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Biomedical subjects

L E Lins

Publications and source records attributed to L E Lins.

At least 37 records · Page 2Linked to original sources
PubMed1990

Altered vasopressin release and osmotic regulation during exercise in patients with pyelonephritic renal scarring.

Children and adults with pyelonephritic renal scarring are at high risk of developing hypertension. The objectives of the present investigation were to study if it is possible to detect early disturbances in blood pressure (BP) control and secretion of hormones involved in the regulation of BP and renal function, in patients with renal scarring. We studied renal function at rest, BP regulating hormones and BP at rest and during graded bicycle exercise until exhaustion. The 22 patients with renal scarring had significantly lower glomerular filtration rate and renal blood flow than the 13 healthy age-matched controls. At rest, the patients had higher diastolic (p less than 0.01) and mean arterial BP (p less than 0.02), higher plasma renin (p = 0.06) and higher serum osmolality (p less than 0.001) but there were no significant differences in systolic BP, angiotensin II, aldosterone or vasopressin (AVP). The patients with renal scarring had higher AVP than the controls during light and moderate exercise and 15 min after maximal exercise. BP and renal hormones increased significantly but similarly during exercise in both patients and controls. There were no significant differences in BP control or release of pressure-regulating hormones at maximal exercise. Maximal exercise did not evoke pathological BP response in normotensive young adults with pyelonephritic renal scarring. The increase in serum osmolality and hypersecretion of AVP during light and moderate exercise may be important in the pathogenesis of hypertension in this group of patients.

Adult↗
PubMed1989

Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up.

OBJECTIVE: Determination of the long term incidence of uraemia, hypertension, and toxaemia in pregnancy associated with non-obstructive focal renal scarring after pyelonephritis in childhood 25-35 years earlier. DESIGN: 27 Year follow up of patients with non-obstructive focal scarring identified from a retrospective review of intravenous urograms performed in childhood between 1951 and 1967. SETTING: Paediatric primary referral centre and urological clinic in tertiary referral centre. PATIENTS: 30 Patients (mean age 33 (range 22-41] with non-obstructive focal renal scarring first detected between 1951 and 1967 and a history of febrile urinary tract infection. MAIN OUTCOME MEASURE: Hypertension and complications of renal damage. RESULTS: Three patients had developed end stage renal disease, seven had developed hypertension, two of 16 women had a history of toxaemia during pregnancy, and seven patients had undergone renal surgery during follow up. Of the 20 patients who had neither had renal surgery nor had end stage renal disease, all had a significantly lower glomerular filtration rate and renal plasma flow and higher diastolic blood pressure, mean arterial blood pressure, plasma renin activity, and serum beta 2 microglobulin concentration than 13 healthy age matched controls. Diastolic blood pressure and plasma renin activity were positively correlated (r = 0.50, p less than 0.05) and so were fractional sodium excretion and both systolic and diastolic blood pressures (r = 0.54, p less than 0.01, r = 0.51, p less than 0.01 respectively). The progress of renal damage was unrelated to the incidence of recurrent infections. CONCLUSIONS: Children with focal renal scarring due to pyelonephritis are at high risk of serious long term consequences. It is essential that they are given adequate attention and care during adolescence and pregnancy.

Adult↗
PubMed1989

Experimental and immunohistochemical studies on the possible role of parathyroid hormone in uraemic pruritus.

Secondary hyperparathyroidism has been suggested as a cause of itching in chronic renal failure. The aim of the present study was to evaluate the possible role of parathyroid hormone (PTH) in pruritus affecting patients undergoing maintenance haemodialysis. In agreement with our previous findings, patients with pruritus had significantly (P less than 0.01) higher serum levels of PTH fragment 53-68 (m-PTH53-68) than patients without pruritus, 47.7 +/- 40.0 and 23.4 +/- 17.1 micrograms l-1 respectively. Serum concentrations of other substances including calcium, phosphate and magnesium did not differ between the two groups of patients. Intradermal injections of human PTH1-34 and PTH44-68 failed to evoke any acute or delayed cutaneous reactions in either patients or controls. Immunohistochemical investigations of skin biopsies from uraemic patients using several different antibodies against PTH were negative. Thus, the present results do not support PTH as a peripheral mediator of uraemic itching.

Adult↗
PubMed1989

Factors influencing physical working capacity in renal transplant patients.

