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Factors associated with physical well-being were examined in a population-based sample of adult end-stage renal disease (ESRD) patients in Michigan (n = 459). The dependent variables were two measures of physical functioning: (1) a ten-item measure of activities of daily living (ADL), and (2) the 45-item physical dysfunction dimension of the Sickness Impact Profile (SIP). Independent variables included four modalities of treatment (in-center hemodialysis, continuous ambulatory peritoneal dialysis [CAPD], related transplant, and cadaver transplant); primary cause of ESRD (eg, diabetes, glomerulonephritis); comorbidity (other illnesses besides primary cause of ESRD); and demographic characteristics (sex, race, age, marital status, education). ADL and SIP unadjusted mean scores differed significantly by category for each of the eight study factors (analysis of variance [ANOVA], P less than 0.0001), with the exception of sex for SIP means. The highest levels of dependency in ADL were reported by patients who were older, female, black, widowed, less educated, treated with in-center hemodialysis, had diabetes as the primary cause of ESRD, and/or reported more comorbidity. The partial effect of each factor on the dependent measures with adjustment for the seven other factors was assessed using analysis of covariance (ANCOVA). In the ADL analysis, sex, race, age, primary cause of kidney failure, and comorbidity were significant factors (probability values ranging from 0.05 for race to 0.0001 for sex, primary cause of ESRD, and comorbidity). The SIP physical dysfunction measure gave slightly different results. Race, age, primary cause of ESRD, comorbid status, and modality of treatment were significantly related to physical dysfunction (P less than 0.05 to P less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Independence in activities of daily living for end-stage renal disease patients: biomedical and demographic correlates. 264 11

Careful ultrastructural studies of the rat model of nephrotic syndrome induced by puromycin aminonucleoside have demonstrated morphological features which are only seen in proteinuric glomeruli fixed without interruption of the blood pressure. These consist of balloon-like swellings bounded by attenuated epithelial cell cytoplasm, with an area of bare basement membrane at the base. A theory of the mechanism of proteinuria was proposed on the basis of these findings. To test the proposed wide validity of that theory, we improved the method of surface fixation and performed similar studies in sequential manner, using chronic serum sickness glomerulonephritis in the rat as a model of proteinuria. Glomeruli were studied by light microscopy, transmission and scanning electron microscopy. The findings were correlated with the level of proteinuria in the 24 h preceding death and with the duration of serum sickness. Epithelial cell 'balloons' are also demonstrated in this model, correlating with the presence of proteinuria, but with slightly different configurations from those seen in puromycin nephrosis. Surface fixation revealed similar balloons in two other models of proteinuria: a graft versus host induced model of systemic lupus erythematosus in the mouse, and chronic streptozotocin-induced diabetes in the rat. A lengthy search failed to find bare basement membranes in any of these models of proteinuria. We conclude, therefore, that the mechanism of proteinuria proposed in puromycin nephrosis does not apply in these models, and we suggest an alternative mechanism by which the 'balloons' may develop, as a further manifestation of the epithelial cell dysfunction which causes foot process effacement.
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PMID:A morphological study of experimental proteinuria using a novel form of surface fixation. 264 11

Under normal conditions glomerular blood flow and glomerular capillary hydrostatic pressure and hydrostatic pressure gradient are regulated within a narrow range in spite of variations in volume status and blood pressure. Glomerular ultrafiltration rate is normally regulated by the hydrostatic pressure gradient, the systemic oncotic pressure, the rate of nephron plasma flow and the glomerular ultrafiltration coefficient. Although the process of glomerular ultrafiltration is driven by the hydrostatic pressure gradient (delta P), regulation of nephron filtration rate (SNGFR) is not mediated by changes in hydrostatic pressure and the correlation between SNGFR and delta P is very poor. There are certain clinical experimental models in which the glomerular capillary hydrostatic pressure gradient is elevated. These models have been: (1) subtotal nephrectomy model, a model of reduced renal mass, (2) glomerular immune induced injury or glomerulonephritis, (3) most models of systemic hypertension, and (4) certain stages of experimental diabetes mellitus, but the mechanisms vary among the conditions. In most of these clinical models the increase in delta P is associated with a reduction in the glomerular ultrafiltration coefficient. It is also clear that superimposition of hypertension upon models of glomerular immune injury and radical subtotal nephrectomy cause progression of renal dysfunction and glomerulosclerosis. One of the contributing factors to this progression appears to be the elevation in glomerular capillary hydrostatic pressure and pressure gradient. However, other factors have been suggested to play a significant role, such as compensatory hypertrophy and possibly the neurohumoral environment. Therapy of systemic hypertension and administration of cardiovascular drugs which alter glomerular capillary hydrostatic pressure may then modify the rate of progresswion of these disorders.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Glomerular hemodynamics in pathophysiologic conditions. 268 27

