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Biomedical subjects

B H Brouhard

Publications and source records attributed to B H Brouhard.

125 records · Page 7Linked to original sources
PubMed1976

IgA nephropathy in children.

Three children presented with proteinuria, microscopic hematuria, episodic gross hematuria and normal renal function. Renal histology consisted predominantly of mesangial IgA deposition. The above clinical and biopsy findings are consistent with a diagnosis of IgA nephropathy. To date, these 3 children have maintained normal renal function. The authors hypothesize that this may be due to the absence of simultaneous complement deposition within the glomerulus.

Child↗
PubMed1975

Effect of antihistamine-antiserotonin and ganglionic blocking agents upon increased capillary permeability following burn trauma.

Tiny (0.2% TBS), partial thickness, non-contact radiant heat burns in guinea pigs resulted, within 3 hours, in significant edema formation and protein leakage at the site of the injury. Areas of skin distant to the burn also showed an increase in water content but no protein leakage. Pretreatment of the animals with either chlorisondamine hydrochloride or a mixture of methysergide and chlorpheniramine significantly decreased postburn edema formation and protein leakage. Liquid emulsion autoradiography revealed that leakage of protein occurs primarily in the areas of skin adjacent to the panniculus carnosus. The studies suggest that: the increase in vascular permeability that occurs as a consequence of burn injuries is humorally mediated; albumin leakage is limited to the injured tissues; and histamine, serotonin, and presumably catecholamines play significant roles in the development of this phenomenon.

Animals↗
PubMedDate not supplied

Impact of a camp experience on choice of coping strategies by adolescents with insulin-dependent diabetes mellitus.

Summer camps for children with IDDM have allowed educators to expand diabetes curricula and test novel approaches to education. Yet few evaluations have been published assessing the effectiveness of these types of educational interventions. The present study was designed as a formative assessment to provide preliminary evaluation of the impact of a life skills curriculum designed to increase awareness of different techniques that may be useful in managing stress. Life skills curricula are included each year as part of the teen session at the Texas Lions Camp for Children with Diabetes. Following the intervention, campers reported an intent to use more problem-focused and fewer detachment strategies to deal with a personally identified stressor. Limitations of the current pilot study are used to illustrate problems inherent in evaluation of camp programs.

Adaptation, Psychological↗
PubMedDate not supplied

Urinary excretion of N-acetyl-beta-D-glucosaminidase in children with type I diabetes mellitus.

N-acetyl-beta-D-glucosaminidase (NAG), a lysosomal enzyme, has been shown to be increased in the urine of patients with various glomerulonephritides, tubulointerestitial diseases, renal allograft rejection, toxic renal injury, and diabetes mellitus. Although it has been suggested that urinary NAG may reflect blood glucose control, no studies have correlated this with other measures of metabolic control. Thirty-four children from a diabetic summer camp were found to have urinary NAG to creatinine ratios significantly above those of normal controls of similar age (5.22 +/- 1.19 versus 1.51 +/- 0.17 U). Urinary NAG was found to positively correlate with an arbitrary control index (r = 0.82; P less than 0.05) and in seven patients with hemoglobin A1c (r = 0.70; P less than 0.001). In a closely followed group of 40 clinic patients, urinary NAG to creatinine ratio was again found to be significantly increased over normal controls (7.55 +/- 0.70 versus 1.51 +/- 0.17 U; P less than 0.05). Again, urinary NAG was positively correlated with HbA1c (r = 0.62; P less than 0.001) and urinary albumin to creatinine ratio (r = 0.47; P less than 0.01). In neither group was there a correlation with UNAG:UCr and duration of disease. Thus, these data suggest that urinary NAG to creatinine ratio appears to be a reflection of blood sugar control.

Acetylglucosaminidase↗
PubMedDate not supplied

Effect of exercise on urinary N-acetyl-beta-D-glucosaminidase activity and albumin excretion in children with type I diabetes mellitus.

