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Biomedical subjects

R J Winney

Publications and source records attributed to R J Winney.

At least 55 records · Page 3Linked to original sources
PubMed1985

Periosteal new bone in patients on intermittent haemodialysis: an early indicator of aluminium-induced osteomalacia?

Periosteal new bone forming along the distal shafts of the tibia, fibula and pelvic inlet was observed to be an unusual feature in patients on intermittent haemodialysis. Sequential skeletal surveys of 13 patients exhibiting this feature were reviewed and correlated with the biochemical, histological and clinical data. The radiological features comprised periosteal new bone, minimal or no evidence of secondary hyperparathyroidism, sclerosis (not in the classical 'rugger jersey' spine distribution but affecting, particularly, the femoral heads) and, in several patients, numerous fractures, particularly of the ribs. There were 10 patients with osteomalacia, in seven of whom the features were consistent with aluminium-induced bone disease. We suggest that the finding of periosteal new bone in the above distribution in a patient on intermittent haemodialysis should alert the clinician to the possibility of aluminium intoxication.

Adult↗
PubMed1985

What is the value of plasma/serum aluminum in patients with chronic renal failure?

In a region with a relatively low incidence of aluminum toxicity water, dialysis fluid and plasma aluminum were monitored in hemodialysis patients before and after the introduction of reverse osmosis (RO) water. Before the use of RO water, there was a close correlation between plasma and dialysis fluid aluminum with exposure to aluminum being reflected equally by either water, dialysis fluid or plasma aluminum. Patients with clinical manifestations of aluminum toxicity were characterised by a plasma aluminum consistently greater than mumol/l and a dialysis fluid aluminum consistently greater than 1 mumol/l. No evidence of clinical toxicity was found in patients in whom the plasma aluminum was maintained up to 5 mumol/l. Following the introduction of RO water, the dialysis fluid aluminum was able to be maintained less than 1 mumol/l, the plasma aluminum fell and no new cases of clinical toxicity were identified over the following five years. An effect of aluminum hydroxide dosage on plasma aluminum could be identified only in patients in whom the dialysis fluid aluminum was less than 1 mumol/l. Plasma aluminum was found to be a poor guide to bone stores but appeared to correlate better with the presence of bone toxicity than total bone aluminum. Regular monitoring of dialysis fluid and plasma aluminum is recommended as a means of detecting exposure to aluminum as well as the source of exposure and as a guide to the risk of clinical toxicity.

Adult↗
PubMed1984

The use of ion exchange to remove aluminum from water used in hemodialysis.

Since the established techniques for removing aluminum from the water used in dialysis (reverse osmosis and deionization) are relatively complex and expensive, it was decided to investigate a number of simple ion-exchange techniques. In 48 of 217 tap water samples obtained from 61 home hemodialysis patients in southeast Scotland, the aluminum content exceeded 2 mumol/L (54 micrograms/L)--a level that has been associated with dialysis dementia and fracturing osteodystrophy. Dialysate prepared from this water after softening had approximately half this aluminum content, but in 17 instances the concentration still exceeded 2 mumol/L. In vitro studies showed that the anion-exchange resin IRA 400 (Rohm-Haas, Philadelphia) in the chloride phase was very effective at removing aluminum. A commercial water softener was modified by the addition of this resin, and installed in the home dialysis training unit at the Princess Alexandra Hospital in Brisbane. Over a 12-month period in which the tap water aluminum content averaged over 10 mumol/L (270 micrograms/L), the product water had an aluminum content consistently under 2 mumol/L, being under 1 mumol/L (27 micrograms/L) on 19 out of 20 occasions. The modified softener was regenerated with a saturated sodium chloride solution at 2-week intervals, using the manufacturer's protocol for the unmodified softener. Provided that dialysate and plasma aluminum levels are monitored on a regular basis, it is felt that this simple technique of aluminum removal may be appropriate for many home hemodialysis situations.

Aluminum↗
PubMed1984

Hypocalcaemic cataract as a presenting symptom of renal insufficiency.

A young man of 17 years presented with bilateral reduced vision because of cataracts. Investigations showed a low level of serum calcium along with other evidence of renal failure. The cataracts were mainly in the posterior pole (cupulliform); faint peripheral cortical opacities were also present--in the form of about a dozen half-loops straddling the equator and extending about half way towards the axial centre of the lens.

Adolescent↗
PubMed1983

Plasma exchange in severe glomerulonephritis--who benefits?

Plasma exchange (PE) and immunosuppression was used in the treatment of 17 patients with severe glomerulonephritis and 17 acute rejections in transplant recipients. No response occurred in crescentic nephritis with anuria; a temporary improvement occurred in other nephritis patients but half of these relapsed on immunosuppression alone. Seven rejection episodes responded. Responses always occurred promptly and prolonged PE did not improve the results. Histology, serum complement or immune complex results did not predict a successful outcome.

Anti-Glomerular Basement Membrane Disease↗
PubMed1982

Plasma exchange in the successful treatment of drug-induced renal disease.

A 20-year-old girl with rheumatoid arthritis who has been treated with D-penicillamine for 7 months presented with fulminating Goodpasture's syndrome and a focal necrotising glomerulonephritis. A 35-year-old man who had been taking a low dose of phenytoin for epilepsy presented with nephrotic syndrome and a mesangiocapillary glomerulonephritis. CH50, C3 and C4 were low and a high level of immune complexes was detected. Both patients had severe lesions which were unlikely to recover on immunosuppression alone so were treated with intensive plasma exchange. 2 patients are described with serious drug-induced renal disease who recovered with intensive plasma exchange and immunosuppression.

Adult↗
PubMed1980

Reversible microcytic hypochromic anaemia in dialysis patients due to aluminium intoxication.

Twelve patients being treated by intermittent haemodialysis developed a severe microcytic hypochromic anaemia despite adequate iron supplements. Serum ferritin concentration was normal or high. Seven patients later developed histologically proven fracturing osteomalacia and one a fatal encephalopathy. Plasma aluminium concentration was high in all twelve patients and the source was the water used to make up dialysis fluid. Following dialysis with aluminium free dialysis fluid, plasma concentrations of aluminium fell, red cell morphology returned to normal and haemoglobin rose. We believe that in addition to causing encephalopathy and osteomalacia, aluminium causes a microcytic hypochromic anaemia. This anaemia appears to be the first manifestation of aluminium intoxication and is reversed by removing the source of aluminium.

Adult↗