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Biomedical subjects

E D Esposti

Publications and source records attributed to E D Esposti.

7 recordsLinked to original sources
PubMed1990

Do calcium channel blockers have any influence on the immunological status of renal graft recipients on ciclosporin therapy?

We have assessed the peripheral distribution of T cells, using the monoclonal antibodies OKT3, OKT4, OKT8 and LEU7 and the proliferative response to phytohaemagglutinin (PHA), in 10 renal transplant recipients. In each patient, the immunological pattern was evaluated twice, both before and after 1 month of calcium antagonist (calcium channel blockers, CaA) treatment. During treatment with CaA, we have observed both a significant decrease in the mitogenic response to PHA and a significant increase in OKT8 cells. Our data support the hypothesis that CaAs per se may have an immunomodulatory effect on T cell distribution independently of changes in ciclosporin (CS) blood levels. These results could also provide a cellular basis for synergism between CS and CaA.

Adjuvants, Immunologic↗
PubMed1982

Renal scintigraphy versus renal vein renin activity for identifying and treating renovascular hypertension.

This paper compares renal scintigraphy (RS) with renal vein renin activity (RVRA), intravenous pyelography (IVP), and peripheral plasma renin activity (pPRA) in a population of hypertensive subjects with suspect renovascular hypertension (RVH), of whom 30 underwent surgery, in order to evaluate (a) screening ability of RS for RVH, and (b) surgical prognosis of RS for RVH. RS agreed with arteriographic findings of arterial stenosis in 91% of patients and proved more sensitive as a screening test than IVP and pPRA. The false-negative rate of RS was 9% and the false-positive rate was 10%. In the patients who underwent surgery RS was positive in 89% and RVRA in 85% of those who benefited from surgery. In this series false-negatives for RS occurred only in the presence of extensive collateral circulation, where RVRA also gave the same result. In patients who had been operated on, the sensitivity and specificity of RS, compared to RVRA, were very high. Our work supports the view that RS is a good screening test in RVH; moreover, it seems to be as accurate as RVRA as a surgical prognostic method for curable RVH.

Adolescent↗
PubMed1978

Influence of ultrafiltration on plasma renin activity and adrenergic system.

The influence of efficient ultrafiltration without dialysis fluid was compared to the standard dialysis technique in two groups of 4 patients with chronic renal failure on maintenance haemodialysis. Supine plasma renin activity (PRA), plasma concentration of noradrenaline (NA), and adrenaline (A) and the Valsalva manoeuvre were determined before and after the period of ultrafiltration at the beginning and at the end of the experiment. The behaviour of these parameters was related to changes of blood pressure and body weight. The rapid weight loss was well tolerated during ultrafiltration only, with a significant increase of plasma catecholamines concentration; in contrast, patients treated with ultrafiltration and dialysis showed no significant increase of NA and A levels and they frequently became hypotensive. No relationship was observed between changes in PRA and those in body weight and blood pressure. Our data suggest that rapid removal of catecholamines during standard dialysis hinders the compensatory increase of the adrenergic activity and is responsible for hypotension.

Blood Pressure↗
PubMed1978

Autonomic function in hemodialyzed patients.

The authors have studied the autonomic function in a group of 34 regular hemodialyzed patients and in a group of 24 normal volunteers with simple, non-invasive and repeteable techniques. To evaluate autonomic function Valsalva manoeuvre, cold pressor test, mental stress test, tilt test, diving reflex test, systolic-time intervals and plasma catecholamines levels were used in all subjects. Uremic patients on maintenance hemodialysis were studied the day after hemodialysis. The response to cold pressor test, mental stress test, tilt test and plasma catecholamines levels resulted normal in all uremic patients, even if 17 out of 34 patients showed an abnormal response to the Valsalva manoeuvre (Valsalva ratio lesser than 1.40). In these patients an alteration of diving reflex and/or a pathological systolic-time interval was found. The authors suggest that sympathetic function is normal in regular hemodialyzed patients and that the abnormal response to the Valsalva manoeuvre is probably due to a defect in the vagal control of the heart and/or an alteration of cardiac performance.

Adolescent↗
PubMedDate not supplied

3 R study: renal outcome in renal ischemia: revascularisation or medical treatment.

Ischemic nephropathy refers to the kidney damage following stenosis or an obstructive lesion in the main kidney arteries. This disorder has been overlooked in the past and a more rational and specific use of clinical criteria, and the development of not very invasive techniques with a good diagnostic accuracy such as spiral CT angiography, NMR angiography and echo-colour-Doppler have improved our ability to identify these patients. It is therefore likely that, in the next few years, we will find ourselves treating an increasing number of patients with renovascular ischemic disorders. Transluminal angioplasty and, more recently, the use of endovascular stents, have led to a marked improvement in the treatment of stenoses and, together with vascular surgery, allow to treat almost all patients with this disorder. There is, however, a lack of prospective and controlled studies, which demonstrate the long term benefit of revascularization treatment, as compared with optimum conservative treatment in reducing cardiovascular mortality, cardiovascular events and preserving renal function. The Ischemic Nephropathy Study Group of the Italian Society of Nephrology has organized a prospective, controlled study over a period of three years, aimed at comparing the effect of revascularization versus medical therapy in 300 patients with renal artery stenosis, ranging between 50 and 90 per cent, who will be randomly assigned to the two treatments. End point will be cardiovascular mortality and morbidity and need for renal replacement therapy.

Follow-Up Studies↗