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Biomedical subjects

H A Bloomer

Publications and source records attributed to H A Bloomer.

At least 19 recordsLinked to original sources
PubMed1981

Clinical course of patients with scleroderma renal crisis treated with captopril.

Since it has been suggested that the renin-angiotensin axis may play an important role in the severe hypertension and in the acute renal deterioration in scleroderma, we sought to determine the effectiveness of angiotensin blockade in the treatment of this disorder. Captopril controlled blood pressure successfully and easily in 4 consecutive patients with scleroderma renal crisis. Mean serum creatinine was 3.5 mg/dl after scleroderma renal crisis immediately prior to captopril. The first patient required maintenance hemodialysis because of progression to advanced renal failure before captopril was available. However, in this patient oliguric renal failure was changed to nonoliguric renal failure immediately after beginning therapy. Serum creatine stabilized in the other 3 patients. Serum creatinine peaked at 4.7 mg/dl, but then progressively improved to 3.5 mg/dl 12 weeks after captopril was begun. None of the other 3 patients required any form of dialysis during the scleroderma renal crises. Mean survival of these 4 patients was significantly greater than that of the 9 previous patients with scleroderma crisis. These observations confirm that angiotensin blockade with captopril is effective therapy to prevent renal deterioration, to control blood pressure and prolong survival in scleroderma patients with renal crisis.

Acute Kidney Injury↗
PubMed1981

Renal pathology in patients with rheumatoid arthritis.

We studied 76 patients with rheumatoid arthritis who had autopsies performed at the University of Utah and Salt Lake Veterans Administration Medical Center. The most common pathological finding in the kidney was interstitial fibrosis (46%) and internal proliferation of the arterioles in the absence of hypertension (54% of the cases). Renal amyloidosis was only found in 7% of the patients. Azotemia (creatinine above 2 mg/dl) was found in 9% of the patients but was not clinically significant. In addition uremia was not a frequent cause of death in patients with rheumatoid arthritis.

Adult↗
PubMed1980

Early pathologic features of hereditary nephritis: a clinicopathologic correlation.

The histologic, immunofluoresence and electron microscopic features of renal biopsies from twelve patients having hereditary nephritis were examined and correlated with the clinical data. In ten patients with normal renal function, light microscopy showed similar but nonspecific glomerular abnormalities consisting of mild focal and segmental hypercellularity and thickening of capillary walls. Biopsies from two patients with azotemia had diffuse lesions of the glomeruli and associated interstitial fibrosis. There were no characteristic findings on immunofluorescence. Electron microscopy revealed alterations in thickness and density of the glomerular capillary basal lamina in all patients. However, lamellation of the basement membrane and the presence of electron dense granules were present only in the two patients with renal functional impairment. These findings support the view that hereditary nephritis is a form of glomerular disease in which ultrastructural changes in the basal lamina of glomerula capillaries are the earliest and most consistent lesions. However, the morphologic spectrum of these ultrastructural abnormalities is broader than previously recognized.

Adolescent↗
PubMed1979

High-dose corticosteroids: their use in treating idiopathic rapidly progressive glomerulonephritis.

To evaluate the response of patients with idiopathic rapidly progressive glomerulonephritis (RPGN) to high-dose corticosteroids, we have studied ten consecutive patients with this disorder. All were given 1 g of methylprednisolone intravenously each day for one week and then placed on a high-dose orally administered prednisone regimen. Four of the ten patients with idiopathic RPGN responded with a sustained reduction in the serum creatinine level of at least 50%. The patients who responded were characterized by a symptomatic illness of short duration and normal blood pressure. Renal biopsies in the responding patients showed minimal glomerular and crescentic sclerosis with mild interstitial fibrosis. The nonresponders had a long symptomatic illness with elevated initial blood pressures. The renal tissue in this group had considerable fibrosis of the crescents, glomeruli, and interstitium. The results suggest that a certain group of patients with idiopathic RPGN will improve with high-dose corticosteroid therapy.

Administration, Oral↗
PubMed1979

Serum C-peptide in renal failure patients following stimulation of pancreatic secretion.

We have demonstrated persistently elevated serum C-peptide concentrations in patients with chronic renal failure on chronic hemodialysis. A blunted serum C-peptide response to intravenous glucose, glucagon and tolbutamide was also found. However, the response to oral glucose stimulation was greater and more prolonged than in control subjects, probably related to the magnitude of hyperglycemia found in patients with chronic renal failure. These observations suggest the existence of a defect in the renal clearance of C-peptide although an abnormality in C-peptide secretion cannot be excluded.

Adult↗
PubMed1978

Adult hemolytic uremic syndrome with renal arteriolar deposition of IgM andC3.

