Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0035078 (renal failure)
 31,970 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twelve patients with progressive renal failure were placed on a very low protein diet supplemented by an essential amino acid-keto acid mixture for six to twelve months. Total daily intake was 0.04 g nitrogen/kg and 50 kcal/kg. Eight subjects had a significant change in the slope of reciprocal plasma creatinine, becoming less steep and in two cases positive. GFR did not improve, but in four patients the decline over twelve months was less than 0.5 mliter/min. There were significant falls in blood and urinary urea, serum phosphate PTH and calcium X phosphate product. Body wt decreased during the first three months. Arm muscle circumference fell by 0.9 cm (P less than 0.005). Serum albumin and transferrin levels did not change significantly. Muscle mass and plasma creatinine fell simultaneously in several patients. Creatinine excretion per kg muscle mass, assessed anthropometrically, declined by 21% in the first three months. This diet may slow the decline in renal function in a proportion of patients. However, muscle mass can be lost. Serum protein levels do not accurately reflect nutritional changes. A fall in plasma creatinine may not be due to improved GFR but instead to altered creatinine metabolism.
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PMID:The risks and benefits of a low protein-essential amino acid-keto acid diet. 372 30

As in many pathological states, changes in the plasma protein binding of drugs are observed in uremia. Renal failure reduces the fraction of many acidic drugs bound to serum albumin. This decreased binding is due to many factors: variations of protein concentrations, structural changes of proteins, competitive displacers in plasma of chronic uremic patients. When the margin between pharmacological and toxic doses is narrow, drug monitoring by measurement of plasma free drug concentrations seems necessary to adjust the dosage regimen in uremic patients.
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PMID:[Plasma binding of drugs in chronic renal failure]. 377 85

The binding by serum albumin of many drugs and endogenous metabolites is impaired in humans and animals with renal failure. Unknown solute(s) retained in renal failure have been extracted from uremic fluids. When added to normal plasma they induce a similar binding defect. Similar activity can be extracted from normal urine. We have devised a series of extraction and purification techniques that yielded three binding inhibitory ligands from normal human urine in sufficient quantity and of a high degree of purity. Rigorous methods have been applied to determine chemical identity of the ligands. Purification steps consisted of: adsorption at pH 3.0 to polystyrene-divinylbenzene resin (XAD-2); elution from the resin with methanol followed by drying and solution in dilute formic acid; passage through SP-Sephadex to remove cations, especially yellow-brown pigments; adsorption to the anion exchanger QAE-Sephadex, and separation into three zones of inhibitory activity with a formic acid gradient; purification to homogeneity with C-8 or C-18 silica reversed-phase chromatography. Using this isolation procedure, followed by mass spectroscopy and nuclear magnetic resonance spectroscopy, we have shown that the binding inhibitory activity is due not to one ligand, but to a family of aromatic acids. To date hippurate, beta-(m-hydroxyphenyl)-hydracrylate and p-hydroxyphenylacetate have been identified as binding inhibitors. Other active ligands remain to be identified.
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PMID:Isolation and chemical identification of inhibitors of plasma ligand binding. 378 82

Selenium deficiency has been implicated as contributing to the development of cardiovascular disease, skeletal muscle myopathy, anemia, increased cancer risk, and deranged immune function. Since these problems may also be associated with renal failure, and the kidney plays an important role in selenium homeostasis, we measured selenium and compared it with nutritional status in 24 stable hemodialysis patients, 12 chronic intermittent peritoneal dialysis patients, and 29 healthy controls. Whole blood and plasma selenium was determined by a spectrofluorometric method. For whole blood the mean (+/- SD) selenium levels were 0.11 +/- 0.02 micrograms/ml in controls vs. 0.071 +/- 0.01 micrograms/ml in hemodialysis cases and 0.052 +/- 0.006 micrograms/ml in peritoneal dialysis (p less than 0.005). Significant decreases were seen also for plasma and red blood cell selenium in all groups respectively. Pre- and postdialysis plasma and whole blood selenium levels showed no significant changes in both dialysis groups. However, predialysis residual peritoneal fluid did contain selenium (0.029 +/- 0.005 micrograms/ml). Some evidence of protein-energy undernutrition was noted in both dialysis groups compared with controls. However, no significant differences in nutritional parameters were noted between hemodialysis and peritoneal dialysis patients. When all groups were combined, significant correlations were found between whole blood selenium and serum albumin (r = 0.61; p less than 0.001), triceps skin fold in females (r = 0.62; p less than 0.001), and midarm muscle circumference in males (r = 0.71; p less than 0.001). We conclude that low blood selenium is present in renal failure patients undergoing hemodialysis. This abnormality is even greater in peritoneal dialysis cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diminished blood selenium levels in renal failure patients on dialysis: correlations with nutritional status. 381 49

Nineteen patients with nephrotic syndrome, 13 with histological diagnosis, were studied throughout 31 pregnancies. Eight were diagnosed for the first time during pregnancy.Antenatal problems due to severe oedema, urinary tract infection, and refractory orthochromic anaemia were encountered. Eight patients were hypertensive at booking, and in two of these pregnancy was terminated; three others had a significant increase in blood pressure. In 12 of the remaining pregnancies a rise in blood pressure of 20 mm. Hg or more occurred towards term.There were 29 live births (including one set of twins), one stillbirth due to a cord accident, and one neonatal death. The infant birth weight, apart from being affected by hypertension, was related to the maternal serum albumin level.The patients have been under observation for up to 20 years. Fifteen have not shown any deterioration of renal function during the prolonged period of observation. One developed oliguric renal failure immediately post partum and three others died, two, four, and 12 years after their pregnancies.
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PMID:Pregnancy and the nephrotic syndrome. 576 44

