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Biomedical subjects

N Edward

Publications and source records attributed to N Edward.

At least 19 recordsLinked to original sources
PubMed1992

Recurrent post-infective Henoch-Schönlein syndrome: a genetic influence related to HLA B35?

The clinical features, laboratory findings, infection stimuli and HLA phenotypes of five young adults with recurrent episodes of Henoch-Schönlein syndrome (HSS) are reported. We define recurrences as the reappearance of the characteristic purpuric rash and associated symptoms more than 8 weeks after the onset of the original episode of purpura. All patients had documented evidence of a bacterial or viral infection before one or more of the relapses, the periods between which varied from 1 to 13 years. Four of our five patients possessed the HLA B35 phenotype and two of these four patients were also HLA B18 antigen positive. Those with the HLA B35 haplotype had recurrent episodes of purpura with nephritis triggered by minor pharyngeal (viral or bacterial) infections. The HLA B35 haplotype has a frequency of 4% in the indigenous Scottish population and has previously been linked with single episodes of the Henoch-Schönlein syndrome with nephritis in German, Slavic and French patients. It has not previously been related to recurrent episodes of the syndrome. We postulate that patients who are HLA B35 positive may be genetically more susceptible to recurrent episodes of HSS with nephritis, stimulated by a heterogeneous group of infective stimuli and resulting in a protracted illness with significant renal involvement.

Adolescent↗
PubMed1992

The short term effects of oral labetalol in patients with chronic renal disease and hypertension.

This double-blind, controlled, crossover study compared the effects on blood pressure control, glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) of labetalol, methyldopa and placebo in patients with chronic renal disease and hypertension. When compared with placebo, BP was significantly lower during treatment with both labetalol and methyldopa (P greater than 0.05) but did not differ significantly between the two active treatment periods; post-exercise heart rates were also significantly lower on labetalol than placebo (P less than 0.05). After treatment with labetalol, ERPF was significantly greater than with the placebo (P less than 0.05) but did not differ significantly between the active treatments. GFR did not differ significantly between the three groups. No significant differences were observed in haematology or liver function test results on labetalol compared with placebo. Labetalol is a safe and effective antihypertensive in patients with hypertension associated with chronic renal disease. In the short term it leads to an increase in ERPF which may be beneficial for such patients.

Administration, Oral↗
PubMed1989

The effect of nifedipine on graft function in renal allograft recipients treated with cyclosporin A.

The effect of the calcium channel antagonist nifedipine on renal allograft function was assessed in two groups of renal transplant recipients at least one year after transplantation. Group 1 comprised 10 patients receiving low-dose prednisolone and cyclosporin A, and Group 2 comprised 9 patients receiving low-dose prednisolone and azathioprine. Before commencing nifedipine, creatinine and sodium clearance rates and the fractional excretion of sodium were similar in both two groups. Lithium clearance rates and the fractional excretion of lithium were, however, significantly lower (p less than 0.01) in Group 1 than in Group 2. The absolute reabsorption of sodium from the distal nephron (p less than 0.01), the absolute reabsorption of water from the distal nephron segment (p less than 0.01) and the fractional reabsorption of sodium from the distal tubule relative to the delivery of sodium from the proximal tubule (p less than 0.05) were also lower in Group 1. After seven days of nifedipine treatment (10 mg/8 h) there was a significant fall in sodium clearance (p less than 0.01) and fractional sodium excretion (p less than 0.05), and an increase in the fractional distal reabsorption of sodium relative to the delivery of sodium from the proximal tubule (p less than 0.01), and the fractional distal reabsorption of water relative to the delivery of water from the proximal tubule (p less than 0.02), in Group 1 but not Group 2. The only alterations observed in Group 2 were an increase in fractional lithium excretion (p less than 0.05), and a significant fall in the absolute proximal tubular reabsorption of iso-osmotic fluids (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

The effect of hemodialysis, vitamin D metabolites and renal transplantation on the skeletal demineralization associated with renal osteodystrophy: a computerized histomorphometric analysis.

