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Biomedical subjects

A Pasternack

Publications and source records attributed to A Pasternack.

At least 145 records · Page 8Linked to original sources
PubMed1988

Mortality from renal diseases in Finland.

A study of mortality from renal disease in Finland in 1951-1982 showed overall rise up to 1962 and thereafter decrease. Extensive use of phenacetin may have contributed to the temporary increase of deaths, but precise evidence is lacking. Renal dialysis and transplantation have effected notable reduction of mortality rates. In the early 1980s half of those who died of renal disease at ages younger than 70 had not received dialysis or transplantation. If these measures had been unrestrictedly available, more patients in this group might have survived.

Cross-Sectional Studies↗
PubMed1988

Hospitalization for renal diseases in Finland 1969-1982.

The number of hospitalized renal patients and the number of days they stayed in hospitals were studied in Finland 1969-1982. In 1969 3.3% and in 1982 1.7% of all bed-days available were occupied by renal patients. The number of hospitalized renal patients first decreased and after 1976 no notable changes were observed. A rising trend in the number of patients as well as in the corresponding bed-days was seen in diabetic nephropathy, lupus nephropathy, renal amyloidosis and polycystic kidney disease. A declining trend, in contrast, was observed in renal infections and nephritis. The proportion of patients over 70 years increased during the study period. An approximation of the outcome of renal diseases was made using the ratio of the number of deaths against the number of hospitalized renal patients. The outcome of patients under 50 years has improved. A slight improvement was observed in most renal diseases, partially due to the increased capacity of dialysis treatment and renal transplantations.

Age Factors↗
PubMed1988

Reduced thickness of gastric mucosa and retarded progression of chronic gastritis in patients with renal failure.

Conflicting results are reported in the literature on the structure and function of gastric mucosa in patients with chronic renal failure (CRF). In the present endoscopic study of 68 CRF patients on conservative treatment (regular dialyses or transplantations had not yet been undertaken), we sought to clarify whether CRF leads to hypertrophic or hypotrophic phenomena in gastric mucosa, as interpreted by the presence and grade of gastritis and by the thickness of the gastric mucosa. We found that the mean progression of gastritis in both antrum and body was significantly slower than expected in CFR patients, and that the thickness of both antral and body mucosa was significantly lower in CFR patients than in non-CRF controls. Furthermore, although the thickness of the oxyntic body mucosa in CRF showed a positive correlation to serum gastrin (SeGa) levels and even though 12 of the patients showed high SeGa levels corresponding to those seen in the Zollinger-Ellison synbdrome (300-1500 ng/l), the thickness of the oxyntic body mucosa in CRF patients did not exceed that seen in control subjects with normal SeGa. We conclude that CRF exerts inhibitory effects on the gastric mucosa resulting in retardation in the progression of chronic gastritis and hypotrophy of the gastric mucous membrane.

Adult↗
PubMed1988

Prevalence of urolithiasis in a Finnish district. An epidemiologic study of adults in Tampere.

Information on the prevalence of urolithiasis in a general population was obtained in an investigation of 5252 persons in the Finnish city of Tampere from September 1980 to February 1982. The study was based on a questionnaire delivered to every 37th citizen in the age groups 20-69 years and to 45-year-old and 65-year-old persons taking part in a health screening program. Persons with a history of urolithiasis were compared with healthy controls. The prevalence figures were 3.0% for men and 1.8% for women aged 20-69 years. The corresponding figures for the 45-year-old group were 4.2% and 1.2% and for the 65-year-old group they were 5.2% and 2.2%.

Adult↗
PubMed1987

Fractional dextran and protein clearances in glomerulonephritis and in diabetic nephropathy.

The renal clearance of dextran and protein of different molecular sizes has been measured in 42 proteinuric patients with diabetes and glomerulonephritis. In both patient groups the fractional low molecular (radii 3.0-3.6 nm) dextran clearances were significantly decreased whereas the fractional high molecular (radii 5.1-7.8 nm) dextran clearances were increased as compared with the controls. A porosity/charge index was constructed by calculating the ratio of fractional clearances of neutral to anionic macromolecules (theta D3.6/theta ALB, theta D5.1/theta IgG). In diabetic patients the relation between the fractional clearances of neutral and anionic macromolecules was dependent on glomerular filtration rate. It seems likely that the altered glomerular permeability in diabetic nephropathy is associated with a decrease of charge as renal function deteriorates. In glomerulonephritis the process is different and there is a high degree of variation from case to case.

