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Biomedical subjects

B G Danielson

Publications and source records attributed to B G Danielson.

At least 109 records · Page 6Linked to original sources
PubMed1984

Peritonitis in patients on continuous ambulatory peritoneal dialysis. A changing scene.

Peritonitis is a serious and common complication in patients treated with continuous ambulatory peritoneal dialysis (CAPD). This work reports the experiences of this complication in 50 patients treated with CAPD for a total time of 844 months. 129 episodes were observed. Coagulase-negative staphylococci were found to be the causative organisms in 57% of the cases. Most episodes were acquired without any evident cause when CAPD was performed at home. Nine episodes were suspected to be the result of bacterial leakage through the intestinal wall. Six of them occurred in patients receiving corticosteroids. During the study period an increasing number of episodes of peritonitis were caused by organisms with multiple resistance to antibiotics. Thus, the microbiological spectrum in CAPD-related peritonitis must constantly be surveyed so that proper measures, e.g. regarding the choice of antibiotics used, can be taken when a change is observed.

Adult↗
PubMed1984

Enalapril treatment in a patient with impaired renal function and intolerance to captopril.

In a 36-year-old woman with malignant hypertension and moderate renal insufficiency from nephrosclerosis normotension was not achieved by the combination of a beta-blocker, a vasodilator, and a loop-diuretic. The angiotensin-converting enzyme (ACE) inhibitor captopril was then added to the therapy. The blood pressure control was good. However, due to adverse reactions, captopril had to be withdrawn. Later on, the patient was successfully treated with enalapril, another ACE inhibitor, without the relapse of any adverse reactions.

Adult↗
PubMed1984

An investigation of biochemical and radiographic signs of hyperparathyroidism in chronic renal disease.

One hundred and twelve randomly selected patients with renal disease (22 on conservative treatment, 35 on haemodialysis and 55 with functioning kidney transplants) were subjected to a longitudinal and follow-up study of biochemical and radiographic signs of secondary hyperparathyroidism (HPT). Special interest was directed towards diagnostic criteria leading to the decision to perform parathyroid surgery, which had been undertaken in 18 patients. The five patients selected for parathyroidectomy while on conservative treatment were clearly distinguishable from the rest of the patients in this group, on the basis of hypercalcaemia, massive elevation of serum parathyroid hormone and radiographic abnormalities, findings which did not occur in patients in whom parathyroid surgery had not been considered. Six patients underwent parathyroidectomy while on haemodialysis. Preoperatively hypercalcaemia was observed in five and this was the only finding separating these patients from non-operated patients. Radiographic abnormalities were observed in only one operated patient. After kidney transplantation, long-standing hypercalcaemia was observed in 27% of patients. Seven patients underwent parathyroidectomy, hypercalcaemia being the indication for surgery in all cases. Hypercalcaemic patients could not be separated from normocalcaemic patients regarding any other determined biochemical variable, or regarding the incidence of osteonecrosis of weight-bearing joints, which was found in 18% of transplanted patients, and which was the only cause of major symptomatic bone disease observed in this study. The findings of hypercalcaemia as a major deciding factor for parathyroid surgery, a low incidence of radiographic bone disease, and absence of major symptomatic bone disease referable to HPT, are in keeping with a more liberal attitude to parathyroidectomy in chronic renal disease than has been stated in other recent reports. With a more expectant attitude and with more active medical treatment some of the operations performed on the patients in this study might have been avoided but, in general, the favourable outcome after surgery and the low overall incidence of clinical problems referable to bone disease at our unit would seem to support our active approach to parathyroid surgery.

Adolescent↗
PubMed1983

Ambulatory diagnostic evaluation of 389 recurrent renal stone formers. A proposal for clinical classification and investigation.

389 consecutive renal stone formers (275 males, 114 females) were investigated in an out-patient stone clinic. Renal tubular acidosis (RTA) was found in 83 patients (22%). Proximal RTA was twice as common as the distal tubular type. The acidification defects were exclusively of the incomplete form with normal basal blood acidbase status. Main diagnoses besides RTA were primary hyperparathyroidism (3.5%), medullary sponge kidney (3.5%), infection induced stones (3%), urate stones (2%), intestinal disorder (1.5%) and cystinuria (0.5%). The metabolic evaluation was mainly based on 24 h urine sampling on a free diet. In 248 patients (64%) no distinct abnormality was considered to be primarily responsible for stone formation. Clinical and biochemical analysis of these so-called idiopathic stone formers disclosed a male preponderance (80%) and, compared to a non-stone-forming control group, a higher urinary calcium excretion, yet with a considerable overlap between the two groups. Hyperuricosuria and hyperoxaluria were rare findings. The conclusion of the study is given as a proposal for clinical classification and ambulatory investigation of renal stone formers.

