PubMed Health⌕ Search

Biomedical subjects

L S Ibels

Publications and source records attributed to L S Ibels.

At least 55 records · Page 3Linked to original sources
PubMed1985

Renal autotransplantation for severe loin-pain/haematuria syndrome.

Most forms of therapy for the loin-pain/haematuria syndrome are unsuccessful, though nerve-block procedures and renal denervation sometimes provide temporary relief. Three young patients, with pain so severe that they were dependent on narcotics, were treated for this syndrome. All three had been repeatedly admitted to hospital. Loin pain was unilateral in two patients and predominantly so in the third. Renal function, excretion urography, and angiography were normal, but renal biopsy specimens showed deposition of the third component of complement in the renal arterioles. All were treated with renal autotransplantation; the kidney causing pain (or the one causing the most pain) was completely excised and reimplanted in the iliac fossa. Two patients had complete relief of pain and the third almost complete relief, despite recurrence of haematuria in all three. It is too early to determine whether this major procedure is justified in the treatment of the loin-pain/haematuria syndrome, but the early results are encouraging.

Adolescent↗
PubMed1985

Osteosclerotic myeloma complicated by diffuse arteritis, vascular calcification and extensive cutaneous necrosis.

Widespread, progressive skin necrosis developed in a 42-year-old male with a 5-year history of osteosclerotic myeloma. Biopsy of the necrotic lesions demonstrated a leucocytoclastic vasculitis with extensive vascular calcification. Radiological investigations demonstrated widespread arterial calcification. Clinical improvement of the established skin lesions followed the institution of a forced calciuresis and parathyroid hormone suppression by induced hypermagnesaemia and phosphate depletion. No further cutaneous necrosis developed. Subsequent treatment with oral immunosuppressive therapy and the diphosphonate, EHDP, has been associated with a complete 18-month remission. The relationship of this apparently unique pathological process to the osteosclerotic myeloma is discussed, together with the rationale for the therapeutic regime instituted.

Adult↗
PubMed1985

Rhabdomyolysis and acute renal failure.

In order to determine the prevalence of rhabdomyolysis-associated acute renal failure (RM-ARF) and assess the effect of oliguria on biochemical features in this condition, 127 cases of ARF seen over 18 months were reviewed. Eleven cases of RM-ARF were seen, a prevalence of 8.6% of all cases of ARF. There were ten males and one female (age range 15-72 years) with precipitating events being trauma in three, coma in two, infection in two and other causes in five. Ten had concurrent clinical or historical evidence of dehydration, two had mild hypokalemia, and one abused alcohol. Serum and urine myoglobin by radioimmunoassay were greater than 800 ng/l in all cases tested. False negative tests for urine myoglobin by o-tolidine reaction after (NH4)2SO4 extraction occurred in four cases. Despite attempted forced saline diuresis and urinary alkalinisation, seven became oliguric and required dialysis for 12-81 days. Initially (pre-dialysis) oliguric patients had significantly higher maximum serum levels of potassium, phosphate, and rate of rise of creatinine, significantly lower trough levels of calcium, and no significant difference in peak creatine phosphokinase or uric acid levels than non-oliguric patients. Two subjects developed recovery phase hypercalcemia, four required fasciotomy for compartment syndromes, three sustained permanent nerve damage, and three required limb amputation. Ten survived, with a mean creatinine clearance of 96 ml/min after nine to 30 months. RM-ARF is common, may be clinically occult and show false negative urine myoglobin tests. Hyperkalemia, hyperphosphatemia, and hypocalcemia are more common in oliguric than in non-oliguric RM-ARF, but both have a good prognosis with appropriate medical and surgical management.

Acute Kidney Injury↗
PubMed1985

Prediction of outcome in acute renal failure by discriminant analysis of clinical variables.

To define factors of prognostic importance in patients with acute renal failure, we studied 23 clinical variables (including preexisting conditions, the acute clinical setting, and complications) by univariate and multivariate analysis in 148 patients. Ten variables contributed to discrimination in the overall analysis. Using a function derived by stepwise discriminant analysis, death could be predicted with a positive predictive value of 100% and a sensitivity of 58%. The performance of this discriminant score was validated in a subsequent group of 113 patients with a positive predictive value of 100% and a sensitivity of 26%. Thus, a fatal outcome of acute renal failure can be accurately predicted in a considerable proportion of patients by a weighted evaluation of clinical variables. The discriminant score may be useful in comparing the severity of illness among series of patients with acute renal failure.

Acute Kidney Injury↗
PubMed1983

Multiple myeloma with renal failure. A case for intensive treatment.

A series of nine consecutive patients with multiple myeloma and renal failure is presented. All patients were treated with urinary alkalinisation with sodium bicarbonate and/or acetazolamide, diuresis with saline, mannitol and/or furosemide, pulse melphalan and prednisone and, where indicated, allopurinol and aluminium hydroxide. A substantial and sustained improvement in renal function has been achieved in all nine patients. Of five patients with a urea more than 25 mmol/L at presentation, the median survival to date is 64 weeks. Of these patients only one has died --not from renal failure but pneumonia, eighteen months after presentation. The others are alive and well. The results confirm the effectiveness of these measures in both improving renal function and prolonging survival, and suggest a more optimistic prognosis for patients with multiple myeloma and renal failure.

Adult↗
PubMed1982

Acute renal failure. Multivariate analysis of causes and risk factors.

