Search PubMed⌕ Search

Biomedical subjects

D J Rainford

Publications and source records attributed to D J Rainford.

At least 19 recordsLinked to original sources
PubMed1996

Mesalazine-associated interstitial nephritis.

BACKGROUND: When used for oral treatment of inflammatory bowel disease, Asacol (a coated form of mesalazine = 5-aminosalicylic acid) can cause interstitial nephritis. The spectrum of severity, frequency of occurrence and the best renal function test to detect this complication are not known. The value of immunosuppression in addition to drug withdrawal is similarly undetermined. METHODS: Four cases of interstitial nephritis which occurred in association with oral Asacol treatment are presented and a further 12 cases who received similar treatment are reviewed. Clinical trials published previously were scrutinized to assess the frequency of impaired renal function. RESULTS: The available evidence suggests that renal impairment of any severity may occur in up to 1 in 100 patients, but that clinically significant interstitial nephritis occurs in less than 1 in 500 patients. This is most reliably detected by an elevated serum creatinine concentration. If the diagnosis of nephrotoxicity is delayed until 18 months after commencement of medication, restoration of renal function, which is seen on withdrawal of medication alone up to 10 months, does not occur and there is no evidence to date to indicate that addition of immunosuppression confers any significant advantage at this later stage. CONCLUSIONS: It is suggested that serum creatinine concentration should be measured each month for the first 3 months of treatment, 3-monthly for the remainder of the first year and annually thereafter. The use of concurrent immunosuppressive therapy may necessitate extension to the period of intensive monitoring. Any elevation of serum creatinine which cannot be related to a relapse of inflammatory bowel disease should prompt immediate withdrawal of Asacol and related medications and substitution of alternative therapy. Neither the lack of urinary abnormalities on routine testing nor the absence of clinical or laboratory features of drug allergy can be relied upon to rule out interstitial nephritis during oral therapy with these drugs.

Administration, Oral↗
PubMed1991

Flexible urethrocystoscopy in nephrological investigation.

Flexible urethrocystoscopy under local anaesthetic was performed on 100 patients as part of their nephrological investigations. This was carried out by a nephrologist, obviating the previous practice of referral to a surgical colleague for rigid instrumentation under general anaesthetic. A pathological diagnosis was made in 69 patients with flexible urethrocystoscopy alone; 17 patients required subsequent rigid cystoscopy to obtain or confirm a diagnosis. Thirty-four patients had normal examinations and of these 13 underwent renal biopsy for diagnosis. Considerable savings in theatre time, man-hours and anaesthetic risk to the patients were made without compromising diagnostic accuracy or patient wellbeing.

Adolescent↗
PubMed1990

Isovolemic hemodialysis combined with hemofiltration in acute renal failure.

One hundred cases of servere acute renal failure managed in the intensive care unit were analyzed to assess the value of isovolemic hemodialysis combined with interdialysis hemofiltration to control fluid balance. Forty-five patients were treated prior to the availability of this technique and 55 subsequently. There was a significant reduction in the oliguric period of survivors in the second group compared with the group treated by intermittent hemodialysis alone (p = 0.0459). The significant difference in age between survivors and deaths observed in the first group (p = 0.0027) was not demonstrated in the second group due to a reduction in the incidence of primarily cardiovascular deaths with an improvement in survival of the elderly.

Acute Kidney Injury↗
PubMed1989

C-reactive protein in acute renal failure.

This paper demonstrates the utility of C-reactive protein (CRP) in the diagnosis of infection in patients with acute renal failure. C-reactive protein can be assayed using plasma as effectively as using serum, thus avoiding the problems of microclots in serum, which can occur in samples from a heparinised patient. Plasma concentrations of C-reactive protein are unaffected by the process of haemodialysis. In the complicated setting of the severely ill patient with acute renal failure, infection remains the most common cause of death and its detection is often difficult. The use of C-reactive protein assay in this setting is illustrated by data from 20 patients, and two representative cases are described in detail. It is recommended that C-reactive protein be assayed daily to aid in the detection of infection in patients with acute renal failure.

Acute Kidney Injury↗
PubMed1989

Proteinuria--what value is the dipstick?

The value of the urinary dipstick in the assessment of proteinuria was investigated in a study correlating laboratory measurements of protein and albumin against the dipstick protein in the same samples of urine; 94 patients (100 admissions) were studied at the Royal Air Force Renal Unit, each patient collecting two 24-h urine samples. Along with each 24-h sample, 10-ml aliquots of urine were obtained at 3 designated times during the day for both ward dipstick testing and laboratory assay; + or more on the dipstick correlated with abnormal proteinuria (greater than or equal to 150 mg/24 h) in 88% of cases, whilst trace values straddled the level of significant proteinuria. Further differentiation of trace was possible by repeat testing during the day. The subsequent presence of a dipstick negative during that day correlated with normality in all but 5% of cases. In order to ensure detection of renal disease presenting as isolated orthostatic proteinuria, assay of the mid-morning sample is recommended.

Adolescent↗
PubMed1988

Acute acalculous cholecystitis in acute renal failure.

Acute acalculous cholecystitis developed in 16 of 92 patients with acute renal failure who had no prior or coincidental biliary tract disease. The cause of this complication is considered to be multifactorial. Risk factors include sepsis, previous surgery, trauma, total parential nutrition, intermittent positive pressure ventilation, opiate sedation, multiple transfusions and hypotension. One patient had 5 risk factors, 15 had 6 or more. Diagnosis was based on clinical suspicion, serial ultrasound scanning and serial estimations of white cell count, liver function and C-reactive protein. Four patients were treated conservatively with antibiotics and ultrasound observation, 10 underwent cholecystotomy and 2 patients had cholecystectomy. Eleven patients survived (69% survival). No patient treated by cholecystotomy required further surgery to the biliary tract. Acute acalculous cholecystitis has become a significant complication in our "high risk" acute renal failure population as intensive care has advanced and patients are surviving longer. Prompt and appropriate treatment will prevent it contributing significantly to the already high mortality of acute renal failure. Anticipation is the watchword.

Acute Disease↗
PubMed1987

Emphysematous gastritis after acute pancreatitis.

A case of emphysematous gastritis associated with extensive gastric infarction after acute pancreatitis and acute renal failure is described. This complication was diagnosed on a plain abdominal radiograph and confirmed endoscopically. Extensive gastric and hepatic infarction was seen at necropsy.

Acute Disease↗
PubMed1986

High altitude haemofiltration.

Evacuating people in acute renal failure by air is difficult because the hazards of fluid overload and anaemia are potentiated by altitude. In two such patients continuous arteriovenous haemofiltration was used to control their fluid problems during aeromedical evacuation. In the first case, a patient with renal failure and blast lung, haemofiltration was performed at 500 ml/h over a four hour journey; in the second, a woman with severe pre-eclamptic toxaemia who developed acute renal failure after caesarean section, haemofiltration was performed at 200 ml/h over a 14 hour flight. Both patients recovered fully. In these two cases haemofiltration permitted control of the intravascular volume during aeromedical evacuation. The technique represents a major advance in the safe transfer of casualties.

Acute Kidney Injury↗