[Prognosis and risk factors in acute dialysis-requiring renal failure after open-heart surgery].
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Acute Kidney Injury↗
Biomedical subjects
H E Hansen
Publications and source records attributed to H E Hansen.
Morphologic renal changes during cyclosporine treatment of psoriasis. Studies on pretreatment and posttreatment kidney biopsy specimens.
BACKGROUND: Because of concern about long-term renal toxicity from low-dose cyclosporine therapy, we studied kidney biopsy specimens in psoriasis patients treated with this drug. OBJECTIVE: The purpose of the study was to investigate whether any morphologic changes appear after approximately 1 year of treatment. METHODS: Pretreatment and posttreatment renal biopsy specimens were performed in 12 psoriasis patients treated with cyclosporine in dosages from 1.8 to 6 mg/kg/day for 6 to 18 months. RESULTS: The study disclosed a slight but significant increase in interstitial fibrous tissue, which negatively correlated with creatinine clearance. The findings were similar to those described in patients receiving higher dosages of cyclosporine. CONCLUSION: The clinical relevance of these so-far minor changes is unknown and does not exclude the use of cyclosporine in severe psoriasis; however, they should be taken into consideration in so-called low-dose therapy.
Adult↗
Hemolytic uremic syndrome in a patient with systemic sclerosis treated with cyclosporin A.
The case is presented of a 48-year-old female suffering from diffuse cutaneous systemic sclerosis (diffuse scleroderma) since 8 years, who went into renal failure as part of hemolytic uremic syndrome following 3 weeks' treatment with 3.8 mg/kg cyclosporin A. Hemolytic uremic syndrome has previously been described in transplant patients receiving cyclosporin A. There are also four cases reported in the literature of renal failure developing in middle aged females with diffuse cutaneous systemic sclerosis after short-term use of low dosage cyclosporin A treatment. It is suggested, that it may be wise not to use cyclosporin A to this category of patients, in which it can not be ruled out, that even a low dose therapy may trigger the rapid onset of scleroderma renal crisis or as in our case provoke hemolytic uremic syndrome.
Acute Disease↗
Epidemiology of nasopharyngeal and salivary gland carcinoma in Greenland.
From 1950 to 1989 one hundred and forty-four cases of either undifferentiated nasopharyngeal carcinoma (NPC) or salivary gland carcinoma (SGC) were diagnosed in Greenlanders, all born in Greenland. The Greenland SGC is an anaplastic carcinoma with histopathology and electronmicroscopic cytopathological alterations as found in undifferentiated NPC. Both NPC and SGC from Greenland and Alaska are associated with Epstein-Barr virus infection. The incidence rate of NPC based on newly diagnosed cases during the last 15 years is 12.7 for men and 9.2 for women. The same figures for anaplastic SGC are 3.4 and 3.1. These are among the highest incidence rates of Epstein-Barr virus associated carcinomas on record. From 1950 to 1989 there has been an increase in the rate of NPC. From the cumulated rate, it can be predicted that the number of cases will continue to increase during the years to come. During the ten year period 1980 to 1989 patients were questioned about their childhood life style and the family history was taken. The Inuit lifestyle is quite different from that of Europeans and Chinese, but in common with Chinese from Guangzhou (formerly Canton) Greenlanders have a high consumption of fish, fresh as well as dried. Familial clustering has been rarely reported, but in the present investigation 27% of the patients diagnosed between 1980 and 1990 had a positive familial history with one or more confirmed cases among first degree relatives.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Postcapillary venule-like transformation of peritubular capillaries in acute renal allograft rejection. An ultrastructural study.
