Abnormal serotonin metabolism in long-term hemodialysis and CAPD patients.
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Blood Pressure↗
Biomedical subjects
K H Shu
Publications and source records attributed to K H Shu.
Complications of membrane-filtration plasma exchange.
BACKGROUND: Plasma exchange (PE) has been extensively used to treat a variety of disease states in the past three decades. Although PE is commonly thought to be a relatively safe procedure, a number of unpleasant side effects may occur. To highlight the need for continuing quality assurance in providing PE service, a retrospective review of PE records over a 13-year period was undertaken. METHODS: From April 1983 to March 1996, 694 therapeutic PE procedures, membrane-filtration type, were performed on a total of 157 patients in this hospital. Plasmaflo op-05(L) (Asahi Japan) was used as the plasma separator and fresh frozen plasma of one plasma volume as replacement fluid. The PE sheets for all procedures were reviewed as were medical charts in order to evaluate clinical efficacy. RESULTS: Totally 694 PEs in 157 patients, 84 male and 73 females, ranging in age from 1 to 75 years (median, 35 years), were treated. Patients received a median of 4 treatments (range, 1 to 34). The most frequent indications were severe jaundice (41.4%), systemic lupus erythematosus (23.6%), and myasthenia gravis (15.3%). The overall effective rate was 40.8%, and was best in neurological diseases (91.4% effective). Complications of PE were noted during 36% of the procedures involving 59.2% of the patients treated. The most common adverse reactions were paresthesia (12.7%), chills (10.2%), urticaria (8.5%), chest pain (5.9%), nausea (2.9%) and dyspnea (2.0%). Less common complications included: catheter infection (0.3%), catheter oozing (1.2%), dizziness (1.3%), headache (0.4%), muscle cramps (1.3%), vomiting (0.4%), abdominal pain (0.9%), fever (0.3%), hypotension (1.3%), bleeding (0.4%), consciousness change (0.7%) and respiratory arrest (0.4%). These complications were classified as "mild" (23%), "moderate" (11.4%) and "severe" (1.6%). No deaths occurred within 24 hours after PE. CONCLUSIONS: Although the use of membrane-filtration PE represents a valuable and relatively safe therapy, some life-threatening reactions do occur.
Adolescent↗
Transplant glomerulopathy--a clinicopathological study.
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Adult↗
Long-term clinical and morphological evaluation of primary membranoproliferative glomerulonephritis.
BACKGROUND: Membranoproliferative glomerulonephritis (MPGN) is a relatively rare primary glomerulonephritis (GN). Its incidence has decreased progressively in the past two decades. To improve knowledge of this rare GN, a retrospective review of 22 patients during a 12-year period was undertaken. METHODS: From November 1982 to December 1994, from a total 814 cases of primary GN, 22 patients with primary MPGN were diagnosed. Clinical data, medical records, renal pathology and outcome were reviewed. RESULTS: Patients included 15 male and 7 females, aged from 11 to 67 years. The average follow-up period was 46.3 months, with a range of 1 to 140 months. Tissue was available for electromicroscopic study in 11 cases; of which 9 cases fulfilled morphologic criteria of Type I MPGN; the other 2 cases were Type II MPGN. The clinical presentations at diagnosis included nephrotic syndrome (86.4%), impaired renal function (63.6%), microhematuria (50%), gross hematuria (31.8%) and hypertension (50%). Low serum C3 was found in 40.9% cases, 44.4% in Type I and 50% in Type III MPGN. The positive rate of hepatitis B virus infection was 22.7% with 33.3% in Type I and none in Type III MPGN. All 22 patients received various combined antihypertensive agents, immunosuppressant, anticoagulant and antiplatelet agents at diagnosis, but 17 had progressive disease, 4 maintained normal renal function with proteinuria and only 1 had complete remission. Fifteen patients, including six Type I and no Type III MPGN, progressed to end-stage renal failure. Both patients with Type III MPGN maintained normal renal function and responded to treatment. The 5 and 10 year actuarial renal survival rates were 33.3% and 16.7% respectively. The median kidney survival time was 51.2 months. CONCLUSIONS: A majority of cases with MPGN presenting with impaired renal function (86.7%) and hypertension (85%) at diagnosis progressed to end-stage renal failure. Delayed diagnosis and poor compliance were possible reasons for compared with for worse prognosis previous reports. But two patients with Type III MPGN had favorable prognosis previously described. Treatments generally failed to halt disease progression. Since at least five cases (22.7%) maintained normal renal function after treatments, a course of immunosuppressant is probably indicated if there is no contraindication. Further study with a larger population is warranted to clarify this issue.
