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Biomedical subjects

S J Rosansky

Publications and source records attributed to S J Rosansky.

At least 37 records · Page 2Linked to original sources
PubMed1990

Comparative incidence rates of end-stage renal disease treatment by state.

End-stage renal disease (ESRD) treatment rates vary significantly between states in the United States. Much of this variation relates to the much higher rate of ESRD in blacks and the differences in race, age, and sex composition of various states. Even after adjusting for race, age, and sex differences utilizing data from new patients reported to Medicare with ESRD between 1980 and 1983, marked variation in treatment incidence rates per million population were still present. Overall rates varied from 45 in North Dakota to 99 in New Jersey. Regional rate patterns were demonstrated with very high rates in southwestern states (Texas, New Mexico, Arizona, and California: 87-91/million). In contrast, several south-central states had lower rates (Arkansas, Louisiana, Mississippi, Alabama, and Tennessee: 66-75/million). By state the rates for blacks were consistently higher than for whites. After adjustment for sex and age differences, the rates for blacks varied from 125 in Arkansas to 242 in New Jersey. Several north-eastern states (Massachusetts, Connecticut, Rhode Island, New Jersey) had higher rates of ESRD in blacks (197-242 million) as compared with several south-central states (Arkansas, Louisiana, Mississippi, Tennessee, Alabama) where rates varied from 125 to 180 million. ESRD rates by primary etiologies by state showed marked variation of the major primary etiologies of ESRD: diabetic nephropathy rates were most predictive of overall ESRD rates, with much higher rates in the southwestern states (28.1-33.2) as compared with the south-central states (12.8-16.3).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

The association of blood pressure levels and change in renal function in hypertensive and nonhypertensive subjects.

We compared the changes in serum creatinine levels over time after a mean follow-up of 9.8 years in essential hypertensive (EH, n = 56) and control (n = 59) male veteran subjects. All subjects had normal serum creatinine levels (62 to 124 mumol/L) and "normal" urinalysis results on entry into the study. Subjects with comorbid renal diagnoses and diabetes mellitus were eliminated from the analysis. Although not statistically significant, the rate of change in the serum creatinine concentration over time was greater in the EH cohort compared with the control cohort (1.08 +/- 4.8 vs 0.027 +/- 3.5 mumol/L per year). The difference was especially marked in black EH subjects vs black control subjects (1.60 +/- 6.2 mumol/L per year vs -0.21 +/- 3.3 mumol/L per year). When age, race, body mass index, and a diagnosis of EH were entered into a logistic regression analysis, EH subjects had a statistically significantly greater rate of decline in renal function than did control subjects (1.5 +/- 8.3 mumol/L per year). When mean time-averaged systolic blood pressure for each subject was also included in the logistic regression analysis, only systolic time-averaged blood pressure was statistically significant (0.063 +/- 0.029 mumol/L per year). We conclude that in the absence of clinically detected parenchymal renal disease, EH subjects have a greater rate of decline in renal function than do nonhypertensive subjects. Time-averaged blood pressure is predictive of the change in serum creatinine concentration not only in EH subjects but also in nonhypertensive subjects. Thus, preservation of renal function may require a blood pressure lower than the currently accepted normotensive range.

Blood Pressure↗
PubMed1986

Procainamide toxicity in a patient with acute renal failure.

A patient developed acute renal failure while receiving oral procainamide (PA). This lead to severe PA and N-acetyl procainamide (NAPA) toxicity. Rebound of NAPA plasma levels postdialysis prolonged the toxicity, which was treated with hemodialysis, hemoperfusion, and combined hemodialysis-hemoperfusion. Because of the potential for PA and NAPA toxicity in patients with renal insufficiency, especially in patients with changing renal function due to acute renal failure, it is recommended that the use of PA be curtailed in this population and that another substitute antiarrhythmic agent be used.

Acecainide↗
PubMed1985

Use of peritoneal dialysis in the treatment of patients with renal failure and paraproteinemia.

