Focal segmental glomerulosclerosis--does treatment work?
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Azathioprine↗
Biomedical subjects
C M Stirling
Publications and source records attributed to C M Stirling.
Treatment and outcome of adult patients with primary focal segmental glomerulosclerosis in five UK renal units.
BACKGROUND: Focal segmental glomerulosclerosis (FSGS) is the least studied of the causes of idiopathic nephrotic syndrome, and there are few specific guidelines for treatment. AIM: To review data from five UK renal units to investigate whether adult patients with FSGS were treated uniformly, and to examine the effect of treatment on proteinuria and survival. DESIGN: Retrospective record review. METHODS: We examined electronic records of patients with idiopathic FSGS for information on baseline clinical parameters, treatment regimens and outcomes. RESULTS: Of 136 patients with primary FSGS and nephrotic range proteinuria, 76 (56%) were treated with prednisolone and of this group, 59% were treated with additional immunosuppression. Among the treated patients, the total remission rate (complete and partial) was 67%, and one hospital achieved a remission rate of 80%. Treated patients had a significantly higher remission rate than those who were not treated. Remission was associated with a 5-year survival off dialysis of 94%, compared with 53% if remission was not achieved. Baseline serum creatinine and remission were independently associated with survival off dialysis in a multivariate Cox proportional hazards model. DISCUSSION: Patients with primary FSGS and nephrotic range proteinuria, who are treated with corticosteroids, are more likely to enter remission than those who are not treated. Remission rates of up to 80% can be achieved with prolonged treatment, and remission is an independent predictor of survival off dialysis. Patients who do not achieve remission have a poor prognosis. Further clarification of optimal treatment regimens requires additional, prospective studies.
Adolescent↗
Growth, photosynthetic performance and shade adaptation of rubber (Hevea brasiliensis) grown in natural shade.
We compared growth, photosynthetic performance and shade adaptation of rubber (Hevea brasiliensis Muell. Arg.) plants growing in natural shade (33, 55 and 77% reduction in incoming radiation) to control plants growing in full sunlight. Stem diameter and plant height, measured over a 15-month period, were greatest in plants grown in full sunlight, and both parameters decreased with increasing shade. At 7 and 14 months after planting (MAP), total plant dry mass was highest in control plants and lowest in plants in 77% shade. Expansion of the fourth leaf whorl, monitored at 5-6 MAP, was slowest in plants in 77% shade and fastest in unshaded plants, which had more leaves and higher leaf areas and inter-whorl shoot lengths. In response to increasing shade, specific leaf area increased, whereas leaf weight ratio and relative growth rate decreased. Chlorophyll a/b ratio decreased with increasing shade, indicating shade-induced partitioning of chlorophyll into light-harvesting complexes. Compared to the response in unshaded plants, CO2 assimilation saturated at lower photosynthetic photon flux densities in plants in 77% shade, with a lower upper-asymptote to the light response curve. Chlorophyll fluorescence revealed no evidence of sustained photoinhibitory damage in unshaded plants. Dynamic photoinhibition decreased with increasing shade, with the greatest depression in the ratio of variable to maximal fluorescence around midday. We conclude that shade adaptation and shade-induced reductions in dynamic photoinhibition account for the enhanced early growth of rubber in light shade.
Adaptation, Physiological↗
Rhabdomyolysis due to simvastatin in a transplant patient: Are some statins safer than others?
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Female↗
The influence of secondary senescence processes within the culm of a pseudoviviparous grass (Poa alpina var. vivipara L.) on the supply of water to propagules.