To describe ultrastructural changes in renal peritubular capillaries during acute allograft rejection, biopsy specimens from five allografts with acute rejection were studied electron microscopically and compared with control specimens. The thickness, cross-sectional area, and luminal circumference of capillary endothelium were estimated morphometrically. Thickening of endothelial cells, loss of fenestration, increase in endothelial cell organelles, increased adherence and passage of lymphocytes and monocytes, and defects in the endothelial lining were demonstrated. The luminal circumference representing the size of the capillary was not changed. A balloonlike fragmentation of endothelial cells was sometimes observed around lymphocytes, suggesting cytotoxic injury to capillaries. The observations indicate that during rejection-induced endothelial activation, peritubular capillaries exhibit postcapillary venule-like transformation that enhances the influx of inflammatory cells into the kidney allograft.
Adult↗
The effect of cyclosporine and azathioprine on GFR and renal histopathology 12 to 24 months after renal transplantation.
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Azathioprine↗
Clinical applicability of the immunomagnetic beads technique for serological crossmatching in renal transplantation.
The aim of the present prospective study was to investigate the clinical applicability of the immunomagnetic (IM) beads technique for serological crossmatching (XM) in renal transplantation. The IM XM were read after various periods of incubation, and the results were compared with those obtained by the conventional Kissmeyer-Nielsen (KN) technique. A total of 132 sera from 96 potential recipients were tested against cells from 62 donors. Eight-nine KN T-cell XM-negative renal allograft transplantations were performed, and the IM XM results were related to clinical 3-month follow-up data (incidence of primary non-function, never functioning grafts, graft losses and rejection episodes). The IM technique was clearly more sensitive than KN, and sensitivity increased markedly with increasing duration of incubation. KN-, IM+ reactions were predominantly found among sera from patients with panel-reactive antibodies (PRA, 2p less than 0.01), and thus probably caused by HLA antibodies. However, positive IM XM, appearing after more than 35 min of incubation, did not influence the overall clinical outcome in the observation period. With reading after exactly 35 min of incubation, XM results obtained by IM and KN techniques correlated well. Thus, we believe, that the IM XM technique will be as safe and effective in avoidance of hyperacute rejections as the conventional assay. In the present material, the incidence of primary nonfunction was significantly (2p = 0.0023) higher among PRA+ recipients compared to PRA- patients. To conclude, we recommended the IM technique with reading after exactly 35 min of incubation for easy, fast (70 min) and reliable XM, that is always possible to perform using peripheral blood.
Cell Separation↗
Prognosis in septicemia complicated by acute renal failure requiring dialysis.
During a 12-year period 419 patients were admitted because of acute renal failure requiring dialysis. Fifty (12%) had septicemia verified by blood culture. In a retrospective study age, sex, focus of infection, blood culture results, kidney function, mode of dialysis treatment, numbers and durations of complicating organ failures, presence of gastrointestinal bleeding, and secondary complicating events of septicemia were recorded for the purpose of establishing a prognostic index based on clinical criteria. Respiratory failure was present in 34 patients, circulatory failure in 31 patients, failure of coagulation system in 25 patients, and hepatic failure in 10 patients. Overall mortality was 46%. Highest death-rates were found during the first days of dialysis. In patients with multiple organ failures, in elderly and in patients suffering from staphylococcus aureus septicemia, a non-significant trend towards higher mortality was found. The mode of dialysis treatment did not influence patient survival. Our intention of establishing a prognostic index based on bedside clinical criteria has not been fulfilled. Even though mortality-rate increases in patients with acute renal failure complicated by failure of one or more vital organs, survival-rate in patients with four or more organ failures was 30%.
Acute Kidney Injury↗
Prognosis and risk factors in acute, dialysis-requiring renal failure after open-heart surgery.
