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)

We measured the serum concentration of vitamin D-binding protein (DBP) in children with chronic renal failure (CRF). We also evaluated the relationships between the peritoneal loss of vitamin D metabolites, DBP and albumin in nine children on continuous ambulatory peritoneal dialysis (CAPD). The serum levels of DBP in children with CRF were significantly higher than in normal children. The mean serum DBP level in CRF children undergoing CAPD was slightly lower than in CRF patients who were not on dialysis. In patients on CAPD, the peritoneal loss of 25-hydroxyvitamin D (25OHD) showed a significant positive correlation with the DBP concentration in the dialysate (r = 0.855, P less than 0.005). In contrast, the peritoneal loss of 1,25-dihydroxyvitamin D (1,25(OH)2D) showed a significant correlation with the loss of albumin in the dialysate (r = 0.779, P less than 0.01). The synthesis of 1,25(OH)2D3 is reduced in advanced renal failure, and the peritoneal losses of the active vitamin D sterols in patients on CAPD may aggravate this deficiency. We recommend that supplementation of active form of vitamin D, such as 1 alpha-hydroxyvitamin D3 or 1,25(OH)2D3, is important in CAPD patients, particularly those with elevated peritoneal loss of DBP and/or albumin.
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PMID:Evaluation of vitamin D-binding protein and vitamin D metabolite loss in children on continuous ambulatory peritoneal dialysis. 162 32

We studied retrospectively patients with hyperparathyroidism after successful renal allotransplantation. Since 1972, 1119 transplantations have been performed in our department, and 534 patients survive with functioning grafts. Hyperparathyroidism requiring parathyroidectomy developed in 32 (5.9%). The frequency of interventions increased markedly after introduction of cyclosporine A treatment in our unit. The time between transplantation and parathyroidectomy was 22.5 months (SD 16.5, range 1-82 months). The age of the patients was 49.0 years (SD 10.5, range 17-63 years); the group consisted of 16 female and 16 male patients. All patients but two (no measurement performed) repeatedly exhibited high serum parathormone and calcium levels and therefore underwent surgery. In comparison to a control group, matched for time of transplantation, age, sex, and cause of renal failure, the patients with hyperparathyroidism had longer dialysis treatment (54.2 months, range 9-132 vs 26.9 months, range 1-72) and exhibited lower phosphate concentrations in the early posttransplantation period. Before surgery, serum chemistry was different for hyperparathyroid and control subjects: serum calcium 2.80 +/- 0.23 mmol/l vs 2.48 +/- 0.13 mmol/l and alkaline phosphatase 157.4 +/- 92.0 U/l vs 85.2 +/- 51.5, respectively. We did not see any influence of oral phosphate binders, calcium supplementation, or vitamin D treatment on the development of parathyroid gland hyperactivity during dialysis treatment. Serum creatinine concentration did not change after parathyroidectomy. In four patients, long-term calcium supplementation after surgery was necessary.
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PMID:Hyperparathyroidism after kidney transplantation: a retrospective case controlled study. 174 6

While awaiting renal transplantation, patients with end-stage renal failure frequently have to spend a period of time on dialysis. Although dialysis controls uraemia, the patient undergoing dialysis still faces problems related to the continuing uraemic state such as anaemia, renal bone disease, malnutrition and cardiovascular complications. Apart from the problems related to uraemia, patients on dialysis are also exposed to problems that are peculiar to the mode of dialysis. In haemodialysis, patients face complications related to the use of heparin and dialyser related problems such as air embolism and haemolysis. Patients on continuous ambulatory peritoneal dialysis (CAPD) are exposed to complications such as infection, hernias and hypertriglyceridaemia. The introduction of hormone therapy with erythropoietin and vitamin D and recent advances in dialysate solutions and biocompatibility of membranes in haemodialysis and in control of infection and a better understanding of peritoneal kinetics in CAPD have helped to overcome some of the problems in dialysis patients.
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PMID:Medical problems in dialysis patients awaiting renal transplantation. 179 67

