Reversible nephrotic syndrome due to mesangiocapillary glomerulonephritis secondary to hepatic hydatid disease.
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Aged↗
Biomedical subjects
A Covic
Publications and source records attributed to A Covic.
Interdialysis blood pressure control by long haemodialysis sessions.
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Blood Pressure↗
Analysis of blood pressure variability derived from ambulatory blood pressure monitoring in 92 uraemic patients.
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Blood Pressure↗
Echocardiographic findings in long-term, long-hour hemodialysis patients.
This article describes the echocardiographic structural and functional findings in a cohort of 30 patients on ten or more years of uninterrupted long-hour (24 hours per week dialysis schedule) hemodialysis (mean duration 187.7 months, range 120 to 299 months). Cardiac structural analysis was remarkable for the prevalence of LVH (76%), very rarely asymmetric (3%). Hemoglobin and (log) plasma renin activity were determinants of the LV wall thickness ratio (r = -0.57 and 0.54, p = 0.003 and 0.044 respectively). Markers of systolic contractile function were frequently normal (100% MVCFS; 85% FSI). Diastolic ventricular compliance was abnormal in 59% of patients. Blood pressure history appeared important in determining LVH, but office/ABPM measures of BP were not. Patients after parathyroidectomy (PTx) had a smaller LVPWTN (8.68 mm/m2 without PTx cf 7.01 mm/m2 after PTx, p = 0.036). Left ventricular cavity size was rarely enlarged (10%), with hemoglobin (r = -0.47, p = 0.012) and PTH (r = -0.65, p < 0.001) the major determinants of EDDN. Left atrial diameter was increased in 77% of patients. Cardiac valvular calcification was seen in 50% of patients. Our findings show that despite good BP control without recourse to antihypertensive drugs, LVH with good LV systolic function is very common in these long-survivors.
Aortic Valve↗
Adenosine effects upon the spontaneous quantal transmitter release at the frog neuromuscular junction in the presence of protein kinase C-blocking and -activating agents.
This paper gives experimental evidence involving protein kinase C (PKC) in the inhibitory effects of adenosine (ADO) upon the spontaneous transmitter release at the frog neuromuscular junction. In the presence of two PKC inhibitors--polymyxin B (5 x 10(-6) mol/l) and H-7 (10(-5) mol/l), both adenosine (5 x 10(-5) mol/l) and its stable analogue 1-PIA (5 x 10(-8) mol/l), significantly increased the rate of the spontaneous release of acetylcholine quanta. Even when PKC was activated with OAG (5 x 10(-6) mol/l) or TPA (162 x 10(-9) mol/l) and quantal release was increased greatly, ADO still inhibited release. ADO deaminase increased the PKC-induced activation of the transmitter release significantly.
1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗
Ambulatory blood pressure monitoring in nephrology: focus on BP variability.
As accurate assessment of hypertension in renal patients must be the cornerstone of better prevention of its deleterious effects, ambulatory blood pressure monitoring (ABPM) has become an essential clinical and research procedure in day to day nephrological practice. However, despite numerous studies in the renal literature, a consensus is needed for normal (desirable?!) ambulatory daytime and nighttime BP levels and for defining normal sleep BP dipping. Nevertheless, blunted sleep BP fall appears to be a ubiquitous finding in renal disease (primary renal conditions, chronic renal failure pre-dialysis, peritoneal and hemodialysis, and renal transplantation). Abnormal diurnal variability should be considered as an important contributor to cardiac and general morbidity as it is clearly associated with a faster decline in renal function and also with more cardiac structural and functional abnormalities - especially left ventricular dilatation. Several mechanisms have been proposed to explain the reduced BP circadian rhythm, but the majority of the supporting evidence is still contradictory. A novel, unifying hypothesis to be tested in future studies, is linking the common diurnal rhythm abnormalities with functional disturbances in aortic and carotid baroreflexes caused by uraemia-related large arterial structural changes (arterial intima and media thickening, arterial calcifications and increased arterial stiffness).
Blood Pressure↗
[Hypertension in chronic kidney failure (the physiopathology, clinical picture and treatment)].
Secondary hypertension in CRF is characterized by particular features; hemodynamics--abnormal high vascular peripheral resistance relative to the cardiac output level; circadian variability--absence of nocturnal physiological BP decline. Hypertension is the main risk factor for renal disease progression, irrespective of the underlying etiology, and is one of the major determinants of the impressive cardiovascular morbidity and mortality seen in uraemic patients (> 50% cases). The atherosclerotic risk and severe retinopathy are more important in CRF hypertension compared to other causes (including essential HTA) at similar BP levels. Treatment targets for renal patients should be less than 130/90 mmHg. The main treatment modality for ESRD hypertension are sodium and water removal through diet, diuretics and dialytic ultrafiltration. Pro's and con's of antihypertensive medication classes are discussed.
