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Biomedical subjects

D A Feinfeld

Publications and source records attributed to D A Feinfeld.

At least 37 records · Page 2Linked to original sources
PubMed1989

Acute renal failure associated with ioxaglate, a low-osmolality radiocontrast agent.

Iodinated radiocontrast agents may cause acute renal failure, particularly in patients with preexisting renal failure, heart failure, or diabetes. The low-osmolality contrast agents cause less hypersensitivity, but substantial nephrotoxicity has not been noted. We report three high-risk patients who developed acute renal failure after one of these new agents, ioxaglate, was administered for coronary arteriography and ventriculography. The renal failure was severe: two of the patients required dialysis. We could find no previously reported cases of acute renal failure associated with ioxaglate. Despite their theoretical advantages, the low-osmolality contrast agents may cause acute renal failure in patients who are at risk and should be used with the same precautions as the conventional agents.

Acute Kidney Injury↗
PubMed1989

Survival of human immunodeficiency virus-infected patients on maintenance dialysis.

It has recently been reported that patients on maintenance dialysis with the acquired immune deficiency syndrome (AIDS) survive only 1 to 3 months. We studied all patients on maintenance dialysis at the Baumritter Kidney Center who were known to be infected with the human immunodeficiency virus (HIV). Five patients met the criteria for AIDS; another ten had anti-HIV antibodies but no opportunistic infections. The AIDS patients survived 8 to 18 months, and two are still alive. Mean survival in the AIDS group was 13.2 +/- 1.9 months, while the HIV(+) non-AIDS group survived 15.7 +/- 3.0 months. While these data are not statistically different, the survival curve in the AIDS group predicted a shorter survival than for the HIV(+) patients without AIDS. In fact, the survival of our dialyzed AIDS patients was similar to that reported for AIDS patients in general. Our experience suggests that dialysis may have no adverse effect on survival in AIDS. We conclude that dialysis patients with AIDS may survive 8 to 12 months or more and that the approach to such patients should be individualized.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Erythrocyte sodium and potassium in patients on peritoneal dialysis.

Intracellular sodium and potassium concentrations were determined on erythrocytes obtained, before and after treatment, from patients with end-stage renal disease undergoing 48-hour intermittent peritoneal dialysis. Erythrocyte sodium increased from 7.5 +/- 0.3 to 8.6 +/- 0.4 mmol/L cells with a mean of 1.1 +/- 0.1 mmol/L cells (P less than .001), but erythrocyte potassium and cellular water content were virtually unchanged. Plasma potassium decreased during dialysis from 4.2 +/- 0.2 to 3.3 +/- 0.1 mEq/L (P less than .001). The increase in red-cell sodium correlated with this decrease in plasma potassium (r = .51, P less than .01). In contrast, erythrocyte sodium and potassium in undialyzed control patients with chronic renal failure did not change over a similar period, and plasma potassium was unchanged (4.3 +/- 0.1 mEq/L before and 4.3 +/- 0.2 mEq/L after 48 hours). Incubation of postdialysis erythrocytes from the dialysis patients in their own plasma at varying potassium concentrations showed that the rise in cell sodium was blunted as the plasma potassium was increased from 3.2 +/- 0.1 to 4.5 +/- 0.2 mEq/L. These results suggest that unlike hemodialysis, which is not associated with short-term changes in red-cell electrolytes, intermittent peritoneal dialysis results in a reversible increase in erythrocyte sodium. This change appears to be causally related to the decrease in extracellular potassium concentration.

Adult↗
PubMed1987

Factors affecting urine volume in chronic renal failure.

Twenty-four-hour urine volume was studied in 80 determinations from 12 patients with chronic renal failure (creatinine clearances between 7.1 and 38.9 L/d) hospitalized on a metabolic ward. Urine volume ranged from 0.91 to 4.51 L/d. Various components of urine that might affect urine output, ie, osmolar excretion, sodium excretion, urea nitrogen excretion, free water clearance, and potassium excretion, were correlated with urine volume to determine their relative effects. Total osmolar excretion correlated highly with urine output (r = .92, P less than .001), while correlation with free water clearance was weak. Of the three osmotic components, total urea nitrogen excretion correlated best with urine volume (r = .86, P less than .001), while the correlation with sodium excretion was less pronounced (r = .75, P less than .001). The relatively greater impact of urea excretion on urine volume was confirmed by multiple regression analysis. However, total cation excretion (sodium plus potassium) gave nearly as good a regression with urine volume (r = .83, P less than .001). Our findings confirm that total osmolar excretion is a major determinant of urine volume in chronic renal failure and suggest that urea excretion may play the most important role in determining output.