An anatomical investigation of the culm of pseudoviviparous alpine meadow grass (Poa alpina var. vivipara L.) revealed that transpiration flow, as delimited by Lucifer Yellow tracer dye, was maintained despite advanced senescence (as evidenced by loss of chlorophyll and chloroplasts), with leafy spikelets driving transpiration flow. Transpiration flow was not hindered by cavitation or tylosis in older culms, the low frequencies of these senescence processes being bypassed via nodal plexi. Despite this, water content of plantlets declined over time and water stress became apparent, suggesting that water supply via the determinate culm was not sufficient for the increasing transpirational demand of indeterminate plantlets. The implications of declining water content on the biomechanical properties of the culm, and concomitant limitations on the pseudoviviparous reproductive strategy, are discussed. Nomenclature of grass follows Hubbard.
Fluorescent Dyes↗
Architectural and physiological heterogeneity within the synflorescence of the pseudoviviparous grass Poa alpina var. vivipara L.
Many biotypes of the northern-hemisphere Arctic-Alpine grass Poa alpina L. reproduce asexually via prolification of the spikelet axis to produce dehiscing shoots. Although capable of photosynthesis, the source-sink characteristics of these synflorescence systems are unknown, including the degree to which plantlets from different regions of the synflorescence are capable of providing for their own carbon requirements, or contributing to other sinks. Photosynthetic rates within the paracladial zone, as determined by infrared gas analysis (IRGA), exceeded respiratory rates by 3-4-fold. (14)CO(2) tracer studies determined that the paracladial zone was not only as efficient at fixing carbon as the youngest fully expanded leaf (per unit dry weight), but that both organs exported carbon mainly basipetally (cf. extensive acropetal export from this leaf in seminiferous grasses). Distal plantlets of the paracladial zone fixed approximately 20% more (14)CO(2) than did proximal plantlets. This was by virtue of their greater dry weight. At dehiscence, 'distal' plantlets were more likely to become established, and possessed relative growth rates more than 10 times those of 'proximal' plantlets. Paracladial heterogeneity was also apparent as an increased proportion of aborted spikelets on proximal paracladia. The possible causes of this heterogeneity are discussed.
Carbon↗
Serum creatinine can predict adequacy of peritoneal dialysis--preliminary report.
AIM: To determine the value of creatinine clearance, estimated using the Cockcroft and Gault formula, in assessing adequacy of peritoneal dialysis. METHODS: We undertook a retrospective analysis of creatinine clearance results derived from a conventional 24-hour collection in 35 stable outpatients on peritoneal dialysis and compared them with those calculated from the corresponding serum creatinine using the Cockcroft and Gault formula. RESULTS: There was a strong correlation between the 2 methods (r = 0.82, p < 0.0001), although the formula tended to over-estimate clearances. The formula had a positive predictive value of 88% and a negative predictive value of 86% for detecting inadequate dialysis. CONCLUSION: The creatinine clearance calculated using the Cockcroft and Gault formula can be used in patients on peritoneal dialysis to estimate adequacy of dialysis. We believe that this method, which is far less expensive and time-consuming, deserves further testing in a larger population in order to define more accurately its role in the management of PD patients.
Creatinine↗
Progressive oedema in a 30-year-old.
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Adult↗
Immunosuppression and outcome in idiopathic membranous nephropathy.
From 1986 to 1996, 53 patients with idiopathic membranous nephropathy (IMN) presented to the Glasgow Royal Infirmary renal unit: 19 (36%) were treated because of progressive disease. We compared outcomes of treated and untreated patients with 37 historical and untreated controls. Five- and 10-year survival rates off dialysis were 83.5 and 53.5%, respectively. At the end of a mean observation period of 5.9 years, 47% of patients were in remission, 13% had reached end-stage renal failure, 15% had died, 13% had persistent proteinuria but stable renal function, and 11% had declining renal function. These results are better than those in historical controls, with a reduction in the number of patients reaching ESRF (13% vs. 22%), a larger proportion of patients achieving remission (47% vs. 30%) and smaller numbers of patients with declining renal function (11% vs. 19%) at the end of a similar follow-up period. These data suggest that the use of immunosuppression in selected patients with IMN improves prognosis, although the results did not achieve statistical significance.
Adult↗