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Biomedical subjects

G Boner

Publications and source records attributed to G Boner.

At least 55 records · Page 3Linked to original sources
PubMed1996

Gallopamil reduces the post-transplantation acute tubular necrosis in kidneys from aged donors.

Due to a shortage of suitable kidneys for transplantation there has been an increase in the use of kidneys taken from old and marginal donors, which has led to a high incidence of acute tubular necrosis. Several reports suggest that the administration of calcium channel blockers improves the initial function after renal transplantation. We conducted a randomized, double-blind placebo-controlled trial to study the effect of the calcium channel blocker gallopamil on the incidence and course of acute tubular necrosis following cadaveric renal transplantation. A trend developed showing a decrease in episodes of acute tubular necrosis in gallopamil versus placebo, and became statistically significant when the outcome of kidneys from donors older than 50 years was analyzed separately [gallopamil 6/14 (42%) vs. placebo 10/11 (91%), P <0.01 corrected chi2]. We conclude that pre-transplantation renal graft perfusion and post-transplantation recipient treatment with gallopamil reduces the incidence of post-transplantation acute tubular necrosis, particularly in kidney taken from older donors.

Adult↗
PubMed1995

Paradoxical heat sensation in uremic polyneuropathy.

Sensory aspects of uremic neuropathy were studied in 36 patients using clinical assessment and quantitative sensory tests (QST). The outstanding abnormality in sensory quality was perception of heat in response to low temperature stimuli. This paradoxical heat sensation was found in the foot in 42% (15) of patients, far beyond the normal prevalence of 10%. Paradoxical sensation was positively related to cold hypoesthesia (P = 0.0004) suggesting disinhibition as a possible mechanism. Paradoxical heat sensation also positively related to creatinine level (P = 0.0012). Pruritus was present in 20 patients (56%), intensity not related to any biochemical or clinical parameter. Signs of sensory polyneuropathy (PNP), based on at least two abnormal parameters in the clinical assessment or QST, were found in 39% of patients (14), of whom 11 had paradoxical heat sensation. Thus, in 4 patients (11%), this sensory aberration preceded other signs for PNP. Paradoxical heat sensation seems to be a common and often early expression of the sensory neuropathy in uremia.

Adolescent↗
PubMed1995

Diabetic nephropathy and pregnancy: the effect of ACE inhibitors prior to pregnancy on fetomaternal outcome.

BACKGROUND: Diabetic nephropathy is associated with an increase in perinatal mortality and morbidity in uncontrolled pregnant patients. Recently angiotensin-converting enzyme inhibitor (ACE-I) was shown to improve the disease status in non-pregnant subjects. The purpose of this study was to examine the effect of prepregnancy treatment of insulin-dependent diabetes mellitus (IDDM) nephrotic women with captopril angiotensin converting enzyme inhibitor (ACE-1), on maternal renal function throughout pregnancy and on the fetomaternal outcome. METHODS: Eight IDDM nephrotic patients planning pregnancy were treated with captopril for a minimum of 6 months prior to conception together with intensive insulin management. Conception was allowed when proteinuria was < 500 mg/day and euglycaemia was achieved. At conception captopril was discontinued. RESULTS: At the beginning of captopril treatment, proteinuria was 1633 +/- 666 mg/day. At conception, proteinuria dropped to 273 +/- 146 mg/day (P = 0.0000) and increased gradually over the three trimesters to 593 +/- 515, 783 +/- 813, and 1000 +/- 1185 mg/day respectively (P = 0.2 between the trimesters); declining to 619 +/- 411 mg/day (P = 0.0002 vs conception) 3 months after delivery. Only in two patients (25%) did proteinuria exceed 1000 mg/day during pregnancy. There was no significant change in any of the other renal function tests: CCT, serum creatinine, uric acid, K+ and blood pressure. However, there were three cases of PET just prior to delivery. Maternal glycaemic control improved significantly prior to conception (P = 0.002) and remained euglycaemic (reflected by daily glucose profile, HbA1C and fructosamine) throughout gestation. Perinatal outcome was excellent. CONCLUSION: Captopril treatment before pregnancy has a prolonged protective effect on maternal renal functions during pregnancy and results in a favourable maternal-fetal outcome.

