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Biomedical subjects

A Darnell

Publications and source records attributed to A Darnell.

At least 109 records · Page 6Linked to original sources
PubMed1981

[Prolonged hypotension after the first dose of atenolol (author's transl)].

A 30 year-old male patient with accelerated arterial hypertension relatively resistent to diazoxide received a single oral dose of 100 mg of atenolol, following which hypotension of more than 24 hours duration and acute renal failure ensued. These alterations were reversible and did not recur with subsequent doses of atenolol. Prior therapy with diazoxide might have potentiated the hypotensive action of atenolol. The abnormality could be due to a phenomenon of hyperreactivity to the first dose of atenolol, similar to what has been described following first doses of prazosin or labetalol. This observation suggests that atenolol therapy must be started with caution, especially in patients previously treated with diazoxide.

Acute Kidney Injury↗
PubMed1981

Acute and rapidly progressive forms of glomerulonephritis in the elderly.

This article presents a comparison of acute glomerular nephritis (AGN) with rapidly progressive glomerular nephritis (RPGN) in patients aged 60 or older. In 7 elderly patients with AGN, the renal disease was preceded by skin infection (4 cases), sore throat (2 cases), or pneumonia (1 case). The 7 patients with RPGN had no history of prior infection. Both AGN and RPGN were manifested clinically as acute renal failure, but the RPGN patients had significantly higher serum creatinine levels and lower hematocrit readings. Hypocomplementemia was a feature only of AGN. The biopsy specimens from patients with RPGN showed crescents in 50--100 percent of the glomeruli, whereas specimens from patients with AGN showed no significant extracapillary proliferation. Six AGN patients recovered and 1 died. Despite dialysis, 4 RPGN patients died and the remaining 3 require maintenance dialysis. It is concluded that AGN in the elderly is more common than previously believed, frequently follows skin infections, and has a reasonably good prognosis. In contrast, RPGN, also not rare in the elderly, has a much worse prognosis.

Acute Disease↗
PubMed1980

[Long-term hemodialysis in acute barbiturate intoxication (author's transl)].

From 1975 to 1978, ten patients were on long-term hemodialysis due to acute barbiturate intoxication. Duration of hemodialysis varied from 16 to 40 hours (mean 23 +/- 9.4 hours). Phenobarbital was the most common type of barbiturate ingested (6 out of 10 patients), and diazepam the drug most frequently taken in association with barbiturates (3 out of 10 patients). All patients were in a state of deep unconsciousness (coma II: 1 case; coma III: 5 cases; coma IV: 4 cases), and all of them required endotracheal intubation. Seven patients needed the assistance of automatic intermittent positive-pressure respirator. Two patients presented hypothermia, and another a peripheral collapse. Long-term hemodialysis was well tolerated without major complications. Significant decreases of barbiturate levels were obtained in all cases (before hemodialysis: 7.3 +/- 1.9 mg/dl, after hemodialysis: 1.8 +/- 1.2 md/dl, corresponding to the pattern of secobarbital used to refer the results). No correlation was observed between initial levels of barbiturates and number of hours of long-term hemodialysis required. Neurologic symptoms improved in all cases. Eight patients were conscious after hemodialysis had been discontinued, and only two patients remained unconscious (coma I). Intratracheal tube could be removed in six patients, but positive-pressure respirator could be took away from all cases. Complete recovery was achieved in eight patients. Two patients died on the 2nd. and 8th. postdialysis days due to respiratory distress. Long-term hemodialysis has proven of value in the treatment of severe barbiturate intoxication, particularly better to conventional hemodialysis.

Adolescent↗
PubMed1980

[Lupus nephritis: clinicomorphological manifestations (author's transl)].

Forty patients with systemic lupus erythematosus have been evaluated for clinicopathological evidence of renal involvement. Average age at the onset of the disease was 23 years; 90 percent of the patients were women. Indications for renal biopsy included clinical symptoms of nephropathy (34 patients) and signs of immunological activity (6 patients(. All biopsied specimens were examined under light microscope; 28 of them under immunofluorescence, and 18 under electron microscope. Histological classification was as follows: I) Normal kidney (2 patients); II) mesangial glomerulonephritis (6 patients); III) focal glomerulonephritis (10 patients); IV) diffuse proliferative glomerulonephritis (19 patients), and V) membranous glomerulonephritis (3 patients). Six patients had no clinical nephritis, two of them had normal kidneys and four had a mesangial glomerulonephritis. Patients in groups III, IV, and V showed clinical and biological evidence of renal involvement. Highest incidence of renal failure, nephrotic syndrome or high blood pressure was found among cases in group IV. Group IV accounted also for the highest mortality rate. Clinical course of 25 cases (1 of type II, 8 or type III, and 16 of type IV) on corticosteroid therapy for an average follow-up of 22.8 months has showed greater clinical improvement (proteinuria and renal function) of nephropathy type III than nephropathy type IV. Renal biopsy is a useful diagnostic and prognostic method in patients with systemic lupus erythematosus, even in those cases without clinical evidence of renal disease.

