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Chronic haemodialysis and renal transplantation are mutually supplementing methods for the treatment of patients with terminal renal lesion. The two methods have proved their worth in clinical practice. The expectance of life of patients with chronic renal insufficiency could essentially be improved during the last years. In last consequence the successes of the transplantation of kidneys depend on the solution of immunobiological problems, which are not yet cleared up nowadays. 1. In the determination of genotypical determinants possibly not all are known or recognizable. 2. The at present clinically usable examination methods do not yet allow to recognize rejections so early that by an aimed immunosuppressive treatment irreversible damages on the graft may be prevented. After a transplantation of kidneys of relatives a long survival time of transplanted patients is better than after a transplantation of kidneys taken from dead bodies. The rejection is still the main factor of the failure of the graft, the sepsis is the most frequent cause of death. It is neccessary, to develop less toxical remedies for the adaptation of the graft. Nevertheless, thousands of optimally transplanted patients prove the usefulness of the allogenic transplantation of the kidney.
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PMID:[Possibilities and limits of kidney transplantation]. 35 41

Since the development of recombinant DNA technology, there has been a rapid expansion of research concerning the use of recombinant DNA synthesized human growth hormone (rhGH) for the treatment of clinical disorders. rhGH has been used to treat patients with acute catabolic stress caused by surgery, trauma and sepsis, children with chronic renal insufficiency and impaired growth, patients undergoing maintenance hemodialysis who are malnourished, and individuals on weight reduction diets. These studies indicate that rhGH enhances protein balance in acutely stressed patients and in malnourished maintenance hemodialysis patients, promotes catch-up growth in children with chronic renal failure, and may reduce protein wasting and enhance lipolysis in obese individuals on weight reduction diets. Experimental studies suggest that in addition to enhancing anabolism, rhGH may increase both immune function and the rate of wound healing. Many, but not all, of the effects of rhGH are mediated through insulin-like growth factor I (IGF-I). For example, the hyperglycemic and lipolytic effects of rhGH do not seem to be caused by IGF-I. Animal or human studies suggest that with severe malnutrition or severe sepsis, rhGH treatment may neither increase serum IGF-I levels nor promote anabolism. These observations provide a rationale for administering IGF-I as an anabolic hormone for severely malnourished or septic patients with renal failure. Further studies will be necessary to examine both the short-term and long-term potential benefits and adverse effects of rhGH or rhIGF-I treatment in these conditions.
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PMID:The rationale for the use of growth hormone or insulin-like growth factor I in adult patients with renal failure. 146 73

Forty-eight patients with acute renal failure (ARF) who were referred to the Department of Renal Medicine, Singapore General Hospital for acute dialysis between August 1985 and August 1989 were studied retrospectively to identify risk factors associated with ARF that serve as prognostic indicators. There was no difference in the mean age of survivors and non-survivors (49.5 +/- 17.5 years vs 53.5 +/- 18 years, p greater than 0.05). The overall mortality rate was 52%. ARF as a result of surgical complication had a higher mortality rate in comparison to ARF from medical complications (66% vs 50%, p greater than 0.05). Septicaemia was the most common cause of ARF requiring dialysis. Hepatobiliary sepsis was the most frequent cause of septicaemia. Pre-dialysis serum urea and creatinine levels, and the number of dialysis treatments did not affect the outcome. Poor prognostic indicators included oliguria or anuria, fluid overload and coma. Patients tended to have a worse outcome if they had more than three risk factors taken from the following list:-decreased renal perfusion, assisted ventilation, coma, gastrointestinal dysfunction, recent surgery, sepsis, congestive heart failure, hepatobiliary dysfunction, malignancy, diabetes mellitus, chronic renal insufficiency and poor nutritional status. Early referral of patients with septicaemia due in particular to hepatobiliary infection may improve the prognosis.
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PMID:Acute renal failure prognostic indices in hospital inpatients referred for haemodialysis. 192 73