Combined Modality Therapy↗
[The surgical problems of continuous ambulatory peritoneal dialysis: 3 years of experience].
PURPOSE: This study presents the surgical problems of CAPD catheter insertion and mechanical complications in 37 cases (39 peritoneal dialysis catheters inserted for CAPD), being our experience along a time period of 3 years. MATERIALS AND METHODS: The catheters were of Tenckhoff-type, with double Dacron cuff (Fresenius Medicale Care). We used an open-type surgical procedure with spinal anaesthesia. RESULTS: In all the 8 cases with previous abdominal interventions the catheters were functional. We found an early catheter obstruction only in two cases, by means of a "greater omentum fimbriae". In the third case a partial omentectomy was performed. In 1 patient with parietal granuloma and frequent peritonitis a new peritoneal catheter was inserted (with a new tegumentary outlet). Hernia was found in 1 patient and was successfully cured by means of surgical intervention. This patient continued the CAPD treatment. In 2 cases we interrupted the CAPD treatment (one renal transplant; one converted to hemodialysis). 25 patients had no catheter-related complications. CONCLUSION: We wish to state that catheter occlusion and hernia must not lead to an abandon of CAPD treatment.
Catheters, Indwelling↗
How reproducible is diurnal blood pressure rhythm in patients with secondary (renal) hypertension?
Abnormalities (reduction in/absence of) in diurnal bp rhythm are much more commonly seen in patients with chronic uremia than in patients with primary hypertension or in normal subjects. Target-organ damage is greater in these patients. However, the extent to which these diurnal bp rhythm changes are consistent or variable is untested. We retrospectively examined 223 ambulatory blood pressure monitoring (ABPM) traces in 92 patients with chronic uremia who had undergone ABPM at least twice (mean 2.3 ABPM traces/patient) over the period 1991-1997. ABPM technique and analysis were constant over this period. We found that for patients with chronic declining renal function but not yet on dialysis therapy, 67% retained the same diurnal rhythm from one ABPM recording to the next; if the known tendency for declining renal function to accompanied by a greater prevalence of "non-dipping" is taken into account, 82% of all patients had a "predictable" diurnal pattern. 79% of transplant patients, 87% of haemodialysis patients and 100% of CAPD patients retained the diurnal rhythmicity from one ABPM session to the next. Non-dipping was much more frequent than dipping (67% vs 33%). We conclude that abnormalities of diurnal BP rhythm are reasonably consistent in patients with renal hypertension, especially as renal function declines and patients enter the renal replacement therapy programme.
Adult↗
[Continuous ambulatory peritoneal dialysis--the infectious complications. The experience of the Nephrology Clinic of Iaşi].
49 of 57 dialysis patients were included in CAPD programs. The age of these patients was ranged between 20-65 years. The mean dialysis interval was 19.7 months, the number of hospital admission being 182 (mean 1.7 +/- 1.2). The mean hospitalization interval was 26.2 +/- 2.0 days. The infectious abdominal wall complications included: exit site infections (10%), trumel infections (10%), properitoneal sepsis (21%). The inflammatory processes were resolved after conservator treatment using antibiotics and antiinflammatory drugs (8%). Catheter removal was necessary in 2% of cases and the passage to hemodialysis was decided in other 2%. Peritonitis occurred in 0.73% patients (1 episode per 6 months of CAPD). These clinical data are better than those reported since now.
Adult↗
[The evaluation of noninvasive samples for detecting anti-cytomegalovirus IgG antibodies].
Patients admitted in dialysis centers are at greatest risk to achieve blood-borne infections. One of the most frequent is the cytomegalovirus infection, acquired from transfused blood products. The aim of our study was to determine the prevalence of IgG anti-CMV in patients on dialysis at the "C. I. Parhon" Hospital from Iaşi (Romania). In addition, the role of non-invasive samples (saliva and capillary blood) for such epidemiological studies was determined. ELISA Wellcome anti-CMV IgG was used for identification of specific antibodies in serum, capillary blood, saliva. The prevalence of anti-CMV IgG in the group of study was higher than that established in general populations and 79.06% saliva specimens and 93.76% of capillary blood samples were positive. To establish the specificity, sensitivity and predictive values of Wellcome anti-CMV when non-invasive samples are used, we compared the results obtained by testing saliva and capillary blood to those obtained by testing serum. We may conclude that the non-invasive samples are useful for CMV-infection surveillance in risk groups.
Adult↗
[Post-rifampicin acute renal failure--serious, but seldom recognized complication of the anti-tuberculosis treatment].
