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Biomedical subjects

G B Appel

Publications and source records attributed to G B Appel.

At least 73 records · Page 4Linked to original sources
PubMed1983

Focal segmental membranous glomerulonephropathy associated with other glomerular diseases.

In four patients with the nephrotic syndrome, renal biopsy revealed focal segmental membranous glomerulonephropathy (FSMGN) associated with the histologic patterns of "nil" disease (two cases), hereditary nephritis and diffuse diabetic glomerulosclerosis. The occurrence of FSMGN in association with other glomerular diseases, presumably unrelated to immune complex deposition, is infrequent in our experience. Rather than necessarily representing an early stage or milder form of membranous glomerulonephropathy, it may be an epiphenomenon. This interpretation has prognostic and therapeutic implications and raises important pathogenetic questions. In particular, this study suggests that in some instances, preexisting functional and structural abnormalities may play a role either in the deposition of preformed circulating immune complexes or in the local formation of immune complexes.

Adolescent↗
PubMed1983

Pharmacokinetics of ceftriaxone in patients with renal failure and in those undergoing hemodialysis.

The pharmacokinetic parameters of ceftriaxone in eight patients with end-stage renal disease were determined during dialysis and during the interdialysis period. The mean half-life, clearance, and apparent volume of distribution during dialysis were 16 h, 722 ml/h, and 16.7 liters, respectively. During the interdialysis period, the half-life was 14 h, clearance was 739 ml/h, and volume of distributions was 14 liters. Individual variability in plasma concentrations occurred even in patients with apparently normal hepatic function. Based on these parameters, a dose of 1 g every 24 h would yield concentrations in excess of the concentrations needed to inhibit most gram-positive and gram-negative aerobic species.

Adult↗
PubMed1981

Wegener's granulomatosis - clinical-pathologic correlations and long-term course.

Although Wegener's granulomatosis is a relatively well defined clinical-pathologic entity, there are few long-term reports of large numbers of patients followed at a single institution. This has hindered appreciation of the diagnosis, management, and course of the syndrome. We report an analysis of 18 patients followed at one medical center. Delay in treatment can be obviated by awareness of this potential diagnosis in any patient with combined respiratory and renal manifestations. Biopsy of involved respiratory tissue yields a high probability of establishing a specific diagnosis, while biopsy of renal tissue often provides confirmatory evidence of a vasculitic disease process. The initial degree of renal involvement as manifested by serum creatinine, proteinuria, and light microscopic morphology correlates well with eventual prognosis. The availability of modern immunosuppressive therapy and of modalities to treat end-stage renal disease appears to have greatly influenced the course of the disease.

Adult↗
PubMed1981

Acute interstitial nephritis due to amoxicillin therapy.

Acute interstitial nephritis (AIN) has been reported in association with therapy with a number of drugs. We report a patient who developed drug-related AIN while receiving intravenous amoxicillin therapy. The patient developed rash, secondary temperature elevation, and eosinophilia in association with nonoliguric renal failure. Renal biopsy showed evidence for AIN and the renal failure was responsive to corticosteroid therapy. AIN may occur in patients receiving any drug of the penicillin class. This reversible form of acute renal failure must not be overlooked in patients with other forms of renal disease.

Acute Disease↗
PubMed1979

Kinetics of intravenous amoxicillin in patients on long-term dialysis.

The kinetics of intravenous amoxicillin was studied in 8 patients with creatinine clearances of less than 7 ml/min who were on long-term hemodialysis. Kinetic parameters were determined using a 2-compartment linear model. The serum half-life (t1/2) of amoxicillin in these patients ranged from 7.5 to 21 hr. The t1/2 fell to 2.84 +/- 0.45 hr during dialysis. Approximately 30% of the dose was recovered in the dialysate during 4 hr of dialysis and there was a 25% reduction per hour in serum concentration. We present a dosage schedule for intravenous amoxicillin in patients with reduced renal function who are undergoing hemodialysis.

Adolescent↗
PubMed1979

Kinetics of intravenous mezlocillin in chronic hemodialysis patients.

The kinetics of intravenous mezlocillin was studied in 8 patients with creatinine clearances under 7 ml/min who were undergoing chronic hemodialysis. Kinetic parameters were determined using a 2-compartment linear model. The mezlocillin serum half-life (t 1/2) in these patients ranged from 2.9 to 7.8 hr (mean, 5.4). The t 1/2 decreased to 1.57 +/- 0.09 hr during dialysis. Approximately 18% of the dose was recovered in the dialysate in 4 hr of dialysis. There was a 30% reduction per hour in serum concentration. The kinetics of mezlocillin, due to removal by nonrenal mechanisms, more closely resemble the kinetics of penicillin G and ampicillin than of carbenicillin and ticarcillin. A dosage schedule for use of intravenous mezlocillin in patients undergoing hemodialysis is presented.

Adult↗
PubMed1979

Pharmacokinetics of intravenous piperacillin in patients undergoing chronic hemodialysis.

The pharmacokinetic properties of piperacillin, a piperazine derivative of ampicillin, were determined in seven patients with creatinine clearances less than 7 ml/min who were undergoing chronic, intermittent hemodialysis. A two-compartment linear model was used to analyze the data. Mean elimination half-life was 1.26 +/- 0.1 h; the mean elimination constant was 0.95 +/- 0.08 h-1; the mean volume of distribution was 0.16 +/- 0.02 liters/kg of body weight; the mean volume of the central compartment was 0.10 +/- 0.01 liters/kg of body weight; and the mean clearance was 0.09 +/- 0.01 liters/h per kg of body weight. Mean elimination half-life while off dialysis of 2.1 h.

Adult↗
PubMed1979

Amyloidosis in chronic heroin addicts with the nephrotic syndrome.

Four chronic heroin addicts had renal amyloidosis and the nephrotic syndrome. Amyloidosis had the secondary type of tissue distribution and developed after many years of addiction. That chronic immunologic stimulation by one or more exogenous antigens or multiple acute inflammatory episodes were important factors in the pathogenesis of amyloidosis in these patients is postulated. Amyloidosis, although uncommon, must be considered among the different types of renal involvement that are known to occur in drug addicts, especially those with the nephrotic syndrome, and amyloid should be specifically searched for in their renal biopsies.

Adult↗
PubMed1978

Gentamicin in 1978.

For a decade gentamicin has been used extensively because of its antimicrobial efficacy and the relatively low prevalence of clinical toxicity. Recently the more frequent appearance of resistant organisms, reports of increased nephrotoxicity and ototoxicity, and the development of newer aminoglycoside antibiotics have raised doubts about the continued use of this agent. This paper reassesses the role of gentamicin. It is clear that an appreciation of the pharmacokinetics and the clinical use of gentamicin as well as an understanding of the patterns of toxicity in animals and humans can lead to more efficient treatment with this antimicrobial agent. Despite ample competition from a number of newer aminoglycoside antibiotics, gentamicin will probably continue to be used widely in the near future.

Amikacin↗
PubMed1978

Acute interstitial nephritis associated with carbenicillin therapy.

Although acute interstitial nephritis has been documented during therapy with many antibiotics of the penicillin class, it has not previously been reported in association with carbenicillin therapy. We report here the case of a patient who developed the characteristic clinical features of this form of injury while receiving prolonged large doses of carbenicillin. Histologic examination confirmed the presence of a striking interstitial nephritis. Carbenicillin should be considered a potential cause of renal damage in patients who develop rash, eosinophilia, and microscopic hematuria in association with deterioration of renal function.

Acute Disease↗