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)

A 46-year-old male tuberculosis patient developed acute renal failure and liver dysfunction following the oral administration of rifampicin (RFP). The mechanism of the reaction was examined by means of enzyme-linked immunosorbent assay (ELISA). 3-formylrifamycin-SV (Formylrifamycin), which is one of RFP metabolites, was conjugated to human serum albumin. ELISA was performed with this conjugate (Formylrifamycin-HSA) as an antigen. We also evaluated 100 tuberculosis patients receiving oral RFP and 45 healthy volunteers in order to determine the incidence of sensitization by RFP. IgG and IgM antibodies specific to Formylrifamycin-HSA were detected in serum from the patient with RFP-induced renal failure. Among the IgG subclasses, IgG1 antibody was detected. IgG and IgG1 antibodies specific to Formylrifamycin-HSA were detected in serum from only one of the 100 tuberculosis patients. Our results indicate that sensitization to RFP can occur on oral administration, and that acute renal failure was caused by IgG, IgM, and IgG1 antibodies specific to Formylrifamycin as a hapten.
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PMID:[Detection of antibody specific to rifampicin metabolite by ELISA--mechanism of sensitization by rifampicin]. 836 38

Neuropathic complications of the burn patient are frequently undiagnosed. A retrospective study was performed looking at neuropathies in patients admitted to a tertiary care burns centre from 1984 to 1991. Nineteen out of a total of 800 patients had signs and symptoms of neuropathy, confirmed on neurophysiological testing. Most patients were severely burned with 11 patients (69%) having a total burn surface area of > 20%. Twenty-eight percent were full thickness burns. Mononeuritis multiplex was the most common finding in these patients, occurring in 11 (69%). This has not been reported before. Three patients (19%) had an isolated mononeuropathy, one (6%) had a radiculopathy and one had a generalized axonal polyneuropathy. Of the patients with mononeuropathy, nine had lesions only in burned areas and four had lesions in burned and unburned areas. Eleven patients had complications of sepsis with five also having renal failure. Age, sex, serum albumin, magnesium, phosphate, creatinine, the presence of sepsis and the number or type of drug did not correlate with the number of affected nerves nor the extent of recovery. The length of hospitalization and severity of the burns were the only two factors which correlated with the number of affected nerves. Vascular occlusion of the vasa nervorum, direct thermal injury or a disseminated neurotoxin are postulated as possible aetiological mechanisms.
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PMID:Neuropathy in burn patients. 838 17

The characteristics, survival rate and risk factors associated with death in patients with end-stage renal failure treated with chronic ambulatory peritoneal dialysis (CAPD) were studied. This is a retrospective study of a cohort of 206 patients, from which the follow-up was complete in 190 patients (92%). Only 16 patients (8%) were lost. The study group is composed of 118 males and 88 females, with a mean age of 39 +/- 15 years. The origin of the renal disease was: unknown in 90 patients (44%); diabetes mellitus in 50 (24%); systemic lupus erythematosus in 16 (8%); obstructive uropathy in 15 (7%); glomerulonephritis in 14 (7%), and miscellaneous in 21 (10%). The average follow-up was 12 +/- 11 months. At the end of study, 66 patients were dead (32%). CAPD was discontinued in 12 (6%). Thirty-eight patients (18%) received kidney transplantation. The survival rate for the whole group was 67 and 48% at 1 and 3 years, respectively. Multivariate survival analysis according to the Cox proportional-hazard model showed that the most powerful predictor associated with high risk of death was low serum albumin levels. According to the Cox model other independent variables significantly associated with increase in the probability of death while on CAPD were advancing age, low serum creatinine concentrations and elevated serum cholesterol levels. These results indicate that the risk factors associated with death in CAPD patients are similar to those observed for hemodialysis patients and suggest that using simple laboratory measurements at the enrollment in CAPD the relative risk of death for each patient can be estimated.
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PMID:Death risk in CAPD patients. The predictive value of the initial clinical and laboratory variables. 841 86

A retrospective review of admission serum protein concentration in 18 children with hemolytic-uremic syndrome (HUS) showed significantly decreased serum total protein, albumin and globulin concentrations upon admission compared with 22 matched controls (P < 0.003). One child with atypical disease without diarrhea had normal serum protein concentrations. A strongly positive correlation (P = 0.006) was found between the age of HUS patients with diarrhea and their lowest total protein concentrations. In 10 children who eventually required hemodialysis, there was a significantly negative correlation (r = -0.8316, P = 0.01) between the admission serum albumin and the patients' highest creatinine levels, suggesting that hypoproteinemia may be a risk factor in the development of renal failure. The pathophysiological and clinical significance of hypoproteinemia in HUS needs further investigation.
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PMID:Hypoproteinemia in the hemolytic-uremic syndrome of childhood. 843 84

