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Biomedical subjects

F Llach

Publications and source records attributed to F Llach.

At least 91 records · Page 5Linked to original sources
PubMed1982

Osteomalacia in chronic renal failure: a syndrome previously reported only with maintenance dialysis.

Osteomalacia without marked elevations of parathyroid hormone (PTH) has been described in maintenance dialysis patients. The proposed etiology has centered upon the transfer of an environmental agent (aluminum) from the dialysis water system. The present report describes an azotemic patient, who, prior to the initiation of dialytic therapy, presented with severe osteomalacia and low PTH concentrations for the severity of renal failure. The osteomalacia was documented by bone histology on two occasions 1 year apart, and aluminum deposits at the osteoidmineralized bone interface were demonstrated with histologic techniques. PTH concentrations were within the normal range (less than 0.1 ng/ml) on three widely spaced intervals. No definite statement can be made regarding the etiology of the osteomalacic syndrome in this patient, but maintenance dialysis does not appear to be necessary for its expression.

Aged↗
PubMed1981

The pathophysiology of altered calcium metabolism in rhabdomyolysis-induced acute renal failure. Interactions of parathyroid hormone, 25-hydroxycholecalciferol, and 1,25-dihydroxycholecalciferol.

We studied six oliguric patients with rhabdomyolysis-induced acute renal failure. On admission, all had marked hyperphosphatemia and hypocalcemia associated with low levels of 1,25-dihydroxycholecalciferol [1,25(OH)2D]. During the early polyuric phase, moderate hypercalcemia was accompanied by marked elevations in plasma 1,25(OH)2D and persistent elevations in parathyroid hormone (both amino and carboxy terminals). During the late polyuric phase, the levels of serum calcium and 1,25(OH)2D reverted to normal. Thus, in rhabdomyolysis-induced acute renal failure, the hypocalcemia of the oliguric phase may be secondary to decreased synthesis of 1,25(OH)2D; severe hyperphosphatemia may also have a major role. The hypercalcemia of the polyuric phase may be partly due to increased synthesis of 1,25(OH)2D, resulting from the high parathyroid hormone levels and recovery of renal function.

Acute Kidney Injury↗
PubMed1981

Diabetic nephropathy associated with fibrin formation.

This communication describes the electron microscopic study of a renal biopsy specimen from a patients with diabetic nephropathy, the nephrotic syndrome, and renal insufficiency. There were large amounts of electron dense materials within glomerular basement membranes and masses of fibrin within glomerular capillaries and Bowman's spaces. The presence of glomerular fibrin suggests that thrombosis may be pathogenetically related to diabetic nephropathy.

Diabetic Nephropathies↗
PubMed1981

Rapid conversion of pH to [H+].

Sir William Osler described the practice of medicine as "an art based on Science." The authors have artfully simplified a frequently needed clinical calculation, using sequential multiplication and obviating the need for logarithmic manipulation.

Acid-Base Equilibrium↗
PubMed1981

Massive pulmonary hemorrhage and fulminant renal failure associated with immune complex glomerulonephritis.

A 54-year-old man had massive pulmonary hemorrhage and fulminant renal failure. Although his clinical presentation was similar to that of Goodpasture's syndrome, his renal disease was associated with deposition of immune complex rather than with production of antiglomerular basement membrane antibody. Serum cryoglobulins were present, presumptive evidence of circulating immune complexes; serum antiglomeral basement membrane antibodies were absent. Renal biopsy revealed a crescentic, exudative glomerulonephritis with a granular immunofluorescence pattern; subepithelial deposits were demonstrated by electron microscopy. This immune complex glomerulonephritis was thought possibly to be postinfectious in origin, with characteristics distinguishing it from Goodpasture's syndrome. Pulmonary hemorrhage and crescentic immune-complex-mediated glomerulonephritis are reviewed.

Acute Kidney Injury↗
PubMed1981

Glomerular IgE deposits in patients with lupus nephritis.

The presence of glomerular IgE deposits (IgE+) and its prognostic significance were examined in 241 patients with various renal diseases. 24 patients (10%) had IgE+, and nephrotic syndrome was present in 22 (92%). 17 of the 24 patients with IgE+ had lupus nephritis. These patients were compared with another group of 32 patients with lupus nephritis, but without IgE deposits (IgE-). Light and electron microscopy showed more severe pathological changes in those with IgE+ than in patients who were IgE-. The number of patients who displayed deterioration in renal function was greater in the former group than in the latter (70 vs. 31%). Our results show that (1) nephrotic syndrome is very common among patients with IgE+; (2) the incidence of IgE deposits in lupus nephritis patients is high (35%) and the incidence of lupus nephritis among patients with IgE deposits is 71%, and (3) the presence of IgE deposits in patients with lupus nephritis may carry a bad prognosis. It is suggested that immunofluorescent studies of renal biopsies should include the evaluation of IgE deposition.

Humans↗
PubMed1981

Progressive systemic sclerosis and nephrotic syndrome. An unusual association resulting in postpartum acute renal failure.

A 27-year-old, full-term pregnant woman with progressive systemic sclerosis (PSS) came to the hospital with marked proteinuria and edema. Two days later, she gave birth to a normal baby. After delivery and during the next 48 hours, renal failure developed. A renal biopsy specimen disclosed findings characteristic of PSS, and immunofluorescence studies displayed nonspecific deposits of fibrinogen and complement. The patient's general condition deteriorated, with development of pericarditis and pulmonary failure; after several peritoneal dialysis treatments, a peritoneal infection developed, and the patient died of Gram-negative sepsis. The association of PSS and nephrotic syndrome is unusual.

Acute Kidney Injury↗
PubMed1980

The clinical spectrum of renal vein thrombosis: acute and chronic.

