Search PubMed⌕ Search

Biomedical subjects

L Arisz

Publications and source records attributed to L Arisz.

At least 109 records · Page 6Linked to original sources
PubMed1989

Circadian rhythm of proteinuria: consequences of the use of urinary protein:creatinine ratios.

Proteinuria in patients with glomerular disease has a circadian rhythm, but for creatinine such a rhythm is either absent or of low amplitude. We found in 18 of 23 admitted patients (group I) and in seven outpatients (group II) a marked circadian rhythm of the protein: creatinine ratio. Estimates of 24-h proteinuria were obtained by multiplying the protein:creatinine ratio of 3-h urine samples with 24-h creatinine excretion, calculated from age, sex and bodyweight. Estimated proteinuria could be as low as 19% or as high as 349% of actually measured 24-h proteinuria; the mean SD was 23%. The best estimate was obtained with the 06.00-09.00 hours urine samples. The estimates correlated better with actually measured 24-h proteinuria than the protein: creatinine ratio per se correlated with the 24-h proteinuria. Day-to-day variation of proteinuria estimates from samples taken at the same time of the day was of similar magnitude as day-to-day variation of actual 24-h proteinuria. We conclude that the usefulness of the protein: creatinine ratio of a random urine sample for estimation of proteinuria is limited, because of the circadian rhythm of proteinuria. However, samples collected at a fixed time of the day are an acceptable alternative for 24-h urine collections in the clinical follow-up of individual patients.

Adolescent↗
PubMed1989

Grey-Turner's sign in sclerosing peritonitis.

A 41-year-old CAPD patient developed Grey-Turner's sign during the course of bacterial peritonitis due to Pseudomonas aeruginosa. At the same time a diagnosis of sclerosing peritonitis was made by CT-scanning of the abdomen. We think that Grey-Turner's flank staining could either have been caused by synthesis of proteases by the Pseudomonas bacteria or by reduced mesenteric flexibility and increased vascularization of the peritoneum due to the sclerosing peritonitis. This could have led to spontaneous mesenteric bleeding with leakage to the retroperitoneal tissues. A possible relationship with an ascites puncture is less likely.

Abdomen↗
PubMed1989

Renal involvement in Behçet's syndrome. Report of a case and a review of the literature.

A patient is described with acute renal failure in Behçet's syndrome. Two types of renal involvement can occur in patients with Behçet's syndrome, viz., proliferative glomerulonephritis and amyloidosis. Glomerulonephritis can occur early in the disease; amyloidosis is a late complication. In patients with amyloidosis of unknown origin, Behçet's syndrome should be considered.

Acute Kidney Injury↗
PubMed1989

Glomerulopathy as a paraneoplastic phenomenon.

A review is presented of the association between a glomerular disease and a malignancy. The incidence of Hodgkin's disease in patients with glomerulopathy is very low, but the incidence of a solid tumour in a patient with glomerulopathy varies between 3 and 13%, mean 7%, and may be as high as 22% in patients over 60 years of age with a membranous nephropathy. A solid tumour was found most frequently in patients with membranous nephropathy. On the other hand, minimal change nephropathy is often associated with Hodgkin's disease and membrano-proliferative glomerulopathy with chronic lymphatic leukaemia. In Hodgkin's disease-associated glomerulopathy, a defect in the function of T lymphocytes is probably important, but the precise pathogenesis has not yet been elucidated. The other glomerulopathies may be mediated by immune complexes, containing tumour-derived antigens and their antibodies, either formed in situ or deposited as complexes from the circulation.

Antigen-Antibody Complex↗
PubMed1988

Deficiencies of vitamins in CAPD patients: the effect of supplementation.

Concentrations of the vitamins B1, B2, B6, B12, C, folic acid, A, E and beta-carotene were determined in blood and 24-h dialysate in 44 CAPD patients. Twenty-five of these patients were studied during chronic treatment (mean 313 days, range 60-1034 days). Nineteen patients were studied during training. In a longitudinal study, 11 patients were analysed again after 77-507 (mean 238) days. In both patient groups a considerable portion of patients (11%-64%) had blood concentrations indicative of a deficiency of the vitamins B1, B6, C and folic acid. The average concentrations of these vitamins were normal in both groups. The only abnormal finding was the mean EGOT activity being deficient in patients on chronic treatment. Mean concentrations of vitamin A were above normal in both groups. In the longitudinal study a significant increase of vitamin B2 and a decrease of vitamin B6 in blood was found. When compared to 24-h excretion in normal urine, loss with 24-h dialysate was low for vitamin B1, normal to relatively high for vitamin B2 and B6, but extremely high for vitamin C and folic acid. The vitamins B12, A, E and carotenoids were hardly detectable in the dialysate. In ten other patients the effect of daily supplementation with 2 mg vitamin B6, 100 mg vitamin C and 400 micrograms folic acid was analysed during a 16-week period. In all patients a significant increase in blood concentrations was obtained. It is concluded that these dosages were sufficient to maintain a normal status of these vitamins in CAPD patients.

