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Biomedical subjects

L Minetti

Publications and source records attributed to L Minetti.

At least 55 records · Page 3Linked to original sources
PubMed1988

Light chain nephropathy: histological and clinical aspects in 15 cases.

Fifteen patients aged 31-74 years (five male, ten female) on renal biopsy showed intense linear deposits of light chains along tubular basement membranes (TBM) by immunofluorescence, and/or granular dense deposits on electronmicroscopy. Multiple myeloma was diagnosed in ten patients. The onset of myeloma and nephropathy was simultaneous in six patients; nephropathy preceded or followed the diagnosis of myeloma in three and one patients respectively. The mode of onset of nephropathy was acute or rapidly progressive renal failure in five cases, chronic renal failure in seven, and heavy proteinuria in three. Only two patients had normal renal function at biopsy. Serum monoclonal component was kappa in five patients, IgG kappa in three, IgD kappa in one, IgG lambda in one, IgA lambda in one, absent in three, and not detected in one. On light microscopy eight cases had nodular glomerulosclerosis, three cast nephropathy and 14 TBM thickening. Immunofluorescence for monoclonal light chain(s) was positive in 11 of 13 cases. Electron microscopy showed finely granular deposits in the inner side of glomerular basement membranes (GBM) and the outer side of TBM in 11 of 11 tested cases. The evolution was towards chronic renal failure in 12 patients (six of whom required dialysis), death in two, unknown in one. Four patients died after a period of dialysis, from infections or cardiovascular complications.

Adult↗
PubMed1988

Different cascade filtration operating modalities in clinical use.

Cascade filtration (CF) can be performed in either the single-pass or dead-end configuration. The distinction, as predicted by experimental models, is that solute removal is lower but constant in the former, and higher but variable with the quantity of filtrate in the latter. Moreover, unpredictable plugging reduces permeability during operation. It is therefore unclear which configuration is preferable in clinical use. In four cryo- and three macroglobulinemic patients, the data of 10 dead-end CF (QP) and 11 modified single-pass CF with high flow rate recycling plasma (QD) were compared. Both groups had similar starting values. Centrifugal primary plasma separation was performed. No exogenous reinfusions were used. Either 0.8 and 1.2 sq.m. surface secondary filters were employed. The ratio of plasma processed to patients' plasma volume was 1.1 +/- 0.3 in QP, and 0.94 +/- 0.09 in QD. The mean percentage removals of albumin, IgG and IgM respectively were 25.8 +/- 9, 32 +/- 17 and 47.5 +/- 26% in QP, 30.5 +/- 12, 40.5 +/- 19 and 48 +/- 17.5% in QD: albumin vs IgM p less than 0.025 in QP and p less than 0.02 in QD. A/G ratio increased from 1.6 +/- 0.5 to 2.06 +/- 0.6 in QP, and from 1.5 +/- 0.3 to 1.7 +/- 0.3 in QD. Plugging occurred in both groups, requiring 2.3 +/- 1.8 washouts/run in QP vs 1.5 +/- 1.2 in QD. IgM removal was comparable. Removal of albumin and IgG was slightly higher in QD. Similar performances can be obtained with either technique in clinical use, provided an adequate fractionation surface is available.

Adult↗
PubMed1987

Pharmacological evaluation of urate renal handling in humans: pyrazinamide test vs combined pyrazinamide and probenecid administration.

