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Biomedical subjects

J H Turney

Publications and source records attributed to J H Turney.

At least 19 recordsLinked to original sources
PubMed1996

Influence of changes in peritoneal fluid on body-composition measurements by dual-energy X-ray absorptiometry in patients receiving continuous ambulatory peritoneal dialysis.

The effect of the presence of intraabdominal fluid on measurement of body composition by dual-energy X-ray absorptiometry (DXA) was determined by scanning 14 patients who were receiving continuous ambulatory peritoneal dialysis (CAPD) before and after the drainage of peritoneal dialysate, resulting in a mean (+/- SD) weight loss of 1.81 +/- 0.34 kg. DXA showed changes in whole-body soft tissue, which were correctly localized to the trunk region on regional analysis. Changes in DXA estimates of mean total lean tissue, 1.78 +/- 0.94 kg, and trunk lean tissue, 1.87 +/- 0.84 kg, were very similar to the actual change in body weight. However, the DXA estimate of change in total soft tissue, 2.11 +/- 0.44 kg, was significantly greater than the change in body weight by 0.3 kg (P < 0.005); the difference was accounted for by a tendency for a reduction in the estimate of body fat affecting the trunk region after drainage of dialysate. DXA was also less good at detecting changes in individual subjects. Estimates of total and regional bone mineral content and bone mineral density were not affected by the drainage of the dialysis fluid.

Absorptiometry, Photon↗
PubMed1996

Survivors of acute renal failure who do not recover renal function.

Overall survival in 1095 patients with severe acute renal failure (ARF) between 1984 and 1995 was 59.5%. Of these, 107 (16.2%) remained dependent on long-term dialysis. The frequency of end-stage renal failure (ESRF) in survivors of ARF varied between 3% and 41% according to the cause of ARF, being highest in those with acute renal parenchymal disease (in whom survival was also among the highest at 84%) and lowest in ARF due to obstetrics and trauma. Patients failing to regain adequate renal function did not appear to differ on clinical grounds from survivors who became dialysis-independent. Survival in those requiring long-term dialysis was less good than for other patients with ESRF, partly due to excess mortality in those for whom vascular disease or surgery was the precipitating cause of ARF. Six patients recovered sufficient renal function to become independent of dialysis after 3-18 months on regular dialysis therapy (6-21 months after onset of ARF). ESRF resulting from ARF is more frequent than previously reported. This increase may be due to a changing case-mix, increasing age of patients (and hence reduced capacity for renal recovery), and an increase in aggressive surgery for patients with advanced vascular disease. This presents a significant and increasing problem, with implications for both clinical management and the provision of dialysis services.

Acute Kidney Injury↗
PubMed1996

Serum hyaluronan concentrations predict survival in patients with chronic renal failure on maintenance haemodialysis.

BACKGROUND: Malnutrition and wasting are common in chronic renal failure and are adverse prognostic features. The underlying mechanisms are complex and not fully understood. Hyaluronan is present in increased concentrations in chronic renal failure and may be associated with adverse features of chronic renal failure. METHODS: We have investigated the relationship of this abnormality to long-term survival. Outcome of 81 patients of median of 5.6 years (3.9-6.8) after measurement of hyaluronan was determined. RESULTS: Survival analysis by the Cox regression model showed that increased concentrations of hyaluronan (P < 0.0001). There was also a weak but significant negative correlation between hyaluronan concentrations and serum albumin concentrations (rs = - 0.27, P = 0.02). CONCLUSIONS: We conclude that serum hyaluronan is a strong independent predictor of long-term survival in CRF may reflect abnormal connective tissue metabolism in this condition.

Adult↗
PubMed1996

Measurement of body composition in chronic renal failure: comparison of skinfold anthropometry and bioelectrical impedance with dual energy X-ray absorptiometry.

