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Biomedical subjects

E H Garin

Publications and source records attributed to E H Garin.

At least 37 records · Page 2Linked to original sources
PubMed1988

Cyclosporine therapy for steroid-resistant nephrotic syndrome. A controlled study.

We have conducted a controlled trial on the efficacy of cyclosporine in eight patients with steroid-resistant nephrotic syndrome (four with idiopathic minimal lesion nephrotic syndrome and four with focal segmental glomerulosclerosis). Patients were randomly allocated to a cyclosporine (5 mg/kg/d) or a control group. After eight weeks of therapy and one month without cyclosporine therapy, patients in the control group were given cyclosporine for eight weeks and those in the cyclosporine group became controls. Before the initiation of treatment, there was no difference between the groups with regard to proteinuria and serum albumin levels. Proteinuria remained unchanged in the cyclosporine group, while there was a significant increase in proteinuria in the control group. There were no significant changes in serum albumin levels in either group during the trial. This study does not support the use of cyclosporine at the dose of 5 mg/kg/d in patients with steroid-resistant minimal lesion nephrotic syndrome or focal segmental glomerulosclerosis.

Adolescent↗
PubMed1988

Pneumococcal polysaccharide immunization in patients with active nephrotic syndrome.

We have studied the IgG and IgM antibody responses to pneumococcal polysaccharides types 3 and 19 in eleven patients with active nephrotic syndrome and fifteen normal adult controls. Immunization in both patients with nephrotic syndrome and normal subjects resulted in significant increases in serum IgM antibody to types 3 and 19 pneumococcal polysaccharides. While controls also had a significant rise in IgG antibody to both types 3 and 19, patients with nephrotic syndrome had an increase in IgG antibody only to type 3. Also, after immunization, geometric mean titers of IgG antibodies to both types 3 and 19 were lower in patients with active nephrotic syndrome than in normal subjects (p less than 0.001). In patients with nephrotic syndrome, a significant correlation was found between serum albumin level and type 3 (p less than 0.01) and type 19 (p less than 0.05) antipneumococcal IgG antibody concentration. Furthermore, antipneumococcal IgG antibody was found in the urine of nephrotic patients, while no IgM antibody was excreted in the urine of nephrotic and adult controls. Our data demonstrate that patients with active nephrotic syndrome are able to mount a normal IgM immune response to pneumococcal polysaccharide antigens. The low IgG antibody levels are likely due to increased urinary losses and/or to a partial inability of these patients to produce IgG antibodies. Moreover, since protection may depend on antipneumococcal IgG antibody, these data raise questions as to the benefits of pneumococcal vaccination in patients with active nephrotic syndrome.

Antibody Formation↗
PubMed1987

A comparison of combinations of diuretics in nephrotic edema.

The metolazone-furosemide combination of diuretics was compared with the thiazide-furosemide combination in nephrotic patients with edema. Nine patients underwent a crossover, randomized study receiving furosemide (2 mg/kg per dose) and either metolazone (dose varied according to weight) or chlorothiazide (10 mg/kg per dose). An additive natriuretic and diuretic effect was observed after both metolazone and thiazide were combined with furosemide. The use of both types of diuretic combination was associated with marked kaliuresis. These combinations of diuretics seem equally effective in inducing natriuresis and diuresis in edematous nephrotic patients.

Administration, Oral↗
PubMed1986

Statistical analysis of statural growth following kidney transplantation.

Factors affecting the growth rates of 59 children and adolescents for the first 2 years following kidney transplantation were evaluated. The factors assessed were age at transplantation, renal function, prednisone dosage, donor source, and prior history of transplantation. The observed growth velocity was expressed as the percentage, of the growth velocity predicted by bone age. Normal growth (greater than or equal to 80%) was exhibited by 37% of the patients and 22% had accelerated growth (greater than or equal to 100%). The chronologic age at transplantation did not correlate significantly with growth when bone age was used as the reference for expected velocity. Males grew better than did females. There was a unique sex/race interaction with black males growing most rapidly. Better renal function, the ability to lower prednisone dosage, alternate day prednisone administration, and a decreasing diastolic blood pressure were positively correlated with better growth rates after transplantation. The donor source and prior history of transplantation did not significantly influence growth rate.

