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Biomedical subjects

G H Hirschman

Publications and source records attributed to G H Hirschman.

18 recordsLinked to original sources
PubMed1996

Development and progression of renal disease in Pima Indians with non-insulin-dependent diabetes mellitus. Diabetic Renal Disease Study Group.

BACKGROUND: Non-insulin-dependent diabetes mellitus (NIDDM) is a major cause of end-stage renal disease. However, the course and determinants of renal failure in this type of diabetes have not been clearly defined. METHODS: We studied glomerular function at intervals of 6 to 12 months for 4 years in 194 Pima Indians selected to represent different stages in the development and progression of diabetic renal disease. Initially, 31 subjects had normal glucose tolerance, 29 had impaired glucose tolerance, 30 had newly diagnosed diabetes, and 104 had had diabetes for five years or more; of these 104, 20 had normal albumin excretion, 50 had microalbuminuria, and 34 had macroalbuminuria. The glomerular filtration rate, renal plasma flow, urinary albumin excretion, and blood pressure were measured at each examination. RESULTS: Initially, the mean (+/-SE) glomerular filtration rate was 143+/-7 ml per minute in subjects with newly diagnosed diabetes, 155+/-7 ml per minute in those with microalbuminuria, and 124+/-7 ml per minute in those with macroalbuminuria; these values were 16 percent, 26 percent, and 1 percent higher, respectively, than in the subjects with normal glucose tolerance (123+/-4 ml per minute). During four years of follow-up, the glomerular filtration rate increased by 18 percent in the subjects who initially had newly diagnosed diabetes (P=0.008); the rate declined by 3 percent in those with microalbuminuria at base line (P=0.29) and by 35 percent in those with macroalbuminuria (P<0.001). Higher base-line blood pressure predicted increasing urinary albumin excretion (P=0.006), and higher base-line urinary albumin excretion predicted a decline in the glomerular filtration rate (P<0.001). The initial glomerular filtration rate did not predict worsening albuminuria. CONCLUSIONS: The glomerular filtration rate is elevated at the onset of NIDDM and remains so while normal albumin excretion or microalbuminuria persists. It declines progressively after the development of macroalbuminuria.

Adolescent↗
PubMed1983

Current concepts of nutritional therapy in chronic renal failure: an update.

The natural course of chronic renal disease with the passage of time is reviewed, parallel with rational nutritional management to counterbalance the ill effects of the progressive renal pathology. Progressive protein restriction, supplementation with essential amino acids and their keto-acid and hydroxy analogues, phosphate restriction, sodium and potassium regulation, and other measures are discussed, together with an elaboration on optimal nutritional management of adult maintenance dialysis patients and of children on dialysis.

Adult↗
PubMed1978

Hypophosphatemic vitamin D-resistant rickets: metabolic balance studies in a child receiving 1,25 dihydroxyvitamin D3, phosphate, and ascorbic acid.

A child with hypophosphatemic vitamin D-resistant rickets was treated for three years with the conventional vitamin D-inorganic phosphate supplementation followed by a new therapeutic regimen consisting of 1,25 dihydroxyvitamin D3 (1,25 (OH)2D3) and half of the previous phosphate supplementation. The effectiveness of the two treatment regimens was compared by calcium, phosphate, and magnesium balance techniques and by serial radiological examinations as well as careful height measurements. In addition, the lowering of the urinary pH with ascorbic acid supplementation seems to be associated with improvement in the renal tubular reabsorption of phosphate, but its distinct effect, separate from the rest of the treatment modalities, was not tested in this study. The conventional treatment did not correct the hypophosphatemia and alkaline phosphatase elevation, whereas the 1,25 (OH)2 D3-inorganic phosphate regimen is well tolerated and effective in achieving a sustained normalization of these variables. In addition, the improved growth and healing of rickets further attest to the efficacy of the new treatment.

Alkaline Phosphatase↗
PubMed1978

Complex acid-base disorders in subacute necrotizing encephalomyelopathy (Leigh's syndrome).

This report describes a case of subacute necrotizing encephalomyelopathy (Leigh's syndrome) in a 7-month-old boy. The clinical data suggest an association with a disorder of renal tubular acidification, characterized by both (proximal) type II and (distal) type I renal tubular acidosis (hybrid type). Concomitantly, the initial uncompensated metabolic acidosis evolved into a mixed metabolic acidosis and respiratory alkalosis-features of this syndrome not previously reported.

Acid-Base Imbalance↗
PubMed1977

Anorexia nervosa with acute tubular necrosis treated with parenteral nutrition.

A patient with nonoliguric acute renal failure secondary to acute tubular necrosis in conjunction with anorexia nervosa is described. Parenteral feeding at a critical time has salutory effects on the biosynthesis of new protein and thereby reduces many of the hazards of azotemia. The technique of estimating endogenous acid production is applied for the first time in a severely malnourished subject and documents the retention of dietary sulfur which presumably is retained in the formation of new tissue in the recovery phase.

Acute Kidney Injury↗
PubMed1976

Renal tubular acidosis: practical guides to diagnosis and treatment.

The syndrome of renal tubular acidosis in some one of its various forms should be suspected when an infant or child has failure to thrive, metabolic acidosis, constipation, diarrhea, vomiting, anorexia, polyuria, or dehydration in infancy. Confirmatory biochemical findings include an inappropriately high urinary pH, inadequate acid excretion and/or abnormal tubular reabsorption of filtered bicarbonate. Growth can be normal when there is sustained correction of the metabolic acidosis through appropriate alkaline therapy.

Acidosis, Renal Tubular↗
PubMedDate not supplied

Factors associated with morbidity and mortality among patients on CAPD.

Since 1981, the National CAPD Registry, sponsored by the National Institute of Arthritis, Diabetes, Digestive, and Kidney Diseases of the National Institutes of Health, has been systematically collecting demographic and follow-up data on patients receiving continuous ambulatory peritoneal dialysis (CAPD) as maintenance therapy for end-stage renal disease. Using life-table methods, this study has identified the association of diabetic glomerulosclerosis with age over 60 or under 20 years as factors jointly relevant in predicting peritonitis, hospitalization, or death. In addition, these outcomes were more likely to occur if patients were black and had been exposed to other dialytic therapy earlier on. The latter two were the only factors jointly predictive of transfer from CAPD onto hemodialysis. Careful monitoring of patients with the above mentioned characteristics may reduce complications, and lead to greater success with this increasingly popular dialysis modality.

Adult↗