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Biomedical subjects

Z Korzets

Publications and source records attributed to Z Korzets.

At least 37 records · Page 2Linked to original sources
PubMed1998

Uremic optic neuropathy. A uremic manifestation mandating dialysis.

A 41-year-old male patient in end-stage renal failure presented on two occasions, over an 18-month period, with painless unilateral visual deterioration and optic disc edema. Clinical findings were compatible with a diagnosis of uremic optic neuropathy. On his initial presentation, the patient refused the onset of dialysis, resulting in a permanent visual deficit of the left eye. On his subsequent admission with a similar clinical picture, this time of the right eye, dialysis combined with corticosteroid therapy was promptly instituted. This led to a rapid improvement of the visual acuity and visual field defects of the right eye concomitant with subsidence of the edema of the optic nerve head.

Adult↗
PubMed1998

Prevalence of cholelithiasis in non-diabetic haemodialysis and continuous ambulatory peritoneal dialysis patients.

Haemodialyzed (HD) patients have been found to have an increased bile cholesterol level and an increased saturation index in bile. These changes were markedly enhanced in the presence of a low-protein diet. To evaluate whether such changes influence the prevalence of cholelithiasis in patients with end-stage renal failure, real-time sonography was performed to detect the presence of gallstones (GS) in 54 HD (28 males, 26 females, mean age 52.4 +/- 15.4 years) and 39 continuous ambulatory peritoneal dialysis (CAPD; 22 males, 17 females, mean age 59.1 +/- 14.9 years) patients. No patient had diabetes. The patients' charts were reviewed for the following data: age, sex, primary renal disease, obesity (20% above ideal weight), history suggestive of gallbladder disease or previous cholecystectomy, duration of dialysis, and serum cholesterol levels. Overall, cholelithiasis was documented in 12 of 93 (12.9%) patients, 7 HD and 5 CAPD. When comparing the factors outlined above, no significant difference was found between HD and CAPD patient groups, either with or without cholelithiasis. Gallbladder disease was asymptomatic in all except 1 patient who required cholecystectomy. Using a healthy control group consisting of local age- and sex-matched inhabitants, GS were found in 8 of 134 (6%) of them (p > 0.05). We conclude that the prevalence rate of GS in our dialysis population (HD and CAPD) is similar to that of a local general population following a western-style diet, irrespective of dialysis mode.

Aged↗
PubMed1998

Is greater than normal nocturnal heart rate in children with renal scars a predictor of reflux nephropathy?

BACKGROUND: The existence of renal scars constitutes the major etiologic factor for the development of hypertension during childhood. Elevated blood pressure in this setting can be considered a secondary form of hypertension. Certain forms of secondary hypertension have been associated with a lower than normal nocturnal fall in blood pressure. Resting heart rate per se has recently been reported to be an independent predictor of risk for cardiovascular mortality irrespective of age and the presence or lack of hypertension. OBJECTIVE: To ascertain the responses of heart rate and blood pressure in normotensive children with renal scars without, however, proteinuria and renal failure. METHODS: Ten children with renal scars documented by a 99Tc dimercaptosuccinic acid (DMSA) scan were subjected to ambulatory blood pressure monitoring. Ten age-matched and sex-matched healthy children served as the control group. Serum urea and creatinine levels, calculated rate of clearance of creatinine, microalbuminuria, plasma renin activity, and levels of aldosterone and catecholamines were determined for each subject. RESULTS: Average daytime and night-time systolic and diastolic blood pressures for the two groups did not differ. Subjects in both groups demonstrated the physiologic decrease in blood pressure during sleep (normal 'dipper' response), which was of equal magnitude for these two groups. Mean daytime heart rates were 92+/- 13 beats/min in children with renal scars versus 80+/-11 beats/min in controls (NS). Mean and minimal heart rates during night-time in children with renal scars were found to be significantly greater [79+/-6 versus 65+/-5 beats/min (mean) and 61+/-10 versus 56+/-7 beats/min (minimal), P < 0.01]. Parameters of renal function, plasma renin activity, and levels of aldosterone and catecholamines were similar for these two groups. CONCLUSION: Despite their having an equivalent physiologic dip in blood pressure during night-time, normotensive children with renal scars have a significantly greater nocturnal heart rate than do control subjects.

Child↗
PubMed1997

Diminished adhesion of CD4+ T cells from dialysis patients to extracellular matrix and its components fibronectin and laminin.

