Reversible acute renal failure associated with hypothyroidism: report of four cases with a brief review of literature

SUMMARY:   We present four adult cases of acute renal failure associated with hypothyroidism. All patients presented with symptoms suggestive of moderate to severe hypothyroidism, such as cold intolerance, constipation, muscle weakness, and lower extremity oedema. Initial serum creatinine levels ranged between 115 and 203 µmol/L (1.3 and 2.3 mg/dL), with creatinine clearances (CrCl) ranging between 0.58 and 0.97 mL/s (34.5 and 58 mL/min). After 6–12 weeks of treatment with levothyroxin, serum creatinine levels decreased to the range of 80 and 124 µmol/L (0.9 and 1.4 mg/dL) and CrCl increased to 0.74–1.64 mL/s (44–98 mL/min). One patient had proteinuria of 800 mg/day, which decreased to the normal range (<200 mg/day) after levothyroxin treatment. One patient developed acute gouty arthritis before normalization of thyroid-stimulating hormone (TSH), which was successfully managed with prednisone therapy. All of our patients had increased creatine kinase (CK), ranging between 1000 and 2360 U/L (normal range, 22–165 U/L), which normalized after 6 weeks of levothyroxin treatment.     

Lipid profile in the progeny of parents with ischemic heart disease

Lipid profile of 50 offsprings of parents with ischemic heart disease and 15 control children aged 5–16 years was studied. The children in both the groups were categorized into 3 sub groups, 5–10, 11–15 & >15 years. The Serum total cholesterol levels (mean ±S.D.) (in mg/dl) in the test group were 169.8±15.13, 173.34±33.56, 177.4±27.89 respectively for the 3 age subgroups. The Serum LDL cholesterol levels (mean ±S.D) (in mg/dl) in the test group were 102.2±15.25, 95.13±30.38, 101.09±26.96 respectively. The serum total cholesterol levels (mean ±S.D) (in mg/dl) in the control group were 123±1.33, 118±7.51 and 127.4±5.77 respectively for the 3 age subgroups. The serum LDL cholesterol levels (mean +S.D) (in mg/dl) in the control group were 56.64±8.75, 43.36±6.10 and 45.16±6.78 respectively. The serum total cholesterol and LDL cholesterol levels in the test group were significantly higher as compared to controls (p>0.05). Among test subjects, 54% had elevated total cholesterol (>170 mg/dl) and 38% had elevated LDL cholesterol (>110 mg/dl). These cases had a significant correlation with elevated parental total cholesterol and LDL cholesterol levels (p>0.05). Thus, a selective screening of the offsprings of parents with premature ischemic heart disease and hypercholesterolemia is advocated.     

Pharmacodynamics of ceftriaxone and cefixime against community-acquired respiratory tract pathogens

Over the last decade or so there has been a growing interest in routes of antimicrobial administration other than by the conventional intravenous route for institutionalized patients and for some outpatients. Both oral (PO) and intramuscular (IM) routes of administration are less costly than giving antimicrobial agents by vein (IV). In addition, fewer complications such as catheter-related sepsis and phlebitis are associated with non-IV routes of administration. Furthermore, a reduced-dosage, reduced-volume IM administration of ceftriaxone may provide a tolerable route of administration and equivalent bactericidal activities compared with higher dose IV ceftriaxone. The purpose of this study was to determine the time that the drug concentration remained in excess of the minimum inhibitory concentration (MIC) (T>MIC) and the duration of bactericidal activities of ceftriaxone one gram administered IV, ceftriaxone 250 mg given IM and cefixime 400 mg given orally against clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in adult volunteers. Single doses of each agent were administered and serum concentrations were collected over the standard dosing period of 24 h for all study regimens. Ceftriaxone, regardless of route of administration and dose, resulted in bactericidal activities and T>MIC for 100% of the dosing period for S. pneumoniae, H. influenzae, and M. catarrhalis. Cefixime maintained at least 50% T>MIC and bactericidal activity against both isolates each of H. influenzae and M. catarrhalis. Against both isolates of S. pneumoniae, cefixime achieved T>MIC for at least 50% of the dosing period, but did not maintain bactericidal activity. Reduced dose ceftriaxone given IM seems to be a viable alternative to ceftriaxone IV if the pathogen, susceptibility and infection site are known. Based on T>MIC exceeding 50% of the dosing interval, cefixime would be considered an effective alternative to IV therapy against common respiratory tract pathogens. Clinical studies need to be conducted to confirm these findings.     

