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 47,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To study the effectiveness and nephrotoxic side-effects of cyclosporin A (CsA) in renal transplant recipients, a prospective randomised trial was designed to compare CsA with azathioprine (Aza). Each treatment group consisted of 40 patients; in the CsA group, 18 were randomly selected for conversion to Aza after 3 months. The 1-year graft survival for CsA-treated patients was 87% compared with 66% for the Aza group (P = 0.033). Anti-rejection therapy was administrated to 78% of the patients in the Aza group and 47% of those in the CsA group (P less than 0.01). There was no difference in the incidence of primary non-functioning kidneys, cytomegalovirus infections, hypertension, or degree of proteinuria between the two treatment groups. At 3 months the mean creatinine clearance was 42 +/- 2 ml/min (mean +/- SEM) for the CsA group compared with 56 +/- 4 ml/min for the Aza group (P less than 0.01), whereas the mean creatinine clearances at 6 months for both the converted and the non-converted CsA-treated patients did not differ from that found in the Aza-treated group. At 1 year, the mean creatinine clearance for CsA-treated patients who were converted to Aza was higher than that found for Aza-treated patients (62 +/- 7 vs 50 +/- 6 ml/min; P less than 0.05). Furthermore, the increment in creatinine clearance observed after conversion from CsA to Aza at 3 months showed a linear relationship (r = 0.9061) with the CsA trough levels before discontinuation of the drug. This indicates that CsA treatment induces a dose-dependent, nephrotoxic side-effect which is probably reversible.
Nephrol Dial Transplant 1986
PMID:A prospective randomised comparative study on the influence of cyclosporin and azathioprine on renal allograft survival and function. 311 Jun 62

Plasma immunoreactive parathyroid hormone (iPTH), 1,25(OH)2D3, calcium and phosphate and urinary creatinine, calcium and phosphate were measured before and following unilateral nephrectomy in six kidney donors. Unexpectedly, plasma calcium rose, from 2.27 +/- 0.02 mmol/l (mean +/- SEM) to 2.41 +/- 0.03 mmol/l on day 7 and to 2.37 +/- 0.02 mmol/l on day 30 (P less than 0.02). A parallel rise in iPTH occurred, from 0.61 +/- 0.16 ng/ml initially, to 1.83 +/- 0.54 ng/ml on day 7 (P less than 0.05) and to 1.18 +/- 0.18 on day 30 (P less than 0.01). The ratio of maximal tubular reabsorption of phosphate to GFR (TmP/GFR) fell by day 2 (P less than 0.01), remaining reduced on day 30 (P less than 0.05). The significance of elevated iPTH in renal insufficiency was further assessed by determining the time course of the disappearance of iPTH after parathyroidectomy in three haemodialysis subjects. Fifty per cent baseline iPTH level occurred after an average of 104.7 min, suggesting that the assay did not predominantly recognize C-terminal PTH fragments. By day 2, plasma 1,25(OH)2D3 had fallen from 34.3 +/- 4.5 pg/ml to 22.8 +/- 3.8 pg/ml (P less than 0.001), but by day 4 had regained its pre-nephrectomy value. Our results suggest that hypocalcaemia may not be the sole stimulus to parathyroid hormone secretion. It is speculated that reduction in circulating 1,25(OH)2D3 may be involved.
Nephrol Dial Transplant 1986
PMID:Acute responses of parathyroid hormone and 1,25 dihydroxyvitamin D3 to unilateral nephrectomy in healthy donors. 311 Jun 74

