Kidney stones and drinking water.
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Biomedical subjects
Publications and source records attributed to M M Friedlaender.
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Results of 73 first cadaveric donor renal transplants in Jerusalem between 1975 and 1980 are presented. There was a better 12-month graft survival in Arabs than in Jews (70.8% vs. 40.8%, P less than 0.035); however, 12-month patient survival was similar (83.3% vs. 85.7%). Acute rejection as the primary cause of graft loss occurred in 12.5% of the Arabs and 38.8% of the Jews (P less than 0.05). HLA-A, -B and -DR antigen-sharing was similar in both groups. Early acute rejection episodes had a poorer prognosis in Jews. Possible explanations for these findings are discussed, but the reason for the higher success rate in Arabs remains obscure.
Four patients with renal stones had hypercalciuria which was dependent on a high sodium intake. Moderate sodium restriction corrected the hypercalciuria. Sodium excretion should be measured in all patients with idiopathic hypercalciuria so that the easily treated sodium-dependent hypercalciuria can be diagnosed.
The effects of 1 alpha (OH)vitamin D3 [1 alpha (OH)D3] and 24,25(OH)2vitamin D3 [24,25(OH)2D3] on the phosphaturic action of parathyroid hormone (PTH) were studied in two groups of parathyroidectomized (PTX) rats. In group 1, PTX PTH-infused rats received intravenous 1 alpha (OH)D3, and in group 2, PTX PTH-infused rats received intravenous 24,25(OH)2D3. PTX PTH-infused rats served as controls. The effects of both vitamin D metabolites on renal PTH-activated adenylate cyclase (AC) were studied in vitro. In group 1, PTH increased fractional excretion of phosphate (CP/CIn) from 0.045 +/- 0.012 (+/- SE) to 0.263 +/- 0.011 (P less than 0.005). 1 alpha (OH)D3 failed to influence this response. In group 2, PTH increased CP/CIn from 0.055 +/- 0.008 to 0.289 +/- 0.027 (P less than 0.005). 24,25(OH)2D3 reduced the PTH-induced rise in CP/CIn from 0.289 +/- 0.027 to 0.192 +/- 0.021 (P less than 0.01) and decreased the urinary excretion of adenosine 3',5'-cyclic monophosphate. In vitro, 24,25(OH)2D3 blunted the PTH-activated AC, whereas 1 alpha (OH)D3 had no effect. These results show that 24,25(OH)D3, similar to two other 25(OH) metabolites of vitamin D-25(OH)vitamin D3 and 1,25(OH)2vitamin D3-suppresses the phosphaturic action of PTH, whereas 1 alpha(OH)D3, which is devoid of a 25(OH) group, lacks this effect. This suggests that a 25(OH) group is a prerequisite for the antiphosphaturic effect of vitamin D, whereas the 1 alpha (OH) group is not essential for this action.
A 45-year-old male was admitted to the hospital because of polyuria and polydipsia. After admission, proteinuria and hematuria were found. The kidney function deteriorated and necessitated the initiation of chronic hemodialysis. Examination of the bone marrow revealed multiple myeloma and kappa light chains were found in the urine. The kidney biopsy showed membranoproliferative glomerulonephritis with dense deposits in the glomerular basement membrane.
The diagnostic usefulness of bone marrow hemosiderin, serum ferritin, transferrin saturation, mean corpuscular volume (MCV) and red cell protoporphyrin (EPP) in the evaluation of iron status in patients on chronic hemodialysis was studied in 39 subjects. The correlation between serum ferritin and the number of transfusions received per month was slightly higher (r = 0.717; p less than 0.001) than the correlation between bone marrow hemosiderin and transfusions (r = 0.685; p less than 0.01). Serum ferritin was useful in identifying subjects with both increased or reduced iron stores. In contrast, transferrin saturation could only be used for indicating iron overload. MCV for indicating iron deficiency, and EPP was not useful in either case. The abnormal increase of EPP in chronic uremia has not been previously described. It is unrelated to iron deficiency and is most probably explained by the known reduction in red cell ferrochelatase activity associated with chronic uremia. Serum ferritin is clearly the most useful diagnostic aid for assessing iron stores in patients on chronic hemodialysis. Whether ferritin is also the best predictor of response to iron therapy, cannot be determined on the basis of the present data.
Renal function and life expectancy can be improved by aggressive antihypertensive therapy in severe hypertension. However, most reports of severe hypertension and renal failure concern primary hypertensive states. 3 cases of primary renal disease, 1 glomerular, 1 obstructive and 1 of chronic pyelonephritis, are described here. In all 3 cases, severe hypertension and renal failure were present. Adequate reduction in blood pressure resulted in substantial improvement in renal function.
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1 alpha-hydroxycholecalciferol [1 alpha (OH)D3], the synthetic analogue of 1,25-dihydroxycholecalciferol, the active metabolite of vitamin D, was administered for a period of 18 to 24 mo to an unselected group of 12 hemodialysis patients and to 2 patients after kidney transplantation. All patients responded with a significant rise in serum Ca and Mg. The whole-body 47Ca retention, used as an index of Ca absorption, rose in eight patients and decreased or remained unchanged in four, but its overall change was not significant. Serum immunoreactive parathormone showed a general tendency to decrease. From the clinical point of view, symptomatic relief of bone pain was seen in most dialysis patients, but no significant change occurred in transplant patients. The main side effects of 1 alpha (OH)D3 treatment were hypercalcemia and pruritus, which generally subsided after the dosage was tapered off.
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