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Antioxidant-dependent inhibition of diquat-induced toxicity in vivo.

The abilities of two experimental antioxidants (U-74006F and U-78517G), as well as the model antioxidant, diphenyl-p-phenylenediamine (DPPD), to protect against diquat-induced toxicity in male Fischer-344 rats were examined. Both experimental compounds afforded near complete protection against diquat-induced hepatotoxicity, as measured by clinical chemistry and histopathological indices. When observed, diquat-induced nephrotoxicity was also inhibited. Minimal protection was afforded by the model compound, DPPD. In follow-up studies with U-78517G, no effect on diquat-induced biliary excretion of oxidized glutathione was observed, suggesting that a shift in the thiol:disulfide ratio is not responsible for diquat-induced hepatotoxicity. These data are consistent with those from previous in vitro studies in our laboratory and are in agreement with studies by others which suggest that lipid peroxidation is an important event in diquat-induced hepatotoxicity in vivo. The antioxidant effects were largely route-independent as either oral pre-treatment alone (200 mg/kg, 24 h before diquat), intravenous pre-treatment alone (6 mg/kg, 5 min before diquat) or the combination of both treatments produced a similar degree of protection. While pre-treatment with antioxidants was quite effective, no significant U-78517G-dependent inhibition of toxicity was observed when administration was delayed by as little as 10 min post diquat. These latter data suggest that initiation of diquat-induced hepatotoxicity is rapid and that these compounds would therefore be unlikely to have clinical utility in the treatment of diquat intoxication.

Alanine Transaminase↗

Assessment of intrarenal perfusion with radioxenon: a critical review of analytical factors and their implications in man.

Radioxenon has achieved wide use for assessing tissue perfusion. Here we review its application to the kidney for assessing mean blood flow and intrarenal perfusion rates. Correlation with alternative methods in animals suggests that the initial disappearance slope provides an adequate measure of mean renal blood flow despite the theoretical limitations of this approach. The stochastic method and compartmental analysis can also provide an acceptable measure fo mean renal blood flow, but only after the slowest flow components have been removed. Compartmental analysis does, however, provide an index of cortical perfusion not available from other methods. The evidence that the rapid component of xenon washout provides an index of cortical perfusion in man is reviewed, along with insights gained from the application of this approach to human disease.

Acute Kidney Injury↗

Case report: sonographic detection of renal transplant cortical calcification.

Cortical calcification in a transplanted kidney was detected by high resolution ultrasound, not visible on plain abdominal radiography. Early recognition of these sonographic appearances should lead to a more accurate diagnosis and institution of appropriate treatment in patients with post-operative transplant dysfunction.

Adult↗

Laparoscopic and computed tomography-guided percutaneous radiofrequency ablation of renal tissue: acute and chronic effects in an animal model.

OBJECTIVES: To evaluate the laparoscopic and percutaneous delivery of impedance-based radiofrequency ablation (RFA) of the kidney by studying the acute and chronic clinical, radiographic, and histopathologic effects in the porcine model. METHODS: Eight kidneys from 4 pigs underwent laparoscopic RFA. Six kidneys from 3 additional pigs received computed tomography (CT)-guided, percutaneous RFA. CT scans were performed immediately after RFA and before harvest at 2 hours, 24 hours, 3 weeks, and 13 weeks. The gross, radiographic, and histopathologic changes were recorded for each period. RESULTS: Grossly, the RFA lesions were sharply demarcated, measuring 3 to 5 cm. Two major complications (14%) occurred (one urinoma, one psoas muscle injury) in 14 ablations. No deaths or significant blood loss occurred as a result of RFA. Radiographically, the immediate CT scanning demonstrated small perinephric hematomas and wedge-shaped defects. Delayed CT showed nonenhancing defects up to 5 cm. Color-flow and power Doppler were unable to distinguish significant tissue changes during RFA. The histopathologic evaluation revealed marked inflammation surrounding the necrotic regions in the early lesions; chronic lesions were characterized by dense fibrosis. The tissue temperatures ranged from 62 degrees to 118 degrees C in the area of ablation. CONCLUSIONS: RFA is readily delivered laparoscopically or percutaneously with minimal morbidity. Impedance-based application of radiofrequency energy allows monitoring and control of ablation. Using a multi-antenna probe, areas of tissue up to 5 cm can be completely destroyed. The RFA lesion can be monitored as a nonenhancing cortical defect on CT.

Animals↗

Impact of end-stage renal disease care in planned dialysis start and type of renal replacement therapy--a Spanish multicentre experience.

BACKGROUND: Timely referral, preparation and initiation of dialysis remain problematic issues. The purpose of this study is to analyse the effect of chronic renal disease care and education on the mode of dialysis start (planned vs non-planned) and on the modality of renal replacement therapy (RRT). METHODS: A total of 1504 patients from 35 hospitals started RRT in 2003. Out-patient, scheduled initiation of dialysis with a permanent vascular or peritoneal access was considered planned. RESULTS: About 46% of the patients started non-planned dialysis. Of all the patients, 75% had > or =3 months of nephrological follow-up, but nearly half were never educated on dialysis options. Haemodialysis (HD) occurred in 82% and peritoneal dialysis (PD) in 18%. Planned starts were associated (all P < 0.001) with many factors: younger age, longer renal and pre-dialysis follow-up, more education on RRT and general care, more medical visits, more PD (27 vs 8%), more follow-up by specific end-stage renal disease (ESRD) units, more permanent access and better biochemical status at the start of dialysis. Some global differences were found between patients: planned vs non-planned with > or =3 months of follow-up, vs non-planned <3 months follow-up or acute non-planned and <3 months of follow-up or acute patients. HD occurred in a similar rate (92%) in patients with non-planned start, no previous follow-up or who were never educated in dialysis modality options. CONCLUSION: Although a high prevalence of nephrologic care and follow-up was provided among incident patients in dialysis, nearly half the patients did not have a planned dialysis start nor dialysis modality education. Planned start was associated with better analytical and multidisciplinary status. PD was more prevalent in planned starts and when education was given. Specific ESRD units were more likely to provide an optimal care.

Diabetes Mellitus↗