Correction by oral adsorbent of abnormal digestive tract milieu in rats with chronic renal failure

In order to examine the mechanism by which the oral carbonaceousadsorbent, AST-120 delays the appearance of glomerular sclerosis,experiments were carried out in 120 male Sprague-Dawley ratsweighing 285–320 g. The rats were first subjected to 2/3,3/4, and 4/5 nephrectomy (n=40). The experiments were begunat 2 weeks after the surgery, and were performed over an 8-weekperiod. Half of each group (n=20) was administered 1 g/day ofliquid AST-120, and the other half received liquid vehicle solutionwith pair feeding in each group. In the 2/3 nephrectomized groupthe administration of AST-120 delayed the occurrence of glomerularhypertrophy and prevented the appearance of glomerular sclerosiswithout any significant differences in renal function, systemicblood pressure (SBP), and urinary protein excretion (U-P). Inthe 3/4 nephrectomized group the administration of AST-120 delayedthe appearance of glomerular hypertrophy and sclerosis withsignificant decreases in SBP and U-P. In the 4/5 nephrectomizedgroup the administration of AST-120 delayed the appearance ofglomerular sclerosis and prevented a decrease in renal function.It is concluded that administration of the oral adsorbent AST-120delays the occurrence of glomerular sclerosis by delaying theappearance of glomerular hypertrophy, systemic hypertension,and the increase in proteinuria. It can be therefore mentionedthat the accumulating substances in the digestive tract worsenthe abnormal milieu of chronic renal failure.     

腹腔镜引导下腹膜透析管置放术

目的　探讨腹腔镜引导下放置腹膜透析管的方法。　方法　选择 9例慢性肾功能衰竭患者 ,在腹腔镜引导将Tenckhoff腹膜透析管置入腹腔并经皮下隧道引出。　结果　所有病例腹膜透析管均放置成功。手术时间 10min～ 2 0min。均成功的进行了腹膜透析。患者术后 2～ 7天出院。　结论　腹腔镜引导放置腹膜透析管技术具有透析管定位准确 ,手术切口小 ,术后疼痛轻。优于常规开腹技术     

Effects of late referral to a nephrologist in patients with chronic renal failure

BACKGROUND: We lack information about the role of late diagnosis of end-stage renal disease (ESRD), late nephrological referral and its impact on biochemical variables and first hospitalization in East Anatolia, Turkey. METHODS AND RESULTS: For a total of 101 ESRD patients, dialysis was initiated between January 1998 and December 2002 at the Yuzuncu Yil University Hospital. Early referral (ER) and late referral (LR) were defined as the time of first referral or admission to a nephrologist greater or less than 12 weeks, respectively, before initiation of haemodialysis (HD). RESULTS: The need for urgent dialysis was less among the early referral cases compared with the late referral cases (P = 0.03). Patients with LR started dialysis with lower levels of haemoglobin (8.6 vs 9.5 g/dL, P < 0.05) bicarbonate (16 vs 12 mEq/lt, P < 0.03) and albumin (2.9 vs 3.29 mg/dL, P < 0.02) and with higher serum levels of blood urea nitrogen (173 vs 95 mg/dL, P < 0.001), creatinine (10 vs 7.9 mg/dL, P < 0.001) and potassium (5.3 vs 4.8, P < 0.04). Hospitalization duration beginning at dialysis was significantly longer in the LR group (27.3 +/- 24) compared with the ER group (13.4 +/- 7.5, P < 0.001). When the groups were compared in terms of distance between the patients home and hospital, there were significantly more patients living far away from hospital (i.e. >100 km) in the LR group compared with the ER (P < 0.0001) group. CONCLUSION: Early referral to a nephrology unit and/or early diagnosis of ESRD results in better biochemical variables, shorter first hospitalization length and a higher percentage of elective construction of AVF and the availability to start with an alternative dialysis modality (i.e. CAPD).     

