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Biomedical subjects

R R Bailey

Publications and source records attributed to R R Bailey.

At least 19 recordsLinked to original sources
PubMed2000

Monitoring of renal function in patients with spinal cord injury.

OBJECTIVE: To assess the sensitivity of serum creatinine level in detecting clinically important and early deterioration of renal function in patients with spinal cord injury (SCI), and to evaluate the optimal method of determining creatinine clearance in these patients. PATIENTS AND METHODS: The serum creatinine level of 36 patients (25 paraplegics and 11 quadriplegics) was evaluated and compared with the corresponding measured creatinine clearance rate. Correlations were also assessed between the creatinine clearance measured by 24-h endogenous clearance, single-shot 99mTc-labelled diethylenetriamine pentaacetic acid (99mTc-DTPA) clearance technique, and the Cockcroft-Gault formula, to test their validity. RESULTS: Of the 36 patients 11 (31%) had a measured creatinine clearance of < 100 mL/min (mean 84.8) and a corresponding normal serum creatinine level. Creatinine clearance calculated by the Cockcroft-Gault formula did not correlate well with that measured by the 24-h endogenous clearance (r = 0.426) and 99mTc-DTPA clearance (r = 0. 366), overestimating creatinine clearance in all but three patients. The mean (SD) difference between the creatinine clearance measured by the 24-h and DTPA clearance technique was 17.7 (16.5)% and the correlation between these techniques was good (r = 0.71). CONCLUSION: Serum creatinine level is not sensitive in detecting early deterioration of renal function in patients with SCI. The Cockcroft-Gault formula generally significantly overestimates the true creatinine clearance and is not recommended. The 24-h endogenous creatinine clearance measured on appropriately collected urine samples is an acceptable accurate and practical method of determining glomerular filtration rate in patients with SCI.

Adult↗
PubMed1998

Treatment of vesicoureteric reflux in a sheep model using subureteric injection of cultured fetal-bladder tissue.

To investigate the role of injecting cultured fetal-bladder tissue into the region of the vesicoureteric orifice (VUO) to correct surgically produced vesicoureteric reflux (VUR), 12 Coopworth ewe lambs were studied. Four weeks after incising the intravesical segment of ureter, VUR was demonstrated by micturating cystourethrography. Bladder tissue was obtained from a fetal Coopworth lamb at 10 weeks' gestation, cultured in RPMI 1640, and injected into the region of the VUO of 1 ureter of each lamb using an open surgical approach. The lambs were killed between 1 and 6 months after the injection. Smooth-muscle cells from the cultured fetal bladder tissue were identified by the monoclonal antibodies HHF-35 for muscle alpha-actin and D33 for muscle desmin, and by electron microscopy. One lamb died of a gastrointestinal infection at 8 weeks of age. Of the remaining 11 animals, the injection of fetal-bladder tissue corrected the reflux in 7, while it was reduced in degree in 3 and persisted unchanged in 1. The reflux on the contralateral control side was also corrected in 6 ureters and improved in 2. Using histochemical techniques, grafted fetal-bladder tissue could not be differentiated from host tissue in the region of the VUO. Histopathological studies failed to show any injected tissue in distant organs. This study has shown that surgically-induced VUR in lambs was corrected or improved by the injection of cultured fetal-bladder tissue into the submucosa adjacent to the VUO.

Animals↗
PubMed1998

A model of sterile vesicoureteric reflux in the sheep.

Eighteen Coopworth ewe lambs were divided into three groups based on the initial cystourethrogram and cystometry findings at 5-7 weeks of age: group 1, 6 lambs with spontaneous low-pressure bilateral vesicoureteric reflux (VUR) on bladder filling were used to study the natural history of reflux; group 2, 5 lambs with no VUR detected were used to establish an experimental model of bilateral VUR using an unroofing surgical procedure; group 3, 7 lambs with spontaneous VUR detected during micturition had the same surgical procedure to increase the degree of VUR. All three animal groups were followed for 4-10 months. Spontaneous VUR was demonstrated in 13 of 18 lambs (25/36 ureters). The presence and severity of spontaneously occurring reflux in group 1 lambs diminished with increasing age. VUR was created successfully in group 2 and increased in degree in group 3 animals. The only significant histological finding in all three animal groups with grades II and III VUR was distal renal tubular dilatation. The sheep is a useful and readily available animal for studying VUR. During 4-10 months of follow-up, sterile reflux without bladder outflow obstruction resulted in distal renal tubular dilatation, but no renal parenchymal damage.

