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Biomedical subjects

K Delin

Publications and source records attributed to K Delin.

At least 37 records · Page 2Linked to original sources
PubMed1984

Factors regulating sodium balance in proctocolectomized patients with various ileal resections.

Patients subjected to proctocolectomy together with an ileal resection will lose increased amounts of sodium with the ileostomy excreta and may develop sodium and water depletion. Studies of sodium balance and measurements of renin activity, aldosterone, and arginine vasopressin in plasma were made in 23 such patients, 8 of them under metabolic-ward conditions while receiving various salt loads. Salt loss never resulted in subnormal sodium levels in serum. The earliest sign of salt depletion was a nearly total inhibition of renal sodium excretion, which could precede activation of the renin-aldosterone axis in these patients. Secretion of vasopressin remained unaffected by sodium-water depletion and by activation of the renin system. The routine monitoring of these patients should include measurements of renal sodium excretion. Measurement of renin and aldosterone levels should be used for evaluation of the severity of a sodium deficiency.

Adolescent↗
PubMed1984

Preoperative diagnosis of renovascular hypertension. The use of acute stimulation of renin secretion.

The gain in the diagnostic power of the routine preoperative bilateral renal vein renin investigation by the inclusion of an acute stimulation of renin release was studied in 25 hypertensive patients with fibromuscular (FMD) and 44 with arteriosclerotic (AS) renovascular disease. Nine FMD and 17 AS patients had renal vein renin ratios greater than or equal to 1.50 under unstimulated conditions. Of these 26 patients, 8 in each group improved after surgical treatment. Among the 14 FMD and 24 AS patients with ratios less than 1.50, another 9 FMD and 7 AS patients improved after operation. After acute stimulation of renin release, no less than 18 FMD and 26 AS patients had a unilateral renin secretion from the diseased kidney and of these, 14 FMD and 14 AS patients were successfully treated with operation of the stenosis. Thus the stimulation was necessary for correct preoperative diagnosis in 38% of 32 successfully operated patients, and at the same time the predictive value of a negative test increased from 0.58 to 0.80. It is concluded that acute stimulation of renin release greatly improves the diagnostic power of the renal vein renin investigation in renovascular hypertension.

Adolescent↗
PubMed1984

Captopril in hypertension after renal transplantation.

The experience with captopril is limited in patients who are hypertensive after renal transplantation. An increased risk of side effects has been expected because of immunosuppressive therapy and a reduced renal function. We have used captopril in 58 transplanted patients with hypertension. On previous antihypertensive treatment diastolic blood pressure could not be maintained below 100 mm Hg. All patients were on immunosuppressive therapy using prednisolone in combination with azathioprine or cyclosporin. Before captopril treatment the mean s-creatinine concentration was 225 +/- 143 mumol/l. Fifty-four patients were treated for more than four weeks and 28 of them for six months or more. The mean daily dose of captopril was 90 mg. All patients also used furosemide and 2/3 were on a beta-blocker. Captopril was discontinued in nine cases within the first two months, in three because of an unsatisfactory effect on BP, in four because of side effects and in two after successful treatment of a renal artery stenosis of the transplant. The patients who were treated with captopril within the first year after transplantation responded better than patients where treatment was started more than one year after transplantation (p less than 0.05). Half of the patients given captopril early even showed a decrease of s-creatinine during treatment. Captopril in combination with a diuretic and a beta-blocker reduces blood pressure in patients with treatment resistant hypertension following renal transplantation. The risk for serious side effects is small provided that the captopril dose is low and white cell counts and s-creatinine levels are closely monitored.

Adult↗
PubMed1984

Renin secretion in advanced diabetic nephropathy.

Low basal and stimulated plasma renin activity (PRA) levels have been reported in patients with diabetic nephropathy (DN). We have measured PRA before and after stimulation with captopril in 28 patients with DN and in 25 control patients. Renal function impairment was similar in both groups. Most patients were treated with furosemide. In 19 patients with DN the PRA-response to dihydralazine was also studied. PRA before and after captopril were higher in the DN than in the control group (p less than 0.001). PRA increased from 4.6 +/- 3.6 to 6.3 +/- 5.3 in the DN, and from 1.8 +/- 2.7 to 2.7 +/- 3.4 in the control patients. The increases in PRA, caused by decreased angiotensin II feed-back inhibition, were comparable. PRA did not increase after dihydralazine despite a pronounced blood-pressure reduction. The difference in response to these stimuli indicate selective lesions involving both the sympathetic innervation and the renal baroreceptor function in DN. Overhydration is a plausible explanation to the low PRA earlier reported in DN. The results thus indicate that a preserved renin secretion capacity is present in DN. Differences in PRA between the both groups can only partly be explained by other factors than DN. Our findings indicate a role for the reninangiotensin-system in hypertension in DN.

Adult↗
PubMed1983

Antidiuretic hormone levels and the effect of indomethacin on ureteral colic.