Adult↗
PubMed1995

Sweat secretion, stratum corneum hydration, small nerve function and pruritus in patients with advanced chronic renal failure.

Sweat secretion, stratum corneum hydration and small nerve fibre function were measured in 40 patients with advanced chronic renal failure (CRF), using pilocarpine iontophoresis, electrical capacitance and a thermal sensory analyser which measures the thresholds of warm and heat pain sensation. Correlations were sought between these parameters, and the presence and severity of pruritus and skin xerosis were compared with 45 healthy control subjects. The mean sweat secretion and stratum corneum hydration of CRF patients were significantly lower than in controls. Thirteen patients had pathological thresholds to warm sensation on the foot, and eight on the hand. None had pathological thresholds to heat-pain. The presence of pruritus did not correlate with any of the following: xerosis, stratum corneum hydration, sweat secretion or the results of thermal testing.

Aged↗
PubMed1995

Microalbuminuria following gestational diabetes.

BACKGROUND: Microalbuminuria (MA) precedes clinical nephropathy in patients with insulin-dependent diabetes mellitus, and is associated with an increased mortality, mostly due to cardiovascular disease in patients with non-insulin-dependent diabetes mellitus. Microalbuminuria is rarely detected in patients with diabetes of less than five years' duration. Our study was designed to determine whether MA and its sequelae also appear 5-8 years after pregnancy complicated by gestational diabetes mellitus (GDM). METHODS: We examined the presence of MA in 72 women who had not conceived since a previous GDM-pregnancy 5-8 years ago and compared them to a control group of 35 women who had no GDM history, and who were matched for age, parity and time since last pregnancy. Microalbuminuria was determined in all subjects using an overnight 8 hours urine collection. Mann-Whitney rank-sum test was used to compare data between the study and the control groups. Student's t test was used to compare data within the study group. RESULTS: Median value of the urinary albumin excretion rate (AER) in the study group was significantly higher than median value of urinary AER of the control group (p < 0.0001), but only 30.5% of the subjects of the study group were found to be microalbuminuria-positive, defined as urinary AER value of more than 21 mg/24 h. No correlation between MA and blood pressure, fasting blood glucose, serum creatinine, blood urea nitrogen and parity was found. CONCLUSIONS: MA was found to be more frequent after GDM and no predisposing factors for its appearance were elucidated. Hence, we suggest that it may well be a sign of early renal disease and that long-term follow-up of all GDM patients for MA and other markers of renal disease is strongly indicated.

Adult↗
PubMed1994

Effects of residual renal function in haemodialysis patients.

Thirty-six haemodialysis patients on treatment for more than six months were studied for residual renal function (RRF). Twenty patients were anuric. The remaining 16 patients with RRF excreted 35-1600 ml urine/day with creatinine clearance ranging 0.17-6.95 ml/min. Patients with RRF were on dialysis therapy for shorter periods than those with anuria (25.5 +/- 18.5 vs. 101.7 +/- 14.2 months, p = 0.001). Twelve out of 20 anuric patients had had previous renal transplantation, whereas none of those with RRF had been transplanted (p = 0.0006). Interdialytic weight gain, serum potassium and phosphate were lower in patients with RRF. Serum phosphate and uric acid were correlated with their respective urinary excretion rates (p = 0.013 and 0.005, respectively), but interdialytic weight gain could not be correlated with urinary output. Creatinine clearance significantly correlated with urinary excretion of potassium, sodium, phosphate and uric acid. In this series of patients a previous unsuccessful renal transplantation was an important factor in the loss of RRF. The presence of RRF contributed to the regulation of the blood levels of phosphate and the excretion rate of potassium, sodium and uric acid.

