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Biomedical subjects

D Adu

Publications and source records attributed to D Adu.

At least 145 records · Page 8Linked to original sources
PubMed1983

Hyperkalaemia in cyclosporin-treated renal allograft recipients.

Mean serum potassium levels were significantly higher for 9 months in renal allograft recipients receiving cyclosporin than in those receiving prednisolone and azathioprine. Sustained hyperkalaemia (serum potassium 6.0-7.1 mmol/l) inappropriate for their renal function (glomerular filtration rate 21-36 ml/min) developed in seven of forty-three cyclosporin-treated patients. All seven patients had hyperchloraemic acidosis; four were able to acidify their urine to pH less than or equal to 5.4. Six of the seven patients were hypertensive and receiving beta-blockers; one had had bilateral nephrectomy. Despite hyperkalaemia, plasma aldosterone levels were within the normal range in five patients and raised in two. During moderate sodium restriction, plasma renin activity was low or low-normal in five of the seven patients. In these patients a combination of hypoaldosteronism and renal tubular damage leading to a tubular defect of potassium and hydrogen ion secretion is the apparent cause of the hyperkalaemia and hyperchloraemic acidosis. Hyporeninaemia caused by beta-blockade probably blunts the aldosterone response to hyperkalaemia, thereby worsening it.

Acidosis↗
PubMed1983

Rapid diagnosis of obscure pneumonia in immunosuppressed renal patients by cytology of alveolar lavage fluid.

16 episodes of pneumonia of obscure origin in 15 immunosuppressed renal patients were investigated without complication by fibreoptic bronchoscopy with alveolar lavage under local anaesthesia. Cytological examination and culture of lavage fluid produced a rapid definitive diagnosis in 15 episodes of pneumonia caused by infections with Pneumocystis, fungi, tuberculosis and staphylococci, or by pulmonary haemorrhage. This led to successful treatment of 10 of the 13 infective episodes.

Adult↗
PubMed1983

High versus "low" dose corticosteroids in recipients of cadaveric kidneys: prospective controlled trial.

Corticosteroids have the major role in the immunosuppressive treatment of patients who have received renal transplants. Despite their extensive use there is still debate about the appropriate dose that will prevent rejection of the renal allograft with the least morbidity. From March 1979 to November 1981 a randomised controlled trial of high (33 patients) v low oral dose (34 patients) of prednisolone along with azathioprine was conducted in recipients of first cadaveric transplants who had received a blood transfusion within six months of transplantation. The main difference in outcome between the two groups was a high incidence of some infections in the high dose group. Patient mortality, graft survival, transplant function, and number of rejection episodes were indistinguishable in the two groups, but rejection episodes tended to occur later in the high dose group. These findings suggest that the use of lower doses of corticosteroids soon after cadaveric renal transplantation does not jeopardise graft survival and results in lower patient morbidity.

Adolescent↗
PubMed1983

Renal and pancreatic transplantation in the treatment of diabetic renal failure.

Twenty-two diabetic patients with renal failure have entered an integrated dialysis and transplant programme in 30 months. Ten have subsequently undergone combined renal and segmental pancreatic transplantation, and have been followed for between one month and 25 months. Currently 80 per cent of the kidneys and 40 per cent of the pancreatic grafts are functioning. Four of the 22 patients have died from myocardial disease. Pancreatic transplantation at the time of renal grafting in diabetics does not significantly increase morbidity, and currently offers a 40 per cent chance of freedom from exogenous insulin. The successful treatment of diabetic renal failure is not compromised by the addition of this developmental procedure.

Adolescent↗
PubMed1983

Late onset systemic lupus erythematosus and lupus-like disease in patients with apparent idiopathic glomerulonephritis.

We report 17 patients who presented with either apparent idiopathic glomerulonephritis (16 patients) or post-streptococcal glomerulonephritis (one patient). Doubts arose about the nature of these patients' disease, either because their initial renal histology was suggestive of systemic lupus erythematosus (SLE) in the absence of its clinical or serological features, or because they developed with time the clinical or serological features of SLE. Three patients had a positive antinuclear antibody (ANA) test at the onset of their illness, but normal levels of serum binding of double-stranded DNA (dsDNAB). In another four patients the dsDNAB was slightly raised but with a negative ANA. On renal biopsy the predominant appearance was membranous glomerulonephritis (GN) in 10, subendothelial mesangiocapillary GN (MCGN) in three, and focal segmental glomerulosclerosis in two; one patient each had a focal proliferative GN and a diffuse endocapillary GN. On 1 micron renal sections stained with toluidine blue, 10 patients had immune deposits at multiple sites within the glomeruli. Over a period of one to 14 years, six patients developed extrarenal features suggestive of SLE, nine a positive ANA, and 12 increased serum levels of dsDNAB. Five patients became hypocomplementaemic. Cryoglobulins were isolated from the sera of 10 out of 12 patients; seven contained DNA. Separated cryoglobulin IgG from eight patients showed antibody activity directed against both ss and dsDNA in four, and against dsDNA only in three. On the basis of the clinical, histological and serological observation during follow-up five patients were reclassified as definite SLE, four as probable SLE and two as possible SLE. Rarely, SLE may present with nephritis as the sole disease manifestation, antedating other clinical features and even immunological markers of the disease by years. In addition, some patients with a glomerulonephritis may show clinical and immunological, or histological features of SLE, but do not fit accepted definitions of the disease.

