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Biomedical subjects

R R Bailey

Publications and source records attributed to R R Bailey.

At least 19 recordsLinked to original sources
PubMed1992

Membranous nephropathy: a 19 year prospective study in 51 patients.

AIM: to study prospectively patients presenting with membranous nephropathy. METHODS: the outcome of 51 patients (33 male; mean age 50.8 SD 17.7 years; 49 caucasian, two Maori), aged 14 years and over, with membranous nephropathy was studied prospectively. The patients were enrolled between 1 July 1972 and 30 June 1991. Patients with systemic lupus erythematosus were excluded. Membranous nephropathy was secondary to drug therapy in eight (gold 3, nonsteroidal antiinflammatory drug 3, penicillamine 1, captopril 1). All patients were hepatitis B surface antigen negative. The majority of patients did not receive immunosuppressive therapy. RESULTS: forty-seven (92%) presented with the nephrotic syndrome, eight (16%) with a plasma creatinine > or = 0.15 mmol/L and 28 (55%) with hypertension. The patients were followed for a mean of 5.4 years, the median being 3.9 years and range four months-19 years. The 10 year cumulative renal survival was estimated to be 78% and overall survival 66%. Six patients have entered a renal replacement programme and six have died of nonrenal causes. Of the remaining 39, eight have renal insufficiency, 27 hypertension and 22 proteinuria. Complete remission occurred in 17 (33%)-11 spontaneously, four following withdrawal of the offending drug and two after immunosuppressive therapy. Poor prognostic indicators at presentation included renal insufficiency, need for antihypertensive therapy, pathological stage IV on renal biopsy and older age. CONCLUSIONS: membranous nephropathy is an indolent disease with a good chance of spontaneous remission. In most patients immunosuppressive treatment appears unwarranted.

Adolescent↗
PubMed1992

Comparison of ciprofloxacin with netilmicin for the treatment of acute pyelonephritis.

A prospective, randomised trial was undertaken to compare the efficacy of ciprofloxacin and netilmicin for the treatment of acute pyelonephritis. Forty-three patients were enrolled and 34 (29 women) completed the protocol. Fifteen of 17 patients treated with ciprofloxacin and 15 of 17 treated with netilmicin were cured. All patients were treated for five days. One patient relapsed after ciprofloxacin and another had a reinfection, while two relapsed after netilmicin. Five of six patients with a urinary tract abnormality were cured. Side effects were generally mild and rapidly reversible. Patients treated with ciprofloxacin spent a mean of 3.7 days in hospital compared with 5.3 days for those treated with netilmicin. The difference in duration of hospital stay was statistically significant (p less than 0.01). Both drugs proved highly effective and safe for the treatment of severe acute pyelonephritis.

Acute Disease↗
PubMed1992

Effect of diet on posttransplant hyperlipidaemia.

Twenty-five patients with a renal transplant for 15 months to 19.4 years, hyperlipidaemia and stable graft function underwent three months of dietary management. Plasma lipid and apolipoprotein concentrations and lipoprotein electrophoresis were measured after a 12 hour fast at enrollment and after three months of diet. The aims of diet were to reduce energy intake in the overweight, restrict fat to 25-30% of total intake, reduce saturated fat content to less than 10% of total energy and cholesterol to less than 300 mg/d. After three months of diet there was a significant fall in mean cholesterol/HDL cholesterol risk ratio and a rise in mean HDL cholesterol concentration. Six patients reverted to a normal lipoprotein electrophoretic pattern with a significant reduction in mean total cholesterol, LDL cholesterol, cholesterol/HDL cholesterol ratio, apoprotein B and apoB/apo A-1 ratio. Most of the other patients who made dietary modifications showed some improvement in their lipid parameters. Dietary modification should be the initial approach to the management of posttransplant hyperlipidaemia.

Adult↗
PubMed1992

Long-term followup of infants with gross vesicoureteral reflux.