Animals↗
PubMed1998

Intravenous drug use and glomerular deposition of lipid-like material.

UNLABELLED: We present a series of 5 intravenous drug users (4 male, age range 24-47 years) with glomerular deposition of a lipid-like material. Three patients presented with the nephrotic syndrome, 1 with acute renal failure and 1 with hypertension and an active urinary sediment. All were continuing to use opiates intravenously (mixed with lemon juice or acetic anhydride and sodium bicarbonate). INVESTIGATIONS: plasma creatinine 0.10-0.30 mmol/l, urinary protein excretion 1.0-6.75 g/24 h, hepatitis C antibody positive (4), all seronegative for hepatitis B and HIV. Renal biopsy showed large vacuolated areas consistent with heavy deposition of lipid-like material in all glomerular cells and infiltrating macrophages. Two showed ATN and another FGS. We suggest that these changes are due to the pattern of illicit drug availability and preparation peculiar to these users.

Acute Kidney Injury↗
PubMed1998

Clinical audit of the use of renal biopsy in the management of isolated microscopic hematuria.

Whether renal biopsies are indicated for the investigation of microscopic hematuria is a subject of debate. In this retrospective study we evaluated our use of renal biopsy in patients who presented between 1985 and 1995 with microscopic hematuria but without proteinuria, hypertension or renal insufficiency. Of 111 patients, 75 had a renal biopsy. Histological diagnoses included thin membrane nephropathy (TMN) (36%), IgA nephropathy (IgAN) (23%), non-IgA mesangioproliferative glomerulonephritis (MPGN) (9%), mild glomerular abnormalities (11%), focal global glomerulosclerosis (FGS) (4%) and normal (17%). After 85 patients had been followed for a mean of 43 months there were no deaths, 3 patients had proteinuria (IgAN 2, no biopsy 1), 1 had proteinuria and renal insufficiency (immune negative MPGN) and 11 were hypertensive (TMN 3, IgAN 2, normal 2, FGS 1, no biopsy 3). Hematuria resolved in 23 patients. Only 11 patients were still attending the nephrology clinic and 27% of the patients who were advised to continue annual follow-up with family doctors had not done so. In summary, the information obtained from renal biopsy rarely altered clinical management. Hypertension developed in 13% of the patients followed but it was not predicted by the biopsy result. Although a renal biopsy will usually be diagnostic it is difficult to justify in patients who have isolated microscopic hematuria.

Adult↗
PubMed1997

Vesicoureteric reflux and reflux nephropathy: the Christchurch contribution.

For the past 40 years members from the Christchurch departments of paediatrics, nephrology, radiology, pathology and nuclear medicine have studied the entity of vesicoureteric reflux and its main complication of reflux nephropathy. Initially the natural history of vesicoureteric reflux was examined by investigating 350 infants with urinary infection by intravenous urography and micturating cystourethrography. The 40% demonstrating reflux were followed up for approximately 12 years. The study showed that infancy and early childhood were the critical periods for renal damage to occur, that the damage was confined to those kidneys subjected to severe degrees of reflux, that lesser degrees of reflux were not associated with renal damage and that a spontaneous lessening of the severity of reflux occurred with increasing age. Other aspects of reflux nephropathy also have been studied including pathogenic mechanisms resulting in renal damage, ultrasonography to examine fetal anatomy, radioisotopic methods for demonstrating renal scarring and reflux, and the long term follow up of adults with reflux nephropathy.

Humans↗
PubMed1997

Measurement of total phospholipids in urine of patients treated with gentamicin.

