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[Renal protective effect of angiotensin II receptor antagonist on growth hormone-treated nephrotic rats].

OBJECTIVE: Children with nephrotic syndrome are always associated with retardation of growth. Growth hormone (GH) administration to these children can stimulate their growth, but it plays an important role in glomerulosclerosis. Thus these children would take a risk to use it to improve their growth. This study was designed to investigate the effect of GH on the kidney of rats with adriamycin-induced nephropathy (AN) and its mechanism, and to observe the renoprotective effect of angiotensin II (AngII) receptor antagonist, irbesartan, in GH-treated AN rats. METHODS: Rats were divided into the following groups: normal control rats, AN rats, GH-treated AN rats and GH plus irbesartan-treated AN rats. There were 8 developing male SD rats (120-130 g) in each group. Urinary protein was measured at weeks 3, 6 and 9. Blood pressure, serum creatinine, BUN, albumin, cholesterol, triglyceride, as well as ACE activity and AngII concentration of the kidney were detected at the end of the study. Renal pathological changes were evaluated also. Immunohistochemistry was used to examine the protein expressions of TGF beta(1), collagen IV and fibronectin in glomeruli. RESULTS: Glomerular sclerosis score of GH-treated AN rats (49.4 +/- 9.8) was significantly higher than that of AN rats (12.8 +/- 5.5, P < 0.01), and this score of GH-treated AN rats plus irbesartan (26.2 +/- 7.5) was significantly lower than the score of GH-treated AN rats (P < 0.01). The changes of urinary protein, hyperlipidemia and hypoalbuminemia in rats of each group consisted with the degree of glomerular injury in rats of each group. There was azotemia in GH-treated AN rats, but rats in the other groups did not have azotemia. ACE activity of kidney was significantly (P < 0.01) increased in GH-treated AN rats [(28.1 +/- 4.1) U/mg pro] and GH-treated AN rats plus irbesartan [(27.6 +/- 3.4) U/mg pro] compared with that in AN rats [(14.6 +/- 4.4) U/mg pro]. AngII concentrations in the kidney of GH-treated AN rats [(17.8 +/- 3.3) pg/mg pro] and GH-treated AN rats plus irbesartan [(27.3 +/- 5.1) pg/mg pro] were significantly higher than that in AN rats [(8.3 +/- 1.9) pg/mg pro] (P < 0.01). The protein expressions of TGF-beta(1), collagen IV and fibronectin in GH-treated AN rats were the most distinct in all groups. These expressions were significantly (P < 0.05) reduced in GH-treated AN rats plus irbesartan. CONCLUSION: GH is able to exacerbate adriamycin-induced nephropathy in rats, which was partly through activating renal tissue RAS and initiating the function of the AngII-TGF beta(1)-ECM axis. Angiotensin II receptor antagonist, irbesartan, has some renal protective effects on AN rats treated with GH.

Angiotensin II↗

Renal disease in the acquired immunodeficiency syndrome in north central Nigeria.

BACKGROUND: The brunt of the human immunodeficiency virus infection/the acquired immunodeficiency syndrome is largely borne by communities in sub-Saharan Africa. We describe renal disease in Nigerians with the acquired immunodeficiency syndrome. METHODS: Consecutive patients with the acquired immunodeficiency syndrome (AIDS) seen in the infections unit of the Jos University Teaching Hospital and a similar group of healthy controls were evaluated for renal disease. Subjects with past history of renal disease, hypovolemia, hypertension, diabetes mellitus and/or a documented fever were excluded from the study. RESULTS: Of the 79 patients with the acquired immunodeficiency syndrome and 57 controls studied, renal disease was present in 41 (51.8%) of the patients in the AIDS group and 7 (12.2%) of controls. While 15 (19%) of the AIDS group had azotemia alone and 20 (25.3%) had proteinuria alone, 6 (7.6%) had azotemia and proteinuria. The mean protein excretion/24 hours was significantly higher in the AIDS group compared to controls, (2.99 +/- 54 g and 0.56 +/- 0.12 g respectively, p = 0.001), while the GFR was significantly higher in controls compared to the study group (103.30 +/- 37.78 and 68.03 +/- 37.55 respectively, p = 0.004). Subjects in the AIDS group with renal disease had a significantly longer duration of illness compared to those without (12.33 +/- 8.67 months and 7.28 +/- 7.78 months respectively, p = 0.008). Age and serum CD4+ cell counts were similar in patients with and without renal disease in the AIDS group. CONCLUSION: Renal disease is a common complication of acquired immunodeficiency syndrome, the duration of illness being strongly associated with its presence.

