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Biomedical subjects

D N Kerr

Publications and source records attributed to D N Kerr.

At least 37 records · Page 2Linked to original sources
PubMed1978

Adverse effect of splenectomy in renal transplantation.

Between January 1968 and June 1974 at Newcastle upon Tyne, 63 patients underwent splenectomy in association with transplantation; 45 of these had splenectomy with bilateral nephrectomy before (20) or at the time of (25) transplantation; 18 had post-transplant splenectomy for leucopenia. Mortality was significantly higher in splenectomized patients than in 136 non-splenectomized controls. Of the 63 splenectomized patients, 25 died within 1 year of transplantation, 12 of severe infection associated with leucopenia. Although splenectomy produced a temporary rise in white cell count, leucopenia during the first year of immunosuppressive therapy was not significantly less frequent in splenectomized patients than in controls. There was no significant difference in graft loss between the splenectomy and control groups. It is concluded that splenectomy is contra-indicated in patients who are to undergo renal transplantation and confers no benefit when carried out because of leucopenia developing after renal transplantation.

Azathioprine↗
PubMed1978

Serum ferritin concentration: a reliable guide to iron overload in uremic and hemodialyzed patients.

The inter-relationships between serum ferritin, hemoglobin, serum iron and total body iron stores were studied in 20 patients with chronic renal failure treated conservatively and in 20 patients on regular hemodialysis. There was no relationship between serum iron or transferrin and bone marrow iron deposits, but serum ferritin concentration was a good indicator of increased marrow iron stores. All patients with serum ferritin levels above 300 microgram/l had increased iron stores. Serum ferritin assay is a useful non-invasive technique for detecting iron overload in uremic and hemodialyzed patients.

Adolescent↗
PubMed1978

Haemodialysis-induced leucopenia and activation of complement: effects of different membranes.

The effects on neutrophil count and complement activity of five different haemodialysis membranes were studied. There was no correlation between the degree of neutropenia and intensity of complement activation. With cuprophan membrane both occurred simultaneously but to unrelated degrees; polyacronitrile induced mild, not significant neutropenia but marked activation of complement; polycarbonate membranes induced severe neutropenia without detectable complement activation. Where complement activation occurred it was via the alternative pathway. Haemodialysis induced neutropenia may have many causes and complement activation is probably not the major responsible factor.

Acrylic Resins↗
PubMed1977

Collaborative care of hypertensives, using a shared record.

A shared hospital-GP record for control of hypertension was studied in a sample of 60 patients. Over 80% of patients brought the record to hospital duly completed. Two-thirds of GPs, and the hospital staff, assessed the record as a useful aid in the care of hypertensives. It is still employed enthusiastically, three years after its introduction.

Attitude of Health Personnel↗
PubMed1977

Kinetics of hemodialysis: a theoretical study of the removal of solutes in chronic renal failure compared to normal health.

A theoretical comparison of various treatment strategies for the dialysis of patients with chronic renal failure has been made covering a wide mol wt spectrum (60 to 5250 daltons) of metabolites. A two-compartment model has been used with the generation rate in the appropriate pool. The comparison for any given metabolite is made, keeping the same level of predicted intracellular concentration as in traditional Kiil treatments, and it is found that the number of treatment hours per week may be reduced pro rata as the dialyzer clearance is increased. This result is independent of the assumed site of metabolite generation, of the distribution volumes, and of the level of the cell wall permeability. The cyclic fluctuation in intracellular concentration and the mean level of intracellular concentration, in relation to the level in normal health, are both predicted for a given metabolite to be lower if thecell wall permeability is assumed to be on the low side rather than on the high side. The clinical implications of the variations in intracellular and extracellular concentration are discussed, and considerable elevation compared to normal health is predicted for both compartments for large molecules, larger than or equal to 1,000 mol wt, which are generated effectively in the extracellular compartment.

Humans↗
PubMed1977

The need and use of a phosphate-enriched dialysate during regular hemodialysis.

A disabling osteomalacic syndrome seen only during regular hemodialysis is described. Its features include skeletal fractures, pain, suppression of pre-existing hyperparathyroidism, and failure to improve with any of the vitamin-D metabolites. Phosphate depletion may be an important etiological factor but this could not explain all cases. A trial with phosphate-enriched dialysate and 1alphaOHD3 resulted in sustained clinical improvement in 54% of the patients and healing of fractures in 33%. Other etiological factors independent of 1,25(OH)2D3 deficiency and phosphate depletion must be considered. Current, indirect evidence suggests that accumulation of water toxins including aluminium may be important.