Adolescent↗
Comparison and correlation of measurements of glomerular filtration rates by Tc-99m DTPA and 24-hour creatinine clearance.
BACKGROUND: The measurement of 24-hour creatinine clearance (CCr) is most commonly used to estimate glomerular filtration rate (GFR). A new rapid method for determining GFR by radionuclide compound Tc-99m diethylenetriamine-pentaacetic acid (DTPA) has been developed and widely used in the last decade. The purpose of this study is to compare and correlate the measurements of GFR by the two method. METHODS: The present series included 6 normal volunteer outpatients and 49 hospitalized patients with various degrees of renal dysfunction who were studied at Taichung Veterans General Hospital from June 1985 to June 1986. All patients underwent both Tc-99m DTPA GFR and 24-hour CCr. Tc-99m DTPA computed GFR was calculated using the formula of Gates. RESULTS: The radionuclide computed GFR for each subject was compared with his or her 24-hour CCr. The correlation coefficient (r) was 0.89 with p < 0.001. The subjects were divided into two groups. Group A consisted of 6 normal volunteers and 14 patients with serum creatinine less than 1.4 mg/dl (creatinine: normal range 0.7 to 1.4 mg/dl). Group B consisted of 35 patients with serum creatinine greater than 1.4 mg/dl. Group B was further divided into Subgroup 1 with serum creatainine from 1.4 to 10 mg/dl, and Subgroup 2 with serum creatinine above 10 mg/dl. There was good correlation and less absolute error between DTPA-GFR and CCr in Group A and Subgroup 1. The results suggest that, when serum creatinine is less than 10 mg/dl, either DTPA or CCr is a good method for detection of GFR. CONCLUSIONS: DTPA-GFR measurement using this radionuclide technique has shown good correlation with CCr when serum creatinine is under 10 mg/dl. In patients with renal impairment and with serum creatinine above 10 mg/dl, neither examination is reliable. A more sensitive test to evaluate GFR in severe renal impairment is required for further investigation.
Adolescent↗
Serum immunoglobulin E in primary IgA nephropathy.
The biosynthesis of human immunoglobulin E (IgE) is regulated by a complex network involving T and B lymphocytes. Diseases associated with high serum IgE (sIgE) levels are usually characterized by T cell disorders. Total sIgE level has been found to be of clinical relevance in minimal change nephrotic syndrome. However, the clinical significance has rarely been studied in primary IgA nephropathy (IgA N). We retrospectively studied 99 cases of primary IgA N. There were 59 males and 40 females with a mean age of 30.0 +/- 12.1 years. The mean follow-up duration was 45.9 +/- 31.1 months. Pathological grading was done according to the criteria of Meadow et al. Median sIgE for the entire group was 122.0 IU/ml (range: 2.8-5805 IU/ml) which was significantly higher than the healthy control group (median: 43,7 IU/ml, range: 5.0-1003 IU/ml, p < 0.001). However, when the IgA N cases were stratified into grades, only grade I (median: 514 IU/ml, range: 72.1-5805.0 IU/ml) and grade II (median: 229 IU/ml, range: 5.0-5464 IU/ml) patients had significantly higher sIgE than the control group (p < 0.0005 and p < 0.001 respectively). Patients with nephrotic ranged proteinuria (32 cases) were further classified into "stable" and "progressive" groups. The "stable" group had a significantly higher sIgE level (median: 922.0 IU/ml, range: 2.8-5805 IU/ml), compared to that of the "progressive" group (median: 55.3 IU/ml, range: 5.0-1600 IU/ml, p < 0.02). The effect of aggressive treatment (including corticosteroid and/or cyclophosphamide, cyclosporine) was also assessed.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Fabry's disease: clinical, pathologic and biochemical manifestations in two Chinese males.
