Cancer development in patients progressing to dialysis and renal transplantation.
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Adult↗
Biomedical subjects
T H Mathew
Publications and source records attributed to T H Mathew.
Left ventricular function in uremia: echocardiographic and radionuclide assessment in patients on maintenance hemodialysis.
Echocardiography and radionuclide ventriculography were performed in 37 uremic patients on maintenance hemodialysis with no apparent coronary artery disease, pericardial effusion, valvular heart disease or heart failure. These non-invasive studies were performed during the interdialytic period (about 18 hours after a dialysis). Sixty-two percent of our patients had abnormal left ventricular function with one or more abnormal echocardiographic parameters. The significant abnormalities were enlargement of the left ventricular cavity, a reduction of myocardial contractility, and thickening of the left ventricular posterior wall. Similar findings were found in 10 undialyzed uremic patients. Measurement of cardiac index and ejection fraction were found to be inadequate for a full assessment of left ventricular function and other parameters such as the mean velocity of circumferential fiber shortening and mean normalized posterior wall velocity should be included. There is a significant number of hemodialysis patients (7/37) with congestive cardiomyopathic features on the echocardiogram. Their clinical features are no different from the other patients in this study, except they have a significantly higher prevalence of uremic hyperparathyroidism. Our findings support that the existence of a specific uremic cardiomyopathy and uremic hyperparathyroidism may play an important role in the pathogenesis.
Adult↗
Multiple use of dialysers. Six uses is the optimum.
In-vivo small-molecule clearances, ultrafiltration rate, and priming volumes were measured in a modern hollow-fibre dialyser after three, six, and 12 uses in a study group of nine regular dialysis patients. A detailed costing of reuse was carried out in order to determine the most cost-beneficial number of uses. Dialyser performance was not affected by any measurable criteria up to 12 uses. A 50% reduction in dialyser cost can be achieved by a policy of three uses, and a 62.5% reduction with a six-use policy. It is recommended that six uses of a dialyser represents the most cost-beneficial decision. A survey of reuse in Australian dialysis units showed that 42% of these are using dialysers, and that there were large regional differences in reuse policy.
Australia↗
A prospective randomized trial of low-dose versus high-dose steroids in cadaveric renal transplantation.
Low-dose steroid regimens, in combination with azathioprine, have become increasingly common for immunosuppression of renal transplant recipients. The change from conventional high-dose steroid regimens was prompted by the results of several prospective trials that showed similar graft survivals with high-dose and low-dose steroids, but a lower incidence of steroid-induced complications in low-dose-steroid--treated patients. However, the number of patients entered into the trials was small, and consequently there remained a possibility that a clinically relevant difference in graft survival could have remained undetected. A multi-center prospective trial was performed to compare graft survival with high-dose (91 patients) and low-dose (98 patients) oral steroids in combination with azathioprine. There was significantly worse graft survival in the low-dose group. The difference was largely due to a poor graft survival in patients receiving low-dose steroids and azathioprine less than 1.75 mg/kg/day. Graft survivals were similar in the high-dose and low-dose steroid patients who received azathioprine doses of greater than 1.75 mg/kg/day. The results indicate that the combination of low doses of both steroids and azathioprine provides inadequate immunosuppression in renal transplantation, although higher doses of azathioprine allow the use of low-dose steroids without significantly more graft losses than with high-dose steroids.
Adult↗
Recurrent focal glomerulosclerosis in renal transplants.
Among 431 renal transplants in 380 patients, 4 patients were identified with focal glomerulosclerosis characterized by presentation with corticosteroid-resistant nephrotic syndrome, early development of histological lesions, mesangial proliferation and rapid progression into chronic renal failure. After transplantation, all patients had early proteinuria and the 4 grafts surviving beyond 3 months developed recurrent glomerular lesions with severe nephrotic syndrome and progression to graft failure. In one patient, recurrent disease developed in two successive grafts. Focal glomerulosclerosis is a nonspecific glomerular lesion, but identification of specific clinical and pathological features may provide guidelines that will predict the risk of its recurrence in transplanted kidneys.
Adult↗
Management of chronic renal failure, 1983.
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Australia↗
Intrarenal abscess in a transplant organ.
We report the first case of an intrarenal abscess in a transplant organ. Diagnosis was made by ultrasonography and excretory urography, and was confirmed by percutaneous aspiration under ultrasonographic guidance. Surgical drainage and systemic antibiotic therapy resulted in complete resolution of the lesion and no change in renal function.
