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PubMed1980

Renal parenchymal malakoplakia. A case associated with renal vein thrombosis and partial recovery of kidney function.

A 65-year-old woman with bilateral renal parenchymal malakoplakia and renal vein thrombosis had severe azotemia, bilaterally enlarged kidneys, urinary tract infection, and sepsis. Angiographic studies demonstrated left renal vein thrombosis. A percutaneous kidney biopsy specimen showed the characteristic Michaelis-Gutmann bodies. After therapy with fluid replacement, antibiotics, and long-term anticoagulation, kidney function improved and both kidneys decreased in size. We suggest that, with adequate treatment of urinary tract infection and correction of potential insults to the kidney, progression of this peculiar disease can be prevented.

Aged↗
PubMed1976

Embolism in a single functioning kidney: report of two cases.

2 cases of embolism in single functioning kidneys are reported. In the first case there was an occlusion of the main trunk of the renal artery; the patient was treated by embolectomy. In the second case the occlusion of a major arterial branch was demonstrated; because of the bad general conditions the patient was treated with medical therapy. The authors review the literature and the indications for embolectomy in embolism in a solitary kidney.

Acute Kidney Injury↗
PubMed1996

[Tumor of a single functional kidney treated with selective embolization].

Occurrence malignant tumor in only one functional kidney (second one was small and cirrhotic with a large cyst) and potentiality of treatment with selective embolization of renal artery were cause of that report. Patient achieved a long and comfortable term of survival (without any troubles). We suggest that method is useful and safe for such cases.

Aged↗
PubMed2003

Impact of cardiac transplantation on kidney function: a single- center experience.

Long-term follow-up of cardiac transplant recipients reveals a progressive decline in kidney function in a significant number of patients. This complication is one of the most important prognostic parameters for the outcome of cardiac transplantation. The risk factors implicated in the pathogenesis of renal dysfunction following cardiac transplantation are numerous, with the immunosuppressive drug cyclosporine (CsA) playing a major role. This case-control study was designed to evaluate the role of different risk factors among patients who had been transplanted at the Northern General Hospital Cardiothoracic Centre (CTC) with the possibility of identifying modifiable risk factors that mitigate the nephrotoxicity of CsA. Over a 10-year period, heart transplantation was performed in 205 patients at the CTC. Seventeen patients who experienced chronic renal failure (CRF) and were treated at the outpatient clinic of the Sheffield Kidney Institute were randomly selected from those who had >2-year graft survival and follow-up after cardiac transplantation. As controls, 15 cardiac transplant patients were randomly selected from 32 with comparable survival and follow-up after transplantation and without evidence of significant renal dysfunction (serum creatinine </=150 micromol/L). The putative risk factors for development of renal insufficiency were retrospectively studied as well as those affecting the rate of progression of CRF. Seventy-five percent of the progressors (cases) had ischemic cardiomyopathy compared with 10% of nonprogressors (controls) (P <.05). CsA trough levels during the follow-up period were higher among the nonprogressors compared with the progressors (P =.03). Follow-up systolic blood pressure revealed a statistically significant correlation with the slope of serum creatinine in the progressor group (r = -.515 and P <.05). At the time of transplantation, ischemic cardiomyopathy as an underlying diagnosis seems to be a detrimental factor, contributing to the pathogenesis of renal dysfunction after heart transplantation. CsA trough levels alone do not seem to discriminate between progressors and nonprogressors. A randomized controlled study may be required to evaluate the possibility of replacing or reducing CsA to the lowest possible dose in the early posttransplant period for the subset of patients with ischemic cardiomyopathy.

Adult↗
PubMed2005

Cross-sectional association of kidney function with valvular and annular calcification: the Framingham heart study.

