Delayed hypercalcemia after non-oliguric acute renal failure associated with rhabdomyolysis

Alterations in the calcium metabolism are a characteristic paraclinical finding in patients with oliguric acute renal failure associated with rhabdomyolysis. A 20-year-old male operated on under general anesthesia developed non-oliguric acute renal failure due to malignant hyperthermia with rhabdomyolysis (urine myoglobin greater than 20,000 nmol/l; reference range less than 0.85 nmol/l). On the 20th postoperative day hypercalcemia was found, reaching a maximum serum level of 3.74 mmol/l (reference range 2.18-2.65 mmol/l) on the 27th postoperative day. Delayed hypercalcemia in non-oliguric acute renal failure associated with rhabdomyolysis has not been reported previously. This case suggests that prolonged control of the serum calcium level should be performed in patients with rhabdomyolysis, even in the absence of oliguria.     

The day-to-day variation in serum digoxin concentration. The H?rsholm digoxin study

Serum digoxin concentration was measured in 70 medical patients 7 and 8 days after admission to hospital. The digoxin treatment taken at home was continued in hospital. There was no statistically significant difference between mean digoxin concentrations in samples taken at day 7 (1.52 nmol/l) and day 8 (1.48 nmol/l). The variation in serum digoxin concentration from day to day expressed as SD was 0.25 nmol/l; 95% confidence limits were +/- 0.51 nmol/l, and 99% confidence limits +/- 0.67 nmol/l. Variations in serum digoxin concentration were not correlated to age, sex, body weight, serum creatinine and the oral dose of digoxin.     

Preservation of renal structure and function in the rat remnant kidney model of chronic renal failure by enalapril treatment

The remnant kidney model of chronic renal failure was established in rats subject to subtotal (1 7/8) nephrectomy and the evolution of renal injury studied over a period of 6 wk. One wk after subtotal nephrectomy, rats had a mean conscious systolic blood pressure of 158 +/- 5 mm Hg and serum creatinine of 128 +/- 9 mumol/l. Both systolic blood pressure and serum creatinine rose over the next 5 wk in concert with progressive glomerulosclerosis and proteinuria. Enalapril, an angiotensin converting enzyme inhibitor, was administered (5 mg/kg/day) to rats (n = 11) from 1 wk after subtotal nephrectomy. Enalapril lowered systolic blood pressure over the treatment period. Systolic blood pressure was 122 +/- 5 mm Hg compared with 176 +/- 7 mm Hg in untreated rats (p less than 0.001) at 6 wk. Serum creatinine 6 wk after subtotal nephrectomy was 110 +/- 9 mumol/l with enalapril treatment, compared with 159 +/- 21 mumol/l (p less than 0.025) in control animals. Enalapril treated rats had lower urinary protein excretion than controls (15 +/- 3 mg/24 hr vs 85 +/- 22 mg/24 hr, p less than 0.0001) at 6 weeks. Glomerulosclerosis, assessed by blinded histological score, was also reduced in the enalapril treated group (1.79 +/- 0.08 vs 2.36 +/- 0.16, p less than 0.01). Enalapril treatment was associated with a reduction in filtration fraction (51Cr-EDTA/125I-hippurate clearance). At 6 wk, filtration fraction was 0.30 +/- 0.03 in enalapril treated and 0.48 +/- 0.03 in control rats (p less than 0.001). Enalapril treatment in the subtotal nephrectomy model of renal failure preserved renal structure and function.(ABSTRACT TRUNCATED AT 250 WORDS)     

Usual values of selenium and glutathione peroxidase in a Belgian population

Several biological parameters for assessing selenium status have been determined in years 1985-1986 in a large Belgian population group, males and females 0 to 92 years old, representative from Brussels and surroundings. In 145 people, 20 to 79 years old, mean concentrations were: 1.06 +/- 0.15 mumol Se/l plasma, 5.0 +/- 1.1 nmol Se/g Hb in erythrocytes and 7.4 +/- 2.0 mu/g Hb for the selenodependent glutathione peroxidase activity measured in erythrocytes (mean +/- standard deviation). Values for urine selenium have a disymmetric distribution and range from 0.05 to 0.65 mumol Se/g creatinine. No difference was evidenced in this group according to sex and age. Children below 20 years and elderly above 80 years have decreased plasma and erythrocyte selenium concentrations but glutathione peroxidase is not modified. These blood selenium concentrations are lower than those determined in a similar population group in years 1980-1981, suggesting a progressive decrease in selenium intake. The concentrations of the biological parameters are not correlated together except in selenium deficient patients having plasma selenium less than 0.75 mumol/l: a significant correlation is observed between plasma selenium and erythrocyte glutathione peroxidase activity, that becomes more intense with decreasing plasma selenium. Finally, two recent investigations are described where a significant response in platelet glutathione peroxidase was obtained during a 60 days selenium supplementation with 100 to 200 micrograms selenium per day, suggesting that usual selenium intake in Belgium (50 micrograms per day) is marginally deficient.     