Post-rifampicin (RMP) acute renal failure (ARF) is a complication seldom recognized of the antiTB treatment worldwide. The renal failure which occurs especially after intermittent administration of RMP is most frequent due to acute interstitial nephritis by allergic mechanism. In our study we found very few cases of acute tubular necrosis or glomerular lesions revealed by rapidly progressive glomerulo-nephritis or nephrotic syndrome. The renal lesions, accompanied by anuria and usually needing hemodialysis, were associated to auto-immune hemolytic anemia, trombocytopenia, hepatic failure and gastro-intestinal disturbances. The authors review their experience (60 cases), representing about half of the cases published worldwide. The main causes of this high prevalence of post-RMP ARF in Romania are discussed: intermittent twice-a-week RMP treatment, high incidence of TB, lack of compliance to treatment, possible contribution of some by-substances in RMP capsule. We described the clinic, biology and evolution of this dangerous and underestimated entity. We compared our experience with the published data, discussing the etiology and pathogenesis, trying to design the fine portrait of this ailment.
Acute Kidney Injury↗
[Renal osteodystrophy (I)].
Renal bone disease represents one of the major complications of end-stage renal disease, accounting for the numerous and various changes at bone level, determined by abnormal calcium and phosphorus homeostasis and by changes in calcitriol and PTH synthesis. PTH represents as well a major uraemic toxin, exerting profound systemic effects, particularly at the cardiovascular level. PTH synthesis is mainly controlled by changes in calcium-phosphorus balance and calcitriol production by the kidneys. Several others factors are important in the development of secondary hyperparathyroidism: acidosis, autonomisation of PTH secretion and peripheral (target-organ) resistance to PTH actions. Although bone biopsy represents the definitive diagnostic test to differentiate between osteitis fibrosa, low-turnover bone disease and bone involvement unrelated to disturbed calcium metabolism (i.e. beta 2-microglobulin-related amyloidosis), plasma intact PTH generally exhibits a reasonably good relation with bone histology parameters. Moreover serum bone-specific alkaline phosphatase isoenzyme, serum pyridinoline and the novel serum markers for bone turnover are highly specific and correlate with bone histomorphometry parameters, so that, preventive and therapeutic strategies should be re-evaluated based solely on biochemical parameters.
Alkaline Phosphatase↗
[Renal osteodystrophy(II)].
Renal bone disease represents one of the major complications of end-stage renal disease, accounting for the numerous and various changes at bone level, determined by abnormal calcium and phosphorus homeostasis and by changes in calcitriol and PTH synthesis. PTH represents as well a major uraemic toxin, exerting profound systemic effects, particularly at the cardiovascular level. PTH synthesis is mainly controlled by changes in calcium-phosphorus balance and calcitriol production by the kidneys. Several others factors are important in the development of secondary hyperparathyroidism: acidosis, autonomisation of PTH secretion and peripheral (target-organ) resistance to PTH actions. Although bone biopsy represents the definitive diagnostic test to differentiate between osteitis fibrosa, low-turnover bone disease and bone involvement unrelated to disturbed calcium metabolism (i.e. beta 2-microglobulin-related amyloidosis), plasma intact PTH generally exhibits a reasonably good relation with bone histology parameters. Moreover serum bone-specific alkaline phosphatase isoenzyme, serum pyridinoline and the novel serum markers for bone turnover are highly specific and correlate with bone histomorphometry parameters, so that, preventive and therapeutic strategies should be re-evaluated based solely on biochemical parameters.
Chronic Kidney Disease-Mineral and Bone Disorder↗
[Prognosis and treatment of membranous glomerulonephritis-a 5-year prospective study].
UNLABELLED: The aims of the study were to describe the clinical, pathological and biological features of membranous GN and to prospectively evaluate the relationships between individual negative prognostic factors--type of therapy and outcome. Between 1993-1998, 13/150 (8.7%) consecutive patients with renal biopsy had membranous GN (M = 62%, age = 42.5 +/- 14.5 years). Main (major) findings in these patients were: asymptomatic proteinuria--23.1%, heavy proteinuria (> 10 g/day)--33.3%, microscopic hematuria--53.8%, increased plasma creatinine levels--33.3%, hypertension--23.1% cases. 60% of the patients with nephrotic proteinuria had an underlying cause (infection, malignancy, immune-mediated systemic diseases). 40% of the patients with nephrotic proteinuria had 0 or less than 2 negative prognostic factors (without any of the recognized severe morphological changes). The following differentiated treatment protocols were applied: no treatment for asymptomatic proteinuria (group A), i.v. methyl-prednisolone boluses + prednisone 1 mg/kgc/day 3 months for those patients with few negative prognostic factors (group B), and steroids (as above) + cyclophosphamide (2 mg/kgc/day 3 months) or the Ponticelli regime in patients with important risk factors (group C). Outcome after a median follow-up period of 24 months was: complete remission in all cases from groups A + B (with only one exception were the underlying cause was breast malignancy); in group C in 75% of the subjects a complete or partial remission (proteinuria < 1 g/day) was obtained. Only one case progressed to chronic renal failure. There were no secondary effects from corticoids or immunosuppressive therapy. CONCLUSIONS: In membranous GN treatment should be tailored to the presence and type of negative prognostic factors. Even in high-risk patients combined steroids and immunosuppressive therapy determines a favorable outcome in 75% of the cases, without severe adverse effects.