Valvular calcification is common in the setting of end-stage kidney disease and is associated with increased risks for cardiovascular disease events. It is unknown whether the prevalence of valvular calcification is increased in milder kidney disease after accounting for cardiovascular risk factors. Participants who attended the sixth examination of the Framingham Offspring Study (1995 to 1998) were eligible. Kidney function was estimated by GFR using the simplified Modification of Diet in Renal Disease Study equation. Mitral annular calcification (MAC), aortic sclerosis, and aortic annular calcification were assessed by two-dimensional echocardiography. Logistic regression was used to examine the odds of valvular calcification among participants with chronic kidney disease (CKD; GFR < 60 ml/min per 1.73 m(2)). A total of 3047 participants (52% women; mean age 59 +/- 10 yr) were available for analysis. CKD was present in 8.6% (n = 262) of the sample. Among participants with valve/annular calcification (n = 284; 9.3%), 20% had CKD, compared with 7% in patients without valvular calcification. After adjustment for age, gender, systolic and diastolic BP, hypertension treatment, total/HDL cholesterol, body mass index, diabetes, smoking status, and cardiovascular disease, participants with CKD had a 60% increased odds of MAC (odds ratio 1.6; 95% confidence interval 1.03 to 2.5). There was no significant association between CKD and either aortic sclerosis or aortic annular calcification (odds ratio 1.1 and 1.1, respectively). After age and gender adjustment, the combination of both CKD and MAC was associated with a three-fold increased risk for death compared with those with neither condition (P = 0.0004). In the community, CKD is associated with presence of MAC before the onset of ESRD. Further research is warranted to understand whether traditional and novel vascular risk factor burden, as well as metabolic derangements found in early kidney disease, can account for the CKD-MAC association.

Aged↗
PubMed1994

The relationship between reduced functioning kidney mass and chronic rejection in rats.

Interest has recently increased in the role of alloantigen-independent factors in chronic rejection. In this context, we examined the long-term effects of reduced functioning kidney mass in a F344-->LEW allograft (A) model. Animals were divided into three groups depending upon the amount of retained kidney. Renal arterial branches in the hilus were ligated so that one-third or two-thirds of the graft remained viable (1/3 and 2/3 groups, respectively); organs were left intact in the third (3/3) group. Urine protein concentrations were determined 4, 6, 8 and 10 weeks after engraftment and organs (five/group/time) were harvested and examined morphologically and immunohistologically. Proteinuria increased progressively in all 1/3, 2/3 and 3/3A animals, but faster in those with reduced kidney mass. This functional decline correlated well with increasing numbers of macrophages followed by interstitial fibrosis and glomerular sclerosis, which had become prominent by week 6 in group 1/3A and by 8 weeks in groups 2/3A and 1/3I (I, isografted), with animals beginning to die. IL-1, IL-6 and TNF production correlated well with the location and number of macrophages in all groups. These results suggest that kidney mass exerts a significant alloantigen-independent influence on chronic rejection. Allogenicity of the graft accelerates and amplifies the process.

Animals↗
PubMed1997

The effect of neomycin on the kidney function of the horse.

The toxic effect of neomycin on the horse kidney was studied. Twelve horses were used, and were divided at random into three groups of four. The first group was treated twice a day with 10 mg/kg I.M. for 15 days and then euthanised; kidney and liver samples were studied and no histopathological changes were observed. Group 2 was treated with neomycin sulphate as in group 1, and group 3 was used as control. Blood samples were taken at 8.00 h and 20.00 h daily from both neomycin treated and control horses. Serum creatinine, potassium, sodium and urinary creatinine remained without change. On day 6 of treatment plasma urea (Urea)p decreased to 5.6 +/- 2.0 mmol/L (P < 0.001) as compared with controls (8.0 +/- 2 mmol/L). Urinary excretion of GGT increased on the third day of treatment to 118.6 +/- 1 IU/L for treated and 89 +/- 8 IU/L for controls (P < 0.001). Thereafter, GGT continued to be elevated significantly for the duration of the experiment, as compared with controls. The (GGT)/(Cr)u ratio increased significantly on the 9th day of treatment, and continued to be elevated for 6 days after treatment. Neomycin kinetics were similar during treatment. It was concluded that neomycin, in the dose used, was not harmful to kidney function in the horse.