Twenty-three patients with end-stage renal failure treated by hemodialysis or transplantation were followed for up to 10 years. Sequential full thickness iliac crest bone biopsies were obtained to assess the effects on bone disease of hemodialysis, treatment with 1,25-dihydroxycholecalciferol [1,25-(OH)2D3] and 24,25-dihydroxycholecalciferol [24,25-(OH)2D3] and renal transplantation. The biopsies were analyzed by a computerized histomorphometric technique which allowed accurate measurements of calcified bone and osteoid areas. Serum aluminum and parathyroid hormone concentrations were also monitored. Hemodialysis was associated with a loss of calcified bone and an increase in osteoid areas. The progressive bone loss was arrested but not reversed following treatment with either 1,25-(OH)2D3 or 24,25-(OH)2D3. Osteoid area was unchanged or reduced following treatment with 1,25-(OH)2D3 in all but three patients who had serum aluminum concentrations in excess of 5 mumol/l. 24,25-(OH)2D3 was not effective in reducing osteoid area, and combined treatment with 1,25 and 24,25-(OH)2D3 had no effect beyond that expected with 1,25-(OH)2D3 alone. Bone biopsies showed loss of calcified bone and an increase in osteoid areas one year and more after successful renal transplantation in five patients. Nineteen of the 23 patients developed serum aluminum concentrations greater than 3 mumol/l, probably because of the use of oral aluminum hydroxide as a phosphate binding agent. In these patients serum parathyroid hormone concentrations greater than 600 pg/ml appeared to prevent the development of osteopenia.

24,25-Dihydroxyvitamin D 3↗
PubMed1985

Evidence that protective Fc-receptor-blocking antibodies in renal transplantation are alloantibodies not autoantibodies.

We have previously shown that the presence in pretransplant recipient sera of Fc receptor blocking antibodies detected by the EA inhibition assay is correlated with improved allograft survival. Twenty-four such sera were assessed for the presence of autoantibodies by the EA inhibition and lymphocytotoxicity assays. No autolymphocytotoxic antibodies were found, and autologous EA inhibition was noted in only one case. EA-inhibiting alloantibodies did occur, and their presence was correlated with improved allograft survival. Sera from 37 dialysis patients were also studied, and neither autologous EA inhibiting nor autologous lymphocytotoxic antibodies were present. Thus Fc receptor blocking alloantibodies that were correlated with improved renal transplant survival were not autoantibodies.

Autoantibodies↗
PubMed1985

Pharmacokinetics of intraperitoneal cefotaxime treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis.

The pharmacokinetics of intraperitoneal cefotaxime as the sole therapy in patients on continuous ambulatory peritoneal dialysis with peritonitis have been examined. The mean plasma concentrations achieved following 1 h of peritoneal instillation of 500 mg of cefotaxime were 5.0 +/- 1.6 micrograms ml-1. The average plasma concentration over 24 h was 6.9 +/- 0.4 micrograms ml-1 and was no different from that found following a further 9-11 days of successful treatment of the peritonitis. However, the mean dialysate effluent concentration of cefotaxime was increased following the resolution of the peritonitis, 165 +/- 22.7 mg per cycle on day 10 or 12 compared with 50.4 +/- 7.3 mg per cycle on day 1, suggesting enhanced peritoneal cefotaxime absorption during acute peritonitis. Nevertheless, during both periods, adequate concentrations of cefotaxime were achieved in dialysate to treat local complications, but plasma levels may be inadequate to treat systemic complications due to Staphylococcus albus.

Adult↗
PubMed1985

IgA nephropathy is not a rare disease in the United Kingdom.

