From 1965 to 1981, 9 out of 346 patients treated by chronic hemodialysis or kidney transplants had tumours of the lower urinary tract. All the tumour patients belonged to the analgesic abusers group (n = 87). The frequency of urinary tract tumours in this analgesic abusers group does not differ from the frequency in analgesic abusers in general (about 10%). In the 9 analgesic abusers a total of 18 urothelial tumours were recorded: 4 tumours of the renal pelvis, 3 of the ureter and 8 tumours of the urinary bladder. One female patient had a tumour of the urethra. Diagnostic and therapeutic problems are discussed on the basis of two case histories. Our experience in recent years is summarized in a program for tumour-screening, diagnosis and therapy for analgesic abusers treated by dialysis and kidney transplantation.

Carcinoma, Squamous Cell↗

PubMed1982

[Netilmicin in refractory urinary tract infections. Good therapeutic effect in spite of long dosage intervals].

Aminoglycoside antibiotics are useful--despite potential toxicity--for treating urinary tract infection when other antibacterial agents have failed to eradicate bacteriuria. That this is true of the recently introduced aminoglycoside netilmicin was shown by 16 cases of tenacious and frequently recurring urinary tract infection. In contrast to previous recommendations, but relying on well known pharmacokinetic data which show prolonged urinary excretion of aminoglycosides, netilmicin was administered according to the following dosage schedule: Intramuscular injections of 3 mg/kg in cases where renal function was unimpaired, and of 2 mg/kg where it was reduced, were administered at dosage intervals of 1 to 4 days. Peak serum levels of netilmicin measured 1 hour after intramuscular injection were within the expected range of 8-14 micrograms/ml (3 mg/kg) and 6-10 micrograms/ml (2 mg/kg). As a result of the long dosage intervals the serum trough levels were usually far below 1 microgram/ml except in patients with moderate renal failure. Urinary concentrations of netilmicin, however, remained for the most part above the limit of antibacterial activity throughout the dosage intervals of 1 to 4 days. One week after the usual three weeks treatment course, urinary concentrations were still between 1 and 5 mcg/ml, and slowly decreasing amounts of the drug could be detected at least in traces up to 3 months beyond the last dose. Considering the type of urinary tract infections selected to receive netilmicin, the response to treatment was satisfactory and seemed unaffected by the long dosage intervals. Bacteriological cure was achieved in 5 of 11 infections associated with chronic pyelonephritis or analgesic nephropathy and in 4 of 5 urinary infections in patients with renal transplants. Treatment failures could be accounted for by obstructive lesions, stones, and in one transplanted patient by infection localized to her own shrunken kidneys. No instance of ototoxicity or nephrotoxicity due to netilmicin could be detected. Netilmicin administered according to the dosage schedule described can be recommended for ambulatory treatment of tenacious, recurring urinary tract infections due to gram-negative bacteria and refractory to cure by the usual oral antibiotic therapy.

Drug Administration Schedule↗

PubMed1982

Morphology of the renal medulla in ischemic acute renal failure in the rat.

In the initial phase of ischemic acute renal failure in the rat the outer medulla is characterized by widening of peritubular capillaries in the inner stripe and by accumulation of cytoplasmic blebs in dilated proximal straight tubules in the outer stripe. Both findings contribute to tubular obstruction. In the maintenance phase, outer and inner stripes show tubular necrosis mainly of proximal straight tubules and thick ascending loops of Henle. In both phases the papilla is apparently spared from damage. Protective measures act at least partly by prevention of peritubular capillary widening in the inner stripe of outer medulla.

Acute Kidney Injury↗

PubMed1982

Superficial nephron obstruction and medullary congestion after ischemic injury: effect of protective treatments.

90 min of renal artery occlusion in previously unilaterally nephrectomized rats produce acute renal failure (ARF) (plasma creatinine at 48 h after ischemia: 636 +/- 44 vs. 133 +/- 9 mumol/l in controls). Between 1 and 48 h after releasing the occlusion, two populations of superficial nephrons could be observed, one with dilated tubules and elevated proximal tubular pressures (PTP: 39 +/- 1 vs. 12 +/- 1 mm Hg in controls) and the other with collapsed tubules and decreased PTP (9 +/- 1 mm Hg). Proximal tubular passage time (PPT) could not be determined with the Lissamine green technique. Seven methods of pretreatment were tested, 5 of which provided partial functional protection (DOCA/NaCl/NaCl, furosemide infusion, inosine bolus, mannitol bolus and the combination of the last two). Neither renal renin levels nor urinary NaCl excretion were consistently correlated with protection. Functionally protected rats consistently showed no PTP increase and normal PPT in the tubules at the kidney surface. However, plasma creatinine at 48 h differed markedly within the 5 protected groups, ranging from 168 +/- 18 to 398 +/- 35 mumol/l. Extensive medullary congestion was seen at 1-6 h after ischemia only in those rats with obstructed, high pressure nephrons at the kidney surface. To conclude: (1) Functional protection from ischemic ARF, both with and without an accompanying increase in solute excretion, was achieved by the abolition of tubular obstruction. (2) Despite similar degrees of restoration of superficial nephron function, the persisting impairment of whole kidney function differed markedly between the protected groups. (3) Impairment of deeper nephron function must therefore play a major role, perhaps through persisting obstruction in the long loops of Henle. (4) High pressure nephrons may compromise medullary venous outflow in the outer zone of the outer medulla.

