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PubMed1978

Acute renal failure after cis-dichlorodiammineplatinum(II) and gentamicin-cephalothin therapies.

Combined gentamicin-cephalothin therapy in four patients after treatment with cis-dichlorodiammineplatinum(II) (CPDD) for advanced solid tumors was complicated by severe acute renal failure. The total dose of gentamicin varied from 240 to 945 mg and that of cephalothin varied from 28 to 48 g. Low-dose (0.5 mg/kg x 8) CPDD was given to one patient, high-dose (3 mg/kg) CPDD was given to two patients, and very high-dose (5 mg/kg) CPDD was given to one patient. The high and very high doses of CPDD were given with concomitant mannitol diuresis. CPDD therapy was complicated by mild transient azotemia in three patients and by severe acute renal failure in one. In the latter, the azotemia began to improve on Day 7 after CPDD treatment. Following gentamicin-cephalothin therapy, all patients developed severe acute renal failure which persisted until death. At autopsy, all patients had extensive renal tubular necrosis at various stages. These findings indicate that gentamicin-cephalothin therapy after treatment with CPDD can be severely nephrotoxic, and that this antibiotic combination should be given with great caution, if at all, to patients receiving CPDD treatment for malignancy.

Acute Kidney Injury↗
PubMedDate not supplied

[Comparative study of the effects of alpha-25-dihydroxycholecalciferol and 24, 25-dihydroxycholecalciferol on calcium-phosphorus metabolism and on bone tissue in experimental kidney insufficiency in rats].

Experimental chronic kidney insufficiency (CKI; within 2-6 months) in rats, kept on a diet containing 0.6% Ca2+ and 0.6% P was accompanied by distinct azotemia, hyperphosphatemia, by a decrease in specific weight, in content of Ca2+, P and hydroxyproline in diaphyses as well as by a decrease in epiphyseal Ca2+. Daily administration of 0.025 micrograms of 1 alpha, 25-dihydroxy-cholecalciferol (1,25 (OH)2D3) into the animals did not normalize any of the patterns studied. At the same time, 1,25 (OH)2D3 increased the rate of hypercalciemia and demineralization of epiphyses, causing a slight hypercalciemia and increasing distinctly calcinosis of aorta as well as of the remaining part of the kidney. After daily administration of 24, 25-dihydroxycholecalciferol (24, 25 (OH)2D3) at a dose of 0.25 micrograms most of the patterns studied were normalized; specific weight, content of Ca2+ and P were increased in diaphyses simultaneously with a decrease in blood phosphorus concentration and in the level of azotemia. 24, 25 (OH)2D3 increased also the collagen content in diaphyses and epiphyses. The higher dose of 24, 25 (OH)2D3 (1.25 micrograms) did not exhibit higher effectivity. No one of the 24, 25 (OH)2D3 doses used did cause hypercalciemia and calcinosis. Combination of 0.025 micrograms 1,25 (OH)2D3 with 1.25 micrograms of 24, 25 (OH)2D3 decreased slightly the hypercalciemic, hyperphosphatemic and calcinosis inducing effects of 1,25 (OH)2D3 preventing completely the osteoporotic alterations in diaphyses but increasing the epiphysis demineralization; these results indicate that the doses of these metabolites must be decreased if their combination is required. The data obtained suggest that 24, 25 (OH)2D3 is a more effective and safe drug in correction of Ca2+-P metabolism impairments as well as of bone destruction under kidney insufficiency conditions as compared with 1,25 (OH)2D3.

24,25-Dihydroxyvitamin D 3↗
PubMed1984

Management of acute illness in cats. Feline urologic syndrome.

Lethargy, anorexia and vomiting suggest azotemia in cats with FUS. Clinicopathologic findings may include azotemia, hyperphosphatemia, hyperglycemia, hyperkalemia, and signs of urinary tract inflammation on urinalysis. Treatment of FUS depends on the degree of illness but generally includes removal of the urethral obstruction, bladder lavage, fluid and antibiotic therapy, and subsequent feeding of a canned, low-Mg diet with added table salt.

Acute Disease↗
PubMed1980

A comparison of plasma phenytoin level determinations by EMIT and gas-liquid chromatography in patients with renal insufficiency.

