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Effects of growth hormone on kidney function in pediatric transplant recipients.

Recent evidence suggests that treatment with recombinant human growth hormone (rhGH) after a successful kidney transplant improves the growth rate of children with short stature. We prospectively investigated eight children (6 boys, 2 girls), focusing on acute rejection episodes and changes in serum creatinine levels during rhGH treatment. The children (mean age 11.6 +/- 3.4 years) received rhGH daily (0.04-0.05 mg/kg subcutaneously). Seven patients completed at least 12 months (20 +/- 8 months) of rhGH treatment. Their mean serum creatinine level was 1.3 +/- 0.7 mg/dl 12 months before, and increased to 3.4 +/- 4.2 mg/dl after 12 months of rhGH treatment, but did not achieve statistical significance (P = 0.06). Their mean calculated glomerular filtration rate was 58 +/- 20 ml/min per 1.73 m2 12 months before, and decreased to 38 +/- 21 ml/min per 1.73 m2 after 12 months of rhGH treatment, but did not achieve statistical significance (P = 0.08). Of the seven patients, two developed acute rejection after 5 and 6 rejection-free years; three lost their grafts and returned to dialysis. These preliminary observations describe untoward renal events in children receiving rhGH treatment after a kidney transplant.

Adolescent↗

Effect of continuous subcutaneous insulin infusion on kidney function and size in IDDM patients: a 2 year controlled study.

Glomerular filtration rate (GFR), renal plasma flow (RPF), kidney volume, and urinary albumin excretion rate were measured in 24 insulin-dependent diabetics, aged 29 +/- 7 years (mean +/- SD) with diabetes duration of 8 +/- 4 years who were randomly allocated to either continuous subcutaneous insulin infusion (CSII) (n = 12) or unchanged conventional insulin treatment (CIT) (n = 12). GFR, RPF, and kidney volume were identical but significantly increased above normal values in the two groups at the start of the study. After 24 months of CSII treatment, significant reduction in GFR was seen compared to pretreatment values (145 +/- 21 ml/min vs 139 +/- 21 ml/min, 2p less than 5.0%). However, RPF was not reduced after 24 months of CSII treatment (608 +/- 104 ml/min vs 601 +/- 106 ml/min). In the CIT group no changes in GFR or RPF was seen, and kidney volume remained unchanged in both groups; urinary albumin excretion was normal or near normal in both groups and remained unchanged. Thus, improved glycemic control in long-term IDDM patients is associated with normalization (reduction) of renal "hyperfunction," but despite this, no reduction was seen in the associated nephromegaly.

Adult↗

[The partial recovery of kidney function in chronic uremia patients during hemodialysis treatment].

Out of 432 patients placed on the treatment with hemodialysis (HD) for terminal renal failure (TRF) at the All-Union Nephrologic Center from January 1, 1978 to December 31, 1987, 17 patients manifested partial recovery of renal function, which enabled dialysis treatment to be discontinued for a time. Among the 17 patients with noticeable improvement of renal function, 8 presented with lupoid rapid-progressing glomerulonephritis (RPGN), 2 with RPGN associated with hemorrhagic vasculitis, 1 with idiopathic RPGN, 4 with chronic glomerulonephritis (CGN), 1 with chronic pyelonephritis, and 1 with polycystic kidneys. In 11 patients with RPGN, the rate of renal failure progression, expressed by the regression coefficient, was much higher among those in whom HD treatment was discontinued that in the group of patients without renal function recovery. In the 4 patients with CGN, renal function was recovered after the correction of marked disorders of purine metabolism, whereas in the 1 patient with chronic pyelonephritis and in the 1 with polycystic kidneys after urinary infection elimination. According to the ultrasonography data, out of the 17 patients with partial recovery of renal function, the size of the kidneys turned out normal in 14 patients.

Chronic Disease↗

[The assessment of kidney function based on renal scintigraphy data with 99mTc-DMSA].

Renoscintigraphy with 99mTc-DMCA with regard to a percentage of an RP uptake by the kidney was performed in 70 patients with uronephrological lesions before operation. A close relationship was established between a percentage of a 99mTc-DMCA uptake by the kidney on the 3rd hour after RP administration and values of the effective renal plasma flow, calculated on the basis of the results of renoscintigraphy with 131I-hippuran. Comparison of the 99mTc-DMCA uptake percentage values on the 3rd and 24th hours in patients with marked lesions of renal tubular functions has shown a high degree of correlation, permitting the recommendation of quantitative renoscintigraphy on the 3rd hour. Analysis of the specific percentage of the RP uptake, calculated for 1 cm2 of the visualized renal parenchyma, makes it possible to increase on the average by 29% the detection of renal function in uronephrological patients.

Adult↗

Is Ace inhibitor treatment a possible cause of better cardiovascular remodelling in well functioning kidney transplant?

Diseases of the cardiovascular system are a common cause of death in renal transplanted patients. In this study we assessed the echocardiographic morphological and functional findings after renal transplantation of two homogenous groups of transplanted patients with normal renal function. The first (A) with spontaneously normotensive patients, the second (B) with moderate hypertension treated mainly with Ace inhibitors. Analysis of these data highlights two noteworthy results: the similar left ventricle hypertrophy found in both groups and the existence of better diastolic compliance among the hypertensive transplanted patients. If this is confirmed by studies currently in progress, the importance of Ace-inhibitors treatment in remodelling cardiac dysfunction after long term dialysis treatment might be seriously considered.

Adult↗

Erythrocyte Na+,K+,Cl- cotransport and kidney function in essential hypertension.

