Biomedical subjects
Publications and source records attributed to R R Bailey.
Renal involvement is uncommon in Sjögren's syndrome. The case is reported of a woman with Sjögren's syndrome who developed renal failure, hypergammaglobulinaemic renal tubular acidosis and a renal tubular concentrating defect due to a severe tubulointerstitial nephritis. There was an impressive response to corticosteroid therapy.
Glomerulonephritis is the main determinant of mortality in the Henoch Schönlein syndrome. We report a prospective study on 17 patients with the Henoch Schönlein nephritis who underwent a renal biopsy during a 12-year period. Three patients have developed end-stage renal failure, 13 are alive with normal renal function and one was lost to follow-up. We recommend that patients with Henoch Schönlein nephritis be followed up, with urinalysis and assessment of renal function, for at least five years.
Sixty consecutive pregnant women with asymptomatic (covert) bacteriuria detected between 16 and 30 weeks gestation were randomly allocated to treatment with either a single 600 mg dose or a standard five-day course of trimethoprim. Twenty-seven of 30 women were cured with a single dose. Six of these 27 women were reinfected later in the pregnancy. Twenty-four of 30 women treated with a five-day course of trimethoprim were cured, and five became reinfected later in the pregnancy. One women vomited the single dose. There were no detrimental effects on the outcome of the pregnancies. Single dose therapy should be considered as the treatment of choice for asymptomatic bacteriuria in pregnancy.
A randomised trial was undertaken to compare the efficacy of netilmicin and ceftriaxone for the treatment of severe or complicated urinary tract infections. Forty-seven patients completed the study. Twenty-three of 24 patients treated with netilmicin and 21 of 23 treated with ceftriaxone were cured. One patient treated with netilmicin had a mild, reversible disturbance of renal function. Six patients developed diarrhoea after ceftriaxone treatment.
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The antihypertensive efficacy and pharmacokinetics of a single 1 mg oral dose of doxazosin were investigated in five healthy male volunteers, six patients with renal failure not on hemodialysis, and four patients with end-stage renal failure studied between two hemodialyses. The dialyzability of doxazosin was studied in five patients. The maximum fall in blood pressure of both volunteers and patients occurred between 4 and 8 hours. In four of five volunteers the blood pressure had returned to baseline within 10 to 12 hours, whereas in the patients with renal failure it took as long as 72 hours. Maximum plasma concentrations were reached in 2.6 to 3.6 hours. The mean AUC did not differ significantly between the groups. The mean (SE) elimination t1/2 was 12.6 hours (3.3) in the volunteers and 13.3 hours (1.8) in the patients with renal insufficiency (not significant). Doxazosin was not appreciably dialyzable.
The prevalence of asymptomatic bacteriuria was assessed in women using different contraceptive methods. Three hundred and twenty women attending a family planning centre were studied, 80 in each of the following groups: diaphragms, intrauterine contraceptive devices (IUCDs), oral contraceptives (OCs) and no contraception. The numbers with asymptomatic bacteriuria in the 4 groups were as follows: diaphragm - 12 (all E coli); IUCD - 3 (E coli; P mirabilis; S saprophyticus); OC - 5 (all E coli); no contraception - 4 (3 E coli; 1 S saprophyticus). The prevalence of Gram-negative bacteriuria in women using diaphragms was significantly higher than for women in the other groups (chi 2 = 8.98; p less than 0.05). Factors such as parity, numbers of sexual partners and frequency of sexual intercourse had no apparent effect. The use of diaphragms may contribute to the risk of Gram-negative urinary tract infections in sexually active women.
A man was admitted with acute pyelonephritis due to Escherichia coli. Three days prior to the onset of his symptoms his wife presented with a 7-day history of cystitis due to E. coli. Before the wife developed her symptoms the couple were having vaginal intercourse every night, and this continued for the first 3 days of her symptoms. The organisms isolated from the urine of both patients were found to have the same biotype, an identical antibiogram, and the same serotype. The temporal sequence of events and the bacteriological findings strongly suggest the sexual transmission of this organism from the wife to her husband.