Biochemical evaluation of leachate-contaminated groundwater on the kidney of Albino rats

The effect of leachate-contaminated groundwater on the cells of the kidney was evaluated. Serum Na⁺ concentration of control rats was observed to be 120±1.0 nmol/l while that of rat placed on simulated leachate was 180±4.0 nmol/l. Serum K⁺, urea and creatinine concentrations of rats placed on simulated leachate and leachate-contaminated groundwater were significantly higher(p<0.05) than those of control rats. The activity of Alkaline phosphatase (ALP) of the kidney and serum, respectively, observed for the control rats were (237±3.70 and 0.37±0.01)nmol/min/mg protein while (116±4.20 and 3.17±0.20)nmol/min/mg protein was the ALP activity of kidney and serum, respectively, observed for the rats placed on simulated leachate. Histological examination of the kidney of the control rats showed no visible lesion while that of rats placed on simulated leachate showed extensive necrosis of muscle fibres and cellular infiltration by macrophages. It is viewed that leachate-contaminated groundwater may damage kidney cells and impair renal function.     

Hepatitis C viral RNA titers in serum prior to,during, and after oral treatment with ribavirin for chronic hepatitis C

Ten patients with biopsy verified chronic hepatitis C virus (HCV) infection were treated with oral ribavirin at a dose of 1,000–1,200 mg per day in two divided doses for 12 weeks. Serum alanine aminotransferase (ALT) levels and hepatitis C viral ribonucleic acid (RNA) levels in serum were followed prior to, during, and 12 weeks posttreatment. ALT levels decreased significantly in all patients during therapy from a mean level of 3.21 μkat/l (range 1.22 to 7.79) before, to 1.25 μkat/l (range 0.78 to 2.04) at the end of treatment (P < 0.005). Hereafter, relapse to pretreatment levels was seen within 12 weeks after treatment stop. The hepatitis C viral RNA levels decreased from a mean 10 log titer of 4.1 (range 1–6) before treatment to 3.4 (range 1–5) at treatment stop. Five patients did not change their HCV RNA titers during treatment. Twelve weeks posttreatment only 3 patients had lower titers than prior to treatment. We conclude that oral ribavirin seems to reduce the viral load, at least temporarily, in some patients with chronic viremic HCV infection. Further studies are needed to evaluate fully the effect of oral ribavirin on chronic HCV infection.     

Critical differences of clinical chemical components in blood from Red Danish dairy cows based on weekly measurements.

The critical difference, which may help to judge whether the difference between two consecutive analytical results may be safely ascribed to natural variation or not, was calculated for 12 clinical chemical components determined in blood samples collected once a week for 5 consecutive weeks from 19 clinically healthy Red Danish dairy cows. For each clinical chemical component, the total variance of the analytical results was divided into the component of variance between cows (S2Inter), the component of variance for weeks within cows (S2Intra) and the component of variance for measurements (S2Anal) using nested analysis of variance. The critical difference calculated in absolute values from S2Intra and S2Anal was 0.15 mu kat per 1 for alanine aminotransferase, 0.55 mu kat per 1 for aspartate aminotransferase, 0.57 mu kat per 1 for alkaline phosphatase, 0.14 mu kat per 1 for gamma-glutamyltransferase, 1.95 mu kat per 1 for creatine kinase, 2.23 mmol per 1 for urea, 22 mu mol per 1 for creatinine, 2.4 g per 1 for albumin, 10.0 g per 1 for serum protein Total, 0.71 mmol per 1 for glucose, 0.54 mmol per 1 for calcium and 0.25 mmol per 1 for magnesium. These critical differences may be used as guidelines to evaluate the difference between two consecutive analytical results in cows. However, the analytical results should not be assessed by the critical differences alone, but should also be compared with the corresponding reference intervals.     