OBJECTIVE: To compare the validity of skinfold anthropometry (SFA) and bioelectrical impedance (BIA) for the measurement of body composition in patients with chronic renal failure (CRF). DESIGN: We compared measurement of % total body fat (%TBF) and fat-free mass (FFM) by BIA and SFA, with dual energy X-ray absorptiometry (DEXA) as the criterion method to determine their value in groups of patients with CRF and a group of normal controls. SETTING: Renal Unit, Leeds General Infirmary and Centre for Bone and Body Composition Research, University of Leeds, UK. RESULTS: 95% levels of agreement of BIA and SFA with DEXA (using the method of Bland & Altman) showed considerable variation, which was greater for both techniques in CRF patients than in a normal control group. In normal subjects, BIA derived values for % TBF and FFM showed a closer agreement with DEXA than did SFA (% TBF BIA-DEXA -8.2 to +3.8%; %TBF SFA-DEXA -4.6 to +12.1%; FFM BIA-DEXA -2.5 to +5.8kg; FFM SFA-DEXA -7.9 to +3.8 kg). However, in CRF patients no differences in the 95% levels of agreement were observed for % TBF or FFM derived from BIA or SFA compared with DEXA (%TBF BIA-DEXA -13.7 to +8.3%; %TBF SFA-DEXA -13.0 to +9.4%; FFM BIA-DEXA -5.1 to +9.6 kg; FFM SFA-DEXA -5.6 to +9.1 kg). CONCLUSIONS: In CRF, errors of both BIA and SFA in comparison with DEXA are greater than in normal subjects. The magnitude of the limits of intermethod difference are relatively much greater for measurement of % TBF than FFM for both BIA and SFA in CRF patients and control subjects.

Absorptiometry, Photon↗
PubMed1996

Whole body and regional body composition in patients with chronic renal failure.

BACKGROUND: Nutritional state is a powerful prognostic factor in chronic renal failure (CRF). Techniques for the assessment of nutrition have limitations which are often most marked in the presence of renal disease. We have used techniques of body composition analysis to assess the nutritional state of groups of patients with CRF. METHODS: Body composition was measured in groups of patients with advanced CRF on conservative treatment, peritoneal dialysis, and haemodialysis and the results compared with a healthy control group. The selection criteria for the CRF patients ensured that they were "stable' with no recent intercurrent illness, and dialysis adequacy was satisfactory according to currently accepted targets. RESULTS: Whole body dual energy X-ray absorptiometry (DEXA) found significant reduction in lean tissue in haemodialysis patients and female peritoneal dialysis patients. Regional analysis with DEXA showed reduction in limb (especially arm), lean tissue in CRF patients, with arm lean tissue being reduced in all three CRF groups for females and both dialysis groups for males. Limb/trunk lean tissue ratios were significantly reduced for all CRF groups. Bioelectrical impedance showed reductions of fat-free mass in the same groups who had reduced whole body lean tissue with DEXA, but skinfold anthropometry failed to detect any significant reduction in fat-free mass. CONCLUSIONS: We conclude that even in "healthy' groups of CRF patients receiving adequate dialytic and dietary management, lean tissue depletion is a common problem. Regional analysis by DEXA, with measurement of limb lean tissue mass is a more sensitive method for the detection of lean tissue depletion than measurement of whole body lean tissue in patients with CRF.

Absorptiometry, Photon↗
PubMed1995

The clinical and biochemical features of acute renal failure due to rhabdomyolysis.

Rhabdomyolysis caused 28 out of 903 (3.1%) of cases of severe acute renal failure (ARF) treated at Leeds General Infirmary over a 14-year period (1980-1993). The commonest cause of rhabdomyolysis was muscle compression, usually due to drug- or alcohol-induced coma. Other causes included fits, infection, acute limb ischemia, trauma, and heat stroke. Prognosis was relatively good, with a 78.6% survival rate and recovery of renal function to normal in all survivors who were followed up. The creatinine/urea ratio was higher in ARF due to rhabdomyolysis than in an unselected group of patients with other causes of ARF but not when the comparison was with sex- and age-matched controls with ARF. This suggests that this previously described feature of rhabdomyolysis simply reflects the increased muscle mass of a younger group of patients, rather than a specific effect of muscle damage. Clinical features of muscle damage were often absent and so the possibility of rhabdomyolysis should be considered in appropriate settings if the diagnosis is to be made early enough to administer treatment that may prevent ARF and the consequences of the compartment syndrome.

Acute Kidney Injury↗
PubMed1994

Acute renal failure in patients with type 1 diabetes mellitus.

Acute renal failure (ARF) is a serious condition which still carries a mortality of around 50%. People with diabetes may be at increased risk of developing ARF, either as a complication of diabetic ketoacidosis or hyperosmolar coma, increased incidence of cardiovascular disease, or due to increased susceptibility of the kidney to adverse effects in the presence of underlying diabetic renal disease. During the period 1956-1992, 1,661 cases of ARF have been treated at Leeds General Infirmary. Of these, we have identified 26 patients also having type 1 diabetes. ARF due to diabetic ketoacidosis is surprisingly uncommon (14 cases out of 23 patients whose notes were reviewed). All cases of ARF complicating ketoacidosis in the last decade have been associated with particularly severe illness requiring intensive care unit support, rather than otherwise 'uncomplicated' ketoacidosis. We discuss the conditions that may result in ARF in patients with diabetes and the particular difficulties that may be encountered in management.

Acute Kidney Injury↗