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Biomedical subjects

R N Fine

Publications and source records attributed to R N Fine.

At least 145 records · Page 8Linked to original sources
PubMed1984

False-negative anti-DNA antibody activity in infantile systemic lupus erythematosus (SLE).

A 2.5-month-old previously healthy female infant presented with serositis , nephrotic syndrome, progressive renal failure, anemia, and thrombocytopenia. Renal biopsy revealed a proliferative glomerulonephritis with glomerular and extraglomerular deposits of IgG, IgM, C3, and Clq by direct immunofluorescence (IF) techniques. Skin biopsy was positive for IgG and C3 deposits in the dermal-epidermal junction by IF. Despite strong clinical and pathological criteria for systemic lupus erythematosus (SLE), tests for antinuclear and anti-DNA antibodies were negative. Circulating immune complexes (CICs) were detected in three separate assay systems. Immunochemical analysis of isolated CICs showed that anti-DNA antibody was present. Analysis of kidney biopsy material by antigen-specific solubilization techniques showed antibodies reactive with ds-DNA in the kidney. These studies confirm that SLE may be a cause of the congenital nephrotic syndrome and that negative SLE serologies may be secondary to binding of available antibody by excess antigen. Analysis of CICs may be helpful in confirming the diagnosis of SLE in seronegative patients.

Adult↗
PubMed1984

Azathioprine suppression of natural killer activity and antibody-dependent cellular cytotoxicity in renal transplant recipients.

The relative effects of azathioprine (AZA) and prednisone (PRED) on natural killer (NK) activity and the antibody-dependent cellular cytotoxicity (ADCC) of K (killer) cells and the number of FcR and other lymphoid cells were examined in renal transplant recipients. In addition to both long-term (greater than 6 months) and short-term (less than 6 months) transplant recipients receiving conventional AZA-PRED therapy, an important group of long-term recipients receiving PRED but not AZA was studied for the first time. Both NK activity and ADCC are profoundly reduced in the long-term AZA-PRED group but are normal in the long-term PRED-alone (no-AZA) group. The short-term AZA-PRED group exhibits NK and ADCC levels significantly lower than normal but not as low as those of the long-term AZA-PRED group. Patient groups with low NK and ADCC also have low circulating Fc receptor-bearing (FcR) cells. A single patient in the long-term AZA-PRED group was removed from AZA therapy, and approximately 3 months was required for the patient's suppressed NK and ADCC to return to normal. These findings indicate that AZA rather than PRED is the major drug important in suppressing ADCC and NK activity in renal transplant recipients. Several months are required for combination AZA-PRED therapy to reduce these cytotoxic activities. Similarly, several months are required for suppressed ADCC and NK activity to return to normal upon discontinuation of AZA.

Adolescent↗
PubMed1984

Role of aluminum hydroxide in raising serum aluminum levels in children undergoing continuous ambulatory peritoneal dialysis.

Serum aluminum concentrations were measured in 16 children undergoing continuous ambulatory peritoneal dialysis after 7.9 +/- 2.1 (mean +/- SE) and 16.6 +/- 2.3 months of therapy, when the estimated simultaneous oral Al intake from Al hydroxide gels was 98 +/- 20 and 104 +/- 32 mg/kg/day, respectively. Serum Al concentrations were 55.2 +/- 11.4 and 59.8 +/- 10.4 micrograms/L, respectively, compared to 8.2 +/- 1.1 micrograms/L in normal children (P less than 0.001). Serum Al levels correlated with oral Al intake (r = 0.86, P less than 0.001) and inversely with body weight (r = -0.68, P less than 0.01) and age (r = -0.67, P less than 0.01). The youngest patient with the highest serum Al concentrations (208 and 174 micrograms/L) and greatest Al intake (310 and 192 mg/kg/day) had bone biopsy features characteristic of aluminum-related bone disease. Thus, higher aluminum intake per kilogram body weight given to young children is likely to raise the serum Al levels and increase the risk of osteomalacia. Aluminum-containing antacids should be used with caution in infants and young children with renal failure.

Administration, Oral↗
PubMed1984

Comparison of continuous cycling peritoneal dialysis with continuous ambulatory peritoneal dialysis in children.