Clyne N, Jogestrand T, Lins L-E & Pehrsson SK. Division of Nephrology and Cardiology, Department of Medicine and Department of Clinical Physiology, Karolinska Hospital, Stockholm, Sweden. We have examined uraemic patients' exercise capacity, and the factors influencing this capacity, before and after successful renal transplantation. Eleven uraemic patients (mean age 41 +/- 10 years) with an average glomerular filtration rate (GFR) of 5 +/- 4 ml/min x 1.73 before and 45 +/- 19 ml/min x 1.73 after transplantation participated in the study. The maximal exercise capacity, measured by standardized exercise test on a bicycle ergometer, averaged 106 +/- 25 W before and 126 +/- 35 W (p less than 0.05) after transplantation. The patients interrupted the tests prior to and after transplantation because of general fatigue, leg tiredness or both. No patient experienced angina pectoris. All, but one, had a normal ECG reaction during exercise. Total haemoglobin (THb) was 55 +/- 8% of the expected normal before and 84 +/- 19% after transplantation (p less than 0.01). The increase in working capacity was linearly correlated to the increase in THb (r = 0.84, p less than 0.01), but not to the improvement in GFR nor to the decrease in parathyroid hormone. In conclusion, successful renal transplantation improves working capacity. The results indicate that an increased THb is a major determinant for this increase in working capacity.

Adult↗
PubMed1988

P-fimbriae receptors in patients with chronic pyelonephritis.

The adherence of fluorescein isothiocyanate-labeled P-fimbriated Escherichia coli to uroepithelial cells from 19 women with chronic pyelonephritis was determined with the fluorescence-activated cell sorting technique. The application of this method has made it possible to study bacterial binding to a large number of cells. Renal function was determined in all patients and the recurrences of P-fimbriated Escherichia coli bacteriuria, cystitis and acute pyelonephritis during a 3-year followup were studied. We found a significant correlation between the P-fimbriae receptor accessibility on uroepithelial cells and glomerular filtration rate (r equals -0.75, p less than 0.001). Uroepithelial cells from the patients with chronic pyelonephritis and renal insufficiency had a higher binding capacity of P-fimbriated Escherichia coli than uroepithelial cells from patients with a normal glomerular filtration rate. There was no correlation between kidney function and the availability of P-fimbriae receptors in a control group of patients with polycystic kidney disease.

Adult↗
PubMed1988

Renal hemodynamics and blood pressure control in patients with pyelonephritic renal scarring.

Pyelonephritic renal scarring is a common cause of renal failure and hypertension. We studied glomerular filtration rate (GFR), renal plasma flow (RPF), filtration fraction (FF), total renal area (TRA), systolic (SBP) and diastolic (DBP) blood pressure in 22 female patients with verified renal scarring and a history of febrile urinary tract infection (UTI) and in 9 healthy age-matched women with normal urograms and no history of symptomatic UTI. The patients with renal scarring had significantly lower GFR, smaller TRA and higher SBP than the healthy controls, but not significantly different RPF or FF. A decrease in GFR and RPF was associated with higher SBP and DBP in the patients with renal scarring. RPF/TRA, representing an approximation of the perfusion of renal tissue and GFR/TRA, were similar in patients with renal scarring and healthy controls. A reduction of renal parenchyma was accompanied by a proportional decrease in GFR and RPF, resulting in unchanged FF. These findings do not support the concept of hyperfiltration as a main cause of renal insufficiency in patients with pyelonephritis renal scarring. An increase in FF and a decrease in GFR/TRA and RPF/TRA was associated with higher DBP and a decrease in GFR/TRA and RPF/TRA with an increase in the urinary albumin excretion. We conclude that renal hemodynamics play an important part in the blood pressure control of patients with renal scarring and that in these patients with various degrees of renal failure there was no evidence of hyperfiltration or hyperperfusion by remnant glomeruli.

Adult↗
PubMed1988

Role of hypervolemia and renin in the blood pressure control of patients with pyelonephritis renal scarring.

Patients with pyelonephritic renal scarring are at risk of developing renal failure and hypertension. We studied glomerular filtration rate (GFR), renal plasma flow (RPF), filtration fraction (FF), systolic (SBP) and diastolic (DBP) blood pressure, fractional sodium, potassium and phosphate excretion, peripheral renin activity (PRA), plasma aldosterone (p-Aldo), urinary albumin excretion (U-Alb) and urinary beta 2-microglobulin excretion (beta 2-M) in hydropenia and during transition to 3% volume expansion with isotonic saline infusion in 22 female patients with renal scarring due to pyelonephritis and 9 healthy controls. The patients had significantly lower GFR, higher SBP and higher PRA in hydropenia, but there was no significant difference in RPF, FF, DBP or p-Aldo. After volume expansion, SBP, DBP, PRA and p-Aldo were significantly higher in patients than in controls. Transition to 3% volume expansion was associated with a similar increase in SBP in both patients and controls, whereas DBP increased significantly more in the patients (p less than 0.01). Volume expansion resulted in a significant suppression of PRA and p-Aldo in both patients and controls. The patients with renal scarring had the same capacity to excrete sodium and water during transition to volume expansion as the healthy controls. The renin-aldosterone system seems abnormally activated and is probably more important than hypervolemia in the development of hypertension in this group of patients.

