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

The effect of 1,25-dihydroxyvitamin-D3 administration on growth rate, renal failure progression and calcium-phosphorus metabolism was evaluated in 8 children younger than 13 years, mean age 6.3 +/- 3.3 (mean +/- SD), with chronic renal failure (glomerular filtration rate: 44.1 +/- 16.5 ml/min/1.73 m2) receiving conservative treatment in whom at least two periods, with a minimal duration of six months each, without and with rocaltrol treatment, could be compared 1.25-dihydroxyvitamin-D3 at dosage of 16.3 +/- 6.3 ng/kg/day resulted in a significant increase (p less than 0.05) of growth index velocity (81.4 +/- 37.8 versus 122.4 +/- 60.3) without altering renal failure progression rate which was assessed by means of 1 to serum creatinine concentration ratio. One hypercalcemic episode (serum calcium equal or greater than 11 mg/dl) every 28.4 months was observed. Our results confirm the beneficial effect of 1.25-dihydroxyvitamin-D3 administration in the management of children with chronic real failure.
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PMID:[Effect of treatment with 1,25-dihydroxyvitamin D3 in children with chronic renal insufficiency]. 343 54

An 11-year-old boy who presented in acute renal failure with significant increases of uric acid and phosphorus in his serum was discovered to have acute lymphoblastic leukemia. Five years later, he had a second and similar episode of acute renal failure, which was responsive to hemodialysis. After three months of daily therapy with allopurinol, a third and final episode of renal failure was unresponsive to peritoneal dialysis. Autopsy revealed an obstructive uropathy; focal nephrocalcinosis; and multiple, small, tan calculi in the calyces of both kidneys. Systemic cryptococcosis was also discovered. The stones, characterized by paper chromatography, electrophoresis, x-ray diffraction, and infrared spectroscopy, were 82% xanthine, 15% oxypurinol, and 3% hypoxanthine. We suggest that attention to the effects of accelerated tumor-cell lysis may protect renal function in patients with a large and drug-sensitive tumor cell load. Similarly, early detection of the fungal complications of leukemic therapy is an essential component of the treatment program.
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PMID:Xanthine lithiasis, nephrocalcinosis, and renal failure in a leukemia patient treated with allopurinol. 348 85

The effects of decreasing serum levels of PTH after parathyroidectomy on circulating levels of 1 alpha,25-dihydroxyvitamin D [1,25-(OH)2D] and bone Gla protein (BGP) were studied in seven patients treated with chronic maintenance dialysis. Before surgery, all patients had extremely elevated levels of PTH, low normal or low levels of 1,25-(OH)2D, high levels of BGP, and histological signs of excess PTH action on bone. The fall in PTH levels after surgery resulted in a further decline in 1,25-(OH)2D concentrations and a reduction in circulating BGP levels. This fall in serum 1,25-(OH)2D and BGP levels was not related to serum calcium or phosphorus. Administration of 1,25-(OH)2D3 from 4-6 months after surgery did not significantly affect serum levels of BGP or PTH. These data indicate that 1,25-(OH)2D is still under regulatory control of PTH in patients without excretory kidney function. This might reflect some remaining endocrine activity of the kidneys in these dialyzed patients or extrarenal production of 1,25-(OH)2D. In addition, the data show that serum BGP levels in renal failure are elevated due not only to impaired clearance but also to PTH-mediated acceleration in bone turnover. Therapy with 1,25-(OH)2D3 in these patients resulted in supraphysiological serum 1,25-(OH)2D levels which did not stimulate BGP production.
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PMID:Effects of parathyroidectomy on circulating levels of 1 alpha,25-dihydroxyvitamin D and bone Gla protein in dialyzed patients. 348 51

Histologic bone changes of osteitis fibrosa and osteomalacia are commonly present in patients with end-stage renal disease. Although many patients are not symptomatic from these bone changes, some patients are severely disabled. Altered metabolism of vitamin D, calcium, phosphorus, and parathyroid hormone occurs in renal failure and contributes to the development of uremic bone disease. This article reviews the current theories of pathogenesis and treatment of renal osteodystrophy. In addition, the clinical presentation, pathogenesis, and treatment of the various aluminum-associated osteomalacic syndromes in uremia are discussed.
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PMID:Review: Renal osteodystrophy--pathogenesis and treatment. 351 48

