Urinary sodium excretion in patients with nephrotic syndrome, and its circadian variation

We analysed sodium excretion and its circadian variation in70 patients with nephrotic syndrome and 19 healthy controlsover 1–3 days, with a regimen of bed rest and constantsodium intake around the clock. We sampled urine and blood andtook their blood pressure every 3 h. We also scored 60 renalbiopsies for presence of interstitial fibrosis and tubular atrophy.Peripheral oedema was estimated in 37 patients. Fifty-nine patients excreted >10mmol sodium per 24 h, inequilibrium with dietary intake. In group A (n = 24), sodiumexcretion followed a normal circadian rhythm, with a daytimepeak. In group B (n = 35), 29 had reversed circadian rhythmwith a night-time peak, and 6 had no apparent rhythm. Nephroticsyndrome was more severe in group B than in A (serum albumin19.5 vs. 24.1 g/l, p<0.05; oedema 7.0 vs. 3.8 kg, p<0.01).Group B also had signs of more advanced renal disease (GFR 49vs. 99 ml/min; number of biopsies with tubulo-interstitial damage:20/28 vs. 4/23; p< 0.001). Reversed sodium rhythm was associatedwith reversed circadian rhythms for GFR, effective renal plasmaflow and urine flow, and blunting or reversal of the day-nightdifferences in blood pressure and plasma renin activity. Elevenpatients had urinary sodium excretion <1 mmol/24 h. Withrespect to severity of nephrosis, they resembled group B, butGFR and incidence of tubulointerstitial lesions were like groupA. Half of the patients with nephrotic syndrome had reversed circadianrhythm for sodium excretion. This nocturnal peak in natriuresis(and diuresis) may be due to re-entry of oedema fluid into thecirculation, with a subsequent increase in renal blood flowand GFR, and especially occurs in patients with structural tubulointerstitialdamage, where sodium reabsorption is incomplete.     

ASSESSMENT OF COGNITIVE FUNCTION IN ALCOHOLICS BY COMPUTER: A CONTROL STUDY

Results are presented of the performance by 103 alcoholics and90 controls on six computer-administered tests of cognitivefunction. The main analysis compared performance of the twogroups when pre-existing differences in intellectual capacity,as estimated by NART. were accounted for statistically. Theperformance of the alcoholics was worse, at a statisticallysignificant level, on 18 of 23 measures. Procedurally, the testswere found to offer practical advantages over conventional procedures.     

RENAL BIOPSY STUDIES IN 150 CHILDREN WITH NON-SPECIFIC GLOMERULOPATHY

ABSTRACT: Van Acker, K. J., Vanden Brande, J. and Holvoet, H. (Departments of Paediatrics and Pathology, State University, Gent, Belgium). Renal biopsy studies in 150 children with non-specific glomerulopathy. Acta Paediatr Scand, 63:345, 1974.–The experience with light microscopic examination of kidney biopsies in 150 children with nonspecific glomerulopathy is reported. Most major types of glomerular lesions, as they are at present known, were observed but in a very uneven distribution. Four groups of clinical symptoms were observed in the primary as well as in the associated non-specific glomerulopathies: hematuria, proteinuria, acute nephritic syndrome and nephrotic syndrome. Although in a number of instances, the histologic lesio.i was suggested by the clinical picture, a correlation was lacking in most instances. More information was obtained from the histology when the evolution was considered, particularly in the primary nephrotic syndrome and the Schonlein-Henoch nephropathy.     

Clinical Observations with a Dual Sensor Rate Adaptive Single Chamber Pacemaker

The Topaz model 515 (Vitatron B.V.) is a dual sensor rate responsive pacemaker for single chamber stimulation. It can be driven by activity counts (ACT) and QT interval measurements. Inappropriate rate modulation due to one sensor can be corrected by "sensor cross-checking." It was implanted in ten patients (20-86 years) of whom seven had complete heart block and atrial arrhythmias. After implantation T-wave amplitude ranged from 0.9mV-3.5 mV. T-wave sensing ranged from 88%–99% in 9/10 patients at the follow-up of 3 weeks. Eight patients remained in default setting of the activity threshold, after evaluation with a short walking test. An exercise test was performed on all patients. In one test, QT sensing was marginal because of lead implantation in the right ventricular outflow tract. Therefore, this pacing rate was only modulated by ACT sensing. All others were tested with equal contribution of information from both sensors (ACT = QT). In 7/9, rate response was satisfactory. When the treadmill was repeated with ACT in five of these seven patients, rate generally accelerated too fast. In one patient the setting was adjusted to "QT > ACT," because of inappropriate acceleration due to activity sensing, in another it was adjusted to "QT < ACT" because of delayed response to activity. The pacing rate and the ACT during treadmill tests in "QT = ACT" mode were more closely correlated in the first 3 minutes, compared with the last 3 minutes. We feel that rate modulation with this new pacemaker is adequate. Sensor blending and sensor cross-checking are of clinical importance.