Resting metabolic rate in chronic renal failure.

OBJECTIVE: A decrease in resting metabolic rate (RMR) in patients with chronic renal failure was assumed to occur because of the decreasing oxygen consumption of the kidneys, which in healthy subjects, accounts for 7.2% of RMR. Contrary to this assumption, RMR per body weight in end-stage renal disease was increased. DESIGN AND METHODS: To test the impact of chronic renal failure on the RMR, direct bedside calorimetry was performed on 51 outpatients (age, 53.2 +/- 13.9 y; creatinine clearance, 6.9 to 52 mL/min). Twenty two of 51 patients were examined repeatedly (at the start of the study, after 3 months, and after 6 months) during declining kidney function. RESULTS: In the total group, RMR per body weight (RMR/BW) was 100.0 +/- 4.96 kJ/kg/day and RMR per body surface area (RMR/BSA) was 4.582 +/- 0.181 kJ/min/1.73m(2). RMR/BW and RMR/BSA correlated significantly with creatinine clearance (n = 51, r = -.763, P <.001; n = 51, r = -.557, P <.001). In the follow-up group, creatinine clearance decreased from 27.5 +/- 9.5 mL/min initially, to 19.4 +/- 6.25 mL/min at 3 months, to 13.0 +/- 3.8 mL/min at 6 months (P <.001), while RMR/BW and RMR/BSA increased from 98.28 +/- 6.3, to 101.64 +/- 5.46, to 105.42 +/- 6.3 kJ/kg BW/d (P <.005), respectively, and 4.41 +/- 0.126, to 4.578 +/- 0.168, to 4.704 +/- 0.168 kJ/min/1.73 m(2) (P <.05), respectively. CONCLUSION: Taking into account the reduced oxygen consumption of the shrinking kidneys, the normal RMR suggests an increased energy expenditure per body cell mass. The raising RMR in deteriorating excretory kidney function reflects the increasing energy expenditure in progressive chronic renal failure.     

Stroke in chronic renal failure

Chronic kidney diseases and cardiovascular diseases have several common risk factors like hypertension and diabetes. In chronic renal disease stroke risk is several times higher than in the average population. The combination of classical risk factors and those characteristic of chronic kidney disease might explain this increased risk. Among acute cerebrovascular diseases intracerebral hemorrhages are more frequent than in those with normal kidney function. The outcome of stroke is worse in chronic kidney disease. The treatment of stroke (thrombolysis, antiplatelet and anticoagulant treatment, statins, etc.) is an area of clinical research in this patient group. There are no reliable data on the application of thrombolysis in acute stroke in patients with chronic renal disease. Aspirin might be administered. Carefulness, individual considerations and lower doses might be appropriate when using other treatments. The condition of the kidney as well as other associated diseases should be considered during administration of antihypertensive and lipid lowering medications.     

瘦素与慢性肾衰

瘦素 (Ｌｅｐｔｉｎ)又称“抗肥胖激素” ,是近年来发现的一种存在于啮齿动物及人体的激素[1] 。由于它的生理功能与调节食物摄取及能量消耗有关 ,而慢性肾衰 (ＣＲＦ)病人常表现为厌食和蛋白营养不良。因此 ,它的发现受到肾脏病学家的高度重视[2 ] ,现对ＣＲＦ时瘦素水平的变化及其意义综述如下。一、瘦素的功能及其调节瘦素是肥胖基因的蛋白产物 ,它几乎完全由脂肪细胞分泌 ,通过血液循环 ,与靶器官受体结合 ,发挥生理功能。瘦素分子由 16 7个氨基酸组成 ,相对分子量 16 0 0 0 ,以游离及结合的形式存在于血浆中。在人类 ,瘦素的血浆浓度随…     

Ionized calcium in patients with chronic renal failure.

Parameters of various renal disorders were studied in 31 patients (17 men and 14 women) who all were in the stage of chronic renal failure (CRF). These parameters included total serum creatinine, ionized calcium, serum creatinine, creatinine clearance and acid-base balance. The results were compared with a control group of 30 healthy subjects. In the patients with first stage CRF, the total serum calcium did not significantly decrease (mean = 2.19 +/- 0.12 mmol/l) and ionized calcium was within reference value limits (mean = 1.28 +/- 0.02 mmol/l). The percentage of ionized calcium in total serum calcium was higher for these patients (mean = 58.43%) than for the control group (mean = 52.25%). For patients with first and second stage CRF, the total serum was significantly lower (mean = 1.92 +/- 0.03 mmol/l) than for the healthy controls (p < 0.001) as well as for patients with first stage CRF (p < 0.05). The ionized calcium in these patients was not significantly lower (mean = 1.14 +/- 0.01 mmol/l); however, its percentage was higher than that of serum calcium (mean = 59.38%). There was a slight negative correlation between the levels of ionized calcium and serum creatinine in patients with first stage CRF (r = -0.30) and a significant correlation in patients with second and third stage CRF.     

