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Biomedical subjects

R Gokal

Publications and source records attributed to R Gokal.

At least 127 records · Page 7Linked to original sources
PubMed1991

Renal osteodystrophy in CAPD.

At start of dialysis most patients have histological bone abnormalities. These can be divided into two groups--high turnover and low turnover bone disease. Low turnover aplastic disease was previously attributed to aluminum accumulation but is now known to occur even in patients with less than 5% surface stainable aluminium. It is characterised by a mineralisation defect, thin osteoid seams, decreased numbers of osteoclasts and osteoblasts and absent aluminium staining. We have avoided aluminium containing phosphate binders (ACPBs) completely, with a combination of oral calcium carbonate and "low calcium" (1.25 mMol/l) dialysis fluid. Phosphate control has been good (mean less than 1.6 mMol/l) and over the first twelve months serum PTH levels have fallen significantly. Transient asymptomatic episodes of hypercalcaemia have occurred but no patient required ACPBs. Bone biopsies at the start of CAPD in 34 patients showed over 50% to have osteitis fibrosa (OF) but in five cases (15.6%) the aplastic lesion was found without aluminium staining. In seven follow-up biopsies OF improved in 3 cases, osteomalacia improved in 1, became aplastic in 1, while aplastic bone worsened in 1 and changed to mild OF in 1. We conclude that the predominant bone lesion in our patients at start of CAPD is OF, but 15% already have aplastic bone. "Low calcium" dialysis fluid enables ACPBs to be avoided in the majority of CAPD patients.

Adult↗
PubMed1990

Kinetic and clinical studies of beta 2-microglobulin in continuous ambulatory peritoneal dialysis: influence of renal and enhanced peritoneal clearances using glucose polymer.

A risk of beta 2-microglobulin (beta 2-M)-associated amyloidosis in long-term CAPD patients has been recognised. We examined the kinetics of beta 2-M and potential clinical manifestations of amyloidosis in patients well-established on CAPD for 1-76 months (mean +/- SEM; 16.4 +/- 14 months). In 57 patients, serum beta 2-M concentration was elevated to 30 +/- 1.8 (mean +/- SEM, mg/l) and correlated positively with the duration on CAPD. In 18 patients studied with variable degrees of residual renal function, serum beta 2-M concentration increased with declining renal function; this was most marked when the creatinine clearance was less than 1 ml/min. Using an isosmolar solution (302 +/- 1.3 mOsm/kg) containing 5% glucose polymer (9.4 mmol/l; MW 16,800), the transperitoneal elimination of beta 2-M was significantly enhanced (1.6 times) compared to conventional 1.36% glucose solution, but without a detectable change in serum concentrations during a 6-h study. No significant difference was found between the estimated minimum volume of distribution of beta 2-M in CAPD and haemodialysis patients. Symptomatic amyloid-associated disease was absent in patients in this study, and may be attributed to the short duration of dialysis.

Adult↗
PubMed1990

An assessment of the effects of impaired renal function and haemodialysis on the pharmacokinetics of fluconazole.

1. The oral pharmacokinetics of fluconazole were studied in three groups of volunteers (n = 5) with various degrees of renal function (GFR greater than 70 ml min-1; 20-70 ml min-1; less than 20 ml min-1) and in a group of patients with chronic end-stage renal failure requiring regular haemodialysis. 2. The pharmacokinetics of fluconazole were markedly affected by impaired renal function with the elimination of half-life in Group III (GFR less than 20 ml min-1) being approximately three times that observed in normal volunteers (Group I). 3. Fluconazole renal clearance was positively correlated with GFR. 4. Non-renal clearance of fluconazole decreased with decreasing renal function. 5. Approximately 38% of the 50 mg dose of fluconazole was removed by haemodialysis extending over a 3 h period.

Adult↗
PubMed1990

The Oxford-Manchester study of dialysis patients. Age, risk factors and treatment method in relation to quality of life.

A retrospective study of 159 patients who started Haemodialysis (HD) or Continuous Ambulatory Peritoneal Dialysis (CAPD), between 1981 and 1984 was carried out in two UK Renal Units. An extension of the study was carried out in one unit during 1985, gathering data on 30 patients aged greater than 65. The aim was to assess whether age, medical or social risk factors, or treatment method, affected perceived quality of life. Assessment was by standardised self-report questionnaire. The overall life satisfaction, measured on Cantril's ladder scale, showed no significant difference between dialysis patients and a normal population. On a quality of life semantic differential scale CAPD patients scored significantly better than HD patients. Satisfaction with sexual relationships showed marked deterioration in all age groups, but this did not seem to affect reported satisfaction with marriage. Those aged greater than 65 scored significantly better than younger patients on dialysis stress scales, and were generally more satisfied with life. When the study population was sub-divided into four groups, by age (less than or greater than 60) and presence or absence of additional factors, were seen to be those least satisfied with life on several different assessment scales.