Adolescent↗
PubMed1986

Pulsed methylprednisolone therapy compared to high dose prednisone in systemic lupus erythematosus nephritis.

This study was done to determine whether intravenous methylprednisolone therapy given concomitantly with low-dose daily, oral prednisone would be as effective as high-dose daily prednisone in the treatment of patients with active systemic lupus erythematosus (SLE) nephritis. Thirteen patients with active SLE nephritis were started on 2 mg/kg prednisone per day, considered the high prednisone phase. Therapy was continued until remission was achieved. Prednisone administration was then tapered to less than 0.5 but more than 0.2 mg/kg per day. On later relapse, these patients received three doses of methylprednisolone (20 mg/kg per dose) on alternate days and continued on the same daily dose of prednisone (less than 0.5 greater than 0.2 mg/kg per day) prior to pulse therapy; this was the methylprednisolone phase. The 13 patients were studied in both phases, serving as their own controls. After 1 month of therapy, no significant differences were observed between treatment phases as to improvement in clinical and laboratory findings. A significant increase in the serum concentration of C3 and C4 was seen both in the high-dose prednisone and methylprednisolone phases, while the serum concentration of anti-ds DNA antibody significantly decreased. Methylprednisolone therapy seems as effective as high-dose prednisone in patients with relapse of SLE nephritis. Because side effects are minimal, methylprednisolone administration may be tried as the therapy of choice for these patients.

Adolescent↗
PubMed1986

Statistical analysis of statural growth following kidney transplantation.

Factors affecting the growth rates of 59 children and adolescents for the first 2 years following kidney transplantation were evaluated. The factors assessed were age at transplantation, renal function, prednisone dosage, donor source, and prior history of transplantation. The observed growth velocity was expressed as the percentage of the growth velocity predicted by bone age. Normal growth (greater than or equal to 80%) was exhibited by 37% of the patients and 22% had accelerated growth (greater than or equal to 100%). The chronological age at transplantation did not correlate significantly with growth when bone age was used as the reference for expected velocity. Males grew better than did females. There was a unique sex/race interaction with black males growing most rapidly. Better renal function, the ability to lower prednisone dosage, alternate day prednisone, and a decreasing diastolic blood pressure were positively correlated with better growth rates after transplantation. Donor source and prior history of transplantation did not significantly influence growth rate.

Adolescent↗
PubMed1986

Effect of concanavalin A on nephrotic peripheral blood mononuclear cells mediated increased 35sulfate uptake in rat glomerular basement membrane.

We have previously shown a significant increase in 35sulfate uptake in rat glomerular basement membrane (GBM) when glomeruli were cocultured with peripheral blood mononuclear cells (PBMC) from patients with idiopathic minimal lesion nephrotic syndrome (IMLNS) in relapse, but an uptake not different than normal controls if glomeruli were incubated with PBMC of patients in remission. In the present study we examined 35sulfate uptake by GBM after PBMC from 12 IMLNS patients in remission were stimulated with Concanavalin A (Con A) (10 micrograms/ml of culture media). There was a significant increase in 35sulfate GBM uptake when glomeruli were cocultured with Con A-stimulated IMLNS PBMC (geometric mean), 331 cpm/mg dry glomerular weight) as compared to glomeruli cocultured with IMLNS PBMC (geometric mean, 200) (p = 0.048); glomeruli alone stimulated with Con A (geometric mean, 182) (p = 0.008) or glomeruli alone (geometric mean, 146) (p = 0.002). No significant differences were seen between the groups when glomeruli were cocultured with PBMC from 12 normal adults. These data show that Con A stimulated PBMC from IMLNS patients in remission alter the sulfate metabolism of rat GBM. The stimulation of PBMC with Con A reproduces the increase in 35sulfate uptake observed when glomeruli are cocultured with PBMC from IMLNS in relapse. Sulfated compounds in the GBM may play a role in glomerular permeability. Since stimulated nephrotic PBMC alter the metabolism of GBM sulfated compounds, these findings may have pathogenic significance.