Blood Urea Nitrogen↗
PubMed1994

Increased serum angiotensin converting enzyme activity in type I insulin-dependent diabetes mellitus: its relation to metabolic control and diabetic complications.

Serum angiotensin-converting enzyme (ACE) was measured in 150 insulin-dependent diabetes mellitus (IDDM) patients and 72 healthy subjects by radioassay, using [3H]-hippuryl-glycyl-glycine as a substrate. Mean (SD) serum ACE activity in diabetic patients was 120 +/- 33 nmol ml-1 min-1 (range 46-215) and was significantly increased by 56% compared to control values (77 +/- 23 nmol ml-1 min-1, range 46-125, P < 0.001). ACE activity > 125 nmol ml-1 min-1 was observed in 60 of 150 IDDM patients. 96 IDDM patients were normoalbuminuric (< 22 mg 24 h-1) and 49 patients were micro- or macroalbuminuric (range 22-6010 mg 24 h-1). Micro- and macroalbuminuric IDDM patients were found to have significantly greater ACE activity values than normoalbuminuric patients (128 +/- 36 vs. 115 +/- 30 nmol ml-1 min-1, P = 0.025). Metabolically well-controlled IDDM patients (glycosylated haemoglobin < or = 8%) had lower ACE activity values than the patients with glycosylated haemoglobin greater than 8% (109 +/- 20 vs. 127 +/- 32 nmol ml-1 min-1, P < 0.02). A significant correlation between degree of metabolic control and ACE activity was found (r = 0.435, P < 0.001) so that an increase in one glycosylated quartile unit is accompanied by an increase in ACE activity of 10.5 nmol ml-1 min-1. Thus ACE activity in the serum of IDDM patients was increased by 56% in 40% of the patients. It was increased in IDDM patients without complications and in patients with retinopathy or nephropathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Adequacy of dialysis and nutritional status in hemodialysis patients.

Twenty-three nondiabetic end-stage renal failure patients on hemodialysis were studied for adequacy of dialysis and nutritional status. Midweek predialysis blood urea nitrogen was 27.1 +/- 6.4 mmol/l of urea, KT/V, according to urea kinetic modelling, was 1.21 +/- 0.22 and mean normalized protein catabolic rate (nPCR) was 1.15 +/- 0.23 g/kg/day. Only 1 patient had a KT/V less than 1 and 4 patients had an nPCR less than 1 g/kg/day. No correlation was found between the different nutritional parameters. All patients had normal serum albumin. However, some of the patients could be classified as severely malnourished when parameters such as body weight (2 patients), triceps skinfold (5) and total lymphocyte count (3) were taken into account. No correlation was found between adequacy of dialysis and the different nutritional parameters. Furthermore, when patients were divided into low and normal KT/V, no differences were found in their nPCR. We conclude that a global assessment of the nutritional status is required in hemodialysis patients, and at least in patients with an acceptable KT/V, nPCR is not dependent on the adequacy of dialysis.

Adult↗
PubMed1994

Tubular cell protein degradation in early diabetic renal hypertrophy.

Renal hypertrophy in diabetes is accompanied by an increase in kidney protein content, which reflects an imbalance between protein synthesis and degradation. This study determines whether altered cellular protein degradation contributes to the imbalance. Diabetes was induced in rats with streptozotocin (55 mg/kg/ip). After 2 or 4 days of diabetes, kidney weight and protein content were measured. Over the 4 days, despite a loss in body weight, kidney wet weight increased by 35% and protein content by 37% in the diabetic rats. Treatment with insulin prevented this increase. Long-lived protein degradation was measured in isolated proximal tubules prelabeled with (14C)valine in vivo. Two days after streptozotocin, protein degradation was depressed by 19% (P < 0.05) and by the fourth day by 27% compared with that in nondiabetic controls (2.6% +/- 0.2 versus 1.9 +/- 0.1% degraded/h; P < 0.01). This was accompanied by a similar diabetes-induced decrease in proximal tubule cathepsin B and L activity. Accordingly, this study provides direct evidence that, in diabetes, tubular cell protein breakdown is depressed and suggests that altered lysosomal cathepsin activity may contribute to this effect. Depressed proteolysis likely contributes to the increase in kidney protein content and hence to diabetic renal hypertrophy.

