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Biomedical subjects

C Brun

Publications and source records attributed to C Brun.

At least 55 records · Page 3Linked to original sources
PubMed1984

Kidney function and quantitative histological changes in patients on long-term lithium therapy.

Renal function and structure were studied in 57 patients on long-term lithium treatment. Nine per cent had a moderate decrease in glomerular filtration rate (GFR), 75% had decreased concentrating ability. No correlation between GFR and the duration of the lithium treatment was found. Twenty-four renal biopsy specimens were studied by light microscopy and compared with kidney biopsies from an age-matched control group of patients without arterial hypertension and who had never been treated with lithium or neuroleptics, but who suffered from acute oliguria or slight proteinuria. The number of sclerotic glomeruli and the focal distribution of intestitial fibrosis was significantly increased in the group of patients treated with lithium. No difference in the total amount of fibrous tissue or the number of atrophic tubules was demonstrated. There was no correlation between the duration of lithium treatment and the structural changes. The biopsy material originated from patients treated with a single and reduced dose regimen only. This regimen might explain the few and slight structural changes found, in contrast to other investigations in which patients were treated with lithium in divided doses.

Adult↗
PubMed1983

Circulating immune complexes and C1 activation in patients with rapidly progressive glomerulonephritis, before and after treatment with immunosuppression and plasma exchange.

Well-known assays for detection of circulating immune complexes (CIC) (C1 q binding assay, C1q deviation test, solid-phase C1 q binding assay, solid-phase conglutinin binding assay, and the platelet aggregation test) were used in 30 patients with different kinds of rapidly progressive glomerulonephritis. In 89% of the patients evidence of CIC was found in at least one of the assays. 81% of the patients were positive in the C1q binding assay and/or the conglutinin binding assay with addition of complement. CIC were more often detected by several assays, and with higher values in patients with systemic disease than in patients with renal involvement alone. CIC were found in 2 patients with Goodpasture's syndrome. 15 patients were reexamined after treatment with plasma exchange, when the disease was clinically inactive. The patients were still on immunosuppressive treatment. In most of these, CIC were detectable, but with lower values than at the start of treatment. Before treatment, high levels of C1r-C1s-C1 inactivator complexes suggested increased C1 activation in 93% of the patients. C-reactive protein was raised, and the concentrations of C1 q, C1s, C4, C3 and factor B were normal or high in most of the patients. Pronounced hypocomplementemia was found only in 2 patients with systemic lupus erythematosus (SLE). After treatment, the levels of C-reactive protein, C1 q, C1s, C3 and factor B had decreased in the non-SLE patients, while the average levels of C4 and C1r-C1s-C1 inactivator complexes were essentially unchanged.

Antigen-Antibody Complex↗
PubMed1983

Postpartum renal failure and malignant hypertension treated with captopril.

A case of postpartum renal failure and malignant hypertension in a 24-year-old woman is reported. The condition occurred three weeks after caesarian section following a normotensive pregnancy. Treatment with a converting enzyme inhibitor, captopril, for one year normalized the blood pressure, with concurrent reduction of plasma angiotension II concentration and markedly improved glomerular filtration rate. It is suggested that activation of the renin-angiotensin system may cause the hypertension and impairment of renal function in postpartum renal failure, and that use of drugs blocking the renin system may be of particular clinical value in this situation.

Acute Kidney Injury↗
PubMed1983

Improved outcome in rapidly progressive glomerulonephritis by plasma exchange treatment.

