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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The outcome of renal transplantation in CAPD patients is still controversial since age and clinical differences often make comparison with hemodialysis patients difficult. The aim of this study was to analyse two homogeneous groups of patients, on CAPD and on hemodialysis. 18 CAPD (Group A) and 18 hemodialysis patients (Group B) were selected for a case-control analysis, matched for age, presence of acute tubular necrosis and Cyclosporine A regimen. Group A and B were not different for male/female ratio, donor age, HLA-Dr mismatches, arterial pressure, cold ischemia, or follow-up. Patient, graft survival and number of rejection episodes did not differ significantly at 1 year; serum creatinine at 6 and 12 months and CyA doses at 1 and 6 months were not different; hospitalization rates for first and subsequent admissions did not differ. Infection-free patients were 9/18 in Group A and 15/18 in Group B, with 12 episodes in Group A and 3 in Group B. Post transplant cholesterol levels showed a trend to increase in both groups and triglycerides levels to a decrease; differences in pre and post transplant in body weight were not significant at 12 months. In conclusion, the outcome of transplantation in CAPD patients is not significantly different from that in hemodialysis patients with similar clinical characteristics.
Adv Perit Dial 1990
PMID:Comparison between two dialytic populations undergoing renal transplantation. 198 44

Intrathecal administration of 4 nmol/kg neuropeptide Y in Dial-urethane-anesthetized rats elicited decreases in arterial pressure, renal sympathetic nerve activity, and a slight decrease in heart rate. The depressor response was associated with a sustained hindquarters and mesenteric vasodilation resulting in a decrease in total peripheral resistance. Intrathecal NPY also resulted in a decrease in renal sympathetic nerve activity. There was a positive correlation between the percent changes in arterial pressure and renal sympathetic nerve activity. With the use of renal nerve activity and heart rate as indexes, NPY resulted in a decrease in baroreflex sensitivity. The depressor effect of intrathecal NPY did not appear to be due to spinal vasoconstriction and ischemia, since spinal microvascular resistance was decreased slightly. We conclude that the intrathecal administration of NPY produces an inhibition of sympathetic nerve activity, resulting in a decrease in total peripheral resistance and arterial pressure.
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PMID:Hemodynamic and sympathetic effects of spinal administration of neuropeptide Y in rats. 226 Jun 94

Thirty-two patients (10 male, 22 female; age 37-82 years) undergoing maintenance haemodialysis or haemofiltration were studied by means of Holter device capable of simultaneously analysing rhythm and ST-changes in three leads. Twenty-five patients were on haemodialysis, seven on haemofiltration, mean duration of haemodialysis/haemofiltration being 3.4 +/- 3 years. Incidence of ventricular tachycardia was low, being detected only in 1 of 32 patients. Ventricular premature beats in excess of 10/h during a period of 2 h were found in 8 of 32 patients and 100 supraventricular premature beats for 2 h or more in 4 of 32 patients. Both ventricular premature beats and supraventricular premature beats were most frequently recorded during the last hour of haemodialysis/haemofiltration. ECG signs of ischaemia were detected in eight patients, four of whom were asymptomatic. Ischaemia also occurred predominantly during the last hour of haemodialysis/haemofiltration. Two symptomatic patients displayed neither arrhythmias nor ST-changes while being monitored. The study shows that silent ischaemia and arrhythmias in patients undergoing chronic haemodialysis/haemofiltration may not be infrequent. Recognition of these events could be of importance in the management of these patients.
Nephrol Dial Transplant 1989
PMID:Incidence of arrhythmias and myocardial ischaemia during haemodialysis and haemofiltration. 251 60