Adolescent↗
PubMed1982

Vascular access for haemodialysis for renal failure in a developing country.

One thousand two hundred and thirty-five haemodialyses have been performed on 92 patients with renal failure. The mean number of dialyses per patient was 13.42 and the survival rate was 60.9%. One hundred and six arteriovenous shunts (98 of arm, 7 of ankle, and one of groin) were created. Three arteriovenous fistulae of arm were created in 2 patients with chronic renal failure. All the operations were performed under local or regional block anaesthesia. The mean shunt complications were clotting (27.4%), bleeding (17.9%) and infection (13.2%). The complications associated with the fistulae were non-function, heart failure, infection, aneurysmal dilatation and bleeding. One death from heart failure was attributable to arteriovenous fistula. It is recommended that patients with renal failure requiring haemodialysis in developing countries should have shunts or fistulae created under regional anaesthesia to avoid the problems of general anaesthesia in uraemic patients.

Acute Kidney Injury↗
PubMed1982

Lupus Nephritis.

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Adult↗
PubMed1982

Anti-ssDNA and antinuclear antibodies in human malaria.

The incidence of serum antinuclear antibodies and serum antibodies to single stranded (ss) and double stranded (ds) DNA was investigated following acute malaria in 58 Caucasians visiting tropical countries but resident in Britain and in 24 Ghanaians resident in Ghana. In Caucasians this infection was associated with a significant increase in the incidence of speckled antinuclear antibodies (38% compared to 3% in controls; P less than 0.001) and a significant rise in antibody levels against ssDNA (14% compared to 5%; P less than 0.05), but no rise in antibodies against dsDNA. Acute malaria in Ghanaians was associated with an incidence of 25% of antinuclear antibodies and 4% of antibodies to ssDNA; these were similar to those found in healthy Ghanaians who are chronically exposed to malaria. Antibodies against dsDNA were not detected. The incidence of antinuclear antibodies and levels of anti-ssDNA antibodies was higher in the Ghanaian healthy population than in normal Caucasians. These observations indicate that malaria is associated with the development of antinuclear and anti-ssDNA antibodies. Ghanaian patients with a tropical splenomegaly syndrome or with a nephrotic syndrome, both of which conditions are suspected of having a malarial aetiology, had serum levels of anti-ssDNA higher than healthy controls. This observation adds further circumstantial evidence to the role of malaria in causing anti-DNA antibodies.

Adult↗
PubMed1981

DNA-anti-DNA circulating complexes in the nephritis of systemic lupus erythematosus.

In order to determine whether circulating antigen-antibody complexes in systemic lupus erythematosus (SLE) consist of DNA and anti-DNA, cryoglobulins were isolated from the sera of 38 patients with SLE nephritis and analysed for DNA and anti-DNA. Cryoglobulins were detected in 36 of the 38 sera, and DNA was found in 30 of 33 examined by either fluorescence of ethidium bromide or a radioimmunoassay. Anti-DNA activity was not detectable in any of the whole cryoglobulins but anti-IgG activity was found in 17. Twenty cryoglobulins were therefore treated by acid dissociation and ultracentrifugation to obtain isolated immunoglobulins; IgG was isolated from all, and IgM from eight. Using a modified Farr assay to detect anti-dsDNA and an enzyme-linked immunoadsorption assay to detect anti-ssDNA, anti-dsDNA activity alone was found in five IgG fractions, anti-ssDNA activity alone in five, and both anti-ds- and anti-ssDNA activity in four. Anti-dsDNA activity was found in three of the IgM fractions. In all, anti-dsDNA activity was found in nine of these 20 cryoglobulins, and anti-DNA in 14. Analysis of these 14 cryoglobulins with anti-DNA Ig fractions showed that there was enrichment of the IgG anti-DNA activity in the cryoglobulin compared to the patient's serum in all but two cases. In six of the 20 cryoglobulins studied there was no detectable anti-DNA activity in isolated IgG or IgM fractions. We therefore concluded that DNA-anti-DNA complexes were present in most of our patients with SLE nephritis, but there was clearly a substantial minority in whom they were undetectable. In some of the latter who also had active disease the cryoglobulins had anti-IgG activity. Thus it would seem that SLE can occur in the absence of DNA-anti-DNA complexes, but with other complexes present. DNA was also found in cryoglobulins isolated from patients with idiopathic glomerulonephritis, but, in contrast to recent reports, anti-DNA activity was not detectable in immunoglobulins isolated from their cryoglobulins.

Adult↗
PubMed1981

The nephrotic syndrome in Ghana: clinical and pathological aspects.

