Search PubMed⌕ Search

Biomedical subjects

A M Davison

Publications and source records attributed to A M Davison.

At least 37 records · Page 2Linked to original sources
PubMed1998

Extracellular fluid volume determined by bioelectric impedance and serum albumin in CAPD patients.

AIM: To investigate the relationship between serum albumin and extracellular fluid volume, as measured by multifrequency bioelectrical impedance, in stable patients treated by CAPD. METHOD: Fifty-nine stable CAPD patients were assessed. Serum albumin (bromocresol green) and CRP, age, dialysate to plasma (D/P) creatinine ratio, normalized protein catabolic rate (nPCR), daily urine and peritoneal protein losses, and extracellular fluid volume (Vecf) were measured in each patient. Vecf was calculated as a percentage of actual body weight (Vecf% ABW), of lean body mass derived from anthropometry (Vecf% LBM) and of total body water (Vecf% Vtbw). Comparisons between those with a normal serum albumin (> or = 37 g/l) and those with a low serum albumin (< 37 g/l) were made by Mann-Whitney U test. Correlations with serum albumin were sought by Pearson's test. RESULTS: The D/P creatinine ratio, daily peritoneal and urine protein losses, and extracellular fluid volume (Vecf% LBM and Vecf% Vtbw) were all significantly greater in patients with serum albumin < 37 g/l as compared to those > or = 37 g/l; P < 0.05. Age, CRP, and nPCR were not different. Serum albumin was negatively correlated with Vecf% LBM, r = -0.25; P = 0.05, Vecf% Vtbw, r = -0.39; P = 0.002, and daily urinary albumin loss, r = -0.25, P = 0.06. CONCLUSION: Hypoalbuminaemia is partly dependent on subclinical overhydration in CAPD patients. Serum albumin is negatively correlated with increased extracellular fluid volume and the proportion of Vecf to Vtbw is increased in hypoalbuminaemic patients. Multifrequency bioelectrical impedance is able to identify these abnormalities.

Adult↗
PubMed1998

Renal disease in the elderly.

There are structural and functional changes which take place in the kidney with age. These changes have an impact on patient management, particularly with respect to drug therapy. It is unlikely that glomerulonephritis is less common in the elderly, and any apparent difference with respect to younger patients most likely reflects clinical practice rather than any inherent difference in the aged kidney. Tubulointerstitial nephritis may be more common and is most likely linked to drug therapy. The management of end-stage renal failure in the elderly should not be significantly different from that in younger patients and should be based on the capacity for rehabilitation rather than any arbitrary age.

Aged↗
PubMed1998

Differences in forensic pathology practice between Scotland and England.

Scotland and England are part of the United Kingdom but have separate legal systems. These legal differences have a substantial effect on forensic pathology practice, and are probably best appreciated by those pathologists who have worked on both sides of the border. This paper seeks to highlight the differences in forensic pathology practice between Scotland and England, discussing the investigation of death in both countries. It concludes that a knowledge of the Scottish procurator fiscal system of death investigation may be beneficial to those contemplating changes to the coroner system. All three authors have practised forensic pathology in Scotland and England or Wales.

Autopsy↗
PubMed1997

Serum albumin and survival in CAPD patients: the implications of concentration trends over time.

HYPOTHESIS: Trends in serum albumin concentration over time provide a better prediction of clinical outcome in CAPD patients than a single mean value. METHODS: This was a retrospective review of outcome at 36 months in 225 adult CAPD patients. Mean serum albumin was determined for the first (SA1) and second (SA2) 6 months of treatment and patients grouped according to SA1 (group I, > 37; group II, 34-37; group III, < 34 g/l) and according to the change in serum albumin (delta SA) between the first and second 6 months (increased/static or decreased). Patient (PS) and technique (TS) survival were determined by Kaplan-Meier survival analysis. The effect of SA1 and delta SA on survival were determined in a multivariate Cox regression analysis model that included age and presence or absence of a systemic disease. RESULTS: By SA1 group, PS and TS survival at 36 months were 94 and 76% (group I), 64 and 53% (group II) and 70 and 52% (group III). If delta SA increased/remained static, then SA1 did not predict PS (group I, 100%; group II, 96%; group III, 74%; P = n.s.) or TS (group I, 72%; group II, 63%; group III, 65%; P = n.s.). If delta SA decreased, PS was worse in groups II and III, both as compared to group I (PS group I, 88%; group II, 52%; group III, 34%; P = 0.02) and as compared to the groups II and III when delta SA increased (PS group II, 74 vs 52%, P = 0.05; group III, 82 vs 34%, P = 0.005) The same trend was seen for TS. In the multivariate Cox regression model, age, direction of change in serum albumin, and presence of a multisystem disease were significant predictors of survival, whereas SA1 was not. CONCLUSION: Early hypoalbuminaemia in CAPD only predicts a worse patient and technique survival if mean serum albumin decreases further from the first to second 6 months of dialysis therapy. Change in serum albumin between the first and second 6 months of CAPD and the mean serum albumin over the first 6 months together offer better discrimination of outcome than either alone.

Adult↗
PubMed1997

Assessment of nutritional status in CAPD patients: serum albumin is not a useful measure.

