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Biomedical subjects

J R Ingelfinger

Publications and source records attributed to J R Ingelfinger.

At least 91 records · Page 5Linked to original sources
PubMed1981

The influence of increased renal mass on cardiovascular function in immature dogs.

Pediatric renal allograft recipients receive a relatively greater increase in renal mass than do adult recipients because the donors are usually adults. They also have a higher frequency of posttransplant hypertension and cardiovascular problems. Avoiding other variables common to both pediatric and adult patients including pre-existing hypertension and renal disease and the use of corticosteroids, renal mass was increased by up to 50% in immature dogs by implanting large kidneys from adult dogs. Cardiovascular and renal function were studied before and after transplantation. Blood pressure was decreased in anesthetized mongrel pups at 2 hr and 3 days after surgery by 22 and 6 mm Hg, respectively; pressure was similarly reduced in conscious, chronically catheterized DLA-matched beagle pups maintained for 14 days, from 96.1 +/- 3.0 to 76.8 +/- 6.7 mm Hg (P less than 0.001). Glomerular filtration rate was decreased at 2 hr and 3 days, but was normal at 14 days. Cardiac output was reduced in four of five recipients at 2 hr but was unchanged at 3 days. Plasma volume was increased at 3 days in the mongrel dogs but was normal in the beagles both at 2 and 14 days. We conclude that an increase in renal mass of up to 50% by itself does not cause hypertension in the dog and that other factors may be implicated in pediatric allograft recipients.

Age Factors↗
PubMed1981

Elevated nephrogenous cyclic adenosine monophosphate to monitor early renal osteodystrophy.

Radiographs, serum chemistries, parathyroid hormone (PTH), and nephrogenous cyclic adenosine monophosphate (cAMP) were evaluated in thirty-two children with normal serum creatinine, chronic renal insufficiency, chronic hemodialysis, and transplantation. Nephrogenous cAMP increases linearly with creatinine, and there is a good correlation (r = 0.89) between immunoreactive PTH (iPTH) and nephrogenous cAMP except for patients with severe renal insufficiency or requiring chronic hemodialysis. Elevated nephrogenous cAMP is evidence for metabolic bone disease earlier than usually recognized. Early measurements of iPTH and nephrogenous cAMP could ensure early therapeutic intervention which might alleviate renal osteodystrophy in chronic renal insufficiency and transplant patients.

Adolescent↗
PubMed1981

Renal growth after transplantation: infant kidney received by adolescent.

Renal growth and function were studied in a sixteen year old recipient of a renal transplant from a 16 month old cadaveric donor. Within one month, as measured by sequential inulin and creatinine clearances, glomerular filtration rate was 40 ml/min, which was more than 6 times the estimated pretransplant clearance. Ultrasound of the transplanted kidney revealed longitudinal growth from 7 cm at transplant to 11.5 cm by 8 weeks post-transplant. Radionuclide renal scintiphotography confirmed rapid functional and dimensional growth. There was no evidence of rejection, obstruction, or other complications during the time the allograft rapidly increased in size. Thus this case demonstrates a remarkable capacity of the human kidney to hypertrophy rapidly.

Adolescent↗
PubMed1981

Mortality of chronic hemodialysis and renal transplantation in pediatric end-stage renal disease.

The long-term mortality of chronic hemodialysis and renal transplantation was analyzed in all children treated for end-stage renal disease at Children's Hospital Medical Center over the pase 8 1/2 years. A total of 216 transplantation or dialysis courses in 120 patients were studied. No patients were excluded from treatment or analysis. Overall actuarial survival was 92% at six months, 90% at 12 months, and 89% at five years. When actuarial survival for each form of treatment was examined, patient survival was 100% at six months and 95% at five years for chronic hemodialysis; 92% at six months and five years for living related transplantation; and 88% at six months and 85% at five years for cadaveric transplantation. We conclude that most children with end-stage renal disease can be kept alive with current treatment programs, and that the mortality of chronic hemodialysis in children is comparable to that of renal transplantation.

Adolescent↗
PubMed1981

Post-transplant hypertension in the absence of rejection or recurrent disease.

Post-transplant hypertension was reviewed in 86 consecutive renal transplant recipients and occurred in 86 percent. In order to eliminate concomitant causes, those 16 of 86 patients in whom there had never been any rejection episode nor any recurrent diseases were further evaluated for the presence of hypertension. Follow-up period was 1-5 years. All 16 patients were hypertensive in the first postoperative weeks. Nine patients, all with various nephritides, had pre-transplant hypertension, leading to pre-transplant nephrectomies in 5. Post-transplant, all 9 were hypertensive in the first 6 months. By one year post-transplant, blood pressure had normalized in 2 and was controlled on medication in 5 others. In contrast, none of the 7 other patients (all with structural lesions) had pre-transplant hypertension though three had pre-transplant nephrectomies. Only 2 of these 7 patients had post-transplant hypertension, mild in both. The experience demonstrates that prior hypertension correlates positively with post-transplant hypertension, irrespective of native kidney nephrectomies. Patients with previous nephritides carry the greatest risk of becoming hypertensive. Furthermore, the majority of young renal allograft recipients appears to develop hypertension, even in the absence of rejection or recurrent disease.

