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Biomedical subjects

R N Fine

Publications and source records attributed to R N Fine.

At least 163 records · Page 9Linked to original sources
PubMed1983

Continuous ambulatory peritoneal dialysis in pediatric patients: a 20-month experience.

Thirty-six patients aged 1.6 to 18.8 years with end-stage renal disease (ESRD) underwent continuous, ambulatory peritoneal dialysis (CAPD) between August, 1980, and May, 1982. With four or five exchanges daily, the mean serum urea and creatinine levels were 75 +/- 24 mg/dl and 9.2 +/- 3.1 mg/dl, respectively, hypertension was controlled in 34 of 36 patients without antihypertensive medications, and transfusion requirements were minimal in nephric patients (0.20 U/month). Despite added energy intake from dialysate glucose absorption, the total energy intake was suboptimal in most patients. The mean growth velocity was only 0.35 cm/month and only 4 of 17 patients observed for more than 6 months exhibited normal growth velocity. The incidence of peritonitis was one episode every 12.5 patient months. Rehabilitation was excellent with all patients engaged in age-appropriate activities. CAPD appears to be an acceptable therapeutic modality for children with ESRD.

Adolescent↗
PubMed1983

Ultrasonography of cystic renal dysplasia.

Cystic renal dysplasia, classified by Osathanondh and Potter as renal cystic disease types II and IV, is probably the result of urinary tract obstruction in fetal life. Since these kidneys function poorly, sonography plays a more significant role in their diagnosis than excretory urography. Familiarity with the sonographic spectrum of cystic renal dysplasia will help the physician to make an accurate diagnosis, and may obviate the need for unnecessary invasive procedures.

Diagnosis, Differential↗
PubMed1983

Peritonitis in children undergoing continuous ambulatory peritoneal dialysis.

The incidence of peritonitis in 29 children undergoing continuous ambulatory peritoneal dialysis during a 20-month period was one episode every 12.5 patient-months. Of the 20 episodes of peritonitis, seven (35%) were treated on an ambulatory basis, and 13 required patient hospitalization. The annualized hospitalization rate for the 29 patients during 252 patient-months was 3.8 days per patient. All patients recovered from peritonitis; the only complication was the need to replace two peritoneal catheters. These data would seem to indicate that the potential threat of peritonitis should not curtail continued utilization of continuous ambulatory peritoneal dialysis in children.

Adolescent↗
PubMed1982

Progression to end-stage renal disease in children with obstructive uropathy.

The course of 54 patients (35 boys and 19 girls) with end-stage renal disease resulting from obstructive uropathy was reviewed. The mean age at the initial sign of obstructive uropathy was 3.5 years. Twenty-two patients (41%) manifested evidence of obstructive uropathy during the first year of life. The mean age at the time of onset of ESRD (dialysis) was 12.2 years and was similar in boys and girls. The mean time interval between the first sign of obstructive uropathy and the initiation of dialysis was nine years. Fourteen patients operated upon at less than one year of age developed ESRD one to 20 years (mean ten years) following their initial surgery. Progression to ESRD occurred despite appropriate surgical management, including corrective as well as diversionary urologic procedures. However, because the patients were selectively referred for care of ESRD, no assessment of the incidence of ESRD caused by obstructive uropathy was possible. The data indicate that prolonged follow-up periods are necessary to assess the ultimate outcome of renal function in young patients with obstructive uropathy. Despite early intervention and intact renal function for many years during childhood, progression to ESRD may occur.

Adolescent↗
PubMed1982

Circulating immune complexes during various forms of renal allograft rejection episodes.

Previous reports on the nephritogenic and immunological enhancing capacity of posttransplant circulating immune complexes (CICs) are conflicting and have been confined to the study of acute rejection episode (AR). This study was undertaken to assess the nephritogenicity of CICs in patients undergoing accelerated acute rejection (AAR) and chronic rejection (CR) episodes. We also assessed the possible role of CICs as mediators of immunological enhancement by assessing CIC levels in long-term-stable allograft recipients. To asses the nephritiogenic role of CICs, 98 CIC determinations were performed on 49 serum samples from 41 pediatric renal transplant recipients using the C1q solid-phase assay (C1q-SPA) and the Raji cell radioimmunoassay (Raji-RIA). Serum samples from normal subjects served as controls. No recipient undergoing AAR had evidence of CICs by eigher assay. 5 of 21 (23.8%) recipients undergoing CR had positive CIC levels in the Raji-RIA, while 4 of 21 (19%) recipients had positive CICs inthe C1q-SPA. There was no statistically significant correlation of CIC levels with long-term allograft function. In addition, there was no evidence supporting antithymocyte globulin as an immunogen in patients demonstrating posttransplant CICs. In summary, CICs do not appear to be an important mediator of AAR or CR episodes, and CICs were not routinely detected in patients with good long-term allograft function.