Fabry's disease is a rare hereditary disease transmitted as an X-linked recessive trait with the primary metabolic defect of an enzyme alpha-galactosidase A, resulting in deposition of glycolipids (ceramide trihexoside) in various tissues, including the kidneys. Two sibling cases of Chinese adult male patients in a family with Fabry's disease were completely evaluated including the clinical, pathologic and biochemical studies. Both of the patients had the similar clinical manifestations such as telangiectases, proteinuria, acral pains, corneal opacities, tortuous renal vessels and recurrent fever. Chronic renal insufficiency was noted in Case 1, whereas Case 2 had normal renal function. Microscopic hematuria was noted in Case 1. In renal biopsy, LM showed foamy vacuolation of the glomerular visceral epithelial cells and EM showed widespread myelin bodies (Zebra bodies) in kidney tissues, most numerous in visceral epithelia in both cases. Those findings are diagnostic for Fabry's disease. The plasma activity of alpha-galactosidase of Case 1 was 0.8 and that of Case 2 was 1.0 (normal reference range: 8.5-18.5 nmol/hr/min). The plasma activity of alpha-galactosidase A of Case 1 was 0.4 and that of Case 2 was 0.8 (normal reference range: 7.9-16.9 nmol/hr/min). All the enzyme activities in both cases were much lower than those of normal subjects. In addition to clinical presentations, pathologic study and biochemical study with assays of plasma or serum activities of alpha-galactosidase and alpha-galactosidase A are important steps in the diagnosis of Fabry's disease.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The clinicopathological spectrum of renal amyloidosis.
BACKGROUND: Renal amyloidosis is an uncommon cause of nephrotic syndrome. The clinical conditions in Chinese people remain obscure. This is a retrospective review of the clinicopathological spectrum of 12 cases diagnosed in Taichung Veterans General Hospital from October 1982 to November 1993. METHODS: Charts and renal pathological slides were reviewed retrospectively. A scoring system was set to evaluate the degree of amyloid deposition in the renal tissue. The clinical profile, immunological data, pathological picture and final outcomes are presented and discussed, with literature review. RESULTS: There were 12 cases of primary amyloidosis including 1 case of multiple myeloma. All were confirmed by renal biopsy. The cases were all male with mean age of onset as 53.3 +/- 11.3 (range: 32 to 65 years). The mean follow-up duration was 22.9 +/- 32.8 months. The initial average creatinine clearance was 66.7 +/- 42.7 ml/min; mean daily urine protein was 7.0 +/- 4.1 grams. Nephrotic syndrome was the main clinical manifestation, present in all 12 cases. Other presenting symptoms and signs included: malaise in 7 cases; hypertension and anorexia in 4 cases; limb numbness in 3 cases; low back pain, dizziness and microhematuria in 2 cases each; anemia, headache, stroke, restrictive cardiomyopathy, hepatomegaly, syncope, body weight loss, dysphagia and skin itching in one case individually. Amyloid cardiomyopathy was present in 4 of the 8 patients who received echocardiography. The mean serum albumin level was 1.9 +/- 0.7 mg/dl, globulin level 3.1 +/- 1.1 mg/dl. Urinary Bence-Jones protein examination was performed in 8 cases; none revealed positive response. The mean immunoglobulin (Ig) level for the patients included: IgG 1018 +/- 901 mg/dl, IgA 262.0 +/- 313.8 mg/dl, IgM 104.8 +/- 84.2 mg/dl. There were at least 4 cases with high levels of one Ig but depressed levels in the others. M-component was shown by immunoelectrophoresis (IEP) in 90% of the cases. IEP impression in 10 cases revealed 2 cases of IgA lambda, 2 cases IgA kappa, 3 cases IgG lambda and 1 case IgG kappa monogammopathy, 1 case free lambda myeloma and 1 case negative. The ratio of kappa to lambda chain was 3:6. Bone marrow biopsy performed in 8 cases found only 1 case with multiple myeloma, one with amyloidosis; the other 6 cases were unremarkable. Mesangium was the site of heaviest amyloid deposition, followed by tubular basement membrane, artery and interstitium. The median survival time for those whose total score was lower than 3 points was 97.5 months; 3 to 5 points, 14 months; 6 points or more, 18.5 months. The median survival time was 21.6 months and 3-year-survival rate was 32.7%. The 2 cases with long-term survival were of 111 months and 84 months. The possible reason included: 1) Organ-limited renal amyloidosis; 2) Light amyloid deposition; 3) Younger age; 4) Other undetected favorable factors. CONCLUSIONS: 1) Renal amyloidosis is not a frequent diagnosis of nephrotic syndrome in Taiwan, but it should be suspected in every patient over 50 years old with a recent onset of proteinuria. 2) Renal amyloidosis can be diagnosed only by renal biopsy. 3) Primary renal amyloidosis is a disease of poor prognosis.