Adolescent↗
PubMed1983

Uricemia and urinary acidification in renal calcium stone disease.

Serum urate concentrations were determined in 487 consecutive patients with stone disease and in 89 controls. Male controls had higher concentrations than female controls but men and women with stones had lower concentrations than controls. Renal acidification defects, incomplete and complete forms, were found in 25 per cent of the patients with stones, with the highest frequency in patients with hyperuricemia. Patients with proximal renal acidification defects had a higher serum urate concentration than patients with normal acidification of the urine. The urinary excretion of urate was higher in hyperuricemic than in normouricemic patients but lower in patients with hyperuricemia and renal acidification defects than in those with hyperuricemia and normal acidification of the urine. This finding indicates that underexcretion rather than overproduction contributes to the higher serum urate concentration in patients with renal acidification defects. Stone patients with high serum urate levels, especially in combination with renal acidification defects, had more severe stone disease and underwent more operations than other patients with stones. Thus, hyperuricemia does not appear to be a common feature in patients with calcium stone disease, although it is associated with formation of large stones for unknown reasons.

Adult↗
PubMed1983

The influence of a high dietary intake of purine-rich animal protein on urinary urate excretion and supersaturation in renal stone disease.

1. Eight recurrent renal stone-forming patients were housed in a metabolic ward and fed on a low (LPD) and a high (HPD) animal protein diet, which were isoenergetic. Metabolic studies were made after 2 weeks on each diet. 2. There was a 90% increase in urinary urate on HPD compared with LPD, whereas serum urate did not change consistently. 3. The urinary acid excretion increased by 200%, including a 100% increase in ammonium ion excretion. A fall in urine pH by 0.9 unit was also seen. 4. The calculated ion activities of the urines revealed a profound increase in the uric acid supersaturation, from undersaturation to supersaturation, and in some cases even surpassing the formation product ratio. The ammonium urate supersaturation also increased. The sodium urate supersaturation was unchanged, despite an induced natriuresis. 5. The risk of forming uric acid or ammonium urate crystals or stones in the urine was increased on a high protein diet, whereas the risk of forming sodium urate crystals was no greater than on a low protein diet. 6. As uric acid and ammonium urate crystals under certain conditions may adsorb a macromolecular fraction of the human urine, which inhibits calcium oxalate crystal growth, it is proposed that this mechanism, along with a decrease in urine pH, may also interfere with the inhibitory activity of calcium oxalate crystal growth and aggregation.

Adult↗
PubMed1983

Clinical outcome of 50 patients started on continuous ambulatory peritoneal dialysis in a Swedish centre.

The outcome of the first 50 patients started on Continuous Ambulatory Peritoneal Dialysis (CAPD) in one centre is reported. The total treatment time was 779 months. Ten patients died while on CAPD. Thirteen patients were transplanted, 4 of whom returned to CAPD after graft failure, 7 were transferred to other forms of dialysis and one to another centre. Twenty-three patients remained on the method. Good control of the symptoms and biochemical parameters of uremia was achieved. The patients were content with a high degree of well-being and freedom from dietary and fluid restrictions. The costs were found to be low. Peritonitis was a major complication, accounting for one death and four transfers to hemodialysis. The total incidence was one episode per every sixth patient month. CAPD represents an important contribution to the treatment of chronic renal failure. Nevertheless peritonitis remains a serious problem and the long-term metabolic effects of CAPD are unknown.

Adult↗
PubMed1983

Comparison of two catheters for peritoneal access in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

The results obtained by means of the Tenckhoff and the Toronto Western Hospital-type (TWH) indwelling catheters for peritoneal access in patients undergoing Continuous Ambulatory Peritoneal Dialysis are reported. Fifty-nine Tenckhoff catheters were used for 592 months and 24 TWH-type for 220 months. One-year catheter survival was 71% in the Tenckhoff group and 77% in the TWH group. The difference does not reach statistical significance. Moreover no statistically significant differences as regards complications could be found between the two catheter types. A major disadvantage was noted with the TWH catheter: on two occasions TWH catheters could not be removed without a laparotomy, being firmly adherent to the intestine or omentum. It is concluded that the TWH catheter is not a superior alternative to the Tenckhoff catheter for peritoneal access in patients undergoing Continuous Ambulatory Peritoneal Dialysis.