Urinary cyclic AMP corrected for glomerular filtration rate in the differential diagnosis of hypercalcemia

To evaluate the usefulness of urinary cyclic AMP (U-cAMP) expressed as nmol/100 ml glomerulus filtrate (GF) when discriminating various hypercalcemic states, we studied 99 patients. Patients with primary hyperparathyroidism (PHPT) showed a positive correlation between individual S-calcium levels and U-cAMP, nmol/100 ml GF (females r=0.49, n=40, p less than 0.01 and males r=0.91, n=7 p less than 0.001). There was also a correlation between U-cAMP, nmol/100 ml GF, and the weight of the adenomas (females r=0.36, n=32, p less than 0.05) and males r=0.79, n=6, p less than 0.05). Patients with PHPT and normal renal function excreted more U-cAMP than controls, 6.0 +/- 1.6 versus 4.3 +/- 1.0 nmol/100 ml GF (mean +/- SD). Of 47 patients with PHPT and normal renal function, 29 showed values below the upper normal limit, 6.3 nmol/100 ml GF (mean +/-2 SD), of the control group; the overlap was 62%. When U-cAMP was expressed as mumol/24 hours, the overlap was 40/47 (85%) and, when expressed as mumol/g creatinine, 31/47 (66%). Three patients with sarcoidosis and two with malignancies and hypercalcemia showed excretory values of U-cAMP, nmol/100 ml GF, above the upper normal limit. Patients with acromegaly or prolactinoma showed normal values of U-cAMP, nmol/100 ml GF. The present data indicate that all three types of determinations of urinary cAMP based on 24 hour urine collections are of little value in the differential diagnosis of hypercalcemic states.     

Effects of blood purification therapy on a patient with ifosfamide-induced neurotoxicity and acute kidney injury

Ifosfamide combined with other antineoplastic agents has been effective in the treatment of osteosarcoma, although adverse effects are reported in the increasing use of ifosfamide. The most serious complications among the ifosfamide intoxications are neurotoxicity and nephrotoxicity. We report on a patient who suffered from ifosfamide-induced neurotoxicity and nephrotoxicity and rhabdomyolysis after chemotherapy, and was successfully treated with blood purification therapy. The patient had osteosarcoma with multiple lung metastases, wherein the chemotherapy included ifosfamide (3 g/m²) and VP-16 (60 mg/m²) per day for 3 days. The first day after chemotherapy, the patient experienced impaired consciousness and renal function. Based on the clinical course and laboratory data, the diagnosis was ifosfamide-induced neurotoxicity and the acute kidney injury caused by ifosfamide-induced nephrotoxicity and rhabdomyolysis. As a detoxification treatment, blood purification procedures were performed daily for 3 days. Thirty-six hours after the first hemodialysis session, the symptoms of neurotoxicity disappeared. In the lead-up to the 10th day following intoxication, the serum creatinine recovered to the baseline level. Serum ifosfamide concentration decreased from 41.9 to 12.1 ng/ml by the second session of blood purification. Despite the absence of an established detoxification method when complications present simultaneously, blood purification therapy should be considered for treating severe concurrent neurotoxicity and nephrotoxicity and rhabdomyolysis.     

Serum neopterin and beta 2-microglobulin concentrations in monoclonal gammopathies

Serum neopterin and beta 2-microglobulin concentrations were investigated in 46 patients with multiple myeloma and in 28 patients with asymptomatic monoclonal gammopathy followed for long periods (median 9.6 years) and showing an absence of evolution. Seventy-two per cent of the patients with multiple myeloma showed beta 2-microglobulin concentrations higher than 3 mg/l with a mean of 6.84 mg/l, whereas all the patients with asymptomatic monoclonal gammopathies had concentrations lower than 3 mg/l with a mean of 1.64 mg/l. Concerning serum neopterin concentrations, 91% of the patients with multiple myeloma had values with in pathological limits (greater than 8 nmol/l) with a mean of 34 nmol/l, whereas all but one of the patients with asymptomatic monoclonal gammopathy had normal values with a mean of 5.19 nmol/l. The differences thus observed in these two groups of patients are highly significant (p less than 0.001). Serum neopterin concentration, unrelated to renal insufficiency, seems to be useful in the differentiation of malignant or benign asymptomatic monoclonal gammopathies.     

Serum zinc concentrations in Finns

Serum zinc concentrations were measured in 1416 Finns aged 15 years and above and belonging to 18 population groups living in various parts of the country. The mean serum zinc concentration was for men 12.7 mumol/l (82 microgram/100 ml) and for women 11.7 mumol/l (77 microgram/100 ml). Zinc levels varied with sex, age, length of fast, time of day and geographic area. It is noted that the incidence of coronary heart disease, the occurrence of a number of elements in soil and water, and the zinc level in human sera can in a statistical sence be linked to soil composition in Finland. Causal relationships, however, remain obscure.     