血、尿内皮素水平与肾性高血压的研究

为探讨血、尿内皮素水平在肾性高血压及肾脏疾病发展中所起的作用 ,对正常人和慢性肾炎患者血浆内皮素 (PET 1 )、2 4h尿内皮素排泄量 (UET 1 )、内生肌酐清除率 (Ccr)和尿 β2 微球蛋白 ( β m)进行了检测。结果显示所有患者的PET 1和UET 1水平均升高 ,且PET 1或UET 1与平均动脉压 (MAP)和β m呈正相关 ,与Ccr呈负相关。提示 :血、尿内皮素均参与肾性高血压形成和肾脏病的进展     

血清饥饿和表皮生长因子上调人肝癌细胞中血管内皮生长因子mRNA表达的研究

目的探讨血清饥饿及表皮生长因子(EGF)对人肝癌细胞血管内皮生长因子(VEGF)基因表达的调节.方法以次黄嘌呤磷酸核糖转移酶(HPRT)为内标,将VEGF与HPRT比值作为VEGF表达水平的参数,对VEGF PCR产物相对定量,分析血清饥饿和5,25ng/ml浓度的EGF在6h时对人肺癌细胞VEGF mRNA表达水平的影响.结果对照组、血清饥饿组、5ng/ml、25ng/ml EGF刺激组VEGF mRNA表达的相对量分别为(24.73±3.19)%、(52.73±9.58)%、(76.30±10.78)%和(114.87±13.55)%,并且EGF组VEGF mRNA的表达水平比血清饥饿组高(P<0.05)、25ng/ml EGF刺激组明显高于5ng/ml EGF刺激组(P<0.05).结论血清饥饿和EGF能刺激人肝癌细胞VEGF基因的表达,提示在人肝癌细胞生长过程中,实质性肝癌细胞的生长可能是呈现出一种"周期性爆炸性生长"的方式.     

The effect of reduction of the peripheral fat content by liposuction-assisted lipectomy (SAL) on serum leptin levels in the postoperative period: a prospective study

The purpose of this study was to investigate the relationship between a decrease in the peripheral fat content by suction-assisted lipectomy (SAL) and serum leptin levels. Twenty-two healthy females who underwent SAL for aesthetic reasons participated in the study. The data included height, weight, dietary habits, and leptin levels before surgery and at 1 and 6 weeks postoperatively. The aspirate ranged between 1000 and 6000 ml, with an average of 2700 ml. Thirteen patients with an aspirate of over 2700 ml all experienced an immediate postoperative decrease in appetite which returned gradually by 12 to 17 days postoperatively. They lost an average of 7% of the total body weight at 6 weeks. The leptin levels 1 week postoperatively were significantly lower than the preoperative levels (p < 0.01); at 6 weeks the decrease in leptin level was not statistically significant. In conclusion, a reduction of the peripheral fat content of more than 2700 ml by SAL has an immediate effect on leptin levels that lasts at least 1 week and correlates with voluntary changes in energy intake.     

Low serial serum neopterin does not predict low risk for chronic renal graft rejection

Research has provided new and potent immunosuppressants which can potentially stop ongoing rejection. Subclinical rejection is a particular problem in the pediatric age group and early identification of children at risk is of the utmost importance. Neopterin has been previously shown to be a non-specific but sensitive marker for immunologic activity. In this study we hypothesized that low serum neopterin in the 1st year after transplantation predicts a low risk of chronic rejection. We retrospectively analyzed serial neopterin data obtained beyond the early postoperative period in 21 children and correlated the peak and average with glomerular filtration rate (GFR) loss during the subsequent years (P=0.63, NS, r=0.10). Our results show that serum neopterin did not differ between the majority of children who developed chronic transplant dysfunction and children with stable transplant function beyond the early post-transplant period. Thus serum neopterin failed to delineate a low-risk population who might be spared more invasive diagnostic procedures such as protocol biopsy. Received: 22 November 1999 / Revised: 3 August 2000 / Accepted: 11 August 2000     

