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Biomedical subjects

R R Bailey

Publications and source records attributed to R R Bailey.

At least 37 records · Page 2Linked to original sources
PubMed1996

Living related renal transplantation: the Christchurch experience.

AIM: To determine the outcome of renal transplants from living related donors. METHODS: Retrospective analysis of 33 living related donor renal transplants done between March 1976 and 31 December 1994 at Christchurch Hospital. RESULTS: One of the 33 renal transplants patients received an ABO incompatible kidney and was excluded from the statistical analysis. Twenty-one (66%) of 32 grafts continue to function. The 1, 5 and 10 year graft survival rates were 82%, 73% and 48%, respectively. The estimated 1 and 10 year patient survival rates were 96% and 94%, respectively. With the introduction of cyclosporin the 1 and 5 year graft survival rates increased to 90% and 80%, respectively. Three patients received donor specific transfusion preconditioning and one patient a skin graft from the prospective donor. Four patients (12.5%) had current and/or peak panel reactive antibody titres of more than 25%. Three of these grafts failed after 2, 95 and 463 days. Two grafts were lost due to catastrophic vascular complications. CONCLUSION: The overall outcome for patients who were not highly sensitised was excellent. The degree of sensitisation of the recipient, and the extent of atherosclerotic vascular disease in the recipient, were major predisposing factors for the graft loss due to rejection and vascular complications during the early post transplant period.

Adult↗
PubMed1996

Audit of the outcome of patients with renal failure presenting to a regional nephrology service.

AIM: To assess the outcome of patients with renal failure presenting to a regional nephrology unit. METHODS: The records of patients with plasma creatinine concentration > or = 0.30 mmol/L who presented between 1 January 1988 and 31 December 1993, or were already under follow up, were studied. RESULTS: The outcome of 491 patients (293 males) aged from 4.8 to 88.8 years, 123 of whom had acute renal failure, was assessed at 30 June 1994. Thirty seven (30%) of the patients with acute renal failure had died. Of the 372 patients with chronic renal failure 139 had started regular dialysis treatment and 95 were dead, including 27 patients, with a mean age of 71 years, who died of untreated end-stage renal failure (ESRF). For 11 (40%) of these patients the patient and/or family made the decision not to start dialysis treatment. The rates of treatment of ESRF are lower in Canterbury and Westland than those in the Auckland region. The latter can be explained partly by the differences in the demography of the respective populations. CONCLUSION: Death from untreated ESRF is uncommon in Canterbury and Westland. The rates of treatment of ESRF with regular dialysis are lower than in the Auckland region.

Acute Kidney Injury↗
PubMed1996

Unravelling the genetics of vesicoureteric reflux: a common familial disorder.

Primary vesicoureteric reflux (VUR) is one of the more common genetic disorders. Little is yet known about the genetics of this potentially manageable childhood condition, which is characterised by regurgitation of urine from the bladder to the kidney. The VUR phenotype is associated with shortness of the submucosal segment of the ureter due to congenital lateral ectopia of the ureteric orifice. VUR is found in 30-50% of infants and young children with a urinary tract infection. A serious concern in families with an affected patient is that approximately one half of siblings or offspring will be affected, but up to a half of these affected siblings and offspring may be asymptomatic in childhood. If left untreated, these patients may present later in life with proteinuria, hypertension or renal failure. VUR is the commonest cause of end-stage renal failure in children, and an important cause in adults. As the kidney damage resulting from severe VUR is preventable, early detection is desirable. The techniques for clinical diagnosis are invasive and costly, reinforcing the importance of identification of a gene for VUR to facilitate genetic screening. Although family studies suggest a major dominant gene, the inheritance pattern is still a matter of debate. In rare instances, VUR occurs in association with other diseases, such as the coloboma-ureteric-renal syndrome, which is caused by a PAX2 gene mutation. In this review, we present evidence that this common disorder may be caused by mutations in the developmental pathway of which the PAX2 gene forms a part.

DNA-Binding Proteins↗
PubMed1996

Chronic ouabain infusion does not cause hypertension in sheep.

