Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In uremic intoxication proteolytic activity in plasma and striated muscle is enhanced. To get further insights into the underlying mechanisms the lysosomal factors of polymorphonuclear (PMN) leukocytes and the plasma elastase-alpha 1-proteinase inhibitor complex were investigated in patients with acute and chronic renal failure. Lysosomal activity was evaluated in peripheral blood smears by the lysis of erythrocytes and plasma (halo formation) around each neutrophil induced by 0.25 M NaC1 borate buffer. In about half of the patients with chronic renal insufficiency on dietary treatment lysosomal activity of PMN leukocytes was reduced. The plasma concentration of elastase-alpha 1-proteinase inhibitor complex was normal in most subjects, but increased in three patients with the highest serum creatinine levels (greater than 13 mg/d1). In the patients with acute renal failure (ARF) of various origin (postoperatively, septicemia, pancreatitis, or dye-induced) halo formation was either reduced or absent. The plasma elastase-alpha 1-proteinase inhibitor complex was increased in 5/6 of the patients by a factor of two to four. Also in the patients on regular hemodialysis treatment halo formation of PMN leukocytes was substantially reduced, whereas the plasma levels of elastase-alpha 1-proteinase inhibitor complex was slightly increased. The finding of reduced lysosomal activity of PMN neutrophils in uremia may be partly due to an enhanced release of neutral proteinases into the circulation as indicated by the elevated plasma levels of elastase-alpha 1-proteinase inhibitor complex in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Granulocyte lysosomal factors and plasma elastase in uremia: a potential factor of catabolism. 620 47

A nephelometric method is described for determination of plasminogen and two types of plasmin inhibitors in human plasma having different affinity toward plasmin. This method is based on the kinetic analysis of effects of whole plasma and plasmin inhibitor fraction obtained from plasma on the activity of exogenously added plasminogen which was determined by measuring the decrease of light scattering of fibrin suspension. With this method we have determined the activity of plasminogen and two types of inhibitors in the plasma of normal subjects and patients with high fibrinogen degradation product values. They include patients with various malignant tumors with DIC, chronic renal failure, sepsis, vascular diseases, and liver cirrhosis with hepatoma.
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PMID:Nephelometric determination of plasminogen and plasmin inhibitors in human plasma using fibrin suspension as a substrate. 622 10

The incidence of nonobstructive colonic dilatation (NCD) is unknown, but the attendant mortality associated with perforation is nearly 50%. Patients with chronic renal failure and transplant recipients may manifest many of the conditions that have been implicated in the development of NCD. Mechanical obstruction and ischemic bowel disease must be eliminated as causes for colon dilatation. Over a four-year period eight patients (mean age 50 years) were treated for presumed NCD. Six patients with a mean cecal diameter of 12.8 cm were treated initially with colonoscopy. Five patients (83%) had successful endoscopic decompression; of the three remaining patients, one underwent urgent ileocolectomy for cecal ischemia after unsuccessful endoscopic decompression, a second (cecal diameter 13 cm) had a tube cecostomy performed as an initial procedure, and the third (cecal diameter 9 cm) was managed successfully with enemas and nasogastric suction. Two deaths occurred in the series (25%), but both were unrelated to colon distension. No complications of colonoscopy were observed. The sequelae of massive NCD (cecal ischemia, perforation, and protracted sepsis) are poorly tolerated in the immunocompromised patient. Conservative management may be employed in patients with a cecal diameter of 9 cm, but urgent diagnostic and therapeutic colonoscopy is recommended for patients with a cecal diameter of 12 cm or greater. Operative tube cecostomy may be necessary if colonoscopic decompression is unsuccessful or cannot be performed.
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PMID:Treatment alternatives in renal failure and renal transplantation patients with nonobstructive colonic dilatation. 634 13

Hypertension, phosphate retention, hyperfiltration hyalinosis and the natural course of the underlying are well known factors leading to progression of chronic renal failure. Acute bacterial interstitial nephritis occurring in a previously diseased kidney, although well documented in experimental animals, has not been shown to aggravate chronic renal failure in man. We report on 3 cases of acute suppurative interstitial nephritis, due to E. coli urinary infection complicated by septicemia. All had rapid aggravation of previously mild renal failure secondary to chronic interstitial nephritis. Sepsis originated from the urinary tract which in 2 instances had been temporarily obstructed. Renal biopsy disclosed a diffuse interstitial infiltrate containing numerous polymorphonuclear leukocytes. This was superimposed on chronic tubular and interstitial lesions. In 1 case there were glomerular lesions with crescents and mesangial C3 deposits. A 2nd biopsy performed in 2 cases was of prognostic interest. In one case it showed active lesions and the necessity of continuing the treatment and in the other a satisfactory healing allowing cessation of therapy. Treatment was guided by antibiograms, the clinical and urinary signs of activity, renal biopsy findings and antibiotics known to be concentrated in renal tissue. The duration of treatment seemed important for the regression of acute renal lesions. Hematogenous bacterial interstitial nephritis should be considered as a possible cause of aggravation in chronic renal failure.
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PMID:[Acute hematogenic interstitial nephritis of urinary origin: an unrecognized factor in the exacerbation of chronic kidney failure]. 634 71