Adolescent↗
PubMed1986

Medical sequelae of reflux nephropathy.

RN represents a significant cause of chronic renal failure. Once established, the entity seems to follow a progressive course, regardless of therapeutic modalities. The association of glomerular lesions and hypertension may exacerbate the deterioration of renal function. Since, in humans, RN is almost always associated with urinary tract infections, treatment and prevention of infections is of paramount importance.

Animals↗
PubMed1985

Indomethacin in the treatment of proximal tubular acidosis.

Treatment of a 7-week-old black male who had proximal tubular acidosis with large doses of bicarbonate did not achieve correction of the acidosis and was accompanied by diarrhea. Addition of indomethacin therapy (2 mg/kg/day) was followed by correction of the acidosis and allowed a decrease in the dosage of alkali.

Acidosis, Renal Tubular↗
PubMed1985

Effect of supernatants from nephrotic peripheral blood mononuclear cells on 35sulfate incorporation in rat glomerular basement membrane.

In previous research, we showed that when peripheral blood mononuclear cells (PBMC) from patients with idiopathic minimal lesion nephrotic syndrome (IMLNS) in relapse were cocultured with rat glomeruli, there was an increased glomerular basement membrane (GBM) uptake of 35sulfate. This study was done to determine whether the increased uptake was due to substances secreted into the nephrotic PBMC culture supernatants. 35sulfate uptake in rat GBM was significantly higher when glomeruli were cocultured with PBMC from 12 IMLNS patients in relapse (geometric mean [GM] = 513 cpm/mg) than when simultaneous assays were done using either PBMC from eight control subjects (GM = 158) (p less than 0.05) or glomeruli incubated without PBMC (GM = 275 cpm/mg) (p less than 0.01). 35sulfate uptake did not increase when glomeruli were cocultured with PBMCs from 11 MLNS patients in remission. Rat GBM 35sulfate uptake was significantly higher when glomeruli were incubated in the supernatants of the PBMC cultures from 16 IMLNS patients in relapse (GM = 234 cpm/mg) than it was when glomeruli were cultured in the supernatants from normal control PBMC (GM = 141 cpm/mg; p less than 0.002) or from glomeruli cultured alone (GM = 141 cpm/mg) (p less than 0.04). Supernatants from PBMC cultures of 11 IMLNS patients in remission did not increase rat GBM 35sulfate uptake. These data suggest that PBMC from IMLNS patients in relapse secrete a factor(s) released into supernatants that increases the 35sulfate rat GBM uptake. Since sulfated compounds in the GBM play a role in glomerular permeability, this finding may have pathogenic significance.

Adolescent↗
PubMed1984

Growth in children with various therapies for end-stage renal disease.

The growth of children undergoing continuous ambulatory peritoneal dialysis (CAPD) therapy for end-stage renal disease (ESRD) was compared with the growth of children undergoing hemodialysis and that of children after successful kidney transplantation. The bone ages of the children were used to predict expected growth velocities. The actual growth velocities observed were then expressed as percentages of the predicted rates. Children receiving CAPD therapy grew better than those treated by hemodialysis and as well as the children who received a kidney transplant. There was some correlation between growth and allograft function in the transplant recipients. Children receiving CAPD were less acidotic and were more likely to exhibit improvement in renal osteodystrophy than children treated by ongoing hemodialysis. There were no significant differences in reported caloric intake between the two groups.

Adolescent↗
PubMed1984

Continuous ambulatory peritoneal dialysis in a program for children with end stage renal disease.