Human hemoglobin (Hb) and Hb cross-linked between the alpha subunits with bis(3,5-dibromosalicyl)fumarate (alpha alpha Hb) were used to treat hemorrhagic shock in water-deprived swine. Water was withheld for 48 h to induce a 10% loss of body mass, and 25 ml/kg of blood were removed in 1 h to produce circulatory shock. Swine were resuscitated with 1) Hb, 2) alpha alpha Hb, 3) human serum albumin, or 4) Ringer lactate. Mild high-output renal failure was observed in the non-cross-linked Hb-treated animals but not in other groups of animals. Swine treated with Hb and alpha alpha Hb had increases in plasma creatine kinase and lactate dehydrogenase activity that were resolved within 7 days. Both Hb- and alpha alpha Hb-treated swine displayed marked elevations of mean blood pressure in the systemic (39 +/- 6 Torr) and pulmonary (20 +/- 6 Torr) circulations that continued for 3 h and were associated with reduced cardiac output and a doubling of the systemic and pulmonary vascular resistances. Oxygen delivery was equivalent, and the rate of correction of the lactic acidosis was equal in all groups.
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PMID:Systemic and pulmonary hypertension after resuscitation with cell-free hemoglobin. 851 95

Total cholesterol (TC) levels were lower than expected in some patients with advanced renal disease and nephrotic-range proteinuria. Studies of 35 clinically stable nonuremic patients and of 12 nephrotic patients with advancing renal failure were therefore performed. Analysis of pooled biochemical data from 35 patients who were hypercholesterolemic on entry to the clinic revealed a positive correlation between TC and reciprocal creatinine (l/Cr) while serum albumin (ALB) was negatively correlated with l/Cr and TC. In the 12 nephrotic patients with negative reciprocal creatinine slopes there was a strong correlation between the slopes of l/Cr and TC. These data suggest that plasma cholesterol falls in the nephrotic hypercholesterolemic patients in whom renal disease progresses, and that the slopes of plasma cholesterol and reciprocal creatinine are closely related.
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PMID:Serum cholesterol falls spontaneously in nephrotic patients with progressive renal disease. 851 96

We monitored thyroid function in 75 peritoneal dialysis patients (55 +/- 15 years). A total of 20 (27%) were hypothyroid; 9 were diagnosed about the time of initiation of dialysis, and 11 prior to onset of renal failure. Thyroid function surveillance found an increase in serum thyrotropin (TSH) concentration to hypothyroid values in only one patient. On replacement therapy serum thyroxine was similar in euthyroid and hypothyroid patients (6.94 +/- 1.69 vs 6.52 +/- 1.65 micrograms/dL, respectively; p = 0.380), but TSH was higher in hypothyroid patients (5.61 +/- 5.67 vs 2.59 +/- 1.49 microU/mL, respectively; p = 0.001). Serum creatinine (8.6 +/- 3.1 vs 11.4 +/- 5.1 mg/dL, respectively; p = 0.049) and albumin concentrations (3.76 +/- 0.47 vs 3.33 +/- 0.71 g/dL, respectively; p = 0.006) were lower in hypothyroid than euthyroid patients. Hyperthyroid patients had higher serum triglyceride concentrations than euthyroid patients (306 +/- 176 vs 189 +/- 122 mg/dL, respectively; p = 0.013). Parathyroid hormone (PTH) was lower in hypothyroid than normothyroid patients (108 +/- 80 vs 261 +/- 265 pg/mL, respectively; p = 0.032). No differences were observed in serum calcium, phosphorus, and alkaline phosphatase. We conclude that hypothyroidism is common in peritoneal dialysis patients, usually antedates dialysis therapy, results in lower serum albumin and creatinine concentrations and higher serum triglyceride concentrations, is associated with lower serum PTH concentrations, and that thyroid function surveillance is not necessary in the absence of symptoms suggestive of hypothyroidism.
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PMID:Thyroid function surveillance in CAPD patients. 853 10