The incidence of epithelial or cutaneous abnormality of the lower genital tract was studied colposcopically in 31 women aged 35 (SD9) years on renal replacement therapy for one to 184 months (mean 73 months). Twenty-four women had a renal transplant and had received immunosuppressive therapy for two to 173 months (mean 61 months). Seven women (two with failed transplants) were on home hemodialysis (one to 48 months, mean 19 months) awaiting transplantation. In 22 women (17 transplant and 5 dialysis patients) no abnormality was found. One hemodialysis patient had an extensive area of vulval intra-epithelial neoplasia. Five transplant recipients had evidence of genital papilloma virus (HPV) infection. No patient had cervical intra-epithelial neoplasia or invasive genital tract malignancy. The high incidence of HPV-associated lesions in this group, and the increasing evidence that HPV changes may predispose to cervical neoplasia suggest that this high risk group require regular gynecological assessment.
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Acute or chronic administration of most beta-adrenoreceptor blocking drugs is associated with a fall in renal blood flow and glomerular filtration rate. In patients with renal insufficiency this effect on renal function may be clinically important. Penbutolol is a non-cardioselective, pure laevo, beta-blocker with intrinsic sympathomimetic activity. Previous studies have suggested that penbutolol may increase the glomerular filtration rate. In this study eight hypertensive patients with renal insufficiency were studied during a three-week placebo period and then for four weeks while taking penbutolol in a dose of 40 or 80 mg daily. Penbutolol produced a fall in the pulse rate in all eight patients. Five of the eight patients had a fall in their supine and standing blood pressure. Effective renal plasma flow and glomerular filtration rate did not change significantly. In seven of the eight patients there was a fall in the calculated renal vascular resistance but the mean fall did not reach statistical significance. Penbutolol appears to be an effective beta-blocker and one that could be used appropriately in patients with renal insufficiency.
In one year 19 patients aged 73 SD 8 yr were referred with renal failure (plasma creatinine 0.14-0.52 mmol/l; urea 7.9-39.5 mmol/l; potassium 2.9-6.1 mmol/l, who were taking amiloride/hydrochlorothiazide (ten), amiloride alone (one) or triamterene/hydrochlorothiazide (eight). Six patients were taking other diuretics. Sixteen patients were being treated for hypertension and three for fluid retention; five hypertensive patients were also taking non-steroidal anti-inflammatory drugs (NSAID). Four patients were hypokalaemic, three were volume-depleted. All potassium-sparing diuretics and NSAID were stopped (four required another diuretic). Six-100 days later renal function was improved in 17 patients, unchanged in one and one patient had died of uraemia. Blood pressure was satisfactory on no therapy in 11 patients and two normotensive patients were oedema-free. In elderly patients with renal impairment potassium-sparing diuretics may cause renal failure, sometimes secondary to hypovolaemia, and NSAID may potentiate the effect.
The case is reported of a woman in whom a chronic hyperchloraemic acidosis and osteomalacia developed follow implantation of her ureters into the rectum. For 14 years she took regular sodium bicarbonate, but a little over four years after discontinuing it she developed clinical, biochemical, radiological and radionuclide evidence of osteomalacia. The latter improved rapidly when sodium bicarbonate was recommenced. This clinical situation is one of the few instances in man where a chronic metabolic acidosis in the context of normal or only mildly impaired renal function can result in osteomalacia.
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Acute renal transplant rejection is a diagnostic and management problem. In the oliguric patient clinical evaluation and biochemical tests are less helpful than in those with a functioning graft. The perfusion index derived from a 99mTc-diethylenetriamine penta-acetic acid scan may be a more reliable marker of acute rejection. We studied 20 consecutive renal transplant recipients with serial radionuclide imaging to assess the usefulness of the perfusion index. Seventy-two of 74 episodes of acute rejection were evaluated. Thirty-three (46%) episodes were predicted or supported by a change in the perfusion index. In the non-functioning transplant, 12 of 15 (80%) acute rejection episodes were predicted or supported. A scan obtained the day after transplantation confirmed graft artery patency in all patients. The perfusion index is a useful diagnostic test for the diagnosis and management of acute rejection, particularly in the non-functioning transplanted kidney.