Clinical and pathological features of the nephrotic syndrome were studied in 36 adults and 25 children in Ghana. No evidence was found to implicate Plasmodium malariae as a cause and in the majority of patients the aetiology was not identified. Minimal change glomerulonephritis responsive to steroids was demonstrated in 14/25 children and 5/36 adults which was surprising as this lesion has been reported only rarely from tropical Africa. The other major histological lesions were focal segmental glomerulosclerosis (12/61), diffuse proliferative glomerulonephritis (11/61) and membranous glomerulonephritis (9/61).

Adolescent↗
PubMed1980

Circulating DNA-anti-DNA complexes in lupus nephritis and idiopathic nephritis.

Although DNA and anti-DNA antibodies have been eluted from diseased tissues in systemic lupus erythematosus (SLE) it is uncertain whether DNA and anti-DNA comprise circulating antigen-antibody complexes in SLE. Cryoglobulins from 20 patients with SLE were examined for (i) DNA, using a radioimmunoassay and an ethidium bromide assay, (ii) anti-DNA activity of IgG and IgM, isolated from the cryoglobulins by ultracentrifugation at pH 3.5, by a modified Farr assay (anti-dsDNA) and a solid phase ELISA (anti-ssDNA). DNA was found in each of the 20 cryoglobulins by both methods. Isolated IgG had anti-DNA activity in 14 cryoglobulins: 5 anti-dsDNA, 5 anti-ssDNA and 4 anti-ds- and ssDNA; isolated IgM had anti-dsDNA activity in 3 cryoglobulins. Isolated IgG/IgM had no anti-DNA activity in 6 of the 20 cryoglobulins. In controls with idiopathic nephritis (11 membranous, 13 mesangio-capillary) DNA was detected in cryoglobulins, but no ati-DNA activity was found. It is concluded that circulating dsDNA-anti-dsDNA complexes are present in SLE, but some patients have SLE without these complexes. Our failure to find dsDNA-anti-dsDNA complexes in nephritis not due to SLE indicates the specificity of such complexes for SLE.

Antigen-Antibody Complex↗
PubMed1978

Plasma potassium in hypertensive Africans on frusemide.

The effects of potassium chloride (as Slow-K 600 mg three times daily) and spironolactone (as Aldactone A 25 mg four times daily) were compared in hypertensive African patients on frusemide. Mean plasma-potassium levels in patients on frusemide plus Slow-K and frusemide plus Aldactone-A rose from 3.6 to 3.8 mOsm/L whilst on frusemide alone mean plasma-potassium fell from 3.7 to 3.6 mOsm/L. The mean blood pressure, both systolic and diastolic, was significantly reduced in the frusemide plus Aldactone-A group when compared with patients on frusemide alone or on frusemide plus Slow-K.

Adult↗
PubMed1976

Acute renal failure in tropical Africa.

Between 1972 and 1975, 55 adult patients with acute renal failure were admitted to the renal unit of Korle Bu Hospital. Fourteen patients died, giving an overall death rate of 25%. Massive intravascular haemolysis after a short febrile illness was the commonest cause of acute renal failure. Clinically these patients presented with blackwater fever but in only one could Plasmodium falciparum malaria be confidently diagnosed. In half the patients various bacterial and viral infections (especially typhoid) could be incriminated as causing this blackwater fever syndrome. The incidence of glucose-6-phosphate dehydrogenase deficiency was 22.5%, but we could not confirm the impression of a greater predisposition to acute renal failure in patients with this enzyme defect.

Acute Kidney Injury↗
PubMed1975

Acute renal failure and typhoid fever.

Over a two-year period, out of 40 adult Ghanaians admitted to the renal unit of Korle Bu Hospital with acute renal failure, 6 (15%) had typhoid fever. During this period approximately 500 cases of typhoid were admitted to this Hospital. Prominent features in these cases were a blackwater fever syndrome and leucocytosis. These features in a patient with typhoid should suggest the possibility of complicating acute renal failure. Three patients showed a deficiency of glucose-6-phosphate dehydrogenase (G-6-P.D.) in their red blood cells. It is suggested that typhoid is likely to be an important cause of acute renal failure in areas where it is endemic and G-6-P.D. deficiency common.

Acute Kidney Injury↗
PubMedDate not supplied

The treatment of diabetic renal failure by continuous ambulatory peritoneal dialysis.

During the 6-year period 1981-1987, 309 patients started chronic ambulatory peritoneal dialysis (CAPD), of whom 75 (24%) had diabetes. Despite severe peripheral vascular problems (20%), ischaemic heart disease (90%), and complete blindness (21%) the 1-year patient survival on CAPD was 88%. The actuarial patient survival for diabetic patients was similar to that of the non-diabetic cohort over the first 18 months but fell to 48% (compared to 70% in non-diabetic patients) at 3 years. Complications associated with CAPD, including the incidence of peritonitis, were no different between the diabetic and non-diabetic patient populations. Successful treatment for end-stage renal disease (ESRD) in diabetic patients can be achieved and justified in a liberal selection programme for the treatment of diabetic ESRD.

Adult↗