Of 1988 patients who underwent open-heart surgery from 1980 through 1988, 68 (3.4%) developed postoperative acute renal failure requiring dialysis (2.5% of adult and 8.3% of pediatric patients). Isolated aortocoronary bypass grafting was the operation with lowest incidence of this complication (0.6%). Acute renal failure usually appeared during the first 3 postoperative days. It carried a mortality rate of 63%, with half of the deaths occurring during the first few postoperative days, due to low cardiac output and progressive multiple organ failure. Logistic regression analysis in cases of aortic valve replacement demonstrated that significant independent preoperative risk factors for acute renal failure were renal insufficiency (serum creatinine greater than 110 mumol/l in greater than or equal to 2 samples) and increased cardiothoracic index/left ventricular end-diastolic dimension. Data from the literature indicated no time-related trend towards reduction of acute renal failure incidence or mortality. Prevention of low cardiac output is of major importance in these respects. Operative intervention before development of advanced disease with left ventricular dilatation and secondary kidney failure is advocated.
Acute Kidney Injury↗
Portal hypertension without liver cirrhosis in renal transplant recipients.
A rare syndrome of portal hypertension with esophageal varices but without evidence of cirrhosis in the liver biopsy was seen in 3 patients in a series of 1000 renal allotransplant recipients immunosuppressed with azathioprine and prednisone. The liver disease began 3-6 years after transplantation with abnormal liver function tests and esophageal varices with bleeding episodes. One patient had also ascites. Liver biopsy at the beginning of liver disease showed in one patient normal structure which eventually developed to slight diffuse fibrosis and nodular hyperplasia. One patient had diffuse fibrosis, and the third patient had strong sinusoidal engorgement with nodular hyperplasia, later on developing to cirrhosis. One patient is still alive and well, the two others died from liver insufficiency. 39 cases of non-cirrhotic portal hypertension in renal transplant recipients and histologic evidence of peliosis, sinusoidal dilatation, nodular hyperplasia or hepatic veno-occlusive disease have been identified in the literature. The cause of this disease is presumably azathioprine, but its rarity shows that it must depend also on other factors.
Adult↗
Acquired haemolytic anaemia due to isohaemagglutinins of donor origin following ABO-minor-incompatible kidney transplantation.
Of 1041 renal allograft transplantations performed in our centre, 142 (13.6%) were carried out with ABO-minor-incompatible kidneys. Anti-recipient ABO antibodies were found in two of 34 patients treated with cyclosporin. These two cases of severe but self-limited haemolysis due to anti-A1 and anti-B, respectively, are reported in detail. Among 108 azathioprine-treated patients no evidence of the disorder was found. The condition should be suspected in any recipient with an unexpected reduction in haematrocrit or other signs of haemolysis after ABO-minor-incompatible organ transplantation.
ABO Blood-Group System↗
Cyclosporin A treatment of systemic sclerosis.
Ten patients with severe progressive systemic sclerosis were treated with cyclosporin A at dosages of 1.5-7.5 mg/kg per day:two patients showed a marked improvement with softening of the involved skin; in one patient there was healing of persistent digital ulcers; one patient showed initial improvement followed by a marked exacerbation; one patient was slightly improved; two patients were unchanged. The clinical results correlated well with levels of serum aminoterminal propeptide of type III procollagen. In the eight patients completing treatment, side-effects such as slight tremor and a transient increase in the serum creatinine and blood pressure were either absent or reverted to normal when the dosage was decreased, except one case who had to be treated with anti-hypertensive drugs.
Adult↗
Ultrastructure of medullary tubules in ischemic acute tubular necrosis and acute interstitial nephritis in man.
Medullary tubules in renal biopsies from twelve patients suffering from ischemic acute tubular necrosis (ATN) and nine patients with allergic, drug-induced acute interstitial nephritis (AIN) were investigated by electron microscopy using quantitative and semiquantitative methods. For comparison, 12 biopsies from patients without renal disease or with minimal change nephropathy were studied. The mean scores for reduction of brush border and basolateral infoldings of the cell surface were significantly increased in the straight part of the proximal tubule and the thick ascending loop of Henle (straight part of the distal tubule) compared with medullary controls, and these changes were significantly greater than the scores for the corresponding convoluted tubules in the cortex. The numbers of missing tubular epithelial cells (indicating sites of cellular desquamation) were significantly increased in the thick ascending loop of Henle in ATN as well as in AIN and in the straight proximal tubule in ATN. This single cell lesion also occurred in the collecting duct. These findings are discussed in the light of recent experimental data indicating the importance of medullary tubules for the pathogenesis of ATN.
