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Biomedical subjects

V Sitprija

Publications and source records attributed to V Sitprija.

At least 91 records · Page 5Linked to original sources

Measurements of urinary state of saturation with respect to calcium oxalate and brushite (CaHPO4.2H2O) in renal stone formers.

Urinary supersaturation with respect to calcium oxalate and/or brushite (CaHPO4.2H2O) is critical for the formation of calcium stones. The aim of this study is to use concentration product ratio (CPR) as a tool to assess the state of urine saturation with respect to calcium oxalate and brushite. One 24-h urine specimen from each of 16 healthy city dwellers (GI), 18 healthy villagers (GII) and 28 villagers with renal stones (GIII) was collected and analyzed for calcium, sodium, potassium, phosphate, uric acid, citrate and oxalate. The CPRs of calcium and oxalate and of calcium and phosphate before and after equilibration of the urine with the corresponding seeding crystals were also determined. Urinary volume and the excretion rate of calcium, potassium, uric acid, citrate and oxalate of GII and of sodium, phosphate, uric acid and citrate of GIII were significantly less than those of GI. The CPRs for calcium oxalate and brushite were 2.9 +/- 0.3 and 1.7 +/- 0.2 for GI, 2.7 +/- 0.2 and 1.3 +/- 0.1 for GII and 2.5 +/- 0.2 and 1.1 +/- 0.1 for GIII, respectively. The CPR values indicated that urine of all groups was generally supersaturated with respect to calcium oxalate salt (CPRs were above 1) and were not different among the groups. With regard to brushite, urine was also supersaturated but the state of supersaturation was less than that of calcium oxalate. Furthermore, instead of being supersaturated, brushite in many urine specimens of GIII was undersaturated and its mean CPR was even significantly less than that of GI (P less than 0.01).

Adult↗

Acute renal failure in obstructive jaundice in cholangiocarcinoma.

This study was aimed at defining the natural history of renal failure in obstructive jaundice due to cholangiocarcinoma, which is an important health problem in northeastern Thailand. Sixty-four patients among a total of 130 patients with obstructive jaundice secondary to cholangiocarcinoma who developed acute renal failure were studied retrospectively. Analysis was made with respect to clinical features, laboratory findings, and outcome. The development of renal failure before surgery was observed in all patients. It was nonoliguric in 80% and was associated with severe jaundice, gram-negative infection (42%), hypotension (31%), hypoproteinemia (30%), hyponatremia (56%), and hypokalemia (63%). The mean duration of renal failure was 2 weeks. All patients underwent surgery for the relief of jaundice. Seventy-seven percent of the patients survived and had recovery of renal function after the relief of jaundice. Twenty-three percent of the patients died of infection. Clinical data highlight the higher serum bilirubin levels and the frequent occurrence of hyponatremia, hypokalemia, and hypotension in renal failure. Their possible roles in contributing to the development of renal failure are discussed.

Adenoma, Bile Duct↗

Identification of urinary metabolites and quantitative measurement of creatinine by a proton nuclear magnetic resonance spectrometry.

1H-NMR spectra of 60 human urine specimens were recorded without pretreatment by a JEOL FX 90 Q spectrometer operating at 89.55 MHz. The signals of the methyl protons of creatinine (3.04 +/- 0.02 ppm) were observed in all spot fasting morning urine samples collected from 7 healthy persons, 10 patients with nephrotic syndrome and 43 patients with diabetes mellitus. The concentrations of creatinine measured by NMR spectroscopy (Y) and the chemical assay based on the Jaffe reaction (X), over the range of 19-190 mg/dl, were compared by the least-squares linear regression analysis (Y = 6.7799 + 0.6717 X). The mean urinary creatinine concentration by NMR spectroscopy appeared to be lower than that obtained by the Jaffe reaction at the normal and high normal levels. In the urine of 20 diabetic patients with an average blood glucose of 251.30 +/- 50.26 (SD) mg/dl typical spectra of the multiple large signals of glucose protons at position from 3.13 +/- 0.04 to 4.04 +/- 0.12 (SD) ppm were shown. Moreover, some urinary metabolites and amino acids spectra were occasionally detected at one time.

Creatinine↗

Low specific gravity urine with crystalluria as discriminant index for nephrolithiasis.

