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PubMed2001

Dramatic recovery of renal function after 6 months of dialysis dependence following surgical correction of total renal artery occlusion in a solitary functioning kidney.

Revascularization of renal artery stenosis for the treatment of hypertension is an established procedure. In selected clinical scenarios, successful revascularization procedures may preserve or restore renal function. We present a 31-year-old man who underwent successful renal revascularization of a solitary functioning kidney after being dialysis dependent for approximately 190 days. He had dramatic improvement of renal function and has remained off dialysis since his surgery 18 months ago. He continues to have severe but controllable hypertension.

Acute Kidney Injury↗
PubMed1987

The causal role of salt depletion in acute renal failure due to captopril in hypertensive patients with a single functioning kidney and renal artery stenosis.

Captopril (C) causes ARF in hypertensive patients with renal artery stenosis (RAS) with a single functioning kidney (SK). Retrospective studies in two patients showed that episodes of C-induced ARF were preceded by a rise in urinary Na+ excretion and a rapid decrease in body weight. These observations prompted us to investigate whether extracellular fluid volume depletion secondary to C-induced natriuresis can be responsible for ARF. Prospective studies were performed in four patients with RAS-SK treated with C. These studies have shown that: ARF is associated with negative Na+ balance and is corrected by salt replacement, even without interrupting C; ARF is preceded by a rise in urinary prostaglandin (PG) E2 and 6-keto-F1 alpha; ARF is prevented by either saline infusion or aspirin administration; ARF does not occur when the dose of C is not sufficient to raise PGs and urinary N + excretion. We conclude therefore that C-induced ARF in patients with RAS-SK can be secondary to salt depletion dependent on a raised secretion of PGs.

Acute Kidney Injury↗
PubMed1978

[Dependence of the serum concentrations of creatinine and urea on the time of day, with normal and impaired kidney function (author's transl)].

Daily variations in the serum concentrations of creatinine, urea and cortisol were studied in 7 patients without kidney or muscle disease, and in 8 patients with impaired kidney function (creatinine clearance less than 40 ml/min). Neither creatinine nor urea showed a circadian rhythm; the daily variations lay within the limits of the methodological scatter. Serum cortisol showed its known circadian rhythm in high amplitude.

Adult↗
PubMed1995

[The effect of the angiotensin-converting enzyme inhibitor enalapril on the rates of progression of chronic kidney failure in patients with different degrees of functional kidney disorders].

By a reciprocal of creatininemia the rate of chronic renal failure progression (CRF) was assessed in 14 patients with nephropathy on enalapril treatment. The day dose ranged from 2.5 to 15 mg. In patients with serum creatinin levels from 0.24 to 0.41 mmol/l (group 1) enalapril significantly inhibited CRF progression, as it did in group 2 (serum creatinin levels from 0.47 to 0.68 mmol/l) but 1 patient. In patients with creatinin levels over 0.71 mmol/l, the influence of enalapril on CRF progression rate was insignificant. All the patients exhibited stabilization of arterial hypertension. Proteinuria diminished in groups 1 and 2, while creatinin clearance decreased in groups 1 and 3. It is inferred that enalapril control of renal function in nephropathy patients is efficient only in early CRF.

Adult↗
PubMed1980

Chronic cadmium exposures associated with kidney function effects.

A follow-up study was conducted on 27 workers with a median of 25 years exposure to airborne cadmium. Two exposure groups had been selected a low exposure group of office, laboratory and supervisory personnel (n = 11, average urinary cadmium 13.1 micrograms/l); and a high exposure group of production workers with long histories of work in areas with substantial airborne cadmium (n = 16, average urinary cadmium 45.7 micrograms/l). An estimate of each subject's time-weighted-average inhalation exposure to cadmium was calculated from personal sampling data (1973-1976) and area sampling data (1943-1976). Based on the findings of another study, the average inhalation exposures in each of the work areas were adjusted for use of personal protective masks (respirators). Comparison of kidney function status between the high and low exposure groups showed a significant reduction in creatinine clearance, and increased uric acid and beta microglobulin excretion by the high group. Significant renal effects were associated with estimated average inhalation exposures of 63 micrograms/m3 over a 25 year period. The relationship between urinary cadmium excretion and cumulative exposure changed for higher exposures; this was consistent with the "critical concentration" model of cadmium's effects on the kidney.

Air Pollutants, Occupational↗
PubMed2004

[Volume replacement with hydroxyethyl starch: is there an influence on kidney function?].