Adult↗
Lymphocyte proliferation in uremic patients: correlation with zinc status.
The pivotal role of zinc in the immune response has been well demonstrated in animals with normal renal function; however, there are fewer studies in uremic patients. Twenty uremic patients on regular hemodialysis (HD), and 20 patients on continuous ambulatory peritoneal dialysis (CAPD) were studied for their lymphoproliferative response to concanavalin A, phytohemagglutinin and pokeweed mitogen. CAPD patients had significantly lower levels of plasma zinc (65.8 micrograms/dL vs 75.1 micrograms/dL, p < 0.05) and serum albumin (3.5 g/dL vs 4.4 g/dL, p < 0.05) than HD patients. However, the stimulation indices were similar between these two groups no matter what mitogens were used, although they were significantly lower than those for the normal control group. Regression analysis revealed that there was no correlation between zinc status and the stimulation indices. However, there was a significant correlation between serum zinc and the absolute counts in HD patients. These findings suggest that zinc does not play a consistent role in the impaired lymphoproliferative response among uremic patients receiving different modes of dialysis therapy.
Adult↗
Primary IgA nephropathy: a nine-year clinicopathologic study in the Veterans General Hospital-Taichung.
IgA nephropathy (IgA N) is the most common type of primary glomerulonephritis (GN) diagnosed in Taiwan. From February 1983 to May 1992, 194 patients with primary IgA N, representing 25.3% of the primary GN, were diagnosed by renal biopsy at this hospital. Clinicopathologic correlation was made in 175 cases of IgA N with adequate clinical and pathologic data including light-(LM), immunofluorescent (IF) and/or electron-(EM) microscopy. Modified classification of Meadow et al. was adopted for the histologic grading of glomerular lesions. Forty-nine biopsies (28.0%) showed Grade IV and V lesions (Grade IV, 10.9%; Grade V, 17.1%, respectively) in association with a high level of serum creatinine and a lower frequency of gross hematuria when compared with lesions of histologic Grades I to III. Patients with Grade V lesions revealed a high frequency of hypertension as compared with those with Grades I to IV. The frequencies of nephrotic range proteinuria in those with various grades of IgA N was not statistically significant in this study. One hundred and thirty patients were followed up for one to eight and half years or until end-stage renal disease (ESRD) developed (mean 3.9 years), excluding the biopsies done at ESRD or from the graft kidney. Forty-two patients (32.3%) had chronic renal insufficiency, of those 25 (19.2%) eventually developed ESRD. Seventy-five percent of the patients with histologic Grades IV and V showed progressive renal disease, while only 16% of patients with Grades I to III lesions revealed progressive disease, the latter indicating a more benign course (P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Effective renal plasma flow in renal transplant rejection].
It is important to differentiate between cell-mediated (acute) and humoral (chronic) rejection in renal transplantation in order to initiate appropriate therapy. Since effective renal plasma flow (ERPF) provides a sensitive method of analyzing renal function, this test was undertaken to evaluate the possibility of differentiating acute and chronic rejections by ERPF. A total of 90 patients (no rejection: 33, acute rejection: 45, chronic rejection: 12) were retrospectively included in this study. ERPF was determined by performing comprehensive renal function test (Tauxe et al., 1980) and Student's unpaired t-test was used to evaluate the statistical difference (no rejection vs chronic rejection, no rejection vs acute rejection, acute rejection vs chronic rejection). The ERPF value of the no rejection group (228.9 +/- 119.2 ml/min) was significantly higher than the ERPF value of the acute rejection group (167.5 +/- 86.9 ml/min) and the chronic rejection group (137.2 +/- 60.2 ml/min) (P < 0.05). By in contrast, there was no significant difference between the acute rejection group and the chronic rejection group (P > 0.05). We concluded that ERPF value alone could not differentiate between acute rejection and chronic rejection in renal transplantation.
Adolescent↗
Immunoglobulin-E-specific suppressor factors in primary glomerulonephritis with nephrotic syndrome.