Animals↗
PubMed1994

Sweat electrolytes in patients with advanced renal failure.

The sweat gland has some similarity with the convoluted tubules of the kidney. Little is known about sweat secretion and electrolyte content of sweat in the uremic gland. A pilocarpine ionotophoresis sweat test was performed in 40 patients with advanced renal failure (RF). Sweat secretion was measured and analyzed for Na, K, and Cl and correlated to blood parameters, type, and duration of dialysis. The sweat weight was significantly lower in all RF patients when compared with this parameter in healthy controls (p < 0.0001). No difference was noted between patients undergoing hemodialysis, those undergoing continuous ambulatory peritoneal dialysis, and those not undergoing dialysis. Men sweated more than women among RF patients and among controls (p < 0.0001). An inverse correlation was found between sweat weight and blood calcium levels (p < 0.001). Sweat K concentration was significantly higher (p < 0.0001) in patients with RF than in healthy controls, while the concentrations of Na and Cl were similar. Several mechanisms are suggested as possible explanations for these changes.

Aged↗
PubMed1994

Which cuff size is preferable for blood pressure monitoring in most hypertensive patients?

The accuracy of blood pressure (BP) measurements in obese hypertensives is still controversial. We investigated whether a large sized cuff could be appropriate for BP measurements in patients with different arm circumferences. Fifty hypertensive patients (23 males and 27 females, mean age 54 +/- 12 years, mean weight 75 +/- 12 kg) underwent BP measurements under standardised conditions using both a standard cuff (23 x 12 cm) and a large cuff (34 x 15 cm). Ambulatory blood pressure monitoring (ABPM) was subsequently performed in each subject using a large cuff. The average of two measurements performed in the clinic was compared with the mean daytime measurements. Thirty-one subjects had an arm circumference of < 30 cm (group 1) and weighted 68 +/- 10 kg, while 19 (group 2) had a larger arm circumference (> or = 30 cm) and were overweight (86 +/- 8 kg). BP in group 1 was 149 +/- 23/91 +/- 12 mmHg with the standard cuff and 143 +/- 24/88 +/- 13 mmHg with the large cuff (P < 0.003). In group 2, the respective readings were 153 +/- 22/100 +/- 16 mmHg (standard cuff) and 144 +/- 19/93 +/- 16 mmHg (large cuff; P < 0.0004). These findings suggest that in overweight hypertensives, the use of the standard cuff results in overestimation of BP and that large cuffs should be used exclusively in this population. The use of a large cuff in lean patients has yet to be clarified.

Adult↗
PubMed1994

Concomitant administration of isradipine and spirapril prevents reduction of renal function induced by acute administration of spirapril in patients with reduced renal function.

Angiotensin-converting enzyme (ACE) inhibitors may cause a further decrease in renal function in patients who already have renal failure. The acute effects of the ACE inhibitor spirapril on renal function were investigated in 10 patients with mild-to-moderate renal failure (serum creatinine of 1.5-2.5 mg/dl). Acute oral administration of spirapril at 6 mg resulted in decreases in inulin clearance (from 53.7 +/- 12.8 to 44.6 +/- 8.8 ml/min; p < 0.02; n = 5) and in PAH clearances (from 215 +/- 141.9 to 184 +/- 37.8 ml/min; p < 0.006; n = 5). However, when the acute administration of 6 mg of spirapril was given concomitantly with isradipine at 5 mg, there were no changes in these renal function parameters.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1993

The leukocyte surface antigens CD11b and CD18 mediate the oxidative burst activation of human peritoneal macrophages induced by type 1 fimbriated Escherichia coli.