A community-based study for crystalluria in morning urine (MU) specimens was carried out under light microscopy. The MU specimens were collected from 29 males with renal stones (GI), 36 age-and sex-matched normal controls (GII) and 27 household members of GI who did not have stones (GIII). The findings can be summarized as follows. 1. In the groups as a whole, almost all crystal and crystal aggregate found was oxalate type and with highest prevalence in GI. 2. In urine with low specific gravity (SG) i.e. less than or equal to 0.010, prevalence of oxalate crystals in GI (57.7%) was significantly higher (p less than 0.05) than in both GII (5.9%) and GIII (13%). Furthermore, at this range of SG, 15 per cent of the MU specimens in GI showed aggregation of oxalate crystals, whereas, the condition was neither found in GII nor GIII. 3. Our data suggest urine supersaturation with respect to calcium oxalate was found in both renal stone patients and normal subjects but more frequently in the former and also suggests more deficiency or lack of inhibitors for oxalate crystal nucleation and aggregation in urine of renal stone patients. The occurrence of oxalate crystals and crystal aggregates in urine of low SG may be useful as an index to discriminate stone patients from normal subjects or as an index to indicate the high risk group in the community.

Adult↗

Furosemide and dopamine in malarial acute renal failure.

The effects of furosemide and furosemide with dopamine on renal function were studied in 23 patients with acute renal failure due to falciparum malaria whose serum creatinine ranged from 230 to 947 mumol/l. Furosemide given intravenously at the dosage of 200 mg 6 hourly for a period of 4 days did not alter the clinical course of renal failure. Intravenous administration of furosemide (200 mg 6 hourly) with dopamine (1 microgram/kg/min) for 4 days increased creatinine clearance and arrested the progress of renal failure when the serum creatinine was less than 400 mumol/l, but failed to alter the course of renal failure when the serum creatinine exceeded 600 mumol/l.

Acute Kidney Injury↗

Norfloxacin versus co-trimoxazole for the treatment of upper urinary tract infections: a double blind trial.

The clinical and bacteriological efficacy of norfloxacin and co-trimoxazole was compared in patients with symptomatic upper urinary tract infections (UTI). Norfloxacin 400 mg or cotrimoxazole (160 mg of trimethoprim plus 800 mg of sulphamethoxazole) were given orally b.i.d. for seven days to 94 Thai patients. Clinical and bacteriological assessments were performed before and at 5, 14 and 21 days after start of treatment. Bacteriological outcome could be evaluated in 69 patients, 35 randomized to norfloxacin and 34 to co-trimoxazole. The bacteriological cure rate assessed four to seven days after treatment was significantly higher in the norfloxacin than in the co-trimoxazole group (94.3% vs. 73.5%; p less than 0.05). Few patients in each group reported mild and transient adverse effects. We conclude that norfloxacin was well tolerated and more effective than co-trimoxazole in the treatment of upper UTI.

Adolescent↗

Renal failure in melioidosis.

In a restrospective study of 220 patients with melioidosis admitted to the hospital over a period of 3.5 years, acute renal failure was noted in 77 patients. Interesting clinical features included hypercatabolism, hypoalbuminemia, hyponatremia, jaundice and multisystem involvement. Prognosis was poor especially when associated with jaundice, lung involvement and the presence of underlying diseases. Mortality rate was 89.6%. Renal failure is believed to the due to renal ischemia from multiple nonspecific factors. In a limited pathological study renal changes consisted of tubular necrosis, microabscesses, interstitial nephritis and mild tubular degeneration.

Acute Kidney Injury↗

Effect of Russell's viper (Vipera russelli siamensis) venom on renal hemodynamics in dogs.

The effect on renal hemodynamics of Russell's viper (Vipera russelli siamensis) venom was studied in 8 mongrel dogs. The venom (0.10 mg/kg) was injected i.v. Measurements of general circulation and renal function were carried out over 48 hr. During the initial post-injection period, mean arterial blood pressure, pulse pressure and heart rate decreased. Total peripheral vascular resistance and renal vascular resistance showed a tendency to increase. There was no change in cardiac output. Thereafter the blood pressure and heart rate returned to the control level 2 hr after injection and remained stable throughout the experiment. The cardiac output remained unchanged, but the pulse pressure later increased. Renal blood flow, glomerular filtration rate, renal fraction and the rate of urine flow were decreased 24 hr after venom injection and rose to the control levels at 48 hr. Renal vascular resistance remained relatively increased, while peripheral resistance decreased, at 24 hr. Blood volume was unchanged throughout the 48 hr. Disseminated intravascular coagulation was not observed, although the clotting time was prolonged. Renal histological studies showed no remarkable changes; tubular necrosis was not seen. The renal hemodynamic changes may initially be due to catecholamine release and later to renin - angiotensin activation with renal vasoconstriction.

