Long-term prognosis of idiopathic membranous glomerulonephritis. Study of 116 untreated patients.
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Biomedical subjects
Publications and source records attributed to C Barbanel.
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We have studied the effects of intravenous infusion of saralasin, a competitive antagonist of angiotensin II, in 27 hypertensive patients: 13 had essential hypertension, 14 had renal lesions which involved the renal artery in 9 cases. In essential hypertensives saralasin administration did not significantly lower blood pressure, even after mild salt depletion. It induced a decrease in blood pressure in 7 patients with renal abnormalities (5 with renal artery stenosis, 2 with unilateral parenchymal disease). It may be suggested that in these cases hypertension was dependent, at least partly, on the renin-angiotensin system. In agreement with other investigators, we have found a relationship between the level of plasma renin activity and the blood pressure decrease obtained by saralasin. In patients with unilateral renal artery stenosis, blood pressure decrease was related to renal vein ratio of plasma renin activity.
Collins solution is one of the world methods used for kidney preservation. A long term survey of transplanted kidneys thus preserved has never been reported. Clinical, biological, radiological and pathological data collected from 225 cadaver kidney tranplantations were analysed according to the total ischemic time (T.I.T) groupe I: TIT less than or equal to 12 hours, groupe II: TIT from 12 to 30 hours). No difference could be demonstrated between the two groups whether considering the percentage of immediate function, the serum creatinine level which was normal up to two years, the incidence of abnormal blood pressure, the pathological changes on routine biopsies performed at 6 months and 2 years and arteriographic features at 2 years. A better graft survival rate was consistently found at 6 months one year and 2 years when TIT was between 12 and 30 hours. This could be related to the higher indicence of well matched kidneys in this group of patients. The efficiency of exchange programs for compatible kidneys is thus emphasized.
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Collins' solution is one of the world-wide methods used for kidney preservation. A long-term survey of transplanted kidneys thus preserved has never been reported. Clinical, biologic, radiologic, and pathologic data collected from 225 cadaver kidney transplantations were analyzed according to the total ischemic time (group 1: TIT less than or equal to 12 hr; group 2: TIT 12-30 hr). No differences could be demonstrated between the two groups, whether considering the percentage of immediate function, the serum creatinine level that was normal up to 2 years, the incidence of abnormal blood pressure, the pathologic changes on routine biopsies performed at 6 months and 2 years, or arteriographic features at 2 years. A better graft survival rate was consistently found at 6 months, 1 year, and 2 years when TIT was between 12 and 30 hr. This could be related to the higher incidence of well-matched kidneys in this group of patients, thereby emphasizing the efficiency of exchange programs for compatible kidneys.
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The authors analyse the principal characteristics of immunosuppression needed after a kidney graft. They review various therapeutic methods and consider the main complication induced by long-term iummunosuppression. They associate published data with their own experience, based on more than 300 transplantations performed with corticosteroids and azathioprine at Necker Hospital.
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Infective complications are analysed in 100 transplanted patients all receiving corticosteroid and azathioprine. 170 infective episodes were noted, only 13 patients never had infection during the period of observation. Two complications were dominated by their gravity : pneumopathies (n equals 29) fatal in 20.6% of cases, and septicemia (n equals 21) fatal in 28.5% of cases. Alone they represented 75% of the overall mortality in this series. More than 50% of failures due to death or detransplantation, were directly due to infection. The results show that this type of complication represents the main limiting factor to renal grafts in patients submitted to immunosuppressor treatment which depresses non-specifically, the whole immune response.
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