Adult↗
PubMed1988

Differences in the peritoneal transport of water, solutes and proteins between dialysis with two- and with three-litre exchanges.

In eight, CAPD patients who either had insufficient results of dialysis treatment (six) or loss of ultrafiltration (two) on a normal scheme (4 X 2-1), the effects of a 3-1 dialysate exchange on the in situ intraperitoneal volume, solute mass transfer, and mass transfer area coefficients were compared with a 2-1 exchange. The solutes investigated were urea, lactate, creatinine, glucose, kanamycin, inulin, beta 2-microglobulin, albumin and IgG. The time course of the intraperitoneal volume showed marked interindividual variations. However, delta mean volume was lower with the 3-1 exchanges than with 2-1. This was the result of an increased water reabsorption rate during 3-1 (2.18 ml/min vs 0.94 ml/min, P less than 0.01), probably caused by increased lymphatic absorption. Peritoneal mass transfer of low-molecular-weight solutes (up to 500) was increased with the 3-1 exchange, but there was no evidence of any alteration in effective peritoneal surface area or peritoneal permeability. By comparing the mass transfer area coefficients of the various solutes to their free diffusion coefficients, it appeared likely that the diffusion of the low-molecular-weight solutes was unrestricted by membrane permeability and only hampered by the effective peritoneal surface area. For the proteins a size-selective restricted diffusion was found.

Adult↗
PubMed1987

Antifungal treatment of Candida peritonitis in continuous ambulatory peritoneal dialysis patients.

Nine peritonitis episodes caused by Candida sp were diagnosed in eight continuous ambulatory peritoneal dialysis (CAPD) patients. Treatment with intraperitoneal administration of amphotericin B and 5-fluorocytosine while the peritoneal catheter was left in situ was effective in six episodes in five patients. Of the three other patients, two started again with CAPD after peritonitis had been cured, but one patient preferred to stay on hemodialysis. In four episodes, peritoneal white cell counts remained high during treatment despite negative cultures. This was probably the result of irritation of the peritoneal membrane caused by the antifungal treatment, possibly by amphotericin B. Persistently-elevated leukocyte counts during antifungal therapy, with or without signs and symptoms of peritonitis, are not necessarily an indication of treatment failure.

Aged↗
PubMed1987

Alterations in the peritoneal transport of water and solutes during peritonitis in continuous ambulatory peritoneal dialysis patients.

The in situ intraperitoneal volume and the mass transfer area coefficients (MTC) of urea, lactate, creatinine, glucose, kanamycin, inulin, beta 2-microglobulin, albumin and IgG were studied in eight continuous ambulatory peritoneal dialysis (CAPD) patients. All patients were studied during a 4-h dialysis dwell, first during peritonitis and subsequently after recovery from the infection. The maximal intraperitoneal volume was reached at 68 min during peritonitis and at 150 min in the study after recovery (P less than 0.01), suggesting increased water transport during the infection. For all investigated solutes MTCs were higher in the presence of peritonitis than after recovery. This increase was most marked for the proteins (greater than 100%). The power curve relationships between MTCs and molecular weight indicated that peritoneal transport of the low- and middle-molecular weight solutes was determined by free diffusion and that the infection-induced rise was due to an increase in effective surface area. For protein transport restricted diffusion was found. The increase of this transport during peritonitis was probably caused by both a larger effective surface area and a higher vascular permeability.

Adult↗
PubMed1987

Circadian rhythm of urinary beta 2 microglobulin excretion in patients with a nephrotic syndrome.

