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Biomedical subjects

R G Walker

Publications and source records attributed to R G Walker.

At least 109 records · Page 6Linked to original sources

"Malignant" IgA nephropathy.

Most patients with mesangial IgA nephropathy who run a progressive course usually do so over a period of 10 to 20 years. This paper describes the course of three young men with similar presenting features and biopsy findings who progressed to end-stage renal failure in less than 4 years from presentation, even though initially all had serum creatinine levels that were in the normal range. They presented with macroscopic hematuria, which has previously been regarded as an indicator of a favorable prognosis, and all three had loin pain, constantly elevated urinary erythrocyte counts, and crescents in renal biopsies. In two cases, treatment appeared to be associated with stabilization of renal function, but deterioration to end-stage renal failure occurred rapidly after treatment was ceased.

Adolescent↗

Clinical and morphological aspects of the management of crescentic anti-glomerular basement membrane antibody (anti-GBM) nephritis/Goodpasture's syndrome.

Twenty-two patients with crescentic anti-GBM nephritis or Goodpasture's syndrome with renal impairment were reviewed. All patients were treated with a combination of plasma exchange and immunosuppression. Sixteen patients (73 per cent) showed improvement in renal function (greater than 30 per cent reduction in serum creatinine level) apparently in response to treatment, and nine patients (41 per cent) made long-term recoveries in renal function. The most important features carrying a bad prognosis were total anuria, and/or a very high percentage of glomeruli showing crescents (greater than 85 per cent) in the initial renal biopsy. Some patients with other so-called 'bad' prognostic features, including severely impaired renal function at presentation, oliguria and the need to institute dialysis had unexpected marked improvement in renal function and/or recovered renal function in the long term provided treatment with plasma exchange was begun promptly and maintained for a sufficient period to allow resolution of the disease process. Renal biopsies at the beginning and later proved to be an extremely valuable guide for the progress and outcome of the disease.

Adolescent↗

Rat liver pyruvate kinase: influence of ligands on activity and fructose 1,6-bisphosphate binding.

The ability for various ligands to modulate the binding of fructose 1,6-bisphosphate (Fru-1,6-P2) with purified rat liver pyruvate kinase was examined. Binding of Fru-1,6-P2 with pyruvate kinase exhibits positive cooperativity, with maximum binding of 4 mol Fru-1,6-P2 per enzyme tetramer. The Hill coefficient (nH), and the concentration of Fru-1,6-P2 giving half-maximal binding [FBP]1/2, are influenced by several factors. In 150 mM Tris-HCl, 70 mM KCl, 11 mM MgSO4 at pH 7.4, [FBP]1/2 is 2.6 microM and nH is 2.7. Phosphoenolpyruvate and pyruvate enhance the binding of Fru-1,6-P2 by decreasing [FBP]1/2. ADP and ATP alone had little influence on Fru-1,6-P2 binding. However, the nucleotides antagonize the response elicited by pyruvate or phosphoenolpyruvate, suggesting that the competent enzyme substrate complex does not favor Fru-1,6-P2 binding. Phosphorylation of pyruvate kinase or the inclusion of alanine in the medium, two actions which inhibit the enzyme activity, result in diminished binding of low concentrations of Fru-1,6-P2 with the enzyme. These effectors do not alter the maximum binding capacity of the enzyme but rather they raise the concentrations of Fru-1,6-P2 needed for maximum binding. Phosphorylation also decreased the nH for Fru-1,6-P2 binding from 2.7 to 1.7. Pyruvate kinase activity is dependent on a divalent metal ion. Substituting Mn2+ for Mg2+ results in a 60% decrease in the maximum catalytic activity for the enzyme and decreases the concentration of phosphoenolpyruvate needed for half-maximal activity from 1 to 0.1 mM. As a consequence, Mn2+ stimulates activity at subsaturating concentrations of phosphoenolpyruvate, but inhibits at saturating concentrations of the substrate or in the presence of Fru-1,6-P2. Both Mg2+ and Mn2+ diminish binding of low concentrations of Fru-1,6-P2; however, the concentrations of the metal ions needed to influence Fru-1,6-P2 binding exceed those needed to support catalytic activity.

Alanine↗

Vitamin E treatment of haemolytic uraemic syndrome.

