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Biomedical subjects

J Montoliu

Publications and source records attributed to J Montoliu.

At least 91 records · Page 5Linked to original sources
PubMed1983

Beta adrenergic modulation of extrarenal potassium disposal in terminal uraemia.

In order to study the effect of epinephrine on potassium (K) metabolism, an epinephrine infusion (0.1 micrograms/kg/min for 30 min) was carried out in 12 essentially anuric and usually hyperkalaemic haemodialysis patients, 72 hr post-dialysis. Two groups emerged, group I (five patients) serum K decreased at least 0.75 mEq/L (from 6.6 +/- 0.2 to 5.4 +/- 0.1 mEq/L) and there were increases in heart rate, serum glucose and insulin values, group II (seven patients), serum K did not decrease and heart rate remained unchanged, but serum glucose and insulin increased slightly. Plasma renin, aldosterone and arterial pH did not change in either group. Propranolol blocked the epinephrine induced decrease in serum K in group I patients. Patients from group II had higher pre-infusion endogenous epinephrine concentrations than patients from group I. In haemodialysis patients beta adrenergic stimulation enhances extrarenal K disposal but about 50 per cent of patients fail to respond, perhaps because of receptor occupancy due to higher endogenous epinephrine concentrations.

Adrenergic beta-Agonists↗
PubMed1983

Increase in serum potassium caused by beta-2 adrenergic blockade in terminal renal failure: absence of mediation by insulin or aldosterone.

To test the hypothesis that beta-blockade might impair potassium (K) tolerance in terminal renal failure we gave propranolol, and then atenolol, to a group of 12 clinically stable non-diabetic patients on chronic haemodialysis and on a constant diet containing approximately 50 mEq of K/day. Propranolol, 60 to 80 mg/day for 10 days induced a significant increase in predialysis serum K from 5.1 +/- 0.1 to 5.8 +/- 0.2 mEq/L (p less than 0.005). Atenolol (50 mg/day for 10 days) in the same group of patients did not produce a significant change in predialysis serum K (5.5 +/- 0.2 vs 5.2 +/- 0.2 mEq/L). Both propranolol and atenolol decreased heart rate but neither drug induced significant changes in plasma aldosterone, arterial pH, serum insulin or blood glucose. Thus in haemodialysis patients, beta-2 adrenergic blockade by propranolol is associated with a significant increase in serum K not mediated by pH, aldosterone or insulin, and probably due to inhibition of intracellular K uptake. Selective beta-1 adrenergic blockade by atenolol at low doses does not change serum K, and therefore, if indicated, cardioselective beta-blockers might be preferable to nonselective drugs in haemodialysis patients.

Adult↗
PubMed1983

Plasmapheresis induced recovery from renal failure in mesangiocapillary glomerulonephritis of acute onset.

Plasmapheresis (PE) was used in the treatment of three patients with biopsy proven mesangiocapillary glomerulonephritis (MCGN) of acute onset and renal failure. The percent of glomeruli with extracapillary proliferation varied from 40 to 90 per cent. Following PE, there were reductions in serum creatinine of 66 per cent, 61 per cent and 82 per cent in patients, one, two and three respectively. Plasmapheresis proved effective in a second episode of renal failure in patient three. After the completion of PE, renal function has remained stable in all patients for periods ranging from two to 12 months. However, haematuria and heavy proteinuria persist in every case. PE appears to facilitate recovery from renal failure in MCGN of acute onset, possibly by removing circulating mediators of acute inflammatory glomerular damage.

Acute Kidney Injury↗
PubMed1981

[Prolonged hypotension after the first dose of atenolol (author's transl)].

A 30 year-old male patient with accelerated arterial hypertension relatively resistent to diazoxide received a single oral dose of 100 mg of atenolol, following which hypotension of more than 24 hours duration and acute renal failure ensued. These alterations were reversible and did not recur with subsequent doses of atenolol. Prior therapy with diazoxide might have potentiated the hypotensive action of atenolol. The abnormality could be due to a phenomenon of hyperreactivity to the first dose of atenolol, similar to what has been described following first doses of prazosin or labetalol. This observation suggests that atenolol therapy must be started with caution, especially in patients previously treated with diazoxide.

