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Biomedical subjects

G A Kozeny

Publications and source records attributed to G A Kozeny.

15 recordsLinked to original sources
PubMed1988

Effects of interleukin-2 immunotherapy on renal function.

Recombinant interleukin-2 (IL-2) infusions have recently been evaluated as a new form of immunotherapy for the treatment of malignancies. This form of therapy has been complicated by the development of fluid retention, azotemia, and hypophosphatemia. To evaluate the effects of IL-2 on renal function, we prospectively studied eight patients who received IL-2 (10(5) micron/kg every eight hours intravenously [IV]) for five days as the initial phase of a treatment protocol using IL-2 plus lymphokine activated killer (LAK) cells. Dopamine and fluids were used to maintain blood pressure and all patients received indomethacin (100 mg/d). IL-2 therapy produced a syndrome similar to endotoxemia with the development of respiratory alkalosis (pH = 7.44 +/- .2, pCO2 = 30 +/- 2) and hypotension (mean BP, 71.3 mm Hg). These changes were accompanied by marked sodium avidity, edema formation, and mild elevations of BUN and creatinine. Hypophosphatemia, hypocalcemia, and hypomagnesemia were commonly seen. No defects in renal calcium, magnesium, phosphorous, net acid excretion, or glycosuria were demonstrated. We conclude: (1) IL-2 induces an increase in vascular permeability causing the development of edema, sodium avidity, and prerenal azotemia as occurs during endotoxemia; (2) IL-2 therapy induces respiratory alkalosis with the subsequent intracellular shift of phosphorous accompanied by increased renal phosphorous reabsorption; and (3) there is no evidence of renal tubular dysfunction (renal tubular acidosis [RTA], renal leak of glucose, phosphorous, or magnesium).

Acid-Base Equilibrium↗
PubMed1987

Occurrence of renal tubular dysfunction in lupus nephritis.

We prospectively evaluated 30 patients who presented with active systemic lupus erythematosus (SLE) for the presence of tubular abnormalities. All patients fulfilled the American Rheumatology Association criteria for SLE. When appropriate, a renal biopsy was performed. Of the 30 patients studied, 12 had no abnormal tubular study results, whereas 18 patients had some form of defect in the handling of potassium, sodium, or hydrogen ions. Eight patients had distal renal tubular acidosis (dRTA) due to an isolated proton secretory defect. Five had dRTA of the gradient or acid back-leak type. Two had an unresponsive voltage-dependent form of dRTA; one had a responsive voltage-dependent form of dRTA. One individual had hyporeninemic hypoaldosteronism and one had dRTA plus hypoaldosteronism. Clinically, patients with the abnormal tubular study results more often presented with nephritis or nephrotic sediment, peripheral edema, or anemia. Renal biopsies failed to demonstrate any difference in glomerular histologic findings and calculated activity, chronicity, or interstitial indexes. We conclude that SLE may be associated with a variety of tubular defects.

Acidosis, Renal Tubular↗
PubMed1986

Myocardial infarction with normal results of coronary angiography following diltiazem withdrawal.

Abrupt withdrawal of calcium channel blocking agents has been associated with symptoms of ischemic heart disease, but acute myocardial infarction has not been noted. Herein is described a severely uremic patient who had an acute myocardial infarction shortly after discontinuance of diltiazem, although results of subsequent coronary arteriography were normal. It is postulated that myocardial damage occurred because of increased intracellular calcium flux, augmented myocardial contractility, and/or drug withdrawal-related coronary spasm.

Adult↗
PubMed1986

Systemic lupus erythematosus presenting with hyporeninemic hypoaldosteronism in a 10-year-old girl.

Hyperkalemia has been noted to occur spontaneously in patients with long-standing systemic lupus erythematosus who did not have advanced renal insufficiency. The patients previously described all had relatively normal renin-aldosterone systems, and the hyperkalemia was thus presumed to be secondary to a primary defect in renal tubular potassium secretion. We describe at 10-year-old girl with lupus nephritis, without significant renal insufficiency, who had hyperkalemia from hyporeninemic hypoaldosteronism postulated to be due to vasculitis involving the afferent/efferent arterioles and juxtaglomerular apparatus.