Adolescent↗
PubMed1981

Growth acceleration following renal transplantation in children less than 7 years of age.

Of 110 consecutive renal allografts performed at Children's Hospital Medical Center 12 were in 11 patients aged 3 to 7 years. Patient and graft survival and linear growth were evaluated in these 11 children. All 11 are surviving, seven (64%) with functioning allografts 12 to 92 months after transplant. Six of these seven have normal renal function (on alternate day prednisone dose less than 0.7 mg/kg every two days plus daily azathioprine) and all seven have shown catch-up growth, reaching and maintaining normal height for age. An eighth patient, now returned to dialysis, grew from below the third percentile at age 3 years to the 25th percentile at age 8 years, after which renal function deteriorated. Three patients rapidly rejected allografts and have had decreased growth velocity for age. In contrast, although many of the remaining 76 patients who received 98 transplants after age 7 years are growing, none showed accelerated linear growth sufficient to catch up if below the third percentile for age or to cross centile lines if above. Neither the degree of pretransplant bone age retardation nor steroid dose per kilogram accounted for lack of growth acceleration of those more than 7 years of age. Despite small sample size, the growth of renal transplant recipients less than 7 years of age suggests that they are good, and in some ways, favored transplant candidates.

Adolescent↗
PubMed1980

Long-term evaluation of chlorambucil plus prednisone in the idiopathic nephrotic syndrome of childhood.

We evaluated the long-term effects of a five to 15-week course of chlorambucil and prednisone in 59 children with idiopathic nephrotic syndrome who had previously received prednisone alone and had had frequent relapses or steroid dependency or resistance. By actuarial analysis of 65 courses of dual therapy followed up for one to 12 years (mean, 5.0), we found that 95 per cent of patients were in remission at one year and 85 per cent at four years. All but two had remissions lasting longer than those induced by steroids alone, and only eight others had one or more relapses after therapy. Life-table analysis of two dosage schedules of chlorambucil at four years showed that 91 per cent of patients on low doses and 80 per cent of those on high doses were still in remission. Although immediate complications were minimal, the potential for long-term toxicity still requires careful selection of patients who receive chlorambucil. Prolonged use of chlorambucil in daily doses above 0.3 mg per kilogram of body weight per day or cumulative doses above 14 mg per kilogram is no longer warranted. Measured in terms of both the immediate and long-term responses, chlorambucil appears to lower the frequency of relapses in idiopathic nephrotic syndrome.

Adolescent↗
PubMed1980

Nephrotic syndrome in the second decade of life.

In 22 (13 females, 9 males) of 224 patients presenting with nephrotic syndrome, onset occurred during the second decade of life. Lipoid nephrosis and its variants (nil, focal segmental, or focal global glomerulosclerosis and mesangial proliferative) accounted for the disease in the majority of patients (13 patients). In all with nil change (7 patients) and one of the 4 with mesangial proliferation the disease completely resolved with steroids. Forty-one percent of patients had nephrotic syndrome as the result of other forms of glomerulonephritis: 1 patient had nephrotic syndrome secondary to poststreptococcal glomerulonephritis which resolved spontaneously. Three patients had membranoproliferative glomerulonephritis and developed renal insufficiency. Proteinuria decreased or disappeared in 4 patients with systemic lupus erythematosus. One patient had membranous nephropathy that was steroid resistant. Presenting symptoms and laboratory data failed to separate nil change from the more severe glomerular lesions. Early biopsy for diagnosis is suggested for patients presenting with de novo nephrotic syndrome in the second decade of life.

Adolescent↗
PubMed1977

Necrotizing arteritis in acute poststreptococcal glomerulonephritis: report of a recovered case.

A patient with biopsy documented acute poststreptococcal glomerulonephritis and arteritis recovered completely with supportive therapy. Illness was preceded by group A streptococcal pharyngitis. At the time of presentation, serum creatinine concentration was 11.5 mg/dl. Serum cryoglobulins containing IgG and C3 were present. The first biopsy, performed during the acute illness, contained glomeruli with typical features of acute PSGN. Medium-sized arteries had extensive necrosis and leukocytic infiltration, and contained IgG, C3, and fibrin. Glomerular filtration rate returned to normal within three weeks; proteinuria cleared by three months, and microscopic hematuria by 11 months. Renal biopsy one year later showed minimal mesangial hypercellularity and no arteritis.

