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Hypertensive emergencies of 10 children with renal hypertension were analysed. Cause of renal disease are chronic renal failure in three, acute renal failure in three, hemolytic uremic syndrome in two, acute post streptococcal glomerulonephritis in one, and renal arterial stenosis in a further patient. Therapy should be started early in the course of the hypertensive emergency, first symptoms are headache and vomiting. Drug of first choice is diazoxide (3-5-(8)mg/kg i.v.). Three patients developed transitory hyperglycemia after repeated injections of diazoxide.
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PMID:[Hypertensive emergencies in children with renal hypertension (author's transl)]. 76 42

The in vitro activity of doxycycline and minocycline (Klinomycin) was determined by serial dilution test in 100 strains of E. coli, 101 strains of enterobacter, 91 tetracycline-sensitive and 52 tetracycline-resistant strains of staphylococci. Only staphylococci were more sensitive against minocycline than against doxycycline whereas other species showed nearly the same sensitivity against both antibiotics. After i.v. infusion of 200 mg minocycline (during 1 h) mean serum levels fell from 3.5 mug/ml to 0.6 mug/ml (after 24 h). Half-life was calculated as 15.7 h, urine recovery as 5.9%. After oral application of 200 mg minocycline serum level peaks were 2.7 mug/ml, serum levels after 24 h 0.7 mug/ml. At repeated administrations daily dosage of 100 mg was too low of 200 mg sufficient to obtain the same serum levels as after the initial dose of 200 mg. CSF levels after oral administration of 0.4 g minocycline were 0.74 +/- 0.09 mug/ml (in serum at the same time 2.2 +/- 0.2 mug/ml). Half-life of minocycline in chronic renal failure (7 adult patients) was not prolonged (15--20 h). Minocycline is especially suitable for treatment of infections of unknown bacterial origin (including such caused by staphylococci). I.v. infusion is indicated only in unconscious or vomiting patients.
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PMID:[Activity in vitro and pharmacokinetics of minocycline (author's transl)]. 78 66

In seven patients with chronic renal failure in an advanced stage 17 episodes of upper abdominal pain, hypertension, vomiting and (in some of them) coma occurred during peritoneal dialysis with sorbitol-containing dialysate. The signs recurred in some of the patients but did not when glucose-containing dialysate of otherwise identical composition was used. Very high levels of sorbitol in CSF and serum were measured in the comatose patients. The precipitating factor is probably a reduced metabolic breakdown of sorbitol in renal failure with preferential intracellular deposition of sorbitol and subsequent cellular oedema. To avoid this dangerous reaction it is necessary to use glucose instead of sorbitol in peritoneal dialysates, despite the technical problems of sterilisation. Where this is not possible, glucose should be added in order to reduce the sorbitol concentration in the dialysate to less than 15g/l.
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PMID:[Severe side-effects during peritoneal dialysis caused by sorbitol-containing dialysate (author's transl)]. 114 25

In children with chronic renal failure (CRF) anorexia, nausea, and vomiting are common yet poorly understood symptoms. We studied oesophageal and gastric motor function in 12 children (age 7 months-6.8 years) with severe CRF not undergoing dialysis who had persistent anorexia and vomiting. Eight of 12 patients had significant gastro-oesophageal reflux (reflux index 5.2% to 21.9%, mean 11.3%; controls < 5%), 7/10 had altered gastric half emptying times (T1/2) for 5% glucose or milk (glucose meal--controls: 8-14 min, two CRF patients: 18-25 min; milk meal--controls: 48-72 min, five CRF patients 27, 28, 82, 83, and 110 min). Gastric antral electrical control activity was abnormal in 6/11 patients, with different types of gastric dysrhythmias whereas the remainder and controls showed a regular dominant frequency of 0.05 Hz. In 7/9 patients fasting serum gastrin concentration was raised (53 to > 400, mean 168 pmol/l, controls < 40 pmol/l). All CRF patients with anorexia and vomiting had one or more disorder of foregut motility. The nature and variety of the motor disorders and the raised concentrations of circulating gastrin suggest that the normal environment generated by CRF affects the function of the smooth muscle of the foregut.
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PMID:Foregut motor function in chronic renal failure. 147 84