The clinical courses in 10 pediatric patients undergoing CAPD for 15.0 +/- 2.8 months and subsequently CCPD for 9.3 +/- 3.2 months were evaluated. During CAPD patients received four or five daily exchanges, and during CCPD five 2-hour nocturnal cycles over 10 hours plus a diurnal dwell. The only significant biochemical difference during CAPD compared with CCPD was the serum creatinine concentration (9.7 +/- 1.0 mg/dl vs 10.8 +/- 0.9 mg/dl, P less than 0.01). The peritonitis rate was one episode every 10.7 patient months during CAPD, compared with one episode every 8.5 patient months during CCPD. There were 21 episodes of exit site infection during CAPD versus 17 during CCPD. Mechanical complications included five ventral hernias in three patients and six peritoneal leaks in three patients during CAPD; two patients had two hernias and two patients had two peritoneal leaks during CCPD. Our results indicate adequate control of the biochemical abnormalities of uremia with CCPD, with the exception of the serum creatinine concentration.

Adolescent↗
PubMed1984

Choosing a dialysis therapy for children with end-stage renal disease.

Although transplantation is the optimal therapeutic modality for the child with ESRD, it is usual for the child to require short- or long-term dialysis prior to obtaining a successful transplant. Various factors such as age, mental and psychosocial status, and primary renal disease influence the choice of dialysis therapy. The medical and psychosocial benefits of home peritoneal dialysis are the determining factors influencing the increasing use of CAPD/CCPD in children requiring prolonged dialysis therapy.

Adolescent↗
PubMed1984

Renal osteodystrophy in children undergoing continuous ambulatory peritoneal dialysis.

This paper describes a retrospective evaluation of the course of renal bone disease in 14 children undergoing treatment with continuous ambulatory peritoneal dialysis (CAPD) for an average of 11.9 +/- 1.5 months (mean +/- SE). The patients were divided in two groups according to the changes in serum alkaline phosphatase activity during the period of observation: five patients had alkaline phosphatase activity that decreased or was relatively stable (group I), and nine patients exhibited a rising serum alkaline phosphatase activity (group II). Serial radiological examinations showed adequate control of renal osteodystrophy in the patients of group I, whereas the patients of group II had no improvement or worsening of their bone disease. Group I had higher serum calcium and lower parathyroid hormone levels than group II at the end of period of observation despite similar dosage of vitamin D metabolite. The progression of bone disease was not related to the duration of CAPD or type of previous treatment for end stage renal disease. The observation that the radiological manifestations of secondary hyperparathyroidism were prevented in patients whose serum calcium levels were frequently above 2.62 mmol/liter (group I) while serum calcium levels between 2.25 and 2.50 mmol/liter in group II patients failed to lead to regression of secondary hyperparathyroidism is consistent with the existence of altered "set-point" regulation of the parathyroid gland in children undergoing CAPD.

Adolescent↗
PubMed1984

Renal transplantation update.

Various factors affect the outcome of renal transplants in humans. Matching for HLA-A, -B, and -DR histocompatibility antigens improves survival rates for renal allografts from first cadaver donors. Zero-HLA-A- and -B-antigen-mismatched grafts and two-HLA-DR-antigen-matched grafts do better, although results differ depending on the recipient's primary renal disease. Pretransplant third-party blood transfusions significantly improve survival rates of cadaver donor allografts. The mechanism of this beneficial effect has not been identified; however, blood transfusions probably do not "select out" high responders among potential recipients by stimulating the production of lymphocytotoxic antibodies. Cyclosporine has been heralded as a potent, nonspecific immunosuppressive agent that will significantly improve renal allograft survival rates. The selectivity of cyclosporine's effect on T lymphocytes is advantageous; however, its side effects, especially nephrotoxicity, may limit its usefulness. Attention to the potential surgical complications of renal transplantation can significantly reduce morbidity and mortality.

Blood Transfusion↗
PubMed1983

Precocious puberty and chronic renal failure.

A 7 1/2-year-old boy with chronic renal failure (CRF) experienced transient central isosexual precocious puberty. Simultaneously, he demonstrated hyperprolactinemia with galactorrhea and apparent secondary or tertiary hypothyroidism. These findings could have been a consequence of an unexplained hypothalamic dysregulation. During this period, marked linear growth ensued (8.7 cm during nine months) associated with rapid bone age advancement (four years during a 21-month period). Whereas most boys with CRF demonstrate delayed pubertal development and suppressed linear growth, our patient's transient condition demonstrated that both growth and puberty can occur in the presence of uremia.

Body Height↗
PubMed1983

Continuous ambulatory peritoneal dialysis catheters in children.

Based on clinical experience with 35 subjects younger than 21 years of age who underwent continuous ambulatory peritoneal dialysis (CAPD) during a two-year period at our institution, this procedure was found to be superior to hemodialysis in children because it allowed great freedom of activity and produced fewer complications requiring hospitalization. Moreover, CAPD appeared to be less expensive than hemodialysis, and no mortality or significant morbidity occurred during the 386 patient-months of catheter usage. Exit site infections, peritonitis, and abdominal hernias were the most common complications, often requiring minor surgical repairs. Using a specific operative technique for catheter placement and smaller volumes of dialysate during the first week after placement, these complications were minimized. Thus, CAPD is an effective, advantageous method for treatment of end-stage renal disease in children.