Hydroxyethyl starch (HES) solutions are synthetic colloids with the pharmacological properties that are closest to natural colloids. In Germany, numerous types of HES preparations with different combinations of concentration, weight-averaged mean molecular weight (Mw), and hydroxyethylation pattern are available. They differ with regard to their volume-supporting capacity, intravascular half-life, and side effect profile. The elimination of HES molecules varies with the Mw and degree of substitution (DS). Large HES molecules undergo hydrolytic cleavage by alpha-amylase and are excreted in the urine, or they are phagocytosed by the reticuloendothelial system. The smaller HES molecules are eliminated by glomerular filtration. The higher the DS, the slower the metabolism and elimination of the molecule. Although HES can be used safely even in large doses in patients without altered kidney function, renal dysfunction and acute renal failure after HES infusion have been reported in patients who share several risk factors, such as preexisting renal disease, advanced age in combination with dehydration, or treatment with high doses of slow degradable HES solutions. Since there is no direct chemical toxicity of HES, the most likely mechanism for HES-induced renal dysfunction may be swelling and vacuolization of tubular cells ("osmotic nephrosis-like lesions") and tubular obstruction due to the production of hyperviscous urine. Considering this pathogenesis, it can be hypothesized that all hyperoncotic colloid solutions can induce renal impairment. In the case of HES, the risk of high plasma colloid osmotic pressure and thus the risk of acute renal failure are probably increased by high concentrations of the colloid or repeated administration of slowly degradable HES with a high Mw and DS. With adequate hydration, using sufficient amounts of crystalloids, HES has little if any adverse effects on renal function. Furthermore, modern -rapidly degradable HES solutions with a low Mw and DS, such as HES 130/0.4, do not increase the risk for renal dysfunction even when used in large amounts perioperatively.

Animals↗
PubMedDate not supplied

[Separate catheterization test in the assesment of the kidney function in patients with renal artery stenosis].

An investigation has been designed to study the functional state of the kidneys in arterial affection of the major trunk by studying indices for separate catheterization of the ureters in 24 patients presenting with the functionally significant stenosis and 21 patient with essential hypertension. It has been established that significance of classical criteria of assessment of separate catheterization tests comes up to 45.2%, semi-classical 70.2%. Strong lateralization of the indices in three collections of urine secures the diagnostic usefulness of the study in 95.2% of cases.

Creatinine↗
PubMed1995

The influence of ketanserin or urapidil on haemodynamics, stress response and kidney function during operations for myocardial revascularisation.

The study was performed to investigate the different effects of ketanserin and urapidil on haemodynamics, kidney function and plasma catecholamine and aldosterone levels. Forty male patients scheduled for myocardial revascularisation were assigned at random to two groups: group K received ketanserin, group U received urapidil. Anaesthesia consisted of fentanyl, flunitrazepam and pancuronium. Haemodynamic variables were evaluated at eight predefined time points of the operation. Creatinine and free-water clearance as well as plasma levels of adrenaline, noradrenaline and aldosterone were measured in three different periods of the operation. While the groups showed no clinically relevant differences in the haemodynamic variables and the hormone plasma concentrations, the creatinine clearance in group K was slightly increased in the period after cardiopulmonary bypass. Both ketanserin and urapidil prevented hypertension even in the presence of elevated catecholamine plasma levels during and after cardiopulmonary bypass.

Adrenergic alpha-Antagonists↗
PubMed1981

Lithium treatment and kidney function. A follow-up study of 237 patients in long-term treatment.

Two years after a survey of the kidney function in 237 patients given long-term lithium treatment the patients were invited for reexamination. Of 184 patients who came for the reexamination 147 had continued lithium treatment; in 37 patients the treatment had been discontinued. The lithium-treated patients were compared with a group of 68 manic-depressive patients who were about to be given prophylactic lithium treatment but who had not yet started. Neither the patients who continued nor the patients who had discontinued lithium showed any deterioration of glomerular filtration rate as assessed through determination of the 24-h creatinine clearance and the serum creatinine concentration; mean values in the lithium-treated patients were the same as mean values in patients not yet given lithium. Impairment of renal water reabsorption, revealed by increased 24-h urine volume and decreased urine osmolality after DDAVP, had progressed in the patients who continued lithium treatment, and multiple regression analysis revealed the duration of treatment and the serum lithium level to be significant predictor variables. In the patients who had discontinued lithium the changes in renal water handling had decreased. The urine volume was the same as that found in the patients not yet given lithium; maximum urine osmolality had not become fully normalized. Side effects such as thirst, nycturia, tremor, diarrhoea, oedema, and weight gain were found with the same frequency at the second as at the first examination in the patients who had continued lithium. In the patients who had discontinued lithium they were infrequent or absent.

Adult↗
PubMed2000

[Kidney function from the molecular viewpoint].