Circulating vitamin D3 metabolites were measured in 31 adult patients with chronic renal failure and 31 adults between 3 and 30 months after renal transplantation. No subject excreted over 1 g urinary protein daily nor received vitamin D or its metabolites. There was a positive correlation between 1,25(OH)2D3 and GFR between 15 and 90 ml/min in both chronic renal failure (r = 0.60, P less than 0.001) and transplant subjects (r = 0.49, P less than 0.01) and between 1,25(OH)2D3 and 25(OH)D3 after transplant (r = 0.69, P less than 0.001), but not in chronic renal failure (r = 0.22, P = ns). There was a weak inverse correlation between 1,25(OH)2D3 and serum phosphate in chronic renal failure (r = 0.36, P less than 0.05) but not post transplant (r = 0.03, P = ns). Compared with 1,25(OH)2D3 concentrations in 16 normal subjects (mean +/- SEM: 39.5 +/- 1.9 pg/ml), chronic renal failure subjects with mild renal impairment (GFR 45-90 ml/min, mean: 61.5 +/- 3.3 ml/min, n = 17) had reduced 1,25(OH)2D3 (28.9 +/- 2.7 pg/ml, P less than 0.01). In transplant subjects with mild impairment (GFR 45-90 ml/min, mean: 61.4 +/- 3.7), 1,25(OH)2D3 was positively (r = 0.79, P less than 0.001) and iPTH inversely correlated (r = 0.51, P less than 0.05) with 25(OH)D3. In each of nine such subjects studied, seasonal variations in 1,25(OH)2D3 (P less than 0.001) and PTH (P less than 0.05, 1-tailed test), as well as in 25(OH)D3 and 24,25(OH)2D3, were observed.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephrol Dial Transplant 1988
PMID:Vitamin D3 metabolites in chronic renal failure and after renal transplantation. 313 43

The immunosuppressive effectiveness and nephrotoxic side-effects of either high-dose cyclosporin (CsA) (16 mg/kg per day) or low-dose (9 mg/kg per day) in combination with azathioprine (Aza) (1 mg/kg per day) were studied in 80 renal transplant patients who also received low-dose corticosteroids. At 3 months, patients who received high-dose CsA were randomly assigned to either continuation of CsA or conversion to Aza, whereas in the triple-therapy group either CsA or Aza was discontinued. No differences in patient (97.5%) or graft survival (90%-92.5%) were found at 1 year. There were no differences in the incidence of primary non-functioning kidneys. The incidence of acute rejection episodes was 45% in the high-dose CsA group and 55% in the group treated with low CsA doses together with Aza (not significant). At 3 months the mean creatinine clearance was 60 +/- 4 ml/min (mean +/- SEM) in the high-dose group (mean cumulative CsA dose 0.96 g/kg) compared with 55 +/- 3 ml/min in the low-dose group (mean cumulative CsA dose 0.60 g/kg). At 1 year no differences in the degree of proteinuria or the incidence of hypertension was found between the different groups. The best mean creatinine clearance at 1 year (77 +/- 5 ml/min) was found in patients who received high doses of CsA for 3 months followed by conversion.
Nephrol Dial Transplant 1988
PMID:High- and low-dose regimens of cyclosporin in renal transplantation: immunosuppressive efficacy and side-effects. 314 26

In six anuric haemodialysed patients, aluminium and iron mass transfer were determined 48 hours after 40 and 80mg/kg body weight desferrioxamine intravenous infusion. All patients were aluminium overloaded (mean +/- SEM: 2.91 +/- 1.05 mumol/g wet tissue bone) and two had high plasma ferritin. Haemodialysis and haemofiltration were performed using a highly permeable membrane. The adequate dose of desferrioxamine for aluminium removal is 40mg/kg, since aluminium mass transfer induced by haemodialysis and haemofiltration (47.4 and 40 mumol/session) are not significantly different from that obtained with 80mg/kg. Iron removal is dose related in high plasma ferritin concentration patients: 50 and 100 mumol/session with haemodialysis and 29 and 175 mumol/session with haemofiltration after 40 and 80mg/kg body weight respectively.
Proc Eur Dial Transplant Assoc Eur Ren Assoc 1985
PMID:Concomitant removal of aluminium and iron by haemodialysis and haemofiltration after desferrioxamine intravenous infusion. 399 42

The effect of continuous subcutaneous insulin infusion on renal function was studied in 12 patients with insulin-dependent diabetes mellitus. Serum creatinine was less than 110 mumol/L in all patients. Total urinary protein excretion was less than 250 mg/24 hr in seven patients (group I) and exceeded 0.5 g/24 hr in five (group II). Initial glomerular filtration rate was higher in group I compared with group II: 136.0 +/- 8.5 ml/min versus 103.2 +/- 4.6 ml/min (mean +/- SEM; p less than 0.02). After one to three months pump therapy glomerular filtration rate decreased in both groups. It remained stable during 32-36 months in group I (126.3 +/- 6.1, and 127.9 +/- 7.7 ml/min, respectively) but deteriorated in group II (98.6 +/- 4.4, and 60.0 +/- 6.8 ml/min, respectively; p less than 0.01 compared with group I). These results indicate that strict blood glucose control with continuous subcutaneous insulin infusion does not prevent deterioration of renal function in type I diabetic patients with clinical proteinuria. This suggests that other factors than metabolic control are involved in the course of diabetic nephropathy.
Proc Eur Dial Transplant Assoc Eur Ren Assoc 1985
PMID:The effect of continuous subcutaneous insulin infusion on renal function in type I diabetic patients with and without proteinuria. 399 67