To determine whether a mild episode of ischaemia may be a factor in the production of cyclosporine (Cys) toxicity, right nephrectomy was performed in three groups of Charles River rats: I. Ischaemia (left renal pedicle clamping) for 20 minutes, without treatment; II. Ischaemia of 20 minutes, followed by IP Cys 60 mg/kg BW/day; III. Sham (no ischaemia) followed by Cys as in Group II. The rats were sacrificed after four days. Cys plus ischaemia produced a lower creatinine clearance (136 +/- 15 microliter/min/100g BW, p less than 0.001) and a higher FENa per cent (0.94 +/- 0.14, p less than 0.05), FEK (1.07 +/- 0.02, p less than 0.01) compared with ischaemia alone creatinine clearance 261 +/- 39, FENa per cent 0.61 +/- 0.08, FEK 0.54 +/- 0.08, FEH2O -0.04 +/- 0.005. Histology showed more vacuolisation of tubular epithelial cells in the Cys plus ischaemia group than in the ischaemia alone group.
Proc Eur Dial Transplant Assoc Eur Ren Assoc 1985
PMID:Cyclosporine and short ischaemia: a new model of experimental acute renal failure in rats. 399 82

Post transplant acute tubular necrosis (ATN) is responsible for approximately 90% of acute renal failure episodes occurring within the first few weeks following renal transplantation. This phenomenon is observed in 34% of cadaver transplant recipients and 9% of those with live donor kidneys. Although the exact cause of post transplant ATN remains unknown, the following factors are thought to be associated with a higher incidence of ATN: 1) donor hypotension, 2) prolonged "warm ischemia time", 3) increased vascular resistance with poor perfusate flow, 4) presence of "ligandin" or excess lactate in the renal perfusate, 5) reduced allograft blood flow, 6) cold lymphocytotoxins in the patient's serum and 7) administration of nephrotoxic drugs particularly to the hypovolemic graft recipients. Therapeutic maneuvers such as hydration of the donors and recipients, harvesting the kidneys from heart beating cadavers, donor pretreatment with massive doses of corticosteroids and alpha-adrenergic blocking agents and warming of the graft immediately after vascular anastomosis, seem to reduce the incidence of ATN. Since the management differs significantly, post transplant ATN has to be distinguished from other causes of acute renal failure such as the renal artery thrombosis, hyperacute rejection and obstruction of the urinary tract. The tests which are of use in the differential diagnosis include, 131-I Hippuran renogram, transplant ultrasound, renal angiogram, retrograde pyelogram and renal transplant biopsy. Patients with established ATN should undergo every other day dialysis, under low dose or regional heparinization, until the creatinine clearance improves to 20 ml/min. The dose of azathioprine has to be reduced to prevent bone marrow toxicity. Even though there are short term disadvantages, the post transplant ATN does not appear to exert any detrimental effects in the long run. However, this issue remains controversial in the published reports.
Clin Exp Dial Apheresis 1983
PMID:Post transplant acute renal failure: a review. 634 76

In the present study 1 h of total occlusion of the left renal artery in conscious rats was chosen as experimental model of ischemic acute renal failure (ARF), while the contralateral kidney was left intact. Chronic high dietary sodium intake, acute isotonic saline infusion, or administration of saralasin did not protect from ARF. Furosemide, mannitol, and verapamil converted oliguric into non-oliguric ARF in 100%, 75%, and 60% of the animals, resp. Protection from oliguria and preservation of GFR inversely correlated with the depression of cortical ATP-concentration (control: 1.32 +/- 0.07 mumoles/g wet weight) 6 h after ischemia by 16%, 41%, and 58% in mannitol- and verapamil- treated rats and in untreated rats, resp. At this time, Na-K-ATPase enzyme activities in renal cortex and papilla were unaffected, while enzyme activity in outer medulla was suppressed from 15.4 +/- 1.4 to 9.4 +/- 1.0 mumoles Pi/mg protein h in all groups of animals. The results suggest that in this model of ARF renal ischemia not only affects cellular energy supply in renal cortex but also causes severe structural and functional impairment in the outer medulla, probably leading to tubular obstruction and depression of glomerular function. Pharmacological protection from ischemic oliguric ARF cannot be achieved by prior induction of high urine flow rates alone but depends on the degree of metabolic and functional reserve of the injured tubular epithelium.
Clin Exp Dial Apheresis 1983
PMID:Renal functional and metabolic studies on the role of preventive measures in experimental acute ischemic renal failure. 641