By the year 2000, the perspectives for hemodialysis performed in adults will be oriented towards facilitation of the practice of hemodialysis as a better control of clinical symptoms observed in end stage renal failure treated by hemodialysis. Blood access is the main problem which remains to be solved. The authors describe the advantages and disadvantages of the methods presently used and give the "state of the art" of "blood access" prosthesis. Almost all symptoms encountered in renal failure patients treated by hemodialysis can be efficiently treated. Hypotensive drugs usually reduce hypertension which resists adequate treatment by hemodialysis. Most of the symptoms of osteodystrophy can be avoided by adequate diet associated with the prescription of vitamin D analogs. Nevertheless, the prolongation of hemodialysis treatment duration over 7 years has led to the apparition of destructive arthropathies which are very painful and handicapping. They are related to amyloid deposit of beta 2-microglobulins. Progress in hemodialysis technics and a better control of uremic symptoms allow application of this treatment at all ages of life. The authors examine specific problems concerning school-aged teenagers and aged persons. They show that results already achieved allow a daily treatment of these patients. This is a first step for the generalisation of this procedure to all patients and its advantages are described. Improvement of hemodialysis technics for the year 2000, as can be expected, mainly depends upon progress in knowledge of biocompatibility parameters between materials used in the artificial kidney and patients tissues, mainly blood vessels.
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PMID:[The future of hemodialysis in the adult]. 180 77

Two cases of rhabdomyolysis with renal failure followed by hypercalcaemia are reported. Both had major hyperphosphataemia and hypocalcaemia, requiring haemodialysis. Hypercalcaemia developed during the diuretic phase, when renal function was still abnormal, and before phosphate blood levels had returned to normal. Soft tissue calcifications occurred in one of the patients. The pathogenesis and treatment of this condition are discussed. Increased levels of serum calcitriol may play an important role in the genesis of hypercalcaemia, which may last for several months. Giving calcium salts and or vitamin D to these patients during the hypocalcaemic phase is dangerous, and should be avoided. The usual treatment for hypercalcaemia my remain ineffective. Mithramycin can lower the serum calcium concentration but the new diphosphonates (sodium etidronate) are very effective in the treatment of this hypercalcaemia. However, in serious or urgent cases, hypocalcaemic haemodialysis may be required, with the simultaneous administration of calcitonin and diphosphonates.
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PMID:[Severe hypercalcemia after rhabdomyolysis and acute renal failure]. 150 21

Studies in the past showed elevated immunoreactive parathyroid hormone (PTH) serum values in early renal failure, but the assays used in these studies could not discriminate between bioinactive fragments of the PTH peptide and biologically active hormone. The availability of a sensitive PTH assay, which quantitates intact hormone, now allows the analysis of biologically active PTH in renal failure. To characterise more precisely the point of onset of hyperparathyroidism in the course of chronic renal failure and its relation to 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], we measured plasma intact PTH and vitamin D metabolite serum values in 63 non-nephrotic uraemic patients (male n = 35, female n = 28, age 31-78 years) with incipient (GFR 60-90 ml/min per 1.73 m3, n = 19) mild (GFR 40-60, n = 22) and moderate (GFR 20-40, n = 22) renal failure, and in 22 age-matched healthy control subjects. Intact PTH concentrations were negatively correlated with GFR (r = -0.57, P less than 0.001). Median plasma intact PTH values (normal range 1.2-6 pmol/l) were 5.6 (range 2.2-13.0) in incipient, 8.1 (2.9-24.0) in mild, and 13.0 (5.4-59.0) in moderate renal failure. Intact PTH values in incipient renal failure were significantly greater than in 22 age-matched control subjects (P less than 0.01). The decline of GFR was paralleled by a progressive decrease in 1,25(OH)2D3 serum values (r = 0.44, P = 0.001). Median values of the hormone (normal range 35-90 pg/ml) were 32 (range 20-66) in incipient (P less than 0.01 vs. age-matched control subjects), 34 (22-74) in mild, and 26 (17-39) in moderate renal failure. In all three groups, mean serum phosphate and total calcium concentrations (corrected for serum protein) were within the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Calcium metabolism in early chronic renal failure: implications for the pathogenesis of hyperparathyroidism. 186 44

Primary hyperparathyroidism is a common condition infrequently complicated by renal stones and overt bone disease. Most cases are asymptomatic or have vague, nonspecific symptoms. There is considerable debate as to whether mild or asymptomatic cases should be managed surgically or conservatively. Important chromosomal abnormalities have now been demonstrated in some parathyroid adenomas. Renal osteodystrophy remains a difficult condition to treat once it is fully established. The use of vitamin D metabolites in the early stages of renal failure and the maintenance of a normal serum calcium and phosphate appear to prevent the development of secondary hyperparathyroidism. Further studies are required to ascertain the optimum way of using vitamin D metabolites and how best to reduce serum phosphorus.
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PMID:Primary hyperparathyroidism and renal osteodystrophy. 188 4