Since August, 1984 renal replacement therapy with haemodialysis, peritoneal dialysis and renal transplant has been carried out regularly at the renal unit of the Kenyatta National Hospital (KNH). Various nutritional disturbances have been met. Nausea, vomiting and anorexia have been noticed frequently particularly in those on intermittent peritoneal dialysis (IPD). The same problems were experienced in those few patients who were on continuous ambulatory peritoneal dialysis (CAPD). The patients were usually malnourished, the malnutrition being of protein-calorie type. At the start of the programme of renal replacement therapy in 1984, the problems of poor nutrition were worse but are currently improving. At the moment our patients with chronic renal failure (CRF) and end stage renal disease (ESRD) on dialysis are scattered all over the medical and paediatric wards at KNH. This has impeded the smooth surveillance of patients' diets by the few available nutritionists. The review of our performance from 1984-1988 on the nutritional status of patients with CRF and ESRD is an attempt to create a normal dietary cover for patients with the above problems.
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PMID:Nutritional requirements in chronic renal failure and end stage renal disease at the Kenyatta National Hospital. 175 9

Renal failure in itself generates a state of malnutrition, due to three main causes: inadequate ingestion (anorexia, vomiting or diet insufficiencies), the existence of catabolic factors (proteins, acidosis, PTH) and extrarenal depuration (which provokes a lack of amino acids and vitamins). Artificial nutrition constitutes a series of measures that can be adopted to act upon each of the above causes. Adequate ingestion compared to inadequate ingestion can be performed orally (especially in chronic renal failure) by parenteral administration (preferable in acute renal failure) and enteral administration (complementary in both cases). The quantity and quality of adequate nutrients is non-dependent on the method of administration; 500 ml, of water should be administered plus diuresis, plus loss from other tracts; the mineral intake of sodium, potassium and phosphorus should be restricted; in the case of vitamins, these should be administered, especially the B and D complexes; there should be sufficient calories to constitute a hypercaloric diet (from 30-50 kg/day), at least 50% in the form of carbohydrates (hypertonic glucose, if administered intravenously, and dextrinolmaltose or starch if administered through the digestive tract) and at least 40% in the form of lipids (preferably of vegetable origin, rich in non-saturated fatty acids); proteins are the mainstay of nutrition in renal failure; thus, with a normal renal function or in dialysis, a dose of 1 g/kg/day is recommended; in chronic renal failure, 0.5 g/kg/day; in cases of renal failure not on dialysis, 0.3 g/kg/day, supplemented by essential amino acids or cetoacids (the effectiveness of the latter is still in dispute).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Artificial nutrition in kidney failure]. 176 Apr 78

Tribal enemas obtained from traditional healers are used widely in Southern Africa for a variety of indications. Inclusion of injurious substances such as potassium dichromate may cause serious colonic and renal complications. Nine such patients, in seven of whom chromate use was confirmed, presented after a mean delay of 7.3 days. All patients had bloody diarrhoea and vomiting and three underwent major colonic resection, requiring a total of ten procedures. One patient suffered mechanical perforation of the rectum, with subsequent necrotizing fasciitis, necessitating rectal excision. Eight patients had acute renal failure and seven required dialysis. One patient died. At follow-up one patient has chronic renal failure and only three are completely well. Although local medical practitioners are aware of the problem, the challenge of preventing harmful cultural practices remains.
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PMID:Colonic complications after toxic tribal enemas. 205 2