The effects of enalapril were assessed in a double-blind study versus propranolol. Twenty-two patients with essential hypertension were titrated with either enalapril (5, 10 and 20 mg twice daily) or propranolol (40, 80 and 120 mg twice daily). With propranolol blood pressure decreased from 154/101 +/- 4/1 to 146/98 +/- 5/2 mmHg (mean +/- SEM); with enalapril it decreased from 151/103 +/- 3/1 to 134/92 +/- 4/2 mmHg, both after 12 weeks of therapy. Effective renal plasma flow remained unchanged in the propranolol group whereas it increased from 413 +/- 19 to 445 +/- 27 ml/min (p less than 0.05) with enalapril. Glomerular filtration rate remained unchanged at either medication. Enalapril is an effective anti-hypertensive agent with a favourable effect on renal haemodynamics.
Proc Eur Dial Transplant Assoc 1983
PMID:Effects of enalapril on blood pressure and renal haemodynamics in essential hypertension. 631 24

This study investigates the effect of dialysis on the 24-hour insulin requirements in uraemic insulin dependent diabetic patients maintained at normoglycaemia using an artificial beta-cell. Five patients were studied twice, namely before initiation of dialysis treatment (mean 14 days) and after a mean of 46 days on chronic dialysis. The mean total diurnal insulin consumption was reduced significantly from 44.7 +/- 2.9 U (mean +/- SEM) before dialysis to 35.0 +/- 2.3 U after dialysis therapy (p less than 0.01). The reduction included the prandial as well as the basal insulin requirements (p less than 0.02). It is most likely that an insulin receptor or a post-receptor defect account for the insulin insensitivity present in uraemia. Our study demonstrates that this defect is at least partly reversible after dialysis treatment.
Proc Eur Dial Transplant Assoc 1983
PMID:Effect of haemodialysis on insulin requirements in uraemic diabetic patients. Studies with the artificial beta-cell. 634 66

Fifty-eight patients on intermittent haemodialysis underwent parathyroidectomy because of severe secondary hyperparathyroidism. Mean individual parathyroid gland weight was 689 +/- 62 (SEM) mg. Mean total gland weight per patient was between two and three grams. Increasing nodule formation within hyperplastic glands appeared to develop with increasing time of duration of hyperparathyroidism. Patients with chronic pyelonephritis had a higher gland weight than those with chronic glomerulonephritis. A direct relationship was found between gland weight and circulating immunoreactive parathyroid hormone, but an inverse relationship between gland weight and plasma aluminium concentration. The higher the parathyroid gland aluminium, the higher was the bone aluminium concentration.
Proc Eur Dial Transplant Assoc 1983
PMID:Secondary hyperparathyroidism in chronic haemodialysis patients: a clinico-pathological study. 665 93

In seven long-term dialysis patients, autopsy material showed varying amount of refractile foreign material in macrophages and giant cells of lung, liver, spleen, bone marrow, skin, thoracic and abdominal lymph nodes, but not in brain, heart, kidney or endocrine organs. Electron microscopy showed its presence within lysosomal membranes of macrophages. Such material was also demonstrable in liver biopsies of patients dialysed for only several months. Possible clinical consequences were hepatosplenomegaly, elevation of transaminases, hypersplenism with pancytopenia and possibly bile duct carcinoma. SEM with X-ray fluorescence showed particles within spleen and liver cells with a characteristic Si K alpha 2.09 kev peak. Identical material was found as fillings on silicone tubing exposed to roller pumps.
Proc Eur Dial Transplant Assoc 1981
PMID:Silicone filings in macrophages of viscera: an iatrogenic complication of haemodialysis. 733


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