Monitoring the blood levels of antiepileptic drugs (AED) has proven to be of value in the clinical management of epileptic patients. We have compared the plasma concentrations of AED determined by enzyme multiplied immunoassays (EMIT) and gas-liquid chromatography (GLC) assays and identified a group of patients (n = 22) in whom the EMIT values for phenytoin were up to three times higher than those obtained by GLC. All these patients were oliguric with various degrees of azotemia, most of them undergoing weekly hemodialysis. The ratio of EMIT over GLC was 2.0 in 14 patients, 2.5 in 5 patients, and near 3.0 in 3 patients. These ratios remained relatively constant during repeated determinations over several months. The magnitude of difference between EMIT and GLC values (microgram/ml) was not related to the degree of azotemia. The discrepancy remained unchanged when various modifications of EMIT and GLC techniques were used. When phenytoin was added in vitro to plasma from nonepileptic oliguric azotemic patients, the measured phenytoin values were close to and not higher than the target values by either methodology. We feel that, when monitoring phenytoin blood levels in epileptic patients with renal insufficiency, one should be aware of a discrepancy between phenytoin values assayed by GLC and EMIT.

Chromatography, Gas↗
PubMed1981

Simple, accurate method for clinical estimation of glomerular filtration rate in the dog.

Simultaneous [14C]inulin and exogenous creatinine clearance procedures were performed on 10 healthy adult dogs of both sexes after constant IV infusions of inulin and a single subcutaneous injection of creatinine. For 30 clearance procedures determined for 10 dogs, the creatinine/inulin (C/I) clearance ratio was 1.03 +/- 0.01, and the results of the 2 tests were highly correlated (r = 0.91). Simultaneous [14C]inulin and endogenous creatinine clearance procedures were performed in the same 10 dogs. For 30 clearance procedures in these dogs, the C/I clearance ratio was 0.70 +/- 0.06 and the 2 tests were less highly correlated (r = 0.79). Fifteen clearance procedures of the same design were conducted on 5 dogs with azotemia induced by surgical reduction of renal mass. In these dogs, the exogenous C/I clearance ratio was 1.09 +/- 0.12, and the endogenous C/I clearance ratio was 0.89 +/- 0.07. It was concluded that the single injection method of exogenous creatinine clearance was a valid method for clinical measurement of glomerular filtration rate in the female dog and would closely approximate glomerular filtration rate in male dogs without azotemia. At normal or near normal plasma creatinine levels, the endogenous creatinine clearance procedure gave erroneously low values for glomerular filtration rate when the common methods of creatinine analysis were used.

Animals↗
PubMedDate not supplied

Chronic reduction in renal mass: micropuncture studies of response to volume expansion and furosemide.

Chronic nephron loss is compensated by functional adaptations which preserve electrolyte homeostasis. The response to volume expansion and diuretics was tested in dogs. Three phase recollection micropuncture studies were performed to assess the response of the remnant kidney in various stages of renal failure to furosemide administration (10 mg/Kg) and graded volume expansion (3 percent and 10 percent body weight). After the diuretic maneuvers, mean fractional excretion of sodium, potassium and water rose progressively in normal dogs (Stage I), with a greater increase in the remnant kidneys in the presence (Stage II) and absence (Stage III) of the contralateral kidney. Proximal and distal TF/P (Inulin) ratios were depressed after 3 percent volume expansion. However, proximal TF/P (Inulin) was not further lowered after 10 percent volume expansion and furosemide administration, while distal TF/P (Inulin) ratios were progressively depressed. The distal TF/P (Inulin) ratios in Stage III were significantly lower than in Stage II under analogous conditions. Our results suggest that the adaptive increase in the response of sodium transport by the remnant kidney to the diuretic maneuvers occurs in the loop of Henle, both in the azotemic and the non-azotemic stage. Adaptation of potassium excretion, as revealed by distal micropuncture, took place in the azotemic Stage III. Chronic functional adaptation for electrolyte transport occurs even before azotemia in the distal nephron and includes the proximal tubule with azotemia.

Adaptation, Physiological↗
PubMed1980

Differential diagnosis of acute renal failure.

This prospective study compares the fractional excretion of sodium, FENa, urinary sodium concentration, UNa, urine osmolality, Uosm, and the U/P creatinine ratio in their diagnostic effectiveness in 87 patients with acute renal failure: 22 acute tubular necrosis, 18 non-oliguric acute tubular necrosis, 12 acute urinary tract obstruction, 14 acute glomerulonephritis, and 21 pre-renal azotemia. Discriminant analysis demonstrated a correct diagnostic classification in 86 of 87 patients using FENa, and only 46, 60 and 65 correct using Uosm, UNa, and U/P Cr, respectively. FENa is identified as the most effective non-invasive test for the differential diagnosis of acute renal failure. An FENa of 1 classifies all entities into two groups: FENa more than 1; acute tubular necrosis, non-oliguric acute tubular necrosis and urinary tract obstruction and less than 1; pre-renal azotemia and acute glomerulonephritis (P less than 0.001).