Adolescent↗
PubMed1987

Intravenously administered frusemide increases glomerular permeability.

1. The effects of frusemide on glomerular permeability were investigated in eight proteinuric patients by measuring the fractional protein and dextran clearances and correlating these observations with changes in renal haemodynamics. 2. Frusemide increased significantly the fractional albumin and IgG clearances. The fractional dextran clearances of molecules with a radius greater than or equal to 5.4 nm also increased significantly after frusemide injection. Pretreatment with indomethacin partly inhibited the increments in clearances of macromolecules. 3. The changes in the fractional protein clearances correlated significantly with those of inulin clearance There was also a high degree of correlation between the changes in fractional protein clearances and prostanoid excretion. 4. The data obtained suggest that frusemide increases glomerular permeability by influencing the effective pores of the glomerular capillary wall. The increased permeability possibly is due to changes in prostanoid synthesis.

Adolescent↗
PubMed1987

Intact parathyroid hormone, ionized calcium and calcium infusion test in the evaluation of hyperparathyroidism in chronic renal failure.

We studied the parathyroid function in patients with advanced renal failure by determining their plasma concentrations of ionized calcium (iCa), intact parathyroid hormone (PTH) and its inactive metabolites (PTH-MM). The suppressibility of the parathyroidism was studied with a calcium infusion test. The intact PTH values of the nondialysis and dialysis patients did not statistically differ from each other. The concentrations of PTH-MM were, however, higher in the dialysis patients than in the nondialysis patients (p less than 0.05). The ratio of PTH-MM to intact PTH was lowest in healthy reference subjects and highest in dialysis patients (p less than 0.01), and did not correlate with the degree of intact PTH elevation in the patient groups. The calcium infusion test was carried out on 15 patients. All showed suppression in the elevated plasma intact PTH concentration and in 6 the intact PTH value normalized. The PTH-MM value did not normalize in any of the patients. During oral calcium treatment the degree of intact PTH suppression at an achieved concentration of plasma iCa was predictable from the infusion test. Three patients were parathyroidectomized after the calcium infusion test. In 2 of these elevated intact PTH normalized within 24 h while in 1 no change took place. In this latter case on clinical improvement was noted. We conclude that the determination of plasma intact PTH concentration especially of combined with plasma iCa value is a reliable means of studying the hyperparathyroidism associated with chronic renal failure.

Calcium↗
PubMed1987

Sensitivity of gastric acid secretion in patients with chronic renal failure.

By means of a dose-response secretion test the sensitivity of gastric acid secretion was investigated in 85 patients with chronic renal failure and in 85 age- and sex-matched controls. The renal patients were also gastroscoped, with biopsy specimens taken from the gastric body. The examinations were repeated on 18 patients undergoing regular dialysis and 8 patients after successful transplantation. The acid secretion sensitivity of the stomach among the non-dialyzed patients was decreased when compared with the controls (p less than 0.01) but tended to normalize during the intermittent dialysis treatment (p less than 0.05) and particularly after transplantation (p less than 0.01). The low secretion responses were independent of gastric body histology and were also seen in patients with normal body mucosa. The maximum theoretic acid output did not differ significantly from that of the controls. It is concluded that there is an inhibition of gastric acid secretion in chronic renal failure. This inhibition depends on the decreased sensitivity to stimulation and is diminished by treatment of renal failure by dialysis or transplantation.

Adult↗
PubMed1987

Immune response to oral polio vaccine in patients with IgA glomerulonephritis.

Oral poliovirus vaccine was used to immunize 51 patients with IgA glomerulonephritis and 44 healthy controls. The patients showed an enhanced antibody response compared to controls. This was apparent in a higher frequency of strong increases in neutralizing antibody titres during the course of immunization as well as higher levels of virus-specific IgA-class antibodies. IgG-class antibodies showed similar activity in both groups. In patients the neutralizing antibodies correlated with the virus-specific IgA-class antibodies, suggesting that the IgA-antibodies synthesized by the patients are functionally competent antibodies.

Antibodies, Viral↗
PubMed1987

Limited value of the fractional excretion of sodium test in the diagnosis of acute renal failure.