Aldosterone↗
PubMed1986

Hypertension, mineralocorticoid-resistant hyperkalemia, and hyperchloremic acidosis in an infant with obstructive uropathy.

An 8-week-old infant with hypertension, hyperkalemia, and hyperchloremic acidosis, presumably due to chloride shunt type of distal renal tubular acidosis, is described. The patient's renin-aldosterone axis was intact. The infant was also found to have an obstructed solitary kidney. Despite correction of the obstruction and improvement in the glomerular filtration rate accompanied by normal development, hyperkalemia and renal tubular acidosis persisted. The defect was still demonstrable 9 months following relief of the obstruction. We conclude that neonatal obstructive uropathy can result in renal tubular acidosis of the chloride shunt type. The reversibility of this defect is, as yet, unknown.

Acid-Base Equilibrium↗
PubMed1985

In vivo effects of acute changes in osmolality and sodium concentration on myocardial contractility.

Effects of acute changes in osmolality and sodium concentration (Na) on myocardial contractility (MC) were examined in anesthetized dogs. Using a carotid to left anterior descending bypass, 4 cc of NaCl and/or dextrose of varying osmolality as injected and the percentage of change in MC measured. At Na = O mEq/L, a positive inotropic response occurred, which varied inversely as osmolality increased from 300 (MC = 100 +/- 23%) to 700 mOsm/L (MC = 39 +/- 10%, p less than 0.01). Similar ranges of positive responses of lesser magnitude were noted at Na = 75 mEq/L. At Na = 150, 190, or 350 mEq/L, similar increments in osmolality caused an increasingly negative inotropic response. An inverse relationship between Na and MC was noted with osmolality held constant. Injections of the nonionic contrast agent, P297, in 5% dextrose or 0.9% NaCl, resulted in 28 +/- 3% or -17 +/- 4% (p less than 0.01) change in MC, respectively. Sodium concentration and osmolality have independent effects on MC. Hyperosmolality/hypernatremia causes a negative inotropic response while hyponatremia causes a positive one.

Animals↗
PubMed1984

Rapid access for emergency dialysis.

Vascular access for acute hemodialysis or ultrafiltration in critically ill patients frequently requires cannulation of large-caliber veins. Repeated cannulation of these vessels present a finite risk of hemorrhage or hematoma. A teflon catheter introducer sheath system (TIS) allows for repeated use of the central circulation, requires only one major vascular entry, and can be adapted for either hemodynamic monitoring or emergency hemodialysis. Forty-six acute hemodialysis have been performed in 25 critically ill patients who have had TIS in place for hemodynamic monitoring. Dialysis was performed by inserting a femoral dialysis catheter through the TIS in place of the Swan-Ganz catheter. We have had no complications using the approach for emergency hemodialysis, and adequate dialysis was accomplished.

Blood↗
PubMed1984

Contralateral hemothorax secondary to chronic subclavian dialysis catheter.

Subclavian vein catheterization offers a rapid, safe method for providing acute or short term hemodialysis. The technique has been associated with very few complications. 3 patients are described who developed hemothorax several weeks after the placement of a subclavian catheter. Perforation of the superior vena cava by the tip of the cannula could be demonstrated only by the injection of contrast media into the catheter.

Aged↗
PubMed1984

Incidence of subclavian dialysis catheter-related infections.

Since 1981, we have performed more than 1,300 dialyses in 74 patients who have had subclavian dialysis catheters (SDCs) in place for a total of 3,065 days. Sixty-one (82%) of these patients have had their SDCs in place for seven to 21 days, including 37 (50%) for longer than 21 days. We have had six culture-proved and three possible (culture-negative) cases of SDC-related infections. Staphylococcus aureus (four cases) and Staphylococcus epidermidis (two cases) were the only organisms isolated. These infections were easily managed with antibiotics and removal of the SDC. There were no infection-related deaths. We believe that the SDC is a safe means of administering hemodialysis.

Aged↗