Adolescent↗
PubMed1977

Histopathology of renal osteodystrophy with particular reference to the effects of 1alpha-hydroxyvitamin D3 in patients treated by long-term haemodialysis.

(1) The bone histology of 233 non-dialysed and 276 haemodialysed patients with chronic renal failure is reviewed. In non-dialysed patients osteitis fibrosa occurred in 83.7% and osteomalacia in 23.6% of patients. Osteomalacia was not found in the absence of osteitis fibrosa. In haemodialysed patients there was a more variable bone histology, sometimes resembling non-dialysed bone disease, but in general with a greater incidence of osteomalacia, especially with increasing time on dialysis. In some patients there was a predominance of osteomalacia accompanied by no or only mild osteitis fibrosa and the serum alkaline phosphatase was normal. (2) The results of treating twenty-six haemodialysed patients with 1alpha-hydroxyvitamin D3 (1alpha-OHD3) are described. Patients with osteomalacia and minimal or no osteitis fibrosa and a normal serum alkaline phosphatase (Group I) in general failed to respond and it is suggested that 1,25-dihydroxyvitamin D3 deficiency is not the sole factor responsible for the osteomalacia in these patients. In contrast, 1alpha-OHD3 therapy was effective in improving osteitis fibrosa and osteomalacia in some patients with moderate to severe degrees of osteitis fibrosa and osteomalacia (Group IIa) and in improving osteitis fibrosa where this occurred alone (Group IIb).

Adolescent↗
PubMed1977

The effect of 1alpha-hydroxyvitamin D3 in pre-dialysis renal bone disease.

Assessment of 18 azotaemic patients treated with long-term 1alpha-hydroxyvitamin D3 (1alpha-OHD3) confirms the generally favourable effect of this analogue of 1,25-dihydroxyvitamin D3 in azotaemic osteodystrophy. Growing children with radiological rickets respond very well as do adults showing mild hyperparathyroidism with or without osteomalacia. However, patients with severe 'pure' hyperparathyroidism and features of autonomy do not respond well and in such patients 1alpha-OHD3 alone should be avoided. Phosphate restriction and occasionally a sub-total parathyroidectomy may be indicated in these patients.

Adolescent↗
PubMed1977

Hereditary angio-oedema with mesangiocapillary glomerulonephritis.

A patient with hereditary angio-oedema (HAO) developed mesangiocapillary glomerulonephritis (MCGN) under observation. HAO is characterized by an inherited defect of complement-deficiency of C1 esterase. MCGN is often associated with another complement abnormality which leads to depression of serum C3 and there is some evidence that the complement abnormality precedes the nephritis. The coincidence of these two rare diseases in the present patient, and in one previously described, suggests that other complement abnormalities may predispose to the development of MCGN.

Angioedema↗
PubMed1977

Androgens in the anaemia of chronic renal failure.

Plasma levels of testosterone-like substances (TLS) were depressed in seven patients with chronic renal failure. Intramuscular testosterone (as Sustanon 250 once a week) elevated plasma TLS levels to above normal throughout the week with an initial high peak. Sublingual testosterone produced a high but brief peak in TLS. Results were similar in renal failure patients and normal controls. A controlled trial of weekly Sustanon 250 in 24 regular dialysis patients produced a significant increase in haemoglobin from 6.8 to 8.2 g/dl. Side effects were mainly mild and acceptable but one patient developed priapism and another a large haematoma. The discriminate use of androgens is recommended for anaemic male patients on regular haemodialysis.

Adult↗
PubMed1977

Ionised calcium during haemodialysis.

In spite of the popularity of high calcium dialysate internationally, most centres in the United Kingdom continue to use a dialysate calcium of 1.5 to 1.6 mmol/L. In eleven patients studied throughout dialysis against such dialysate we conclude that it is sufficient to raise ionised calcium. Patients so treated have little elevation of PTH pre-dialysis and it is further suppressed during dialysis.

Adult↗
PubMed1977

Separation of dialysis and ultrafiltration-does it really help?

Ultrafiltration alone for fluid removal has been used and assessed in a number of clinical studies. A paired study of ultrafiltration alone against haemodialysis has shown that as compared to haemodialysis, ultrafiltration alone within the ultrafiltration rates used is well tolerated. The use of ultrafiltration alone for both acute and chronic fluid overload has been shown to be an ideal therapeutic procedure. In a third study using the Rhodial 75 system and RP6 dialyser in a group of non-fluid-overloaded patients the separation in time of ultrafiltration from haemodialysis has shown no obvious advantages over regular haemodialysis.

Adult↗