AIDS-Associated Nephropathy↗

[Clinical investigation of cis-platinum nephrotoxicity in 244 cases of primary lung cancer].

Cisplatin (CDDP) is used widely in the treatment of a large number of carcinomas. The clinical use of cisplatin, however, can be complicated by myelotoxicity, intestinal toxicity and nephrotoxicity. We reviewed CDDP nephrotoxicity in 244 cases with primary lung cancer retrospectively. The enzyme histochemically localized in proximal tubular cells, N-acetyl-beta-D-glucosaminidase (NAG) and beta 2-microglobulin (BMG), a low molecular weight peptide normally reabsorbed by the renal tubular cells that has been used as an indicator for renal proximal tubular damage, were measured. And fractional excretion of Na (FENa%) and serum magnesium (Mg) levels were also measured before and after CDDP administration serially. The following results were obtained; 1) Over 45% of patients with lung cancer showed transient hyperexcretion of urinary NAG and BMG after CDDP administration. And peak excretion of NAG and BMG appeared to occur within 36 hours after administration of CDDP. 2) Almost all cases with persistent azotemia after CDDP administration showed high values of FENa (%), in spite of gradual normalization of urinary NAG and BMG excretion. 3) Hypomagnesemia was a common complication of CDDP nephrotoxicity that might be caused by a defect in renal Mg reabsorption. CDDP-induced nephrotoxicity seemed to be initiated by an acute, mainly proximal tubular impairment that reflects alterations in excretion of urinary enzymes and low molecular weight protein. In cases with persistent azotemia after CDDP administration depressed renal function might be attributed to the impairment of proximal as well as distal tubular reabsorptive functions.

Acetylglucosaminidase↗

IgA associated glomerulonephritis.

Immunohistological analysis of 1146 renal biopsies revealed IgA associated glomerulonephritis (IgAGN) in 83 (7.24%) patients (33 children, 50 adults). Clinical features were unusually severe in a high proportion. Nephrotic syndrome (NS) responding poorly to prednisolone was found in 24%, hypertension (HT) in 39%, and azotemia in 34% of patients. NS was slightly more frequent in children than in adults, but HT and azotemia occurred twice as often in adults as in children. Histologically, extensive glomerular crescents and sclerosis were prominent. In addition, moderate arteriolitis and arteriolosclerosis and marked tubulointerstitial nephropathy were notable features. Thus, a low incidence and marked severity characterized IgAGN in this study.

Adult↗

Acute spontaneous tumor lysis presenting with hyperuricemic acute renal failure: clinical features and therapeutic approach.

BACKGROUND: Acute spontaneous tumor lysis syndrome (STLS) presenting with hyperuricemic acute renal failure (ARF) is a rare disease which can be overlooked in patients with neoplasic disorders, requiring prompt recognition and aggressive management. This study examined the incidence, clinical characteristics and prognosis of this condition. METHODS: A retrospective study was performed, reviewing the records of all patients who developed ARF at Chang Gung Memorial Hospital between 1st July 1999 and 30th October 2002. Acute STLS was diagnosed based on pretreatment hyperuricemic ARF, ratio of urinary uric acid to creatinine (Cr) >1.0, and significantly elevated lactate dehydrogenase (LDH) (>500 units/L), together with a pathologically proven malignancy. Clinical course, metabolic parameters, response to therapeutics and outcome were assessed in all patients. RESULTS: STLS-induced acute uric acid nephropathy was identified in 10 out of 926 ARF patients (1.08%) studied. Most presentations were non-specific or related to malignancy symptoms. All patients had advanced tumors with large tumor burden, and abdominal organ involvement in 80% of patients. The 10 hyperuricemic patients became oliguric despite conservative therapy, and remained hyperuricemic (mean +/- SD: 20.7 +/- 5.0 mg/dL) until dialysis initiation. Seven patients (70%) developed diuresis, with an associated resolution of hyperuricemia, azotemia and metabolic derangements following dialysis initiation. The patients who developed diuresis had mean serum uric acid levels 9.3 +/- 3.1 mg/dL and median levels 9.8 mg/dL. Three patients (30%) survived, with two patients suffering residual renal function impairment. CONCLUSIONS: Acute STLS presenting with hyperuricemic ARF is a rare cause of acute uric acid nephropathy in patients with bulky or occult neoplastic disorders. The tumors that developed STLS had advanced stage or large tumor burden. Frequent abdominal organ involvement and non-specific initial presentations can obscure the nature of the disease and delay diagnosis. Unlike hyperuricemia and oliguria, which are constant findings, azotemia or impaired renal function is not always manifest on initial presentation. Poor outcomes in patients with STLS developing acute uric acid nephropathy make early recognition, aggressive management and prompt dialysis mandatory.