Analysis by immunofluorescence-activated cell sorting of human peritoneal macrophages from patients undergoing intermittent peritoneal dialysis revealed that they express the CD11/CD18 surface antigens, with CD11b and CD18 as the predominant ones. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of immunoprecipitates obtained from lysates of 125I-labeled macrophages with rabbit polyclonal antibodies against the CD11a-c/CD18 complex or against CD18, revealed four radioactive bands corresponding to CD11a, CD11b, CD11c, and CD18. Monoclonal antibodies against CD11b and CD18 inhibited by 80 and 90%, respectively, the oxidative burst activation of the macrophages by type 1 fimbriated Escherichia coli, whereas monoclonal antibodies against CD11a, CD11c, and CD43 were without effect. Our results suggest that CD11b and CD18 (receptors for C3bi) serve also as receptors for mannose-specific E. coli on human peritoneal macrophages and may be involved in the lectinophagocytosis of the bacteria by these cells.

Antibodies, Monoclonal↗
PubMed1993

Angiotensin converting enzyme activity in the serum, lung and kidney of diabetic rats.

Diabetes Mellitus in its early stages, is associated with kidney enlargement and increased glomerular filtration rate in humans and in rats. The present study was designed to clarify the direct effect of diabetes on serum and tissue angiotensin converting enzyme (ACE) activity in streptozotocin-induced diabetic rats. Serum ACE activity, as determined using a radiometric assay, was significantly increased in the diabetic rats (n = 15) 14 days after induction of diabetes (670 +/- 31 vs. 506 +/- 14 nmol ml-1 min-1). Lung ACE activity, but not renal, was significantly elevated at 7 and 14 days by 29 and 46%, respectively. Plasma renin activity in the diabetic rats was decreased at 7 and 14 days by 41 and 78%, respectively. Incubations of lung slices in the presence of glucose at different concentrations did not affect in-vitro release of the enzyme. Administration of insulin (8 units kg-1) to diabetic rats (n = 6) on the 4th day for 11 days reduced ACE activity to values below control. Thus, serum and lung ACE activity is increased in the diabetic rat and reduced upon insulin treatment.

Animals↗
PubMed1993

Bacteremia complicating peritonitis in peritoneal dialysis patients.

Bacteremia is a rare complication of peritonitis in end-stage renal failure (ESRF) patients treated by peritoneal dialysis. Three of our ESRF patients on peritoneal dialysis developed bacteremia during a peritonitis episode (1/19 peritonitis episodes). In 2 cases, the responsible organism was Escherichia coli and peritonitis was most likely associated with infection of the biliary tract. The 3rd patient had a perforation of the colon and Klebsiella spp. was the infective organism. Only the last patient survived but had to be transferred to hemodialysis. Bacteremia during peritonitis is infrequent in peritoneal dialysis patients and it appears to be related to other intra-abdominal events.

Aged↗
PubMed1993

Compliance in hemodialysis patients: a multivariate regression analysis.

Successful treatment of patients with end-stage renal failure requires, in addition to dialysis, strict control of dietary, fluid and medication intake. In the present study we measured, in 50 chronic hemodialysis patients, serum potassium (K), serum phosphate (PO4) and interdialytic weight gain as indices of diet, medication and fluid compliance, respectively. Dietary compliance did not correlate with fluid or medication compliance, whereas fluid intake and medication compliance were related (p = 0.01). Age, time on dialysis, place of birth and whether the patient came accompanied or not to the dialysis unit were the main variables affecting serum K levels. Sex, ethnic origin and education significantly affected serum PO4. Sex, place of birth, marital status, number of children and years of education affected fluid intake. The compliance of the hemodialysis patient with different aspects of his regimen is thus multifactorial. Attempts to improve compliance and thus reduce morbidity and mortality should be aimed at identifying the population with low compliance and exposing them to educational programs.

Adult↗