Pulmonary calcinosis is a recognized complication of renal failure. The resulting pulmonary compromise may be severe or even fatal. The potential contribution of hypercalcemia, hyperphosphatemia, and increased calcium-phosphorus product to the development of pulmonary calcinosis has been controversial. We describe four patients (ages 2 1/4 to 18 years) who had severe pulmonary calcinosis and respiratory failure within three to five days after renal transplantation. Initial clinical and roentgenographic findings suggested noncardiogenic pulmonary edema. Marked pulmonary hypertension was present in the two patients in whom pulmonary artery pressure data were available. Other clinical features in common included poor allograft function with persistent uremia requiring dialysis and evidence of moderate to severe secondary hyperparathyroidism. In three of the patients, the calcium-phosphorus product increased markedly after transplantation, to peak values of 122 to 147. This increase occurred at the same time as the onset of respiratory failure. Peak serum calcium levels were 10.0 to 11.0 mg/dL and peak serum phosphorus levels were 9.2 to 13.5 mg/dL. All patients died of respiratory failure five to 58 days after transplantation. The posttransplantation period may be a time of increased risk of potentially fatal pulmonary calcinosis in pediatric renal transplant recipients. The diagnosis should be considered in any patient with respiratory failure of unknown cause following renal transplantation.
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PMID:Pulmonary calcinosis after renal transplantation in pediatric patients. 352 Dec 66

Four patients previously treated by traditional dialysis (HD, 240 min) were switched to biofiltration (BF, 180-210 min) and followed for twelve months. Before and at the end of this period, clinical and biochemical data were assessed for each patient. Patients treated for 180 min by BF presented no increase in BUN but a significant increase of predialytic phosphorus. The 210 min BF schedule achieved the same pattern of depuration as HD. Acidosis was corrected better in all patients during BF. No hypoxemia and no change of WBC count were observed during BF. Cardiac function, assessed by echocardiography, improved similarly with each session of both methods. BF is a useful alternative treatment procedure for patients with endstage renal failure.
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PMID:Biofiltration, a new method of short hemodiafiltration: preliminary report. 355 56

Accumulation of aluminum occurs in children with renal failure and can cause anemia, disabling osteodystrophy, and encephalopathy. Effects on bone mineralization are of particular concern in pediatric patients with growth potential. We measured plasma aluminum levels in 36 patients on continuous ambulatory peritoneal dialysis (CAPD) and 22 on hemodialysis under surveillance at a single pediatric center. The levels were above normal in 35 and 21 patients, respectively, and the values correlated with the oral dose of aluminum-containing phosphate-binding medications (r = 0.57; P less than 0.001). Younger and smaller children had higher plasma aluminum levels and also received larger doses of oral aluminum-containing compounds. Mean plasma aluminum levels (57.2 +/- 52.8 and 48.7 +/- 32.1 micrograms/liter, respectively) and the daily oral doses of elemental aluminum (47.3 +/- 37.6 and 39.2 +/- 26.7 mg/kg, respectively) were not statistically different in patients on CAPD and those on hemodialysis. Plasma aluminum levels did not correlate with estimated cumulative oral intake of aluminum, total duration of dialysis, serum calcium and phosphorus concentrations, N-terminal parathyroid hormone levels, or transfusion requirements. Retention of aluminum is common in children undergoing dialysis, correlates with the amount of aluminum administered orally, and results in similar elevations of plasma aluminum with CAPD and hemodialysis. Younger and smaller children are at increased risk for accumulation of aluminum. Alternative methods for control of serum phosphorus are needed in children with end-stage renal disease.
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PMID:Plasma aluminum levels in pediatric dialysis patients: comparison of hemodialysis and continuous ambulatory peritoneal dialysis. 356 Oct 41

