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Biomedical subjects

A Blumberg

Publications and source records attributed to A Blumberg.

At least 55 records · Page 3Linked to original sources
PubMed1987

Behavior of beta 2-microglobulin in patients with chronic renal failure undergoing hemodialysis, hemodiafiltration and continuous ambulatory peritoneal dialysis (CAPD).

beta 2-microglobulin (beta 2-m) is the major component of a new form of amyloid deposit found in carpal tunnel syndrome and dialysis arthropathy of long-term hemodialysis patients. In 52 patients on maintenance hemodialysis, serum beta 2-m concentration was elevated to 37.9 +/- 1.4 (normal 1.2 +/- 0.6) mg/l. It was correlated with the time on hemodialysis (r = 0.43, p less than 0.01) and was inversely correlated with residual renal function (r = 0.87, p less than 0.001). In 20 patients on CAPD, beta 2-m likewise was increased to 31.6 +/- 2.3 mg/l; daily elimination by dialysate was only 34 mg (normal 150 mg). Hemodialysis with a cuprophane membrane caused a rise in serum beta 2-m, whereas hemodiafiltration with a polysulfone membrane performed in 5 patients over 2 1/2 months was accompanied by a decrease in serum beta 2-m from 39.5 +/- 0.7 to 29.7 +/- 1.0 mg/l predialysis (19.1 +/- 1.1 postdialysis). On the other hand, beta 2-m elimination reached only approximately 100 mg per day in spite of markedly elevated serum levels. It is concluded that serum beta 2-m is massively elevated in long-term hemodialysis and CAPD patients; contrary to routine hemodialysis with cuprophane membranes, newer more permeable membranes will permit some elimination of beta 2-m. However, based on quantitative considerations it seems difficult to obtain beta 2-m concentrations in the high normal or moderately elevated range with present day techniques.

Humans↗
PubMed1986

[Early recognition of and treatment possibilities in diabetic nephropathies].

Diabetic nephropathy due to glomerulosclerosis develops in 40% of patients with type I diabetes (in type II the incidence is only around 5%). Two mechanisms are of pathogenetic importance: hemodynamic changes with glomerular hyperfiltration leading to glomerulosclerosis and proteinuria, and biochemical alterations of the glomerular basement membrane consisting of an increase and glycosylation of collagen IV as well as a decrease in negatively charged proteoglycans and sialic acid. Diabetic nephropathy runs through several stages, the first being characterized by hyperfunction and hypertrophy. The appearance of microalbuminuria after 10-15 years of diabetes seems to be a good indicator of the later development of clinically overt nephropathy with large urinary protein losses and decreasing renal function. Successful treatment of hypertension may slow the decrease of renal function. For those patients who have reached terminal renal failure, the treatment modalities of hemodialysis, continuous ambulatory peritoneal dialysis (CAPD) and renal transplantation offer a reasonable chance of prolonging life, although the results are generally less good than in non-diabetic renal patients of the same age group. However, the ultimate goal of therapy must remain the successful prevention of the devastating late sequelae of diabetes, including diabetic nephropathy.

Albuminuria↗
PubMed1986

[Hemoglobin A1c in patients under periodic hemodialysis or continuous ambulatory peritoneal dialysis].

In 44 dialyzed patients (27 nondiabetic hemodialysis, 10 CAPD patients and 7 diabetics) hemoglobin A1c (HbA1c) concentrations were measured comparatively by column chromatography (using Bio-Rad columns) and the thiobarbituric acid (TBA) method. With column chromatography the values were significantly higher in each patient group than in healthy controls. In the diabetics, who on average showed elevated blood glucose levels, HbA1c concentrations were higher than in the other dialysis patients, although there was some overlap. On the other hand, concentrations measured in non-diabetic patients with the TBA method were only marginally higher than in controls. It is well known that column chromatography measures carbamylated hemoglobin with HbA1c, and for this reason false high concentrations are found in renal failure. The TBA method is precise and specific in this situation but unfortunately is too time-consuming for routine determinations. The simple column chromatographic method is of only limited value in the control of diabetics with renal failure; nevertheless, unequivocally elevated concentrations of greater than or equal to 7% HbA1c are a good indicator of unsatisfactory metabolic control.

Diabetes Mellitus, Type 1↗
PubMed1985

Thymopentin as adjuvant to hepatitis B vaccination. Results from three double-blind studies.

The influence of adjuvant thymopentin therapy on the effect of vaccination with HB-Vax was investigated in three independent double-blind studies in which three different time/dose schedules of the adjuvant therapy were used. The first study was conducted with 30 hemodialyzed patients who had previously been non- or hyporesponders. Forty and 26 nonvaccinated hemodialyzed patients were chosen for the two additional studies. A 50-mg dose of thymopentin or placebo was administered subcutaneously in all studies. In one study, in which only one adjuvant injection was administered simultaneously with each vaccine injection, thymopentin inhibited the antibody response. On the contrary, in the other two studies, in which three injections of adjuvant were administered during the week following the vaccination (in one of these studies three injections were also given before the vaccination), no difference in the effect of vaccination was observed in patients on either placebo or thymopentin. Comparison of the results of the present studies with those of earlier observations emphasizes the importance of time/dose schedules of adjuvant therapy in vaccination.