The changes in urinary beta 2 microglobulin excretion during the day were studied in 20 patients with a nephrotic syndrome under standardized conditions and compared with the known circadian variations in urinary albumin excretion in the same patients. Fifteen of the 20 patients (75%) had a circadian rhythm for beta 2 microglobulin in the urine. Phase as well as relative amplitude of the beta 2 microglobulin circadian rhythm varied between patients. In addition, its presence, normality, amplitude and phase were largely different from the albumin rhythm. Observations made in 10 healthy individuals suggest that day-night variability in the excretion of beta 2 microglobulin and albumin in the urine is also present in the absence of clinically important proteinuria. Circadian variations in urinary beta 2 microglobulin excretion are found in a majority of the patients with nephrotic syndrome and as they differ in several respects from the day-night fluctuation in urinary albumin excretion the mechanism is probably different.

Adolescent↗
PubMed1987

The relationship between peritoneal glucose absorption and body fluid loss by ultrafiltration during continuous ambulatory peritoneal dialysis.

Eight continuous ambulatory peritoneal dialysis (CAPD) patients were studied during six consecutive days using dialysate with a different glucose concentration on each day. For all dialysate glucose concentrations ranging from 70 to 198 mmol/l, an inverse linear relationship was found between the percentage of absorbed glucose and the ultrafiltration rate. In each patient a linear correlation was demonstrated between the dialysate glucose concentration and the quantity of body fluid removed by ultrafiltration. Therefore the dialysate glucose concentration without net removal of fluid could be calculated for each patient: DGCUF = 0. This DGCUF = 0 is a parameter of the relationship between the transport of water and glucose over the peritoneal membrane and can thus be considered a marker of the individual ultrafiltration. The calculated DGCUF = 0 was compared with DGCUF = 0 predicted from the glucose absorption using the equation as derived from our data: DGCUF = 0 (mmol/l) = 2.1 X glucose absorption (%) -67 (mmol/l). As marked day to day variations were found, the results of these predicted DGCUF = 0 should be interpreted cautiously when used for long-term follow-up of peritoneal permeability in CAPD patients.

Adult↗
PubMed1986

Simple assessment of the efficacy of peritoneal transport in continuous ambulatory peritoneal dialysis patients.

The efficacy of peritoneal transport was assessed in 13 permeability studies in 11 continuous ambulatory peritoneal dialysis (CAPD) patients. During each study the in situ intraperitoneal volume was measured as well as the dialysate and plasma concentrations of various solutes with a molecular weight range from 60 to 5,500. As clearance estimations are unsuitable for the purpose of permeability studies, mass transfer area coefficients were used. By applying a simple mathematical model assuming first-order kinetics, these coefficients were calculated for urea, lactate, creatinine, glucose, kanamycin, and inulin. The accuracy of the calculations is indicated by their r values. After pooling these correlation coefficients, the mean approached 1.00 for all solutes with high confidence limits, indicating the usefulness of the model. A further simplification was tested using only an initial- and end-dialysate sample and two blood samples, without the measurement of the in situ intraperitoneal volume. Except for inulin the results of this simplification correlated well with the results described above. The reproducibility of the simplified mass transfer area coefficient calculations was investigated on 15 occasions in 3 other CAPD patients. The coefficients of variation of low molecular weight solutes varied between 15 and 20%. It is concluded that mass transfer area coefficient estimations using the latter method can be performed in any CAPD patient and probably yield sufficient information to establish the efficacy of the membrane transport mechanism during clinical follow-up.

Adult↗
PubMed1986

Peritoneal permeability to proteins in diabetic and non-diabetic continuous ambulatory peritoneal dialysis patients.

Peritoneal permeability to proteins was measured in diabetic and non-diabetic continuous ambulatory peritoneal dialysis patients during peritonitis and control periods. Clearances of albumin, transferrin, IgG, C3 and alpha 2-macroglobulin appeared to decrease as molecular weight increased. This relationship could be described by a power curve fit. The decrease was more than could be explained by differences in free diffusion only, indicating a size-selective barrier in the peritoneum. For all measured proteins clearances were higher in the diabetic patients. This may reflect a generally increased permeability due to their microangiopathy. The largest increase in protein loss and protein clearances was found during peritonitis. Our results do not suggest increased local production of any of the investigated proteins during the inflammation. Therefore, an increase in either peritoneal permeability or effective surface area or both is the most likely explanation. It is concluded in this study that peritoneal protein clearances are dependent on their molecular weight and that they are proportionally increased in patients with diabetes and during peritonitis.

Adult↗