During the last 3.5 years we have had facilities to perform effective plasma exchange treatment (PE). During this period of time 12 patients of idiopathic and 19 patients of collagenous rapidly progressive glomerulonephritis (RPGN) appeared, Goodpasture's syndrome excluded. In an attempt to evaluate the separate effect of immunosuppression (IS) and PE, PE was if possible withheld for two weeks. In 3 patients IS alone had a satisfactory effect and therefore no PE was performed. In 2 severely ill patients IS and PE were instituted simultaneously. In 6 patients PE was started 5-12 days and in 17 patients at least 14 days after the start of IS. In 3 patients PE was started first because of suspected septicemia. 23 of the 31 patients improved; 6 from IS alone, 3 from IS and probably also from PE, 1 from PE and probably from IS, 5 both from IS and PE and 1 from PE alone. In 7 patients the individual effect of IS and PE could not be evaluated. At follow up 1-37 (median 13) months 13 patients had a S-creatinine below 200, 2 patients 200-300 and 1 patient 510 mumol/l. 3 patients went into RDT immediately and 7 after 4-22 months. 5 elderly patients died, only 1 from uremia, the others from cardiovascular diseases. The outcome was unpredictable from clinical and laboratory data. Addition of PE in the treatment of RPGN seems to have improved the outcome considerably.

Adult↗
PubMed1983

Plasma exchange in two cases of minimal change nephrotic syndrome with acute renal failure.

One idiopathic and one nonsteroidal anti-inflammatory drug associated case of minimal change nephrotic syndrome with acute renal failure are described. Both patients were severely ill and needed dialysis. Treatment with corticosteroids and azathioprine for 19-21 days was ineffective. After start of plasma exchange treatment both patients rapidly recovered. The suggested effect of plasma exchange in these conditions can hardly be ascribed only to correction of the colloid oncotic pressure. An elimination of a circulating factor(s) of pathogenetic importance must also be suspected.

Acute Kidney Injury↗
PubMed1982

Immunosuppression and the additive effect of plasma exchange in treatment of rapidly progressive glomerulonephritis.

Attempts were made to evaluate the separate effect on kidney function of immunosuppressive treatment (IS) and plasma exchange (PE) in 27 patients with rapidly progressive glomerulonephritis (RPGN). Twenty-four of the patients were treated with PE. Initial IS was supplemented with PE within 6-12 days in 5 patients, and after at least 14 days in 13. Because of suspected septicemia, 2 patients were first treated with PE, and IS was not initiated until the possibility of septicemia had been excluded. In 4 severely ill patients wih rapid clinical deterioration, both treatments were started simultaneously. Twenty patients improved during one or both treatments, 4 with IS alone, 2 with IS and doubtfully with PE, 3 with IS and probably also with PE, 5 both with IS and PE and one with PE alone. In 5 patients the individual effects of IS and PE could not be evaluated. In another 2 patients the combined treatment seemed to influence the course favourably. In the remaining 7 patients the effect of the treatment was doubtful or nil. Two further patients with Goodpasture's syndrome were treated. They were admitted late, and both kinds of treatment were instituted simultaneously. One of them died in respiratory insufficiency, the other remained oliguric while the pulmonary changes faded. Thus, PE added a positive effect to IS in several patients with RPGN. The treatment had few and mostly mild side-effects.

Adult↗
PubMed1982

Lithium treatment: does the kidney prefer one daily dose instead of two?

Renal structure and function were investigated in two groups of long-term lithium treated patients. Lithium was administered in two different ways either in a one-dose per day schedule where the whole dose of lithium was given between 8 and 10 p.m. or in a schedule where the lithium dose was given, divided into two or three doses, during the day. Kidney biopsy was performed, and structural changes in the kidney tissue were determined together with 24-h urine volume in the individual patients. The functional as well as the structural changes were most pronounced in patients given their lithium in divided doses during the day. Lithium may be more harmful to the kidney when the lithium administration gives a relatively constant serum lithium level than when the administration causes greater variations including peak values and low minimum levels in serum lithium. The reason for this might be that a number of regenerative processes only occur in periods with low lithium concentrations.

Adult↗
PubMed1982

Haemorrhagic breast infarction complicating anticoagulant therapy.

Haemorrhagic infarction of the breast induced by anticoagulant therapy is rare and has been infrequently reported in the literature. The following report illustrates such a case in which there was development of massive haemorrhagic infarction of the breast during treatment with nicoumalone for deep venous thrombosis after an operation for carcinoma of the colon.

Acenocoumarol↗
PubMed1981

Glomerulonephritis in infections with Yersinia enterocolitica O-serotype 3. II. The incidence and immunological features of Yersinia infection in a consecutive glomerulonephritis population.