Abscess↗
Scanning electron microscopy of glomerular and non glomerular red blood cells.
Phase contrast microscopic examination of the urine has been recently shown to be of value in predicting whether hematuria is due to glomerulonephritis or lesions of the lower urinary tract. Glomerular red cells show variations in size and shape and have distorted surfaces. Non glomerular red cells are uniform in size and shape and have smooth surfaces. Scanning electron microscopy was performed on urine sediment containing either glomerular or non glomerular red cells to better define their surface characteristics. Glomerular red cells exhibited a variety of forms, most cells having lumpy projections from the surface, some showing fragmentation of the membrane and others showing gross distortion. In contrast non glomerular red cells show smooth surfaces and usually maintain the normal biconcave disc shape of peripheral red blood cells. Scanning electron microscopy can better define surface structural abnormalities of urinary glomerular and non glomerular red blood cells.
Analgesics↗
Detection of glomerular bleeding by phase-contrast microscopy.
Midstream urine specimens from 303 consecutive patients with haematuria were examined with phase-contrast microscopy to determine whether the source of the haematuria could be predicted on the basis of urinary red-cell morphology. In 253 patients a definite diagnosis was made but the data for the other 50 were inadequate to allow a definite diagnosis. With phase-contrast microscopy the origin of haematuria was considered to be glomerular in 120 patients (115 had proven glomerulonephritis and 5 had lesions of the lower urinary tract) and non-glomerular in 105 patients (100 had lesions of the lower urinary tract and 5 had proven glomerulonephritis). A mixed picture of glomerular and non-glomerular red cells was seen in 28 patients, most commonly in association with IgA nephropathy and renal calculi. The assessment of urinary red-cell morphology by means of phase-contrast microscopy can add importantly to clinical information and, together with the presence of red-cell casts and protein in the urine, can help the clinician decide on initial investigations in patients with haematuria.
Erythrocytes↗
Effect of long-term cimetidine treatment on left ventricular function in haemodialysis patients with active hyperparathyroidism.
1 The effect of long-term oral cimetidine on left ventricular function was evaluated in chronic haemodialysis patients with active hyperparathyroidism. 2 Radionuclide ventriculography (seven patients) and echocardiography (five patients) revealed a significant increase in ejection fraction and mean velocity of circumferential fibre shortening six months after treatment. 3 The improved cardiac performance was associated with improvement of bone histology. C-terminal parathyroid hormone, serum calcium, and mean arterial pressure changed little after treatment. 4 The improved cardiac performance is thought to be related to the suppression of uraemic hyperparathyroidism by cimetidine. 5 The present study suggests that uraemic hyperparathyroidism may play an important role in "uraemic cardiomyopathy".
Cimetidine↗
Beta 2-microglobulin excretion and urinary cytology in analgesic nephropathy.
Patients with analgesic nephropathy are at risk from uro-epithelial malignancy. Enhanced secretion of beta 2-microglobulin occurs from epithelial cancer cells. In order to find a screening test for malignancy in analgesic nephropathy, urinary levels of this protein were measured in patients with analgesic nephropathy with urine cytological abnormalities and were compared to a control group with glomerulonephritis. Mean fractional excretion of beta 2-microglobulin was higher (8.61 +/- 1.76 SEM) in patients with analgesic nephropathy than in those with glomerulonephritis (1.13 +/- 0.76) (P less than 0.025). Those patients with analgesic nephropathy who had malignant cells in the urine had higher mean fractional excretion (18.56 +/- 5.77) than those with only atypical cells (8.5 +/- 2.0) (P less than 0.05) who in turn had higher mean values than those with normal cytology (2.12 +/- 0.62) (P less than 0.0025). It is suggested that the increased beta 2-microglobulin excretion in analgesic nephropathy is due to secretion from abnormal urothelial cells as well as reduced tubular catabolism. Beta 2-microglobulin may be of use as a screening test for malignancy in analgesic nephropathy.
Adult↗
Effect of renal transplantation on left ventricular function in hemodialysis patients.