BACKGROUND: Cell-mediated immunity is impaired in uraemia. The recognition and ensuing interactions of immune cells, such as CD4+ T lymphocytes, with adhesive glycoproteins of the extra-cellular matrix (ECM) are mediated by integrins of the beta 1 subfamily. We have previously demonstrated that uraemic sera inhibit the proliferation and adhesion of normal CD4+ T cells to ECM components. In the present study, the adhesive capacity of CD4+ T lymphocytes of dialyzed patients (both haemodialysis [HD] and continuous ambulatory peritoneal dialysis [CAPD] was evaluated. METHODS: Adhesion of CD4+ T cells from dialysis patients to intact ECM and its immobilized moieties, fibronectin (FN) and laminin (LN) was measured following phorbol-12-myristate-13-acetate (PMA) stimulation. In addition, cell surface expression of beta 1 integrins (VLA 4-6) was determined by FACScan analysis. RESULTS: Compared to normal cells, CD4+ T cells of dialysis patients demonstrated a significantly reduced adhesion to ECM, FN and LN (27-28 vs 52-55%, P < 0.001). This decreased adhesive capacity was not normalized upon incubation of the cells with normal sera. Cell surface expression of beta 1 integrins was not modified. The inhibition of cell adhesion was more pronounced in CAPD patients (23-24% vs 29-30% in HD, P < 0.02). Serum albumin correlated directly with cell adhesion. Aged HD patients' T cells demonstrated increased adhesion to ECM and its ligands, whereas a reverse trend was demonstrated in the CAPD group. CONCLUSIONS: T cells of dialysis patients exhibit abnormal adhesive activity, which may be due to an acquired cellular defect induced by uraemic milieu. CAPD patients show a greater degree of adhesion impairment, possibly due to their lower concentrations of serum albumin.

Adult↗
PubMed1997

Pefloxacin in adriamycin induced nephrotic syndrome in the rat.

BACKGROUND: Pefloxacin, a fluorinated 4-quinolone, has recently been advocated as a first-line treatment for minimal-change nephropathy (MCN) or focal segmental glomerulosclerosis (FSGS). To further evaluate this issue we have utilized an animal model resembling human MCN, namely adriamycin-induced nephrotic syndrome in Wistar male rats. METHODS: Adriamycin at a dose of 7 mg/kg was injected intravenously to all rats at day zero. Rats were divided into two groups: group A (n = 20) given only water served as the control group while group B (n = 19) was administered pefloxacin at 150 mg/kg. At days 7, 14, 21 and 28, the rats were placed in metabolic cages and daily proteinuria determined. RESULTS: The nephrotic syndrome developed in all rats within 7 days of adriamycin administration. At day 7, proteinuria in group B was 173 +/- 78 vs 423 +/- 626 mg/day in group A, P < 0.02, but thereafter at days 14, 21 and 28, no significant difference in urinary protein excretion was noted. CONCLUSIONS: These results suggest that in this animal model of NS mimicking human MCN, pefloxacin's antiproteinuric effect is only of a mild and transitory nature. In view of the above data and the overall results in human patients (detailed herein), the use of pefloxacin as definitive treatment of the NS cannot be recommended.

Animals↗
PubMed1997

Orthostatic hypoxaemia in dialysed adult polycystic kidney disease patients.

BACKGROUND: Recently we observed a unique clinical phenomenon, namely, orthostatic or postural hypoxaemia in a 72-year-old female adult polycystic kidney disease (APKD) patient, maintained on CAPD. Extensive investigations failed to yield a satisfactory explanation for her ambulatory hypoxaemia. METHODS: To validate our observation, 15 dialysed patients underwent blood gases analyses in both the supine and ambulatory positions (SpO2 and ApO2 respectively). Patients were divided into two groups: group 1 (n-7) whose end-stage renal failure (ESRF) was due to APKD and group 2 (n-8) in whom ESRF was due to other causes. Both haemodialysed (HD) and CAPD patients were included. ApO2 was determined as the pO2 immediately upon standing up. Readings in HD patients were taken at the end of the dialysis session, that is, at the patients' dry weight. RESULTS: Respective SpO2 and ApO2 of the two groups were 85 +/- 17.1 and 78 +/- 20.5 vs 85.8 +/- 19 and 91 +/- 21 mmHg. Delta change in pO2 defined as the mean decrease (negative value) or mean increase (positive value) of ApO2 in relation to SpO2 was -7.85 (group 1) vs + 5.2 mmHg (group 2), P < 0.005. In group 1, six of seven patients demonstrated a negative delta. In group 2, four of eight showed a positive delta whilst the remaining four had no change in the delta value. CONCLUSION: Orthostatic hypoxaemia may occur in dialysed patients whose ESRF is due to APKD.