Human immunoglobulin (Ig) E synthesis is regulated by T-cell-derived binding factors which include potentiating factors and suppressor factors (IgE-SFs) and B-cell-derived factors. Seventeen cases of primary glomerulonephritis (GN) with nephrotic syndrome and high serum IgE were studied for their serum IgE-SFs. These include 8 cases of minimal-change disease (MCD), 3 cases of IgM nephropathy, 4 cases of focal segmental glomerulosclerosis, and 2 cases of IgA nephropathy, aged between 20 and 60 years (mean: 37.2). A significantly lower activity of these factors was noted in the patient group as shown by a lower overall inhibition rate on in vitro IgE synthesis (median: 22.9 vs. 53.2%, p less than 0.05). Some of them even exhibited an enhancing activity in their serum as shown by a negative inhibition rate. These findings suggest that there is a T cell disorder in some of the primary GNs with high serum IgE, especially in MCD, which causes an abnormal regulation of IgE synthesis.
Adult↗
Pentazocine addict nephropathy: a case report.
Medical complications associated with narcotic addiction include bacterial endocarditis, pneumonia, pulmonary embolism and renal disease. Renal disorders associated with pentazocine abuse are rarely reported. They vary with method of administration, dosage, and duration of abuse. We describe a 33-year-old male addict, using intravenous pentazocine for 6 years. He has nephrotic syndrome with a rapid deterioration of renal function to a uremic stage within 3 weeks. The laboratory data includes: IgG 1270 mg/dl, IgA 369mg/dl, IgM 326mg/dl, C'3 65.2 mg/dl, C'4 16.3 mg/dl, and serum soluble interleukin-2 receptor level (sIL-2R) greater than 6000U/ml. A renal biopsy revealed membranoproliferative glomerulonephritis (MPGN) type I with tubulointerstitial nephritis. Immunofluorescent (IF) study revealed granular deposition of C'3 and IgM in mesangium and the glomerular capillary wall. The pathogenesis of glomerular disease in drug addicts is discussed, and the literature reviewed.
Adult↗
Epstein-Barr virus-associated T-cell lymphoma of the maxillary sinus in a renal transplant recipient.
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Adult↗
[Bone mineral density in patient with renal transplant].
Progressive renal failure may cause disturbance of mineral metabolism. Successful renal transplantation may correct many features of disturbance of calcium and phosphorus metabolism. Dual photon absortiometry (DPA) provides a noninvasive method for the serial measurements of bone mass of the vertebral bodies. Using this method, bone mineral density (BMD) was detected and evaluated in patients with renal transplants. In this study, BMDs of lumbar vertebrae 2 to 4 were measured and the mean value was presented as gm/cm2. Forty seven patients (over 40 years of age) with renal transplants and 103 normal controls of a similar age group were included in this study. Surprisingly, no significant difference in bone mineral density was found between the patients with renal transplant and the normal controls in our preliminary study.
Adult↗
Hypertension following successful renal transplantation.
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Female↗
Glomerular diseases in human renal allograft.
A total of 64 renal graft biopsies performed on 44 transplant patients from among 116 transplants (12 from living donors, 104 from cadavers) were analyzed during the period from July 1983 to December 1990. The frequency of allograft glomerular disease was 22.7% (10/44). Membranous glomerulonephritis (MGN) was detected in five patients; focal segmental glomerulosclerosis (FSGS), in two; transplant glomerulopathy, in two; and IgA nephropathy, in one. Nephrotic syndrome occurred in nine of the ten patients. Progressive deterioration of graft function developed in four patients associated with chronic rejection, and two of them later lost the graft. The remaining six patients had no chronic rejection and retained a stable renal condition with one exception, a patient who suffered from acute total occlusion of the right internal iliac artery and who eventually lost the graft. It is concluded that MGN is the most common allograft glomerular disease, but the outcome of the graft is probably related to the coexistent chronic rejection.
Adult↗
Persistant abnormal serum parathyroid hormone after renal transplantation: correlation between renal graft function.
Secondary hyperparathyroidism in uremia renal transplantation. We studied the i-PTH (immunoactive parathyroid hormone) of nineteen immunoactive parathyroid hormone) of nineteen patients before and after renal transplantation with average of 20 months post transplantation. In group I patients with normal i-PTH serum level had an significant lower serum level of creatinine than Group II with elevated abnormal i-PTH. While the calcium and phosphorus showed no significant difference between group I and Group II patients. We suggested that abnormal serum i-PTH level after renal transplantation after one year was closely related to renal graft function. This group of abnormal serum i-PTH should be closely monitored for their renal graft function.
Calcium↗