Animals↗

PubMed1982

Re: the use of magnesium-containing phosphate binders in patients with end-stage renal disease on maintenance haemodialysis.

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Humans↗

PubMed1982

Hgcl2-induced acute renal failure in the rat. Effect of water diuresis, saline loading, and diuretic drugs.

A variety of pretreatment-treatment protocols were applied to rats with ARF induced by the subcutaneous injection of 6 mg of HgCl2 per kilogram body weight. Renin depletion induced by DOCA-saline pretreatment was associated with protection against HgCl2-induced ARF only when the saline diuresis was maintained by drinking 1% NaCl after injury. Twenty-four dehydration followed by free access to tap water annihilated the protective effect of DOCA-saline pretreatment despite maintained depletion of renal renin. Continuous intravenous loading with saline and furosemide, although increasing renal renin levels, afforded as much protection as saline loading alone. Ethacrynic acid, which did not increase salt excretion in our rats, as well as water diuresis, failed to be protective. A loose correlation was found between he amount of histological damage to the convoluted parts of the proximal tubules and the degree of renal functional impairment. Thus protection against HgCl2-induced ARF was independent of the renal renin level but closely related to urinary NaCl excretion after the injury. Saline diuresis could act by relieving or preventing tubular obstruction.

Acute Kidney Injury↗

PubMed1982

Dialysis treatment and psoriasis in Europe.

One hundred and fifty out of 944 European dialysis centers reported experience with patients suffering from psoriasis. Ninety-three centers returned special questionnaires on 97 patients with end stage renal failure (ESRF patients) and on 49 patients dialyzed for psoriasis but who had normal renal function (NRF patients). Improvement of skin disease was reported in 17 out of 27 NRF patients according to both "objective criteria" and the patients' personal opinions. However, most of these patients had been on dialysis for less than one year (9.9 +/- 11.1 months) which is too short to allow for the spontaneous recurrence of psoriasis. In contrast, 60% of ESRF patients had been on dialysis for 45 +/- 3.1 months. Skin disease definitely improved in 20% of these patients after commencement of dialysis. This proportion is greater than the expected spontaneous long-term remission of psoriasis.

Adult↗

PubMed1981

Gentamicin-induced acute renal failure in the rat. Effect of dehydration, DOCA-saline and furosemide.

Acute renal failure was induced in rats by subcutaneous injection of 200 mg/kg body weight gentamicin on 3 consecutive days. Following the last gentamicin injection, the animals began to produce increased amounts of dilute urine and usually remained polyuric throughout the experimental period which lasted up to 2 weeks. Plasma concentrations of creatinine rose to values between 2 and 10 mg%, of urea to values between 100 and 1,000 mg% 5-7 days after the last gentamicin injection and returned to levels slightly above control after 14 days. Average proximal tubular pressure was slightly elevated to 13.7 +/- 0.5 mm Hg on the 2nd day after the last gentamicin dose, decreased to 6.1 +/- 0.4 mm Hg after 1 week, and returned to 11.8 +/- 0.2 mm Hg after 2 weeks (control proximal tubular pressure 11.6 +/- 0.2 mm Hg). These average values hide the fact that early in this model of gentamicin-induced acute renal failure many tubules had proximal tubular pressures increased to values between 18 and 25 mm Hg, suggesting tubular obstruction. Decreased proximal tubular pressures and the histological finding of wide-spread necrosis of proximal convolutions is suggestive of tubular leakage. Dehydration, similarly to other models of acute renal failure, markedly potentiated gentamicin-induced acute renal failure. Salt diuresis induced either by DOCA-saline or by furosemide failed to afford functional protection and increased the degree of morphological damage. No relation was found between the concentration of gentamicin in renal tissue and the degree of functional or morphological impairment.

Acute Kidney Injury↗

PubMed1981

Malignant diseases in patients treated by dialysis and transplantation in Europe.

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Adult↗

PubMed1981

[Cadaveric kidney transplantation in patients over 55 years].

The progress of 24 patients aged over 55 who received kidney transplants from dead bodies is compared with that of 42 recipients aged under 55. The functioning of the transplants and mortality do not differ in the two groups 3 and 12 months after transplantation. However, in the group of older transplant patients we found a high incidence of analgesic nephropathies, twice as many associated cardiac complications and an increased incidence of tumours. It seems no longer justifiable to withhold such kidney transplants from patients over 55 on grounds of age.

Adult↗

PubMed1981