Immunological studies of patients with Down's syndrome. Measurements of autoantibodies and serum antibodies to dietary antigens in relation to zinc levels

Recurrent diarrhoea and weight loss in many adult patients with Down's syndrome (DS), initiated a search for malabsorption based on determination of serum IgG and IgA antibody levels to dietary antigens. The results were compared with measurements of autoantibodies and serum zinc levels. DS patients had increased IgG and IgA activities to gluten proteins, casein and ovalbumin compared with an age- and sex-matched group of other mentally retarded patients in the same institution. Intestinal biopsy was performed in six of the 38 patients; one had total and one partial villous atrophy. Serum zinc was significantly lower in DS patients (median 14.7 mumol/l, range 5.5-20 mumol/l) than in the controls (median 16.4 mumol/l, range 12.7-19.5 mumol/l). DS patients with increased IgA activity to gluten weighed less and had lower concentrations of zinc in serum than DS patients with normal IgA activity. Twenty-eight per cent of the DS patients had autoantibodies to the thyroid gland. Our results suggest intestinal malfunction in DS, perhaps related to a defect of immune regulation caused by reduced levels of zinc in serum.     

Prevalence and incidence of moderate and severe chronic renal failure in south-western Finland, 1973-76

In an area of south-western Finland with 195 000 inhibitants and a highly centralized health care system, all subjects with elevated serum creatinine (greater than or equal to 230 mumol/l) were registered on the basis of data collected from all hospitals and clinical laboratories of the region. The prevalence of chronic renal failure (S-creatinine greater than or equal to 230 mumol/l) was 67 per 100 000 inhabitants and that of severe chronic renal failure (S-creatinine greater than or equal to 500 mumol/l) 12.3/10(5). The annual incidence of chronic renal failure (S-creatinine greater than or equal to 230 mumol/l) was 31.7 per 100 000 inhabitants and that of severe chronic renal failure (S-creatinine greater than or equal to 500 mumol/l) 11.9/10(5). Age-specific prevalences and incidences rose progressively with age and were very high in the aged population. Chronic interstitial nephritis, in a broad sense, was the most common cause of chronic renal failure, and it was related to analgesic abuse in about half of the cases. Eleven of 68 subjects entering the study with a serum creatinine greater than or equal to 500 mumol/l had no previous knowledge of their chronic renal disease.     

The protective effects of vitamin A in experimental myoglobinuric renal failure

The protective effects of vitamin A administration on renal failure in a rat model of rhabdomyolysis were investigated in this study. Three groups of rats (seven rats in each group) were employed in this study. Group 1 served as control, Gly group was given 50 % glycerol (7 mL/kg, I.M.), and Gly-Vit A group received glycerol and vitamin A daily (1,000 IU/kg, I.P.). Ninety-six hours after glycerol injection, blood samples were collected by heart puncture. Serum concentrations of creatinine, blood urea nitrogen (BUN), creatine kinase (CK), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) activities were measured in serum samples. Histopathologic pattern of renal tissue damages was also evaluated. Gly-Vit A groups had lower serum concentrations of creatinine, LDH, and CK than the Gly group, and the administration of vitamin A decreased rhabdomyolysis induced renal tubular damages in Gly-Vit A group rather than in Gly group (P?相似文献   

Formation of nitric oxide by peripheral blood leukocytes in the norm and in pathology

The study was made of nitric oxide (NO) generation by leukocytes of peripheral blood from healthy subjects and patients with a compound trauma. How to isolate leukocytes from the whole blood is shown. Leukocyte isolation rate reached 98%. Generation of NO by leukocytes was made in the medium containing medium RPMI 1640 (free of phenol red), calf embryonic serum (5%), L-glutamine (2 mM), gentamycin (80 mcg/ml), penicillin (100 U/ml), streptomycin (100 mcg/ml). Incubation lasted for 15 h at 37 degrees in tissue culture plates with 24 cells 16 mm in diameter (Costor, USA). NO generation was defined in supernatants of cultivated leukocytes (5 x 10(6)) with Griss reagent in reaction with stable metabolite nitrite. NO content among the leukocytes from healthy subjects was 0.63 +/- 0.08 nmol, in trauma 1.10 +/- 0.08 nmol, relative production of NO by healthy subjects was 1.27 +/- 0.17 mumol/l, in trauma 2/21 +/- 0.18 mumol/l, absolute production was 0.99 +/- 0.15 mumol/l and 1.98 +/- 0.19 mumol/l, respectively. The findings point to an important role of nitric oxide generation by leukocytes in reaction with superoxide radical in production of peroxynitrite responsible for severity of endotoxicity.     

