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Biomedical subjects

C Ponticelli

Publications and source records attributed to C Ponticelli.

At least 253 records · Page 14Linked to original sources
PubMed1981

Prevention of calcium nephrolithiasis with low-dose thiazide, amiloride and allopurinol.

We report 5 years' experience with low-dose hydrochlorothiazide, 50 mg/day and amiloride, 5 mg/day, in 519 patients with recurrent calcium nephrolithiasis. Additional treatment with allopurinol, 100 mg/day was prescribed for approximately 50 percent of the patients. All patients had active stone formation, having 3,464 stones in 3,126 patient-years (6.67 stones per patient, 1.10 stones per year). Hypercalciuria was present in 65 percent of the patients and hyperuricosuria in 24 percent. The administration of low-dose hydrochlorothiazide was effective in reducing urinary calcium excretion in most patients. It is possible that the hypocalciuric effect of hydrochlorothiazide were enhanced by amiloride, an agent which has been shown to cause hypocalciuria when given alone. Significant side effects requiring discontinuation of the drug were observed in only 5 percent of the patients. During 872.8 patient-years of treatment, only 53 new stones were formed (0.10 stones per patient, 0.06 stones per year) in contrast with the 916 predicted ones. The difference (chi-square) is statistically significant (p less than 0.001). These results show that the administration of low-dose hydrochlorothiazide and amiloride, either alone or in association with allopurinol, is clinically effective in reducing the rate of recurrence of calcium nephrolithiasis.

Adult↗
PubMed1981

Acute renal failure in idiopathic nephrotic syndrome.

In 4 adults with idiopathic nephrotic syndrome an acute renal failure with prolonged anuria has been observed. At renal histology 1 patient showed minimal glomerular changes and 3 showed focal glomerulosclerosis. No vascular abnormalities were seen. In all cases severe tubular lesions with casts and cell debris in the lumina were observed. In 2 patients renal function improved after 3 and 6 months, respectively; the remaining 2 died after several months from the onset of acute renal failure being still anuric. Although the pathogenesis of this complication is unknown, tubular obstruction by proteinaceous casts and vasoconstriction may play an important role. The prognosis of this complication is severe, but the possibility of spontaneous recovery even after protracted anuria cannot be ruled out.

Acute Kidney Injury↗
PubMed1981

Platelet abnormalities in renal transplantation.

Forty-six transplant patients had lower platelet serotonin and higher plasma beta-thromboglobulin (beta-TG) than normal controls. These abnormalities were more pronounced in acute rejection (AR) than in chronic rejection (CR), but were also present in normally functioning transplants (FT). Patients also showed lower serum levels of thromboxane B2 (TxB2) than controls. Plasma fibrinopeptide A (FPA) was higher in AR, but not in CR and in FT, than in controls. Therefore, in renal transplant recipients, platelets continue to circulate after in vivo activation, the abnormalities being roughly proportional to the extent of graft injury. Granule-bound substances secreted into the circulation might produce ischaemia and platelet aggregates, damaging the graft and aggravating the rejection lesions.

Blood Platelets↗
PubMed1981

Factor VIII/von Willebrand factor in glomerular nephropathies.

Levels of factor VIII/von Willebrand factor were measured in 105 patients affected by glomerulonephritis either of primary origin or associated with systemic diseases. The median plasma concentration of factor VIII-related antigen was significantly higher in the patients than in healthy controls. Amongst patients with primary glomerulonephritis, higher levels were observed in minimal change nephropathy than in other types. In patients with secondary glomerulonephritis, plasma factor VIII-related antigen was particularly elevated in lupus nephritis and in renal amyloidosis. Altogether, patients with the nephrotic syndrome showed higher levels than patients with lesser degrees of proteinuria. A negative correlation was found between the plasma concentration of factor VIII-related antigen and that of serum albumin but no correlation was observed with the extent of proteinuria. In 48 patients, plasma factor-VIII procoagulant activity was also measured and found to be elevated to the same extent as factor VIII-related antigen in the majority of cases. The urinary excretion of factor VIII-related antigen, evaluated in 72 patients, was found in variable amounts in 31 cases without any correlation with proteinuria. Glomerular deposits of factor VIII-related antigen were an uncommon finding. After 24 months, there was no clear evidence of an unfavourable association between increased plasma levels of factor VIII-related antigen and the course of the disease. Our findings suggest that the measurement of levels of factor VIII/von Willebrand factor in plasma or urine must be interpreted with caution in predicting the clinical course of patients affected by glomerular disease.

Antigens↗
PubMed1981

Renal disease in essential mixed cryoglobulinaemia. Long-term follow-up of 44 patients.

The mode of presentation of renal disease in 44 patients with essential mixed cryoglobulinaemia (EMC) was: acute renal failure (two patients), acute nephritic syndrome (six patients), nephrotic syndrome (eight patients), proteinuria and/or haematuria (28 patients). Renal biopsy, performed in 35 patients showed proliferative lesions in 33, while only minimal glomerular changes were seen in the remaining two. Immunofluorescence studies showed: IgG (85 per cent), IgA (36 per cent), IgM (90 per cent), C3 (90 per cent), C1q (47 per cent), and C4 (33 per cent) deposits, mainly located in subendothelial position. On electron microscopy, crystalloid structure of deposits and monocyte infiltration of capillary loops were the outstanding feature. The survival rate was 75 per cent at 10 years from the onset of clinical symptoms. Thirty-nine patients were followed for three to 146 months (mean 53.8). Twelve patients died, cardiovascular disease and infection being the commonest cause of death. Thirteen patients showed acute renal failure of acute nephritis syndrome: nine recovered completely, whereas the remaining four died during the acute renal episode. Three patients developed chronic renal failure, but only one period required chronic dialysis. The ominous significance of renal impairment in EMC should therefore be revaluated. The high prevalence of hypertension (28/44 patients) which was refractory to treatment in six, may be important to the clinical outcome.

