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J B Copley

Publications and source records attributed to J B Copley.

At least 37 records · Page 2Linked to original sources
PubMed1989

Back to basics: the urinalysis: a selected national survey and review.

An accurately performed urinalysis is vital to the screening and assessment of renal disease. We sent questionnaires to nephrology training programs throughout the United States and compared techniques described in the responses to standard urinalysis methodology gleaned from literature review. There were notable deviations in performance and interpretation between the nephrologists and the standard urinalysis. It appears that additional emphasis should be place don this basic and important laboratory test. Further study is needed to determine if more accurate performance will influence patient diagnosis and outcome.

Female↗
PubMed1989

Communication of information about therapeutic alternatives: end-stage renal disease model.

We analyzed data from questionnaires obtained from 59 patients with end-stage renal disease and nine nephrologists and transplant surgeons to determine outcome of transplantation and dialysis (probability estimates) and the relative advantages of these two treatments (attitudinal responses). Data from national and local studies were available for comparison with the probability estimates. Results indicate that although personal experience with transplantation can bias a patient's estimate of treatment outcome, neither physicians nor patients had a bias toward optimism. Attitudinal responses were similar for patients and physicians, suggesting that physicians communicate personal views more easily than information. Results suggest that shortcomings in information processing need not make informed consent procedures invalid.

Adolescent↗
PubMed1988

Calcium citrate, a nonaluminum-containing phosphate-binding agent for treatment of CRF.

Calcium citrate was evaluated as a dietary phosphate binder in 81 patients with end-stage renal disease. These patients were grouped as follows: Group 1, 43 patients who were treated with calcium citrate; and Group 2 (the control group), 38 patients who were treated with aluminum-containing compounds. Blood chemistries were measured monthly and medications adjusted to maintain the following levels: serum calcium, greater than 9 mg/dl; serum phosphorus, less than 5.5 mg/dl; and total CO2 content, greater than 22 mmol/liter. At the end of the treatment period, the following serum values were obtained in Groups 1 and 2, respectively: calcium, 9.6 +/- 1.2 mg/dl (mean +/- SD) versus 8.9 +/- 0.8 mg/dl (P less than 0.001); phosphorus 5.5 +/- 1.9 mg/dl versus 7.0 +/- 2.3 mg/dl (P less than 0.005); and calcium-phosphate product, 52 +/- 18 versus 61 +/- 21 (P less than 0.05). Differences in alkaline phosphatase, total CO2 content, and C-terminal parathyroid hormone (C-PTH) values were not statistically significant between the two groups. Fifteen patients in Group 1 were then switched to aluminum-containing compounds and chemistries were compared one month later. During calcium citrate therapy, serum calcium was significantly higher, while C-PTH and serum alkaline phosphatase were significantly reduced. No difference was noted in serum phosphorous and total CO2 content. A questionnaire completed by 17 patients in Group 1 documented excellent patient tolerance to calcium citrate. Hypercalcemia (greater than 10.5 mg/dl) was the only significant complication, but only one patient became symptomatic. We conclude that, as a phosphate binder, calcium citrate is at least as effective as aluminum-containing compounds.

Adult↗
PubMed1988

Effect of red blood cell lysis on protein quantitation in hematuric states.

To simulate hematuria, blood from healthy volunteers was added to urine samples of varying osmolalities to produce urocrits ranging from 0.01 to 3.0%. Specimens were then analyzed for protein concentration by a method using a combination of 3% sulfosalicylic and trichloroacetic acids. Microscopic hematuria (urocrit of less than 0.05%) was not associated with proteinuria, but gross hematuria often resulted in substantial amounts of protein being detected. In iso- and hypertonic urines, modest elevations in protein concentration (69-97 mg/dl) were detected. Hypotonic urines produced marked proteinuria (1,302-1,863 mg/dl). Urine protein electrophoreses identified hemoglobin as the responsible protein. Isolated hematuria can cause false-positive proteinuria on the basis of RBC lysis and release of hemoglobin into the urine. The diagnostic and prognostic implications of clinical proteinuria in the hematuric patient can be significant. Thus, in a patient with gross hematuria, a urine protein electrophoresis should be accomplished to assess the contribution of hemoglobin to the total protein determination.

