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Biomedical subjects

C Kjellstrand

Publications and source records attributed to C Kjellstrand.

34 records · Page 2Linked to original sources
PubMed1983

Kidney transplantation: the use of abnormal kidneys.

We transplanted 6 anatomically abnormal kidneys: a horseshoe kidney that after division was transplanted into 2 recipients; 1 kidney with ureteral stones and hydronephrosis; 1 ectopic and 1 hydronephrotic kidney; 2 kidneys with extensive ureteric lesions, donated as free organs. All these kidneys ultimately had normal function in the recipients, long-term in 4.2 patients died but in neither was the death caused by the renal abnormality.

Adult↗
PubMed1981

Contrast nephropathy.

Contrast nephropathy is an adverse alteration in renal function induced by intravascular contrast media. Most cases involve transient asymptomatic episodes; yet a significant number involve oliguria and/or permanent renal damage. The incidence of contrast nephropathy in the general hospitalized population is about 5%, and is associated with preexisting renal insufficiency and diabetes mellitus. The incidence in patients with normal renal function is significantly lower - 0.6% following IVP and 2% following angiography. Angiography carries risks inherent to the technical problems of the procedure itself. Preexisting renal insufficiency is the most significant predisposing condition of contrast nephrotoxicity. As many as two-thirds of patients with chronic renal failure may experience an acute deterioration in renal function following exposure. Most of these episodes are transient and benign. Diabetic patients with preexisting renal insufficiency are at an even greater risk; about 75% of such patients will experience renal complications. The risk is even higher in JODM patients with severe renal disease; there is an over 90% incidence of nephrotoxicity with as many as half sustaining permanent renal damage. Adequate hydration does not appear to reduce the incidence of contrast nephropathy in susceptible patients, but it may reduce the likelihood of oliguria and permanent damage. In multiple myeloma the risk of contrast-induced renal failure is low, and probably involves a different pathogenesis than seen in other cases of contrast nephropathy. The incidence in myeloma patients is probably increased in the presence of dehydration and renal insufficiency. Peripheral vascular disease, hypertension, old age and large and repeated doses of contrast may increase the risk in susceptible patients. Prevention of contrast nephropathy must start with identification of patients at risk. In patients with preexisting renal insufficiency, and especially diabetic patients with preexisting renal insufficiency, the anticipated benefit should outweigh the potential risk of exposure to contrast media.

Angiography↗
PubMed1980

Four new dialyzers.

Dialyzers with a variety of sizes and performance characteristics are presently available for the dialysis of adult patients. We evaluated four currently available disposable adult dialyzers in vitro and in vivo during treatment of adult patients. All four dialyzers, Gambro GLP 1.36m2, 17 mu, Cordis Dow 3500, Gambro GF 120M, and Travenol HD 1000 were well suited to the dialysis of adult patients. By considering the clinical status of the patients and the performance characteristics of the dialyzer (solute removal, priming volume, ultrafiltration, etc.) it is possible to employ a hemodialyzer which more precisely meets the needs of the patient without increasing risk factors associated with hemodialysis.

Arteries↗
PubMed1978

Renal transplantation in a patient with lipoatrophic diabetes. A case report.

A patient with congenital generalized lipodystrophy developed nephrotic syndrome with progressive renal glomerulosclerosis attributed to diabetic nephropathy. Renal transplantation was performed and the patient was discharged with normal renal function. Marked hyperlipidemia (17,500 mg/dl) persisted. One month later renal malfunction developed, and an open renal biopsy was performed when there was no response to antirejection therapy. Massive lipid deposition in renal tubular cells with tubular necrosis and hemorrhage was present but only minimal evidence of graft rejection. Rejection therapy was tapered and renal function stabilized. Death occurred 2 months later because of pulmonary sepsis. Patients with generalized lipodystrophy and severe hyperlipidemia may be at an unusually high risk for renal homograft destruction.

Adult↗
PubMed1978

Evaluation of three dry-sterilized hollow fiber artifical kidneys.

We investigated three new dry sterilized hollow fiber artificial kidneys (HFAK) (Cordis Dow CDAK 1.3, Travenol CF 1200, Extracorporeal Tri-Ex 1). Dry sterilization makes these dialyzers more economical by shortening set-up time. Dry sterilization also eliminates iatrogenic administration of residual sterilant. Water of imbibition can significantly increase the blood compartment volume of the dialyzer during dialysis. Consequently, a corrected blood volume for each dialyzer was established; these corrected volumes varied from 13--36% greater than the volume determined before dialysate flow. With low dose heparinization of these dialyzers there was between an 18 and 45% decrease in the post dialysis volume, presumably due to fiber clotting during dialysis. This volume added to the residual blood loss measured by a colorimetric technique accounted for a possible blood loss ranging between 26.9 and 53.9 ml per dialysis for these three dialyzers. Our results suggest that a relationship between dialyzer clotting and decreased dialyzer efficiency may exist. These three capillary flow dialyzers had a much lower platelet drop (0--9% pre to post) when compared to 30--40% drop of flat plate dialyzers. These dialyzers were found to be safe and easy to use but the high fiber clotting warrants further investigation in chronic dialysis patients on high dose heparin.