Adult↗
PubMed1983

Dietary animal protein and urinary supersaturation in renal stone disease.

Eight stone-forming patients were given diets that were high (HPD) and low (LPD) in dietary animal protein, each for two weeks. Urines were collected by the end of each diet period. Urinary calcium, phosphate, urate and acids were increased on HPD whereas citrate and urine-pH decreased. The urinary supersaturation and thereby the risk of forming crystals and stones of uric acid and ammonium urate was increased on HPD. The supersaturation of calcium oxalate was unchanged, but the inhibition of calcium oxalate crystallisation may have become unfavourably affected.

Calcium↗
PubMed1982

Urinary excretion of urate in renal calcium stone disease and in renal tubular acidification disturbances.

The 24-hour urinary excretion of urate was investigated in 467 consecutive stone formers - 350 males and 117 females - and 89 apparently healthy controls with no history of stone disease. Males had a higher urinary excretion of urate than females but there was no difference between stone formers and controls. Urinary urate decreased with advancing age. Patients with a proximal tubular acidification defect had a lower urate clearance than patients with a normal acidification of the urine. Patients with hyperuricosuria presented a higher frequency of stone operations but a lower stone episode rate than matched normouricosuric stone formers. Hyperuricosuria in combination with renal acidification defects was associated with the highest frequency of stone operations. Hyperuricosuric patients also had a higher excretion of calcium than normouricosuric patients. Hyperuricosuria is not a common feature of calcium stone disease but when present is associated with a more severe stone disease in terms of stone operations.

Acidosis, Renal Tubular↗
PubMed1982

Effects of bendroflumethiazide on urate metabolism during treatment of patients with renal stones.

Treatment with bendroflumethiazide (2.5 mg, twice daily with potassium supplements) in 63 patients with calcium-containing renal stones for a minimum period of 1 year (average duration of treatment 2.6 years) increased the serum urate values in all patients with an average of 90 mumol./l. (conversion factor: 1 mmol. urate = 183 mg.). Despite this the mean urinary urate excretion was unchanged. In the individual patient a systematic effect of therapy was evident since in patients with low pretreatment values the thiazide increased the urate output while in those with the highest levels before therapy it caused a reduction. In most patients there was a reduction of the urate clearance during therapy, which was most evident in those with the highest pretreatment clearance values. In patients with incomplete types of renal acidification defects the same effects were seen on urate metabolism during thiazide treatment as in the other, idiopathic, stone formers. Although the possible role of urate in calcium stone formation has not been definitely settled this study shows that thiazides do not cause hyperuricosuria and hence their beneficial effects on calcium excretion are not counteracted.

Adult↗
PubMed1982

Inhibitory activity of human urine on calcium oxalate crystal growth: effects of sodium urate and uric acid.

1. Freshly voided urine from healthy subjects was pooled and ultrafiltered (10,000 daltons). The ultrafiltrable and the macromolecular portions were preincubated with calcium oxalate, uric acid and sodium urate crystals and the effects on the inhibitory activity of calcium oxalate crystal growth assessed by monitoring the disappearance of [14C]oxalate from the solution. 2. The inhibitory activity of the ultrafiltrate was higher than that of the urinary macromolecular fraction. Both uninhibited and inhibited crystal growth processes followed second-order kinetics. 3. Calcium oxalate crystals adsorbed almost all the urinary macromolecular inhibitors whereas sodium urate or uric acid crystals adsorbed only 10-20%. 4. In the presence of a metastable solution of calcium oxalate, the incubation of the urinary macromolecular fraction with sodium urate crystals caused a pronounced reduction in the inhibitory activity. A similar effect was seen with uric acid crystals, but to a lesser degree. 5. We conclude that the effect of sodium urate or uric acid crystals alone on naturally occurring urinary macromolecular inhibitors of calcium oxalate crystal growth is weak, but that in the presence of metastable calcium oxalate this is greatly enhanced. A substantial adsorption of the inhibitors on to the crystals is suggested, possibly secondary to epitaxial growth of calcium oxalate on the surface of the urate crystals.

Calcium Oxalate↗
PubMed1982

Effects of magnesium hydroxide in renal stone disease.

