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Biomedical subjects

R N Fine

Publications and source records attributed to R N Fine.

At least 127 records · Page 7Linked to original sources
PubMed1987

Acute renal allograft rejection. Comparative value of ultrasound versus magnetic resonance imaging.

Both magnetic resonance imaging (MRI) and ultrasound (US) have been reported to be useful in differentiating between acute allograft rejection and other causes of graft dysfunction in renal transplantation. The aim of this study was to evaluate the comparative usefulness of these techniques in the assessment of patients with acutely rising serum creatinine levels. Seventeen patients with 19 episodes of acute serum creatinine elevations were evaluated for the presence of acute rejection. The ultimate diagnoses of acute rejection were based on either renal pathological findings, or the response to standard antirejection therapy. Clinical, US and MRI diagnoses were assessed independently, without knowledge of the results of the other evaluation techniques. We found that US alone was useful in diagnosing acute rejection (x2 = 4.95, P less than 0.05), and when taken in the clinical setting was an added advantage (x2 = 6.68, P less than 0.01). MRI did not increase the diagnostic accuracy significantly.

Adolescent↗
PubMed1986

Surgical management of peritoneal dialysis catheters in children: five-year experience with 1,800 patient-month follow-up.

Currently at our institution more than 90% of the children with end-stage renal disease are managed with continuous ambulatory peritoneal dialysis (CAPD) in preference to hemodialysis until a successful transplant is accomplished. Recent refinements in CAPD catheters and dialysis techniques have greatly added to the many medical, psychological, and economic advantages of CAPD compared with chronic hemodialysis. Ninety-three patients less than 21 years of age underwent insertion of 167 peritoneal dialysis (PD) catheters over a 5-year period. A variety of PD catheters were used, including 121 (73%) double-cuff Tenckhoff catheters, 22 (13%) single-cuff, and 24 (14%) column disc catheters (Lifecaths, Physio-Control Corp, Redmond, WA). There were three (3%) noncatheter-related mortalities and minimal significant morbidity during the 1,819 patient-months of catheter use. Exit site infections (61%) and peritonitis (59%) were frequent but minor complications, occasionally requiring catheter replacement. Other noninfectious complications included abdominal hernias (42%), dialysis leaks (14%), distal cuff extrusion (11%), catheter obstruction (7%), and hydrothorax (2%). Forty-five of the 60 hernias (75%) were surgically repaired in patients while receiving CAPD. Persistent or recurrent peritonitis was common with Pseudomonas, Serratia, and fungal infections and often resulted in catheter removal and loss of the peritoneal dialysis membrane. Catheter survival for the double-cuff Tenckhoff was significantly better (P .005) than the single-cuff or Lifecath. Based on this experience we have found that using specific operative techniques for CAPD catheter placement and early surgical management for severe peritonitis reduces the incidence of complications and modality failure.

Adolescent↗
PubMed1986

Effects of oral calcium carbonate on control of serum phosphorus and changes in plasma aluminum levels after discontinuation of aluminum-containing gels in children receiving dialysis.

Orally administered calcium carbonate was evaluated as a phosphate binding agent in 15 children, ages 0.6 to 17.2 years, receiving maintenance dialysis. Changes in plasma aluminum concentration were assessed after discontinuation of treatment with aluminum-containing gels. The mean daily dose of calcium carbonate was 5.1 +/- 2.5 gm (384 +/- 315 mg/kg/day), and correlated inversely with body weight (r = 0.72, P less than 0.01) and age (r = 0.71, P less than 0.01). Mean serum calcium, phosphorus, and bicarbonate values were unchanged throughout the study. Plasma aluminum concentration fell from 90 +/- 51 to 34 +/- 22 micrograms/L (P less than 0.005). Dietary phosphorus intakes were 44 +/- 21 and 42 +/- 19 mg/kg/day during the control period and at the end of the study, respectively. Transitory hypercalcemia was the only side effect in 92% of the patients. In none of the patients did uncontrolled hyperphosphatemia, metabolic alkalosis, diarrhea, or symptoms or signs of hypercalcemia develop. Our data indicate that calcium carbonate is an effective phosphate binding agent in children receiving dialysis, and should be used in lieu of aluminum-containing gels in young children with renal failure.

Adolescent↗
PubMed1986

Total abdominal wall reconstruction in the prune belly syndrome.

A total of 6 boys with the prune belly syndrome underwent total abdominal wall reconstruction by a technique that permits simultaneous bilateral orchiopexy and/or urinary tract reconstruction. Until now, the psychosocial implications of the abdominal wall disfigurement caused by this syndrome have been ignored. This procedure provides an excellent cosmetic result that, in turn, promotes psychological health and a positive body image in these children.