Over the last 10-15 years the use of cellular and molecular biology permitted the analysis of kidney function at a cellular/molecular level. These advances allow a more detailed understanding of physiological/pathophysiological mechanisms. By taking examples from our studies on the renal handling of inorganic phosphate this gain in knowledge' is illustrated.

Animals↗
PubMedDate not supplied

Kidney function in long-term pediatric survivors of acute lymphoblastic leukemia following allogeneic bone marrow transplantation.

Renal dysfunction may occur in survivors of bone marrow transplantation (BMT). The renal function of children who have survived 5 to 10 years after BMT has not been reported. Bone marrow transplantation was performed in 55 children with acute lymphoblastic leukemia less than 18 years of age at the University of Florida between September 1983 and October 1992. All received a uniform conditioning regimen of high-dose cystosine arabinoside and fractionated total body irradiation. Twenty-three are currently surviving. The survival average period following transplantation is 79 +/- 6.6 (SD) months. The longest survival is 129 months after BMT. We retrospectively examined data evaluating kidney function prior to transplantation, within 150 days after transplantation, and at each child's most recent clinic visit (1.7 to 10 years after transplantation). We were able to collect follow-up data regarding renal function for 17 survivors. Two children (11%) have renal dysfunction in the form of hypertension, glucosuria, and hematuria. One of them had acute renal insufficiency during the first 100 days following BMT. An unexpected finding was the presence of hyperfiltration in 10 patients. In conclusion, in this homogeneous group of children, allogenic BMT did not lead to significant long-term renal dysfunction.

Adolescent↗
PubMed2002

Salicylate protects hearing and kidney function from cisplatin toxicity without compromising its oncolytic action.

Salicylate has recently been demonstrated to protect against the auditory and vestibular side effects of aminoglycoside antibiotics. Similarities in the toxic mechanisms suggest salicylate as a treatment strategy to prevent the ototoxic side effects of cisplatin (CDDP). We first tested protection of the inner ear in Wistar rats receiving a single infusion of 16 mg CDDP/kg body weight with or without treatment with 100 mg/kg salicylate (bid) for 5 days beginning one day before the CDDP infusion. Cisplatin induced a threshold shift of more than 30 dB (at 14 kHz; measured by auditory evoked brain stem response) that was significantly reduced by salicylate. We then examined the protective potential of salicylate on the cochlea, peripheral nerves, and kidney in a rat model of breast cancer--Fisher344 rats implanted with highly metastatic MTLn3 breast cancer cells. Animals received 3 x 5 mg CDDP/kg (given every third day), and salicylate was administered at 100 mg/kg (bid) from 2 days before to 3 days after CDDP treatment. Salicylate significantly attenuated the CDDP-induced threshold shift from approximately 20 dB (at 16 and 24 kHz) to approximately 5 dB, and drastically reduced the loss of cochlear outer hair cells. Likewise, salicylate protected kidney function (measured as plasma blood urea nitrogen and creatinine levels) from CDDP toxicity. Protection of nerve conduction velocities of both sensory and motor nerves was minimal. The chemotherapeutic efficacy of CDDP on suppression of tumor mass and cancer cell metastasis remained unaffected by salicylate. The results suggest that administration of salicylate may become the basis of an effective therapeutic intervention against the ototoxic and nephrotoxic side effects associated with CDDP chemotherapy.

Animals↗
PubMedDate not supplied

Kidney function after left renal vein ligation in the dog.

The ligature of the left renal vein is an alternative whenever this vessel is injured. The purpose of this study was to evaluate the capacity of the affluents of the left renal vein, proximal to the ligature, to maintain tissue vitality and function of the left kidney. Fifteen mongrel male dogs were divided in 3 groups of 5 dogs: Group I (control) - a laparotomy was performed, and the abdominal structures were only identified; Group II - the left renal vein was tied, close to vena cava; Group III - the same procedure as for Group II and a right nephrectomy. Blood urea nitrogen and serum creatinine levels were measured before the procedure, and every 3 days during 4 weeks in the postoperative period. Renal arteriography and an excretory urogram were performed on the animals that survived 60 days. Thereafter, or immediately after precocious death, the kidneys were removed for histological examination. All the animals of Group III died before two months (mean = 10.5 +-3.2 days), while the animals of Group II survived during that period. There was a complete exclusion of the left kidney in all dogs that underwent renal vein ligature. In the animals of Group II, the renal cortico-medullary limits could not be identified. At microscopy, the aspect was suggestive of nephrosclerosis. In the animals of Group III, the left kidney was enlarged, and a great amount of intravascular and intrapelvic blood clots were observed. At microscopy, extensive areas of necrosis, inflammatory infiltration, and hemorrhage were identified. In conclusion, the tributaries of the renal vein were not sufficient to maintain the tissue vitality and function of the left kidney after ligature of its main vein.

Animals↗