[Kidney function in experimental kidney failure].
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Pre- and postoperative kidney size and kidney function were studied in 46 living kidney donors aged 20-74 years. Kidney size was measured by planimetry and by estimation of a renal index. Kidney function was assessed by endogenous creatinine clearance and serum creatinine. Planimetry was superior to the renal index for expressing changes in renal size. Compensatory renal hypertrophy took place in donors up to the age of 74, but the greatest changes in renal size were observed in donors of under 40. Total renal function decreased postoperatively to about 77% of the initial level; this change in renal function was inversely correlated with age, but in all subjects studied the function remained within normal limits.
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Within the first 6 weeks after kidney transplantation the diagnostic and prognostic importance of some characteristics of partial renal function was studied in 48 patients with postoperative acute renal failure (ARF), precrisis, acute rejection of the transplant, and a crisis-free course of the postoperative period. It was established that the numerical data and the diagnostic importance of the characteristics under study are determined by the degree of the preceding ischemic lesion of the kidney. Some functional criteria of the crisis irreversibility and the effect on its temporary parameters of postoperative ARF were defined.
In this study the effects of percutaneous transluminal renal angioplasty on blood pressure and renal function were studied in 9 hypertensive patients with stenosis of the main artery of a solitary functioning kidney. The outcome of the percutaneous dilatation of the renal artery stenosis, and the effects on blood pressure and renal function were evaluated for a mean period of 16.4 +/- 2.13 (SE) months (ranging from 3 to 65 months). A successful dilatation of the renal artery stenosis was shown in all the patients by the aortography performed 1 h after the procedure. At the discharge (7.8 +/- 0.9 days after dilatation), blood pressure was 'cured' in 2 patients and 'improved' in the remaining patients; renal function was improved in all patients who had reduced renal function. At the last follow-up, no restenosis was found in patients who repeated the follow-up angiography; blood pressure was 'cured' in 3 patients and 'improved' in 6 patients, and renal function appeared steadly improved. In contrast with other reports, our results demonstrate that percutaneous renal angioplasty is a safe and effective procedure and should be attempted before considering surgical intervention in patients with artery stenosis of a solitary functioning kidney.
Kidney function was studied in six normal males before and during a 2 h glucagon (10 ng/kg/min) infusion. The following variables were determined during each 20 min clearance period; glomerular filtration rate (GFR), renal plasma-flow (RPF) , filtration fraction (FF), urinary albumin and beta2-microglobulin-excretion rates. Glucagon infusion resulted in a fourfold increase in plasma glucagon concentration. The infusion induced a significant increase in GFR (+9%), FF (+9%) and urinary beta2-microglobulin excretion rate (+32%), (p less than 0.01). RPF and urinary albumin excretion rates were not significantly changed. We suggest that glucagon may contribute to the reversible kidney function alterations typically found in poorly regulated juvenile diabetes, a state with relative or absolute hyperglucagonaemia.
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We have investigated the influence of kidney function on soluble interleukin-2 receptor (S-IL-2R) serum levels. S-IL-2R is a glycoprotein with a molecular weight of 45 kDa. The serum concentration of S-IL-2R was positively correlated to serum creatinine (r = 0.35) and complement factor D (r = 0.30), a low molecular weight protein, and the reciprocal value of S-IL-2R was negatively correlated to 51Cr-EDTA clearance (r = -0.35). When measuring S-IL-2R and factor D in a wide range of serum creatinine (140-1,380 mumol/l), a high positive correlation was found between factor D and serum creatinine. S-IL-2R and serum creatinine had r = 0.92 and r = 0.79, p = 0.0001, respectively. The correlation coefficient between factor D and S-IL-2R was 0.86. S-IL-2R is used as a marker for an increased activity of the immune system and in a variety of lymphoproliferative disorders. However, it is important to keep in mind that a reduced kidney function may contribute to the increased S-IL-2R levels seen in different immune diseases. Therefore, renal function should be taken into account in the interpretation of elevated plasma concentrations of S-IL-2R.
On eight volunteers with reduced kidney function, 1 g of carbenicillin indanyl sodium was administered orally for the single dose studies and was given orally in a dose of 1 g every 6 h for 7 days for the multiple dose studies. The patients were divided into two groups according to their kidney functions: group I moderately impaired and group II severely impaired. In the single dose studies, the mean peak level was 12.6 microgram/ml for group I and 26.9 microgram/ml for group II. In the multiple dose studies, the drug tended to accumulate in group II, but the level obtained in group II did not exceed more than 300 microgram/ml. In the single dose studies, the mean peak level in the urine was 1,478.5 microgram/ml for group I and 350.0 microgram/ml for group II. In the multiple dose studies, despite the multiple dose regimen, the level obtained from group II patients only transiently exceeded more than that which will effectively inhibit the growth of Pseudomonas, Klebsiella and Enterobacter. In the single dose studies, the mean cumulative amount excreted in the urine within 24 h was 314.2 mg for group I and 120.1 mg for group II and the difference between both groups was significant (p less than 0.05). For the multiple dose studies, the amount was 278.0 mg for group I and 127.2 mg for group II, respectively. The total amount excreted in the urine within 24 h and the serum level obtained 6 h after ingestion of 1 g of carbenicillin indanyl sodium was correlated to the creatinine clearance and the rate of PSP excreted in the urine within the first 15 min of the test.
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The influence of diet and feed restriction on kidney function was studied in aging male albino rats. Rats were fed either a commercial feed (LB) or a modified human diet (MHD) from weaning until sacrifice at either 12 or 24 mo. of age. Restricted rats were fed for only 15 out of each 48 hours. Feed restriction during either the first, the second, or both years of life was beneficial in delaying age-associated changes in kidney function as indicated by decreased proteinuria, increased in vitro transport of paraaminohippuric acid, and reduced incidence and severity of renal lesions. Urinary creatinine and blood urea nitrogen levels were also favorably influenced by restriction. Most parameters were modified by diet as well as by restriction, with MHD being generally associated with improved kidney function. Improvement in kidney function may have been more related to a reduction in protein intake than to a reduction in caloric intake as a whole.
The effect of dietary protein on kidney function expressed by creatinine clearance was studied in healthy subjects following a "normal" unrestricted protein diet and compared with a group of vegetarians maintained on a long-term low-protein diet. Both groups had similar kidney function and displayed the same rate of progressive deterioration in renal function with age. These results suggest that, in contrast with the important therapeutic effect of low-protein intake on the progressive deterioration of kidney function in diseased kidneys, such a diet does not significantly affect kidney function with "normal aging" in healthy subjects.
A 34-year-old woman with xanthogranulomatous pyelonephritis mimicking a renal tumour is presented. Preoperative examinations including renal ultrasonography, computed tomography, renal angiography and fine needle biopsy could not exclude malignancy. The diseased kidney had good function and there was no history or signs of urinary tract infection or calculi. During operation a frozen section biopsy showed xanthogranulomatous pyelonephritis and a kidney-saving enucleation of the tumour was performed. The patient recovered uneventfully with good kidney function on the operated side.