In uremic intoxication proteolytic activity in plasma and striated muscle is enhanced. To get further insight into the underlying mechanisms the neutral proteinases of polymorphonuclear (PMN) leukocytes were investigated in patients with acute and chronic renal failure. The following studies were performed: 1. Neutral proteolytic activity of PMN neutrophils in blood smears (according to Klessen, 1978). 2. Serum levels of elastase alpha 1 proteinase inhibitor complex (Neumann et al., 1981). In about half of the patients with chronic renal insufficiency on dietary treatment the proteolytic activity of PMN leukocytes (halo formation are due to digestion of erythrocytes and plasma) was reduced. The serum concentration of elastase alpha 1 proteinase inhibitor complex was normal in most subjects, but increased in 3 patients with the highest serum creatinine levels (greater than 13 mg/dl). In the patients with acute renal failure (ARF) of various origin (postoperatively, septicemia, pancreatitis or dye induced) halo formation was either reduced or absent. Serum elastase alpha 1 proteinase inhibitor was increased in 5/6 patients by a factor of two to four. Also in the 15 patients on regular hemodialysis treatment halo formation was substantially reduced, while the serum levels of elastase alpha 1 proteinase inhibitor complex was slightly increased. The finding of reduced proteolytic activity of PMN neutrophils in uremia is probably due to an enhanced release of proteinases into the circulation as indicated by the elevated serum levels of elastase alpha 1 proteinase inhibitor complex in some patients. The release of proteinases might be in part due to the effect of "uremic toxins". In the RDT patients the contact of the blood with the dialyzer (cuprophane) membrane might be an additional factor. In the patients with ARF the underlying disease (infection, shock, trauma) contributes to the release of proteinases. These disturbances may be harmful for the patient, if the blood concentration or function of the most important proteinase inhibitors (alpha 1 proteinase inhibitor, alpha 2 macroglobulin) is reduced.
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PMID:Release of granulocyte neutral proteinases in patients with acute and chronic renal failure. 636 15

A case of multiple myeloma in a 41-year-old white man that resulted in chronic renal failure is discussed. During the period of hemodialysis treatment, remission of the patient's myeloma was induced by chemotherapy. Thereafter a transplanted cadaver kidney functioned well for 3.5 years despite episodes of sepsis, administration of nephrotoxic chemotherapeutic agents, and recurrence of the myeloma with intermittent excretion of Bence Jones protein in the urine. The results of this fully documented case, as well as two other cases we have previously reported, support the strategy of offering cadaver renal transplantation to carefully selected individuals who require long-term dialysis and whose myeloma is in remission after chemotherapy.
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PMID:Renal transplantation in a patient with multiple myeloma and light chain nephropathy. 640 97

A nutritional support team was used in the assessment and management of patients on a general urological service. Indications for nutritional evaluation included history of weight loss, anorexia, significant infection, chronic neoplastic disease, trauma or major surgery. The fat and protein status of the patient was assessed by anthropomorphic and laboratory determinations. The patient then was categorized as having mild, moderate or severe degrees of nutritional depletion. Deficiencies in vitamins, trace elements or essential fatty acids were not noted. Caloric and protein needs were calculated by multiplication of the basal energy expenditure by a metabolic activity factor, which was derived from the degree of illness or stress. Nutritional support was provided by enteral feedings via oral, nasogastric or jejunal feeding tubes and/or intravenous hyperalimentation via peripheral or central venous nutrient lines. During a 6-month interval nutritional consultation was requested for 50 patients, who represented 7 per cent of the urological admissions. Nutritional support was provided for patients who had obstructive uropathy with or without neoplasms, radiation cystitis, sepsis, urinary fistulas, mental depression, end stage renal disease or neurological dysfunction. In patients in whom urological treatment controlled the disease nutritional support maintained the weight, and stabilized serum albumin and lymphocyte counts. We concluded that a nutritional support program has a significant and, often, unappreciated role in the management of urological patients.
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PMID:Nutritional support in a general urological service. 642 56