Human alpha 1-microglobulin levels in various body fluids.

alpha 1-Microglobulin levels in serum and urine were estimated by using single radial immunodiffusion, resulting in the following mean values: umbilical cord blood serum, 40.6 mg/l; normal adult serum, 44.2 mg/l; and normal urine, 5.7 mg/24 h urine volume. Slightly higher levels of serum alpha 1-microglobulin were found in infants and the aged. Serum and urine alpha 1-microglobulin levels in patients with renal failure, however, were greatly increased, mean levels being 231.5 mg/l and 100.7 mg/24 h urine volume, respectively. Serum alpha 1-microglobulin levels in these patients correlated well with both serum creatinine and beta 2-microglobulin levels. Serum alpha 1-microglobulin level did not correlate positively with serum levels of other plasma proteins, such as alpha 1-antitrypsin, haptoglobin, complement, etc. Ouchterlony immunodiffusion also revealed the presence of alpha 1-microglobulin in synovial fluid, ascites, pleural effusion, amniotic fluid, cyst fluid, and cerebrospinal fluid. The levels of alpha 1-microglobulin in these fluids were measured by single radial immunodiffusion, except that its level in cerebrospinal fluid was measured by radioimmunoassay. Mean alpha 1-microglobulin concentration was 20.8 mg/l in synovial fluid, 28.7 mg/l in ascites, 21.5 mg/l in pleural effusion, 2.7 mg/l in amniotic fluid, 8.2 mg/l in cyst fluid, and 42.3 ng/ml in cerebrospinal fluid.     

Folate and vitamin B12 status of adolescent girls in northern Nigeria

The diets of populations in many developing countries are low in folate and vitamin B12 and a deficiency of either of these vitamins results in increased risk for cardiovascular disease and neural tube defects. The rates of neural tube defects in Nigeria are among the highest reported worldwide. Since many girls marry at an early age in northern Nigeria, we therefore determined the folate and vitamin B12 status of adolescent girls between 12 and 16 years of age in Maiduguri, Nigeria. The mean serum folate concentration for subjects was 15.3 +/- 5.2 nmol/L. Whereas only four subjects (2.4%) had serum folate concentrations lower than 6.8 nmol/L, a level indicative of negative folate balance, 9% of the subjects had serum vitamin B12 concentrations at or below 134 pmol/L, the lower limit of the reference range for their age group. Serum homocysteine was measured in 56 of the 162 subjects and the mean level was 15.9 +/- 5.0 mumol/L. The majority of subjects had serum homocysteine concentrations above the upper limit of the reference range for their age group. We conclude that the adolescent girls we studied were at greater risk for vitamin B12 deficiency than folate deficiency. This conclusion is consistent with the fact that their diet included few foods that contained vitamin B12.     

Girls with virilisation in childhood: a diagnostic protocol for investigation.

AIM: To analyse critically a protocol for the investigation of girls presenting with virilisation in childhood. METHODS: Twenty five girls aged 1.6-8.7 years with features of virilisation were evaluated. Twenty four had presented with pubic hair, eight with auxilliary hair, seven with facial acne, four with clitoromegaly, and 10 with tall stature. They underwent clinical assessment (height, weight, height velocity, staging of puberty, physical examination for acne, body odour, and clitoromegaly) and laboratory assessment comprising basal concentrations of cortisol, 17 OH-progesterone (17 OHP), androstenedione, dehydroepiandrosteronesulphate (DHEAS), testosterone, and oestradiol. The above steroids were also measured during the short synacthen test (0.25 mg intramuscularly) in 16 subjects and low dose dexamethasone suppression tests (0.5 mg at six hourly intervals over 48 hours). Pelvic ultrasound, computed tomography and magnetic resonance imaging of adrenals were carried out when the biochemical findings suggested that there might be an autonomous source of androgen secretion. RESULTS: Clinical and laboratory assessments differentiated the patients into three diagnostic categories: adrenarche (18 cases), congenital adrenal hyperplasia (five cases), and adrenocortical tumour (two cases). The last had elevated concentrations of DHEAS, 1.5 and 19.1 mumol/l (normal value < 0.5 mumol/l), androstenedione, 24.6 and 21.8 nmol/l (normal < 1 nmol/l), and testosterone, 4.5 and 2.4 nmol/l (normal < 0.8 nmol/l), with none suppressing on dexamethasone suppression. Congenital adrenal hyperplasia subjects had elevated basal serum concentrations of 17 OHP (n = 4): 250, 140, 14, and 14.1 nmol/l (normal < 10 nmol/l) and elevated peak values of 17 OHP after synacthen (n = 3): 76, 179.5, and 175 nmol/l. Adrenarche patients had elevated basal concentrations of DHEAS (median: 2.3 mumol/l; n = 17) and androstenedione (median 2.6 nmol/l; n = 17). Nine patients also had elevated basal serum testosterone concentrations (median 0.9 nmol/l). Peak values of 17 OHP after synacthen were significantly different from baseline (n = 12) and were < 50% of the lowest value in congenital adrenal hyperplasia. Serum DHEAS, androstenedione, and testosterone suppressed following dexamethasone suppression (n = 16), thereby distinguishing adrenarche patients from adrenal tumour patients. Clinical details did not distinguish patients, except for clitoromegaly which was present only in the tumour and congenital adrenal hyperplasia patients. CONCLUSIONS: This protocol proved useful and practical in cases of virilisation presenting particular diagnostic difficulty.     