AIMS: The excretion of phospholipids in urine may be a marker of the early renal toxicity of the aminoglycoside antibiotics. Urinary phospholipids are formed in myeloid bodies which develop in the lysosomes of proximal tubules during treatment with the aminoglycosides, and overflow into the urine. METHODS: Published assays were modified in order to measure the total phospholipid concentrations in human urine. Phospholipids were extracted from freeze-dried urine samples, digested in concentrated sulphuric acid, and the inorganic phosphorus content determined by complexing with ammonium molybdate and measuring the absorbance at 820 nm. Ten septicaemic patients treated with gentamicin for 5-7 days had significantly higher urine phospholipid concentrations than 10 healthy untreated control subjects (P < 0.0001). There was a negative linear relationship between phospholipid excretion and creatinine clearance (r2 = 0.71). RESULTS: In 34 patients with acute pyelonephritis, increased phospholipid concentrations were observed prior to treatment compared with healthy controls (P < 0.001) and did not alter during treatment with gentamicin. However, the phospholipid concentrations decreased significantly after treatment was completed (P < 0.03). CONCLUSIONS: These studies suggest that urinary phospholipids may indicate early aminoglycoside toxicity but with poor specificity, as many of the infections being treated may themselves be associated with phospholipiduria.

Adolescent↗
PubMed1997

Acute bone-marrow oedema in cyclosporin-treated renal transplant recipients.

Transient musculoskeletal pain may occur in renal transplant patients on cyclosporin (CyA). Of 28 consecutive patients transplanted in this unit between 20 January 1995 and 2 May 1996, eight (two published elsewhere) developed this problem. Before transplantation, three of the patients had received prednisone intermittently or continuously for 15, 5 and 2 years, for asthma, crescentic GN and SLE, respectively. All patients had normal hand radiographs prior to transplantation. Five developed acute rejection following transplantation requiring treatment with methylprednisolone; one also required OKT3 (7 days). Weight-bearing joints of the lower limbs became affected at 3-40 weeks (mean 14) following transplantation. MRI changes (T1-, T2-weighted and STIR images) were consistent with acute bone-marrow oedema. Bone scintigrams showed enhanced tracer uptake in affected joints. A spontaneous complete remission occurred in five patients within 4-16 weeks, and this was supported by serial imaging. The other patient underwent core decompression of the femoral heads with relief of symptoms, but MRI showed bilateral avascular necrosis (AVN) of the femoral heads. MRI proved useful in detecting acute bone-marrow oedema and its possible progression to AVN. The former may be either a distinct entity or a forerunner of AVN.

Adolescent↗
PubMed1997

Comparison of the effects of ouabain and brain natriuretic peptide in saline-loaded sheep.

1. It has been claimed that ouabain is an endogenous hormone that may be pivotal in the pathogenesis of some forms of hypertension and may exaggerate natriuresis in situations characterized by volume overload. We compared the haemodynamic, renal and endocrine effects of ouabain (at approximately 187 ng/kg per min for 2 h) with those of brain natriuretic peptide (BNP; at 5 pmol/kg per min for 2 h) in nine saline-loaded sheep in a balanced, randomized, single-blind, placebo-controlled crossover study. 2. Brain natriuretic peptide infusion reduced mean arterial pressure whereas ouabain infusion caused no change. Haematocrit rose steadily during BNP infusion but fell during ouabain infusion. Neither ouabain nor BNP affected urine volume, sodium, potassium or creatinine excretion. Mean heart rate declined during the ouabain and placebo infusions, but was not altered during BNP infusion. Endogenous ouabain concentrations were not detectable at baseline or during BNP or placebo infusions, but rose to concentrations of 11 +/- 1.3 nmol/L during the ouabain infusion. 3. These results suggest that ouabain is not an endogenous hormone present at physiologically relevant concentrations. Furthermore, ouabain does not cause natriuresis during saline-loading in sheep and is therefore unlikely to be responsible for the exaggerated natriuresis seen in some forms of hypertension.