Adult↗
PubMed1997

Relapsing Henoch-Schönlein purpura associated with a tubo-ovarian abscess due to Morganella morganii.

Henoch-Schönlein purpura is the most common vasculitis in children. It is frequently preceded by either viral or bacterial infections of the upper respiratory tract. We present a 15-year-old female who developed recurrent episodes of Henoch-Schönlein purpura. Eventual investigation of the patient's abdominal pain, initially attributed to vasculitis involving the gastrointestinal tract, revealed a left tubo-ovarian abscess caused by Morganella morganii. Salpingo-oophorectomy resulted in complete remission of the disease process.

Abscess↗
PubMed1997

Pregnancy-induced hypertension in rats with adriamycin nephropathy is associated with an inadequate production of nitric oxide.

Hypertensive complications are relatively common in pregnancy, particularly in the presence of preexisting renal disease. Although the pathogenesis of such complications is still unknown, recent animal studies have suggested that it may be related to impaired synthesis of nitric oxide (NO). Rats with adriamycin nephropathy develop a "preeclamptic-type" pregnant state characterized by elevated blood pressure, lack of hyperfiltration, and enhanced proteinuria. Preliminary studies with this model have implicated inadequate NO synthesis in the development of preeclamptic-like pregnancy. The aim of the present study was to confirm this hypothesis. Pregnant rats, both normal (PREG) and those with adriamycin nephropathy (AN-PREG), received 100 mg/L N omega-nitro-L-arginine methyl ester PO from the middle of gestation to term (day 11, term approximately 22 days). One group of AN-PREG rats received either L-arginine or D-arginine (2 g/L) from midpregnancy. At term, systolic pressure, mean arterial pressure, urinary metabolites of NO, creatinine clearance, and urinary protein were assessed. At term, compared with virgin rats with adriamycin nephropathy, untreated AN-PREG rats had increased systolic pressure, mean arterial pressure, and proteinuria (mean arterial pressure, 124 +/- 2.5 versus 99.7 +/- 1.6 mm Hg [P < .05]; proteinuria, 434 +/- 58 versus 216 +/- 63 mg/d [P < .05]). Creatinine clearance did not change (1.68 +/- 0.23 versus 1.35 +/- 0.09 mL/min, P = NS). In PREG rats, urinary metabolites of NO increased approximately threefold at term pregnancy compared with control. By contrast, in AN-PREG rats, excretion of urinary metabolites of NO increased only by approximately 1.7-fold (P < .01) versus PREG rats. With the exception of AN-PREG rats, inhibition of NO synthesis with N omega-nitro-L-arginine methyl ester enhanced blood pressure and decreased creatinine clearance but did not influence proteinuria. Excretion of urinary metabolites of NO was similarly inhibited in all rats. In AN-PREG rats, L-arginine normalized blood pressure (91 +/- 2.15 mm Hg) and lowered proteinuria partially but significantly. D-Arginine had no effect. In summary, AN-PREG rats are unable to adequately increase NO synthesis when physiologically required. Correction of this deficit by L-arginine treatment induced a significant clinical improvement.

Animals↗
PubMed1996

Frequent involvement of the internal cuff segment in CAPD peritonitis and exit-site infection - an ultrasound study.