This paper describes the results of experiments designed to investigate the role of oxygen radicals in the pathogenesis of rat experimental glomerulonephritis. Generation of oxygen radicals was induced by phorbol ester in rats with Masugi nephritis, aminonucleoside nephrosis and streptozotocin-induced diabetes mellitus. Marked formation of fibrin thrombi was observed in the glomerular capillaries during the heterologous phase of Masugi nephritis, but not during the autologous phase. Induction of fibrin thrombi was also seen in nephrotic rats which had received the aminonucleoside, puromycin, but not in diabetic rats. These results suggest that in Masugi nephritis, oxygen radicals may be related to the formation of fibrin thrombi. Neutrophils seem to be of importance in the pathogenesis of such lesions.
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PMID:Generation of oxygen radicals and formation of fibrin thrombi in glomerular capillaries of rats with nephrotoxic nephritis. 273 16

Analysis of data from the Canadian National Renal Failure Register indicates that Canadian Natives are at much higher risk for end-stage renal disease (ESRD) than the Canadian population in general. Using two population estimates for the total Native population, the age-standardized incidence rate of newly registered ESRD cases between 1981 and 1986 among Natives was at least 2.5 times (and may be as high as four times) the national rate. Natives were particularly at higher risk for ESRD to diabetes, glomerulonephritis, and pyelonephritis, whereas for the other causes the risk was no different from that of other Canadians. As technologically sophisticated treatment facilities are only available in major urban centers, Native ESRD patients and their families living in remote areas of Canada are faced with major psychosocial disruptions of relocation.
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PMID:Excessive burden of end-state renal disease among Canadian Indians: a national survey. 278 48

Glomerulonephritis patients transplanted with cadaver kidneys had a significantly higher one-year graft survival when immunosuppressed with cyclosporin rather than standard therapy (80% versus 59%, p less than 10(-5]. For nephrosclerosis patients the corresponding rates were 70% and 59% (p greater than 0.05); and in those with antecedent diabetes mellitus, polycystic kidney, and pyelonephritis the differences were negligible. In glomerulonephritis patients, but not in the other groups, cyclosporin was additive to the effect of transfusions and of HLA-A, B and HLA-Dr matching.
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PMID:Preferential effectiveness of cyclosporin in patients receiving kidney transplants after glomerulonephritis. 285 55

Urinary excretion of glycosaminoglycans (GAGS) and sialic acid (SA), as well as the activity of two renal enzymes related to glycoprotein metabolism, N-acetyl-beta-D-glucosaminidase (NAG) and beta-galactosidase (GAL), and two others unrelated to glycosaminoglycans and glycoprotein metabolism, gamma-glutamyltranspeptidase (gamma-Gt) and angiotensin-I-converting enzyme (ACE), were evaluated in 40 insulin-dependent diabetic patients with normal range albuminuria, 21 patients with mesangial glomerulonephritis, and 30 control subjects. Diabetic and glomerulonephritic patients excreted a significantly higher amount of GAGS and SA, and showed greater NAG and GAL activities; gamma-Gt and ACE levels were within normal ranges. No correlation could be demonstrated between diabetes duration and GAGS, SA, NAG and GAL findings. Moreover, no correspondence between degree of metabolic control, as reflected by glycosylated hemoglobin (HbA1a-c) and GAGS, SA, NAG and GAL emerged.
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PMID:Urinary glycosaminoglycans, sialic acid and lysosomal enzymes increase in nonalbuminuric diabetic patients. 287 16

Relaxation times T1 of normal and abnormal urine samples were measured with a 0.02 tesla MRI device in a spectrometric mode. Protein containing urine from patients with glomerulonephritis showed a slight shortening of T1 relaxation time. Radiographic contrast medium, pH, osmolality or glucose in diabetes did not significantly change the T1 relaxation time of urine. Urine can be used as a T1 relaxation reference in MR imaging of the pelvis even if the patient has received radiographic contrast medium or has diabetes or proteinuria for any reason.
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PMID:Proton T1 relaxation time of normal and abnormal urine. 296 Mar 55