Abdominal Muscles↗
PubMed1986

Experience with renal transplantation in children undergoing peritoneal dialysis (CAPD/CCPD).

For children with end-stage renal disease, renal transplantation is the ultimate goal because it offers the potential of maximum rehabilitation. In order to evaluate the infectious risk of renal transplantation in patients previously maintained on continuous ambulatory peritoneal dialysis (CAPD) and/or continuous cycling peritoneal dialysis (CCPD), we retrospectively evalauted the clinical course of 44 pediatric patients (mean age 12.0 +/- 5.7 [SD] years) who received 32 cadaver and 16 live-related donor renal grafts after being maintained on peritoneal dialysis for 756 patient-months (mean 17.1 +/- 11.5 months). In the posttransplant period, 25 patients (57%) required dialysis because of acute tubular necrosis or acute rejection. Peritonitis developed in five patients (11%) following transplantation; two were being dialyzed at the time. Exit-site and tunnel infections occurred in nine patients (20%). In all instances, antibiotic treatment and/or catheter removal was curative. Posttransplant ascites developed in 12 patients (27%) and was alleviated by catheter drainage. The catheters were left in situ at the time of transplantation and electively removed when stable graft function was present. The 1- and 2-year actuarial graft survival rate was 65% and 55%, respectively. One patient died in the immediate posttransplant period, which was unrelated to peritoneal dialysis. In conclusion, pediatric patients maintained on CAPD and/or CCPD can be safely transplanted. The potential infectious risks related to peritoneal dialysis can be managed with appropriate management of the catheter and prompt antibiotic therapy. The patient and graft survival rates are comparable to those with patients receiving hemodialysis prior to transplantation. There is no need to limit access to transplantation in children undergoing CAPD and/or CCPD.

Adolescent↗
PubMed1986

Aluminum removal by peritoneal dialysis: intravenous vs. intraperitoneal deferoxamine.

Aluminum removal via peritoneal dialysis was evaluated after the administration of deferoxamine in patients treated with CAPD and CCPD. The intravenous administration of deferoxamine, 40 mg/kg, led to a 730 +/- 139% increase in aluminum removal, compared to an increase of 641 +/- 178% after the drug was administered intraperitoneally. The mean dialysate: plasma concentration ratio for aluminum rose from 0.17 +/- 0.03 to 0.32 +/- 0.03 with intravenous deferoxamine administration, and from 0.19 +/- 0.05 to 0.38 +/- 0.07 with the intraperitoneal instillation of deferoxamine. In the seven patients with paired studies using both modalities of administration, there were no significant differences in the increments in plasma aluminum or in aluminum removal over a 24-hour period. In patients from whom effluent dialysate was collected for several days after the administration of deferoxamine, daily aluminum losses increased from 218 +/- 76 micrograms/24 hours before the administration of desferrioxamine to 1521 +/- 339, 1120 +/- 232, and 948 +/- 328 micrograms/24 hours over three successive days after deferoxamine. These data indicate that aluminum is effectively removed after the administration of either intravenous or intraperitoneal deferoxamine. The enhanced rate of removal of aluminum by peritoneal dialysis persists for several days after a single dose of deferoxamine. The efficacy and safety of long-term treatment with intraperitoneal deferoxamine requires further study.

Adult↗
PubMed1986

Spontaneous anti-tubular-basement-membrane antibody production by lymphocytes isolated from a rejected allograft.

The immunological events mediated by, and antigen specificity of, allograft-bound lymphocytes (ABLs) are poorly understood. To further define the role of antibody-mediated rejection, a rejected allograft from a patient with primary anti-TBM disease was sterilely minced and pressed through a microscreen. The ABLs were isolated by density gradient centrifugation. Using this technique, 8.5 X 10(6) ABLs were isolated. Then 1 X 10(6) washed ABLs/ml were suspended in RPMI 1640 with 20% fetal calf serum and cultured in microtiter plates with media only, or with pokeweed mitogen (PWM) (100 micrograms/culture). The cells were incubated for 7 days and supernatants were collected and assayed for total IgG and IgM by a solid-phase enzyme immunoassay (EIA) and reactivity with normal human kidney targets by indirect immunofluorescence (IF) and immunoperoxidase (IP) techniques. Total IgG production was 500 ng/ml for both spontaneous and PWM stimulated cells. No IgM production was detected. IF and IP studies demonstrated IgG-anti-TBM antibodies in the spontaneous supernatants only. IgG antibodies reactive with peritubular capillaries (anti-PTC) were also noted. IgG-anti-TBM anti-bodies and antibodies reactive with arterioles were subsequently demonstrated by direct immunofluorescence techniques in the rejected allograft. Analysis of serum samples obtained at the time of allograft rejection showed no IF or IP reactivity with the kidney targets. Subsequent analysis of anti-TBM production by the patient's peripheral blood mononuclear cells (PBMs) showed IgM-anti-TBM only. These studies suggest that the IgG-anti-TBM and IgG-anti-PTC antibodies reactive with the allograft resulted from in situ antibody production by ABLs; the role of anti-TBM antibodies in mediating the AR is unclear, but their presence suggests recurrence of the original disease in the allograft. Anti-PTC antibodies could be important in mediation of the vascular AR.