The effect of renal transplantation on left ventricular function was evaluated in 14 patients with end-stage renal disease requiring maintenance hemodialysis. They had no apparent clinical evidence of heart disease. Ischemic heart disease was excluded by history, electrocardiography and radionuclide ventriculography. Echocardiography and radionuclide ventriculography were recorded in the interdialytic periods. Sixty-four per cent of the patients had abnormal left ventricular function despite adequate hemodialysis. Left ventricular function was reassessed within the first two months after successful renal transplantation. All parameters improved shortly after the transplantation. Cardiac index increased by an average of 0.76 +/- 0.11/min/m2 (P less than 0.001), stroke volume by 23.9 +/- 0.5 ml (P less than 0.001), ejection fraction by 9.7 +/- 1.9% (P less than 0.001), mean normalized posterior wall velocity by 0.17 +/- 0.06 second-1 (P less than 0.01), mean velocity of circumferential fiber shortening by 0.28 +/- 0.02 circle/second (P less than 0.001), and mitral valve diastolic closure rate by 17.2 +/- 2.3 mm/second (P less than 0.01). Our findings support the existence of a specific uremic cardiomyopathy which is a functional defect probably related to poorly dialyzed uremic toxins.
Adult↗
Bone disease in analgesic nephropathy.
Clinical, biochemical, radiological and bone biopsy findings were studied in 15 patients with end stage renal disease due to analgesic nephropathy and compared with data from age and sex matched controls who had end stage renal disease from other causes. Patients with analgesic nephropathy had significantly higher osteoid volume (P less than 0.04), reduced calcification fronts (P less than 0.001) and lower percentage mineralization (P less than 0.04). Serum alkaline phosphatase was significantly higher in the analgesic group (P less than 0.005). It is concluded that osteomalacia is more common and severe in the group of patients with end stage renal disease due to analgesic nephropathy. There was no relationship between osteomalacia and the duration of renal failure, acidosis, aluminium deposition or other serum biochemical abnormalities.
Alkaline Phosphatase↗
Prolonged confusion after cimetidine.
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Aged↗
A controlled trial of plasmapheresis in the treatment of renal allograft rejection.
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Clinical Trials as Topic↗
Multiple use of dialysers: an Australian view.
Multiple uses of dialyzers has been studied in a single hospital and by survey of all Australian dialysis units. An annual saving of $84,000 was achieved in a 46-patient unit. No significant patient morbidity or mortality occurred. In Australia 43% of all haemodialysis patients are on a multiple use regime. The 1-year patient cumulative survival for units with a reuse policy is 92.8% and for those with a single use of policy is 87.1%. Anti-N-like antibodies are being found in low but increasing frequency as the reuse program continues.
Antibody Formation↗
Single day or single dose treatment of urinary tract infection with Co-trimoxazole.
Forty-eight women with urinary tract infection due to Co-trimoxazole sensitive organisms were randomly allocated to receive either two tablets (0.96 grams) of Co-trimoxazole twice a day for one day, four tablets (1.92 grams) of Co-trimoxazole as a single dose, or, two tablets of Co-trimoxazole twice a day for seven days. The infection cure rate was comparable in each group being 82%, 87% and 81% respectively. The patients who received the single dose had a high incidence of minor side effects. Accordingly one-day treatment appears to be the treatment mode of choice. Failure to respond to single dose or single day treatment may indicate those patients requiring investigation of their urinary tract.
Drug Administration Schedule↗
Acute post-streptococcal glomerulonephritis in adults: a long-term study.
The long-term outcome after acute post-streptococcal glomerulonephritis was studied in 57 patients (52 aged 16 or over) followed for a period of one to 14 years (mean seven years). All patients presented with hypertension, haematuria and proteinuria. The antistreptolysin-0 titre was raised or the serum complement was low in all cases at the initial episode. All patients had histological evidence of a diffuse proliferative and exudative glomerulonephritis at onset. Follow-up renal biopsy was performed in 33 patients; in 18 patients this was carried out five years or more after the initial illness. Five patients died beyond two years, only two having had abnormal renal function at the time or death. Four patients were found to be mildly hypertensive without other clinical abnormalities. Eleven patients had proteinuria, haematuria or abnormal renal function; in three of these repeat renal biopsy was normal, incomplete resolution was reported in five, obsolescent glomeruli in one, and two others were not biopsied. No patient who had normal renal function at the time of follow-up had abnormal renal histology on biopsy. Obsolescent glomeruli were present in two other biopsies in association with evidence of incomplete resolution. It was concluded that the majority of patients with acute PSGN have a good prognosis. Histological resolution of the renal lesion may not occur for nine years.
Acute Disease↗