Antigen-Antibody Complex↗
PubMed1981

Circulating immune complexes in pediatric renal allograft rejection.

Previous reports on the generation and nephritogenic capacity of post-transplant circulating immune complexes (CICs) are conflicting. To assess the pathogenicity of CICs in acute rejection (AR), 784 CIC determinations were performed on 392 serum samples from 27 pediatric renal allograft recipients using the C1q-solid phase assay (C1q-SPA) and the Raji cell radioimmunoassay (Raji-RIA). Serum samples from transplant recipients not undergoing rejection episodes and from normal subjects served as controls. Of the 784 CIC determinations, 723 (92.3%) were negative in both assays. CICs were present at some point post-transplant in eight (19.6%) recipients. Correlation of CIC levels with allograft rejection was found in only two patients with CIC levels responding to antirejection therapy; however, statistical analysis of data by chi 2 analysis failed to reveal a significant correlation of CICs with AR episodes. Allograft histology in three recipients demonstrated characteristic signs of AR. Immunofluorescent studies did not reveal significant deposition of immunoglobulin or complement. Sucrose density gradient ultracentrifugation studies confirmed the immune complex nature of materials reactive with the CIC assays. There was no immunological evidence supporting antithymocyte globulin (ATG) as an immunogen in patients demonstrating CICs post-transplant. CICs do not appear to be an important mediator of AR. Statistical analysis of data using the chi 2 test failed to reveal a positive correlation of CIC levels with AR or ultimate allograft outcome.

Antigen-Antibody Complex↗
PubMed1981

Autolymphocytotoxic antibodies in patients on dialysis awaiting renal transplantation.

Two-hundred eighty sera from 78 dialysis patients were examined for autolymphocytotoxic antibodies (ALCAs). Thirty-five (12%) sera in 18 (23%) patients had ALCAs. Eight patients had ALCAs in multiple sera. Two patients had ALCAs against both T and B lymphocytes, 2 against T lymphocytes, and 14 against B lymphocytes. In those sera with ALCAs against both B and T lymphocytes, broad thermal reactivity was present. In sera with ALCAs against only B lymphocytes, the majority were reactive at 5 C. Sixteen (89%) patients with ALCAs had some form of glomerulonephritis; five had rapidly progressive glomerulonephritis (RPGN) and three had systemic lupus erythematosis (SLE). Nine of 10 sera with a positive crossmatch against B lymphocytes from a renal transplant donor did not have ALCAs against autologous B lymphocytes; three sera with ALCAs against B lymphocytes and two with ALCAs against T lymphocytes had negative crossmatches against transplant donor lymphocytes. Positive crossmatches against donor B and T lymphocytes attributable solely to ALCAs were therefore uncommon in our patients. Nevertheless, patients at risk to develop ALCA, including those with SLE and RPGN, should be identified and their sera tested for ALCAs. Once identified, studies can be carried out to distinguish a positive crossmatch attributable to ALCAs from that attributable to HLA alloantibody.

Adolescent↗
PubMed1981

Diagnosis and treatment of allograft rejection.

Several immunologic tests hve been developed to predict allograft rejection prior to functional renal impairment. Unfortunately, no test has as yet proven unequivocally to be of clinical value. Serial serum creatinine determinations and 131I hippuran scintiphotography have proven to be the most useful tests in detecting rejection episodes. Treatment of an acute rejection episode is often successful, but chronic rejection causes a slowly progressive deterioration of allograft function and is unresponsive to treatment.

Creatinine↗
PubMed1981

Dialysis and renal transplant in a hemophiliac.

Hemodialysis was initiated in a mild-moderate hemophiliac at 15 years of age. Hematuria had been a frequent and persisting feature from the age of five years without documented cause. Anemia and proteinuria was first detected at 13 years. A cadaver donor renal transplant was carried out after three months of hemodialysis. Massive intravesical bleeding complicated the immediate post-transplantation period. The allograft rejected after three months and the patient was maintained for eight years on home hemodialysis. A second cadaver donor allograft was carried out at 23 years of age. Again, massive intravesical hemorrhage was a problem post-transplant. The allograft is currently functioning 27 months post-transplant. Factor VIIIc activities have fluctuated between 5% and 40% in the absence of factor infusions.

Adolescent↗