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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We measured plasma sulphur amino acids in twenty-two patients with chronic renal failure and compared the findings with those obtained in twenty-two normal subjects. In fasting blood (08.00 hours) cysteine-homocysteine mixed disulphide was significantly increased in the renal patients, mean values (+/- SD) being 8.2 +/- 3.4 and 3.1 +/- 1.0 mumol/l respectively (P less than 0.001). The increase was positively correlated with reduced renal function, as assessed by serum creatinine (r = 0.62; P less than 0.01). Homocystine was detected in nineteen patients, the mean concentration (+/- SD) being 1.7 +/- 0.6 mumol/l; it was not found in any normal subject. Methionine levels were not different but there were significant increases in cystine (P less than 0.001) and taurine (P less than 0.05) in the patients. Similar values for these amino acids were found in a second blood sample drawn at 16.00 hours. Changes in the other neutral and acidic amino acids measured were in agreement with those reported in chronic azotaemia. We concluded that plasma levels of all the principal sulphur amino acids except methionine are elevated in chronic renal failure emphasizing the importance of the kidney in sulphur excretion. Prolonged accumulation of homocysteine and cysteine-homocysteine mixed disulphide may be relevant to the development of accelerated vascular disease in patients with chronic renal failure by producing endothelial damage.
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PMID:Sulphr containing amino acids in chronic renal failure with particular reference to homocystine and cysteine-homocysteine mixed disulphide. 11 20

Lipoprotein lipid analysis has been carried out in 39 women and 28 men with chronic renal failure on haemodialysis. The results have been analysed in relation to the etiology of the renal disease and compared with those obtained in age- and sex-matched controls and in triglyceride-matched controls. Serum cholesterol was normal or low in glomerulonephritis but was normal in analgesic nephropathy. Serum triglycerides and VLDL lipids were raised uniformly regardless of the etiology of the renal disease. LDL triglyceride and HDL triglyceride were also raised. LDL cholesterol and phospholipid were low in glomerulonephritis but were normal in analgesic nephropathy. HDL cholesterol was reduced in both male and female patients regardless of etiology, statistical significance was not reached for the women. The ratio of esterified to free cholesterol tended to be reduced in all the lipoproteins regardless of sex or etiology but the changes were not significant in all groups. Comparison of the lipid abnormalities with those found in other hyperlipidaemic states suggests that the lipid disorders found in chronic renal failure are probably insufficient to explain the rapid development of vascular disease which has been reported.
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PMID:Lipoprotein lipids in chronic renal failure and haemodialysis. The influence of etiology and implications for atherogenesis. 22 78

To assess the role of serum factors in the genesis of accelerated vascular disease in chronic renal failure, human arterial smooth muscle cells (SMC) and dermal fibroblasts were grown in culture and the effects of serum from chronic dialysis patients on cell proliferation was studied. Exposure to serum from these renal failure patients was associated with significantly greater growth of both SMC and fibroblasts than that observed with control serum. A portion of this mitogenic effect appears to be related to the presence of a factor(s) which is heat stable, dialysable, and is contained in the lipoprotein deficient fraction of plasma of density greater than 1.25 g/dl. These findings suggest that circulating substances which stimulate the proliferation of SMC may contribute to accelerated cardiovascular disease in patients undergoing chronic dialysis treatment.
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PMID:Chronic renal failure and atherogenesis--Serum factors stimulate the proliferation of human arterial smooth muscle cells. 51 37

The dyslipoproteinemia of chronic renal failure (CRF) was characterized by discrete Apo B-containing lipoprotein particles separated by sequential immunoprecipitation of VLDL, IDL and LDL with antisera to Apo E and Apo C-III. CRF patients before and during dialysis had increased concentrations of Apo B-containing lipoproteins (LP) due to increased levels of triglyceride-rich LP-B:C and LP-B:C:E particles with no significant change in the levels of cholesterol-rich LP-B. Patients on hemodialysis had lower concentrations of LP-B:C and higher concentrations of LP-B:C:E than predialytic patients. The increase of Apo B-containing lipoprotein particles in CRF may contribute to atherosclerotic vascular disease and to glomerulosclerosis and progression of renal insufficiency.
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PMID:Increased concentrations of Apo B-containing triglyceride-rich lipoprotein particles in patients with chronic renal failure. 146 58

During the last years there has a significant increase of elderly patients included in chronic dialysis programs. No agreement has been reached about the preferable treatment modality. In this study we analyse our experience in the management of patients over 70 years of age undergoing chronic acetate hemodialysis (HDCA). Sixty four of those patients have initiated HDCA between May 1982 and December 1990 (Mean age 75.9 +/- 4.8). The etiology of renal disease was unknown in a significant number of cases. Morbility was largely due to vascular disease (both cardiac and cerebral). Main causes of death were also vascular disease and infections. Actuarial survival was 79.6% at 12 months and 46.3% after 5 years. Although HDCA is associated with a greater morbility it is the most widely used modality of treatment for chronic renal failure in Portugal and in our experience, it is an acceptable method for elderly patients.
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PMID:[Chronic hemodialysis with acetate in patients over 70 years old]. 157 Jul 46