The majority of children (1 year old or less) with gross vesicoureteral reflux already have renal damage at the time of presentation or reflux nephropathy develops during the first few years of life. We report the long-term followup of 31 patients (16 boys) presenting in infancy with gross vesicoureteral reflux (Rolleston classification) between 1952 and 1970. They had a total of 44 grossly refluxing ureters (13 bilateral, 18 unilateral) and presented between ages 1 day and 48 weeks (mean 15.3 weeks). Of the 31 infants 5 died within the first year of life, 4 were followed for up to 11 years before being lost to followup and 1 was killed in a motor vehicle accident after 19.5 years of followup. The remaining 21 patients have been followed for 16 to 37 years (mean 23.9 years); 4 have normal kidneys, and 13 have unilateral and 4 have bilateral reflux nephropathy. Of those patients with unilateral reflux nephropathy proteinuria, hypertension and renal failure developed in 1 born with a single kidney and he is now on hemodialysis, while 2 others have a diastolic blood pressure of 90 mm. Hg or greater. Of the 4 patients with bilateral reflux nephropathy 2 have proteinuria and renal insufficiency, with 1 progressing towards end stage renal failure. Infants who present with gross vesicoureteral reflux within the first year of life appear to do well if free of severe bilateral reflux nephropathy at presentation. Patients with reflux nephropathy should remain under regular nephrological supervision with particular attention given to proteinuria, renal function and blood pressure.

Female↗
PubMed1992

The effect of celiprolol on glomerular filtration rate and renal blood flow in patients with chronic renal impairment and healthy volunteers.

A double-blind, placebo controlled study investigated the effects of celiprolol, 200 mg daily for 7 days, on glomerular filtration rate (GFR) and estimated renal blood flow (ERBF) in eight healthy volunteers and eight patients with chronic renal insufficiency. In healthy volunteers the mean difference in GFR was 4.8 ml min-1 (95% CI -8.2 to 17.7 ml min-1) and the mean difference in ERBF was 49.8 ml min-1 (95% CI -47.5 to 147 ml min-1) after celiprolol. In patients with chronic renal insufficiency the mean difference in GFR was -2.1 ml min-1 (95% CI -64.6 to 65.8 ml min-1). The study had sufficient power to detect a 15% change in GFR for normals and 10% for patients, and for ERBF, changes of 14% and 23% were detectable. Celiprolol at a dose of 200 mg daily for 7 days can be used in patients with chronic renal insufficiency without adversely affecting GFR or ERBF.

Adolescent↗
PubMed1992

Effect of angiotensin converting enzyme inhibitors on erythropoietin concentrations in healthy volunteers.

The possibility that the ACE inhibitors, enalapril and captopril, may decrease plasma EPO concentrations was studied in a single-blind, cross-over study in 10 healthy volunteers. Plasma EPO concentrations, haemoglobin concentration, red blood cell count, plasma creatinine concentration and mean arterial pressure were measured at baseline and after 28 days treatment with both ACE inhibitors. A significant fall in mean plasma EPO concentration occurred with both ACE inhibitors and returned to baseline after stopping the drugs. It is likely that ACE inhibitors decrease EPO formation, by inhibition of angiotensin-II production. This effect could be important in patients with renal failure, renal transplantation or other chronic conditions with an associated anaemia. Haematological parameters should be monitored in such patients when they are treated with an ACE inhibitor.

Adult↗
PubMed1991

Long term complications following renal transplantation.

The long term complications of renal transplantation were assessed in 36 patients who had lived for 10 or more years with a functioning renal transplant. Thirty-three patients were alive with a mean plasma creatinine of 0.13 mmol/L (SD 0.07). A 62 year old women died from a myocardial infarction 11 years after transplantation and two women developed chronic rejection and returned to dialysis after 17 years. Nineteen patients have required antihypertensive therapy, five have suffered ischaemic heart disease and two a cerebrovascular event. Malignancy has developed in 13 patients, with four having two or more organs involved. Skin cancers (9 squamous cell, 4 basal cell) were present in all 13 patients and recurred in six. The other malignancies included carcinoma of cervix (2), cervix and bladder (1) and thyroid (1). Three patients have required parathyroidectomy for autonomous hyperparathyroidism, two splenectomy for hypersplenism, and one bilateral hip replacement for avascular necrosis of the femoral heads. The development of hypertension, vascular disease and malignancy are the most important long term complications after renal transplantation. Strategies must be formulated to reduce the morbidity and mortality from these causes.

Adult↗
PubMed1991

Epstein-Barr virus infection acquired from a cadaveric renal transplant.

A 42-year-old man, seronegative for Epstein-Barr virus (EBV), received a cadaveric renal transplant. Serology from the 27-year-old male donor indicated an active EBV infection. Following treatment for acute rejection with OKT3 the recipient developed a severe systemic illness. Clinical features strongly suggested an acute EBV infection and serology showed seroconversion for EBV. The patient died and autopsy histology revealed widespread polymorphic lymphocyte infiltration in lymph nodes and solid organs. To our knowledge this is the first report of a kidney being transplanted from a donor who was subsequently shown to have had EBV infection at the time of organ retrieval. The EBV status of an organ donor should be considered more frequently.

Adult↗