Adolescent↗
PubMed1980

[Hemolytic-uremic syndrome in the adult (author's transl)].

This article presents six cases of hemolytic-uremic syndrome, defined as the combination of acute renal insufficiency, microangiopathic hemolytic anemia, and thrombocytopenia, in six adult patients, two men and four women, between 20 and 52 years old. Three of the cases were considered idiopathic, two secondary to the use of oral contraceptives, and one appeared after an abortion. All of the patients presented severe hypertension, frequently accompanied by increased renin levels; in no cases was there any important coagulation disorder. In all of the biopsies there were lesions denoting intravascular thrombosis in the arterioles and medium-sized arteries of the kidney, as well as thickening of the glomerular basal membrane. Immunofluorescence was positive for fibrinogen and C3 in the majority of biopsies examined. Two patients suffered acute pancreatitis, hypertension having perhaps been an important factor in this complication. One of the two patients died as a result of acute hemorrhagic pancreatitis and was the only death in the series. Of the five remaining subjects, three required periodic hemodyalisis and the other two presented a considerable degree of chronic renal failure, which confirms that the prognosis for the hemolytic-uremic syndrome is much worse for the adult than for the child.

Adult↗
PubMed1980

Familial IgA nephropathy: report of two cases and brief review of the literature.

Immunoglobulin A nephropathy developed in two siblings who shared the DRw4 antigen but who were otherwise HLA-A, -B, and -C unrelated. It is suggested that a genetically induced alteration in the immune response can cause some of the cases of mesangial IgA glomerulopathy and that close blood reltaives of patients with this disease should be checked for the possible existence of renal abnormalities.

Adult↗
PubMed1979

[Nephrotic syndrome by diffuse mesangial sclerosis (author's transl)].

This case deals with a 15-month old male child affected with a nephrotic syndrome resulting in grave chronic renal failure, determined histologically as diffuse mesangial sclerosis. The most frequent causes of nephrotic syndrome in the first year of life are analyzed along wiht their diagnostic differential, with special attention to the Finish or microcystic congenital nephrotic syndrome and to diffuse mesangial sclerosis. In the discussion contradictions existing in the bibliography on diffuse mesangial sclerosis are shown in its clinical and developmental aspects as well as the prognostic and even in the pathological anatomy, which leads us to believe that this illness may be more complex than what it appears, and subdividing it into illnesses of different etiology, development and prognosis; or that some of the cases. described as such may not be the same as those described by R. Habib in 1973. In the present case the deposits of C3 and IgM are worth noting, as they were not described in the other 11 cases, also the study done with the electron microscope, which also was not done in the previous cases.

Complement C3↗
PubMed1979

Renin-induced massive proteinuria in man.

A 30 year old man developed renovascular hypertension and extreme elevation of plasma renin activity. Daily proteinuria ranged from 13 to 31 g. There were no criteria for the diagnosis of malignant hypertension. A primary glomerulopathy was excluded by a basically normal renal biopsy from the unprotected kidney. On electron microscopy the epithelial cell foot processes were not fused, thus ruling out simultaneous lipoid nephrosis. The source of renin was removed by means of a left nephrectomy. Following the procedure the patient became normotensive, the renin values normalized and the proteinuria disappeared. The results suggest that renin can cause significant proteinuria in man.

Adult↗
PubMedDate not supplied

Abdominal sonographic study of autosomal dominant polycystic kidney disease.

PURPOSE: The purpose of this study was to determine whether kidney size in patients who have autosomal dominant polycystic kidney disease (ADPKD) is related to renal function, hypertension, or extrarenal manifestations of the disease and to sonographically evaluate the abdominal manifestations of ADPKD. METHODS: Between 1994 and 1998, 400 individuals from 85 families with a history of ADPKD were examined. There were 213 persons with ADPKD and 187 unaffected family members; there were 182 males and 218 females, 1-82 years old (mean, 39.3 years). We obtained a complete medical history, performed a physical examination, measured the arterial blood pressure and serum creatinine levels, and performed abdominal sonography on each subject. The sonographic features that were studied were renal length and the presence and number of cysts on the kidneys, liver, and pancreas. RESULTS: There was a relationship between kidney size and age (p < 0.05), kidney size and renal function (p < 0.001), and kidney size and hypertension (p < 0.001). The overall prevalence of hepatic cysts in patients with ADPKD was 67%, and the prevalence increased with age. The presence of hepatic cysts was related to the severity of renal disease. Females had more severe polycystic liver disease, and massive polycystic liver disease (ie, hepatomegaly with innumerable cysts) was seen only in females. The prevalence of pancreatic cysts in the 187 persons in whom the pancreas was well evaluated sonographically was 5%. CONCLUSIONS: Kidney size in patients with ADPKD is related to renal function, hypertension, and extrarenal involvement and can be used to predict the outcome of the disease. Hepatic cysts are very common in patients with ADPKD and are related to age and renal function; pancreatic cysts are infrequent in these patients.

Abdomen↗