We studied the clinical and pathological data for 334 patients age 65 or more who underwent renal biopsy for acute renal failure (ARF, n = 55), subacute renal failure (SRF, n = 72), chronic renal failure (CRF, n = 57), proteinuria (n = 137), and hematuria (n = 13). Tissue diagnoses were glomerulopathy (n = 252, 75.4%), acute tubular lesions (n = 18), interstitial nephritis (n = 23), vascular diseases (n = 36, including 14 with cholesterol emboli), and five miscellaneous diagnoses. Of the 55 patients with ARF, 23 had a glomerular lesion, 15 had acute tubular necrosis, and 8 had acute interstitial nephritis. Of 72 patients with SRF, 49 had a glomerulopathy, 12 had a vascular disorder, and six had acute interstitial nephritis. Hence, patients with ARF or SRF exhibited a high potential for reversible lesions. Only 11.3% of patients with CRF had potentially reversible causes. The most common causes of proteinuria were membranous glomerulopathy (34.3%), minimal change disease (14.6%), focal segmental sclerosis (11.7%), and amyloidosis (8.8%). Of the 25 patients with advanced nephrosclerosis, 24 had renal failure, 20 were hypertensive, and 13 had cholesterol emboli. Of 33 patients with diabetes mellitus, 66.7% were found to have lesions not related to diabetes. We conclude that renal biopsy is most useful in older patients with ARF or SRF because of potentially reversible renal disease. Old age alone is not a contraindication to performing a renal biopsy.
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PMID:Renal biopsy in patients 65 years of age or older. An analysis of the results of 334 biopsies. 235 29

One hundred adult Sudanese patients who presented to Soba University Hospital (SUH) with established chronic renal failure (CRF) were studied to determine the aetiology. Thirty-eight had chronic glomerulonephritis, 12 renal calculi, nine diabetic renal disease, seven chronic pyelonephritis, five sequelae of acute renal failure (ARF), four renal vascular disease, three polycystic disease of the kidneys, and two obstructive uropathy. In 20 patients the aetiology was not determined because of late presentation to hospital. The results were compared with those of the developed countries, which differ greatly from Sudan in climate, diet, race, culture and social habits. The main differences were in the prevalence of renal calculi which, although being the second commonest cause of CRF in the Sudan, were rare in European countries. Also, diabetes mellitus was a much commoner cause of CRF in Sudan than Europe. Other aetiological factors were similar.
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PMID:The aetiology of chronic renal failure in adult Sudanese patients. 260 79

Thrombogenesis and accelerated atherogenesis occur in the homocystinurias, both those due to recessively inherited cystathionine beta-synthase deficiency and to disorders of remethylation of homocysteine to methionine. The evidence strongly implicates high levels of plasma homocysteine as the mediator. Homocysteine damages cultured human venous and arterial endothelial cells and enhances detachment from their substrate, changes not found with comparable concentrations of other amino acids tested. Homocysteine is oxidized in vitro to homocystine in an oxygen-dependent reaction producing hydrogen peroxide. Since the effects of homocysteine in cell cultures can be prevented by catalase, hydrogen-peroxide-induced injury may be the mechanism responsible. Five different laboratories have documented an association between mild homocysteinaemia and premature vascular disease. The majority of affected patients are heterozygotes for cystathionine beta-synthase deficiency whose endothelial cells may have an enhanced susceptibility to injury by homocysteine. Mild homocysteinaemia also occurs in chronic renal failure in which vascular disease is prominent. Mechanisms linking mild homocysteinaemia and possible vascular effects are not yet understood, but could involve prostaglandins and oxidized low-density lipoprotein, and possibly also free radicals.
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PMID:Mechanisms of thrombogenesis and accelerated atherogenesis in homocysteinaemia. 268 Aug 9

Investigation of changes of the ocular fundus by ophthalmoscopy, coloured photography and fluoroangiography confirmed assumptions that the most frequent finding is hypertonic angiopathy and angiosclerosis. Hypertonic retinopathy and neuroretinopathy were recorded only in one quarter of the cases, most frequently during the initial years of dialysation treatment. The part played by a high blood pressure in chronic renal failure before and during dialyzation treatment is important. Under the influence of many metabolic changes in dialysed patients a general affection of the blood vessels and tissues of the retina, choroid and optic nerve develops. The appearance of the ocular fundus in the patient reminded of findings in subjects by two or more decades older and supported thus the theory of hastened ageing in chronic renal failure with regular dialysation treatment.
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PMID:[Changes in the ocular fundus in patients with chronic kidney failure on regular dialysis therapy]. 279 Oct 37

The experience with CAPD using the Tenckhoff catheter in 115 patients over a 7 year period has been reviewed. The general indications for CAPD in the patient with chronic renal failure are the mental and physical ability of the patient or his relatives to perform CAPD. In our series, diabetes mellitus has been a relative indication for CAPD, because diabetic patients often have vascular disease severe enough to make long-term hemodialysis difficult. The general contraindications are abdominal problems such as hernias, abdominal wall infections, inflammatory bowel disease, adhesions, and gastrointestinal stomas. Other contraindications are lumbar disk disease and respiratory insufficiency. The surgical principles of catheter insertion have been described. Complications associated with the Tenckhoff catheter were either mechanical (intraabdominal organ injury, incisional hernia, catheter leakage, catheter occlusion, or catheter dislodgement), or infectious (peritonitis or abdominal wall infection). The single most common organism isolated from effluent dialysate in 65 patients with peritonitis was Staphylococcus epidermidis in six patients (9.2 percent), and in 20 patients (30.8 percent), no organism could be isolated. For those patients who had peritonitis, the average frequency was at 8.9 months of CAPD. There were only three deaths (3 percent) directly related to the Tenckhoff catheter and these were due to peritonitis and sepsis. Only 22 (19 percent) of the 115 patients in this series had to discontinue CAPD because of its ineffectiveness or the patient's or relative's inability to perform CAPD.
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PMID:Surgical aspects of the Tenckhoff peritoneal dialysis catheter. A 7 year experience. 315 18


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