Acute Kidney Injury↗
PubMed1980

Multiple myeloma: a clinicopathologic study of 62 consecutively autopsied cases.

The clinical, laboratory and pathologic findings were studied in 62 consecutively autopsied patients with multiple myeloma between 1954 and 1975. All patients were 40 years of age or older. Bone pain was the initial symptom in 2/3 of patients. Anemia (81%), thrombocytopenia (29%), azotemia (41%), hypercalcemia (46%) and hyperuricemia (52%), were common laboratory findings at diagnosis. Ninety-seven percent had a monoclonal protein in serum or urine. Extensive plasma cell replacement of marrow was invariably seen at autopsy although in 15% of patients no abnormality was found on skeletal survey. Extraskeletal spread (67%) was due to direct extension to paraosseous tissue resulting from cortical destruction and to distant organ involvement mainly of splenic red pulp and hepatic sinusoids. The patients were susceptible to bacterial infection, mainly gram-negative, of the lung (56%), urinary tract (35%), and blood (24%). Fungal infection was less frequent and usually consisted of superficial candidal overgrowth of gastrointestinal tract ulcerations (18%). Amyloidosis (10%) was perivascular and associated with light chain proteinuria. Renal failure as a cause of death (21%) was secondary only to infection (52%). Severity of histologic findings in the kidney at autopsy had little correlation to initial BUN concentration. The median survival was 11.5 months with alkylating agent therapy (responders, 29 months; non-responders, 6 months), and 6 months with urethan. Initial azotemia (greater than 80 mg/dl) and hypercalcemia (greater than 12 mg/dl) were important prognostic indicators (median survival, less than 1 month and 3 months, respectively). A good response to alkylating agent therapy, initial BUN less than 40 mg/dl and serum calcium less than 12 mg/dl were favorable to prognostic indicators.

Adult↗
PubMed1995

Pheochromocytoma in two horses.

A 12-year-old Standard-bred mare and a 21-year-old Quarter Horse gelding were treated for signs of abdominal pain and sweating. The mare also had muscle fasciculations, azotemia, and ataxia, and was euthanatized after signs of pain became refractory to analgesics. The gelding died when ventricular tachycardia developed during general anesthesia for exploratory celiotomy. Adrenal pheochromocytomas (bilateral in the mare), associated with retroperitoneal and intra-abdominal hemorrhage, were found on postmortem examination. Pheochromocytoma should be considered in older horses with signs of abdominal pain and sweating. Further consideration of pheochromocytoma should be afforded in older horses in which muscle fasciculations, ataxia, azotemia, and intraperitoneal hemorrhage are recognized. Identification, by per rectum palpation, of retroperitoneal swelling in the dorsal aspect of the abdomen also should alert the diagnostician to the possibility of a ruptured pheochromocytoma.

Abortion, Veterinary↗
PubMed1994

A case of infant with bilateral multicystic kidney and ureteropelvic junction obstruction; surgical treatment after percutaneous nephrostomy.

We report a case of bilateral multicystic kidney and left ureteropelvic junction (UPJ) obstruction in a female infant. She was diagnosed to have severe cystic disease from 20 weeks of gestation. After birth with cesarean section, she was transferred to the neonatal intensive care unit (NICU) of our hospital. One day after birth, she was referred to our department for progression of azotemia. We placed a nephrostomy catheter into the largest renal cyst, but it did not work. One week later, we placed another nephrostomy catheter into another cystic lesion inside of the first one. It worked well for nine months and azotemia was improved. At the age of nine months her upper urinary tract was reconstructed by pyeloplasty. We observed peristalsis of ureter and first urination from bladder.

Female↗
PubMed1994

Prophylaxis of experimental bone marrow transplant nephropathy.

Renal radiation injury is a known complication of both local kidney irradiation and total body irradiation (TBI). TBI is felt to play an important role in the late-onset chronic renal failure seen after bone marrow transplantation in human beings. Two-hundred and eleven WAG/Rij/MCW rats underwent 0 to 20 Gy TBI followed by syngeneic bone marrow transplant (BMT). Rats received either no drug or verapamil, enalapril, or captopril in the drinking water starting 9 days before TBI and continuing thereafter. Follow-up continued up to 55 weeks after TBI/BMT. No-drug irradiated animals developed significant proteinuria 6 weeks after TBI, were azotemic by 9 weeks after TBI, and were hypertensive by 13 weeks after TBI. Survival was inversely related to the dose of TBI. There was a dose-related reduction in proteinuria, blood pressure, and azotemia with increasing doses of captopril. At 500 mg/L, captopril was more effective than 50 mg/L enalapril in controlling proteinuria, blood pressure, and azotemia and in enhancing survival of irradiated animals. Verapamil, 700 mg/L, did not control proteinuria, blood pressure, or the development of renal failure and did not enhance survival when compared with no-drug irradiated animals. We conclude that angiotensin-converting enzyme inhibitors are beneficial in preventing radiation nephropathy and that control of proteinuria may be of particular importance in preventing progression of renal failure in this model.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1977