Urinary N-acetyl-beta-D-glucosaminidase (NAG), a proximal tubule lysosomal enzyme, has been used as an indicator of subtle renal injury. Since it has been positively and significantly correlated with hemoglobin A1c and microalbuminuria, it has been suggested that this enzyme may also reflect metabolic control. Albumin excretion is exacerbated in adult diabetic individuals during exercise; such exercise-induced albuminuria may be a forerunner of diabetic nephropathy. Metabolic control, degree of exertion, and duration of diabetes have been suggested to influence this increase in albuminuria during exercise. Studies of children are few and have produced inconsistent results. Thus we studied 28 insulin-dependent diabetic children ranging in age from 5 yr to 16 yr and 27 age-matched controls using treadmill exercise; two exercise periods consisting of (1) graded increases in speed and grade at 3-min intervals until exhaustion and (2) a constant speed and grade necessary to produce 2/3-3/4 maximal heart rate for 30 min were performed. Capillary blood glucose, urinary NAG/creatinine (cr) ratios (UNAG/Ucr) and urinary albumin/creatinine ratio (Ualb/Ucr) were measured before and after each exercise period; hemoglobin A1c was also measured. The latter averaged 11.8 +/- 0.6% (mean +/- SEM); contrary to previous studies, this was not correlated with pre- or postexercise UNAG/Ucr. During both exercise periods, blood glucose dropped 271 +/- 19 mg/dl to 213 +/- 21 mg/dl (period 1) and 230 +/- 22 mg/dl to 157 +/- 21 mg/dl (period 2).(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylglucosaminidase↗
PubMedDate not supplied

Use of angiotensin-converting enzyme inhibitors in chronic progressive renal disease.

Chronic renal insufficiency is a progressive, self-perpetuating process which is influenced in part by activation of the intrarenal renin-angiotensin system. Oral angiotensin-converting enzyme inhibitors are being studied in animals and humans to determine whether they slow the decline in renal function characteristic of progressive renal disease. In animals that have reduced renal mass, streptozotocin-induced diabetes mellitus, or puromycin aminonucleoside nephrosis, these agents can reduce proteinuria, decrease the frequency of sclerotic glomeruli, and normalize intrarenal hemodynamics. They also may decrease glomerular hypertrophy that occurs after renal ablation. In human trials, angiotensin-converting enzyme inhibitors decrease proteinuria by altering the glomerular capillary permeability. The effect of these agents on progressive disease may be influenced by how soon therapy is begun and how long it is continued.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

Calcium-channel blocking agents as therapy for amphotericin B nephrotoxicity.

Amphotericin B is a broad-spectrum antifungal agent shown to be effective in the treatment of systemic fungal infections. Unfortunately, therapeutic doses are often associated with a variety of adverse effects, including nephrotoxicity. Studies of the deleterious effects of amphotericin B on the renal microvasculature are yielding clues to sparing kidney function. In selected patients, concomitant use of a calcium-channel blocker may prevent the nephrotoxic effects of amphotericin B and allow full therapeutic doses to be used.

Amphotericin B↗
PubMedDate not supplied

Cytokines and the pathogenesis of insulin-dependent diabetes mellitus.

Insulin-dependent diabetes mellitus is an autoimmune phenomenon in humans. At onset, the diabetic pancreas shows a well-characterized insulitis. The inflammatory cells are specifically directed toward beta cells of the pancreatic islets. Several hypotheses link genetic susceptibility for diabetes to immunologic mechanisms. The cytokines interferon gamma and interleukin-6 have essential roles in the progressive destruction of beta cells. Studies with experimental models may improve definition of the pathogenesis of insulin-dependent diabetes mellitus. Combining genetic studies that detect susceptibility to insulin-dependent diabetes mellitus with future therapies aimed at interrupting cytokine production or cytokine receptor expression may lead to prevention of insulin-dependent diabetes mellitus.

Animals↗
PubMedDate not supplied

Preglomerular and postglomerular blood flow: relationship to kidney disease and treatment.