OBJECTIVE: To determine whether essential hypertensive patients with high Na+,K+,Cl- cotransport (COT) display alterations of some indices of kidney tubular reabsorption similar to those observed in Milan hypertensive (MHS) rats, which have high COT in both erythrocytes and kidney tubular cells, and hypertension caused by a primary increase of tubular reabsorption. DESIGN: Two sets of experiments were performed. First, renal function in two subgroups of hypertensive patients (one with 'high' and one with 'normal' COT was compared with that in normotensive controls. Secondly, the natriuretic and diuretic effects of a single oral dose of frusemide (25 mg) were analysed in six high- and in six normal- COT hypertensive patients. RESULTS: Compared with normotensives and with normal-COT hypertensives, high-COT hypertensives had lower fractional uric acid excretion and plasma renin activity with similar glomerular filtration rate and urinary sodium and potassium excretion. COT was negatively correlated with fractional uric acid excretion in the essential hypertensive patients but not in the normotensives. The diuretic natriuretic response to frusemide was much higher in high- than in normal-COT hypertensives. CONCLUSION: These results are consistent with the hypothesis that patients with high COT have abnormal renal handling of sodium similar to that observed in MHS rats.

Adult↗

[Improvement in the informativeness of diuretic kidney function scintigraphy by calculation of a washout index].

Diuresis renography after administration of 123I-(131I-)Hippuran of 248 patients (492 kidneys) were compared retrospectively with clinical findings, history, i.v. urography, and ultrasound examinations. A new wash-out-index was calculated. In cases with obstructive dilatation of the collecting system this index was smaller than 0.9. If it was 0.9 to 1.2 additional diagnostic procedures seem necessary. An index more then 1.4 excludes obstruction. The shape of the renogram curve after furosemide is important for the diagnosis too. A concave shape was found in non-obstructive dilatation, a convex shape in obstructive dilatation of the renal pelvis. The wash-out-index is a reliable parameter if cases with reflux, lower ureteral obstruction and shrunken kidneys are excluded.

Humans↗

Effects of immediate blood flow enhancement on the postischemic kidney: functional, morphologic, and biochemical assessments.

Our purpose was to assess the influence of blood flow enhancement to the immediate postischemic kidney on tubular cell energetics and on the severity of the resulting ischemic acute renal failure (IARF). Female Sprague-Dawley rats were subjected to 40 minutes of bilateral renal artery occlusion (RAO). Half of the rats received a 5% body weight infusion of iso-oncotic saline solution (IOS; over 50 minutes) to acutely increase renal blood flow (RBF) immediately after vascular clamp release. The remaining half of the rats served as controls. The short-term effects (0 to 1 hour after vascular reflow) of IOS infusion on RBF, clearance iothalamate sodium (Cioth), urine Na excretion (UNaE), urine flow rate, tubular metabolic work (renal oxygen consumption, Qo2), adenine nucleotide concentrations, and renal histologic findings were assessed. The severity of the IARF (Cioth histologic findings) was also compared between the IOS-treated and the control groups 24 hours later. Postischemic (0 to 1 hour) RBF in control IARF rats and IOS-treated IARF rats was 2.3 +/- 0.3 and 13.6 +/- 0.4 ml/min, respectively (P less than 0.01) (normal RBF 6.1 +/- 0.4 ml/min). At 0 to 1 hour after reflow IOS-treated IARF rats had significantly higher Cioth (13 X), UNaE (18 X), urine flow (18 X), and Qo2 (4 X) than the control IARF group. Despite the fourfold increase in aerobic tubular work induced by IOS infusion, renal adenosine triphosphate (ATP) content did not decrease. At 24 hours after vascular reflow the severity of IARF was the same in the control and IOS-treated groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗

Association between serum homocysteine and markers of impaired kidney function in adults in the United States.

BACKGROUND: Circulating homocysteine, a risk factor for cardiovascular disease (CVD), is often elevated in chronic kidney disease and end-stage renal disease (ESRD) patients. Little is known about the risk of elevated homocysteine associated with less advanced renal insufficiency in the community. METHODS: Serum homocysteine concentration measures (umol/L) from the National Health and Nutrition Examination Survey (NHANES) 1991-1994 participants who were aged >/=40 years and fasted >/=6 hours (1558 men and 1829 women) were categorized as <9, 9 to 11.9, 12 to 14.9, and >/=15. Renal function levels were determined by Modified Diet in Renal Disease (MDRD) estimated glomerular filtration rate (GFRest) (mL/min/1.73 m(2)) and the urinary albumin-to-creatinine ratio (ACR) (mg/g). Cumulative odds ratios (OR) of exceeding any given homocysteine cut point were computed by gender, using ordinal logistic regression. Each model included GFRest (<60, 60 to 90, >/=90), ACR (<15, 15 to <30, >/=30), age, race/ethnicity, red blood cell folate, serum vitamin B(12), and dietary vitamin B(6) intake as independent variables. RESULTS: The adjusted ORs for elevated homocysteine risk were 9 to 11 times greater in adults with the lowest GFRest levels (<60 mL/min/1.73 m(2)) compared to those with normal GFRest levels. Association measures for marginal GFRest levels (60 to 90 mL/min/1.73 m(2)) were weaker but significant. Albuminuria (ACR >/=30 mg/g) was a significant, independent renal risk factor for elevated homocysteine in men and women (adjusted OR = 1.78, 95% CI 1.08-2.93, and adjusted OR = 1.83, 95% CI 1.21-2.76, respectively) relative to those with low normal albumin excretion, but high normal albuminuria (ACR = 15-30 mg/g) was not. CONCLUSION: In the general population, renal insufficiency is strongly associated with an increased risk of elevated circulating homocysteine, independent of B vitamin status. These results raise the possibility that elevated homocysteine may be an important risk factor to explain the heavy burden of CVD associated with kidney disease.

Adult↗