Acute Kidney Injury↗
PubMed1981

Acute and rapidly progressive forms of glomerulonephritis in the elderly.

This article presents a comparison of acute glomerular nephritis (AGN) with rapidly progressive glomerular nephritis (RPGN) in patients aged 60 or older. In 7 elderly patients with AGN, the renal disease was preceded by skin infection (4 cases), sore throat (2 cases), or pneumonia (1 case). The 7 patients with RPGN had no history of prior infection. Both AGN and RPGN were manifested clinically as acute renal failure, but the RPGN patients had significantly higher serum creatinine levels and lower hematocrit readings. Hypocomplementemia was a feature only of AGN. The biopsy specimens from patients with RPGN showed crescents in 50--100 percent of the glomeruli, whereas specimens from patients with AGN showed no significant extracapillary proliferation. Six AGN patients recovered and 1 died. Despite dialysis, 4 RPGN patients died and the remaining 3 require maintenance dialysis. It is concluded that AGN in the elderly is more common than previously believed, frequently follows skin infections, and has a reasonably good prognosis. In contrast, RPGN, also not rare in the elderly, has a much worse prognosis.

Acute Disease↗
PubMed1981

Postsynaptic adrenergic unresponsiveness in hypotensive haemodialysis patients.

In order to ascertain the significance of autonomic dysfunction in hypotensive maintenance haemodialysis patients, plasma norepinephrine (NE) was measured by radioenzymatic assay in 15 nondiabetic uraemic subjects of similar age and time on dialysis, five of them chronically hypotensive and 10 normotensive. Hypotensive patients had: 1) Significantly higher NE levels than their normotensive counterparts, both in basal conditions and after orthostatism and 2) significantly lesser increments in mean arterial blood pressure during a NE infusion than the normotensive group. Rather than implicating a mechanism based on autonomic neuropathy, our results suggest that in haemodialysis patients with chronic hypotension, there is a defect located at the adrenergic postsynaptic level.

Adult↗
PubMed1980

[Partial defect in the secretion of antidiuretic hormone and disproportionate polydipsia (author's transl)].

A 20-year-old patient was evaluated because of polydipsia and polyuria; by means of the dehydration test a partial defect in the secretion of antidiuretic hormone (ADH) was demonstrated, since the urinary osmolality after the administration of exogenous vasopressin was superior by 25 percent to the maximum spontaneous urinary osmolality reached after a period of fluid restriction. Nevertheless, there was also a component of psychogenic polydipsia because the daily basal fluid intake was superior to 15 liters, and in view of the fact that the urinary osmolality could reach 600 mOsm/kg, the endocrine defect cannot totally be responsible for the enormous volume of fluid intake. This is the first case in the world literature in which the association between potomania and deficiency in the secretion of ADH is reported. Since ADH is one of the factors which regulate the behaviour of various animal species it is possible that its deficiency may be directly responsible for the psychic disorder which led to the potomania. It is also possible that an anatomical hypothalamic lesion, too small to be demonstrated, might have a simultaneous effect on the centers regulating thirst and the neurons producing vasopressin.

Adult↗
PubMed1980

[Hemolytic-uremic syndrome in the adult (author's transl)].

This article presents six cases of hemolytic-uremic syndrome, defined as the combination of acute renal insufficiency, microangiopathic hemolytic anemia, and thrombocytopenia, in six adult patients, two men and four women, between 20 and 52 years old. Three of the cases were considered idiopathic, two secondary to the use of oral contraceptives, and one appeared after an abortion. All of the patients presented severe hypertension, frequently accompanied by increased renin levels; in no cases was there any important coagulation disorder. In all of the biopsies there were lesions denoting intravascular thrombosis in the arterioles and medium-sized arteries of the kidney, as well as thickening of the glomerular basal membrane. Immunofluorescence was positive for fibrinogen and C3 in the majority of biopsies examined. Two patients suffered acute pancreatitis, hypertension having perhaps been an important factor in this complication. One of the two patients died as a result of acute hemorrhagic pancreatitis and was the only death in the series. Of the five remaining subjects, three required periodic hemodyalisis and the other two presented a considerable degree of chronic renal failure, which confirms that the prognosis for the hemolytic-uremic syndrome is much worse for the adult than for the child.

Adult↗