Increased incidence of coronary heart disease associated with combined elevation of serum triglyceride and cholesterol concentrations in the nephrotic syndrome in man.
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Biomedical subjects
Publications and source records attributed to K D Edwards.
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A comprehensive one-day renal function test consisting of a single outpatient visit lasting nine hours, with a minimum of time off work or away from home, is described in detail. Although a large number of laboratory tests are performed in one day, patients usually appreciate thoroughness, and the cost is more than offset by the saving in occupancy of hospital beds and by the early and precise diagnosis of reversible aspects of renal disease. Some aspects of improved methodology, such as the sequential determination of minimum urinary pH, bicarbonate, titratable acid, ammonium, and total acid on a single sample using an automatic titrator, are given in detail. Clinical application of the comprehensive nine-hour renal function testing system is illustrated by the result sheet of a patient with analgesic nephropathy, who was shown in one day to have secondary severe renal failure (glomerular filtration rate 20% of normal for age and surface area), renal tubular acidosis of the distal gradient type (minimum urinary pH 6.20), increased urinary white cell excretion rate, hyaline casts, and absence of red cell casts, consistent with a diagnosis of analgesic nephropathy and urinary tract inflammation. Normal values with 95% range for this laboratory are also given. This testing system has been found to be very useful in investigating patients with analgesic nephropathy, renal tubular acidosis, and after renal transplantation.
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A one-week introductory course in clinical biochemical and research techniques was devised to provide a brief but concentrated experience for interested persons. Urinary creatinine concentrations were measured to demonstrate acceptable degrees of precision of a method (co-efficients of variation, 0.5-2.4%), and to give confidence by favourable comparison with routine laboratory results (day 2, mean 0.95 vs 0.94 mg/ml). Subjects then submitted themselves to one-day renal function testing, and subsequently measured their own urinary acid-base parameters by autotitrimetry and glomerular filtration rates by spectrophotometry. The values obtained for the latter fell within the normal range (85-124% of normal, corrected for age and surface area). Finally, statistical methods and a small desk-top computer were employed to compute linear regression equations, correlation coefficients, and t tests from the week's data. The course contained a number of features which stimulated learning, including active participation by the learner, and the use of meaningful materials to induce both desire for success and tolerance of mistakes.
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