A rare case of aplastic anemia which was considered to be induced by allopurinol was reported. A 48-year-old female had suffered from urolithiasis and chronic renal insufficiency. She was administered allopurinol for hyperuricemia for 4 months, and subsequently developed severe pancytopenia and bone marrow suppression. After stopping of allopurinol administration, she was administered prednisolone but died of gastro-intestinal tract bleeding and sepsis on the 21th hospital day, without hematological recovery.
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PMID:[Aplastic anemia probably induced by allopurinol in a patient with renal insufficiency]. 231 10

During ten years 59616 haemodialyses were performed with 18139 capillary dialysers on 226 patients being in the final stage of chronic renal insufficiency. With the semi-automatic technique applied blood can be eliminated from the dialyser in 15-20 minutes. Formalin used for desinfection is washed out of the apparatus such a way, that formalin content of the last washing solution ranges between 0-0.1 microgram/ml. Anti-N antibody indicating the presence of formalin could be detected in the serum of 2 patients out of the 120 cases tested. The same dialyser is used repeatedly on one patient, 3.29-times on the average. The regenerated dialyser eliminates compounds of small-and middle molecular weight with the same efficiency up to the 4th repeated use. Ratio of pyrogenic reactions is low, 0.08%. Neither infection or sepsis associated with the regeneration occurred. Rehabilitation degree as well as the survival time of patient corresponded with the average European standard. Because of the "first use syndrome" (allergic symptoms, hypotension, nausea, vomiting, headache, cramps etc.) with 5 patients haemodialysis could be performed only with regenerated dialysers dialyses. From the considerable sums saved by regeneration process 7 satellite dialysing units were established and equipped.
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PMID:[Experience with the regeneration and repeated use of dialyzers (1977-1987)]. 261 56

Forty-two patients with chronic renal insufficiency were subjected to Brulamycin therapy to combat complications such as sepsis, infection of the lower respiratory tract (bronchopneumonia) or of the urinary tract, Cimino fistula inflammation or peritonitis when the pathogenic agent was sensitive to nothing but aminoglycosides. The proper Brulamycin dose was selected under close clinical and laboratory control so as to fit the dialysed patient and his state of impaired renal function. The various forms of dialysis have been studied to determine their Brulamycin blood level diminishing effects. Familiarity with these effects is as important as with the patient's age, sex, body weight and actual state of renal function. The results confirm the experience gained by other authors that Brulamycin treatment--in curative non-toxic doses as indicated by the blood level index--is useful against severe infectious complications in anuric patients.
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PMID:Experience with brulamycin therapy in dialysed patients. 323 5

Hypoglycemia has rarely been described as a clinical sign of severe bacterial sepsis. We recently encountered nine patients in whom hypoglycemia (mean serum glucose of 22 mg/dl) was associated with overwhelming sepsis. Clinical disease in these patients included pneumonia and cellulitis; in three patients, no focus of infection was apparent. Altered mental status, metabolic acidosis, leukopenia, abnormal clotting studies and bacteremia were common features in these cases. In four patients, no cause for hypoglycemia other than sepsis was present. In five patients, another possible metabolic cause for hypoglycemia was present (alcoholism in four and chronic renal insufficiency in one) although none had been observed to be hypoglycemic on previous hospitalizations. Streptococcus pneumoniae (three cases) and Hemophilus influenzae, type b, (two cases) were the most common pathogens, and the over-all mortality was 67 per cent. The mechanism(s) for hypoglycemia with sepsis is not well defined. Depleted glycogen stores, impaired gluconeogenesis and increased peripheral glucose utilization may all be contributing factors. Incubation of bacteria in fresh blood at room temperature does not increase the normal rate of breakdown of glucose suggesting that the hypoglycemia occurs in vivo. Hypoglycemia is an important sign of overwhelming sepsis that may be more common than has previously been recognized.
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PMID:Hypoglycemia as a manifestation of sepsis. 699 Jul 58