Because low plasma vitamin E concentrations have been reported in patients with haemolytic uraemic syndrome and there is accumulating evidence of lipid peroxidation in this disease, treatment with the antioxidant vitamin E was undertaken in 16 consecutive children with the syndrome. Twelve children had features at presentation suggesting a poor prognosis for recovery but despite this all 16 patients survived and are well three months later. Fifteen children now have normal values for serum creatinine, blood pressure, and urinalysis for protein but one has slight renal impairment. Although this is not a report of a controlled trial, it seems that patients treated with vitamin E have fared considerably better than our previously treated patients with haemolytic uraemic syndrome, even in the presence of early, adverse prognostic features. We suggest that vitamin E alters the natural history of the disease, and in view of the absence of any observed side effects further experience with this treatment is being sought.

Child↗

Chronic interstitial nephropathy in mice induced by psychosocial stress: potentiation by caffeine.

Chronic psychosocial stress in male mice produces chronic interstitial nephropathy not explained by renal vascular disease or urinary infection. Four groups of male CBA mice were studied. Group 1 and group 2 were placed in Henry-Stephens complex population cages for 5 months. Group 2 had caffeine, 800 micrograms/ml, added to their drinking water. Control groups 3 and 4 were unstressed, but group 4 had 800 micrograms/ml of caffeine added to their water. Stressed animals developed chronic interstitial nephropathy which was more severe in animals drinking caffeinated water. In addition, the percent of cortex involved in interstitial fibrosis was higher in group 2, 18.0 +/- 1.4, than in group 1, 15.2 +/- 2.3 (p less than 0.05). Both groups had more fibrosis than unstressed animals (p less than 0.01). Blood urea nitrogen was more elevated in group 2, 47 +/- 13 mg/dl, than in group 1, 29 +/- 17 mg/dl (p less than 0.05). Again both values exceeded those in unstressed animals (p less than 0.01). It is concluded that prolonged environmental stress can lead to the renal morphologic changes of chronic interstitial nephritis. Both renal pathology and function are worse when there is concurrent high caffeine intake. The relevance of this model to human disease related to analgesic use or with affective illness requires further study.

Animals↗

Renal pathology associated with lithium therapy.

Renal biopsies have been examined in patients either currently (50 patients) or previously (5 patients) on maintenance lithium therapy for severe affective disorders. In patients currently taking lithium, a distinctive lesion of the distal convoluted tubules and collecting ducts was identified. This lesion consisted of vacuolation and swelling of the cytoplasm with accumulations of PAS positive material; this material was confirmed to be particulate glycogen by light and ultrastructural techniques. This 'lithium-associated' lesion was not present in patients who had discontinued lithium therapy. Prospective studies showed that the accumulation of glycogen occurs in distal tubules and collecting ducts within days of commencing lithium treatment. The relationship of this distinctive lesion to the patchy focal cortical interstitial fibrosis seen in these biopsies remains to be elucidated.

Adult↗

A food pelleter for experimental diets for rats.

Food pellets for an experimental diet for laboratory rats were produced for long-term nephrotoxicity study using a modified, commercially available pasta machine. This method eliminated the disadvantages of powdered diets and provided the advantages of pelleted diets at low production cost. A commercially available, pelleted diet was pulverized, the test agent and water added, and the mixture repelletized. No special feeding equipment was required because the repelletized diet was fed in standard lid-type feeders. It was not necessary to sterilize the diet.

Animal Feed↗

A clinico-pathological study of lithium nephrotoxicity.

Lithium salts, well recognised as acute nephrotoxins, have recently been implicated in the development of a chronic focal interstitial nephropathy. As part of a clinico-pathological study of lithium nephrotoxicity, renal function and renal histology has been compared between 25 patient on maintenance lithium therapy and 19 patients with affective illnesses prior to commencement of lithium therapy. Significant evidence of chronic renal damage was present in biopsies of lithium treated patients when compared with cadaveric donor kidneys (p less than 0.001). Similar damage was noted in biopsies from patient prior to lithium and differed from donor kidneys (p less than 0.01). The degree of damage was not significantly different between the patients on lithium and those not yet on lithium. An acute specific tubular lesion was note in patients on lithium, and a marked degree of distal tubule dilation and microcyst formation were also observed. Significant defects in urinary concentrating ability and urinary acidification were present in patients on lithium and there was a correlation between the degree of these defects and the duration of lithium therapy. There was no evidence of a substantial reduction in glomerular filtration rate, which could be ascribed to the lithium therapy.