The present study was undertaken to investigate the effect of ATP-MgCl2 on the recovery of renal function following renal ischemia. Bilateral renal ischemia was produced for 90 minutes in dogs. Immediately after the release of ischemia, ATP-MgCl2 (50 mumoles/kg) was given intravenously. Serum creatinine and FeNa were measured following the release of ischemia. Renal cellular energy charge, glomerular endothelial thickness and per cent circularity of interstitial cells were measured. Creatinine and FeNa were significantly lower in ATP-MgCl2 treated dogs compared to those in saline treated controls. Changes in energy charge, glomerular endothelial thickness and per cent circularity indicated ischemically induced renal cellular edema was reversed with ATP-MgCl2 through the improvement of energy metabolism. Taking those experimental data into consideration, ATP-MgCl2 was given to 16 acute renal failure patients and 13 patients survived. ATP-MgCl2 administration is effective for the treatment of acute renal failure.
Clin Exp Dial Apheresis 1983
PMID:Experimental and clinical study on ATP-MgCl2 administration for postischemic acute renal failure. 660 31

The incidence, causes and complications of severe rhabdomyolysis (creatine phosphokinase (CK) > or = 5000 U/l) were studied during a 7-year study period in a large university hospital population. This condition was present in 0.074% of all admitted patients. The mortality in the study group (n = 93) was 32% and the incidence of acute renal failure (ARF) 51%. Ischaemia was the most frequent cause, and drugs, alcohol and/or coma were the second most common cause of severe rhabdomyolysis. Patients with rhabdomyolysis due to ischaemia were older, had ARF more often, and also had the highest mortality. Hyperkalaemia (potassium > or = 5.5 mmol/l) occurred in 13% of the patients, and all of them had or developed an impaired renal function. Hypocalcaemia (calcium < or = 2.00 mmol/l) was found in 41%. The incidence of ARF and electrolyte disturbances was higher in patients with CK levels exceeding 15,000 U/l. Mortality was significantly higher in patients with ARF. Plasma concentrations of potassium and calcium correlated better with the severity of renal failure than with the maximal height of plasma CK.
Nephrol Dial Transplant 1994
PMID:Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis. 797 89

Sclerosing peritonitis (ScP) is a rare but fatal complication of continuous ambulatory peritoneal dialysis (CAPD), presenting as small bowel obstruction. We have observed that only patients receiving a renal transplant survived more than a few months after the diagnosis of ScP. We now report prolonged survival of patients given immunosuppressive therapy with or without a functioning transplant. ScP was found at laparotomy in 17 Glasgow patients, 15 of whom had been exposed to chlorhexidine in alcohol. All patients discontinued CAPD after diagnosis. Within a year 12 died with recurrent bowel obstruction; none received immunosuppressive therapy. The remaining 5 patients received immunosuppressive therapy; 4 are alive between 1 and 9 years later, and one patient with widespread vascular disease died after 3 years with mesenteric ischemia. Four of the 5 received a renal transplant. One patient rejected his transplant; when immunosuppression was stopped he developed symptoms suggestive of recurrent ScP. Immunosuppressive therapy was restarted and he remains well 3 years later. The fifth patient, who did not receive a transplant, was immunosuppressed after ScP was diagnosed. She remains well 18 months later. Our experience suggests that immunosuppression is beneficial in ScP.
Adv Perit Dial 1993
PMID:Immunosuppression in sclerosing peritonitis. 810 20

A segmental necrosis of the ascending colon sometimes affecting the terminal ileum was observed 13 times in 12 end-stage renal disease patients over a 5400 patient-years observation period. In all but three cases the patient was operated within 24 h of onset of the abdominal pain. Three patients had a bowel perforation; nine had a limited intestinal necrosis. All underwent a partial resection or colectomy. Two died within 1 month. In all cases the mucosa was necrotic, the submucosa small vessels were congested and the mesenteric vessels were normal. Ischaemic bowel disease has been previously reported in uraemic patients, but our cases do not fit with the usual reported features of this complication. The absence of typical mesenteric infarction, vascular thrombosis, stenosis or major atherosclerotic lesions is surprising. The ascending colon topography of the lesions is very unusual. Ischaemia, constipation and other factors may play a role.
Nephrol Dial Transplant 1995 Dec
PMID:Segmental necrosis of ascending colon in haemodialysis patients. 891 53


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