Effects of acetate and bicarbonate dialysates on tolerance to dialysis have been examined in 30 patients with chronic renal failure (CRF). Symptomatic homeostatic impairment (nausea, vomiting, headache) and cardiovascular instability (tachycardia, arrhythmia, dyspnea) were less common (p less than 0.05) in bicarbonate dialysis. The cardiovascular symptoms correlated with antihypertensive effects of acetate (p = +0.48). Tolerance to ultrafiltration was better with bicarbonate dialysis. Gas chromatographic measurement of blood acetate concentrations in 7 patients on bicarbonate dialysis showed them to be 1.4 +/- 0.31 mmol/l at the beginning of dialysis treatment and 1.7 +/- 0.24 mmol/l at its end (normal, 1.7 +/- 0.14 mmol/l). Of 26 patients on acetate dialysis, 9 patients showed initial and late acetate concentrations of 1.7 +/- 0.26 and 2.5 +/- 0.23 mmol/l, respectively, while in 17 patients an initial concentration of 4.8 +/- 0.32 mmol/l rose to 9.0 +/- 1.1 mmol/l at the end of the treatment (p less than less than 0.01). Dialysis-induced complications had a higher incidence in the latter group (p less than 0.02). Acetate dialysis was poorly tolerated by 65% of the patients. The intolerance was aggravated by myocardial lesions and slow acetate turnover indicated by blood acetate concentrations above 7-8 mmol/l.
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PMID:[The effect of acetate and bicarbonate on the tolerance for hemodialysis therapy in chronic kidney failure]. 208 65

Intracranial pressure (ICP) was continuously monitored in a thirty-two-year-old female of acoustic neurinoma complicated with chronic renal failure. Severe headache with vomiting has begun to appear during hemodialysis for several months, prompting a diagnosis of an obstructive hydrocephalus. Continuous ventricular drainage was placed after admission and changes of ICP were monitored during hemodialysis. Dynamic changes of electrolytes, protein, sugar, urea nitrogen, and creatinine levels in the cerebrospinal fluid (CSF) as well as osmolarity were measured every one hour during the hemodialysis. An increment of ICP started to occur gradually after initiation of hemodialysis reaching the maximum value 23 minutes later. It was spontaneously decreased to the initial level 8 minutes later followed by fluctuations thereafter consisting of the changes of 20 to 30 mmHg. A remarkable rise in osmotic pressure in CSF has been observed corresponding to the rise of ICP which created a large difference from the blood osmotic pressure that consistently decreased following the onset of hemodialysis. Whereas, the absolute values of all measured factors including electrolytes and urea nitrogen in CSF have decreased consistently which did not seem to contribute intermittent increment of osmotic pressure of CSF. The cause of ICP increment in our case was considered mainly due to increase of water content in the brain tissue caused by the widening of osmotic gradient between the CSF and blood, although the substances responsible to the actual increase of CSF osmotic pressure remained unclear.
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PMID:[Elevation of intracranial pressure during hemodialysis--continuous measurement of cerebrospinal fluid pressure in a patient with acoustic neurinoma]. 220 42

Twenty-two infants (mean age 7.5 months) with chronic renal failure (CRF) were studied for their nutrition, growth, and upper gastrointestinal function. Most infants had a history of poor caloric intake and 7 had received supplemental feeding (SF) prior to the investigation. All infants were undergrown, underweight, and malnourished. The infants were characterized as having only a fair interest in food, refusing feedings, and vomiting excessively. Sixteen of 22 infants (73%) had significant gastroesophageal (GE) reflux demonstrated by 24-h esophageal pH monitoring. Gastroesophageal scintiscans were less sensitive and specific in detecting the reflux. Infants with GE reflux were significantly younger and more often required SF than those without GE reflux. There were no significant differences in the degree of renal failure, growth failure, caloric intake, protein intake, or nutritional status between the infants with and without GE reflux. From these studies we conclude that GE reflux should be considered as one of the factors contributing to the feeding problems of infants with CRF.
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PMID:Feeding disorders and gastroesophageal reflux in infants with chronic renal failure. 264 12


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