Adult↗
PubMed1988

Pruritus in patients on maintenance hemodialysis.

Twenty-nine patients undergoing maintenance hemodialysis were examined for dermatologic symptoms. Nineteen patients (66%) complained of pruritus, which was classified as mild (34%), moderate (24%), and severe (8%). Patients with pruritus did not differ from those without pruritus regarding serum concentrations of creatinine, urea, calcium, alkaline phosphatase or aluminum, nor was there any difference in duration of hemodialysis, age or sex. In pruritic patients serum concentrations of parathyroid hormone were significantly higher when determined with a mid-region radioimmunoassay technique (p less than 0.01) and higher, although not significantly, when the intact parathyroid hormone molecule was measured. Serum concentrations of phosphate were significantly lower in patients with pruritus (p less than 0.05).

Adult↗
PubMed1988

Lipoproteins and metabolic control in hypertensive type II diabetics treated with clonidine.

Twenty patients with type II diabetes mellitus and hypertension (WHO stages I and II) participated in a 3-month double-blind cross-over study to evaluate the effects of clonidine (75-300 micrograms daily) on blood pressure, glycemic control and plasma lipoproteins. Already after 1 month's treatment with clonidine the systolic and diastolic blood pressures had decreased, from 168/103 to 161/98 mmHg (p less than 0.01). Fasting blood glucose and HbA1c concentrations were unaffected by 3 months' treatment. Similarly, plasma lipid and lipoprotein concentrations remained unchanged throughout the study (i.e. mean high and low density lipoprotein cholesterol concentrations were 0.89 and 3.87 mmol/l on placebo vs. 0.90 and 3.98 mmol/l on clonidine). Adverse effects were mild and tolerable, and consisted mainly of dryness of the mouth. We conclude that clonidine lowers the blood pressure in patients with type II diabetes without any adverse effects on glycemic control or plasma lipoproteins.

Blood Glucose↗
PubMed1988

The sensitivity of uremic and normal human skin to histamine.

Cutaneous reactions induced by intradermal histamine injection were studied in uremic patients with and without pruritus who were undergoing maintenance hemodialysis and also in healthy subjects. Flare reactions were significantly smaller in both groups of patients than in controls. However, the itch responses following histamine injection were greater in patients with pruritus than in non-pruritic patients and healthy subjects, indicating an augmented sensitivity to pruritogens in these patients. The development of histamine tachyphylaxis was demonstrated in healthy human skin. After repeated histamine injections at intervals of 90 min, both itch and flare responses decreased rapidly. A similar decline in histamine reactivity occurred when the interval between injections was extended to 24 h. The phenomenon of histamine tolerance was confirmed in 2 uremic patients.

Adult↗
PubMed1987

Symptomatic recurrent urinary tract infections in patients with renal scarring in relation to fecal colonization with P-fimbriated Escherichia coli.

We evaluated prospectively 49 women with renal scarring and a history of febrile urinary tract infections in regard to the incidence of recurrent symptomatic urinary tract infection and fecal colonization with P-fimbriated Escherichia coli. During a 3-year followup 26 patients (53 per cent) had symptomatic urinary tract infection (0.036 infections per patient-month), including 8 (16 per cent) who had 9 new episodes of febrile urinary tract infection, while 33 (67 per cent) had Escherichia coli bacteriuria (10(5) bacteria per ml. urine in pure culture). Thus, patients with previous febrile urinary tract infections and renal scarring have a high risk for recurrent infections. For comparison, the incidence of symptomatic urinary tract infection also was determined in 35 women with a recent episode of acute nonobstructive pyelonephritis and with normal kidneys on excretory urography. These patients had 0.031 symptomatic infections per patient-month. The fecal flora were examined twice a year for P-fimbriated Escherichia coli in 48 patients with renal scarring. Of these patients 21 (44 per cent) had at least 1 fecal colonization with a P-fimbriated Escherichia coli strain. However, in only 1 instance was a relationship detected between the presence of P-fimbriated Escherichia coli in the fecal flora and the development of subsequent febrile urinary tract infection. The findings indicate that fecal sampling twice a year is not of value to predict future urinary tract infections in adults with renal scarring.

