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Biomedical subjects

E I Feinstein

Publications and source records attributed to E I Feinstein.

At least 37 records · Page 2Linked to original sources
PubMed1985

Reduced alpha-2-antiplasmin levels in the nephrotic syndrome.

Venous and arterial thromboembolism frequently complicate the nephrotic syndrome. Increased platelet aggregation, high levels of fibrinogen and other procoagulants, and depressed levels of antithrombin III and plasminogen are commonly cited as reasons. Less attention has been paid to changes in the hemostatic system which might protect against thrombosis. We found a high frequency of reduced alpha 2-antiplasmin levels in 40 patients with nephrotic syndrome, correlating with serum albumin and with antithrombin III levels. Since alpha 2-antiplasmin is a major determinant of the sensitivity of fibrin thrombi to lysis, and since reduced levels would be expected to promote fibrinolysis, we conclude that in many patients with nephrotic syndrome depressed antiplasmin levels may help reduce the risk of thrombosis posed by diminished antithrombin III levels.

Antithrombin III↗
PubMed1984

Use of noninvasive laboratory testing in the prediction of thrombosis in the nephrotic syndrome.

A noninvasive method for diagnosing thrombosis in the nephrotic syndrome could be useful clinically. We measured hematocrit, fibrinogen, creatinine, antithrombin III, plasminogen, and alpha-2-plasmin inhibitor levels in 20 patients with nephrotic syndrome objectively studied for the presence of thrombosis, and found that by using combinations of three or more of these variables good discrimination could be obtained between those patients with and without thrombosis. We conclude that it is possible to predict risk of thrombosis in nephrotic syndrome using relatively simple noninvasive laboratory tests.

Antithrombin III↗
PubMed1984

Severe hyperuricemia in patients with volume depletion.

Profound hyperuricemia (19-42 (27 +/- 3.3) mg/dl) was noted in seven adult patients with volume depletion and marked prerenal azotemia (SUN, 155 +/- 30 mg/dl and serum creatinine 5.2 +/- 1.1 mg/dl). The serum level of uric acid returned to normal following the administration of 3.2 +/- 0.4 liters of saline/day over a period of 3.4 +/- 0.6 days. Throughout the course of the illness, there were significant correlations (r = 0.83, p less than 0.01) between the serum levels of both urea nitrogen and creatinine and those of uric acid. Because of the rapid reversibility of this hyperuricemia with hydration, it should be differentiated from other clinical conditions associated with acute renal failure and profound hyperuricemia.

Adult↗
PubMed1984

Serum thyroid hormone indexes in patients with primary hyperparathyroidism.

Serum total reverse triiodothyronine (rT3) levels are normal in patients with renal diseases with and without renal insufficiency but elevated in nonrenal nonthyroidal illnesses. To evaluate the role of secondary hyperparathyroidism of renal diseases in this difference, serum thyroid hormone levels were studied in 27 patients with primary hyperparathyroidism (PHP) and normal renal function. In PHP, total T3 levels were reduced (118 +/- 6 ng/dL, normal: 147 +/- 3 ng/dL) and correlated with PTH levels. Serum rT3 levels were also decreased (27 +/- 3 ng/dL, normal: 34 +/- 2 ng/dL). Values for serum total thyroxine (T4), T3 uptake ratio, free T4 index, and thyrotrophin were not altered. Serum rT3 levels were increased (63 +/- 13 ng/dL) in patients with hypercalcemia due to malignant neoplasms who had low T3 levels, undetectable PTH and normal renal function. Thus, PTH excess may be the factor responsible for the failure of rT3 levels to increase in PHP and secondary hyperparathyroidism.

Adult↗
PubMed1983

Total parenteral nutrition with high or low nitrogen intakes in patients with acute renal failure.

This study was undertaken to assess the clinical and metabolic responses to total parenteral nutrition (TPN) in patients with acute renal failure who could not be nourished adequately through the enteral tract. The TPN provided either about 21 g/day of essential amino acids (EAA) or a larger quantity of essential and nonessential amino acids (ENAA); the ratio of essential to nonessential amino acids in the latter preparation was 1.0:1.0. Attempts were made to give sufficient ENAA nitrogen to equal or slightly exceed the urea nitrogen appearance (UNA). Five patients were randomly assigned to receive TPN with EAA (2.3 g of nitrogen per day) and six patients to receive ENAA (11.3 g of nitrogen per day). Hypotension with trauma or infarcted intestine was the cause of acute renal failure in 10 of the 11 patients. Three of the five patients receiving EAA recovered renal function, and two survived. In the patients receiving ENAA, as compared with those given EAA, UNA was significantly greater (14 +/- 7.4 [SD] vs. 7.5 +/- 3.0 g/day; P less than 0.01), and nitrogen balance, estimated from the difference between intake nitrogen and UNA was slightly, but not significantly, less negative (-3.0 +/- 4.0 vs. -5.2 +/- 2.9 g of nitrogen per day). These preliminary findings suggest that in comparison to TPN with EAA, there is no advantage to larger amounts of ENAA (76 +/- 13 g/day). Studies are indicated to assess whether a multifaced approach using TPN with ENAA and possibly a larger proportion of the branched-chain amino acids, higher energy intakes, anabolic agents, and continuous arterio-venous hemofiltration will improve morbidity and mortality in patients with acute renal failure.

Acute Kidney Injury↗
PubMed1983

Alterations of serum reverse triiodothyronine and thyroxine kinetics in chronic renal failure: role of nutritional status, chronic illness, uremia, and hemodialysis.