Adjuvants, Immunologic↗
PubMed1984

[Acute rhabdomyolysis following administration of succinylcholine].

Acute rhabdomyolysis without hyperthermia, after anesthesia including succinylcholine, is described in a father and son. Rhabdomyolysis-associated acute renal failure was mild in the son but severe in the father. Known enzymatic muscular defects were excluded as cause. The clinical picture of anesthesia-associated rhabdomyolysis is discussed on the basis of these two cases and a review of the literature.

Acute Disease↗
PubMed1984

Oxygen affinity of erythrocytes and pulmonary gas exchange in patients on continuous ambulatory peritoneal dialysis.

In 11 patients on continuous ambulatory peritoneal dialysis 2,3-diphosphoglycerate, oxygen (O2) affinity of red cells (P50), blood gases, ventilation, and O2 consumption were studied. Contrary to patients on maintenance hemodialysis, 2,3-diphosphoglycerate and P50 were normal in patients on continuous ambulatory peritoneal dialysis; they were correlated with each other. Arterial O2 pressure was normal; under the conditions of dialysis with 35 mmol lactate per liter dialysis fluid a slight metabolic acidosis persisted; it was combined with a moderate respiratory alkalosis. Position had no influence upon pulmonary gas exchange with the exception of the alveolo-arterial gradient which was elevated when the abdominal cavity was filled with dialysis fluid and the patients assumed the supine position. Ventilation was in the normal range, whereas O2 consumption was low, possibly due to a reduction in muscle mass in some of the patients. It is concluded that pulmonary gas exchange and erythrocyte O2 transport were normal and that O2 requirements tended to be low in this group of patients on continuous ambulatory peritoneal dialysis.

2,3-Diphosphoglycerate↗
PubMed1983

[Plasmapheresis treatment in multiple myeloma with kidney insufficiency].

Two patients with multiple myeloma and renal insufficiency are described. In both cases free lambda-chains were demonstrated in blood and urine. Plasmapheresis induced a marked reduction of lambda-chains in both patients. In one patient, a 63 year old man, oliguria ceased but renal function remained impaired and required treatment with longterm hemodialysis. The patient died after 6 1/2 months from sudden circulatory failure. In the second patient, a 68 year old woman, renal function was recovered sufficiently to enable hemodialysis to be stopped. Plasmapheresis may efficiently lower the paraprotein concentration in plasma and bring about improvement of renal function, at least in certain cases. However, treatment should be started before the terminal oliguric stage of renal insufficiency has been reached.

Aged↗
PubMed1983

Immunogenicity of a hepatitis B subunit vaccine in hemodialysis and in renal transplant recipients.

A hepatitis B subunit vaccine was given to 59 medical staff members, 106 hemodialysis patients and 28 renal allograft recipients. The vaccine consisted of formalin-inactivated hepatitis Bsurface antigen (HBsAg) and was given in 3 doses (times 0, 1 and 6 months) of 20-40 micrograms. Some of the vaccinees received anti-HBs antibodies together with the first vaccine dose (active/passive vaccination). One month after the last infection, 93% of the medical staff members who had received active/passive immunisation and 97% of those who had received active immunisation had detectable anti-HBs antibodies with mean titers ranging from 1:512 to 1:1024. In the group of hemodialysis patients antibodies were detectable in 63-65% of the individuals who had received active or passive/active immunisation in mean titers between 1:32 and 1:64. Finally, only 32% of the renal allograft patients developed measurable anti-HBs antibodies, the titers of responders being still lower than in the hemodialysis patients. Side effects occurred following 10% of all vaccine injections and were always mild in nature. Within the 12 months observation period period following the first vaccination, 3 HBV events occurred in the 193 individuals: One aclinical case detected by a transient seroconversion against the hepatitis B core antigen, one anicteric and one icteric hepatitis case. The data illustrate the difficulties for active immunisation against hepatitis B of hemodialysis patients or of renal transplant recipients.

Antibodies, Viral↗
PubMed1983

Single-dose ceftriaxone kinetics in functionally anephric patients.

The disposition profile of ceftriaxone was studied in 12 functionally anephric patients (creatinine clearance less than 10 ml/min) who received bolus injections of 150, 500, and 1500 mg IV in a noncrossover fashion. As in healthy subjects, the kinetics in uremic patients were nonlinear for total (bound plus unbound) and linear for free (unbound) drug. The plasma protein binding was reduced due to a decreased association constant, resulting in a doubling of the free fraction in plasma. Ten of 12 patients showed nonrenal clearance values of unbound drug (ClFNR) identical to those in healthy adults and only minor increases in their biologic t1/2(beta) compared to normal (12 and 8 hr). These patients would require no dose adjustments in their dosing regimen. Two of the patients exhibited decreased ClFNR values and increased t1/2(alpha) of 20 and 34 hr. Anephric patients with impaired nonrenal elimination would require minor dose adjustments.