False Positive Reactions↗
PubMed1987

Prevention of peritoneal dialysis catheter-related infections.

There is a significant correlation between patient morbidity and peritoneal dialysis-associated catheter-related infections. Infection occurs when barriers to microorganism invasion are disrupted. To establish and maintain strong barriers against this invasion, care must be taken with placement of the catheter and with short- and long-term maintenance. There must be particular emphasis on planning placement of the catheter. Exit-site selection, type and configuration of the catheter, whether the catheter will contain one or two cuffs, and whether placement will be midline or lateral are all important factors to be considered. Tips are offered to enhance barrier establishment as the catheter is placed, as is a discussion of postplacement exit-site and wound care, and exit-site care after healing has occurred. Finally, the importance of recognizing catheter-related infections is emphasized and four types of infection are defined. Given the anecdotal nature of much of the material presented and the lack of well-defined clinical research on the subject, carefully designed randomized prospective studies are needed to determine the best method for both catheter placement and maintenance.

Bacterial Infections↗
PubMed1987

Improving house staff ordering of three common laboratory tests. Reductions in test ordering need not result in underutilization.

Most studies of modifying test ordering have focused on costs. Questions not addressed are whether programs to reduce testing lead to a higher proportion of clinically indicated tests and is underutilization an adverse outcome of such programs? To investigate this, we studied the house staff's ordering of three common laboratory tests at baseline and after educational and administrative interventions. Over a 2-year period, 3,603 urine cultures, sputum cultures, and admission urinalyses were reviewed. A lecture emphasizing the indications for these tests followed by chart audit and weekly feedback increased the proportion of clinically indicated tests. Subsequently, an administrative intervention requiring the intern to list the reason for ordering the test on the laboratory request form further improved test ordering. Underutilization, defined as a failure to order a potentially indicated test, was assessed during two representative periods. The "underutilization rate" (omitted tests per 100 patients) was no worse during maximal intervention than it was 9 months after the last intervention (7.7 vs. 11.1, NS). No immediate adverse consequences resulted from tests not ordered. Our findings indicate that it may be possible to selectively reduce the ordering of unnecessary tests without sacrificing quality of care.

Clinical Laboratory Techniques↗
PubMed1987

'Idiopathic' hematuria. A prospective evaluation.

Evaluation of the patient with isolated hematuria is often problematic. Sixty-five patients with this entity were studied prospectively with renal biopsy; serum IgA levels, skin biopsy for IgA immunofluorescence, and HLA typing were also studied in most patients. Previously, all patients had had a non-contributory history and physical examination, normal results of structural evaluation, serologic and clotting studies, and proteinuria of less than 1000 mg/d (less than 1 g/d). Seventy-eight percent were found to have abnormal renal biopsy results and were divisible into two patient groups: those with IgA nephropathy (49%, 32/65) and those with multiple nonspecific abnormalities (29%, 19/65). Ancillary testing, demographic data, and clinical data, other than abnormal amounts of proteinuria, were not distinguishable between these groups and patients with normal renal biopsy results (22%, 14/65). Etiologic differentiation of the hematuria was possible only by renal biopsy. At present, renal biopsy in this group of patients makes no difference therapeutically or, probably, prognostically. It should not, therefore, be considered necessary for routine management of asymptomatic hematuria.

Adult↗
PubMed1986

Isolated asymptomatic hematuria in the adult.