Adolescent↗
PubMed1983

Characterization of soluble circulating immune complexes by antigen-specific dissociation: detection in the Raji cell radioimmune assay.

The Raji cell radioimmune assay (RC-RIA) was used to demonstrate antigen-mediated dissociation of soluble circulating immune complexes (CICs). The dissociation resulted in a reduction in size and number of CICs which was reflected in diminished RC-RIA activity. Two sets of experiments were performed to examine the effect of preincubating excess antigen with immune complexes. First, bovine serum albumin (BSA) was preincubated with preformed BSA-anti-BSA immune complexes and RC-RIA activity was examined before and after incubating. Second, CIC-positive sera from two patients with human thyroglobulin (HuTg)-mediated immune complex glomerulonephritis were preincubated with HuTg and RC-RIA activity was examined. Significant reductions in RC-RIA activity were seen in both situations. The validity of these observations was confirmed by immunofluorescence and electrophoretic techniques. Sucrose density gradient ultracentrifugation studies confirmed the antigen-mediated diminution in size and number of soluble immune complexes as the mechanism responsible for diminished RC-RIA activity.

Animals↗
PubMed1983

Fetal hydronephrosis: problems in diagnosis and management.

Experience with the prenatal diagnosis and management of four cases of congenital renal abnormalities is presented. Neither prenatal intervention nor early delivery was indicated in any of these patients. The current enthusiasm for aggressive management of fetal renal abnormalities may underestimate difficulties in prenatal diagnosis and overestimate the potential benefits of early intervention.

Adult↗
PubMed1983

Calycovesicostomy for total ureteral obstruction after renal transplantation.

Surgical reconstruction for ureteral obstruction is necessary in 1 to 10 per cent of renal transplants. On an acute basis edema, ischemia, lymphocele and hematoma formation cause ureteral obstruction. Chronic etiologies include ureterovesical obstruction and retroperitoneal or ureteral fibrosis. Options for repair are myriad and include repeat ureteral reimplantation, pyeloureterostomy, ureteroureterostomy, pyelocystostomy and calycovesicostomy. We report on the desirability of calycovesicostomy as a last resort option for total ureteral obstruction after renal transplantation.

Adult↗
PubMed1983

Nutritional status of children undergoing continuous ambulatory peritoneal dialysis.

Nutritional status was assessed in 24 clinically stable children, aged 9.68 +/- 4.31 (SD) yr, who underwent CAPD for 6.6 +/- 4.4 months. Energy intake tended to be more suppressed than protein intake. Several nutritional parameters were more abnormal in children less than 10 yr old as compared to children 10 yr of age or older. In comparison to normals of the same chronological age and sex, both groups of patients displayed reduced height, weight, midarm, and midarm muscle circumference, and, in the younger children, triceps skinfold; height retardation was particularly severe. Compared to height/age, anthropometry was not reduced in older children while triceps skinfold and midarm circumference were decreased in children younger than 10 yr. In both groups, serum total protein, albumin, transferrin, and many plasma amino acids were decreased, and serum triglycerides and cholesterol were elevated. Serum total protein decreased during treatment with continuous ambulatory peritoneal dialysis. These observations suggest decreased stature and poor nutritional status in children undergoing continuous ambulatory peritoneal dialysis. Low protein and energy intake and dialysate protein losses may contribute to these abnormalities.

Adolescent↗
PubMed1983

Cadaver renal transplant outcome in recipients with autolymphocytotoxic antibodies.

The major impact of autolymphocytotoxic antibodies (ALCA) on renal transplantation has been in the interpretation of the pretransplant crossmatch as a cause of false-positive results. Less attention has been paid to the direct affects of ALCA on renal allografts. We have examined the sera of 38 recipients of 41 cadaver renal allografts for the presence of ALCA. There were 9 patients with ALCA who received 10 allografts. In these allografts with ALCA, actuarial graft survival was significantly improved (P less than 0.05) over that of 31 transplants without ALCA. In recipients with ALCA, graft survival was 90% at six months and 60% at one and two years; in recipients without ALCA, graft survival was 48% at six months, 35% at one year and 24% at two years. ALCA may be exerting graft-enhancing properties by means of an autoregulatory effect upon the recipient's immunologic system.

Autoantibodies↗