Colchicine myoneuropathy in chronic renal failure patients with gout

Colchicine myoneuropathy is a rare and often underdiagnosed disease. It often presents as painless subacute muscle weakness. We present a case of painful colchicine myoneuropathy in a 76-year-old man with chronic renal failure and gout. Published work about clinical presentations of colchicine myoneuropathy in gouty arthritis patients are reviewed. During the previous year, the patient had a drug regimen of colchicine 0.5 mg three times per day for a 3 day course each month. He developed bilateral lower leg weakness and severe myalgia. His serum creatinine level was 680.7 micromol/L and creatinine kinase was 959 IU/L on admission. Laboratory findings included decreasing amplitude of motor and sensory nerve conduction velocity and an electromyogram showed small amplitude, short duration polyphasic waves over the right biceps. A muscle biopsy disclosed vacuolar changes in the cytoplasm. These results all supported a diagnosis of colchicine myoneuropathy. After cessation of colchicine, the creatinine kinase level decreased approximately 50% in 6 days, myalgia subsided and his muscle weakness improved gradually over the next 2 weeks.     

Incidence of side-effects associated with high-dose ferric gluconate in patients with severe chronic renal failure

SUMMARY: Ferric gluconate complex in sucrose (Ferrlecit™) has been associated with less side-effects than iron dextran; however, the recommended dose of 62.5–125 mg per treatment is only suitable for haemodialysis (HD) patients. We retrospectively analysed the incidence of the side-effects associated with a high dose of Ferrlecit™ infusion (20 treatments in 13 patients; 10 treatments of 250 mg/3–4 h, and 10 treatments of 500 mg/5 h infusion). The patients were in the age range of 32–75 years old, seven with chronic renal failure (CRF), and six on dialysis treatment. One (10%) of the 10 treatments using a 250 mg dose was complicated with severe nausea/vomiting, diarrhoea and a burning sensation in the feet. Three (30%) of the 10 treatments using a 500 mg dose were complicated with: chills, severe nausea/vomiting, hypotension and syncope in one; severe nausea/vomiting, diarrhoea and hypotension in one; and an episode of vomiting in one patient. A single treatment with a 250 mg dose resulted in no significant change in haematological parameters. A single treatment with a 500 mg dose resulted in a significant increase in haemoglobin (Hgb) and haematocrit (Hct), but only a rising trend in serum iron,% transferrin saturation and ferritin pre versus 1–2 months postinfusion. In conclusion, Ferrlecit™ doses of 250 or 500 mg are complicated with significant untoward reactions in 10–30% of patients, in a dose-dependent fashion.     

Natural history of chronic renal failure: a reappraisal.

In this retrospective study we have analysed the rate of progression of renal insufficiency, ascertained from the slopes of the plot of inverse serum creatinine against time, of 102 patients with moderate to severe chronic renal failure (CRF). We have applied 'breakpoint' analysis of the slopes to identify changes in the rate of progression and attempted to determine the factors associated with these changes. Seventy-one patients were found to have progressive CRF, while the remaining 31 had stable or improving renal function. Of the parameters studied, using weighted least-squares analysis, proteinuria was the most significant predictor of progression (regression coefficient: -0.1775, P = 0.0075, adjusted r2 = 0.1059). A positive correlation was observed between proteinuria and diastolic blood pressure (DBP) (r = 0.336, P = 0.0054). Once the predictive value of proteinuria was taken into account, there was no difference in the progression rate between diagnostic groups, other than those patients with polycystic kidney disease who had a significantly faster rate of progression (P = 0.0037). In 49 patients, there was at least one change in the rate of progression with time. There was an inverse correlation between change in slope and a change in DBP (r = -0.352, P = 0.003). We conclude that changes in DBP are often associated with the frequent changes in the rate of progression of CRF. However, a causal link could not be established as in a large number of cases the two changes appeared to occur simultaneously in the absence of changes in antihypertensive therapy.     