Acute Disease↗

Role of GFR estimation in assessment of the status of nephropathy in type 2 diabetes mellitus.

OBJECTIVES: Study the status of glomerular filtration rate (GFR) estimation vis-a-vis other noninvasive modes of assessment of renal involvement in Type2 Diabetes Mellitus (T2DM) and assess the temporal profile of the prevalence of nephropathy with a cross sectional cohort. METHODS: A total of 100 patients of T2DM were selected after screening and segregated into 3 groups according to duration of T2DM. Duration of < 5 years constituted group A and had 31 patients, group B duration was between 5-15 years and had 40 patients, rest belonged to group C with duration > 15 years. The parameters studied and compared were (1) various grades of albuminuria--normal, micro and macro by 24 hrs. urinary albumin excretion rates (UAER- gm/24 hr), (2) sonologically detected renal size(normal, small, large) and morphology (loss or presence of corticomedullary differentiation, (3) serum creatinine level (</> 1.4 mg/dl) and (4) different levels (high, normal, low, very low) of GFR (ml/min) by DTPA renal scan. RESULT ANALYSIS: There was high prevalence of nephropathy in all durations. Microalbuminuria had a high prevalence in patients of shorter duration (group A-74.2%). Albuminuria increased with duration but plateued off with longer duration (> 15 yrs) (UAER - 0.0842 +/- 0.083 vs. 0.906 +/- 0.84 vs. 1.346 +/- 1.28). Sonographic loss of corticomedullary differentiation and azotemia were late feature only and none had a contracted kidney. Only the parameter of GFR showed a graded and rather linear decrement with duration (132.57 +/- 19.3 vs. 76.33 +/- 20.8 vs. 40.08 +/- 17.1). Hyperfiltration had a high prevalence in patients of early detection (61.3%) and was the earliest change noted before change in any other parameter. GFR shows wide variation in various grades of albuminuria, especially microalbuminuria, and azotemia. A value in the normal range was uncommon (8%). CONCLUSION: GFR estimation is probably the most rational noninvasive mode of assessing the renal status in patients of T2DM, irrespective of the status of the other noninvasive methods as they express significant variation in inception and progression.

Albuminuria↗

[Case of traditional herbal medicine-induced aristolochic acid nephropathy developing to end-stage renal failure].

A 48-year-old male was referred to our university hospital for severe azotemia with muscle cramp. He had been taking Chinese herbs as a traditional medicine to reduce hyperuricemia for about 9 months. Urinalysis showed trace proteinuria and hematuria without any casts. Renal glucosuria was also observed. In addition to azotemia, hyperchloremic metabolic acidosis and severe anemia were revealed. Hemodialysis was conducted and his general condition improved. A renal biopsy specimen revealed severe interstitial fibrosis and tubular atrophy with cellular degeneration. No remarkable glomerular changes were observed except for wrinkling of the basement membrane in a few glomeruli. Aristolochic acid was detected in the Chinese herbs, leading to the diagnosis of aristolochic acid nephropathy (AAN). His renal dysfunction was considered to be irreversible and he underwent maintenance hemodialysis. In Japan, AAN or Chinese herbs nephropathy decreased after an outbreak from 1995 to 2000. The public should be warned again that Chinese herbs, which are not permitted by the Japanese government, may contain aristolochic acid.

Aristolochic Acids↗

The risk of ligation of the left renal vein in resection of the abdominal aortic aneurysm.