Eighteen infants, children, and adolescents were trained in the techniques of continuous ambulatory peritoneal dialysis (CAPD) as a therapy for end stage renal disease (ESRD) at the University of Florida. Fourteen patients successfully continued CAPD 4-24 months, for a total of 193 patient-months. Uremic symptoms were well controlled with blood urea nitrogen concentration (BUN) decreased to between 60 and 80 mg/dl. Parathyroid hormone levels increased but roentgenographic evidence of osteodystrophy improved in most patients. The rate of peritonitis was one episode in 7.7 patient-months. Blood transfusion requirements decreased for patients transferred from in-center hemodialysis to CAPD with no significant decrease in average hematocrits. Caloric intake was adequate and anorexia was usually not a major problem. Children who were evaluated for growth were under 15 years of age, with bone ages less than 12 years, and were using CAPD for longer than 6 months. Their mean growth velocity was 74.7 +/- 20.4% (SD) of the predicted velocity.

Adolescent↗
PubMed1984

Prostaglandin synthesis inhibitors and primary antibody response in experimental nephrotic syndrome.

The effect of prostaglandin (PG) synthesis inhibitors on the primary antibody response to sheep red blood cells (SRBC) in rats with aminonucleoside-of-puromycin (AP) nephrosis was studied. The response to SRBC was determined 5 days after intraperitoneal administration of SRBC by measuring IgM antibody-forming spleen cells (AFC). In nephrotic rats, SRBC were injected when animals were fully nephrotic. A significant decrease in the number of AFC (P less than 0.05) and a significant increase in the plasma concentration of 6-keto-PGF1 alpha (P less than 0.02) were observed in 22 nephrotic rats compared to 24 normal rats. Treatment of nephrotic rats with indomethacin (5 mg/kg per day, 8 rats) and aspirin (200 mg/kg per day, 7 rats) initiated before the development of nephrosis returned the antibody response and the plasma level of 6-keto-PGF1 alpha to normal, while the same treatment in control rats did not alter the antibody response. These data suggest that in AP nephrosis the observed decrease in antibody response to SRBC is likely due to an increase in PG production at the time of immunization.

Animals↗
PubMed1983

Nephrotic syndrome and diffuse mesangial proliferative glomerulonephritis in children.

The clinical course, response to therapy, and outcome were analyzed in 25 children with nephrotic syndrome associated with moderate to severe mesangial cell proliferation. The conditions of more than two thirds of the patients (16/23) failed to respond to prednisone therapy, and renal insufficiency or failure developed in 13. Our data suggest an association between response to therapy and degree of mesangial cell proliferation. Persistent nephrotic syndrome was associated with slow deterioration of renal function.

Adolescent↗
PubMed1983

Continuous ambulatory peritoneal dialysis in a pediatric population.

Seven children aged from 6 weeks to 14 years were treated for end-stage renal disease by continuous ambulatory peritoneal dialysis (CAPD) for 60 patient months. Satisfactory control of their uremia was achieved. Peritonitis was diagnosed on seven occasions (one case per 8.6 patient months) and did not interfere with continuation of dialysis or decrease peritoneal membrane permeability. Patients older than 5 years grew at rates comparable with those of patients receiving hemodialysis. Two infants receiving CAPD exhibited normal growth rates. Families demonstrated good psychosocial adjustment to the technique. Thus, CAPD seems to be a satisfactory alternative to hemodialysis for long-term therapy .

Adolescent↗
PubMed1983

Serum inhibitor of phytohemagglutinin-induced lymphocyte proliferation in Bartter syndrome.

Serum from four patients with Bartter syndrome inhibited the response to phytohemagglutinin of autologous and homologous (healthy donor) lymphocytes. The abnormal response was normalized in three patients by the administration of indomethacin (2 mg/kg/day), a known inhibitor of prostaglandin synthesis. The serum prostaglandin E2 concentration of these patients before indomethacin therapy was significantly increased (P less than 0.02), as compared with that in controls. The serum PGE2 concentration measured in two of three patients undergoing indomethacin therapy was normal. Because PGE2 is known to inhibit the response of lymphocytes to phytohemagglutinin, we postulate that PGE2 may mediate the reduced blastogenic response observed in patients with Bartter syndrome.

Bartter Syndrome↗