Accepted causes (acute insults) and risk factors for the development of acute renal failure were defined, quantitatively assessed, and tested for statistical significance in 143 patients with acute tubular necrosis. Sixty-two percent of patients had more than one acute insult, and 48 percent had more than one suspected risk factor. Hypotension, excessive aminoglycoside exposure, pigmenturia, and dehydration were identified as highly significant acute insults, while it was concluded that sepsis and administration of radiocontrast material could not be incriminated as causes of acute tubular necrosis. An additive interaction between acute insults was demonstrated, and the severity of acute renal failure was related to the number and severity of acute insults. Patients with oliguric renal failure had more severe acute insults than patients with nonoliguric renal failure. Preexisting renal disease and chronic hypertension were significant risk factors, the latter only when hypotension had been one of the acute insults. An age of more than 59 years, gout and/or chronic hyperuricemia, diabetes, and long-term diuretic administration were not found to be significant risk factors.

Acute Kidney Injury↗
PubMed1982

Trace element abnormalities in chronic uremia.

We studied the elemental composition of autopsy tissue samples to characterize the trace element changes induced in various human tissues by uremia. Samples from the United States and Australia, including those from 120 uremic patients who had been on dialysis, 29 uremic patients who had not been on dialysis, and 64 control subjects, were analyzed by x-ray fluorescence. Tissues analyzed were aorta, bone, brain, heart, kidney, liver, lung, muscle, and spleen; elements measured included potassium, calcium, iron, copper, zinc, selenium, bromine, rubidium, strontium, molybdenum, cadmium, tin, and uranium. Uremic abnormalities that were statistically very significant were found, including increases of calcium, strontium, molybdenum, cadmium, and tin and decreases of potassium and rubidium. The distribution of iron, copper, and zinc are altered. We conclude that these abnormalities are primarily the result of the uremia and that, generally, they are neither greatly moderated nor exacerbated by the dialysis procedure.

Adolescent↗
PubMed1981

Self-poisoning with propranolol.

A 14-year-old boy who ingested 8000 mg of propranolol developed sudden onset of arrhythmias, cardiac failure and convulsions. He responded to ventilator support, transvenous pacing, and massive dosage of isoprenaline. The clinical features and management of propranolol overdosage are outlined.

Adolescent↗
PubMed1981

Calcification in end-stage kidneys.

This study was carried out to determine the frequency and to quantitate the severity calcium-phosphate deposits in end-stage kidneys. In 57 of 59 end-stage kidneys obtained from patients with a variety of different renal diseases, calcium levels were greater than 2 standard deviations (SD) above control values. The mean calcium concentration was 157 +/- 24 mmol/kg dry defatted tissue in the end-stage kidneys as compared to 17 +/- 1 mmol/kg in the control kidneys. Histologically, calcium was deposited in the cortical tubular cells, basement membranes and interstitium. It would appear that calcification occurred during the course of renal failure rather thant terminally in that the kidney calcium concentration bore no relationship to the calcium X phosphate product, and the calcium concentration in the kidneys of uremic patients undergoing dialysis (144 +/- 23 mmol/kg) was no greater than that found in uremic patients not undergoing dialysis (188 +/- 62 mmol/kg). It is suggested that calcification may damage the diseased kidney accelerating the rate of renal functional deterioration.

Adolescent↗
PubMed1981

Effects of thyroparathyroidectomy, phosphate depletion and diphosphonate therapy on acute uraemic extra-osseous calcification in the rat.

1. The effects of acute uraemia on arterial and visceral calcium concentrations were studied in acutely uraemic rats. The influences of thyroparathyroidectomy, phosphate depletion and diphosphonate therapy on extra-osseous calcium concentrations were assessed in this model. 2. Aortic and visceral calcium concentrations were greater in acutely uraemic rats than in non-uraemic rats. Both prior thyroparathyroidectomy and prior phosphate-depletion resulted in lower aortic and visceral calcium concentrations in non-uraemic rats and prevented the increase in aortic and visceral calcium concentrations with acute uraemia. Diphosphonate given for 5 days before and for 2 days after the induction of acute uraemia resulted in lower tissue calcium concentrations than in non-diphosphonate-treated acutely uraemic rats. In contrast, diphosphonate given only immediately before or only after induction of acute uraemia did not prevent the increase in extra-osseous calcium concentrations with acute uraemia. 3. It is concluded that acute uraemia results in an increase in arterial and visceral calcium concentrations. Both thyroparathyroidectomy and phosphate depletion are effective in preventing the increase in extra-osseous calcium concentrations in acute uraemia. Diphosphonates may have a future role in preventing such calcification.

Animals↗
PubMed1980

What is it?

Explore the source record for details and available documents.

Adult↗
PubMed1980

Multiple myeloma presenting as recurrent obstructive uropathy.

A 51-year-old patient who presented with a four-day history of abdominal pain was found to have unilateral ureteral obstruction and an intracalyceal radiolucent filling defect on radiological studies. Further investigation of this was refused by the patient but then years later a repeat intravenous pyelogram showed persistence of the initial intracalyceal filling defect and ureteral obstruction in the contralateral kidney along with multiple intracalyceal radiolucent filling defects. Subsequent investigation led to a diagnosis of kappa light chain myeloma. The diagnosis of multiple myeloma should be considered in patients presenting with unexplained radiolucent filling defects.

Humans↗
PubMed1980

Filarial chyluria associated glomerulonephritis and therapeutic considerations in the chyluric patient.

Two patients with chyluria who were successfully treated by surgical disconnection of the lymphatics from the renal pelvis are reported. One patient also had an associated glomerulonephritis, possibly secondary to filariasis. Although glomerulonephritis associated with filariasis has been reported previously the details of renal biopsies in man have included only light microscopic findings. In this patient immunofluorescent and electron microscopic studies showed mesangial deposits of immunoglobulins and complement which suggests that glomerulonephritis in patients with filariasis may be an immune complex type.

Adult↗