Ouabain is claimed to be a hormone of adrenal origin, capable of raising arterial pressure in rats. We infused ouabain in conscious sheep under carefully controlled circumstances to determine its effects on blood pressure, urine electrolytes, and vasoactive hormones. Eight healthy ewes were studied while taking a constant intake of dietary sodium and potassium. Ouabain infusion at 0.25 mg daily over 22 days reduced heart rate and arterial pressure and had no effect on pressor responsiveness to incremental intravenous infusions of angiotensin II. Ouabain induced minor, but statistically significant, decrements in urine volume, urinary sodium excretion, plasma renin and angiotensin II concentrations, and a rise in plasma aldosterone and cortisol. Plasma ouabain levels averaged 1.37 +/- 0.28 nmol/l during ouabain infusion. In conclusion, high-dose chronic ouabain infusion in sheep did not elevate arterial pressure or alter pressor responsiveness to angiotensin II, was antidiuretic and antinatriuretic, and induced minor perturbations in circulating renin, angiotensin II, aldosterone, and cortisol.

Adrenocorticotropic Hormone↗
PubMed1996

Single oral dose treatment of uncomplicated urinary tract infection in women.

A single oral dose of an antimicrobial agent is as effective as a conventional 3-day course for the treatment of uncomplicated lower urinary tract infections. A case history of a young woman with recurrent cystitis is presented to demonstrate this approach to the management of a common clinical problem. The place of antimicrobial prophylaxis is also discussed.

Administration, Oral↗
PubMed1996

DMSA renal scans in adults with acute pyelonephritis.

The 99mTc-DMSA scan is accepted as the most sensitive imaging modality for detecting areas of renal parenchymal scarring. More recently the DMSA scan has also been shown to be of value in imaging areas of renal parenchymal involvement in both children and adults with acute pyelonephritis. We assessed the acute DMSA scan findings in a consecutive series of 81 patients hospitalized with acute pyelonephritis. Acute pyelonephritis was diagnosed if the patient had a fever of > 37.8 degrees C, loin pain or tenderness and infected urine (99% Escherichia coli). Patients had a blood culture taken (8 positive), as well as a hematological (leukocytosis 75%) and biochemical screen, C-reactive protein (CRP) (increased in 57 of 66 [86%]) and urinary tract ultrasonography. If the initial DMSA scan was abnormal it was repeated after three months and in some instances again at six months. If persisting defects were noted an intravenous urogram was then undertaken. Of the 81 patients, 37 (46%) had an abnormality on the DMSA scan. Nineteen had a single defect, 12 multifocal defects, five features suggestive of pre-existing renal parenchymal scarring (all later shown to have reflux nephropathy) and one a shrunken kidney. Those patients with an abnormal scan had a higher CRP concentration than those with a normal scan. Of the 31 patients who had either a focal or multifocal defect on their initial DMSA scan there was adequate follow-up on 24 patients. In 18 of these the defects had resolved by six months (usually within three months), while of the remainder, three were shown to have reflux nephropathy, one had a large single renal cyst and another an area of parenchymal calcification. Fifty-three of 76 patients (70%) had normal ultrasonography. In adults with acute pyelonephritis, the DMSA scan may prove to be the most useful renal imaging procedure.

Acute Disease↗
PubMed1996

Prospective, randomized, controlled study comparing two dosing regimens of gentamicin/oral ciprofloxacin switch therapy for acute pyelonephritis.