The epidemiology of chronic renal failure and provision of renal services in Albania

Tirana, the only dialysis facility in Albania (pop 4 million),has a stock of 12 patients and three haemodialysis machines.To determine the need for renal services in Albania we studiedthe incidence and outcome of patients with chronic renal failure(CRF) referred to the renal service in Tirana (pop 300000) over1 year. Case-notes of all patients with a serum creatinine concentration300 µmol/l during the study period (1992) were examinedand outcome at 2 years recorded for each patient. In all, 84 patients (mean age 41.6±17.5 years, 56% male)were referred to nephrologists of whom 35 (42%) came from Tirana,giving an annual incidence of 116 per million pop. 77% wereunder 40 and had no co-morbid illness. Glomerulonephritis, themost common renal diagnosis, affected 26% patients. 22% patients(mean age 38±18.1) died within 2 years and only 5% receiveddialysis. The mean age of those who received dialysis was 29±8.3compared with those who were not dialysed (42±18.0).The 59 patients (24 from Tirana i.e. 80 per million) who werealive with advanced CRF (creatinine > 500) had a mean creatinineof 623±93 µmol/l and would be candidates for dialysis.Patients with progressive renal failure in Albania are regularlyfollowed and treated with antihy-pertensives and dietary modification.The need for RRT, however, is not being met even for young patientswith no co-morbidity.     

Whole body and regional body composition in patients with chronic renal failure

BACKGROUND.: Nutritional state is a powerful prognostic factor in chronicrenal failure (CRF). Techniques for the assessment of nutritionhave limitations which are often most marked in the presenceof renal disease. We have used techniques of body compositionanalysis to assess the nutritional state of groups of patientswith CRF. METHODS.: Body composition was measured in groups of patients with advancedCRF on conservative treatment, peritoneal dialysis, and haemodialysisand the results compared with a healthy control group. The selectioncriteria for the CRF patients ensured that they were ‘stable’with no recent intercurrent illness, and dialysis adequacy wassatisfactory according to currently accepted targets. RESULTS.: Whole body dual energy X-ray absorptiometry (DEXA) found significantreduction in lean tissue in haemodialysis patients and femaleperitoneal dialysis patients. Regional analysis with DEXA showedreduction in limb (especially arm), lean tissue in CRF patients,with arm lean tissue being reduced in all three CRF groups forfemales and both dialysis groups for males. Limb/trunk leantissue ratios were significantly reduced for all CRF groups.Bioelectrical impedance showed reductions of fat-free mass inthe same groups who had reduced whole body lean tissue withDEXA, but skinfold anthropometry failed to detect any significantreduction in fat-free mass. CONCLUSIONS.: We conclude that even in ‘healthy’ groups of CRFpatients receiving adequate dialytic and dietary management,lean tissue depletion is a common problem. Regional analysisby DEXA, with measurement of limb lean tissue mass is a moresensitive method for the detection of lean tissue depletionthan measurement of whole body lean tissue in patients withCRF.     

Reducing high phosphate levels in patients with chronic renal failure undergoing dialysis: a 4-week, dose-finding, open-label study with lanthanum carbonate.

BACKGROUND: The majority of patients with end-stage renal disease on dialysis are hyperphosphataemic. Lanthanum carbonate has been shown to be a highly effective phosphate binder in pre-clinical studies. A 4-week, open-label, dose-titration trial was conducted to assess the ability of lanthanum carbonate to control phosphate levels in patients with chronic renal failure. METHODS: This preliminary study was of 6 weeks duration: 2 weeks of washout followed by 4 weeks of dose titration. Patients (n = 59) were titrated on the basis of weekly serum phosphate levels from a daily dose of 375 mg lanthanum carbonate to a maximum dose of 2250 mg. Patients were maintained on the dose that controlled serum phosphate to between 1.30 and 1.80 mmol/l (4.03-5.58 mg/dl). Serum phosphate levels represented the main efficacy assessment. Safety was also evaluated. RESULTS: Most patients were successfully titrated to 1500 and 2250 mg lanthanum/day (mean dose at end of titration: 1278 mg). At completion of the study 70% of patients achieved a serum phosphate of 相似文献   