Normal urinary calcium/creatinine ratios in African-American and Caucasian children

A random urine calcium/creatinine ratio (UCa/Cr) is of practical use in screening for hypercalciuria. However, due to worldwide variations, reference values for the pediatric population are not yet well established. Furthermore, no study has been conducted to establish normal UCa/Cr values in young African-American (AA) children. It has also been previously reported that an elevated UCa/Cr is related to a high urine Na/K ratio (UNa/K). The objectives of the present study were: (1) to set normal values of random UCa/Cr by age and race in the pediatric population of Metropolitan Kansas City, (2) to identify potential racial differences in UCa/Cr between Caucasian (CS) and AA children, and (3) to determine the relationship between UCa/Cr and UNa/K in healthy children.A total of 368 healthy children of both genders were enrolled in the study. They were divided into four age groups as follows: (1) <7 months, (2) 8–18 months, (3) 19 months to 6 years, and (4) 7–16 years. Each group was subdivided into AA and CS. A non-fasting random urine specimen from each subject was analyzed for Ca, Na, K and creatinine.The median UCa/Cr values for AA were: (1) 0.13, (2) 0.09, (3) 0.06, and (4) 0.04 and for CS they were (1) 0.26, (2) 0.11, (3) 0.10, and (4) 0.09. The data showed a strong inverse relationship between UCa/Cr and age, the youngest children demonstrating the highest UCa/Cr. In each age group, UCa/Cr in CS exceeded the corresponding value in AA. The age-dependent 95th percentiles of UCa/Cr values for CS were (1) 0.70, (2) 0.50, (3) 0.28, and (4) 0.20 and for AA they were (1) 0.38 and (3) 0.24. Due to outliers, the 95th percentile could not be established for the other two AA subgroups. The relationship between UCa/Cr and UNa/K was found to be extremely weak in both AA (r ² =0.00005) and CS (r ² =0.02). On the other hand, a strong linear correlation was observed between UNa/K and age (CS r ² =0.23, P<0.001, AA r ² =0.19, P<0.001), explaining in part the lack of correlation between UNa/K and UCa/Cr.We conclude that the child’s age, ethnicity and geographic location should be taken into consideration when assessing UCa/Cr ratio. Contrary to what has previously been reported in hypercalciuric children, no significant relationship was found between UCa/Cr and UNa/K in healthy children. Received: 7 June 2000 / Revised: 21 September 2000 / Accepted: 23 September 2000     

强直性脊柱炎的急性反应物研究进展

血清淀粉样蛋白A、基质金属蛋白酶、C反应蛋白等生物标记物通过炎性因子或其自身抑制物等多种炎性物质调节在机体内的表达,作用机制在诊断和治疗强直性脊柱炎(AS)过程中已愈发明晰。血清淀粉样蛋白A、基质金属蛋白酶表达水平在判定AS活性强度和监测治疗发挥了重要作用,其特异性要强于C反应蛋白和红细胞沉降率,是最具有潜力的功效蛋白。现就对近年来医学界对AS的临床检验生物标记物——急性期反应物的研究进展做一综述。     

ROC曲线选择肾衰竭患者透析时肾小球滤过率的临界值

目的应用ROC工作曲线选择慢性肾衰竭（CRF）患者开始血液透析时肾小球滤过率的临界值，探讨其在CRF患者中的应用价值。方法回顾分析血液透析中心2001年6月-2006年6月间开始第一次血液透析的所有146例CRF患者资料。同期获得血清c反应蛋白（SCRP）和肾功能检查等实验室数据。采用ROC工作曲线选择最佳临界值。结果SCRP浓度和肾功能水平之间呈负的直线相关关系。选择GFR8．5ml／min时，诊断的灵敏度为88．9％，特异性为89．5％，准确性为88．3％。结论慢性肾衰竭患者SCRP水平增高；当肾功能水平下降到一定水平以后会引起SCRP的明显升高，选择GFR8．5ml／min具有较高的灵敏度、特异性，对制定科学的开始血液透析时的肾功能标准具有重要的临床意义。