Humans↗
PubMed1987

Clearance of ethylene glycol by kidneys and hemodialysis.

A patient with acute ethylene glycol poisoning was treated with ethanol administration and hemodialysis, and his renal function remained consistently normal. Serial measurements of serum and urine levels of urea, creatinine, ethylene glycol, and ethanol were performed to compare the relative contributions of the hemodialyzer and the patient's kidneys in clearing ethylene glycol from the blood. Simultaneous measurements of the serum-osmolal gap (corrected for ethanol) and anion gap were correlated with these data. Mean renal clearance of ethylene glycol was 27.5 +/- 4.1 ml/min, with a fractional ethylene glycol excretion of 19.8 +/- 1.5%. This was lower than the mean urea clearance of 89.4 +/- 11.0 ml/min and fractional urea excretion of 66.0 +/- 7.8%. Hemodialyzer clearance of ethylene glycol was 156 ml/min. There was a nearly exact correlation between the serum ethylene glycol level and the corrected osmolal gap (r = 0.998, p less than 0.01). The calculated renal elimination half-life of ethylene glycol was 18 hr. We conclude that with a moderate diuresis, the normal human kidney contributes significantly to the removal of ethylene glycol from the blood. Corrected serum osmolal gap provides a nearly exact approximation of the serum ethylene glycol level and is a useful therapeutic guide.

Adult↗
PubMed1987

Renal considerations in cardiovascular drug therapy.

The increasing number of patients with both cardiac and renal disease makes it important for the clinician to bear in mind the effect of both renal failure and peritoneal or hemodialysis on the handling of drugs. Guidelines are available for specific medications; however, they must be used in the light of the patient's individual response and metabolism.

Acute Kidney Injury↗
PubMed1987

Innovative drug delivery systems in cardiovascular medicine: nifedipine-GITS and clonidine-TTS.

Innovative drug delivery systems have been developed for nifedipine and clonidine that prolong the pharmacologic activity of the medications, allowing once daily dosing. The nifedipine-GITS (gastrointestinal therapeutic system) tablet formulation and the clonidine-TTS (transcutaneous delivery system) patch may also reduce side effects in patients while preserving the therapeutic efficacy of the origin drug formulations (nifedipie capsule, clonidine tablet).

Administration, Cutaneous↗
PubMed1987

Serum myoglobin in patients on intermittent and continuous ambulatory peritoneal dialysis.

Serum myoglobin levels were determined in patients maintained on chronic peritoneal dialysis. Eleven intermittent peritoneal dialysis patients had a mean serum myoglobin of 174 +/- 29 ng/ml. In 7 patients tested serially, there was no consistent change in serum myoglobin: the mean level was 154 +/- 36 ng/ml pre-dialysis and 170 +/- 20 ng/ml post-dialysis. Seventeen patients on continuous ambulatory peritoneal dialysis had a mean serum myoglobin of 215 +/- 18 ng/ml. Two patients given oral carnitine supplements had a substantial decrease in their serum myoglobin levels. Patients on peritoneal dialysis, like those on hemodialysis, tend to have elevated serum myoglobin levels, and neither form of dialysis affects serum myoglobin concentration. This hypermyoglobinemia may be due to metabolic changes in muscle.

Adult↗
PubMed1986

Myoglobinuria in chronic renal failure.

Serum and urine myoglobin levels were determined on 14 patients with stable chronic renal failure. Serum myoglobin ranged from 38 to 350 ng/mL. Eleven patients had myoglobinuria between 15 and 250 ng/mL; none developed myoglobinuric renal failure. Fractional excretion of myoglobin in the myoglobinuric patients increased as creatinine clearance decreased, although there was no correlation between filtered load and excretion rate of myoglobin. This confirms that renal failure leads to hypermyoglobinemia and usually to myoglobinuria. Surviving nephrons tend to reabsorb less of the filtered load of myoglobin as renal function diminishes.