Kidneys, Artificial↗
PubMed1977

Osmolality changes during hemodialysis. Natural history, clinical correlations, and influence of dialysate glucose and intravenous mannitol.

We studied the influence of both a high-glucose-concentration dialysate (717 mg/dl) and intravenous mannitol (1g/kg) on the serum osmolality changes in stable patients on chronic dialysis. During regular dialysis, serum osmolality fell 10 mosmol/kg H2O. This fall was reduced to 5.2 mosmol/kg H2O when the high-glucose-concentration dialysate was used, and to 4.3 mosmol/kg H2O when intravenous mannitol was used. When the two methods were combined, the serum osmolality fall was reduced to 1.7 mosmol/kg H2O. The clinical signs of disequilibrium declined (from 67% to 10%) in parallel with the decline in serum osmolality changes. This fall was independent of the ultrafiltration rate. A high-glucose-concentration dialysate and intravenous mannitol can each reduce the osmolality changes that occur during hemodialysis, but when used alone, intravenous mannitol is more effective of the two. The reduction of osmolality changes also leads to reduction of the mild clinical signs usually associated with disequilibrium.

Adolescent↗
PubMed1975

The bacteriological quality of hemodialysis solution as related to several environmental factors.

The bacterial concentrations of the municipal water increased by more than 39-fold when subjected to reverse osmosis; then decreased by greater than 200-fold within the reservoir and water supply system of the hemodialysis center. The bacterial concentrations of dialysate solutions in contact with proportioning single-pass artificial kidney machines were as low or lower than the water from the hemodialysis center system (less than 10 CFU/100 ml.). The complete opposite was observed in the recirculating single-pass artificial kidney machines where bacterial concentrations in the dialysate solution reached levels greater than 1.0 X 10(6) CFU/100 ml.

Bacillus↗
PubMedDate not supplied

Antidiuretic hormone regulation in hemodialysis.

The relative influence of stimulation and suppression of osmoreceptors and low and high pressure baroreceptors was studied in 12 patients on hemodialysis. The stimuli were separated by ultrafiltration and dialysis. When high and low baroreceptors were deloaded by volume contraction during ultrafiltration, but there was no change in osmolality, the antidiuretic hormone (ADH) level rose steeply. When osmoreceptors were suppressed, but there was no influence on baroreceptors during dialysis, ADH level declined by the same amount it had increased during ultrafiltration. When osmoreceptors were stimulated by an increase in osmolality in the phase between dialyses, but baroreceptors were loaded by an increase in volume, ADH levels did not change. Others showed that when baroreceptors are stimulated and osmoreceptors suppressed during simultaneous ultrafiltration and dialysis, there is also no change in ADH levels. These results indicate that the hierarchy of receptors regulating ADH is osmoreceptors followed by high and low baroreceptors. Simultaneous stimulation or suppression of both baroreceptors appears equal to the influence by osmoreceptors.

Blood Pressure↗
PubMedDate not supplied

Patient related factors leading to slow urea transfer in the body during dialysis.

We studied the trans compartmental speed of urea transfer by comparing concentration changes of blood urea nitrogen to mass changes of urea during 80 dialyses in six patients. The speed of urea transfer was studied as a dependent factor of 15 patient characteristics: age; gender; fluid overload; and pre and post values of and change in pulse and temperature, calcitonin gene related peptide, and mean arterial blood pressure. Concentration changes in blood urea nitrogen were measured as pre and post dialysis urea concentration, the total urea in the body was measured by pre dialysis urea and tritium total body water determinations, and the actual mass of urea removed by collecting all dialysate. As a mean, concentration of blood urea nitrogen fell 54% but the mass urea removed was only 40% for a mean ratio of 1.41. Nine factors were associated with the speed of urea transfer. Patients with fast transfer had more normal fluid balance, a normal pulse rate, body temperature, calcitonin gene related peptide values, and blood pressure both before and after dialysis. The patients with a slower transfer of urea had a lower blood pressure before and after dialysis and a more labile pulse rate and body temperature. Patients with unpredictable urea transfer were the most edematous and had the most labile blood pressure. It is important to know which patients have slow urea transfer. Such patients should not be treated by fast dialysis, and those with the slowest rates may do particularly well on continuous ambulatory peritoneal dialysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