Two cases of idiopathic adult hemolytic uremic syndrome in which deposits of IgM and C3 were identified in renal arterioles showing fibrinoid necrosis are reported. Fibrin was also identified in the lumina of the involved vessels, but there was no laboratory evidence of disseminated intravascular coagulation. In both cases, serum C3 was decreased and C4 was normal, suggesting involvement of the alternate pathway of complement activation. These two cases suggest that in some instances the adult hemolytic uremic syndrome may be immunologically mediated, and that renal vascular thrombosis is a secondary phenomenon.

Antigen-Antibody Complex↗
PubMed1978

Hereditary nephritis: a re-examination of its clinical and genetic features.

In order to re-evaluate current concepts of hereditary nephritis we studied the urinary findings, the course of the disease, and its genetic transmission in two large pedigrees. We identified 150 patients with hereditary nephritis. Our data show that microscopic hematuria is the most reliable urinary criterion for diagnosing hereditary nephritis in both male and female patients. The hematuria is frequently accompanied by erythrocyte casts indicating that the renal lesion is a glomerulitis. Men are more severely affected than women. They have striking urinary abnormalities, which are present in early childhood, and they progress to renal failure in adult life. Affected women have less obvious urinary abnormalities and rarely develop uremia. In these two families a sex-linked dominant mode of genetic transmission was present. The demonstration that hereditary nephritis is X-linked, at least in some families, helps to explain the difference in severity between men and women and the variable expression among affected women.

Adolescent↗
PubMed1978

Abnormalities in the regulation of growth hormone in chronic renal failure.

Carbohydrate intolerance is a common abnormality in patients with chronic renal failure. In this group of patients we investigated the interrelation among glucose, insulin, and growth hormone and confirmed the presence of carbohydrate intolerance and hyperinsulinemia. In addition we demonstrated alterations in growth hormone regulation, characterized by (1) the lack of suppression of growth hormone by orally induced hyperglycemia and paradoxical increase in serum levels of growth hormone after the administration of intravenous glucose or glucagon; (2) lack of release of growth hormone with induced hypoglycemia and an exaggerated response to levodopa administration. Furthermore, thyrotrophin-releasing hormone stimulated growth hormone release, a phenomenon not observed in the control population. Our studies show an impaired hypothalamic regulation of growth hormones secretion in patients with renal failure undergoing long-term hemodialysis.

Adult↗
PubMed1978

Cholesterol embolization: a complication of angiography.

Cholesterol embolization is not widely recognized as a complication of major arteriographic procedures. In a retrospective study of 71 autopsies of patients who underwent diagnostic arteriographic procedures (20 with aortograms, 51 with cardiac catheterization and coronary angiography), we found an incidence of cholesterol embolization of 30% and 25.5%, respectively, in comparison with 4.3% in an age and disease-matched control population. The organs most frequently affected are the kidney and spleen following aortogram, and the myocardium following cardiac catheterization. The clinical importance of these findings cannot be ascertained from this study, but our experience with a single case demonstrates that radiographic studies may produce substantial morbidity.

Adult↗
PubMed1977

Abnormalities in the regulation of prolactin in patients with chronic renal failure.

We have investigated the hypothalamic-hypophyseal regulation of prolactin secretion in patients with chronic renal failure treated with chronic hemodialysis. When compared to control subjects, baseline serum prolactin levels were elevated in the renal failure patients (range 11 to 16 mmicrogram/ml for renal failure patients, 6 to 9 mmicrogram/ml for controls, P less than 0.05). In addition, serum prolactin levels in the renal failure patients failed to suppress significantly following the administration of L-dopa, and did not increase in response to chlorpromazine or thyrotropin releasing hormone. These findings suggest an abnormal regulation of prolactin secretion and appear to be another example of the endocrine dysfunction that occurs in uremic subjects.

Adult↗
PubMed1976

Thyroid dysfunction in uremia: evidence for thyroid and hypophyseal abnormalities.

Disturbances in thyroid function and a high prevalence of goiter develop in patients on chronic hemodialysis. This study shows that in patients on dialysis, mean serum thyroxine and triiodothyronine levels are lower than normal. Patients with chronic renal failure not on dialysis, have mean serum thyroxine levels similar to normal subjects and low mean serum triiodothyronine levels. However, both serum thyroxine and triiodothyronine concentrations decrease as the renal failure worsens. In addition, both groups of patients with renal failure have a decreased serum thyroxine response to oxogenous thyrotrophin and a diminished serum thyrotrophin response to thyrotrophin-releasing hormone. These data suggest the presence of an intrathyroidal and an hypophyseal defect in uremic patients. Although serum iodide concentrations are elevated, there is no correlation between the level of serum iodide and the degree of renal failure. Therefore, we have no direct evidence that iodide excess is responsible for the abnormalities observed.

Adolescent↗