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Biomedical subjects

R R Bailey

Publications and source records attributed to R R Bailey.

At least 55 records · Page 3Linked to original sources
PubMed1995

A long term follow up of adults with reflux nephropathy.

AIM: To assess the long term follow up of patients with reflux nephropathy. METHODS: Two hundred and ninety-four patients over 15 years of age (females 235; caucasians 288) presented between 3 wk and 72 yr of age (mean 17.3 yr; SD 14.4 yr). One hundred and seventy-six had unilateral reflux nephropathy and 118 had bilateral reflux nephropathy diagnosed on intravenous urography and/or a DMSA scintigraphy. RESULTS: The majority of patients, particularly women, presented with a urinary tract infection. Twenty-five patients (8.5%) had hypertension at presentation, 15 (5.1%) loin or abdominal pain, 14 (4.8%) proteinuria and six (2%) renal insufficiency. At the last follow up (mean age 34.2yr; SD 13.7yr; range 15-81yr), 113 patients (38%) had hypertension or were on antihypertensive therapy. This was significantly more frequent in those with severe bilateral renal parenchymal scarring. Proteinuria was present in 92 (31%); 40 of these had renal insufficiency. Seventy-one (24%) had a creatinine clearance < 70 mL/min and 43 (15%) a urinary tract infection. Eighteen patients had suffered from a urinary calculus. Proteinuria and renal insufficiency were significantly more frequent in those with severe bilateral reflux nephropathy. CONCLUSION: All patients with reflux nephropathy who have proteinuria, hypertension or renal insufficiency should be under regular follow up.

Abdominal Pain↗
PubMed1995

Cyclosporin in renal transplantation: a 9 year experience.

AIM: Review our 9 year experience using cyclosporin A (CyA) in a triple immunosuppressive regimen for renal transplantation. PATIENTS: Between 1 October 1984 and 30 June 1993 117 patients had a total of 130 renal transplants. This review was confined to 52 of these patients who had been on CyA for at least 12 months and had remained under regular surveillance in this clinic. RESULTS: Patients were given 10 mg/kg of CyA prior to transplantation then 8 mg/kg/d in two divided doses after the onset of graft function. The maintenance dose was tapered to a mean of 3.5 mg/kg/d (SD 1.4) within 9 months and thereafter ranged from 3.0-3.4 mg/kg/d. Individual patients differed significantly in the trough whole blood CyA concentrations that they produced on a certain dose. Chronic CyA nephrotoxicity occurred in 3 patients and equivocal changes in another patient, while on a CyA dose of 3.0-4.0 mg/kg/d. CONCLUSION: CyA was an effective drug as part of a triple immunosuppressive regimen for renal transplantation. Chronic CyA nephrotoxicity was an unpredictable finding and occurred with doses as low as 3.0-4.0 mg/kg/d and with drug concentrations within the recommended therapeutic range. All patients on CyA should be under regular supervision and early graft biopsy undertaken if there is evidence of graft dysfunction.

Adolescent↗
PubMed1995

Reversible erythrocytosis in a patient with a hydronephrotic horseshoe kidney.

A 33-year-old man with dystrophia myotonica presented with erythrocytosis and an increased plasma erythropoietin concentration. Investigations showed a horseshoe kidney, one moiety of which was grossly hydronephrotic. Fluid aspirated from the latter had a similar erythropoietin concentration to that in plasma. Following partial nephrectomy, the hematocrit and plasma erythropoietin concentration returned to normal.

Adult↗
PubMed1995

Effect of enalapril on erythrocytosis in hypertensive patients with renal disease.