Preparation and application of control sera for neuromuscular disorders

The lack of assayed quality control sera to reliably determine the presence of low creatinine, high creatinine, and high aldolase activity levels in patients with progressive muscular dystrophy prompted us to attempt the development of such sera. The mean serum creatinine and creatine values in patients with neuromuscular disorders were 0.24 mg/dl and 1.42 mg/dl, respectively. Aldolase activity spanned a wide range from normal to 273 IU/l. On the basis of these findings, sera containing 0.2 mg/dl of creatinine, 1.6 mg/dl of creatine, and 60 IU/l of aldolase activity were prepared by the reconstitution of pooled sera. The coefficients of variation (CVs) of creatinine assays for control sera containing 1.0 mg/dl or more were less than 1.5%. However, precision was poor at creatinine concentrations below 0.4 mg/dl, with CVs as high as 3.3%. Since the precision of creatinine measurement is poor at low concentrations, the creatinine assay has its own limitations if employed clinically for the purpose of evaluating renal function in patients with muscle atrophy or in children who have low serum creatinine levels. The high creatine and aldolase activity levels of the prepared control sera gave satisfactory results when analyzed for intra-assay and inter-assay variation.     

Glomerular epithelial cell changes in early postischemic acute renal failure in rabbits and man.

Spreading and flattening of glomerular podocyte cell bodies and major processes and an apparent lack of foot processes were observed by scanning electron microscopy in a reversible pedicle-clamping model of acute renal failure in ADH-treated rabbits and in biopsy specimens taken 1 hour after transplantation from patients who later showed clinical signs of "acute tubular necrosis." Glomerular changes were quantified by morphometry in A) normal rabbit kidneys, B) rabbit kidneys obtained 2 hours after 1 hour of left pedicle clamping and right nephrectomy, C) kidneys similar to Group B except that the animals were treated with an agent that reliably lessens the eventual severity of renal failure (clonidine, 30 microgram/kg given intravenously 1/2 hour before unclamping), D) 1-hour-posttransplantation biopsy specimens from human kidneys that functioned well after transplantation (recipient serum creatinine less than 2.5 mg/dl on Day 3), and E) 1-hour-posttransplant biopsy specimens from kidneys that later manifested posttransplantation ischemic acute renal failure (recipient serum creatinine greater than or equal to 2.5 mg/dl on Day 3). The fraction of glomerular capillary surface covered only by podocyte processes smaller than 1 mu (and not by cell bodies and wider processes) was .65 +/- .02 (SEM) in A; .48 +/- .03 in B; .64 +/-.03 in C; .57 +/- .01 in D; and .38 +/- .04 in E (A vs B, P less than .01; B vs C, P less than .02; D vs E, P less than .01). In Groups D and E there was a significant negative correlation between the fraction of glomerular capillary surface covered only by podocyte processes less than 1 mu in width and serum creatinine on the third posttransplantation day (r = --.86, P less than .01 by the Spearman rank test). It is concluded that podocyte changes are seen by scanning electron microscopy early in clinical and experimental postischemic acute renal failure and are more pronounced in those groups that eventually develop more severe renal failure. It is unclear whether these changes reflect a decrease in glomerular hydraulic permeability or an increase in glomerular permeability to protein.