The left renal vein can be ligated during aortic operation to attain better access to the perirenal aorta. This maneuver has been considered safe, with a low incidence of postoperative renal complications. This study was done to evaluate the risk of left renal vein ligation and its influence on renal function in patients with elective resection of abdominal aortic aneurysms. The records of 332 patients undergoing elective repair of abdominal aortic aneurysms during a five year period were reviewed. The clinical and operative data of patients who had left renal vein ligation and those who did not were similar. Left renal vein ligation was not associated with an increased mortality rate but was strongly associated with an increase in serum creatinine level and a clinical diagnosis of postoperative azotemia. Nine of 13 patients who had left renal vein ligation had postoperative azotemia compared with 21 of 319 patients without left renal vein ligation (p less than 0.001). The mean change of preoperative and postoperative creatinine value was an increase of 1.92 milligrams per deciliter in patients with left renal vein ligation in contrast with 0.26 milligram per deciliter in patients without ligation (p less than 0.00075). Thus, ligation of the left renal vein increases the risk of postoperative renal complications and its use should be selective.

Adult↗

[The use of enterosorption in the combined therapy of patients with urolithiasis complicated by chronic kidney failure].

The results of conservative treatment of 51 patients with urolithiasis complicated by chronic renal failure in the intermittent stage have been analyzed. There were two groups of patients. The first one included 36 patients receiving enterosorption in addition to routine multimodality treatment. The second group was made up of 15 patients who did not undergo enterosorption which consisted in oral application of SKH-1K coal in a dose of 10 to 15 g 3 times a day 1.5 h after meal for 10 days. The treatment efficacy was judged from the patients' general health status, central hemodynamics (cardiac index and peripheral vascular resistance), the level of azotemia, and the content of medium-sized molecules. As shown by the data obtained, the multimodality treatment coupled with enterosorption produced an appreciable improvement of the patients' health status, reduction of the signs of intoxication, while the level of medium-sized molecules and creatinine reached the control. The hypokinetic circulatory syndrome seen before the treatment disappeared. At the same time the second group patients retained the high level of azotemia, whereas the content of medium-sized molecules remained increased. Besides, they demonstrated the hypokinetic circulatory syndrome. It is thus recommended that enterosorption be applied to the treatment of patients with chronic renal failure.

Adult↗

Continuous hemodiafiltration in children.

Continuous arteriovenous hemofiltration is a form of renal replacement therapy whereby small molecular weight solutes and water are removed from the blood via convection, alleviating fluid overload and, to a degree, azotemia. It has been used in many adults and several children. However, in patients with multisystem organ dysfunction and acute renal failure, continuous arteriovenous hemofiltration alone may not be sufficient for control of azotemia; intermittent hemodialysis or peritoneal dialysis may be undesirable in such unstable patients. Recently, the technique of continuous arteriovenous hemodiafiltration has been used in many severely ill adults. We have used continuous arteriovenous hemodiafiltration in four patients at Children's Hospital Medical Center. Patient 1 suffered perinatal asphyxia and oliguria while on extracorporeal membrane oxygenation. Patients 2 and 4 both had Burkitt lymphoma and tumor lysis syndrome. Patient 3 had septic shock several months after a bone marrow transplant. All had acute renal failure and contraindications to hemodialysis or peritoneal dialysis. A blood pump was used in three of the four patients, while spontaneous arterial flow was adequate in one. Continuous arteriovenous hemodiafiltration was performed for varying lengths of time, from 11 hours to 7 days. No patient had worsening of cardiovascular status or required increased pressor support during continuous arteriovenous hemodiafiltration. The two survivors (patients 2 and 4) eventually recovered normal renal function. Continuous arteriovenous hemodiafiltration is a safe and effective means of renal replacement therapy in the critically ill child. It may be ideal for control of the metabolic and electrolyte abnormalities of the tumor lysis syndrome.

Acute Kidney Injury↗

Peritoneal dialysis in dogs and cats: 27 cases (1976-1987).

The records of 25 dogs and 2 cats treated with peritoneal dialysis during an 11-year period were evaluated. The indications for peritoneal dialysis were acute renal failure in 21 animals, chronic renal failure in 5 animals, and azotemia of undetermined cause in 1 animal. Peritoneal dialysis resulted in a significant (P less than 0.05) decrease in serum urea nitrogen concentration in 19 of the dogs and a significant (P less than 0.05) decrease in serum creatinine in 20 dogs. The most common complication of peritoneal dialysis was hypoalbuminemia (11 animals affected). Other common complications were dialysate retention/catheter obstruction (8 animals), peritonitis (6 animals), hypochloremia (6 animals), and subcutaneous leakage of dialysate (6 animals). Twelve dogs and 2 cats died during treatment, 6 dogs were euthanatized, and 1 dog was lost to follow-up evaluation. The remaining 6 dogs survived and were discharged from the hospital after successful peritoneal dialysis. On the basis of the results of this study, the authors concluded that peritoneal dialysis, although associated with a high complication rate, was a successful technique for reducing azotemia in dogs with acute and chronic renal failure. Survival rates were poor because of the severity of the underlying renal diseases.

