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Query: UMLS:C0035078 (renal failure)
 31,970 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Advances in medical technology and knowledge have influenced morbidity and mortality in surgically treated diseases. The authors have compiled four consecutive retrospective studies of demography, morbidity and mortality of patients with acute pancreatitis to summarize the experience from 1956 to 1985 at the Montreal General Hospital with 629 patients. The death rate has remained unchanged. Hypotension, gastrointestinal bleeding and respiratory failure have assumed lesser roles as major complicating factors. Renal failure and gram-negative aerobic pancreatic sepsis are the common causes of death. The last two reviews revealed that surgical debridement and drainage combined with appropriate biliary procedures salvaged two-thirds of the patients with sepsis. Deteriorating nutritional status, heralded by a fall of serum albumin level below 30 g/L, is associated with a poor prognosis. Interval cholecystectomy in patients with mild biliary tract pancreatitis is associated with a low death rate (0.01%).
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PMID:Acute pancreatitis--30 years' experience at a teaching hospital. 202 95

A 63-year-old man with diabetes mellitus for 15 years was admitted to our hospital in 1990 because of end-stage renal failure. Five days after beginning continuous ambulatory peritoneal dialysis (CAPD) he developed an eosinophilic peritonitis (EP). With protein loss in the dialysate and a decreased serum albumin level, the patient developed ankle edema. The patient was treated with glycyrrhizin, and his EP resolved. It is suggested that an allergic background may play an important role in the development of EP in patients on CAPD.
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PMID:Eosinophilic peritonitis responding to treatment with glycyrrhizin. 181 51

Among 244 patients aged 18 to 98 years who were consecutively hospitalized in a department of internal medicine because of a febrile disease, 52 (21%) were bacteremic. On a logistic regression analysis, five variables known within 24 hours of admission were found to be associated both significantly and independently with bacteremia: low serum albumin level, low premorbid performance status, chills, renal failure, and an assumptive diagnosis of urinary tract infection on admission. The logistic model was used to divide patients into three groups. In group 1, the percentage of bacteremic patients was 5%, in group 2, 40%, and in group 3, 83%. The percentage of deaths in the three groups was 0%, 23%, and 50%, respectively. The model was validated in a second group of 257 patients. The percentage of bacteremia was 1% in group 1, 23% in group 2, and 65% in group 3. The death rate in three groups was 3%, 4%, and 35%, respectively. The accuracy of the attending physician in diagnosing bacteremia within 24 hours of hospitalization was compared with that of the model. Use of the model could have improved the diagnostic accuracy in 5% of the patients in group 1 and in 18% of patients in group 3.
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PMID:Bacteremia in febrile patients. A clinical model for diagnosis. 188 46

Rheum, a well known herb unique in its cathartic effect is now introduced to prevent progression of uremia. A clinical prospective trial was conducted to evaluate its effect in comparison with the Captopril. 30 cases with initial Scr level of 344.8 +/- 114.0 mumol/L were allocated randomly to 3 groups. Rheum E treated group, Captopril treated group and Rheum E + Captopril group. The long term (6-22 mos) follow-up results showed that the progression rate of renal failure, calculated by regression analysis of 1/Scr vs time, was found to be retarded after treatment, being more marked in both Rheum E and Rheum E + Captopril group. Uremic symptoms improved after the treatment with serum albumin level increased. To explore the mechanism of therapeutic effects of Rheum on CRF, a series of experimental studies were performed. Rheum can suppress the proliferation of glomerular mesangial cells in culture. In 5/6 nephrectomized rats, the O2 consumption of remnant kidney was obviously decreased by feeding the animal Rheum E and the hypermetabolic state was ameliorated as well. A group of 5/6 nephrectomized rats were fed with Rheum E for 28 wks. It was found that the level of azotemia of this treated group was lessened remarkably as compared with the controls. The serum albumin and transferrin contents of the treated animals were much higher than the controls while the blood cholesterol and triglycerides decreased unexpectedly. In conclusion, both the in vivo and in vitro studies have proved the effectiveness of Rheum in preventing the progression of CRF.
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PMID:[Clinical and experimental studies of rheum on preventing progression of chronic renal failure]. 191 31

