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Biomedical subjects

R R Bailey

Publications and source records attributed to R R Bailey.

At least 73 records · Page 4Linked to original sources
PubMed1994

End-stage reflux nephropathy.

Forty-two of 371 patients (11.3%) entering a dialysis-transplant program had end-stage reflux nephropathy. Thirteen of these 371 patients were under 16 years of age, with 6 of them having reflux nephropathy. Most patients presented with severely impaired renal function, hypertension, and proteinuria. Documented urinary tract infections occurred in only 4 of the 18 male and 14 of the 24 female patients. Thirty-five patients had hypertension, which in 22 had not been detected before presentation. Five presented with accelerated hypertension. Eight of the 24 women presented during a pregnancy. Twenty-nine patients are still alive, 20 with a functioning renal transplant. Reflux nephropathy is an important cause of end-stage renal failure, particularly in younger people. All patients presenting with renal insufficiency and proteinuria, with or without urinary tract infections or hypertension, should have reflux nephropathy excluded.

Adolescent↗
PubMed1994

Effect of hemodialysis and recombinant human erythropoietin on determinants of blood viscosity.

Blood viscosity (hemorheology) is a major determinant of the rate of blood flow, and increases in viscosity are known to be involved in the etiology of vascular diseases. This placebo-controlled study investigated the independent and combined effects of hemodialysis and recombinant human erythropoietin (rHuEpo) on determinants of blood viscosity in patients with chronic renal failure and related any changes to the normal physiological range. Hemodialysis patients were shown to have a high incidence of rheological abnormalities although the degree of anemia associated with chronic renal failure compensated for these changes. The main effect of both hemodialysis and rHuEPO treatment was an increase in hematocrit associated with a rise in blood viscosity and inconsistent changes in red blood cell (RBC) deformability. The rise in viscosity was significant only following rHuEPO treatment. Hemodialysis-induced increases in blood and plasma viscosity correlated strongly with the degree of hemoconcentration. Although hemodialysis patients have inherent hemorheological abnormalities, correction of renal anemia with rHuEPO to a hematocrit level of < 0.35 in conjunction with dialysis-induced hemoconcentration did not result in adversely high blood viscosity levels in any patient.

Anemia↗
PubMed1993

Renal artery stenosis as a cause of heavy albuminuria.

We report three cases of heavy albuminuria occurring in hypertensive patients with unilateral or bilateral renal artery stenosis. In two of the patients the albuminuria and hypertension were corrected by removing the ischaemic kidney. The mechanism of the albuminuria, particularly in atheromatous renal artery stenosis, is probably multifactorial.

Adult↗
PubMed1993

Hemorheology and fistula function in home hemodialysis patients following erythropoietin treatment: a prospective placebo-controlled study.

The beneficial effect of correcting anemia in end stage renal failure using recombinant human erythropoietin (rHuEPO) is sometimes complicated by thrombosis of the arteriovenous fistula. This placebo-controlled study investigated the relationship between hemorheological changes caused by rHuEPO and alterations in fistula function and heparin requirements in home hemodialysis patients. Erythropoietin induced a rise in high shear rate blood viscosity, a determinant of blood flow in large vessels. Doppler assessment of brachial artery blood flows, tests of fistula function and heparin requirements were similar in the two patient groups. These findings indicate that rHuEPO treatment of renal anemia resulted in the expected rise in red blood cell mass and blood viscosity although these changes did not cause problems with arteriovenous access or alter fistula function in the short term.

Adult↗
PubMed1993

Management of lower urinary tract infections.

Most urinary tract infections (UTIs) present as bacterial cystitis in healthy women in the sexually active age group. The commonest pathogen is Escherichia coli and most of the remainder are due to Staphylococcus saprophyticus. Many women are prone to recurrent UTIs and these are invariably due to a reinfection with a different organism. After diagnosis, a curative course of treatment should be given, but the approach should be different if the infection is uncomplicated (normal urinary tract and normal renal function) as opposed to complicated (male patient, abnormal urinary tract, impaired host defence mechanisms, impaired renal function, infection with a virulent organism). It is believed that traditional dosage regimens for uncomplicated UTIs are extravagant. There is no convincing evidence that a long course of medication is more effective than a short one; in fact, the use of single dose therapy for uncomplicated UTIs is gaining support. Trimethoprim 600mg, cotrimoxazole (trimethoprim/sulfamethoxazole) 1.92g, fosfomycin trometamol 3g and the 4-quinolones are the preferred agents for single dose treatment. Failure of single dose therapy is a simple guide for the need for further urinary tract investigation or more intensive therapy. If UTIs recur, it may be necessary to consider long term, low dose prophylaxis. The most effective drugs for this type of treatment include nitrofurantoin 50mg, trimethoprim 100mg and norfloxacin 200mg, given at night. More recent studies show that a dose administered on alternate nights, 3 nights a week or after intercourse is just as effective.

4-Quinolones↗
PubMed1992

Membranous nephropathy: a 19 year prospective study in 51 patients.

AIM: to study prospectively patients presenting with membranous nephropathy. METHODS: the outcome of 51 patients (33 male; mean age 50.8 SD 17.7 years; 49 caucasian, two Maori), aged 14 years and over, with membranous nephropathy was studied prospectively. The patients were enrolled between 1 July 1972 and 30 June 1991. Patients with systemic lupus erythematosus were excluded. Membranous nephropathy was secondary to drug therapy in eight (gold 3, nonsteroidal antiinflammatory drug 3, penicillamine 1, captopril 1). All patients were hepatitis B surface antigen negative. The majority of patients did not receive immunosuppressive therapy. RESULTS: forty-seven (92%) presented with the nephrotic syndrome, eight (16%) with a plasma creatinine > or = 0.15 mmol/L and 28 (55%) with hypertension. The patients were followed for a mean of 5.4 years, the median being 3.9 years and range four months-19 years. The 10 year cumulative renal survival was estimated to be 78% and overall survival 66%. Six patients have entered a renal replacement programme and six have died of nonrenal causes. Of the remaining 39, eight have renal insufficiency, 27 hypertension and 22 proteinuria. Complete remission occurred in 17 (33%)-11 spontaneously, four following withdrawal of the offending drug and two after immunosuppressive therapy. Poor prognostic indicators at presentation included renal insufficiency, need for antihypertensive therapy, pathological stage IV on renal biopsy and older age. CONCLUSIONS: membranous nephropathy is an indolent disease with a good chance of spontaneous remission. In most patients immunosuppressive treatment appears unwarranted.

Adolescent↗
PubMed1992

Comparison of ciprofloxacin with netilmicin for the treatment of acute pyelonephritis.

A prospective, randomised trial was undertaken to compare the efficacy of ciprofloxacin and netilmicin for the treatment of acute pyelonephritis. Forty-three patients were enrolled and 34 (29 women) completed the protocol. Fifteen of 17 patients treated with ciprofloxacin and 15 of 17 treated with netilmicin were cured. All patients were treated for five days. One patient relapsed after ciprofloxacin and another had a reinfection, while two relapsed after netilmicin. Five of six patients with a urinary tract abnormality were cured. Side effects were generally mild and rapidly reversible. Patients treated with ciprofloxacin spent a mean of 3.7 days in hospital compared with 5.3 days for those treated with netilmicin. The difference in duration of hospital stay was statistically significant (p less than 0.01). Both drugs proved highly effective and safe for the treatment of severe acute pyelonephritis.

Acute Disease↗