Aldosterone↗
PubMed1997

Over 11 years of stable renal function after remission of nephrotic-range proteinuria in type I diabetics treated with an ACE inhibitor.

It has previously been considered inevitable that a progressive deterioration in renal function would occur in type I diabetics who have proteinuria in the nephrotic range. We have reviewed all type I diabetic patients presenting with nephrotic-range albuminuria to this department over a 13-year period. Of 16 patients identified, 4 have demonstrated a prolonged stability of renal function, with 2 losing their albuminuria. The latter 2 patients, who have been treated with an angiotensin-converting enzyme inhibitor for over 11 years, are presented in detail. The possible factors contributing to progression and the role of angiotensin-converting enzyme inhibitors in the treatment of advanced diabetic nephropathy are discussed.

Adult↗
PubMed1997

OKT3 for the treatment of steroid-resistant acute renal allograft rejection.

OKT3 (Orthoclone) was first used in this unit on February 25, 1987. Up until March 31, 1996, 153 patients had a total of 163 transplants. Fifty of these patients who received 53 transplants (28 male, mean age 37.5 years, 48 cadaveric donors), were treated with OKT3 for steroid-resistant acute rejection. Forty-nine graft biopsies were undertaken and 47 showed acute rejection. In the other 4 episodes a clear-cut clinical and laboratory diagnosis of severe rejection was made. OKT3 (5 mg i.v.) was started at a median of 19 days following transplantation and was successful in reversing 43 of 51 (84%) episodes of steroid-resistant acute rejection. Of those treated, the patient and graft survival at 1 year was 86 and 69%, at 3 years 82 and 64% and at 5 years 79 and 61%, respectively. Adverse effects were common. Four patients died from sepsis within the first 3 months after transplantation. OKT3 was effective in reversing 84% of steroid-resistant acute rejection episodes.

Adolescent↗
PubMed1997

Effect of lacidipine, a dihydropyridine calcium antagonist on renal function of hypertensive patients with renal insufficiency.

There are few studies on the use of dihydropyridine calcium antagonists in hypertensive patients with moderate renal insufficiency. We undertook an open study on the effects on renal function, albumin excretion and blood pressure of the slow-onset, long-acting dihydropyridine calcium antagonist, lacidipine, in 14 patients with stable, chronic renal insufficiency (mean assessed GFR 0.78 ml/s, range 0.50-1.17 ml/s) and moderate hypertension. Following a 2 week washout phase, lacidipine was administered for 24 weeks in a dose of 2 mg/day with the dose being titrated at 2 weekly intervals to a maximum of 6 mg/day in order to achieve adequate blood pressure control. Frusemide was introduced if blood pressure was not controlled on the maximum lacidipine dose. Blood pressure, creatinine clearance, 24 h urinary albumin excretion and plasma creatinine and albumin concentrations were measured at regular intervals throughout the study. Isotopic GFR was determined at the end of the washout period and at week 24. Lacidipine was not very effective in controlling blood pressure and had an adverse effect on renal function. In 3 patients with an incipient nephrotic syndrome this necessitated withdrawal from the study. Mean GFR of the 10 patients who completed the study decreased from 0.69 ml/s/1.73 m2 at baseline to 0.56 ml/s/1.73 m2 at week 24 (p = 0.006) with a decline in GFR being observed in 9 of these patients. The decrease in GFR was greatest in patients with poorly controlled blood pressure. An insignificant increase in mean urinary albumin excretion occurred during the study with this increase being observed only in patients with albuminuria > 1 g/24 h at baseline. These findings indicated that systemic hypertension altered glomerular hemodynamics and that the vasodilatation of pre-glomerular vessels which followed introduction of the calcium antagonist may have exacerbated this situation. The withdrawal of an angiotensin converting enzyme inhibitor during the washout period may have contributed to these changes. We suggest that renal function should be monitored closely in patients with renal insufficiency when a calcium antagonist is being used to control blood pressure, particularly in those with either marginal blood pressure control, significant albuminuria or an incipient nephrotic syndrome.

Adult↗