Adult↗
PubMed1980

[Results of renal transplantation from cadavers in 200 patients].

We report our experience of 202 cadaveric renal transplant performed over a 9 year period. Actuarial patient survival rate was 87.5% at 1 year and 81% at 9 years; graft survival rate was 58.5% at 1 year and 43% at 9 years. In order to improve patient and graft survival, from September 1977 renal transplantation was performed only in patients with a previous careful clinical selection and who had received at least three blood transfusions. Out of 18 patient, actuarial patient and graft survival rate at 1 year were 100% and 76% respectively.

Adolescent↗
PubMed1980

[Prognostic significance of anuric acute rejection].

32 graft rejection episodes requiring dialysis within four days appeared in the first month after transplantation in 224 renal transplants. Our report shows that oliguric renal failure is not related to the severity of rejection but probably to the appearance of an acute tubular necrosis. Therefore graft renal failure requiring dialysis is not necessarily related to a bad prognosis.

Acute Kidney Injury↗
PubMed1980

Acquired dysfunction due to the circulation of "exhausted" platelets.

An acquired platelet functional defect was found to be present in eight patients who presented with various clinical conditions--three with renal allograft rejection, three with the hemolytic uremic syndrome or thrombotic thrombocytopenic purpura, one with acute consumption coagulopathy due to an incompatible transfusion and one with systemic lupus erythematosus. They showed defective platelet aggregation and reduced levels of adenine nucleotides and serotonin with abnormal uptake and storage of the amine. The bleeding time was more prolonged than predicted from the platelet count. These abnormalities were strikingly similar to those occurring in patients with congenital storage pool deficiency. The acquired defect is thought to be related to the presence in the circulation of "exhausted" platelets following their in vivo exposure to inducers of the release reaction such as damaged endothelium, thrombin and immune complexes. The bleeding tendency of the underlying diseases might be aggravated by the impairment of platelet function.

Adenosine Diphosphate↗
PubMed1980

Hemolytic uremic syndrome in adults.

The long-term clinical course of 11 adults with hemolytic-uremic syndrome (HUS) is reported. All patients were treated with heparin and antiplatelet drugs, and ten required dialysis. One patient died after 38 days; the others recovered from anuria after seven to 400 days. One patient was resubmitted to regular dialysis five years later, and another died because of cerebral hemorrhage. Among the remaining eight patients, four show renal failure and four have normal renal function after one to ten years of observation. All but three require vigorous antihypertensive therapy. It is concluded that in adults with HUS (1) recovery may occur even after a prolonged anuria; (2) severe hypertension and progressive renal failure may appear later in apparently recovered patients; and (3) heparin and antiplatelet drugs seem to be beneficial in reversing acute renal failure.

Adult↗
PubMed1980

Reversible acute renal faiure in diffuse scleroderma.

A case of severe hypertension and acute renal failure developing in a 56 year old woman affected by diffuse scleroderma is reported. The patient was treated by peritoneal dialysis, antihypertensive agents and plasma infusions, which led to the correction of arterial hypertension and partial recovery of renal function. This report emphasizes the possibility that the correction of malignant hypertension may prevent progressive renal falure in some patients affected by diffuse scleroderma.

Acute Kidney Injury↗
PubMed1979

Urinary excretion of factor VIII after renal transplantation.

The urinary excretion of factor-VIII-related antigen (VIIIRAg) was measured in 72 patients with kidney transplants and compared with that of two end-products of fibrin-fibrinogen lysis (fragments D and E) to assess their usefulness in monitoring the onset of rejection episodes. Specific and sensitive radioimmunoassays were used to measure the three proteins. Unconcentrated urine samples of 24-hour collections were obtained from 20 healthy subjects, 48 patients with stable transplants, and 24 patients with recent transplants serially followed up from the day of transplantation. Factor VIIIRAg and fragments E and D were not detectable in the urine from healthy subjects but were present in 39%, 60%, and 100% respectively of samples from patients with stable transplants. During 33 acute rejection episodes in 19 patients with recent transplants factor VIIIRAg and fragments E and D were significantly increased above the values observed in patients with stable transplants in 82%, 73%, and 64% of samples respectively; in patients with recent transplants showing no clinical sign of rejection increased excretion of these proteins was observed in 11%, 26%, and 22% of samples respectively. The presence of factor VIIIRAg in urine from patients with kidney allografts suggests that endothelial cell-factor VIII-platelet interactions might pay a key part in the pathogenesis of acute rejection. The results suggest that the assay of factor VIIIRAg in urine is more useful than assays of fragments D and E as a corroborative index of transplant rejection.

Antigens↗
PubMed1979

Multicentre comparative trial of tienilic acid and hydrochlorothiazide in hypertensive patients.

To compare the clinical and metabolic effects of a new diuretic uricosuric agent, tienilic acid, with those of hydrochlorothiazide, a multicentre double-blind trial was performed in 56 hypertensive patients. Twenty-eight patients were randomly assigned to take tienilic acid and 28 to take hydrochlorothiazide. The diuretic and anti-hypertensive actions of the two compounds were similar. No significant differences were observed between tienilic acid and hydrochlorothiazide in their effects on urinary and serum electrolytes, hepatic and renal function tests, and fasting lipids. The patients who received tienilic acid showed a significant fall in serum uric acid, mediated by the uricosuric effect. The availability of an agent combining diuretic, antihypertensive and hypouricemic effects offers promise in the treatment of arterial hypertension.

Adolescent↗