Elevated bile acid serum concentrations in uremics.
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Biomedical subjects
Publications and source records attributed to P L Balestri.
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Measurement of serum bile acids was performed in 86 uremic patients without any liver or bile tract diseases. Thirty-six patients (23 males and 13 females, aged 21-60 years) were on conservative dietary treatment, whereas 50 uremics (31 males and 19 females, aged 23-82 years) were on maintenance hemodialysis. The assays were made by means of enzymatic procedure and confirmed by RIA method too. Elevated serum concentrations of bile acids (> 6 mumol/L) were found in 24 out of the 86 uremics (27.9%), and the prevalence was similar in patients on conservative (10/36, 27.7%) and on dialysis treatment (14/50, 28%). Then, abnormally elevated concentrations of circulating bile acids are present in a quite high percentage of uremics both on hemodialysis and on conservative dietary therapy. The existence of a subclinical liver disease or an abnormal entero-hepatic cycle of bile acids might explain these findings.
The author reports the probable pathogenetic connexions between oligo-elements and uremic encephalopathy. Acquired data concerning this rare pathology of the CNS are reported as well as those of more doubtful scientific validity. The behavior of the neuro-psychic sphere and the symptomatology deriving from both deficit and excess of Al, As, Mg, Cr, Mn, Se, etc. are subject to special attention. The result of these changes is a complex of syndromes that are difficult to identify, also because uremia is beset by a large number of complications which more or less directly involve the central and peripheral nervous system.
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The daily urinary excretion of oxalate has been found to be lower than normal in patients with renal failure and the decrease to be directly proportional to the impairment of renal function. It has also been found that the gut flora from uremic patients destroys oxalate 'in vitro' more efficiently than the gut flora from normal people. It is postulated that an adaptation occurs in the gut flora of uremics to 'metabolize' oxalate, and this enteric elimination may account for its decreased urinary excretion.
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