We reviewed the initial serological data of 50 patients with biopsy-proven lupus nephritis. As compared with a group of lupus patients without nephritis, patients with nephritis had lower serum complement C3 (p less than 0.05) and C4 (p less than 0.005) levels and higher serum DNA binding activity (p less than 0.001). The frequency of rheumatoid factor, antiphospholipid, anti-ENA, and fluorescent antinuclear antibodies was similar in both groups. We correlated the serological data of the patients with nephritis with the clinical severity of their disease. Using a functional staging system based on the serum albumin and creatinine levels at the time of biopsy, we found that patients with functionally milder disease (proteinuria without nephrotic syndrome or renal failure) had higher C3 (p less than 0.05) and lower DNA binding (p less than 0.005) than patients in the more severe functional classes (nephrotic syndrome with or without renal failure). In contrast, C4 levels were always very low, irrespective of functional severity. We also correlated the serological data with the pathological findings. Patients suffering from diffuse proliferative nephritis had higher DNA binding values than patients with focal proliferative (p less than 0.01) or membranous (p less than 0.001) nephritis. By contrast, complement levels were not correlated with the severity of biopsy changes. Taken together, the data presented here suggest that C3 and DNA binding, but not C4, correlate with the clinical severity of lupus nephritis at presentation whereas DNA binding, but not complement levels, correlates with the severity of pathological changes.
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PMID:Lupus nephritis: the significance of serological tests at the time of biopsy. 193 81

M.T. battled SLE for 9 years before renal failure occurred. She is now free of extrarenal symptoms of lupus, as has been described elsewhere (Ziff & Hilderman, 1983). The patient has regained here appetite, lost 13 pounds, recovered some strength and reestablished her social network. Without the severe proteinuria, M.T. has a chance to improve her nutritional status and increase her albumin. Her pulmonary status may also improve if she can refrain from smoking. Although fatigue is a debilitating feature of lupus, M.T. has increased stamina and is learning energy conservation techniques. Immediately after surgery, she did experience problems with bleeding, pneumonia, and pleural effusions, but the medical and nursing management prevented serious adverse outcomes. Fluid balance is no longer problematic, and M.T. is approaching her ideal body weight as her nutritional status improves. Her serum albumin has increased to about 2.6 gm/dl with some decrease in her proteinuria.
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PMID:Case study of a patient with severe nephrotic syndrome. 195 89

The effect of the methylprednisolone (MP) pulse therapy on renal function was examined in 15 patients with renal or collagen disease. Three nephrotic patients who had reduced renal function and active renal disease with progressive deterioration of renal function prior to the use of MP developed transient renal failure following an MP pulse therapy. The renal failure in each case was reversed by discontinuation of MP and/or by forced diuresis using albumin and furosemide. We examined the correlations between the individual changes in serum creatinine (Scr), body weight (BW) and urine volume (UV) before and after the pulse therapy and other laboratory data such as Scr, total serum protein and albumin. There were significant correlations between a change in Scr on the one hand and changes in BW and UV, Scr and serum albumin on the other. These findings mean that the effect of the MP pulse therapy on renal function depends on the clinical state of the patient and that renal deterioration after the pulse therapy may be more marked in patients who are more nephrotic and more impaired in renal function and suggest that increasing sodium and water retention during an MP therapy and the associated renal interstitial edema, proposed as one of the mechanisms of acute renal failure occurring in patients with minimal-change nephrotic syndrome, may be responsible for the MP-induced transient renal failure.
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PMID:Effects of the methylprednisolone pulse therapy on renal function. 204 79