We treated 25 patients with ureteral colic and urographically verified stones with 50 mg. indomethacin intravenously. Pain was relieved completely in 17 patients, while in 8 incomplete or no pain relief was achieved after the infusion of indomethacin. Patients completely relieved of pain had significantly higher levels of antidiuretic hormone in plasma before the infusion of indomethacin (18.2 plus or minus 3.4 pg./ml.) than patients with incomplete or no pain relief (7.2 plus or minus 1.3 pg./ml.) (p less than 0.01). These findings indicate that the volume status and/or the level of antidiuretic hormone may be of critical importance for pain relief after infusion of indomethacin in patients with ureteral colic.

Adult↗
PubMed1982

Captopril in treatment-resistant essential and renal hypertension.

Captopril, an angiotensin converting enzyme inhibitor, was used to treat 25 patients with treatment-resistant hypertension of long duration. Seven patients had essential hypertension, 10 renovascular hypertension and 8 renoparenchymatous hypertension. All patients had GFR greater than 25 ml/min/1.73 m3 BSA. The acute blood-pressure-lowering response to the drug was shown to be dependent on the prevailing activity in the renin-angiotensin system. Its long-term effect was not correlated to the activation of the renin-angiotensin system as the mean blood-pressure decrease was not significantly different for high renin and normal renin patients (21 +/- 3% vs. 19 +/- 2%). All patients needed addition of diuretics and betablockers for optimum control. Nine patients have been well controlled for one year and several of them are now approaching two years' treatment. A few adverse effects were observed, including taste disturbances and increased proteinuria. The latter side effect occurred in two patients with decreased renal function and pre-existing proteinuria. Upon reduction of the dose the proteinuria returned to pre-treatment levels within a few months. We conclude that altogether 78% of these patients with treatment-resistant hypertension obtained greatly improved long-term blood-pressure control on treatment including captopril.

Blood Pressure↗
PubMed1982

Captopril treatment in hypertensive dialysis patients.

Captopril was used for treatment resistant arterial hypertension in 17 dialysis patients. Excellent blood-pressure control with diastolic blood-pressure less than 95 mmHg was obtained in 10 out of 17 patients (59%), with captopril as only drug in 8 patients. Six patients have been treated more than 6 months and 4 patients have been on the treatment for 1 year. The dosage of captopril could be kept low with maintained antihypertensive and angiotensin converting enzyme blocking effects. The acute blood-pressure lowering effect of captopril in dialysis patients was correlated to the initial plasma renin activity (p less than 0.001) but not long-term treatment, which was successful also in several low-renin patients. A few adverse reactions were encountered, e.g. urticaria and bullous exanthema, but all resolved when captopril treatment was stopped. Plasma potassium increased only from 4.8 +/- 0.1 to 5.0 +/- 0.1 mmol/l at the end of 1 month's treatment. Captopril appears to be a valuable drug for treatment of arterial hypertension in dialysis patients and offers an alternative to bilateral nephrectomy for the management of treatment resistant hypertension in these patients.

Blood Pressure↗
PubMed1980

Hemoperfusion with Amberlite resin in the treatment of self-poisoning.

Ten patients with various intoxications were treated with resin hemoperfusion. Three of four patients with grade IV coma due to tricyclic antidepressant (TCA) poisoning could be extubated during or on termination of hemoperfusion. Clearance values of 135--185 and 190--200 ml/min were obtained for amitriptyline and nortriptyline, respectively. One patient with severe chloral hydrate poisoning could be extubated after less than one hour's hemoperfusion. A clearance of 140 ml/min was obtained in a uremic patient with AV block II due to digitoxin intoxication. Four patients with mushroom poisoning were treated with combined hemoperfusion-hemodialysis. A transient fall in platelet count was seen in all patients. Resin hemoperfusion is of definite value in selected, severe cases of self-poisoning with psychotropic drugs such as TCA and possibly in cases of mushroom poisoning where the prognosis with hemodialysis and supportive therapy is doubtful.

Adult↗
PubMed1978

Observations on the use and limitations of renal vein renins in hypertensive patients.

From our consecutive series of renal vein renin studies in 170 patients with kidney disorders and hypertension, we present those cured by surgical correction of a unilateral renal artery stenosis during the period 1973--75. The renin secretion patterns of these patients range between no demonstrable abnormality, even with a stimulating procedure using dihydralazine 7.5 i.v., and massive renin secretion already during basal conditions. Thus, the renin secretion may not be increased even after stimulation in some patients with durable unilateral renovascular hypertension. This fact may be explained by the rise of the systemic blood pressure, eventually maintained by sodium and water retention and accompanied by adaptive changes in the contralateral kidney. The perfusion pressure is thereby kept normal in the affected kidney, eliminating a stimulus for renin secretion. It is likely that many cases of renovascular hypertension pass through an early stage where no involvement of the renin-angiotensin system may be discovered. Of course, these patients will also benefit from surgery. The conclusion is that renin studies for diagnostic purposes should be performed when patients are on treatment and kept normotensive for some time, and that an additional challenge of the perfusion pressure, i.e., by use of dihydralazine, intravenously should be performed.

Humans↗