Adolescent↗
PubMed1986

Postpartum renal failure in a patient with membranoproliferative glomerulonephritis type II.

The previously reported detrimental effects of pregnancy on the course of membranoproliferative glomerulonephritis type II (MPGN type II) are limited and are usually considered to be mild. Based on these reports, a 19-year-old female with the diagnosis of MPGN type II who had stable renal function (creatinine 0.9 mg/dl) and a mild nephrotic syndrome with hypertension for 5 years of close follow-up was advised to complete her pregnancy. After a full-term pregnancy, complicated only by moderate nephrotic syndrome, a healthy female infant was born. Two weeks after delivery, the patient presented with acute renal failure and malignant hypertension, without evidence of hemolysis of hepatic failure. Immunologic parameters, including, C3, C4, antinuclear antibodies, circulating immune complexes as well as antibodies to glomerular basement membrane antigen and tubular basement membrane antigen were negative. Peritoneal dialysis was initiated and a renal biopsy was performed which showed MPGN type II with 50% crescents. Despite pulse therapy with methylprednisolone, renal function did not improve, resulting in the need for chronic dialysis. Although no specific nephritogenic mechanism was shown, the course of this patient should be considered when counseling female patients with MPGN type II, regarding the possibility of pregnancy exacerbating their disease, or resulting in rapidly progressive renal failure.

Acute Kidney Injury↗
PubMed1986

Prediction of the progression of chronic renal failure in children: are current models accurate?

Mathematical models have been used since 1976 in an attempt to predict the progression of chronic renal failure. These models have used the serum creatinine level as either a reciprocal or logarithmic plot against time. The accuracy of such predictions are characterized by either a correlation coefficient (r value) or prediction error (time at which dialysis was predicted minus time at which dialysis actually occurred). Retrospectively, we analyzed 37 children who progressed to end-stage renal disease, grouped them by their respective primary diseases, and calculated both r values and prediction error for each individual and group. Although r values for each group (with the exception of patients less than 1 year of age) were comparable, prediction errors were widely disparate among the various groupings. Individuals within each of the groups had disparate values even though identical r values were present. These observations indicate that predictive models using serum creatinine levels are of limited clinical use and are least useful for patients younger than 1 year of age.

Creatinine↗
PubMed1985

The adolescent with end-stage renal disease.

The adolescent with ESRD is frequently immature in relationship to chronological age. Growth and pubertal development are major concerns for the adolescent with ESRD. If renal failure had its onset prior to adolescence, it is likely that puberty will be delayed and ultimate adult height retarded for the patient requiring ESRD care during the adolescent period. Non-compliance with the therapeutic regimen is a major clinical problem encountered in the management of the adolescent. Significant morbidity can result from non-compliance with the dialysis regimen and non-compliance is a major cause of allograft loss in the adolescent transplant recipient. The special needs of the adolescent must be considered if ESRD care is to be successful.

Adolescent↗
PubMed1985

Urinary tract infection in infants and children evaluated by ultrasound.

Fifty-nine pediatric patients with urinary tract infection (UTI) underwent renal ultrasonography, excretory urography, and voiding cystourethrography. The imaging procedures were analyzed retrospectively to determine their relative effectiveness in detecting abnormalities that might predispose the patient to UTI. Voiding cystourethrography provided valuable information, particularly the presence or absence of vesicoureteral reflux, that could not be obtained from the other procedures. Excretory urography was less specific than ultrasonography in the majority of patients, with the exception of those who had renal scarring. The authors recommended ultrasonography as the initial imaging procedure in the evaluation of children with UTI. When the sonogram is normal, excretory urography is not considered necessary, but voiding cystourethrography is thought to be essential. If sonography is abnormal, excretory urography and/or other follow-up studies are indicated.

Adolescent↗