Acute Disease↗
PubMed1977

Warts in a pediatric renal transplant population.

18 of 49 pediatric renal transplant recipients, all of whom were on continual steroid and immunosuppressive treatment, were found to have warts. Although all 18 patients received treatment for this problem, only 5 had the warts successfully eradicated. The frequency of warts among transplant patients is three times that of the general childhood population and twice that of a group of nephrotic pediatric patients who received immunosuppressive therapy. We propose that drug-induced suppression of cell-mediated, and to a lesser extent, humoral immunity, may predispose people to develop warts.

Female↗
PubMed1977

Frequency and etiology of gross hematuria in a general pediatric setting.

Since the frequency of gross hematuria in general, unselected, pediatric outpatient settings has not been reported, we reviewed all patients with this symptom or sign at a pediatric emergency walk-in clinic during 24 consecutive months. Of a total of 128,395 patient visits, gross hematuria was proven in 158 (1.3/1,000 visits). Fifty-six percent of all patients had readily apparent causes for their gross hematuria. Twenty-six percent of all hematuric patients had documented urinary tract infections, but only 9% had apparent glomerular disease.

Adolescent↗
PubMed1976

Chlorambucil treatment of frequently relapsing nephrotic syndrome.

Chlorambucil, in combination with prednisone, was compared with prednisone alone in a randomized controlled trial in 21 children with either steroid-dependent or frequently relapsing nephrotic syndrome to assess its effect on the duration of remission and the rate of relapse. All control patients treated with prednisone alone continued to relapse at the same rate, with all patients experiencing a return of proteinuria by seven months. Conversely, those who received the same prednisone therapy along with chlorambucil for six to 12 weeks remained in complete remission, without further medication, during 12 to 34 months of follow-up observation. Complications were minimal. Immediate side effects commonly reported with cyclophosphamide were not seen with chlorambucil. Comparison with published reports also suggests that remission induced by chlorambucil is more stable than that after cyclophosphamide. Chlorambucil appears to be of value in the frequently relapsing nephrotic patient, adding an effect that is unattainable with prednisone alone.

Adolescent↗
PubMed1976

Pathophysiological response of the blood coagulation system in acute glomerulonephritis.

A new procedure, plasma fibrinogen chromatography, has been utilized, together with other blood coagulation assays, to quantify fibrin formation in 43 children with acute poststreptococcal glomerulonephritis (AGN) from the time of hospitalization until recovery. During the prediuretic phase of AGN, significant evidence for substantial increase in fibrin formation (intravascular coagulation) included gross increase in plasma high molecular weight fibrinogen complexes (HMWFC), the development of either hypo- or hyperfibrinogenemia and gross depression of coagulation factor XIII concentration and of alpha2-macroglobulin concentration. During the diuretic phase of the disease, these abnormalities regressed and evidence of enhanced plasma fibrinolytic activity, documented by an increase in fibrinogen first derivative, was detected. Concomitantly, urinary excretion of fibrin(ogen) degradation products (FDP) underwent substantial increase. With disease recovery, which occurred in all children, urinary FDP excretion ceased and all coagulation findings normalized.

Acute Disease↗
PubMed1974

Normal glomerular permeability and its modification by minimal change nephrotic syndrmone.

It has been suggested that the glomerular basement membrane restricts the passage of large molecules only, the barrier to filtration of smaller molecules being at the level of the epithelial slit pore. This hypothesis was investigated by measuring glomerular permeability to (125)I-labeled polydisperse polyvinyl pyrrolidone (PVP) in 16 children with idiopathic nephrotic syndrome (INS) and in 6 children of comparable age who had no evidence of renal disease. Studies were performed in the patients with INS before, during, and after treatment with steroids. PVP in blood and urine samples was separated according to molecular size by solumn chromatography, to permit the calculation of permeability to inert macromolecules of sizes ranging from 8,000 mol wt. In untreated INS, glomerular permeability to molecules > 40 A was normal; permeability to smaller molecules was markedly reduced, frequently to 20% or less of normal. There was an average decrease in inulin clearance (C(in)) of 24%. Glomerular permeability and C(in) returned to normal in INS treated with steroids only when proteinuria disappeared. The results support the concept, derived from studies with ultrastructural tracers, that the final barrier to filtration may be at the level of the epithelial slit pore. Thus fusion of the epithelial foot processed with obliteration of the slit pores was associated with impaired passage of smaller molecules of PVP into the urine. Reversal of the pathologic abnormality resulted in return of permeability to normal. The decreased C(in) seen in INS may not reflect true glomerular filtration rate, but may result from restricted passage of inulin molecules (mol wt 5,000) through the epithelial slit pore.

Adolescent↗