Adult↗
[The cardiovascular risk after renal transplantation (1): Hypertension and left ventricular hypertrophy].
Cardiovascular disease is the main cause of death in end-stage renal failure treated by hemodialysis or peritoneal dialysis. Though reduced in renal transplant recipients compared to the dialysis population, an excess cardiovascular mortality is still present after transplantation. The authors are reviewing the main data on mortality in the renal transplant population, focusing on major risk factors: hypertension, left ventricular hypertrophy. Chronic immunosuppression is also discussed in this context, as a major determinant of blood pressure elevation after renal transplantation. The presence of these factors and the extent of cardiac and vascular abnormalities in the dialytic patient are closely related to outcomes in the post-transplant period. It is thus mandatory to approach and minimize all these in the dialytic and even predialytic period of chronic renal failure in order to reduce renal transplant mortality in patients with functioning grafts.
Humans↗
[Cardiovascular risk after renal transplantation(II): ischemic heart disease, hypercholesterolemia, hyperhomocysteinemia and smoking].
Cardiovascular disease is the main cause of death in end-stage renal failure treated by hemodialysis or peritoneal dialysis. Though reduced in renal transplant recipients compared to the dialysis population, an excess cardiovascular mortality is still present after transplantation. The authors are reviewing the main data on mortality in the renal transplant population, focusing on major risk factors: ischaemic heart disease, hypercolesterolemia, smoking, hyperhomocysteinemia. The presence of these factors and the extent of cardiac and vascular abnormalities in the dialytic patient are closely related to outcomes in the post-transplant period. It is thus mandatory to approach and minimize all these in the dialytic and even predialytic period of chronic renal failure in order to reduce renal transplant mortality in patients with functioning grafts. Finally, an algorythm in managing cardiovascular disease pre- and post-transplantation is proposed.
Algorithms↗
[Permanent cardiac pacing for chronic symptomatic atrioventricular block in uremic hemodialysed patients. A prospective study].
Though sudden cardiac death accounts for as much as 15% of all cause mortality in uremia, reports concerning advanced A-V block, requiring permanent cardiac pacing in end-stage renal disease (ESRD) hemodialysed (HD) patients are very few. This is the first long term prospective study reporting on systematic permanent pacemaker implantation, in a cohort of ESRD patients from a single HD unit. Between 01/06/1997 and 30/12/2001, 396 pacemakers were inserted for advanced, symptomatic A-V block in our institution, including 5 in ESRD, HD patients (M/F--4/1, age 47-73, M +/- SD--61 +/- 12 years) from a single dialysis center, treating 137 patients during the study period. Thus, the incidence and prevalence of A-V defects treated by permanent pacing in uremic patients was 0.81% and 3.65% respectively. Conversely, the incidence and prevalence of ESRD treated by hemodialysis, among patients with advanced A-V conduction disturbances, requiring permanent pacing were 0.28% and 1.26%. Mitral valve calcifications were present in all patients; 3 subjects also had extensive aortic valve calcifications. Left ventricular hypertrophy (echocardiographic Framingham criteria) was present in 4 patients, but the systolic function (ejection fraction and fractional shortening index) was normal in all cases, although a clinical picture of chronic heart failure was seen in 3 subjects preoperatively. A-V conduction defects were attributed to extensive metastatic calcifications, involving the cardiac squeleton, consecutive to severe hyperparathyroidism and inadvertent use of calcitriol and calcium carbonate as phosphate binders. No technical difficulties, short or long-term complications related to pacemaker implantation (4 VVI and 1 VVD devices) were encountered. Acute threshold and sensing values were similar with those of non-uremic patients. During follow-up, one patients died from a non cardiac death. If optimal hemodialysis is provided, benefits of permanent pacing are equal in uremic or non uremic patients and pacemaker implantation should be instituted as a prompt life-saving method in all dialysis patients with chronic symptomatic advanced A-V blocks.
Aged↗