Treatment of hypertension with an angiotensin converting enzyme inhibitor (ACEI) may be associated with a decrease in haemoglobin concentration especially in patients with renal insufficiency. This open study in 19 patients with a variety of renal diseases with complicating hypertension investigated the effects of the ACEI, enalapril, on haemoglobin and plasma erythropoietin (EPO) concentrations. Blood samples were obtained at baseline and 2, 60 and 120 days after starting treatment with enalapril. By day 60 there was a significant decrease in mean haemoglobin concentration (mean decrease 7.4 g/l) that was sustained until day 120. Apart from a small, but significant, reduction by day 2, mean plasma EPO concentration remained constant throughout the study. The magnitude of the decrease in haemoglobin concentration was, however, significantly correlated with the baseline plasma creatinine concentration and creatinine clearance. These results suggested that the degree of renal insufficiency was important in determining the haematological response to ACE inhibition. While the mechanism of these changes remains unclear, our findings suggest that inhibition of the renin-angiotensin system, rather than decreasing EPO production, may reduce the erythropoietic activity of the hormone.

Adult↗
PubMed1995

Effect of enalapril on hemorheology in hypertensive patients with renal disease.

An open, prospective study was undertaken to investigate the effects of enalapril on hemorheology in patients with renal disease and complicating hypertension. Cellular and plasma determinants of blood viscosity and renal function were measured in 19 patients at baseline and 2, 60 and 120 days after treatment with enalapril (mean dose 5.4; range 2.5-20 mg/day). Within 2 days of starting enalapril there was a significant decrease in apparent blood viscosity measured at high shear rate (-0.15 mPa.s; p < 0.05) which fell further by day 60. The decrease in blood viscosity was primarily the result of hemodilution, as evidenced by a concurrent fall in plasma albumin concentration and plasma viscosity. A small, but significant decrease, in hemoglobin concentration (-7.4g/l; p = 0.03), and a trend of improved red blood cell (RBC) and white blood cell (WBC) rheological properties may have also contributed to the decrease in blood viscosity. We conclude that enalapril had a beneficial effect on hemorheology in patients with renal disease. The mechanism of the rheological changes appeared to be multifactorial and would be expected to decrease vascular resistance to blood flow.

Adult↗
PubMed1995

Effect of losartan on haematology and haemorheology in elderly patients with essential hypertension: a pilot study.

This small open study in elderly patients with essential hypertension investigated the effects of the angiotensin II AT1 receptor antagonist on red blood cell haematology and haemorheology. Administration of losartan over a 1-year period was not associated with a significant reduction in haemoglobin or plasma erythropoietin (EPO) concentrations and haemorheological indices remained unchanged. These findings are in contrast to similar studies with angiotensin-converting enzyme (ACE) inhibitors that have shown a significant reduction in erythropoietic activity and a decrease in blood viscosity. Our results indicate therefore that blocking the angiotensin II AT1 receptor does not affect erythropoiesis. Losartan has no adverse haemorheological effects and was associated with a small and statistically insignificant decrease in blood viscosity.

Aged↗
PubMed1994

Cutaneous manifestations of renal transplantation in a New Zealand population.

AIM: To document the skin manifestations of renal transplant recipients. METHODS: The findings in 52 patients (27 males; mean age 43.5 yr; range 22-74 yr; SD 12.0) with a stable renal transplant for a mean of 115.6 mth (range 3-258; SD 70.6). Thirty seven patients were on prednisone and azathioprine and 18 on prednisone, azathioprine and cyclosporin. RESULTS: Including prior observations, 48 cutaneous malignancies were identified in nine patients, with the ratio of squamous cell to basal cell carcinoma being 1.2:1. No metastases were detected. Actinic keratoses were present in 20 patients and tended to be multiple and present on sun exposed skin. A wide range of nonneoplastic lesions was documented, including warts in 75%. Human papillomavirus was isolated from 43% of warts. CONCLUSIONS: Renal transplant recipients require regular skin examination. Patients with high recreational or work related sun exposure prior to, or after transplantation, and those who have had a previous skin malignancy, should be identified as high risk patients for skin cancer and have regular dermatological follow up.

Adult↗
PubMed1994

Long term follow up of patients with IgA nephropathy.