Age Factors↗
PubMed1989

Evidence that matching for HLA antigens significantly increases transplant survival in 1001 renal transplants performed in the northwest region of England.

In the 20-year period from March 1968 to March 1988, 860 patients received 1001 renal transplants in the Northwestern Regional Renal Transplant Unit at Manchester Royal Infirmary. Through a continuing policy of avoiding mismatches for HLA antigens and lymphocytotoxic antibody crossmatching, transplant survival rates were found to correlate with the degree of HLA-A and B antigen mismatching from 1968 to 1978 and with HLA-B and DR antigen mismatching from 1979 to 1988. Mismatching for HLA-B and DR antigens was also found to correlate with transplant survival in highly sensitized patients and in patients transplanted since 1981, the "cyclosporine era." Recipients who were HLA-DR1 positive were found to have the highest graft survival compared to recipients negative for this antigen. In contrast, HLA-DR3 positive recipients had the poorest outcome. Transplants from HLA-DRw6 positive donors showed higher transplant survival rates than donor kidneys positive for any other HLA-DR antigen. A correlation of transplant survival with HLA-B and DR mismatching was seen whether kidneys were collected within our region or received through the UK Transplant Service. We conclude that avoidance of mismatching for HLA-B and DR antigens confers high transplant survival rates (91.1% at 5 years for 0 HLA-B and DR mismatches), and in order to achieve this rate for most recipients exchange of donor kidneys between transplant centers will be essential.

Adolescent↗
PubMed1989

Fundus changes in mesangiocapillary glomerulonephritis type II: clinical and fluorescein angiographic findings.

Previously we have demonstrated a deposit in Bruch's membrane in a single case of mesangiocapillary glomerulonephritis type II. We studied a group of patients with this disease and described extensive clinical and fluorescein angiographic abnormalities, which were in marked contrast to the findings in a group of patients with other forms of glomerulonephritis. This finding contributes to our understanding of the pathophysiology of the complex of the retinal pigment epithelium, Bruch's membrane, and choriocapillaris.

Adult↗
PubMed1989

Alternative osmotic agents.

After a decade of experience with continuous ambulatory peritoneal dialysis, several long-term complications are emerging which relate either directly (ultrafiltration of short duration, metabolic derangements) or indirectly (hyperosmolality, low pH) to the use of glucose as an osmotic agent. These considerations have motivated the search for an alternative to glucose. Some of the substances which have been proposed to replace it have been reviewed.

Dialysis Solutions↗
PubMed1989

Kidney transplantation in the northwest region of England--experience of 1,132 transplants in 21 years.

1. In more than 1,100 kidney transplants performed at a single center in 21 years a conservative approach to immunosuppressive therapy and HLA antigen matching has ensured high survival rates after both short- and long-term follow-up. 2. Retransplantation has been carried out in 16.6% of patients with transplant survival rates not differing significantly from those in first transplant recipients. 3. Living-related donor transplants accounted for only 7.9% of cases since 1982 and transplant survival was no different from HLA-A,B,DR-identical cadaver donor transplants. 4. Pretransplant blood transfusions were given to over 98% of recipients since 1982 and transplant survival in such CsA-treated patients was 10% higher than in the few nontransfused recipients. 5. By adopting a meticulous policy of pretransplant cytotoxic antibody screening and HLA antibody definition followed by careful pretransplant crossmatching using all available patient sera, accelerated transplant rejection has largely been avoided. 6. Monitoring of posttransplant recipient sera has shown that the appearance of cytotoxic antibodies leads to transplant failure and these antibodies are usually directed against HLA antigens mismatched between donor and recipient. 7. Matching for HLA antigens has a striking positive effect on transplant survival with more than 30% difference between the no mismatch and no match groups. Positive HLA matching effects on transplant survival were found in retransplants, highly sensitized recipients, male and female recipients, all ABO blood groups, and after long-term (20 years) follow-up.

Adolescent↗
PubMed1989

A collection of problems in CAPD.

Several isolated problems, which in magnitude may appear small, yet can be enormous management problems, are discussed. In most instances experience is limited and literature is sparse. An attempt has been made to collate personal experience with that from the literature in arriving at guidelines for management of these problems.

AIDS-Associated Nephropathy↗