The effect of alterations in dwell time, dialysate dextrose concentration, and nitroprusside on immunoglobulin removal during peritoneal dialysis and a comparison of plasmapheresis versus peritoneal dialysis on immunoglobulin removal was studied. 1 h of plasmapheresis removed approximately 100 times as much IgG and 50 times as much IgM and IgA as 1 h of peritoneal dialysis. Nitroprusside added to peritoneal dialysate doubled the hourly removal rate of IgG using 1- and 8-hour cycles and increased IgA and IgM removal by 25 and 10%, respectively, using 8-hour cycles. It was estimated that peritoneal dialysis with nitroprusside added to peritoneal dialysate augments intact immunoglobulin clearance (above endogenous clearance) by approximately 10%. We hypothesized that peritoneal dialysis could significantly increase light-chain removal and thereby may be efficacious in the treatment of light chain related amyloid formation and light chain induced renal failure.

Adult↗
PubMed1984

The incidence of treated end stage renal disease in the eastern United States: 1973-1979.

Incidence rates of treated end stage renal disease (ESRD) by age, sex, race, and reported primary etiology were analyzed for 20 contiguous Eastern States for the period 1973-1979. For White males and females rates have stabilized at 60 and 40 per million person-years, respectively, since 1977. The incidence rates for Blacks (125 per million person-years in males, and 100 in females in 1979), for hypertensive and diabetic nephropathy patients, and for the 65+ age group continue to increase. Higher incidence rates in males were noted for both races during the entire study period. Blacks had twice as high an incidence of treated ESRD as Whites, primarily due to hypertensive and diabetic nephropathy patients (7 and 2.5 times higher, respectively).

Adolescent↗
PubMed1983

Relationship of creatinine clearance to orthoiodohippurate measured effective renal plasma flow.

Effective renal plasma flow (ERPF) was measured utilizing 1-131 orthoiodohippurate (OIH). The OIH ERPF was correlated in 50 patients with routine 24-hour urine creatinine clearance measurements and with a formula predicting creatinine clearance based on age, weight, and serum creatinine (formula creatinine clearance). The filtration fraction (routine creatinine clearance/OIH ERPF) in 38 patients with hypertensive nephrosclerosis, tubulointerstitial renal disease, or normal renal function were compared. Filtration fractions in the three groups tested were not statistically different. ERPF had a correlation coefficient of 0.62 with routine creatinine clearance and 0.72 with formula creatinine clearance. Thus, OIH ERPF correlates with creatinine clearance measurements but cannot be used to replace creatinine clearance as a method of evaluating renal function. The reasons for the lack of a stronger positive correlation between ERPF and glomerular filtration rate (GFR) remain to be elucidated.

Adult↗
PubMed1983

Vancomycin pharmacokinetics in patients with peritonitis on peritoneal dialysis.

Vancomycin pharmacokinetics were studied in four patients with peritonitis undergoing chronic intermittent peritoneal dialysis. Serum levels exceeding 4.0 micrograms/ml were maintained for 8 and 13 days after a single 1-g intravenous dose. Vancomycin serum concentrations measured before, during, and upon completion of dialysis revealed no appreciable decline. Peritoneal fluid concentrations in two patients exceeded 4.0 micrograms/ml for more than 12 days.

Aged↗
PubMed1983

Choosing therapy for end-stage renal disease.

Patients with end-stage renal disease must decide which form of therapy they want--hemodialysis, peritoneal dialysis or transplant. Each method has advantages and disadvantages. Home dialysis and related donor transplantation are generally the preferred modes of therapy, because they allow for maximum patient rehabilitation and survival. The informed family physician can help the patient choose the most appropriate treatment.

Graft Rejection↗
PubMed1982

Subspecialty consultations in a teaching hospital.