Between January 1976 and December 1987, 278 patients (172 men, 106 women) aged over 15 and living in a region of some 400,000 inhabitants were treated with dialysis for end-stage chronic renal failure (CRF). The annual incidence of new cases treated was evaluated separately for 3 consecutive 4-year periods: 1976-79 (period A), 1980-83 (period B) and 1984-87 (period C). The incidence rose from 4.6-4.9 in periods A and B to 7.8/100,000 in period C, i.e. a 38 per cent progression. At the start of dialysis the mean age of women did not significantly vary throughout the 3 periods, whereas it increased significantly in men during period C. There was a significant increase of primary glomerulonephritis (GN) throughout the 3 periods: 1.25, 1.70 and 2.35/100,000 respectively; this disease accounted for 27.3, 34.6 and 30.6 per cent of all causes of CRF. Similarly, the incidence of secondary nephropathy (diabetes, amyloidosis) treated with dialysis increased from 0.6 (A) to 1.0 (B) and 1.9/100,000 (C) (P less than 0.05 with period A). The same happened with polycystic kidney: 0.25, 0.65 and 0.93/100,000. During period C, when 95 per cent of primary GN were diagnosed histologically, igAGN (13 per cent), diabetes (13 per cent) and polycystic kidney (12 per cent) were the main causes of CRF. During the whole 12-year period under study, when 80 per cent of primary GN were diagnosed, the prevalence of causes of CRF varied according to the patients' age. In patients under 65 at the start of dialysis primary GN were the principal causes of CRF (36.8 per cent, including 15.5 per cent of IgAGN), followed by secondary nephropathies (20.3 per cent, including 10.7 per cent of diabetes), chronic interstitial nephropathies (18.7 per cent, including 9.6 per cent of reflux nephropathy), hereditary nephropathies (14.4 per cent, including 10.7 per cent of cystic kidney) and vascular nephropathies (7 per cent). Above the age of 65, the principal causes of CRF were chronic interstitial nephropathies (27.7 per cent, including 8.9 per cent of drug-induced nephropathy), followed by secondary nephropathies (20 per cent, including 6.7 per cent of amyloidosis and 11.1 per cent of diabetes), vascular nephropathies (20 per cent), primary GN (12.2 per cent), and hereditary nephropathies (12.2 per cent) including 11.1 per cent of polycystic kidney).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Epidemiology of chronic renal insufficiency treated by dialysis in a region in France. Changes in a 12-year period]. 297 86

Since January, 1, 1976, epidemiologic study of renal diseases has been leading in a French rural area of 400,000 inhabitants located in north coast of Britanny. Annual incidence of end stage renal failure (ESRF) treated by dialysis increased of 25% when two consecutive periods of five years each were compared: A (1976-1980) 46 per 10(6) inhabitants, B (1981-1985) 62 per 10(6) inhabitants. In 1986, the progression was confirmed: 96 per 10(6). At the time of the beginning of dialysis treatment, mean age (+/- SD) was not different between two periods: 53 +/- 17 yrs (A) vs 51 +/- 17 yrs (B) but it increased in 1986: 61 +/- 14 yrs. Sex ratio (M/F) progressed from 1 (A) to 1.75 (B). The study of causes of ESRF showed a net increase of secondary renal diseases (diabetes, amyloidosis), interstitial nephropathies due to obstructive uropathy (lithiasis) and drugs. For the period B, 91% of primary glomerulonephritis reaching ESRF had had renal biopsy. Idiopathic IgA nephropathy was the first cause of ESRF (13.7%, 0.85 pts/100,000) before diabetes (12%, 0.75/100,000), Polycystic disease (11.3%, 0.70/100,000), reflux nephropathy (9.6%, 0.60/100,000), focal and segmental glomerulosclerosis (8.8%, 055/100,000). Prevalence of ESRF for primary glomerulonephritis was calculated to 20.6% and according to the histological type to 28.3% for idiopathic IgA nephropathy, 34.8% for local and segmental glomerulosclerosis, 40% for idiopathic crescentic glomerulonephritis and only 6.6% for membraneous nephropathy. In the studied area, 58% of patients were treated out of hospital (at home or in self-dialysis units) whose 46% by hemodialysis and 12% by CAPD.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Epidemiology of terminal renal insufficiency treated by dialysis and therapeutic options in a population of 400,000 inhabitants (1975-1986)]. 333 May 78


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