The term "isolated asymptomatic hematuria," as it relates to both gross and microscopic hematuria, is defined; and the pros and cons of detection techniques used to localize the source of the hematuria are discussed. An algorithm is provided to optimize detection of structural defects and intrinsic renal disease in an effort to avoid subjecting the patient with this difficult-to-diagnose problem to unnecessary invasive tests. Although invasive tests should be performed where deemed necessary in the clinician's aggressive search to detect any structural abnormality, controversial areas of the evaluation of these patients are addressed. To justify various branch points of the algorithm, a discussion of both renal cell carcinoma and primary renal hematuria is proffered.

Adult↗
PubMed1986

Primary renal hematuria presenting as unilateral gross hematuria.

A patient with unilateral gross hematuria was found to have mesangial proliferation and IgM deposition on renal biopsy, consistent with the entity of primary renal hematuria. This case refutes previous assumptions that renal biopsy is normal in patients with unilateral hematuria. Glomerular lesions may be more common than previously suspected in the setting of unilateral hematuria. Renal biopsy can be useful both to define the natural history of unilateral hematuria and prevent repeated diagnostic procedures in patients with abnormal biopsies.

Adult↗
PubMed1985

Utility of skin biopsy in the diagnosis of IgA nephropathy.

Thirty-seven patients with the diagnosis of IgA nephropathy were evaluated with punch skin biopsies of non-sun exposed skin. Biopsies were performed regardless of clinical activity. Biopsies were positive for IgA immunofluorescence in two patients. In an effort to enhance positivity of biopsies, patients were pretreated with 0.1 mL of histamine and then repeat biopsies were performed on 14 patients with previously negative skin biopsies. All 14 patients had negative repeat skin biopsies for IgA immunofluorescence. A review of the literature revealed 76 positive skin biopsies in a total of 138 patients with IgA nephropathy. Positive skin biopsies were also reported in 169 of 510 patients with other renal diseases. We conclude that a 4 mm punch skin biopsy with or without histamine is an insensitive and non-specific test for diagnosing IgA nephropathy.

Biopsy↗
PubMed1985

Continuous ambulatory peritoneal dialysis and scleroderma.

A patient with scleroderma has been maintained on continuous ambulatory peritoneal dialysis (CAPD) for the past 18 months after having developed associated renal failure. Peritoneal clearances, pulmonary function tests, and hand studies have shown seasonal changes from summer to winter with ambient temperature variations. Rehabilitation and quality of life have been acceptable, blood pressure has been well controlled off all medications, and there has been relatively little disease progression. Attempts have been made to maintain low-dose captopril therapy to suppress plasma renin activity. This case suggests that CAPD is an acceptable and, perhaps, indicated treatment modality for renal failure associated with scleroderma.

Female↗
PubMed1985

Acute interstitial nephritis associated with mezlocillin, nafcillin, and gentamicin treatment for Pseudomonas infection.

Two patients developed acute interstitial nephritis (AIN) following treatment with mezlocillin sodium. Diagnosis was made by renal biopsy. Gallium 67 citrate scanning was abnormal in both. All patients were receiving multiple-drug therapy, but AIN has either not been described with the other drugs, or the temporal relationship between the AIN and termination of other drug therapy makes a causative relationship unlikely. All were infected with Pseudomonas aeruginosa. A role for the infecting organism or drug synergism in contributing to the renal disease cannot be excluded.

Acute Disease↗
PubMed1984

Allergic bronchopulmonary aspergillosis: a case report and comment on reliability of testing sources.

A case of allergic bronchopulmonary aspergillosis (ABPA) is presented. Difficulty in establishing the diagnosis occurred because of a false-negative precipitin result obtained from a commercial laboratory. This would seem to support the contention that the paucity of ABPA cases reported in the United States is secondary to the low potency and variable composition of commercial antigens available for skin tests and immunodiffusion, resulting in false-negative skin and precipitin tests. Furthermore, positive tests to species of Aspergillus other than fumigatus heretofore considered non-pathogenic must now be considered as possible etiologic explanations.

Adult↗