Magnesium is a known inhibitor of the formation of calcium oxalate crystals in the urine and was proposed for prophylactic treatment in renal stone disease as early as the 17th and 18th centuries. We have treated 55 patients with recurrent renal calcium stone disease without signs of magnesium deficiency (normal serum magnesium, urinary magnesium, intracellular magnesium in muscle biopsies, gastrointestinal absorption of 28Mg, and magnesium loading test) from our outpatient stone clinic for up to four years with 500 mg Mg2+, in the form of Mg(OH)2, daily. The mean stone episode rate before therapy was 0.8 stones/year/patient. Forty-three recurrent renal calcium stone-formers without medical therapy served as controls. Serum magnesium increased initially but after one year returned to the pretreatment level. Urinary magnesium excretion increased promptly and remained elevated during the follow-up period. The urinary calcium excretion remained unchanged. The magnesium/calcium ratio in the urine increased and approached a value earlier found in healthy subjects without stone disease. Urinary citrate increased on therapy when analysed after three years of treatment. The mean stone episode rate decreased from 0.8 to 0.08 stones/year on treatment and 85% of the patients remained free of recurrence during follow-up, whereas 59% of the patients in the control group continued their stone formation. Side effects were few. Magnesium treatment in renal calcium stone disease is effective with few side effects. No clinical signs of magnesium excess were observed.

Adult↗
PubMed1982

Renal handling of urate in patients with calcium stone disease.

The renal handling of urate was investigated in 28 recurrent calcium stone formers and 12 healthy controls. 12 patients were hyperuricosuric and 16 patients had incomplete proximal or distal acidification defects. Measurements of the glomerular filtration and the tubular reabsorption of filtered urate were made through the pyrazinamide (PZA)-suppression test of urate secretion. Hyperuricosuria could not be explained by defects in the renal handling of urate. Patients with proximal acidification defects had a higher tubular reabsorption of filtered urate than the other subjects. Tubular reabsorption of filtered urate was inversely correlated, and filtered urate escaping reabsorption positively correlated to the 24-hour excretion of urate. In contrast, the PZA-suppressible fraction of urate excretion, which is the net effect of tubular secretion and post-secretory reabsorption and thought to be the main regulator of urate excretion, was not correlated to the 24-hour excretion of urate. It is concluded that the renal handling of urate is basically normal in calcium stone disease, whereas minor deviations may co-exist with renal tubular acidification dysfunction.

Calcium↗
PubMed1982

Neutrophil and eosinophil degranulation during hemodialysis are mediated by the dialysis membrane.

During hemodialysis of heparinized blood without having a patient in the circuit, the serum concentrations of lactoferrin, myeloperoxidase (MPO) and eosinophil cationic protein (ECP) steadily increased, indicating neutrophil and eosinophil degranulation. The increments in serum of these granular proteins were more pronounced using plate dialyzers than capillary dialyzers. The release of granule constituents does not seem to reflect merely a sequestration of granulocytes in the dialyzer, since the increase of the serum concentrations of lactic dehydrogenase was very modest. The intracellular contents of lactoferrin, MPO, lysozyme and ECP were reduced after experimental dialysis in the granulocytes isolated from the blood, indicating that the cells in association with degranulation were not entrapped in the dialyzer. The relatively modest increase of the plasma concentrations of lysozyme during experimental hemodialysis, in spite of the reduction of the intracellular content of lysozyme, was explained by the propensity of lysozyme for adhering to the dialysis membrane. Serum samples obtained at different times during dialysis did not induce an enhanced release of granular proteins from isolated granulocytes in vitro. The earlier observed increase during hemodialysis of the serum concentrations of granular proteins in uremic patients can be explained by the dialysis membrane triggering granulocytes to degranulate.

Blood Proteins↗
PubMed1982

The determination of ultrafiltrable calcium and magnesium in serum.

Ultrafiltrate of human serum was investigated in order to evaluate the serum content of calcium and magnesium. The acid and base concentrations and pH of the serum was altered through titration with HCl- or NaOH-solutions. The Pco2 was varied in the titrated serum using different carbon dioxide tensions. This was performed when serum was filtered in a recycling system. It is shown that the analysis of calcium and magnesium have to be done under anaerobic conditions or at standardized pH and Pco2 situations, as the concentrations vary with both pH and Pco2. The concentration ratio between ultrafiltrate and serum for calcium and magnesium was found to be 0.56 and 0.74 respectively at pH=7.41 and Pco2=40 mmHg.

Calcium↗