[Functional oligo-anuria versus acute renal failure].
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Biomedical subjects
Publications and source records attributed to H Hornak.
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By means of gel-chromatographic investigations in the serum, sweat, urine and ultrafiltrate of healthy test persons, patients with renal insufficiency at the stage of the compensated and decompensated retention and of patients undergoing dialysis in the eccrine sweat substances in the area of so-called molecules of medium size from 1,100 to 2,050 Dalton are made evident. On account of the well-known heterogeneity of the gel-chromatographically separated fraction the concentration of the molecules of medium size is not unequivocally to be determined. It is, judged according to the peak hights of the chromatograms, less than 1/12 of the concentrations in the serum and the urine, but approximately corresponds to the content in the ultrafiltrate of patients undergoing haemodialysis. In patients with renal diseases the secretory possibility of the eccrine sudoriferous gland for molecules of medium size is not disturbed. A compensatory increased secretion of medium-size molecules via sweat in chronic renal insufficiency is not to be proved. The method of the gel-chromatography and the importance of the medium-size molecules for the pathogenesis of uraemia are critically discussed.
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In a case report the rare nail-patella-syndrome is presented. Typical and pathognomonic signs are: nail aplasia or dystrophy, iliac horns, hypoplasia or aplasia of the patellae, elbow dysplasia and a nephropathy with electron microscopic demonstrable collagen-like deposition in the glomerular basal membrane. The clinical relevance is determined by the course of the renal disease.
In 12 endstage kidney disease patients (8 liver healthy and 4 with liver diseases) the activities of cytochrome P450-dependentmixed functional oxidases system (MFO) of the liver were studied by using the 14C-aminophenazon breath test before and after dialysis. We were interested in the influence of uremia and dialysis treatment on MFO-activity. Our results show that uremia seems to have a pressing influence on MFO-activity. The activity was only significantly increased after dialysis in the group of patients without liver disease. We observed that the MFO-activity was reduced in patients with liver diseases. This is a restriction of the liver metabolic demethylation capacity. It is unclear if the 14C-aminophenazone breath test in dialysis patients is qualified to estimate metabolic capacity of the liver. Differentiation between the influence of uremia and of the liver disease on the alteration of MFO-activity cannot be made.
By the experience of two smaller dialysis centers the prognosis and problems of dialysis therapy in older patients are described. The age in the onset of dialysis treatment ranged from 45 to 54 years. In the beginning of dialysis the average life expectancy of older patients is markedly lower in comparison with younger patients, but remarkable in single cases with more than 4 and 5 years. The problems of adaptation and complications do require much attention and allowance. Contra-indications to dialysis therapy in older patients could not be explained. The demand for a stronger consideration of this patient group in planning of dialysis capacity is established through an international comparison and a possible rehabilitation of the patients.
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We report the case of a 22-year old male patient with terminal renal failure consecutive to hereditary osteolysis affecting the tarsal and carpal bones associated with chronic glomerulonephritis. This is one of the first cases where prolonged survival was obtained by repeated haemodialysis and kidney transplantation. The various clinical features of this syndrome are described, together with its possible repercussions on bone abnormalities induced by repeated haemodialysis of kidney transplantation.
The question is of nephrological interest, whether the secretory product of eccrine sudoriferous glands apart from the well known function for thermoregulation is useful as excretory product for the therapy of renal insufficiency. In 17 healthy subjects and 39 patients with renal insufficiency thermal sweat was obtained by exposition in the sauna and four-tub bath. Control of the trainability of sweating in 23 patients during six weeks in the Kneipp cure sanatory. For the daily fluid balance remarkable quantities of sweat could be achieved. The sweat performance is trainable. The content of soluta in the sweat of patients with renal insufficiency surmounts that of healthy test persons. The excretion of nitrogen metabolites, electrolytes and acidity is quantitatively different and is analysed individually. Apart from the reliable methods of the conservative and invasive therapy of the uraemia the thermically stimulated sweating can be recommended as an adjuvant therapeutic regime.
A thrombosis rate of 50% in the subcutaneous arteriovenous connection applied between 1969 and 1975 led to the elaboration of a regime the operative and postoperative criteria of which are demonstrated. With the help of the new conception the rate of the early occlusions could be reduced to 1,25% in the fistulae applied since 1977.
We describe a new sensitive and specific method for determination of oxalate in human serum. By using the chemiluminescence decay of monoperoxyoxalic acid very low concentrations of oxalate (200 nmol/L) can be determined. The mean serum oxalate level in apparently healthy controls was 14.5 +/- 8.5 mumol/L. Supplementation of ascorbic acid leads to an increase in serum oxalate level. While serum oxalate concentrations of calcium oxalate stone formers (x = 16.4 +/- 9.8 mumol/L) are not significantly different from the control group, an extreme increase of serum oxalate is evident in haemodialysis patients. The serum oxalate concentration decreased during dialysis treatment from 141.4 +/- 32.1 mumol/L to 36.4 +/- 12.7 mumol/L.