Glomerular Filtration Rate↗
PubMed1986

Urinary glutathione-S-transferase in cisplatin nephrotoxicity in the rat.

Rats given a single toxic dose of cisplatin all developed detectable glutathione-S-transferase activity in their urine between the third and fifth day after injection of cisplatin, simultaneously with the decreased urine osmolality and increased urine volume characteristic of cisplatin nephrotoxicity. Peak urinary glutathione-S-transferase levels occurred at the same time as maximal serum creatinine levels, and there was a significant statistical correlation between these two variables. These findings suggest that urinary glutathione-S-transferase activity is a marker for proximal renal tubular injury from cisplatin.

Animals↗
PubMed1985

Glutathione-S-transferase in human renal cell carcinoma.

Homogenates of human renal cell carcinomas were tested for glutathione-S-transferase, an enzyme of normal proximal tubule cells. All tumors were positive; mean tumor fraction enzyme activity was 0.040 +/- 0.02 mumol/min/microgram protein. Glutathione-S-transferase activity in homogenates from normal kidney was 0.022 and 0.054 mumol/min/microgram protein. Finding similar levels of a major cytosolic enzyme in tumor and renal cortex confirms the origin of renal cell carcinoma in the proximal nephron. Glutathione-S-transferase, which binds carcinogens and steroids, may play a role in carcinogenesis and serve as a marker for this tumor.

Carcinoma, Renal Cell↗
PubMed1984

Nephrotic syndrome associated with use of the nonsteroidal anti-inflammatory drugs. Case report and review of the literature.

Although acute interstitial nephritis associated with the use of nonsteroidal anti-inflammatory drugs has long been recognized, only recently has its association with 'minimal change' nephrotic syndrome been reported. We report here a case of this pattern of nephrotic syndrome without concurrent interstitial nephritis associated with the use of tolmetin. The clinical picture, laboratory data, course, and relevant histopathologic findings of previous cases in the literature of nephrotic syndrome related to the use of the nonsteroidal anti-inflammatory drugs are reviewed and discussed.

Aged↗
PubMed1982

Hypertensive encephalopathy and the neurologic manifestations of malignant hypertension.

In a prospective study, 34 patients with 41 admissions for malignant hypertension were examined by a neurologist before and after antihypertensive treatment. Neurologic examination was normal in 17 cases, and neurologic diagnoses in 19 others included acute cerebral infarction (10), uremic encephalopathy (4), dementia of uncertain etiology (3), multiple infarct dementia (1), and chronic paranoid schizophrenia (1). Five patients had a generalized neurologic syndrome consistent with hypertensive encephalopathy, characterized by altered mental function with or without generalized convulsions. In these patients, neurologic examination was normal 1 to 7 days after lowering of blood pressure, while renal function remained unchanged. Neurologic disease is therefore common in malignant hypertension, and hypertensive encephalopathy may be more frequent than previously described.

Adult↗
PubMed1982

The effect of renal failure and hemodialysis on serum and urine myoglobin.

In 33 patients with chronic renal disease, the concentration of myoglobin in serum and urine was found to be significantly elevated over that of normal controls. Hemodialysis had no statistically significant effect in lowering the serum myoglobin of patients with end stage renal disease. Similarly, no difference was found in serum myoglobin in blood entering and leaving the dialysis coil. Since myoglobin was not detectable in the dialyzate, these data illustrate that myoglobin is not appreciably dialyzable. The association between chronic renal failure and high concentration of serum and urine myoglobin was confirmed. These abnormally high levels of myoglobin in serum and urine do not necessarily lead to myoglobinuric renal failure.

Adult↗
PubMed1981

Urinary ligandin and glutathione-S-transferase in gentamicin-induced nephrotoxicity in the rat.

1. Eight rats developed detectable glutathione-S-transferase activity in their urine after three daily injections of toxic doses of gentamicin. 2. Seven of the eight rats had immunodetectable ligandin in their urine at this time. 3. The level of enzyme activity correlated well with the degree of elevation of serum creatinine. 4. This confirms ligandinuria and urinary glutathione-S-transferase as markers of acute renal proximal tubular injury.

Animals↗