Uricosuric and antiuricosuric drugs have been utilised widely for the study of tubular urate transport in humans. A normal suppression of urate excretion after pyrazinamide is usually taken as evidence of normal presecretory reabsorption. However, in patients with reduced presecretory reabsorption, during pyrazinamide inhibition of urate secretion unreabsorbed urate might still undergo reabsorption along postsecretory sites, allowing for a normal pyrazinamide suppression of urate excretion. To test this possibility, we have performed the pyrazinamide test both alone and after pretreatment with probenecid, which should block postsecretory urate reabsorption. The test was performed in 8 controls, in 9 patients with 'low-excretory' hyperuricaemia, and in 7 patients with tubular urate wasting. Pyrazinamide-non-suppressible urate excretion after pretreatment with probenecid did not differ from the excretion obtained after pyrazinamide alone in hyperuricaemic patients (mean difference 1.33 +/- 2.3% of filtered urate; P = NS); it was slightly higher in controls (3.4 +/- 3.4; P less than 0.05), but was much higher in patients with tubular urate wasting (19.6 +/- 12.7; P less than 0.005). The pyrazinamide test, performed alone, was normal in three patients with tubular urate wasting, but it was abnormal in all patients after pretreatment with probenecid. These results are consistent with the possibility that, during maximal pyrazinamide effect, some uric acid escaping reabsorption at presecretory sites may undergo reabsorption along postsecretory sites, leading to a quantitative overestimation of presecretory reabsorption. This phenomenon appears to have clinical relevance, especially in patients with abnormal urate reabsorption.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

The influence of dialysis fluid composition on dialysis tolerance.

To evaluate the role of bicarbonate loss through the dialyser and acetate flux to the patient in the development of symptoms during acetate dialysis, bicarbonate loss during acetate dialysis was prevented by using a combination of acetate and bicarbonate in the dialysate. Seven uraemic patients were treated for 4 months with acetate dialysis and, successively, for a similar period of time with bicarbonate, and a combination of acetate and bicarbonate dialysis. Blood-pressure drop and the incidence of hypotension and symptomatic episodes were similar in bicarbonate and combination dialysis, and significantly lower than in acetate dialysis. Serum acetate concentrations were similar during acetate and combination dialysis. These findings indicate that bicarbonate loss rather than the presence of acetate was responsible for the patients' intolerance to acetate dialysis.

Acetates↗
PubMed1987

Clinical evaluation of segmental tubular reabsorption of sodium and fluid in man: lithium vs free water clearances.

Segmental sodium reabsorption in the proximal and distal tubule was evaluated by different methods in seven healthy subjects, seven patients with recurrent calcium nephrolithiasis, five patients with isolated renal glucosuria and three patients with Fanconi syndrome. In all the subjects, the delivery of fluid from the proximal tubule, evaluated as 'chloride' factor during maximal water diuresis (DDCl, 12.4 +/- 5.5 ml/dl GFR), was lower (P less than 0.001) than 'volume' or 'chloride' factors during maximal water diuresis plus frusemide administration (40 mg i.v.) (Vf, 22.5 +/- 7.5 and DDClf, 27.1 +/- 8.9 ml/dl GFR, respectively), and of lithium clearance (FELi, 28.1 +/- 12.6%). Vf was lower than DDClf (P less than 0.001) and FELi (P less than 0.005), while DDClf and FELi did not differ; these unequal results are likely to represent different degrees of free water back-diffusion along distal tubule segments in the free water clearance studies. Accordingly, estimation of sodium reabsorption in the distal tubule showed corresponding differences within the four methods as those observed for the distal delivery: it was 25.5 +/- 12.2% when evaluated as [FELi-FECl]; 24.8 +/- 8.3 ml/dl GFR when evaluated as [CH2Of/GFR + delta FECl] (i.e. free water clearance during frusemide plus the frusemide-induced absolute increase in FECl); 19.5 +/- 6.7 ml/dl GFR (P less than 0.001 vs [FELi-FECl] and [CH2Of/GFR + delta FECl] when evaluated as [(CH2O + CH2OBD)/GFR] (i.e. CH2O before frusemide plus the frusemide-induced absolute increase in urine flow rate); and 10.0 +/- 4.8 ml/dl GFR when evaluated as CH2O (P less than 0.001 vs all the other evaluations).(ABSTRACT TRUNCATED AT 250 WORDS)

Furosemide↗