Proximal femur fractures in elderly people are more and more frequent. Falls and senile bone disorders are the risk factors of this fracture. In order to understand the mechanisms of these bone disorders, we studied 21 consecutive patients with this fracture using bone histomorphometry. Measurements of serum intact parathormone (PTH), 25-(OH)-vitamin D, 1,25-(OH) 2-vitamin D and osteocalcin have been performed in these 21 patients, included in a larger series. We excluded patients with renal failure (serum creatinine greater than 140 mumols/l), cancer, or previous metabolic bone disease. There were 19 female and 2 male patients, ranging from 75 to 96 years, (mean 84.9). We found a low frequency of cortical (2/21) and trabecular (3/21) osteoporosis. There was no case of clearcut osteomalacia. Following histomorphometric bone study, two patients showed a typical pattern of hyperparathyroidism, and in a third one, this condition seemed very likely. In these three patients who were among the oldest, and who had high levels of serum PTH, chronic renal failure and primary hyperparathyroidism could be excluded. High bone remodeling was frequent in our patients, as reflected by the enhancement of eroded surfaces (13 cases) and of osteoid thickness (7 cases). Intact PTH level was elevated in our series compared to normal values in adults (in accordance to the PTH elevation in the case control study in a larger series). These findings suggest a major role of a secondary hyperparathyroidism in senile bone disorders favoring proximal femur fractures. This hyperparathyroidism is probably secondary to mild calcium and vitamin D deficiency. It may lead to architectural bone changes favoring this fracture.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hyperparathyroidism in proximal femur fractures biological and histomorphometric study in 21 patients over 75 years old. 191 14

In order to analyze the place of dialysis in a hemodialysis/transplantation program, the duration of each treatment modality, mortality rate and quality of inclusion in the social network were studied. Complications which arose during hemodialysis were evaluated by comparing the 1970's and the 1980's. Sixty children with terminal renal failure, aged 3 to 15 years, were entered in a hemodialysis/transplantation program between May 1971 and December 1988. Patients were followed up until December 1989. Among the 47 (78%) survivors at the end of the follow-up period, 25 had a functioning renal transplant and 22 were undergoing dialysis. Among the 13 deaths, 7 occurred during renal transplantation or immediately after loss of the transplant and 6 occurred under dialysis. Mean duration of treatment, including both dialysis and transplantation, was 7 years 11 months. Mean time spent under dialysis was 4 years 9 months. Time spent with a functioning transplant was 3 years 10 months for the 46 transplant recipients. Mean time spent on the transplant waiting list fell from 3 years 6 months before 1980 to 2 years after 1980. Virtually no cases of renal osteodystrophy, acute arterial hypertension or hepatitis B were seen after 1980 as a result of the use of higher-potency vitamin D derivatives, recent antihypertensive drugs including ACE inhibitors, and the Hevac B vaccine. Similarly, safety and patient comfort during dialysis improved substantially, as well as the quality of rehabilitation. Growth remained a significant problem although improvements can be expected to occur in the near future. Hemodialysis is an indispensable complement to transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The role of dialysis in the treatment of terminal renal insufficiency in children]. 203 83

Renal excretion is the major route of magnesium elimination from the body and a positive magnesium balance would be expected under conditions of renal insufficiency. However, a compensatory decrease in tubular reabsorption is operating to maintain an adequate urinary magnesium excretion even when glomerular filtration rates are very low. Nevertheless, in end-stage renal disease, the limited ability of the kidney to excrete an increased magnesium load may result in toxic concentrations of the ion in serum. While magnesium intoxication is a real hazard when magnesium-containing drugs are given, magnesium balance may be normal or even decreased in uraemic patients. This is usually due to decreased dietary intake combined with the impaired intestinal magnesium absorption which characterizes chronic renal failure. Impairment of magnesium absorption seems to be related to deficient synthesis of the active metabolite of vitamin D by the non-functioning kidney. Following the institution of chronic haemodialysis or continuous ambulatory peritoneal dialysis (CAPD) treatment, the major determinant of magnesium balance is the concentration of magnesium in the dialysate. Changes in the dialysate magnesium have been used to reduce the incidence of renal osteodystrophy, to alleviate uraemic pruritus, or to retard the development of arterial calcification in chronic renal disease. However, uncertainty about magnesium, calcium and parathyroid hormone relationships in renal failure makes a reasoned approach to such manipulations extremely difficult.
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PMID:Magnesium metabolism in chronic renal failure. 213 26


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