Acute Kidney Injury↗

[Aortic perianeurysmal fibrosis causing bilateral ureteral obstruction: a case report].

A 54-year-old male with the chief complaint of bilateral flank pain was admitted to our hospital. Blood chemistry test revealed marked azotemia and retrograde pyelogram showed bilateral hydronephrosis with median shift of narrowed ureters. Abdominal CT scan demonstrated a well-defined dense mass around the aorta implicating bilateral ureters. These findings were interpreted as aortic perianeurysmal fibrosis resulting in bilateral ureteral obstruction. On laparotomy, a large hard mass was found in the lower part of aorta, vena cava, common iliac vessels, inferior mesenteric artery and bilateral ureters. Because of the extension of the mass, ureterolysis and intraperitoneal displacement of ureters wrapped with isolated omentum was performed. Postoperative recovery from azotemia and ureteral obstruction was satisfactory. Biopsy specimen of the mass showed marked fibrosis with non-specific inflammation.

Humans↗

[Percutaneous nephrostomy as a technic for emergency drainage: review of cases].

Percutaneous nephrostomy (PCN) is currently one of the procedures of choice for emergency drainage of the upper urinary tract. Moreover, it permits morphologic and functional diagnostic possibilities as well as a wide variety of new and frequently definitive therapeutic procedures. We report on 58 PCN procedures performed in 55 patients from May 1983 to February 1989. PCN was indicated for complicated or uncomplicated uni- or bilateral supravesical obstruction, with infection and/or azotemia. All patients submitted to PCN for complicated obstruction with infection and/or azotemia showed a marked clinical and analytical improvement. Apart from resolving this emergency, it reduced the morbidity and mortality rate of subsequent surgical treatment of the underlying cause of obstruction because patient status was markedly improved. The major complications, retroperitoneal hematoma and sepsis, were rare. We frequently observed that the catheter had come out or become obstructed in our series. PCN affords the following advantages: it can be performed with local anesthesia; it is a simple technique; there are no absolute contraindications; its morbidity and mortality rates are low; and, it can be easily converted into a permanent procedure. In our view, all the foregoing advantages, as well as its therapeutic and morphologic and functional diagnostic possibilities, make PCN one of the procedures of choice in emergency treatment of upper urinary tract obstruction.

Adult↗

Percutaneous nephrostomy in short-term management of ureterolithiasis and renal dysfunction in a filly.

Percutaneous nephrostomy was used to provide urine output in a 3-year-old Thoroughbred filly with azotemia and obstructive ureterolithiasis. Previous left ureteral surgery had failed to provide clinical improvement, and the filly became more azotemic. Nephrostomy was performed in the standing patient, with ultrasonographic guidance and local anesthesia. Continuing IV fluid therapy and diuresis through the nephrostomy tube resulted in a decrease in clinical signs of azotemia. However, the filly developed a cecal impaction, which ruptured during surgery because of colic, and was euthanatized.

Animals↗

[Renal complications of multiple myeloma].

In connection with the analyses of 84 post-mortem examinations (47 men, 37 women, average age: 66.3 years) the author dealt with the renal complications of multiple myeloma. The signs of cylinder nephropathy, light-chain nephropathy, amyloidosis, nephrocalcinosis, urate nephropathy, acute renal insufficiency, renal vein thrombosis, acute and chronic pyelonephritis as well as the tumorous infiltration of the renal tissue have been sought for. The severity of the lesions were ranged into minimal, slight, moderate, and severe groups. On the basis of the semiquantitative morphological picture and the clinical data: 1. intact kidney (41 patients), 2. involvement of the kidney without azotemia (10 patients), 3. involvement of the kidney with azotemia (17 patients, serum creatinine level: greater than 177 mumol/l) and 4. renal involvement with chronic renal insufficiency associated with uremia (16 patients) were discerned. In the background of 33 cases (39%) with deteriorated renal function cylinder nephropathy was found most frequently (27 occasions) (32%). Every other complication occurred significantly less frequently e.g. amyloidosis or kappa-light-chain nephropathy occurred in 3 cases each.