From 1956 through 1989, 38 men and 26 women were seen at the Mayo Clinic with biopsy-proven AA. The underlying disorder was rheumatic disease in 42, infectious disease in 11, inflammatory bowel disease in 6, and other causes in 5. All patients were symptomatic at the time of diagnosis. Fifty-eight of the 64 patients had proteinuria or renal insufficiency. Fourteen also had significant symptoms of gastrointestinal amyloid, and 6 had amyloid goiter. None of the patients had symptomatic cardiac involvement, and only 3 had palpable hepatomegaly. Renal, gastric, rectal, fat, and marrow biopsies were positive for amyloid in 100%, 94%, 82%, 58%, and 46% of tested patients, respectively. The median survival of the entire group was 24.5 months. Thirty-five of the 47 deceased patients died as a direct result of their amyloidosis, primarily from complications of renal failure. Nine were successfully treated and had regression of the disease. Two with bronchiectasis responded to long-term cyclic antibiotic therapy, as did 1 patient with osteomyelitis. One patient with inflammatory bowel disease responded to surgical resection, and 1 with familial Mediterranean fever responded to colchicine. Four patients with rheumatic disease were treated with cyclophosphamide (in 2) and methotrexate (in 2), with complete resolution of their renal disease. All 9 successfully treated patients are alive, with a median follow-up of 58 months. Statistical analysis revealed that creatinine values greater than or equal to 2.0 mg/dl (P less than 0.003) and a serum albumin value less than 2.5 g/dl (P less than 0.02) were associated with a poorer survival. The single strongest variable associated with poor survival was a serum creatinine level greater than 2 mg/dl at presentation, with a median survival of 11.2 months compared to patients with a creatinine level less than 2.0 mg/dl, with a median survival of 56.9 months.
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PMID:Secondary systemic amyloidosis: response and survival in 64 patients. 206 9

We evaluated the results of essential amino acids supplementation added to a protein restricted diet (0.6 g/kg/day) in patients with advanced renal failure (creatinine clearance under 20 ml/min). A diet containing food with high biologic value was used as control. Diets were tested during 7 months. Anthropometric and nutritional (serum albumin and transferrin) values were normal in both groups both at the beginning and at the end of the treatment period. A slight increase in weight in the natural diet group and in serum phosphorus level in the amino acid supplemented group was observed. Two patients in each group required chronic dialysis, renal function remaining stable in the rest. We conclude that both forms of diet supplementation were effective in preserving nutritional status possibly in delaying deterioration of renal function in patients with advanced renal failure.
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PMID:[Treatment of chronic renal failure: effects of a supplemented diet with essential amino acids]. 213 4

The urinary albumin excretion measured by the albumin creatinine clearance ratio (Calb/Ccreat) and the mean supine arterial blood pressure (MAP) were studied before the start of ACE inhibition, at the start and during up to 1 year of ACE inhibition with Captopril or Enalapril in 35 patients with various chronic proteinuric renal disorders with or without renal failure, arterial hypertension and nephrotic syndrome. Before the start of ACE inhibition mean Calb/Ccreat, MAP, s-albumin and s-creatinine did not change. During ACE inhibition the Calb/Ccreat was reduced from 75% (p less than 0.05) in patients with minimal albuminuria to 41% (p less than 0.005) in patients with extensive albuminuria. Average reduction of albuminuria was 44% at one year's observation time. Serum albumin increased 9% (p less than 0.05), serum creatinine did not change significantly and MAP showed a slight, not uniformly significant decrease. The reduction of Calb/Ccreat was of the same order in the different renal disorders studied and was independent of the renal function, presence or absence of nephrotic syndrome and treatment with antihypertensive or immunosuppressive drugs. The decrease in Calb/Ccreat during ACE inhibition was related to the reduction in MAP at most time intervals, but Calb/Ccreat decreased also when MAP was unchanged or increased. Thus the decrease in Calb/Ccreat during ACE inhibition does not only seem to be a consequence of a decrease in the systemic arterial blood pressure but reasonably also due to changes in the intra-renal hemodynamics and most probably a decrease in the glomerular capillary pressure.
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PMID:Reduction of albuminuria after angiotensin converting enzyme inhibition in various renal disorders. 218 37


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