Aminoglycosides are drugs of choice for severe gram-negative urinary tract sepsis. Recent evidence suggests that they are just as efficacious, but less nephrotoxic and ototoxic, if given as a single daily dose rather than in divided doses. We considered that a single, large dose of an aminoglycoside followed by oral therapy with a different antibiotic might be equally effective and possibly less toxic. This randomized, controlled study compared a single large i.v. dose (10 mg/kg) of gentamicin (S) with a standard multiple dose regimen (M) of gentamicin (2.5 mg/kg i.v. stat and then computer generated divided doses aiming for peak and trough concentrations of 8 and 1.5 mg/l respectively) for the treatment of patients with suspected acute pyelonephritis requiring hospitalization for parenteral antibiotic treatment. All patients were switched to oral ciprofloxacin either four hours after the S dose or when clinically appropriate in the M regimen. For all patients the total duration of treatment was five days. Fifty-three patients (48 women; mean age 32 yr) were enrolled. Clinical and bacteriological efficacy could be assessed in 41 patients. Thirteen of 16 in the S arm and 24 of 25 in the M arm were clinically cured and the other four clinically improved. Fifteen of 16 in the S arm and 23 of 25 in the M arm were cured bacteriologically (sterile urine 7-10 days after treatment). In 41 patients high tone audiometry was carried out before or very soon after the start of treatment, and again at the end of treatment. Ototoxicity (> or = 10 dB loss in > or = 2 frequencies in both ears) was observed in 3 of 18 in the S group (17%) and 7 of 23 in the M group (30%) (NS). Other side-effects and toxicity were mild and not different between groups. Substantial cost savings occurred in the S group. In summary, a large single dose of gentamicin was comparable in efficacy and toxicity to a standard regimen, but cheaper and more convenient to use.

Acute Disease↗
PubMed1995

Use of acitretin for the skin complications in renal transplant recipients.

AIM: To review our experience using acitretin for the skin complications in renal transplant recipients. METHODS: Fifteen longterm caucasian renal transplant recipients suffering skin complications were treated with acitretin (10-50 mg daily), a second generation retinoid. Indications for its use were progressive actinic keratoses, widespread warts or recurrent skin malignancies. The therapeutic benefit was assessed by the general condition of of the skin and the number of skin malignancies excised, and the side effects by regular enquiry, skin examination and laboratory tests. RESULTS: All 15 patients reported that the skin became softer and smoother. Actinic keratoses and warts improved or disappeared. Six patients had been on acitretin for over 12 months. The number of malignancies decreased in four of these six patients. Nine patients had cutaneous side effects due to acitretin necessitating a reduction in dose in five patients and discontinuation in the remaining four patients. No patient had any disturbance of their liver or renal function tests or lipid profile. No interaction was found between cyclosporin A and acitretin (seven patients). CONCLUSIONS: Most patients treated with acitretin experienced subjective improvement and actinic keratoses and warts improved or disappeared. Its effect on the skin malignancy rate was variable. Acitretin was reasonably well tolerated. The benefits of this drug remain anecdotal, making a prospective, multicentre, placebo controlled study essential.

Acitretin↗
PubMed1995

Pregnancy in renal transplant recipients: the Christchurch experience.

AIM: Assess the pregnancies of our female renal transplant recipients and to document long term maternal and fetal outcome. METHODS: Between 7 June 1972 and 31 December 1992 112 females had at least one renal transplant. Sixty-four of these 112 women were in the reproductive age and had a functioning graft. RESULTS: Nine women had 16 pregnancies which resulted in 11 live births and three first trimester abortions. Two unplanned pregnancies were terminated. Mean age at transplantation was 17.2 yr [range 16-22.5 yr] and mean interval from transplant to pregnancy was 6.8 yr [range 1.8-9.0 yr]. Prednisone and azathioprine were used in all patients and cyclosporin in five. For seven of the successful pregnancies plasma creatinine remained < or = 0.10 mmol/L. One of these women developed allograft nephropathy 5 years after delivery and returned to dialysis 9 years later. For the other four successful pregnancies the preconception plasma creatinine was 0.12-0.14 mmol/L. The woman with two successful pregnancies had a halving of glomerular filtration rate during the second pregnancy, but it has remained stable for 15 years; one was poorly compliant with her immunosuppressive regimen and reached endstage renal failure two years after delivery; one developed cyclosporin nephrotoxicity, but 18 months later renal function was stable after a dosage reduction. Ten infants were delivered by caesarean section, four of them urgently. Three babies were preterm and five growth retarded. One died of sudden infant death syndrome at four months. All other infants developed normally. CONCLUSION: There is no contraindication to pregnancy in female transplant recipients who have stable graft function and controlled blood pressure. Management of such pregnancies should be by shared obstetrical/nephrological/paediatric care.

Adolescent↗