The present study is a prospective evaluation of 151 patients with the nephrotic syndrome in regard to the incidence of renal vein thrombosis, modes of clinical presentation, pathogenetic course and response to anticoagulant therapy. Of the 151 nephrotic patients studied, 33 had renal vein thrombosis and membranous nephropathy was present in 20. There were two modes of clinical presentation: (1) a sudden renal vein thrombosis was observed in the young patient with acute flank pain, marked costovertebral angle tenderness and macroscopic hematuria; a characteristic intravenous pyelogram, renal histologic changes and anticoagulant therapy were followed by marked improvement in renal function; (2) long-term renal vein thrombosis was observed in the older patients; they were asymptomatic and intravenous pyelograms disclosed no abnormalities; there were no suggestive renal histologic findings; the incidence of thromboembolic phenomena other than renal vein thrombosis was high, and there was mild progressive deterioration of renal function which was not altered by anticoagulant drugs; treated nephrotic patients with chronic renal vein thrombosis did not experience a new episode of thromboembolism whereas untreated nephrotic patients without renal vein thrombosis did. Finally, the sequence of nephrotic syndrome leading to renal vein thrombosis was clearly established showing the pathogenetic role of the nephrotic syndrome in renal vein thrombosis. Possible mechanisms in the pathogenesis of renal vein thrombosis are also discussed.

Acute Disease↗
PubMed1980

Unique effects of 24,25-dihydroxyvitamin D3 in uremic patients.

The effects of 24,25-dihydroxyvitamin D3 (24,25[OH]2D3), given orally for 7-10 days at doses of 2 and 4 microgram/day, were evaluated in patients with advanced renal failure. There was a significant fall in serum Ca and a rise in alkaline phosphatase; both returned to pretreatment levels 2 weeks after cessation of therapy. There was no change in intestinal absorption of 47Ca. These observations are significantly different from those observed during treatment with 1,25(OH)2D3 or 25(OH)D3, indicating that different vitamin D sterols can clearly exert different biologic effects.

Alkaline Phosphatase↗
PubMed1980

Relief of idiopathic generalized pruritus in dialysis patients treated with activated oral charcoal.

The effect of oral charcoal on idiopathic generalized pruritus in 11 stable patients undergoing maintenance hemodialysis was compared to that of placebo dextrose in a controlled, double-blind, cross-over study. Contrasted to placebo, charcoal, 6 g daily for 8 weeks, relieved pruritus subjectively in all but one patient (P = 0.01). Symptomatic relief from pruritus coincided with objective resolutions of active, scratch-induced skin lesions (P = 0.03). No significant alterations were noted in the serum concentrations of standard laboratory variables, including lipids, alkaline phosphatase, phosphorus, or calcium, during treatment with either charcoal or placebo. No adverse effects from the charcoal were noted during the study.

Adult↗
PubMed1979

Diabetes mellitus with immune complex glomerulonephritis.

The present study describes 3 patients with the simultaneous occurrence of diabetic nephropathy and immune-complex mediated glomerulonephritis. Renal manifestation included proteinuria and hematuria which were preceded by or co-existent with an infectious process. Renal manifestation included proteinuria and hematuria which were preceded by or co-existent with an infectious process. Renal histology showed the characteristic change of diabetic nephropathy along with those of immune complex glomerulonephritis. Immunofluorescence studies showed a linear pattern with a superimposed granular pattern of IgG and C3 deposits. Renal function and urinary findings improved in the 2 patients who were followed up.

Adult↗
PubMed1979

Heroin associated nephropathy: clinical and histological studies in 19 patients.

Nineteen patients, 20 to 47 years old with heroin addiction and renal disease, were studied. Patients with pre-existing systemic disease that can cause renal pathology were excluded. The mean duration of the addiction was 3.8 +/- 8 years. Most of the patients had the nephrotic syndrome. Renal biopsy revealed focal histological changes in 10 patients (5 with focal sclerosis) and diffuse changes in 9. Immunofluorescence studies done in 17 patients revealed diffuse deposition of IgG and beta 1C in 11 patients and focal deposits in 6 (mostly IgM). They were followed for a period ranging from 7 to 67 months. Most patients experienced progressive deterioration of renal function except in 4 cases in whom there was cessation of the drug addiction. These 4 displayed a rise in glomerular filtration rate (from 87 +/- 16 to 100 +/- 11 ml/min), marked reduction in proteinuria (from 6.5 +/- 2.6 to 0.4 +/- 0.1 g/24 hr) and an increase in serum albumin (from 3.2 +/- 0.5 to 4.0 +/- 0.1 g/dl). In summary, the fact that the renal abnormalities of our patients could not be explained by other diseases and the marked improvement upon cessation of the addiction favors the notion that heroin addiction "per se" may be the cause of the nephropathy. However, the heroin nephropathy was not manifested by a specific histological or immunofluorescence pattern.

Adult↗
PubMed1978

Renal damage with intestinal bypass.

Renal function and biopsies were studied in 18 patients, 7 to 108 months after intestinal bypass. Enteropathy was found in 12 and hyperoxaluria in 16. Every biopsy showed a type of focal interstitial nephritis, tubular atrophy, fibrosis, and glomerular hyalinization. Damage ranged from minimal to extensive and renal function from normal to end-stage failure. Tubular injury had resulted partly from oxalate deposits. However, in 10 patients no oxalate crystals were seen. In eight others, most of the damaged areas were remote from crystal deposits. Immunoglobulin M and C3 deposits, found in glomerular capillaries and the messangium in six of 11 specimens, and the presence of circulating immune complexes in five of 10 patients, in addition to the extraintestinal organ involvement, suggested immune complex mesangial injury as one factor in bypass nephropathy. With progressive impairment of renal function, a biopsy appears justified. If damage is significant, the bypass should be dismantled.

Adult↗