Malnutrition at the initiation of dialysis is a strong predictor of subsequent increased mortality on dialysis. Few studies have documented the relationship between the progression of renal failure and spontaneous dietary protein intake (DPI) and other indices of malnutrition. In this prospective study, renal function was sequentially measured by creatinine clearance (CrCl) and DPI by 24-h urine collection; simultaneously, multiple sequential biochemical nutritional indices, including serum albumin, transferrin, prealbumin, and insulin-like growth factor-I (IGF-I) concentrations, were measured. The study involved 90 patients (46 men and 44 women) with chronic renal failure (CRF) of various causes monitored in an outpatient clinic. Dietary interventions were minimal. The mean duration of follow-up was 16.5 +/- 11.8 months. The results show that the mean (+/- SD) DPI was 1.01 +/- 0.21 g/kg per day for patients with CrCl over 50 mL/min and decreased to 0.85 +/- 0.23 g/kg per day for patients with CrCl between 25 and 50 mL/min. The DPI further decreased to a level of 0.70 +/- 0.17 g/kg per day for patients with CrCl between 10 and 25 mL/min and was 0.54 +/- 0.16 g/kg per day for patients with CrCl below 10 mL/min. This trend was statistically significant (P < 0.001). A similar statistically significant trend was observed for serum cholesterol, transferrin, and total creatinine excretion (all P < 0.01). A mixed model analysis indicated that for each 10 mL/min decrease in CrCl, DPI decreased by 0.064 +/- 0.007 g/kg per day, transferrin decreased by 16.7 +/- 4.1 mg/dL, weight decreased by 0.38 +/- 0.13% of initial weight, and IGF-I decreased by 6.2 +/- 1.9 ng/mL. It was concluded that the progression of renal failure is associated with a spontaneous decrease in DPI, especially below a CrCl of 25 mL/min, and that most nutritional indices in CRF patients worsen as CrCl and DPI decrease. Dietary protein restriction should be used cautiously in CRF patients when CrCl falls below 25 mL/min.
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PMID:Spontaneous dietary protein intake during progression of chronic renal failure. 858 13

Small bowel bacterial overgrowth (SBBO), well known to occur in end-stage kidney failure, is responsible for producing uremic toxins and contributing to the patient's decreased nutritional well-being. In this study, 8 hemodialysis patients were treated with a course of oral Lactobacillus acidophilus (LBA) in an attempt to alter this SBBO. LBA treatment was effective in lowering 2 compounds generated in vivo. Serum dimethylamine (DMA) levels dropped from 224 +/- 47 to 154 +/- 47 micrograms/dl at the end of LBA treatment (p < 0.001). Nitrosodimethylamine, a carcinogen, levels also decreased significantly from 178 +/- 67 (untreated) to 83 +/- 49 ng/kg (after LBA treatment). Patients nutritional status, assessed as serum albumin, body weight, caloric intake, midarm muscle area (MAMA) and appetite improved modestly, but not significantly. LBA changed small bowel pathobiology by modifying metabolic actions of SBBO, reducing in vivo generation of toxins and carcinogens and promoting nutrition with no adverse side effects.
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PMID:Biomodulation of the toxic and nutritional effects of small bowel bacterial overgrowth in end-stage kidney disease using freeze-dried Lactobacillus acidophilus. 867 36

Cross-sectional studies in steady state dialysed chronic end-stage renal failure patients show urea clearance (Kt/V) and total urea excretion (protein catabolic rate) correlate positively. However, urea clearance is total urea excretion divided by BUN. Thus urea clearance and BUN relate reciprocally, and so their mathematical product (total urea excretion) is independent of clearance. As such clearance cannot also be a positive correlate of total excretion as demanded by the cross-sectional studies. Furthermore the clearance formula dictates that the positive urea clearance and total urea excretion correlation found in the cross-sectional studies can only occur if the increased urea clearance fails to reciprocally lower the BUN. Thus the relations of urea clearance, urea excretion, and BUN requires further definition. To so define we examine dialysis urea excretion, dialysis urea clearance, BUN, and serum albumin in 13 stabilized chronic uremics with minimal native renal function who are treated by continuous ambulatory peritoneal dialysis (CAPD). Urea clearance and BUN correlate positively (r = 0.62, p < 0.05) and both also correlate positively with dialytic urea excretion and (urea clearance r = 0.912, p < 0.001, BUN r = 0.88, p < 0.001). In addition dialytic urea excretion and serum albumin indexed to body size correlate positively (p < 0.05). Thus in the steady state urea clearance associates with both an increase in BUN and urea output. However the law of conservation of mass makes urea output is a function of protein intake. Thus increased clearance cannot directly increase such output, and so increased clearance must first increase intake but in doing so it increases the retention of the byproducts of enhanced intake, BUN and other protein metabolites, so leading to a paradox, the more removed, the more remains. These observations taken together suggest that in chronic uremia treated by continuous dialysis, elevation of the BUN may be a marker for an adequate restoration of protein metabolism if inadequate dialysis is excluded.
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PMID:Improved urea clearance raises the BUN in continuous peritoneal dialysis. 870 60


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