Adult↗
PubMed1983

Cardiac arrhythmias in patients on maintenance hemodialysis.

17 patients on maintenance hemodialysis were monitored for cardiac arrhythmias using ambulatory electrocardiographic recording. Atrioventricular dissociation was found in a patient with an elevated serum digoxin concentration, intradialytic supraventricular tachycardia had been present in a second patient during acute uremic pericarditis prior to the study. Ventricular premature beats (VPB) were absent or of low grade (occasional/uniform) in 14 patients and did not increase on dialysis. 3 patients had potentially dangerous VPB of higher grades (multiform, salvos or R on T) which occurred on or after dialysis in 2. 2 of these 3 patients were overdigitalized, and 2 had severe cardiac disease (amyloid, old myocardial infarction). Several other risk factors (age, hypertension, cardiac hypertrophy, smoking, hyperlipidemia, electrolyte changes) did not seem to be of importance for VPB. In these patients on maintenance hemodialysis, potentially dangerous VPB were rare and occurred mainly during or after dialysis in patients with preexisting heart disease and/or digitalization.

Arrhythmias, Cardiac↗
PubMed1983

Vitamin nutrition in patients on continuous ambulatory peritoneal dialysis (CAPD).

In 10 patients who had been on CAPD for 8.75 months, blood levels of the vitamins A, E, B-complex and C were measured and a precise diet history using food weighing for 3 days was obtained. Plasma vitamin A was elevated in all; since retinol binding protein (RPB) was elevated even more, the ratio of retinol to RBP was low. Vitamin E levels were also high. The vitamins B1, B2 and B6 were measured using erythrocyte enzyme activities. Vitamin B1 was low or borderline in 5, vitamin B6 was decreased in 3 and erythrocyte pyridoxal phosphate in 8 patients. Folic acid was low or borderline in 6 patients, whereas the vitamins B2 and B12 were normal in all. Vitamin C was diminished in 4 patients, and in dialyzate 60% of plasma concentrations were found. The intakes of the vitamins B1, B6 and B12 were below the recommended range. After supplementation of water soluble vitamins for 7 weeks the vitamins A and E remained elevated and B1 remained low, B6 and C had normalized in all and folic acid was markedly elevated. In CAPD decreased blood concentrations of some water soluble vitamins are found due to insufficient dietary intake and loss into dialyzate. Tentative recommendations are given for the replacement of the vitamins B1, B6, folic acid and C.

Adult↗
PubMed1983

Red cell survival and red cell enzymes in patients on continuous peritoneal dialysis (CAPD).

In 11 patients on CAPD with persisting anemia the survival of red cells labelled with 51Cr, red cell mass and the levels of several enzymes within red cells were measured. 51Cr red cell survival was shortened in 9/11 (mean +/- SD:20.0 +/- 4.9 days) and correlated with red cell mass, i.e. with the degree of anemia (r = 0.79, P less than 0.01). Determinations of the levels of enzymes of the hexose monophosphate shunt and the glycolytic pathway revealed no obvious defects in red cell metabolism. The level of hexokinase (HK) was normal whereas the activities of glucose-6-phosphate dehydrogenase (G-6-PD), 6-phosphogluconate dehydrogenase (6-PGD), glutathione reductase (GR) and pyruvate kinase (PK) as well as reduced glutathione (GSH) were increased significantly. CAPD did not eliminate the hemolytic component of anemia in the majority of these patients.

Anemia↗
PubMed1982

[Sleep disorders in patients with chronic renal insufficiency in long-term hemodialysis treatment].

Of 22 patients on maintenance hemodialysis investigated during a period of 20 days for sleep disturbances by means of a semistructured questionnaire, 14 patients reported sleep disturbances. The patient group was found to be homogeneous with respect to factors influencing sleep behavior, such as age, personality and comedication. The sleep disturbances of the dialyzed patients was characterized by diminished sleep efficiency (time asleep/time in bed) and more fragmented sleep, while time of lying in bed awake was perceived as particularly disturbing. The sleep disturbance could be interpreted as a form of secondary metabolically induced insomnia. A single dialysis caused increased fatigue and diminution of well-being, but also an increase in the first fragment of sleep and of the total duration of sleep, i.e. it induced a modification toward a more physiologic sleep pattern. The retention of "middle molecules" could be of importance for the occurrence of uremic sleep disturbance. Patients who were underdialyzed relative to middle molecules were more numerous in the group with disturbed sleep, but the difference did not reach significance in the small number of subjects studied.

Adult↗