The effect of concomitant mercuric chloride and gentamicin on kidney function and structure in the rat.

In order to define the possible effects of gentamicin on the course of experimental acute renal failure, the interaction between gentamicin and mercuric chloride was studied in rats. Acute renal failure was induced with 1 mg. of HgCl2 per kilogram intravenously. When given alone, HgCl2 produced a uniform, reproducible, nonoliguric, acute renal failure with a low mortality rate. Animals receiving gentamicin over the course of HgCl2-induced acute renal failure, in doses sufficient to produce a 1 hour postinjection serum concentration of 10 mug/ml., recovered glomerular filtration in a fashion similar to animals receiving only HgCl2(p greater than 0.05). Animals that recovered from HgCl2-induced acute renal failure were given 10 mg./Kg. of gentamicin every 4 hours for 15 days and developed proteinuria and decline in urine osmolality to the same degree as animals given gentamicin alone, but failed to develop azotemia. Nevertheless, morphological changes associated with gentamicin nephrotoxicity were found which were similar in severity to those seen with gentamicin alone. Animals pretreated with 10 mg./Kg. of gentamicin every 4 hours for 7 days were then given HgCl2. Acute renal failure in these animals was more severe than in animals receiving HgCl2 alone, as manifest by a greater degree of azotemia and death (p less than 0.05). The data indicate that in the rat the concomitant administration of gentamicin did not interfere with recovery from HgCl2-induced renal failure. Rats recovering from HgCl2-induced acute renal failure were resistant to a depression in glomerular filtration when given gentamicin. The prior administration of gentamicin enhanced the nephrotoxicity of HgCl2.

Acute Kidney Injury↗
PubMed1996

Hospital-acquired acute renal failure in dogs: 29 cases (1983-1992).

OBJECTIVE: To assess factors associated with development of hospital-acquired acute renal failure (HARF) and to determine outcome of and prognostic indicators for dogs with HARF. DESIGN: Retrospective case series. ANIMALS: 29 dogs. RESULTS: The most common inciting causes for developments of HARF were exposure to a nephrotoxicant and advanced age. Mortality was 62%, and factors that contributed to mortality were age and initial urine output. Dogs > or = 7 years old and dogs that were initially oliguric had an odds ratio of mortality of 8.8 and 20, respectively. The effect of preexisting heart disease on mortality approached significance (P = 0.053). The magnitude of azotemia at the time of diagnosis was not related to the chance for survival. Dogs that died had a significantly higher initial anion gap and serum phosphorus concentration than did dogs that survived. We did not detect a relationship between cause of HARF and outcome (survived vs died or euthanatized). CLINICAL IMPLICATIONS: In most cases, HARF is associated with a poor outcome. Older dogs may be at increased risk for development of HARF, and once HARF has developed, have a greater chance of dying. Prognosis can not be determined on the magnitude of azotemia at the time of diagnosis or on the inciting cause of HARF.

Acid-Base Equilibrium↗
PubMed1996

Effect of treatment of hyperthyroidism on renal function in cats.

OBJECTIVE: To determine whether increases in BUN and serum creatinine (SCr) concentrations, which have been reported to develop after surgical bilateral thyroidectomy in hyperthyroid cats, also develop after treatment of hyperthyroidism with radioactive iodine and methimazole. DESIGN: Prospective, clinical trial. ANIMALS: 58 hyperthyroid cats. PROCEDURE: Urine specific gravity, SCr, BUN, and serum thyroxine (T4) concentrations were determined before and 30 and 90 days after treatment of hyperthyroidism with radioactive iodine, methimazole, or surgical bilateral thyroidectomy. RESULTS: Mean SCr and BUN concentrations determined 30 and 90 days after treatment were significantly higher than those measured before treatment. Mean SCr, BUN, and T4 concentrations were not different among groups before treatment or 30 and 90 days after treatment. CLINICAL IMPLICATIONS: Reduction of serum T4 concentrations after treatment of hyperthyroidism may result in azotemia in older cats with chronic renal disease. Treating azotemic hyperthyroid cats with methimazole until it can be determined whether correction of the hyperthyroid state will exacerbate the azotemia may be prudent.