Aged↗

The antiinflammatory effects of essential fatty acid deficiency in experimental glomerulonephritis. The modulation of macrophage migration and eicosanoid metabolism.

Dietary polyunsaturated fatty acid modulation exerts a beneficial effect in immune-mediated glomerulonephritis. To elucidate the mechanisms underlying this phenomenon, the effects of essential fatty acid (EFA) deficiency on the heterologous phase of nephrotoxic nephritis in rats (induced by the injection of a rabbit antiglomerular basement membrane antibody) were studied. The heterologous phase of nephrotoxic nephritis was characterized by an invasion of leukocytes into the glomerulus. Polymorphonuclear neutrophils predominated early on (3 h), whereas macrophages predominated at 24 and 72 h. EFA deficiency selectively prevented the influx of macrophages into the glomerulus. The invasion of polymorphonuclear neutrophils, in contrast, was unaffected. The influx of leukocytes into the glomerulus during nephritis was accompanied by a marked enhancement (10- to 40-fold) in glomerular thromboxane and leukotriene B4 production. EFA deficiency largely attenuated this change. Renal dysfunction during the heterologous phase of nephritis was manifested as azotemia, polyuria, sodium retention, and proteinuria. With EFA deficiency, polyuria, azotemia, and sodium retention were not seen. Proteinuria was reduced by approximately 85%. To address whether the lack of macrophage migration into the glomerulus in the context of nephritis with EFA deficiency might be due to a functional defect in macrophage migration, the chemotactic responsiveness of EFA-deficient macrophages was examined. EFA-deficient macrophages displayed normal chemotactic migration toward activated C. In sum, EFA deficiency prevents the invasion of macrophages into the glomerulus in nephrotoxic nephritis and attenuates the accompanying metabolic and functional alterations, but does not affect macrophage chemotactic responsiveness. Alterations in macrophage elicitation and lipid mediator generation by inflamed glomeruli thus appear to be central to the salutary effect of dietary polyunsaturated fatty acid modification on glomerulonephritis.

Animals↗

Kinetics of drug action in disease states. V. Acute effect of urea infusion on phenobarbital concentrations in rats at onset of loss of righting reflex.

It has been reported that patients suffering from azotemia attributable to urinary obstruction required significantly less thiopental for induction and maintenance of general anesthesia than did a comparable group of patients with normal blood urea concentrations. Moreover, the thiopental requirements of normal subjects could be reduced by urea administration. In rats, experimental renal dysfunction was associated with reduced concentrations of phenobarbital (PB) in serum, serum water, brain and cerebro-spinal fluid at onset of a defined hypnotic effect (loss of righting reflex) produced by a slow i.v. infusion of PB. To determine the mechanism of this effect, these studies have now been repeated in normal rats made azotemic (approximately 170 mg of urea nitrogen/100 ml of serum) by intra-arterial infusion of urea and in control animals infused with saline solution. The total dose of thiopental required to produce loss of righting reflex was significantly reduced in the rats infused with urea. confirming the clinical observations. Similar results were obtained with PB and heptabarbital, two barbiturates that (unlike thiopental) are not racemic mixtures and are therefore more suitable for this investigation. On the other hand, urea infusion had no apparent effect on the concentrations of PB and heptabarbital in serum, brain and cerebrospinal fluid at onset of loss of righting reflex. Urea apparently affects the distribution kinetics of barbiturates and this, rather than increased receptor sensitivity, appears to be responsible for the decreased barbiturate dose requirements in acute experimental azotemia produced by urea infusion.

Animals↗

Effects of renal failure on leukotaxis.

Effects of renal failure and experimental azotemia on in vitro leukocyte migraton were studied. Migration of normal leukocytes in sera from patients with untreated renal failure was regularly decreased, while sera from patients on chronic dialysis exerted no inhibitory effect. Serial sera obtained from two patients starting chronic dialysis exhibited a gradual decrease and ultimate disappearance of the serum inhibitory effect. Experimental azotemia serum supported increased migration of normal leukocytes. Leukocytes from renal failure patients migrated normally when incubated in autologous uremic serum or in normal homologous serum. These results provide evidence that serum from untreated renal failure patients inhibits the in vitro migration of normal leukocytes. This inhibitory capacity is apparently correctable by hemodialysis.

Acute Kidney Injury↗