Clonidine as an adjuvant for lidocaine in axillary brachial plexus block in patients with chronic renal failure

BACKGROUND: Clonidine is often used as an adjuvant for local anaesthetics in regional anaesthesia; however, its effects on axillary block in chronic renal failure patients have not been investigated. These effects were the focus of this study. METHODS: Twenty-eight adult chronic renal failure patients (ASA physical status III) scheduled for arteriovenous fistula construction were studied in a prospective, randomized, double-blind, controlled design. All axillary block procedures were performed by the same anaesthesiologist using the nerve stimulator technique. The control group received 40 ml of lidocaine (10 mg ml(-1)) combined with 1 ml of saline, and the clonidine group received 40 ml of lidocaine (10 mg ml(-1)) mixed with 150 microg of clonidine. Characteristics of the patients and the blocks were recorded, in addition to data on the nerves stimulated, intraoperative haemodynamic parameters, and sedative and analgesic requirements. RESULTS: The onset time for sensory blockade was longer in the clonidine group than in the controls (P = 0.013), and both motor and sensory blocks lasted longer in the clonidine group (P = 0.004, P < 0.001, respectively). In addition, the clonidine group had lower mean arterial pressures, heart rates and higher sedation scores compared to the controls (P < 0.05 for all). CONCLUSION: Use of clonidine (150 microg) as adjuvant for lidocaine in axillary blocks for arteriovenous fistula construction in chronic renal failure patients prolongs blockade, decreases both heart rates and blood pressures and provides sedative effects.     

Late diagnosis of chronic renal failure and mortality on maintenance dialysis

BACKGROUND.: Recent observations in our country have shown that late diagnosisof chronic renal failure (CRF) is an important cause of latereferral and late commencement of maintenance dialysis. We prospectivelyinvestigated the influence of late diagnosis of CRF on patientmortality during dialysis therapy. METHODS.: Among 184 consecutive patients with non-diabetic end-stage renaldisease starting chronic dialysis at the Federal UniversityHospital in the city of So Paulo, 106 had a late diagnosis ofCRF (less than 1 month before starting dialysis) and 78 hadan early diagnosis. During the first 6 months of dialysis treatment,patient survival was compared in the two groups, using the Kaplan-Meiermethod and the Cox proportional hazards model. RESULTS.: Six-month patient survival rate was lower in the late than inthe early diagnosis group (69% versus 87%, P<0.01). In thelate diagnosis group, the hazard ratio of mortality was 2.77(95% C1, 1.36–5.66) times that of the early diagnosisgroup. In a multivariate analysis, after adjusting for age,comorbid illness, and serum biochemical measurements, time ofdiagnosis did not remain significantly associated with mortalityrisk. In this analysis, age, pulmonary infection, and low serumalbumin were significant predictors of mortality. CONCLUSIONS.: Patients with a late diagnosis have a higher mortality riskduring the first 6 months of maintenance dialysis. This increasedrisk is related to comorbid conditions, some of which couldbe prevented by predialysis care. Interventions to promote earlydiagnosis of CRF and adequate predialysis follow-up need tobe evaluated if the survival of patients with chronic renalfailure is to improve.     