A retrospective analysis of all renal biopsies performed in the Grampian Region of Scotland during 1977-1980 revealed that IgA nephropathy was the most frequently encountered glomerular lesion. The commonest indications for renal biopsy were the presence of asymptomatic urinary abnormalities (90/184; 48.9%) especially asymptomatic haematuria (42/184; 22.8%). A histological diagnosis was made in 36 of the 42 patients presenting with asymptomatic haematuria (85.7%); 16 of the 26 cases of IgA nephropathy presented in this way. Overall, IgA nephropathy was detected in 14.1% of all biopsies and accounted for 21.8% of primary glomerular diseases. This study indicates that IgA nephropathy is apparently more common in Grampian than elsewhere in the United Kingdom. However, it is suggested that this does not represent a true variation in the prevalence of the condition; IgA nephropathy is probably a common cause of haematuria in the United Kingdom.

Adolescent↗
PubMed1985

Acute renal failure: the tip of the iceberg?

This study reports the experience, during a six-year period, of the Aberdeen Renal Unit in the treatment of patients with acute renal failure. The combination of a relatively stable population base and a single regional dialysis centre has allowed the incidence of acute renal failure to be assessed. Approximately 30 patients per million population were dialysed annually for acute renal failure; 69 per cent of these patients (20.5 per million population per year) were dialysed for acute reversible intrinsic renal failure (ARIRF) and mortality in this group was 44 per cent. Patients with more severe disease at the time of presentation to the renal unit, as defined by a clinical severity score, had significantly reduced survival rates. However, it was not possible to predict the outcome in individual cases; ten of 24 patients with clinical severity scores which indicated a poor prognosis survived the period of oliguria and were discharged from hospital. The fact that other renal units dialyse fewer patients per million population per year for ARIRF probably reflects a reluctance to refer patients whose general condition appears poor. As the overall mortality rate reported in this study does not differ significantly from rates reported previously from centres treating a smaller proportion of patients, such decisions may not be correct. It is well known that facilities in Britain for treating patients with end-stage renal disease are inadequate; it now appears likely that some patients who might benefit from acute dialysis are being denied treatment for a potentially reversible disease process.

Acute Kidney Injury↗
PubMed1985

Functional characteristics of the glomerular filter in the IgA-nephropathy.

The purpose of the present study was to compare the functional characteristics of the glomerular filter in patients having a well defined glomerulonephritis, the IgA nephropathy, with those of normal age-matched controls. A bolus intravenous injection of inulin (60 mg/kg), para-amino hippuric acid (36 mg/kg) and Rheomacrodex (130 mg/kg) was administered to each subject and followed by the timed collection of venous blood and urine samples. Compared to the controls, the nine patients with IgA nephropathy had no significant differences in renal plasma flow or glomerular filtration rate. The control group showed filtration of the neutral graded dextrans which diminished in a linear fashion with increasing molecular size. In contrast, the IgA patients showed two-phased glomerular sieving with a reduction in the filtration of dextrans sized 40 A or less and an increased filtration of those larger than 50 A. These changes in dextran filtration indicate the appearance of a population of larger than normal pores in the glomerular filter in the IgA nephropathy, although concomitant alterations in the electrostatic properties of the filter mechanism cannot be excluded.

Adolescent↗
PubMed1985

The value of Tc-DTPA transit times and NMR T1 measurements in monitoring the progress of renal transplants.

The value of 99Tcm-DPTA transit times and NMR T1 measurements in monitoring the progress of renal transplants has been investigated. Renal transit times were calculated from 182 renograms performed on 29 patients and from 22 of these patients 67 proton spin-lattice relaxation time (T1) measurements were obtained using the Aberdeen Mk 2 NMR Imager. The clinical status of each patient at the time of investigation was defined in retrospect. The principal value of the mean transit time (MTT) was in differentiating between acute rejection and other causes of raised plasma creatinine. During a rejection episode the MTT is raised out of the normal range of 227 +/- 26 s but with chronic rejection or other causes of raised plasma creatinine the MTT remains within normal limits. NMR T1 values appeared to be of little diagnostic value as the normal range was found to be very wide ranging from 340 to 640 ms.

Creatinine↗