A chart review of 60 consultations by the nephrology service of a teaching hospital was carried out to determine their diagnostic and therapeutic utility. General medicine residents on elective rotations in nephrology performed 72% of the consultations, only 26% being written by residents in the subspecialty. Consultants made an average of 2.2 diagnoses per patient, of which 57% confirmed the working diagnosis already in the medical record. They made an average of 3.0 recommendations for further investigation per patient, but referring physicians implemented only 58% of these. An average of 1.6 recommendations for therapy were made per patient, of which 64% were implemented. The apparent neglect of the consultant's advice for investigation and therapy suggests that the written consultation to some extent fails to convey information useful for the referring physician and the patient. Further study is needed to determine if this failure reflects inadequate training of house officers as consultants.

Hospitals, Teaching↗
PubMed1982

An analysis of the United States renal transplant patient population and organ survival characteristics: 1977 to 1980.

This study examines the relationship between renal transplant organ survival and the extent of HLA (human leukocyte antigen) A and B loci antigen matching. Combined dialysis and transplant records for patients in the End Stage Renal Disease Medical Information System (ESRD MIS), 1977 to 1980, were analyzed to examine transplant organ survival characteristics and changes in demographic pattern and donor types compared to previously reported studies of the United States transplant patients. Actuarial survival curves for high match (3 or 4 HLA A and B loci antigen matches) versus low match (0, 1, or 2 HLA A and B loci antigen matches) groups were analyzed for their relative difference and its statistical significance. In addition, this relationship was analyzed with controls for age, sex, race, mixed lymphocyte culture (MLC), crossmatch, and prior time on dialysis. For both cadaver and living related donor transplants, statistically significant differences were found between the survival curves of high and low match groups. Comparing low match and high match groups, there were differences in 1-year organ survival of 4.8 and 11.3%, respectively, for cadaver and living related donor transplants. MLC negative and crossmatch positive status appear to improve transplant organ survival beyond the effects of HLA matching. The study also designates several methodological problems inherent in transplant organ survival studies including: whether or not to include patient deaths as therapeutic failures, and whether or not to analyze transplant organ survival at one point in time or to compare overall survival curves for the entire study period.

Actuarial Analysis↗
PubMed1982

Multiple cholesterol emboli syndrome.

Of four patients with the syndrome of multiple cholesterol emboli (MCES), three had acute renal failure. One patient recovered stable renal function. A radiocontrast study preceded three of the cases. All four patients exhibited the "purple toe" livido reticularis syndrome. Three had a previously unreported findings--necrosis of the scrotum and foreskin of the penis, suggesting that penile and scrotal necrosis may be additional clues to the presence of MCES.

Acute Kidney Injury↗
PubMed1982

Isopropyl alcohol poisoning treated with hemodialysis: kinetics of isopropyl alcohol and acetone removal.

A comatose and hypotensive patient was successfully treated with hemodialysis after ingesting 480 mL of isopropyl alcohol. Removal of isopropyl alcohol and its major metabolite acetone was measured in urine, blood, and dialysate. According to dialysate measurements, approximately 19 g of isopropyl alcohol and 7 g of acetone were removed per hour using a standard 1 m2 dialyzer. The average dialysance of isopropyl alcohol and acetone were 137 and 165 mL/min, respectively. Removal of isopropyl alcohol was 52 times and acetone 40 times more efficient through hemodialysis than through urinary excretion. Since coma and hypotension portend a bad prognosis and since urinary excretion is slow relative to hemodialysis removal, hemodialysis may be considered life-saving in patients comatose from isopropyl alcohol poisoning. There have been two previous reports of hemodialysis used for treatment of isopropyl alcohol intoxication [1, 2]. Neither of these reports describes the kinetics of isopropyl alcohol removal. This paper reports a third patient treated with hemodialysis who afforded us the opportunity to study blood, urine, and dialysate levels of isopropyl alcohol and its chief metabolite, acetone. By utilizing these results a comparison was made of urine excretion to dialysis removal of these compounds to compare their respective efficacy. In addition, the estimated removal by dialysance calculations was compared to estimated removal by measurement of dialysate volumes and concentrations.

1-Propanol↗