Animals↗
PubMed1994

Monitoring kidney function in diabetic nephropathy.

Progression in diabetic nephropathy is usually determined by repeated measurements of glomerular filtration rate and expressed as rate of decline in glomerular filtration rate. Our aim was to evaluate the agreement between rate of decline in glomerular filtration rate estimated from the Cockroft-Gault formula: (140-age)*K*body weight*(1/S-creatinine) and measured by the plasma clearance of 51Cr-EDTA. All insulin-dependent diabetic patients with diabetic nephropathy followed-up for at least 5 years with at least 5 simultaneous measurements of glomerular filtration rate, s-creatinine, and weight were included in the study. Forty-three patients (32 male/11 female), age 31 (18-61) years were enrolled. Observation period: 6.6 (5.1-9.9) years and number of investigations per patient 6 (5-16) (median(range)). Baseline glomerular filtration rate (ml/min) was 97 (30) measured and 107 (37) estimated (mean(SD))(p < 0.001) and the 95% limits of agreement were -42.0 to 20.8 ml/min. Measured and estimated glomerular filtration rate correlated significantly (r = 0.91, p < 0.00001). Rate of decline in kidney function ml.min-1.year-1 was 4.7 (3.3) measured and 4.8 (3.5) estimated (mean(SD)) (NS), but the 95% limits of agreement showed a wide range -3.9 to 3.5 ml.min-1.year-1. A significant correlation between rate of decline in measured and estimated glomerular filtration rate was present (r = 0.84, p < 0.00001). In conclusion, glomerular filtration rate is overestimated by the Cockroft-Gault formula. The mean rates of decline in glomerular filtration rate are comparable, but the limits of agreement are wide, which make the Cockroft-Gault method unacceptable for clinical purposes, i.e. monitoring progression in kidney function in the individual patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Clinical studies of kidney function in sheep. I. Methods and reference values of healthy animals].

Investigations of renal function have been done on the basis of renal clearance (Clr) and excretion (E) of endogenous creatinine in health sheep of different body weight (89 female, 19 male). Creatinine-E was negatively correlated with body weight in female sheep, it can be calculated from body weight. The Creatinine-Clr in ewes ranged from 1.1 to 2.3 ml/min/kg and was highly correlated with inulin-Clr (r = 0.88, p < 0.001). Fractional excretion (FE) of creatinine, determined by inulin-Clr was 118%. That demonstrate a tubular secretion of 15% of the total excretion. Therefore the creatinine-Clr may be considered representative enough for the glomerular filtration rate (GFR). Urea-FE was 24-50%, and urea-Clr about 50% of the inulin-Clr, that points to a high tubular urea absorption (50-75%). For that reason urea is not appropriate for the characterization of kidney functions. Water, sodium, glucose, L-lactate and 3-OH-hydroxybutyrate were absorbed in the renal tubules nearly completely (FE < 2%). So they are suitable as endogenous markers for insufficient tubular absorption. Calcium, phosphate, magnesium and potassium are reabsorbed incompletely, depending on the supply of these substances (FE 0-15%, potassium 5-100%). A method for clinical determination of kidney function by measurement of concentrations of metabolites and electrolytes in blood plasma and spontaneous urine is described and evaluated. The method is based on the calculation of the creatinine-excretion, depending on sex and body weight, and especially allows the examination of male and sick animals without quantitative sampling of urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2001

Late effects of anticancer therapy on kidney function in children with acute lymphoblastic leukemia.

