old hemodialyzed woman required transplantectomy for rejection. At awakeness after general anesthesia (induced with fentanyl, propofol, and 6 mg of vecuronium, repeated with a single 2 mg dose 30 min later), she presented diafragmatic and muscular limb weakeness that lasted 180 min in spite of prostigmine administration. A 2 h 30 min predilutional hemofiltration was then performed, which induced rapid disappearance of neuromuscular blockade. Even if vecuronium can be used in dialysis patients, one should remember its possible side effects, especially with repeated doses, in determining prolonged neuromuscular blockade. Cautious use of this drug in renal failure is mandatory. Low dosage must be employed and repeated administration avoided. Neuromuscular blockade seems to be rapidly reversible with dialytic treatment.