Chronic hemodialysis (HD) and peritoneal dialysis (PD) patients in one dialysis center were examined for (EO)-related sensitization. Five of 56 (8.9%) HD patients and 0 of 30 PD patients skin tested with a conjugate of human serum albumin (HSA) and EO had positive skin prick tests. The sera of 13 of 107 (12.1%) HD patients including sera from 5 patients with negative skin tests were positive in an EO-HSA radioallergosorbent test (RAST). Sensitized patients in this population did not experience allergic-type reactions during hemodialysis. There were no positive EO-HSA RAST results which could be ascribed to PD. Non-specific cutaneous responsiveness of the renal failure patients was compared with that of normal adult subjects by the use of skin prick tests with codeine phosphate and histamine phosphate. A significantly reduced responsiveness is present in chronic renal failure patients which would be expected to lower the sensitivity of the diagnostic skin test by comparison with the RAST.
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PMID:Ethylene oxide allergy in a dialysis center: prevalence in hemodialysis and peritoneal dialysis populations. 646 90

Serum from patients with advanced renal failure contains substances that inhibit binding of small ligands to albumin. The extractable inhibitors of binding to albumin (lx), which were previously shown in rat kidney slices to inhibit para-aminohippurate (PAH) transport, were added to the in vitro perfused rat kidney in an attempt to investigate effects on organic acid transport in the intact organ. Following addition of extract to the perfusate there was an immediate and profound decrease in whole kidney PAH secretion. Mean PAH clearance fell an average of 60% +/- 7% after addition of extract from human uremic pleural exudate and an average of 62% +/- 6% after addition of similarly prepared extract from normal human urine. There was no change in inulin clearance, vascular resistance, urine flow, or fractional reabsorption of sodium. The effect was shown to be as marked when bovine serum albumin (4.0 g/dL) was added to the perfusate, clearances falling 66% +/- 7%. Controls showed no change in PAH or inulin clearance during 90 minutes of in vitro perfusion. An increase in ultraviolet (UV) absorbance by the urine within minutes after addition of inhibitor to the perfusate suggested tubular secretion of a major portion of the extract. Partial recovery of PAH clearance was observed after 20 to 40 minutes in most kidneys and near complete recovery occurred in some kidneys. The inhibitory effect was duplicated by addition of hippurate at 24 mg/dL (1.2 mmol/L) to the perfusate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Suppression of para-aminohippurate transport in the isolated perfused kidney by an inhibitor of protein binding in uremia. 669 43

By univariate analysis of patients with membraneous nephropathy, terminal renal failure was associated with male sex, a large amount of proteinuria, low serum albumin concentration, low creatinine clearance rate, high serum creatinine concentration, and high systolic blood pressure, but was not associated with age or prednisone treatment. In a multivariate life table analysis that controlled for all these factors simultaneously, the risk of developing terminal renal failure was significantly independently associated only with sex, serum albumin concentration, and prednisone treatment, being higher in men, lower in those treated with prednisone, and inversely related to serum albumin. Except for the minimal electron-dense deposition, the electron microscopic findings had no predictive value.
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PMID:Membranous nephropathy: predictors of terminal renal failure. 669 77

Lipids of the blood serum were studied in 29 patients with untreated nephrotic syndrome (NS) and in 28 patients treated with corticosteroids or nonsteroid drugs. None of the patients had evidence of renal failure, either acute or chronic. The patients with untreated NS showed massive proteinuria, marked hypoproteinemia, considerable hypertriglyceridemia and hypercholesterolemia. Serum high-density lipoprotein cholesterol (HDL cholesterol) concentrations were lower in these patients than in the control group, including 35 normal subjects, and correlated with the total serum protein (r = 0.46, p less than 0.05) and serum albumin (r = 0.46, p less than 0.05). An inverse correlation was observed between HDL cholesterol and serum triglyceride levels (r = -0.58, p less than 0.01). In the treated patients the laboratory indices of NS were less pronounced. HDL cholesterol levels were within normal limits in 14 patients with NS treated mostly with nonsteroid drugs, while in the patients receiving the corticosteroids (14 subjects) they were significantly higher than in the control group.
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PMID:High-density lipoprotein cholesterol in patients with untreated and treated nephrotic syndrome. 671 5

The methods most commonly used for determination of albumin in serum depend on its binding of dyes. The binding of many drugs as well as of several dyes is impaired in azotemic sera from patients with renal failure. We therefore evaluated four methods used to measure albumin concentration in sera of patients with various degrees of renal failure, comparing results with those by the most specific method, radial immunodiffusion. The automated bromcresol green, manual immediate bromcresol green, cellulose acetate electrophoresis, 2-(4'-hydroxyazobenzene)benzoic acid binding, and Na2SO3 precipitation/biuret methods were evaluated. The correlations with results of radial immunodiffusion for azotemic sera differed from method to method but were approximately the same for each method, as in previous published reports for samples from a heterogeneous population of patients. The ratios of serum albumin concentration by these methods to albumin concentration as measured by radial immunodiffusion ranged from 0.96 to 1.13 for 29 to 41 normal and azotemic sera, but none of the ratios showed any variation beyond random scatter over a range of serum creatinine from 6.0 to 180 mg/L. Thus the choice of method to apply to azotemic sera will depend on the relative importance of accuracy, speed, cost, and technical complexity.
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PMID:Four methods for determining albumin in azotemic sera evaluated. 678 Feb 42


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