Adult↗

Cadmium telluride detectors in the external measurement of glomerular filtration rate using 99mTc-DTPA (Sn): comparison with 51Cr-EDTA and 99mTc-DTPA (Sn) plasma sample methods.

GFR was determined in 16 patients using an external detector to monitor disappearance of a single injected dose of 99mTc-DTPA (Sn) simultaneously with determinations of GFR using plasma sample methods for 99mTc-DTPA (Sn) and 51Cr-EDTA. Values of GFR were correlated closely between the external determinations of GFR and the plasma sample methods of 51Cr-EDTA and 99mTc-DTPA (Sn) with correlation coefficients of 0.97 and 0.99, respectively. Although the external detector method is apparently accurate, its advantages are as yet insufficient to warrant its adoption as the method of choice for determination of GFR.

Cadmium↗

Structural and functional effects of long-term lithium therapy.

To determine the effects of long-term lithium therapy, we have studied the renal histology and the renal function of 47 patients with affective disorders who were either currently receiving or had previously received maintenance lithium therapy (lithium patients), and we have compared the results with those of 32 other psychiatric patients with similar affective illnesses who had never taken lithium (prelithium patients). The renal biopsy samples, analyzed by a point-counting technique for interstitial fibrosis, were not different in degree between the lithium and the prelithium patients. Interstitial fibrosis was also not different between prelithium patients and age-matched transplant donor kidney controls, but it was greater in lithium patients when compared with the donor kidney controls (P less than 0.01). The specific distal tubular lesion associated with lithium therapy was present in all the biopsy samples of the patients who were currently receiving lithium therapy. Marked distal nephron dysfunction, as measured by urinary concentrating ability (P less than 0.0001) and urinary acidification (P less than 0.0001), was evident in lithium patients compared with the prelithium patients. These defects were correlated with the duration of lithium therapy. Serum creatinine estimations (P less than 0.01), serum beta-2 microglobulins (P less than 0.01), and 51Cr-EDTA clearances (P less than 0.01) suggested some impairment of GFR in lithium patients compared with prelithium patients. These defects did not correlate with the duration of lithium therapy. From these studies we concluded that the marked distal nephron dysfunction induced by lithium might produce prerenal impairment of GFR because the renal function abnormalities have no structural basis when the degree of interstitial fibrosis of other psychiatric patients is used as a control. Prospective studies are needed to answer the controversial question of whether stable maintenance lithium therapy produces chronic nephrotoxicity.

Adult↗

Renal cortical interstitial volume in mesangial IgA nephropathy. Dissociation from creatinine clearance in serially biopsied patients.

It has recently been proposed that renal cortical interstitial fibrosis is causally related to progressive decreases in glomerular filtration rate in a variety of renal diseases including glomerulonephritis. One hundred and eighty-eight renal biopsies in 81 patients with mesangial IgA nephropathy were analyzed for the percentage of relative interstitial volume by a point-counting technique. These data were correlated with serum creatinine, endogenous creatinine, endogenous creatinine clearance, and from age-matched donors were used as controls for the interstitial volume measurement. There was a negative nonlinear correlation between percentage of interstitial volume measurement. There was a negative nonlinear correlation between percentage of interstitial volume and creatinine clearance (r = 0.601, p less than 0.001). These correlations were not explained by age. However, serial biopsies in 39 patients clearly demonstrated that the percentage of interstitial volume could be dissociated from creatinine clearance. The prognosis in individual patients for progression to chronic renal failure could not be predicted from the relative interstitial volume at initial biopsy. Patients with mesangial IgA nephropathy demonstrated higher interstitial volumes than age-matched cadaver donors (p less than 0.001). Although interstitial volume and creatinine clearance are inversely related, the ability to dissociate these two variables in serial biopsies draws into question the hypothesis that interstitial fibrosis is causally related to changes in creatinine clearance. Studies to validate this hypothesis should involve patients followed with serial biopsies and renal function studies. In mesangial IgA nephropathy, interstitial changes are most likely secondary to the activity of the glomerular process.

Adult↗

A technique for hemiacidrin dissolution of renal stone complicating an ileal conduit.

A technique for dissolving a renal stone complicating an ileal conduit is described. Free ureteric reflux was present, which allowed retrograde irrigation of the stone by infusion of hemiacidrin solution into the ileal conduit. With careful attention to urine infection and the pressure within the system, this technique might be applicable to other patients in whom free ureteric reflux is present and pyelolithotomy, percutaneous nephrostomy or the passage of ureteric catheters is difficult.

Adult↗