Current concepts in the nutritional support of patients with renal disease are reviewed. In chronic renal failure, alterations in fat, carbohydrate, and glycogen metabolism usually occur and may be worsened by acute illness. Total parenteral nutrient (TPN) therapy is rarely required unless complications occur. In contrast, acute renal failure is generally associated with hypovolemia, sepsis, soft tissue injury, and coagulation defects, all of which influence metabolism and extracellular fluid volume; the gluconeogenesis that often occurs in these patients masks the metabolic effects of uremia. Nutritional support of patients with renal disease aims at providing adequate nutrients while limiting accumulation of nitrogenous waste. Current concepts concerning essential amino acids (EAAs), nonessential amino acids (NEAAs), and urea recycling are reviewed. The caloric needs of patients with renal failure are assumed to be similar to those of other hospitalized patients. There is no clinically important advantage of using an EAA formulation rather than mixed (EAA and NEAA) amino acids. Since fluid restriction is recommended and protein use is improved with diets with a high calorie-to-nitrogen ratio, the use of TPN solutions with dextrose 350 g is recommended. If glucose intolerance is severe, fat should be considered as a calorie source. Recommendations for monitoring the metabolic status of patients with renal failure receiving nutritional support are reviewed. Monitoring the metabolic status of patients with renal disease is crucial to providing safe and effective nutritional therapy. There appears to be no clinically important advantage to amino acid products specially formulated for use in renal disease.
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PMID:Nutritional support of patients with renal disease. 642 98

We report the use of cefoperazone in 62 cases of serious infection, most of which occurred in patients with renal impairment. 43 severe or complicated urinary tract infections, 11 cases of pneumonia and 8 with other severe sepsis were treated with cefoperazone 1 to 2 g twice daily usually for 5 to 10 days. Of the patients with urinary tract infection, all who were symptomatic showed a rapid clinical response; 26 (61%) were cured including 11 of 16 with chronic renal failure; 12 relapsed and 5 were reinfected with a different pathogen. All of these patients were infected by organisms sensitive to cefoperazone by disc testing but in 5 of those who relapsed the cefoperazone MIC was in fact greater than or equal to 50 microgram/ml. Ten of 11 cases with radiologically confirmed pneumonia were cured with cefoperazone. 7 episodes of pneumonia were in patients with end-stage chronic renal failure (6 were on dialysis) and 1 was in a patient with acute renal failure. Seven of 8 cases with severe sepsis were cured with cefoperazone. 1 patient was withdrawn from the study when acute bronchospasm followed a 2 g intravenous dose. 2 of the successfully treated patients had functioning renal transplants, 2 of 3 with severe chronic renal failure were on dialysis and 1 had acute renal failure. Side effects included minor disturbances of liver function in 6 patients (11%), diarrhoea in 7 (13%) and marked alcohol intolerance in one, 4 patients with chronic renal failure developed a coagulation disorder which was corrected with vitamin K. None of the patients showed deterioration in renal function while receiving cefoperazone. Cefoperazone promises to be an effective drug for the treatment of a wide spectrum of severe infections in hospitalised patients including those with impaired renal function.
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PMID:Cefoperazone in the treatment of severe or complicated infections. 645 95

In the present study we report the renal pathological findings from autopsy material along with relevant clinical data on 21 spinal cord injury patients with end-stage renal disease (SCI-ESRD) treated with maintenance haemodialysis. These data are compared with the relevant clinical and post-mortem findings on 43 ambulatory dialysis patients who expired during the same time period. The SCI-ESRD patients exhibited markedly different clinical and renal histopathological data when compared to the ambulatory--ESRD group. Chronic pyelonephritis and amyloidosis dominated the findings and were the major causes of renal insufficiency. Acute pyelonephritis, papillary necrosis, calculous disease, pyonephrosis and perinephric abscess formation were also more frequently present in the SCI-ESRD patients. Hypertension and nephrosclerosis, which were common findings in the ambulatory--ESRD patients were comparatively rare in the SCI-ESRD patients. In addition, the incidence of acquired cystic disease (ACD) was considerably less in the SCI-ESRD group. Although the reasons for these findings are not entirely clear several possible explanations are given. Infection with gram negative sepsis was the predominant cause of death in the SCI-ESRD patients, while death secondary to cardiovascular disease predominated in the ambulatory-ESRD group. Furthermore, the urinary tract and infected decubitus ulcers were determined to be the major source for sepsis in the SCI patients. From these findings it would follow that more effective prevention and control of these infections would result in not only a lower incidence of renal failure but also a substantially reduced morbidity and mortality in chronic SCI.
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PMID:Renal pathology in end-stage renal disease associated with paraplegia. 671 46


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