Post-fertilization effects of chronic renal failure in male rats

We evaluated the potential for growth and intrauterine development of embryos generated from the fertilization of oocytes with spermatozoa recovered from animals with chronic renal failure (CRF). Group A included sham-operated rats ( n  = 28), group B1 involved CRF rats that had undergone erythropoietin plus bromocryptine treatment ( n  = 28), and group B2 included CRF rats that had received normal saline. Embryos derived from the in vitro fertilization of oocytes with spermatozoa recovered from rats of group A or group B1 or group B2 were transferred to female recipients. We induced CRF in a group of rats (group B; n  = 56; the total kidney volume was reduced to one-sixth with two operations). One week after the second operation, the rats of group B were randomly divided into group B1 (they subsequently received bromocryptine plus erythropoietin) and group B2 (they received injections of saline). Nine weeks after the second operation, the fertility of each male rat was assessed by mating tests and in vitro fertilization of oocytes. The mean litter size was significantly smaller in the subpopulation of fertile animals in group B2 than in the fertile rats of group B1 and in the fertile rats of group B1 than in the fertile rats of group A. Per cent of transferred blastocysts that developed into alive offspring were significantly lower in group B2 than in group B1 and in group B1 than in group A. Epididymal spermatozoa demonstrated a significantly larger DNA-oxidative damage in group B2 than in group B1 and in group B1 than in group A. These findings demonstrate that sperm-DNA damage because of CRF development is accompanied by a defect in the development of embryos generated in vitro. We may suggest that bromocryptine and erythropoietin protecting sperm DNA from oxidative damage improve reproductive potential in rats with CRF.     

The effect of oral adsorbent on surgically induced hepatic failure

The oral adsorbent AST-120 is one type of activated carbon for oral use. In the present study, AST-120 was administered, to clarify its effect, on surgically induced hepatic failure in dogs and rats. Portacaval shunts and varying extents of hepatectomies were performed on 44 dogs. Eleven dogs were given an ordinary diet (control group), and 33 dogs received the oral adsorbent with an ordinary diet after the operation (AST group). Plasma bile acids and ammonia increased, and body weight decreased in both groups. However, after the administration of AST-120, the plasma bile acids and ammonia decreased significantly, and the body weight tended to increase in the AST group. Portacaval shunts and about 70 per cent hepatectomy were performed on 59 Sprague-Dawley rats. These rats were divided into two groups, diet with the oral adsorbent (AST group, n=19) and an ordinary diet alone (control group, n=40). DNA synthesis and protein synthesis of the liver were measured on the 5th, 10th and 20th postoperative days using radioisotopes in these rats. Both DNA and protein synthesis of the liver were increased significantly in the AST group. Histological examination revealed many more glycogen granules in the cytoplasm of hepatocytes in the AST group compared to the control group on the 5th postoperative day. It was suggested that some metabolic toxin was adsorbed by AST-120 in the alimentary tract.     

Hot bath for the treatment of chronic renal failure

Background: Dialysis and its complications were debated recently. There was lack of an adjuvant renal replacement method to reduce the complications of patients with chronic renal failure and dialysis itself. Materials and methods: In this article, we reviewed the role of thermal sweating in treating of the patients with chronic renal failure, and the role of traditional Chinese medicine in the therapy of chronic kidney diseases. Results: Thermal sweating can reduce interdialytic weight gain and improve the patients’ blood pressure; Chinese herbal medicine can promote the excretion of uremic toxicities and relieve the skin disorders of these patients. Conclusions: Traditional Chinese medicine-mediated hot bath could be one of the adjuvant renal replacement methods.     

慢性肾衰竭患者继发甲状旁腺功能亢进外科治疗进展

随着透析技术的进步,慢性肾衰竭患者的生存时间逐渐延长,但影响患者生活质量甚至严重威胁患者生命的许多并发症也随之出现.继发性甲状旁腺功能亢进(SHPT)是血液透析患者的常见并发症之一,并且有一定的发病率和病死率,特征性表现主要有:低钙、高磷和高甲状旁腺激素.大多数患者可以通过药物治疗而痊愈,然而,药物治疗并不是都能很好地调节甲状旁腺功能的紊乱,部分患者需要外科干预.本文对慢性肾衰竭血透患者SHPT外科治疗的现状做一综述.