Four patients with upper urinary tract transitional cell carcinoma were treated with bacillus Calmette-Guerin (BCG) via a percutaneous nephrostomy tube or a retrograde ureteral catheter. A 68-year-old female and an 80-year-old male had carcinoma in situ (CIS) in the left upper urinary tract (cases 1 and 2). A man aged 47 had CIS in the left upper urinary tract, bladder, and prostatic urethra (case 3). CIS in the left upper urinary tract was identified in a woman aged 63 with chronic renal insufficiency (case 4). Two patients (cases 1 and 2) responded to this therapy. In the other two patients nephrectomy was performed due to residual tumor. There were extensive tuberculous granulomas in the kidneys. In one resected kidney (case 4) carcinoma had invaded the renal parenchyma. The reviewed literature showed that BCG perfusion therapy was effective in 71% (27 of 38 renal units) for the upper urinary tract tumors and that there were 5 cases of severe complication, including sepsis in 2, high fever in 2, and ureteral stricture in 1. Based on the fact that the kidney receives a profuse blood supply and that the renal pelvis and ureter have a thin wall, careful management is mandatory to prevent severe adverse effects and insidious tumor progression.
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PMID:[Intracavitary bacillus Calmette-Guerin therapy for upper tract transitional cell carcinoma]. 869 56

A patient who had taken lovastatin for 7 years received erythromycin before dental procedures. Multiple organ toxicity developed, manifested as rhabdomyolysis, acute renal failure, pancreatitis, ileus, livedo reticularis, and elevated aminotransferase values, without liver injury. No previous reports have identified multiple organ injury of this magnitude. A computer literature search identified only three other reported instances of erythromycin and lovastatin interaction. Manifestations in these previous cases consisted of rhabdomyolysis in all three, as well as elevated aminotransferase values and acute renal failure in two cases. In all the cases, the clinical presentation of organ toxicity occurred after the cessation of erythromycin therapy between day 1 and day 5. Advanced age and chronic renal insufficiency were identified as potential risk factors for drug interaction. Health care professionals should be aware of the potential interaction between these two commonly prescribed drugs, which can mimic sepsis.
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PMID:Multiple organ toxicity from addition of erythromycin to long-term lovastatin therapy. 949 76

The aim of this study was to investigate the effect of a bone marrow transplantation (BMT) on renal function in children. In a 5-year period, 142 children received a BMT at the Department of Pediatrics of the University Hospital Leiden. The study was performed retrospectively using the estimated glomerular filtration rate before and 1 year after BMT, and weekly measurements of serum creatinine during the first 3 months after BMT for assessment of renal function. Patient characteristics (sex, age, diagnosis), conditioning regimen, type of BMT, major complications (sepsis, veno-occlusive disease and graft-versus-host disease (GVHD)) and the use of nephrotoxic medication were listed. In the first 3 months after BMT 17 (12%) patients died, 13 from transplant-related complications other than renal failure and four from relapse of the disease. Forty-eight children (34%) had a period with acute renal insufficiency. A high pre-BMT serum creatinine, transplantation with either a non-HLA-identical related or a matched unrelated donor were risk factors for acute renal insufficiency after BMT. Sepsis and the use of intravenous vancomycin were risk factors for acute renal insufficiency only for patients with a high pre-BMT serum creatinine. GVHD seemed to have a beneficial effect on renal function of BMT recipients. One year after BMT a total of 35 (25%) patients had died, 16 from transplant-related complications and 19 from relapse of the disease; another 17 patients could not be evaluated. Twenty-five of 90 evaluable children (28%) had chronic renal insufficiency. Chronic renal insufficiency 1 year after BMT was correlated with a high serum creatinine in the first 3 months after BMT. None of the children of this retrospective study on renal function after BMT needed dialysis.
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PMID:Bone marrow transplantation in children: consequences for renal function shortly after and 1 year post-BMT. 975 43


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