THE CURRENT STATE: Children with curable cancer are potentially at risk of long-term renal sequelae. The nephrotoxicity is considered dose related and includes a variable reduction of glomerular filtration rate along with tubular dysfunction. SUBJECTIVE: The aims of the present study were: to analyse kidney damage as well as the clinical course in children treated for ALL, to determine what type of nephrotoxic damage is most frequent in relation with the used treatment, to determine possible risks of acute and chronic nephropathy of anticancer therapy, to standardise evaluation of kidney function in children after their complex antitumourous treatment has finished. METHODS AND MATERIAL: We examined a group of 36 children (21 boys, 15 girls, average age at diagnosis of ALL 6.9 years)) treated for ALL using the therapeutical protocol ALL BFM 90. The average period after the treatment had finished was 48 month. The following parameters were examined: urinalysis and urine sediment, clearance of creatinine, tubular resorption, ultrasound of kidneys, 24 hrs proteinuria (PU) and urine concentration of albumine, transferine, alpha-1-microglobuline and Tamm-Horsfall protein. Concentration function of kidneys was examined by test with DDAPV. RESULTS: After finish of cytostatic therapy had 19 patients (52.8%) PU. Glomerular PU was found in 3 children (15.8%), in 3 children (15.8%) was found mixed PU and 13 children (68.4%) had tubular PU. Reduction of GFR had 5 patients (13.9%) and 19 patients (52.8%) had reduction of DDAPV test. CONCLUSION: Sensitive laboratory analysis of proteinuria is required for timely detection of the most frequent type of kidney damage in the course of treatment with cytostatics but also other concurrently administered drugs. Thus we can reliably detect mainly patients with glomerular/mixed proteinuria who are potentially imperilled by the risk of the development of chronic renal failure. If there is higher level of glomerular/mixed proteinuria even after the treatment has finished, the patients have to undergo another nephrological monitoring. (Tab. 3, Ref. 20.)

Adolescent↗
PubMed2002

Effects of long-term creatine supplementation on liver and kidney functions in American college football players.

The purpose of this study was to determine the effect of long-term Cr supplementation on blood parameters reflecting liver and kidney function. Twenty-three members of an NCAA Division II American football team (ages = 19-24 years) with at least 2 years of strength training experience were divided into a Cr monohydrate group (CrM, n = 10) in which they voluntarily and spontaneously ingested creatine, and a control group (n = 13) in which they took no supplements. Individuals in the CrM group averaged regular daily consumption of 5 to 20 g (mean SD = 13.9 5.8 g) for 0.25 to 5.6 years (2.9 1.8 years). Venous blood analysis for serum albumin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, bilirubin, urea, and creatinine produced no significant differences between groups. Creatinine clearance was estimated from serum creatinine and was not significantly different between groups. Within the CrM group, correlations between all blood parameters and either daily dosage or duration of supplementation were nonsignificant. Therefore, it appears that oral supplementation with CrM has no long-term detrimental effects on kidney or liver functions in highly trained college athletes in the absence of other nutritional supplements.

Administration, Oral↗
PubMed1983

Early aggressive antihypertensive treatment reduces rate of decline in kidney function in diabetic nephropathy.

The effect of early aggressive antihypertensive treatment on kidney function in diabetic nephropathy was studied prospectively in ten insulin-dependent diabetics (mean age 29 years). During the mean pretreatment period of 29 (range 23-38) months the glomerular filtration rate (GFR) decreased significantly and the urinary albumin excretion rate and arterial blood pressure rose significantly. During the 39 month (range 28-48) period of antihypertensive treatment with metoprolol, hydralazine, and frusemide (furosemide) or thiazide, arterial blood pressure fell from 144/97 mm Hg (mean of all pretreatment values) to 128/84 mm Hg (mean of all post-treatment values), urinary albumin excretion from 977 micrograms/min to 433 micrograms/min, and GFR from 80 to 62 ml/min/1 . 73 m2. The rate of decline in GFR decreased from 0.91 ml/min/month before treatment to 0.39 ml/min/month (range 0.08 to 0.68 ml/min/month) during treatment.

Adult↗
PubMed1987

A cross-sectional survey of kidney function in refinery employees.