INTRODUCTION: In CAPD patients serum albumin is frequently used as an index of nutritional status, although it is recognized that hypoalbuminaemia may be caused by many factors. We have further examined the relationship between serum albumin and nutrition. METHODS: Nutritional status was assessed by biochemistry, anthropometry, mid-arm muscle circumference, muscle strength (hand grip and back), and lean body mass (from anthropometry, creatinine kinetics and bioimpedance) in a group of 76 stable CAPD patients. Correlations between biochemical and nutritional parameters were sought and data were compared between patient groups defined by serum albumin (> or = 37 vs < 37 g/l on two occasions 2 months apart) and separately according to subjective global assessment score (normal nutrition, A vs mild to moderate, B, and severe, C, malnutrition). RESULTS: In patients with a low SGA score, actual body weight, body mass index, mid-arm muscle circumference, lean body mass, subscapular skinfold thickness, hand grip strength (males and females) and iliac and triceps skinfold thicknesses and back strength (females only) were all significantly less than in patients with a normal SGA score. In contrast, none of these variables differed in either gender when patients were compared according to serum albumin. Serum albumin was correlated with serum creatinine (r = 0.45, P = 0.01), daily urine protein excretion (r = -0.42, P = 0.02) and uncorrected weekly creatinine clearance (r = -0.39) in females, but not with any index of body composition in either gender. CONCLUSION: Whilst SGA identified a patient group with significantly abnormal body mass, muscle mass and muscle strength, serum albumin did not. Serum albumin is not a useful marker of malnutrition in stable patients on CAPD.

Adolescent↗
PubMed1996

Hepatorenal failure.

Acute renal and hepatic failure can occur for many reasons. The hepatorenal syndrome is acute renal failure of unknown cause developing in a patient with chronic liver disease, usually cirrhosis. The pathogenesis is functional in nature due to a combination of redistribution of fluid between compartments and intrarenal events reducing renal blood flow (activation of the renin-angiotensin system, increased renal sympathetic activity, and a decrease in vasodilating and increase in vasoconstricting prostaglandins). Management of combined renal and hepatic failure consists of measures to control the uraemia and the effects of hepatic dysfunction. Haemodialysis is accompanied by a number of specific problems such as maintenance of cerebral perfusion and anticoagulation. At present the best dialysis mode is continuous haemodiafiltration using a biocompatible membrane. The prognosis of the hepatorenal syndrome is poor and depends on recovery of hepatic function. Liver transplantation may be required.

Acute Disease↗
PubMed1996

Glomerulonephritis in the elderly.

The records of 7086 patients reported to the MRC Glomerulonephritis Registry between 1978 and 1990 were examined; 1368 patients were aged > 60 years at the time of biopsy. In 1978 12% of patients aged > 60 years underwent biopsy, whereas in 1990 30% of patients were aged > 60 years. The most common reasons for biopsy were nephrotic syndrome (31%), acute renal failure (26%) and chronic renal failure (25%). In patients presenting with nephrotic syndrome, the most common histological appearance was membranous nephropathy (36.6%), minimal changes (11%) and amyloidosis (10.7%). Secondary nephrotic syndrome was associated with amyloidosis (32 patients), diabetes mellitus (11 patients) and carcinoma (10 patients). Glomerulonephritis in the elderly is not uncommon and the apparent increasing incidence is most likely due to an increased referral of patients for investigation rather than a true increase in the incidence of this condition.

Adult↗
PubMed1996

Serum hyaluronan concentrations predict survival in patients with chronic renal failure on maintenance haemodialysis.

BACKGROUND: Malnutrition and wasting are common in chronic renal failure and are adverse prognostic features. The underlying mechanisms are complex and not fully understood. Hyaluronan is present in increased concentrations in chronic renal failure and may be associated with adverse features of chronic renal failure. METHODS: We have investigated the relationship of this abnormality to long-term survival. Outcome of 81 patients of median of 5.6 years (3.9-6.8) after measurement of hyaluronan was determined. RESULTS: Survival analysis by the Cox regression model showed that increased concentrations of hyaluronan (P < 0.0001). There was also a weak but significant negative correlation between hyaluronan concentrations and serum albumin concentrations (rs = - 0.27, P = 0.02). CONCLUSIONS: We conclude that serum hyaluronan is a strong independent predictor of long-term survival in CRF may reflect abnormal connective tissue metabolism in this condition.

Adult↗
PubMed1995

Risk of neoplasia in renal transplant patients.

Renal allograft recipients are at an increased risk of neoplasia, although the extent of the problem has not been established in a typical European transplant population. To assess this risk we did a comprehensive, retrospective study of 918 patients transplanted at one centre over 24 years. The centre (Leeds) serves Yorkshire and Humberside, a region in northern England with a population of 3.6 million. The search, which made use of six sources of information, revealed 70 patients (7.6%) who had developed a neoplastic lesion, 10 patients having more than one type. More than half (42) were cutaneous lesions (mostly squamous cell carcinomas). The risk of developing neoplasia in the first 10 years after transplantation was calculated to be 14%. By 20 years this had risen to 40% compared with a 6% cumulative risk of neoplasia in an age-matched control population (p < 0.005). The full extent of this problem in the European transplant population has been underestimated and, now that recipients are surviving longer, there is a clear need for both lifelong surveillance and closer investigation of these patients.

Adult↗