Animals↗
PubMed1995

[Survival rates in patients with systemic lupus erythematosus].

To assess the impact of demographic and clinical factors on prognosis in patients with systemic lupus erythematosus (SLE), we examined the survival rate by lifetable analysis in 566 patients. All patients were Shanghai citizens who were diagnosed as having SLE in Huashan Hospital between 1959 and 1992. According to American Rheumatism Association's preliminary criteria. The survival rate from the time of SLE onset was 93% at 1 year, 73% at 5 years and 60% at 10 years. On univariate analysis, we found that the following factors worsened the probability of survival; male, neuropsychiatric manifestation, pleurisy-pericarditis, anemia, thrombocytopenia, lymphocytopenia, proteinuria, hematuria, urinary cast, azotemia, decreased endogenous creatinine clearance, increased cholesterol in serum, hypocomplementemia, abnormal electrocardiograph and high corticosteroid dose of treatment. On multivariate analysis, we found the four independent risk factors were male, azotemia, hypocomplementemia and high corticosteroid dose of treatment.

Adolescent↗
PubMed1996

The natural history of renal artery stenosis: who should be evaluated for suspected ischemic nephropathy?

Ischemic renal disease is defined as a clinically significant reduction in glomerular filtration rate in patients with hemodynamically significant renal artery stenosis. The most common etiology for this is atherosclerotic renal artery disease. The three major clinical settings in which one must suspect ischemic renal disease include acute renal failure precipitated by the treatment of hypertension particularly with angiotensin-converting enzyme inhibitors; progressive azotemia in a patient with known renal vascular hypertension treated medically; and unexplained progressive azotemia in an elderly patient with refractory hypertension and other evidence of atherosclerotic disease. Prevalence of ischemic renal disease secondary to atherosclerosis can be estimated from the incidence of atherosclerotic renal artery lesions leading to renal vascular hypertension and the natural history of these lesions. Autopsy series, arteriography studies, and review of populations of patients in end-stage renal disease programs all suggest that ischemic renal disease has a high and increasing prevalence in our aging population.

Angiography↗
PubMed1977

Renal tubular acidosis due to the milk-alkali syndrome.

A 60-year-old man with a history of excessive ingestion of calcium carbonate presented with azotemia, hypercalcemia and hyperphosphatemia. His acid-base status was initially normal. Following the cessation of calcium carbonate treatment, the hypercalcemia and azotemia disappeared, and the patient was found to be in metabolic acidosis with blunted acid excretion and a urine pH of 6.1. Kidney biopsy showed focal tubular calcification; the tubular damage was apparently caused by hypercalcemia and had resulted in renal tubular acidosis. During the three months of observation since that time there has been a tendecy for spontaneous remission of the renal tubular acidosis. Impaired renal hydrogen ion excretion prevented the development of metabolic alkalosis despite ingestion of alkali initially, and was later responsible for the metabolic acidosis. Renal tubular acidosis occurring as a sequel to the milk-alkali syndrome may aggravate the danger of nephrocalcinosis in this syndrome.

Acidosis, Renal Tubular↗
PubMed1996

Cutaneous epitheliotropic lymphoma in a ferret.

An 8-year-old spayed female ferret was examined for diffuse generalized alopecia, erythema, erosions, crusts, and ulcerated plaques that were nonresponsive to long-term administration of corticosteroids. Cutaneous epitheliotropic lymphoma was diagnosed on the basis of histologic examination of skin biopsy specimens. Neoplastic cells were determined to be of T-lymphocytic origin by results of immunohistochemical staining with a rabbit anti-CD3 monoclonal antibody. Additional laboratory abnormalities detected included anemia, azotemia, isosthenuria, pyuria, and bacteriuria. Treatment included isotretinoin and amoxicillin trihydrate plus clavulanate potassium administered orally, and oatmeal-based shampoos. Isotretinoin was tolerated well and cutaneous lesions resolved after 60 days of treatment, but pretreatment azotemia worsened and the ferret was euthanatized. Necropsy revealed cutaneous epitheliotropic lymphoma, pyelonephritis, and interstitial nephritis. Renal disease most likely was caused by immunosuppression secondary to chronic treatment with corticosteroids and aging. Isotretinoin, although not curative, may be useful for the palliative treatment of cutaneous epitheliotropic lymphoma in ferrets.

Amoxicillin↗