AIM: To assess the long term outcome of patients with IgA nephropathy. METHOD: The outcome of 151 patients (120 male; mean age 32.5, median age 29.6, SD 15.4 years; 146 Caucasian) with biopsy-proven IgA nephropathy. The patients were enrolled between 30 April 1973 and 21 August 1992. RESULTS: Ninety-five (63%) of the patients presented with microscopic haematuria, with or without proteinuria and/or renal insufficiency. At presentation renal insufficiency was present in 34% and hypertension in 48% of patients. During a mean follow up period of 63.3 months (range 0-233 months) 12 patients have reached end stage renal failure, five have died of a nonrenal cause and 25 were lost to follow up. The actuarial renal survival rate was 92.6% at five years and 91.1% at both 10 and 15 years. A significantly poorer renal survival rate was seen in those patients with a plasma creatinine > or = 0.12 mmol/L, hypertension, a serum albumin of < 35 g/L, or a 24 hour urinary albumin excretion > or = 1.0 g at presentation, and this became apparent within the first few years of follow up. CONCLUSIONS: The long term outcome of IgA nephropathy is better than previously reported. Those patients with a poor prognosis can be identified with considerable certainty at presentation.

Actuarial Analysis↗
PubMed1994

The plasma interleukin-6 and stress hormone responses to acute pyelonephritis.

The relationships between the "stress hormones" corticotrophin (ACTH), vasopressin (AVP), corticotrophin releasing hormone (CRH) and cortisol, and the cytokines, interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor were studied during an acute infection. Ten patients (7 female, 3 male, age range 16-56 years) with acute pyelonephritis and normal renal function were studied during the first 72 hours following hospital admission. Peptide hormones were measured by radioimmunoassay, cortisol and cytokines by ELISA. Reference ranges for all hormones were from samples donated by 40 or more volunteers from the electoral roll. The reference data for IL-6 was obtained from 20 normal donor sera. The mean plasma IL-6, AVP and CRH concentrations on admission to hospital were significantly raised above the mean 08:00h values of the normal volunteers (p < 0.001 for AVP and CRH, p < 0.01 for IL-6), but mean plasma ACTH and cortisol were not. Mean plasma IL-6 and AVP were raised more than two standard deviations above the mean of the reference range for 72 hours, although IL-6 tended to fall after 24 hours. No change in plasma IL-1 and tumour necrosis factor was observed in three patients. The correlation between plasma IL-6 and cortisol concentrations at all sampling times and in all subjects was highly significant (p < 0.001). Significant correlations between plasma IL-6 and AVP (p < 0.005), and IL-6 and ACTH (p < 0.05) were also observed. No correlation between IL-6 and CRH could be demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1994

Effect of ouabain on pressor responsiveness in normal man.

To assess the effects of ouabain on pressor and vasoactive hormone responsiveness, 10 healthy volunteers were pretreated with ouabain (0.5 mg i.v. 42 and 18 h before study) or placebo before pressor challenge with angiotensin II (ANG II; 2, 4, and 8 ng.kg-1.min-1 for 30 min/dose) and norepinephrine (NE; 5, 15, and 45 ng.kg-1.min-1 for 15 min/dose). There were no differences at baseline between the two study days regarding mean arterial pressure (MAP) or heart rate. Baseline pulse pressure, however, was significantly greater after ouabain (47 +/- 3 vs. 41 +/- 1 mmHg; P < 0.05). The mean maximum increments in MAP during ANG II and NE infusions were 17.5 +/- 1.1 and 10.5 +/- 1.3 (SE) mmHg, respectively, after ouabain and 19.2 +/- 1.3 and 10.4 +/- 1.5 mmHg after placebo (not significant). The mean heart rate was lower during both infusion periods on the ouabain study day compared with control (P < 0.05). Baseline plasma levels of ANG II, aldosterone, plasma renin activity, atrial and brain natriuretic peptide, guanosine 3',5'-cyclic monophosphate, NE, and epinephrine and achieved levels during the two infusions were similar on the two study days. We conclude that short-term ouabain administration does not alter pressor responsiveness or plasma levels of vasoactive hormones in healthy volunteers.

Adult↗