Abstract：

With the development of the dialysis technology,the survival time of patients with chronic renal failure is prolonged,while more complications which affect the quality of life or even threat the life of patients are followed.Secondary hyperparathyroidism(SHPT)with a certain incidence and mortality is one of the common complications,and its main characteristic performances ale hyperphosphatemia,hypocalcemia and high level of parathyroid hormone.Most patients Can be cured by the treatment of medicine while surgical treatment is still required by some cases in which the disorder of the parathyroid function can not be well regulated through medicine treatment.The purpose of this paper is to make a review of the recent studies of surgical treatment in patients with SHPT.     

Endothelin in chronic renal failure.

The aims of the present study were to determine plasma endothelin (ET) in chronically uraemic patients, the renal clearance of endogenous ET in normal dog and man, and the effect of acute volaemic expansion on ET. The mean plasma ET concentration in haemodialysis patients was 57.5 +/- 5 pg/ml before haemodialysis and remained unchanged at 52.5 +/- 5 pg/ml after haemodialysis. They were thus significantly elevated both before and after haemodialysis (P less than 0.01) compared with plasma ET in normal subjects of 20.8 +/- 0.8 pg/ml. There was no evidence of ET clearance across the cuprophane membrane of the dialyser. Resting plasma ET values in the 15 non-dialysed uraemic patients ranged between 20 and 52.5 pg/ml (mean 38.2 +/- 2.3 pg/ml), significantly greater than those observed in controls (P less than 0.01). In CAPD patients, plasma ET was also significantly (P less than 0.01), elevated (63 +/- 10 pg/ml) when compared to controls, and similar to those observed in patients before haemodialysis. In dogs, mean ET did not diminish between the aorta and the renal vein (28.1 +/- 1 versus 28.4 +/- 2 pg/ml). In man mean ET did not significantly decline between the renal artery and the renal vein (17 +/- 3 to 13 +/- 0.8 pg/ml). In the seven healthy subjects who received 2000 ml of isotonic saline intravenously ET remained unchanged (24 +/- 2; 23 +/- 1 and 23 +/- 2 pg/ml before and 1 and 2 h after starting hydration respectively). We have thus shown that plasma ET is elevated in patients with chronic renal failure especially those on dialysis and CAPD.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effectiveness of low-dose erythropoietin in predialysis chronic renal failure patients

Recombinant human erythropoietin (rHuEpo) has been shown tobe both effective and usually safe in patients with chronicrenal failure who have not yet reached the stage requiring dialysis.There are, however, disturbing reports on the possibility ofdeterioration of the reserve renal function in association withrHuEpo therapy. Most of the published studies have used rHuEpoin doses of 50–150 U/kg three times weekly subcutaneously.An open-label trial of rHuEpo therapy was conducted on 21 patientswith chronic renal failure treated sequentially at a referralhospital, rHuEpo was used in doses of 50 U/kg twice weekly for4 weeks followed by 25 U/kg twice weekly for 8 weeks subcutaneously,a regimen substantially lower than current recommendations.This was associated with a gentle but significant increase inhaematocrit (P<0.05) and haemoglobin (P<0.05), while theserum creatinine and the reciprocal of the creatinine remainedstable, with a tendency to improve rather than worsen (P=0.06).We conclude that there is no need to aim at a rapid increasein haematocrit and haemoglobin by rHuEpo therapy; rather a gentleincrease using modest doses is both effective and safe.     

A study of erythropoiesis inhibitory factors in chronic renal failure sera

Summary: Three separate high molecular weight fractions, designated as FI, FII and FIII, were isolated from sera of chronic renal failure (CRF) patients by precipitate with ammonium sulfate of different concentrations and DEAE celluose. All fractions had obvious suppressive effect on red blood cell growth, both erythroid colony (CFU-E) and BFU-E in vitro , but the maximal inhibitory rate that may be found in Fl or in FII and FIII depends entirely on individuals. the study also showed that none of these fractions was a homogeneous substance in SDS-PAGE electrophoresis. As well, a close correlationship between serum erythropoietin level and the inhibitory rate of the isolated fractions was observed. It is suggested that the inhibitory factors might exist in CRF sera and play a role in triggering the anaemia of CFR.