In a consecutive series of 38 patients with acute glomerulonephritis (GN), 17 showed serological or immunological signs of current or previous yersiniosis. None of these 17 patients had raised antistreptolysin-o titres. Only half of these patients had had clinical symptoms of Yersinia infection. Light microscopic examination revealed that 12 of the 17 patients had proliferative and 4 epimembranous GN. In 8 out of 14 biopsy specimens, Yersinia antigen could be demonstrated by immunoglobulins and complement. Immunofluorescence microscopy examination of all biopsy specimens containing sufficient tissue for a valid analysis showed deposits of complement and immunoglobulin G, most specimens also immunoglobulins A and M. It is considered highly likely that Y. ent. O:3 may be, and frequently is, an etiological factor for development of acute GN. It would be advisable not only to investigate all patients with acute GN for streptococcal infections, but also to carry out serological and bacteriological tests for Y. eng. O:3 infection and to institute an active therapeutic approach to acute infections caused by this bacterium.

Acute Disease↗
PubMed1979

Immune deposits in human glomerulopathy. Fluorescent microscopy findings in 366 kidney biopsies correlated to symptoms, clinical course and immunosuppressive therapy.

366 kidney biopsies from 339 patients, 290 of which were classified on combined light microscopy (LM) and clinical criteria as glomerulonephritis (GN) and 49 as non-glomerulonephritis nephropathy, were examined by immunofluorescent microscopy (IFM) without knowledge of the clinical or LM findings at the time of examination. The IFM findings in the glomeruli were correlated to (l) the LM diagnosis, (2) the clinical symptoms, (3) the clinical course, and (4) the effect of immunosuppressive treatment. A few IFM results were found to correlate significantly with the LM diagnosis and clinical symptoms, but not to the effect of immunosuppressive treatment. It was impossible using IFM alone to group patients into any specific categories with uniform symptomatology and prognosis. Defined by IFM "immune complex nephritis" was demonstrated in 72%, and linear nephritis was found in 2% of the patients with GN. IgA occurred more frequently in GN secondary to systemic disease, particularly in SLE (60%) and HSP (88%). IgA was demonstrated in only 10% of patients with nonglomerulonephritic nephropathy. Demonstration of IgA is therefore a good indicator for corroborating the LM diagnoses of GN. Demonstration of IgG and/or IgM in GN was not found to be sufficient evidence for GN because these deposits also appeared in 40% of patients with non-glomerulonephritic nephropathy. An immunopathological classification based solely on glomerular deposits of immunoglobulin/C3 appears to have no practical importance. The demonstration of glomerular deposits of immunoglobulin/C3, however, showed to be a necessary supplement to clinical and morphological findings in some instances, in order to attain practical diagnostic boundaries within the very ill-defined concept which today constitutes GN.

Adult↗
PubMed1978

Cytostatic treatment of glomerular diseases. IV. The effect of combined immunosuppressive treatment on serum creatinine and proteinuria evaluated by sequential statistical analysis. Report from a Copenhagen study group of renal diseases.

Sequential statistical testing of the development of the disease in the single patient was used in the assessment of immunosuppressive treatment of renal glomerular diseases. After an initial period of prednisone (P) treatment, this was supplemented first by azathioprine (A) and later in addition by cyclophosphamide (C). The time of transition from one treatment to another was determined by the result of the current statisical testing of the correlation between serum creatinine concentration and proteinuria on the one hand and the time and the varying doses of the drugs on the other. Twenty-nine patients entered the study. Thirteen were withdrawn, eight for technical reasons, three due to side-effects and two on account of renal deterioration and transfer to dialysis treatment. Eight patients were cured, one during P treatment, five during P + A, and two during the combination of P, A and C. Eight patients completed treatment without being cured. In the overall material no statistically significant change in serum creatinine was noted, whereas the proteinuria decreased during P + A and P + A + C. No dose-dependent therapeutic effect of the drugs was demonstrated. In conclusion, this combined treatment with P, A and C did not seem to yield any major therapeutic progress. The technic of sequential statistical testing may be a useful tool in clinical research.

Adolescent↗