ātients with end-stage chronic renal failure (CRF) and those receiving dialysis therapy have normal or decreased serum total T4 (TT4), reduced serum total T3 (TT3), and normal total reverse T3 (TrT3) levels. Those with nonrenal nonthyroidal illnesses or malnutrition have low TT4 and TT3 but elevated TrT3 values. To evaluate the mechanism(s) for the normal TrT3 levels in CRF, we performed intravenous bolus kinetic studies of rT3 and T4 in patients with CRF, in those treated with chronic hemodialysis, in patients with nonrenal nonthyroidal illnesses, and in normal subjects. The CRF patients were selected to have good nutritional status as indicated by normal serum transferrin, relative body weight, and body mass index values. The CRF patients had normal TrT3, TT4, and free T4 values, increased free fraction of rT3, free rT3, and thyroxine-binding globulin levels, and decreased TT3 concentrations. Noncompartmental analysis of the rT3 kinetics indicated normal production rate, reduced cellular clearance rate, and increased pool size and residence time values in both the CRF and nonrenal patients. In CRF, the serum clearance rate was normal, but the fractional rate of exit, permeability, extravascular binding, and the apparent volume of distribution were increased. In contrast, the nonrenal patients had reduced serum clearance rate, permeability, and extravascular binding, whereas the fractional rate of exit and apparent volume of distribution were not significantly altered. The T4 kinetics in CRF paralleled those of the nonrenal patients, with a reduced fractional rate of exit and permeability in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

Clinical and metabolic responses to parenteral nutrition in acute renal failure. A controlled double-blind study.

1. Thirty patients with acute renal failure who were unable to eat adequately were evaluated while they received parenteral nutrition with glucose alone (n = 7), glucose and 21 g/day essential amino acids (EAA, n = 11) or glucose, 21 g/day essential and 21 g/day nonessential amino acids (ENAA, n = 12). Energy intake did not differ with the three treatments. Patients were studied in a prospective double blind fashion. 2. Thirteen patients recovered renal function and 11 survived to leave the hospital. Those in whom renal failure was attributed to hypotension and/or sepsis had a poorer recovery of renal function (17%) and survival (17%). Recovery of renal function and survival was greater in patients on the medical service as compared to the surgical service and in those who received more energy. Recovery of renal function was worse in those treated with dialysis. There were no differences in recovery of renal function of survival among the three treatment groups. 3. Many patients were markedly catabolic as indicated by nitrogen balances, urea in nitrogen appearance rates (UNA), serum protein concentrations, and plasma amino acid levels. There was no correlation between the degree of catabolism and recovery of renal function or survival. Mean UNA in individual patients also correlated with body weight. Among the three groups, however, UNA was significantly less with the group receiving EAA as compared to ENAA. 4. Serum protein concentrations were lower than normal in all treatment groups. Serum albumin fell significantly during the treatment in the more catabolic patients. Plasma amino acid levels tended to fall in all three groups and concentrations at the end of the treatment were frequently lower than normal. 5. These data suggest that acute renal failure patients who are unable to eat adequately are often hypercatabolic and have a high mortality, particularly if hypotension or sepsis is the cause of renal failure. The improved survival in those with higher energy intakes, the high rate of net protein breakdown, the low serum protein levels and the reduced plasma concentrations of both essential and nonessential amino acids suggest that greater quantities of energy and both essential and nonessential amino acids may be beneficial to such patients.

Acute Kidney Injury↗
PubMed1981

Alterations of thyroid hormone indices in acute renal failure and in acute critical illness with and without acute renal failure.

The present study evaluated thyroid hormone indices of patients with acute renal failure without other systemic illnesses (n = 12), as compared to patients with critical illnesses in the presence (n = 16) and absence (n = 6) of acute renal failure. Abnormalities in the group with acute renal failure alone included decreased serum levels of total T4 and T3, and elevated levels of free rT3. Serum levels of free T4 by equilibrium dialysis and the enzyme immunoassay, T3 uptake ratios, TSH and total rT3 were normal. These findings are consistent with the presence of decreased binding of T4 and rT3 to their serum carrier proteins. Critically ill patients with acute renal failure differed in that they had lower total T4 and T3 levels and elevated T3 uptake ratio values. As in the group with acute renal failure alone, total rT3 levels were normal and free rT3 values were elevated. The group with critical illness alone differed only in that the total rT3 concentrations were elevated in all patients. The alterations of thyroid hormone indices in acute renal failure are similar to those of other nonthyroidal illnesses with the exception of the normal total rT3 levels. This suggests that the failing kidney or the metabolic consequences of uremia specifically affect rT3 metabolism.

Acute Kidney Injury↗
PubMed1981

Delayed hypercalcemia with acute renal failure associated with nontraumatic rhabdomyolysis.

Delayed hypercalcemia developed in two patients with acute renal failure and rhabdomyolysis. In patient 1, the hypercalcemia appeared 14 days after the beginning of the diuretic phase of the illness and was associated with severe diastolic hypertension and soft-tissue calcification, including the lungs and skeletal muscles. The blood levels of 25-hydroxyvitamin D (25OHD3) were elevated during the hypercalcemia and decreased to normal when the patient became normocalcemic. In patient 2, the hypercalcemia occurred 55 days after the start of the diuretic phase and at a time when renal function was normal.

25-Hydroxyvitamin D 2↗
PubMed1980

Charcoal sorbent-induced hypolipidemia in uremia and diabetes.

Rats with hyperlipidemia associated with streptozotocin-induced diabetes or azotemia after subtotal nephrectomy were administered a diet containing 5% activated charcoal. Significant lowering of nonfasting serum cholesterol and triglyceride levels resulted. Charcoal-feeding also altered the abnormal high density lipoprotein electrophoresis pattern of diabetic rats toward normal.

Animals↗