The relevance of routine physical examinations, laboratory tests, and x-rays in guiding therapeutic decisions was investigated in 54 patients on hemodialysis. Patients were observed for 1 year, while recording all therapeutic interventions and tracing the procedures that had determined them. In no case did a variation in treatment follow the routine physical examination of a patient who was not symptomatic or already signaled for BP or dialytic problems by the hemodialysis nurses. A number of major therapeutic interventions were conversely necessary for acute illnesses that could not be foreseen during the routine physician-patient encounter. Of the many laboratory tests, only the determination of complete blood cell count, serum electrolytes, and calcium and phosphorus levels were frequently associated with therapeutic decisions. No intervention was directly related with x-ray bone examination. On the whole, a subgroup of 11 "high-risk" patients who required frequent and multiple therapeutic interventions was identified, the remaining 43 needing only rare and minor adjustments. It is concluded that routine physical examinations are probably useless in identifying and treating intercurrent problems of patients with chronic end-stage renal failure and that only very few hematochemical laboratory tests should be regularly performed. On the basis of a benefit/risk and benefit/cost examination, it is suggested that personally tailored follow-up schemes would probably be a more appropriate way of monitoring patients on maintenance hemodialysis.
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PMID:Are "routine" clinical and laboratory examinations of any help in the treatment of chronic hemodialysis patients? 360 81

To assess the effect of different dialysis modalities on renal osteodystrophy, a controlled study was performed in six patients undergoing continuous ambulatory peritoneal dialysis and six hemodialysis-treated patients. All patients were enrolled at the initiation of dialysis, and age, sex, cause of renal failure, prior treatment of renal osteodystrophy, and baseline serum and bone histologic variables were similar in the two groups. After initial blood samples and bone biopsy specimens (with double-tetracycline labels) were obtained, renal osteodystrophy in both groups received comparable treatment with aluminum hydroxide to maintain serum phosphorus levels between 3.5 and 5.5 mg/dl, and with calcium carbonate and calcitriol to maintain total serum calcium levels between 10 and 11 mg/dl. Blood and bone samples were obtained again after nine months. All patients were asymptomatic at the beginning and end of the study. Phosphorus values were well controlled, and total calcium increased similarly in both groups. Although ionized calcium levels increased in both groups, the final level was higher in hemodialysis-treated patients than in patients undergoing continuous ambulatory peritoneal dialysis (2.82 +/- 0.07 meq/liter and 2.5 +/- 0.05 meq/liter, respectively; p = 0.005). Amino-terminal parathyroid hormone levels normalized in both groups, and histologic improvement of osteitis fibrosa occurred in a similar proportion of patients in both groups; however, quantitative improvement was greater in the hemodialysis-treated patients. Osteomalacia, assessed qualitatively and by dynamic histomorphometric measurements, was ameliorated to a much greater degree in patients undergoing continuous ambulatory peritoneal dialysis compared with hemodialysis-treated patients. Bone aluminum staining was absent in all biopsy specimens. Overall, bone histologic findings improved to a greater degree in patients undergoing continuous ambulatory peritoneal dialysis. When patients undergoing continuous ambulatory peritoneal dialysis or hemodialysis and receiving similar treatment for renal osteodystrophy were compared, patients treated with continuous ambulatory peritoneal dialysis appeared to have a greater improvement in their metabolic bone disease.
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PMID:Controlled study of renal osteodystrophy in patients undergoing dialysis. Improved response to continuous ambulatory peritoneal dialysis compared with hemodialysis. 360 32

Twelve patients with chronic renal failure who exhibited a progressive decline in 24-hour creatinine clearance, despite being given for 2 to 10 months a diet containing 0.3 g per kg ideal weight of protein and 7 to 9 g mg per kg ideal weight of phosphorus, supplemented with vitamins, CaCO3, and 10 g per day of essential amino acids, were changed to a supplement containing predominantly ketoacids. In six patients whose serum creatinine was 7.5 mg/dl or greater at changeover, progression continued unabated. In six patients with serum creatinine levels at changeover of 6.6 to 7.4 mg/dl, one was non-compliant with the diet and progressed to dialysis. In the other five, progression, measured as the rate of change of a bimonthly radioisotope clearance, has been undetectable during the ensuing one to two years. There has been no change in urea appearance, blood pressure, phosphaturia or proteinuria. Nutrition has been maintained. Thus this ketoacid supplemented regimen apparently halted the progression of moderately-severe chronic renal failure for at least a year in a small group of patients in whom restriction of protein and phosphate intake without ketoacids failed to halt progression. In more severe renal failure, no effect on progression was seen.
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PMID:Progression of chronic renal failure in patients given ketoacids following amino acids. 362 95


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