BACKGROUND: The extent of involvement of the subcutaneous Tenckhoff catheter tract in CAPD peritonitis and catheter-related infections is of major therapeutic importance. By definition, both peritonitis and exit-site infections do not involve the catheter tract. However, diagnosis of these infections as well as the more sinister tunnel infection is based mainly on clinical signs. METHODS: We examined the usefulness of ultrasound examination (US) of the catheter tract in delineating catheter-related (exit-site and tunnel) infections, and their relationship to each other and to peritonitis. CAPD patients with no evidence of peritonitis or catheter-related infections for 6 months prior to examination served as controls. US were performed by one of two experienced radiologists using the Acuson 128XP/10 scanner with a 7-MHz linear transducer. A positive US was defined as an area of hypoechogenicity (indicative of fluid collection) >2 mm in width along any portion of the catheter tract. Findings were localized into segments(S) as follows: S1, limited to external cuff; S2, intercuff segment adjacent to the external cuff; S3, intercuff segment adjacent to the internal cuff; S4, limited to the internal cuff; and S5, involvement extending throughout the catheter tract. RESULTS: Between March 1993 and January 1995, 39 CAPD patients, all with a double-cuff straight Tenckhoff catheter with the exit site situated above the point of entry into the peritoneum were studied. A total of 56 US were performed divided among 26 episodes of peritonitis, four tunnel infections, 13 exit-site infections,and 13 controls. There were 30 positive US distributed among 16 peritonitis, four tunnel, eight exit site infections and two control patients. The two positive controls went on to develop peritonitis within 1 month of the US. The majority of the US findings (13/16 in episodes of peritonitis and 5/8 exit site infections were localized to segment 4, that is, to the internal cuff region. Apart from a significant increase in width in all infected segments versus a normal tunnel, no differences in size were seen between peritonitis, exit-site, or tunnel infections, nor were there any differences in size and localization in these infections when comparing the offending organism (Gram-positive, negative, or culture negative). CONCLUSIONS: We conclude that peritonitis and exit-site infections are frequently accompanied by involvement of the catheter tract. The localization of infection to the internal cuff region in cases of exit-site infection probably occurred as a result of downward migration along the catheter tract. This supports the notion that ideally the exit site should be pointing caudally or that the peritoneal catheter have a swan-neck configuration. With regard to peritonitis, infection within the peritoneal cavity appears to extend and involve the internal cuff region. Thus both the internal and external cuffs do not seem to pose an effective barrier against the spread of infection.. Based on our data, we recommend that US be performed as a routine investigation in all cases of exit-site infection and in cases of refractory or relapsing peritonitis.

Adult↗
PubMed1996

Increased prevalence of HCV antibodies in dialyzed Ashkenazi Jews--a possible ethnic predisposition.

BACKGROUND: The prevalence of hepatitis C (HCV) antibodies in dialysis patients is considerably higher than that found among healthy blood donors. This increased seroprevalence has been correlated to increased duration of dialysis, mode of dialysis and to the number of blood transfusions administered. However, factors other than nosocomial ones also seem to play a part in disease transmission. The role of the patient's ethnic origin, possibly reflecting on his/her genetic makeup has received scant attention. In this study, HCV seroprevalence in our dialysis population, which consists of three major ethnic subgroups (Ashkenazi Jews, Sephardi Jews and Arabs), was examined. METHODS AND RESULTS: Altogether HCV seropositivity was determined in 120 dialysed patients--65 males/55 females (76 hemodialysis, 44 CAPD), using second generation ELISA confirmed by RIBA-2. Mean age was 59.7 +/- 15.7 (range 16-86 years). Patients had to have been on dialysis for a minimum of 3 months (mean duration 45.2 +/- 44.5 months). Patients whose end-stage renal disease was due to diabetic nephropathy (DN) or those who had previously been transplanted (TP) were considered as separate groups and compared to the group as a whole. Of the 120 patients, there were 49 Ashkenazi Jews (40.8%), 57 Sephardi Jews (47.5%) and 14 Arabs (11.7%). Overall HCV prevalence was 21.7% (26/120) with a significantly greater prevalence in HD compared to CAPD (30.3 vs. 6.8%, P < 0.01). Respective values for Ashkenazi Jews, Sephardi Jews and Arabs were 30.6, 15.8, and 14.3% (P < 0.01, Ashkenazi Jews vs. Sephardi Jews and Arabs). DN had a lower 3.7% while TP had a higher 46.1% prevalence compared to the group as a whole (P < 0.01). In general, the increased frequency of anti HCV antibodies was significantly correlated to the duration of dialysis and the number of blood transfusions administered. This, however, was not the case in the greater prevalence of HCV found in Ashkenazi Jews compared to Sephardi Jews and Arabs which was independent of the above factors and the mode of dialysis. CONCLUSION: Our results showing increased HCV seropositivity in Ashkenazi Jews compared to Sephardi Jews and Arabs, suggest that ethnic factors might predispose to HCV transmission and infectivity.

Adolescent↗