BACKGROUND: In the kidney, the afferent and efferent arterioles normally constrict or dilate in response to changes in systemic blood pressure to maintain glomerular filtration while protecting the glomerulus from excessive pressure. In diabetes mellitus and hypertension, the two most common causes of kidney failure, sustained hypertension within the glomerulus damages the glomerular membrane and eventually results in loss of kidney function. SUMMARY: Techniques developed in the last 10 years allow direct study of the glomerulus and the glomerular circulation. In both diabetes and hypertension, the afferent vessels may dilate, resulting in excessive pressure in the glomerulus. Calcium antagonists, angiotensin-converting enzyme inhibitors, and cyclosporine have direct effects on the preglomerular and postglomerular vessels, and the afferent and efferent arterioles may respond differently to the same agent. CONCLUSIONS: Techniques for studying afferent and efferent arteriolar changes and glomerular filtration rate may provide important insights into the actions of drugs and into renal diseases. Clinicians are beginning to be able to select drugs that have desired effects on the renal microcirculation.

Animals↗
PubMedDate not supplied

Hypertension in children and adolescents.

BACKGROUND: Children have lower blood pressure than adults do, and normal values for children have been established based on age and also on height and weight. Blood pressures in childhood correlate with blood pressures in adulthood, although weakly; a stronger correlation has been established between obesity in childhood and adulthood. Further, obese people are more likely to have high blood pressure than are slender people, both as children and adults. In hypertensive children, the higher the blood pressure and the earlier hypertension appears, the more likely is a secondary cause. KEY POINTS: Physicians should measure and record children's blood pressure, just as they do their height and weight. An algorithm can help physicians decide whether a child with high blood pressure needs further workup and treatment. Nonpharmacologic therapy includes dietary sodium restriction, weight reduction (if the child is overweight), aerobic exercise, and relaxation. In some cases pharmacologic therapy may be necessary. In general, all children should be encouraged to be physically active and to eat healthy foods.

Adolescent↗
PubMedDate not supplied

Isolated antinuclear antibody-negative lupus nephropathy in young children.

Systemic lupus erythematosus (SLE) is a multisystem disease in which the kidneys are frequently involved. The clinical and histopathologic diagnosis of SLE is based on the American Rheumatism Association (ARA) and the World Health Organization classification, respectively. A few adults who qualify as SLE by the ARA criteria but are antinuclear antibody (ANA)-negative have been reported. We found only one report of a child with SLE where renal disease was the only manifestation but who had a positive ANA. This report describes 3 children who presented with the nephrotic syndrome and in whom the renal histology is highly suggestive of SLE. Short-term follow-up as failed to demonstrate other systemic involvement and the ANA has continued to be negative.

Antibodies, Antinuclear↗
PubMedDate not supplied

Effect of varied protein intake on the nephropathy of the diabetic mouse (C57BL/s J db/db).

Protein intake has been suggested to influence progression of renal disease by affecting intraglomerular pressures and flows. The renal disease of the diabetic mouse (C57BL/Ks/db/db) has been proposed as a suitable model of human diabetic nephropathy. Ten diabetic mice and ten non-diabetic controls were placed on 1 of 3 protein intakes, 4%, 27% and 50%, and serial functional measurements were made at 2 to 3 week intervals until week 20. All diabetic animals showed similar degrees of hyperglycemia. The creatinine clearances were generally higher in the diabetic mice than the controls, except the 4% protein intake diabetic group, until week 20 when the 27% db/db mice showed a significant decline (p less than 0.05) compared to the control mice. Albumin excretion was significantly higher in the 27% and 50% protein intake db/db mice than the controls. Again the 4% group showed albuminuria not different from the control animals. Histologic studies at 20 weeks showed minimal abnormalities in the normal and 4% protein intake diabetic group. The 27% and 50% intake diabetic mice showed a progressive increase in severity of mesangial matrix expansion with segmental sclerosis. Electron microscopy confirmed these findings. Immunofluorescence microscopy showed a marked increase in mesangial immunoglobulin G and M. With similar degree of hyperglycemia, higher protein intake was associated with more severe histologic changes, greater albuminuria and early decline in GFR. Thus protein intake can markedly affect the progression of renal disease in the diabetic mouse.

Age Factors↗