Animals↗

Hemolytic uremic syndrome in leptospirosis bataviae.

Hemolytic uremic syndrome was observed in a 46-year-old man who had leptospirosis. Renal failure was severe with a prolonged clinical course. Despite clinical recovery there was residual renal damage indicated by mildly elevated serum creatinine. This is the first report of hemolytic uremic syndrome in leptospirosis.

Creatinine↗

Complement changes in falciparum malaria infection.

Complement profiles were sequentially studied in 183 Thai adults infected with Plasmodium falciparum. On the first day of admission, CH50, C1q, C4 and C3 were low in 65%, 8%, 19% and 62% of cases, respectively. All patients with low C1q or C4 also had low C3 and CH50. Simultaneous reduction of C1q, C4, C3 and CH50 were found in 10 instances. Factor B was not reduced in any of the patients indicating that only the classical pathway is activated during acute falciparum malaria infection. The incidence and the degree of hypocomplementaemia were higher in patients with cerebral, renal and hepatic complications although significant difference was seen only for C3. After 3-4 days of effective anti-malarial treatment, normalization of C1q and C4 was found in almost all instances whereas C3 and CH50 remained low in 27% and 54% of the cases, respectively. Normalization of C3 was achieved at 4 weeks after discharge while low CH50 still persisted. The reasons for the persistently low CH50 remain unknown.

Adult↗

Urine uric acid and urine creatine ratio in acute renal failure.

The urine uric acid (UUA) and urine creatinine (UC) concentration ratio was studied in 23 patients with acute renal failure. The ratio was higher than 1 in 12 patients and lower than 1 in 11. The clinical characteristics of the first group of patients included the association of infectious disease with high fever, hyperbilirubinemia, nonoliguric renal failure, less reduction of creatinine clearance, and higher urinary excretion of uric acid when compared with the second group. Jaundice and perhaps overproduction of uric acid due to hypercatabolism are believed to be responsible for the high uric acid excretion and the high UUA-UC ratio.

Acute Kidney Injury↗

Low protein diet and chronic renal failure in Buddhist monks.

Clinical observations were made in five Buddhist monks with chronic renal failure on a low protein diet. These monks consumed only one meal and meditated three to four times a day. The estimated protein intake was from 15 to 19 g a day. Renal function remained stable over three years of observation. The general condition was satisfactory without any evidence of protein energy malnutrition. The data were compared with those of another group of patients who had a comparable degree of impairment of renal function but who consumed three meals a day of low protein diet. Protein intake was estimated to be from 25 to 30 g a day. These patients developed uraemia with severe renal failure and protein deficiency within three years. The findings support the role of protein restriction in maintenance of renal function in chronic renal failure and perhaps suggest a beneficial role for meditation.

Adult↗

Autoantibodies in falciparum malaria: a sequential study in 183 Thai patients.

Various autoantibodies were sequentially studied in 183 consecutive Thai adults infected with Plasmodium falciparum. On the first day of admission, 31.1% of the patients had positive fluorescent anti-nuclear antibodies (FANA) and 16.9% had positive smooth muscle antibodies (SMA). The incidences of positive FANA and SMA rose progressively with times when the patients returned for the 2 and 4 week follow-ups after discharge, although most of their malaria was cured. The majority of the positive FANA and SMA titres lay between 1:20 and 1:160. The positivity of the FANA and SMA did not correlate with the complications of malaria, nor the initial serum IgG or IgA levels. However, they significantly correlated with the initial hyper-IgM. More interestingly, almost all of the positive FANA were of the speckled type of nuclear staining. The antigen specificity of the speckled FANA were found not to be the double stranded DNA or the extractable nuclear antigens. The polyclonal B cell activation in active malarial infection was postulated.

Adolescent↗

Acute interstitial nephritis in snake bite.

Acute renal failure with prolonged oliguria was observed in a patient following the bite of a Russell's viper (Vipera russellii siamensis). Renal biopsy revealed interstitial nephritis in addition to tubular necrosis and mesangial proliferation usually noted. There was no deposition of immunoglobulins. The finding expands the spectrum of renal changes in snake bite.

Acute Kidney Injury↗