We examined sensitive biochemical and immunological markers of kidney function and damage in 53 male oil refinery workers exposed to hydrocarbons and compared their results with those of a control group of 61 age-matched nonexposed males. The mean duration of employment of exposed males was 11 years. The current levels of exposure to a variety of aliphatic and aromatic hydrocarbons, as determined by personal monitoring, were well below the current threshold limit values. No difference was found in the urinary tubular parameters beta-N-acetyl-D-glucosaminidase, beta 2-microglobulin (beta 2-m) and retinol-binding protein. Similar serum beta 2-m levels indicated no impairment of the glomerular filtration rate in the exposed workers. The levels of circulating immune complexes were also identical in both groups. The mean albuminuria was slightly higher (p less than .005) in the exposed group in a quantitative assay but was not dipstick-detectable. The mean urinary excretion of a renal antigen was also higher (p less than .05) in the exposed group and correlated with the excretion of albumin. Finally, slightly higher titers of anti-laminin antibodies were found in five exposed employees, but this was not accompanied by an increased albuminuria. We conclude that chronic low-level hydrocarbon exposure in these refinery workers does not lead to clinically significant renal abnormalities. Nevertheless, some findings are consistent with the possible role of hydrocarbon exposure in the induction of renal disturbances.

Adult↗
PubMed1985

Kidney function in a selected lithium population. A prospective, controlled, lithium-withdrawal study.

Forty-six lithium (Li) patients who had been on Li for about 1-11 years were studied while on Li and after about 3 months (7 weeks-26 months) off Li. Kidney function was compared between patients on Li and the same patients off Li, and, in 32 matched pairs, between patients on and off Li and psychiatric controls. Urine osmolality (U-osmol) was significantly lower, urine volume higher in patients on Li than in controls. Measures of both glomerular and tubular function improved when Li-patients discontinued medication. U-osmol remained somewhat lower than in controls and was negatively correlated with time-on-Li. Although serum creatinine was somewhat higher in Li-patients off Li than in controls, clearance values were not different between the two groups. Long-term lithium treatment causes a permanent reduction of tubular function. Time-on-Li is a risk factor. In this population the reduction was clinically insignificant. In addition, Li treatment causes a reversible reduction of both tubular and glomerular function. The results can probably be generalized to other outpatient Li populations with the same time-on-Li and with U-osmol below 800 mOsm/kg during ongoing treatment.

Adult↗
PubMed1999

Co-administration of co-trimoxazole does not augment tacrolimus-induced impairment in kidney function in rats.

Co-trimoxazole is an antibiotic that is frequently used in organ transplant patients. Our objective was to determine the effect of co-trimoxazole on tacrolimus-mediated functional impairment of the kidney in rats. Sprague Dawley rats were divided into three groups. Group 1 (dextrose) received 5% dextrose and Group 2 (tacrolimus) received tacrolimus (1 mg/kg/day) as a continuous intravenous infusion for seven days. Group 3 (combination) received tacrolimus as above and co-trimoxazole (30 mg/kg/day trimethoprim and 150 mg/kg/day sulfamethoxazole) intraperitoneally for six or seven days. Biochemical and functional parameters were measured pre- and post-drug infusion. On day 7, glomerular filtration rate (GFR) was evaluated using 3H-inulin while the effective renal plasma flow (ERPF)/cationic tubular secretion was assessed using 14C-tetraethylammoniumbromide(TEA). GFR (mL/min/kg) as measured by inulin clearance was higher (p < or = 0.05) in the dextrose (12.0 +/- 1.4) group as compared to tacrolimus group (6.0 +/- 1.3) and combination group (6.4 +/- 1.6), but there was no difference between the tacrolimus and combination group. ERPF/cationic tubular secretion (mL/min/kg) was also significantly higher in the dextrose group (62.6 +/- 10.3) as compared to the other two groups. ERPF/cationic tubular secretion was not different between the combination (33.3 +/- 5.9) and the tacrolimus (35.1 +/- 6.7) groups when there was no co-trimoxazole in the body. However, in the presence of co-trimoxazole ERPF/cationic tubular secretion was significantly reduced in the combination (23.1 +/- 3.5) group as compared to the tacrolimus group (35.1 +/- 6.7). These results indicate that co-trimoxazole does not further potentiate tacrolimus induced impairment in kidney function but is likely to further inhibit cationic tubular secretion in patients on tacrolimus therapy.

Animals↗