Adult↗
Kidney biopsies in methotrexate-treated psoriatics.
Kidney biopsies were studied in 19 psoriatics treated with methotrexate (MTX) from 1 month to 16 years. Only 3 of the patients had received the drug for less than 1 year. Four patients had been treated for more than 10 years. The total doses of MTX ranged from 30 to 14,340 mg. In 17 of the 19 patients the cumulative MTX dose was 500 mg or more. In 9 patients the cumulative doses were over 2 g. With the exception of 1 patient, which presented sequelae of acute renal failure unassociated with MTX treatment, all other biopsies showed renal structures which, assessed by routine judgement, were found normal. Semiquantitative evaluation of interstitial fibrosis and arteriolar hyalinosis as well as interstitial volume estimated by morphometry showed no significant changes. No patient showed clinical or laboratory signs of renal impairment.
Adult↗
Changes in renal biopsies during low dosage cyclosporin treatment.
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Adult↗
Prognosis in acute pancreatitis complicated by acute renal failure requiring dialysis.
Acute pancreatitis complicated by acute renal failure (ARF) requiring dialysis is a rare condition with a mortality rate of 80%. During the period 1977-1988 419 patients were admitted to our hospital because of ARF requiring dialysis. Fourteen (3%) had ARF caused by acute pancreatitis. Ten patients developed respiratory failure, eight patients circulatory failure, four hepatic failure, and one disseminated intravascular coagulation. Three patients had complicating septicemia and two gastrointestinal bleeding. Ten patients (71%) died. All patients with four or more organ failures besides the pancreatic failure died. Median time from start of symptoms until death was 28 days. Mortality in this series does not differ from that reported over the last 40 years. The need of multicenter trials for the purpose of improving prognosis is emphasized.
Acute Disease↗
[Extracorporeal treatment of poisoning. An analysis of 72 consecutive cases from the period 1977-1988].
During a period of 12 years, extracorporeal treatment of 72 cases of poisoning in the form af dialysis and/or haemoperfusion was undertaken in Medical Department C of Arhus Municipal Hospital. Where 54 patients were concerned, the causes of poisoning were medicinal. Eleven cases were caused by ethyl alcohol, six were caused by technical poisons and one by cantharidine which is employed in veterinary medicine. In 50 cases the primary indication for extracorporeal treatment was elimination of the drug or other poison. In the remaining 22 cases the indication was acute renal failure. The total mortality was 4%.
Denmark↗
Genetically different cell subpopulations in hydatidiform moles. A study of three cases by RFLP, flow cytometric, cytogenetic, HLA, and morphologic analyses.
Most investigators find a good correlation between the morphologic and cytogenetic classification of hydatidiform moles (HM), but exceptions have been noted. We have examined three cases of HM, using chromosome marker analysis on cultured cells, human leukocyte antigen typing on cultured and uncultured tissue, and restriction fragment length polymorphism (RFLP) analysis and flow cytometry on uncultured cells. In one morphologically partial mole, only one cell population (triploid) was found and data obtained by the above-mentioned techniques were concordant. The other two moles, which were classified morphologically as complete, consisted of several cell subpopulations differing in DNA content. In both cases only one cell population was disclosed by cytogenetic investigation. In one case, the cytogenetic analysis indicated that the cultured cells were near triploid with paternal chromosomes exclusively, whereas RFLP analysis showed that maternal X chromosomal alleles were present in the mole. The present findings demonstrate that some HMs contain cellular subpopulations with differing DNA content. One explanation for discordance between cytogenetic and morphologic classification may thus be the detection of only one cell subpopulation when karyotyping.
Chromosome Aberrations↗