Adult↗
PubMed1987

Factors limiting physical working capacity in predialytic uraemic patients.

The exercise capacity of 20 predialytic uraemic patients (mean age 43 +/- 12 years) was studied prospectively. Nine of these patients were examined twice in a longitudinal study. The maximal working capacity, measured by standardized exercise test on a bicycle ergometer, averaged 74 +/- 19% of the expected normal. Normal exercise ECG were registered in 16 out of 20 patients. Total hemoglobin/kg body weight (THb) was 67 +/- 16% of the expected normal and serum parathyroid hormone concentration (PTH) was 39 +/- 39 micrograms/l (normal range 0.5-1.5). Partial correlation showed a correlation between exercise capacity and PTH (p less than 0.05). In the longitudinal study the decrease in steady state exercise capacity was correlated to the decrease in THb (p less than 0.05), but not to the increase in PTH. In conclusion, patients with predialytic uraemia have a reduced maximal working capacity, due to several possible factors one of which is a reduced THb. Ischaemic heart disease seems to be of minor importance.

Adult↗
PubMed1987

Renal size, glomerular function and urinary excretion of albumin and beta 2-microglobulin in patients with renal scarring due to pyelonephritis.

We have determined glomerular filtration rate (GFR), renal plasma flow (RPF), urinary excretion of albumin and beta 2-microglobulin, urinary osmolality and total renal area in 22 female patients with renal scarring and a history of febrile urinary tract infections (UTI) and in nine healthy age-matched controls with normal i.v. urography. The aim of the study was to compare different methods of determining glomerular function in patients with renal scarring due to previous pyelonephritis and to determine the urinary excretion of beta 2-microglobulin in these patients. All individuals were investigated in hydropenia. The patients with renal scarring had significantly lower GFR, smaller kidneys and lower urinary osmolality than the controls. A significant positive correlation between GFR and total renal area (r = 0.70, p less than 0.001) and between GFR and urinary albumin excretion (r = -0.69, p less than 0.001) was demonstrated. This indicates that determinations of total renal area from an i.v. urography and the urinary albumin excretion can be used for estimating GFR. Increased urinary excretion of beta 2-microglobulin does not occur in patients with renal scarring until the glomerular function is severely deteriorated.

Adult↗
PubMed1987

Microalbuminuria in long-term insulin-dependent diabetes mellitus. Prevalence and clinical characteristics in a normotensive population.

Albumin excretion rate was determined by radioimmunoassay in overnight urine from 102 normotensive patients with insulin-dependent diabetes mellitus of more than 10 year's duration. Based on two samples, 16 patients (16%) exhibited microalbuminuria, defined as a mean excretion rate greater than 20 micrograms/min. Microalbuminuric patients were significantly younger at onset of diabetes but did not differ from normoalbuminuric patients concerning age or duration of diabetes. Nonetheless, diastolic and mean arterial blood pressures were significantly higher in the microalbuminuric group. The existing glycemic control, assessed by glycosylated hemoglobin (HbA1c) was better in normoalbuminurics, but not significantly so. The albumin excretion rate in microalbuminuric patients correlated significantly (p less than 0.01) to diastolic (r = 0.69) and to mean arterial blood pressure (r = 0.69), but did not correlate to HbA1c. Thus, it is concluded that even normotensive patients with signs of early diabetic nephropathy, i.e. microalbuminuria, exhibit small, but significant increases in blood pressure.

Adolescent↗
PubMed1987

A single dose of a low molecular weight heparin fragment for anticoagulation during hemodialysis.

A low molecular heparin fragment (Fragmin, mol. wt. 4-6000 d), given as a single injection (dose 5000 anti-Xa U), was used as an anticoagulant during hemodialysis in 11 patients. In comparison, our routine heparinization procedure was used; conventional heparin was given as a bolus injection at the start and then as continuous infusion during dialysis to prolong the whole blood activated clotting time (WBACT) 125-175%. Fibrin formation, followed by visual inspection and the measuring of fibrinopeptide A and fibrin monomer concentrations were equally suppressed by the two regimens. WBACT was less prolonged with Fragmin. Anti-Xa activity above 0.39 U/ml was maintained throughout the dialyses with Fragmin. In conclusion a single dose of Fragmin gives sufficient anticoagulation for hemodialysis lasting up to 4 hours.

Adult↗