The excreted fraction of filtered sodium (FeNa) was examined in 54 patients with acute intrinsic renal failure in whom renal biopsy was performed to determine the morphology of the acute renal disease. In patients with acute tubulointerstitial nephritis oliguric patients had almost constantly elevated FeNa values, whereas in non-oliguric patients with acute tubulointerstitial nephritis this was observed in less than half. The five patients with acute extracapillary glomerulonephritis had an FeNa greater than 1. FeNa values were low, especially in non-oliguric patients who had mild impairment of renal function. The presence of a high FeNa value correlated significantly with severe morphological tubular changes observed on renal biopsy. We conclude that patients with acute tubulointerstitial nephritis cannot be distinguished from those with acute glomerulonephritis by FeNa, as in both types of acute nephritis the FeNa test shows both low and elevated values.

Acute Kidney Injury↗
PubMed1987

Characterization of uraemia-induced decrease in insulin binding on erythrocytes.

In the present study it was found that uraemic plasma contains inhibitors which affect insulin binding on erythrocyte insulin receptors. Insulin radioreceptor assays performed in the absence of uraemic plasma revealed no defects in the receptors of the uraemic erythrocytes. Uraemic plasma caused a 48% decrease in insulin binding on healthy erythrocytes at a high (10.1 ng/ml) insulin concentration, but only a 17% decrease at a low (70 pg/ml) insulin concentration. The inhibition of insulin binding by uraemic plasma decreased during a haemodialysis treatment from 18% to 13% at the low insulin concentration, and from 30% to 23% at the high insulin concentration. Insulin insensitivity in uraemia appears to be due to inhibition of the insulin receptors.

Erythrocytes↗
PubMed1987

Normalization of lipoprotein lipase and hepatic lipase by gemfibrozil results in correction of lipoprotein abnormalities in chronic renal failure.

Eighteen patients with chronic renal failure (serum creatinine 173-756 mumol/l) and hyperlipidemia were treated with gemfibrozil (1200 mg/day). The drug caused a significant improvement of the dyslipidemia within one week and the effect was progressive during the 28 weeks of treatment. Very-low-density lipoprotein triglycerides and very-low-density lipoprotein cholesterol decreased by about 50% and high-density lipoprotein cholesterol increased by 30%. The lipoprotein changes occurred simultaneously with a significant activation to normal levels of postheparin plasma lipoprotein and hepatic lipases. Opposite effects were observed when gemfibrozil was discontinued and the patients were given placebo. No major harmful effects were observed.

Adult↗
PubMed1987

Serum urea-creatinine ratio as a prognostic index in hemodialysis patients.

The role of the molar ratio of serum urea and creatinine concentrations (urea-creatinine ratio) as a variable affecting survival was studied in a series of 134 hemodialysis patients. The two-year survival rate was 78.4% for patients with a urea-creatinine ratio under 25.5 (lowest tertile) and 42.1% for patients with a urea-creatinine ratio over 31.3 (highest tertile). The correlation of the urea-creatinine ratio and survival was investigated by forming exponential models involving potential confounding factors. The relationship between the urea-creatinine ratio and survival did not disappear after adjusted by age, sex, blood pressure, body mass index and primary renal disease. The goodness of the fit of the exponential model for survival was significantly poorer if the urea-creatinine ratio, diastolic blood pressure and patients' age were deleted. Thus these factors had a marked and independent effect on survival. The relative risk of death was 1.8 for patients with a urea-creatinine ratio of 30 and 3.4 for patients with a urea-creatinine ratio of 40 when the risks of death were compared with the situation in which the urea-creatinine ratio was 20. The urea-creatinine ratio seems to play a role in predicting the survival of hemodialysis patients. It may thus be one of the very few survival affecting factors which can be influenced by active procedures.

Adult↗
PubMed1986

Renal transplantation in 45 patients with amyloidosis.

The results of renal transplantation in patients with amyloidosis were studied in 45 patients receiving primary cadaver grafts at a single center between March 1973 and October 1981. A control group of 45 patients with glomerulonephritis receiving primary cadaver grafts during the same period was also studied. These were matched according to the number of A and B locus incompatibilities and the date of transplantation. The 3-year survival of the patients with amyloidosis was statistically significantly inferior (51%) to that of the controls (79%). Age over 40 years was the major factor determining low survival in these patients. Mortality was concentrated in the early posttransplantation period. The 3-year graft survival rate was the same in amyloidotics (38%) and controls (45%); with death of patients not included in graft loss, the corresponding figures were 53% and 49%. Appearance of amyloid in the transplant was established by biopsy in four patients at 11-37 months of follow-up. Renal transplants functioning for more than one year were calculated to incur a minimum risk of 20% of acquiring amyloid.

Adult↗