Erythrocyte ferritin levels in chronic renal failure patients.

The authors studied the level of erythrocyte ferritin and its importance as a marker of iron metabolism in renal anemia patients. METHODS: We studied 33 chronic renal failure patients--12 men and 21 women, aged 33-72 years. Hemoglobin levels, erythrocyte counts, hematocrit, mean corpuscular hemoglobin, serum creatinine, iron and ferritin in serum and erythrocytes were measured on a regular basis throughout the study period employing the monoclonal IRMA "Micromedic" kit. RESULTS: Serum iron levels were significantly lower in first degree chronic renal failure (CRF) patients (11.07 +/- 1.54 mmol/l) as compared with the controls (P < 0.01) whereas serum (91.10 +/- 4.00 ng/ml) and erythrocyte (0.83 +/- 0.08 ng/g Hb) ferritin levels were within normal limits. There was a moderately positive correlation (r = 0.37) between serum and erythrocyte ferritin levels. In second and third degree CRF patients the serum iron (7.82 +/- 0.72 mmol/l), serum ferritin (77.60 +/- 3.24 ng/ml) and erythrocyte (0.71 +/- 0.06 ng/g Hb) ferritin levels were significantly lower as compared with those of first degree CRF patients. In the hemodialysis patients erythrocyte ferritin levels showed a tendency towards increase as compared with those in second and third degree CRF patients (P < 0.05). There was a moderately negative correlation (r = -0.44) between serum iron and erythrocyte ferritin levels in this group of patients. CONCLUSIONS: 1. Erythrocyte ferritin levels can be useful in the complex diagnostic assessment of the anemic syndrome in CRF patients. 2. Erythrocyte ferritin is a reliable indicator of iron overload in hemodialysis patients. 3. Erythrocyte ferritin gives no advantage in the evaluation of iron metabolism of medically treated CRF patients.     

Recombinant erythropoietin and chronic renal failure

The hormone deficiency that underlies anemia in chronic kidney failure can now be corrected. Along with the primary benefit of raising the hematocrit and reversing anemia, dramatic secondary benefits can be achieved. Exercise capacity, neuropsychiatric and sexual function, and overall quality of life are enhanced. Guidelines for management are discussed.     

Myocardial calcification in chronic renal failure

The authors present the case of a young man who--as a consequence of chronic renal failure and long-term dialysis--developed a calcific cardiopathy. The myocardial calcification was proved histologically by light microscopy. They established that the calcification started in damaged myofibers and was principally caused by the secondary parathyroid hyperfunction. The diagnosis and therapy of the myocardial calcification is discussed on the basis of references. The prevention of this complication may improve the life-expectancy of patients treated by chronic dialysis.     

Captopril for refractory hypertension in patients with chronic renal failure and renal transplantation.

The converting-enzyme inhibitor, captopril, was given to ten patients with refractory severe hypertension of renal origin: 6 patients had chronic renal failure, 3 patients had hypertension following renal transplantation, and one patient had hypertension and congestive cardiac failure. Control of blood pressure was achieved with doses from 78 to 400 mg/day. Severe hyperkalaemia occurred in one patients, ageusia (dose dependent) in another, and one patients withdrew from treatment because of nausea.     

Living with chronic renal failure

We describe our impressions gained in the process of systematic interviewing of children with chronic renal failure. In spite of improved techniques of medical treatment in recent years, many of these children and their families remain under considerable strain. This is caused by anxieties about the child's general prospects for the future, problems in accepting the illness and treatment, particularly with a late onset of the condition, and multiple hospital admissions with occasional life-threatening incidents. In spite of their less serious nature, chronic features such as poor growth and urinary incontinence seem to be particularly worrying for many children and their parents. We feel that it is worth considering how to improve the supports for these families, helping parents to be more aware of community facilities that are available, and striving to improve communication between the different agencies (hospital, general practitioners, schools, etc.) involved.