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Biomedical subjects

R van Leusen

Publications and source records attributed to R van Leusen.

At least 37 records · Page 2Linked to original sources
PubMed1991

Urine cytology as a screening method for transitional-cell carcinoma in dialysis patients with analgesic nephropathy.

The abuse of analgesic-containing drugs leads to chronic nephropathy with an increased risk of developing a transitional-cell carcinoma of the urinary tract. In our experience follow-up is often stopped or has never been started when patients present for dialysis. We use urine cytology as the screening method. Nine of the 138 patients entering dialysis between 1980 and 1990 had analgesic nephropathy. In three patients urine cytology led to a suspicion of malignancy. Cystoscopy and/or retrograde pyelography showed a carcinoma of the renal pelvis in two patients and a carcinoma of the bladder in one patient. The patients with carcinoma of the renal pelvis died of cardiovascular complications within 2 years of nephroureterectomy. An autopsy was performed in one of these patients and there were no residual tumours or metastases. In the other patient autopsy was not performed, but urine cytology again suggested malignancy. The patient with a carcinoma of the bladder is still alive. She was treated with transurethral resection of the tumour and etoglucide instillations. We conclude that urine cytology is a good screening method for the early detection of transitional-cell carcinomas in dialysis patients with analgesic nephropathy.

Analgesics↗
PubMed1991

Continuous ambulatory peritoneal dialysis (CAPD) in patients with diabetic nephropathy.

A 3-centre study was done to analyse the results of 70 patients with end-stage renal disease caused by diabetic nephropathy and treated with CAPD. Fifty patients had insulin-dependent diabetes (mean age 42, mean duration of diabetes 24 yr); 20 had non-insulin-dependent diabetes (mean age 61, mean duration 15 yr). Total treatment time was 1563 months and ranged from one to 83 months (median 18). Patient survival was 86% at 1 yr and 33% at 4 yr. Technique survival was 87% and 63%. Cox's multiple hazard regression analysis showed that age above 45 yr (relative risk 2.2), systolic hypertension (2.6) and cardiac disease (2.2) at the start of CAPD were associated with shorter patient survival. Metabolic control was good. Haemoglobin rose during the first 3 months. Plasma creatinine concentration increased with time, probably due to the loss of residual renal function. HbA1c levels were in the normal range for 60% of the patients. Mean hospital stay was 42 days per year, 26 as a consequence of vascular complications and 16 due to peritonitis and catheter-related problems. We conclude that CAPD is a good renal replacement modality for patients with diabetic renal failure. The patient survival is dependent on age, systolic hypertension and cardiac disease at the start of CAPD.

Adult↗
PubMed1985

Thallium concentrations in body fluids and tissues in a fatal case of thallium poisoning.

A fatal case of thallium poisoning is described in which the thallium concentration was quantitated in plasma and urine during treatment and in tissue samples obtained on postmortem examination. As ileus paralyticus and the onset of renal failure were already manifested on admission of the patient, charcoal hemoperfusion and this technique in combination with hemodialysis were applied which showed to be tenfold more effective than the simultaneous renal elimination. The highest thallium concentration was found in the heart and not in kidneys as reported previously in animal experiments. Evidence is presented that thallium distribution in kidneys is dose dependent.

Adult↗
PubMed1982

Mechanism of elevated serum pancreatic polypeptide concentrations in chronic renal failure.

Basal serum concentrations of pancreatic polypeptide (PP) in five patients with chronic renal failure (CRF; 165-2100 pmol/liter) were significantly (P less than 0.01) higher than those in six age-matched normal control subjects (18-54 pmol/liter). Ingestion of a mixed meal resulted in significantly (P less than 0.01) larger increases in serum PP in patients with CRF (245-1740 pmol/liter) than in the normal subjects (72-196 pmol/liter). The iv administration of somatostatin (125 micrograms as a bolus injection, followed by infusion of 125 micrograms/h) to two patients with CRF and two normal subjects completely abolished postprandial PP release. By administering the same dose of somatostatin 60 min after ingestion of the meal, the disappearance rate of endogenously released PP could be estimated. The half-life of disappearance for PP in patients with CRF (t1/2 = 13.2 +/- 1.8 min) was significantly (P less than 0.01) increased compared to that in the normal subjects (t1/2 = 5.6 +/- 0.8 min). Sephadex G-50 column chromatography of basal sera from three patients with CRF revealed three major peaks of PP: one eluting in the void volume, one coeluting with the 4200 molecular weight human PP standard, and one in between. The PP peak coeluting with standard PP comprised 64 +/- 3% of total PP immunoreactivity. Ingestion of food, followed by subsequent infusion of somatostatin, resulted in marked changes in the PP peak coeluting with standard PP, while the two larger molecular forms remained relatively unchanged. At least three findings may be related to the mechanism of elevated serum PP concentrations in patients with CRF: 1) the presence of large molecular forms of PP, 2) a slower disappearance rate for postprandially released PP, and 3) increased postprandial secretion of PP indicating hyperresponsiveness of PP cells to physiological stimuli.

Aged↗
PubMed1982

Cyclical changes in serum thyroid hormone concentrations related to hemodialysis: movement of hormone into and out of the extravascular space as a possible mechanism.

Chronic hemodialysis (CHD) patients suffer from a chronic illness that is believed not to involve the thyroid. However, they may have low serum T4 and T3 concentrations. The influence of a single hemodialysis treatment on serum thyroid hormone concentrations was studied in twenty-three CHD patients. It was found that serum total T4 and free T4 concentrations were significantly higher immediately after hemodialysis than before treatment. Immediately after hemodialysis serum T3 and TSH concentrations were unchanged. Eighteen hours after hemodialysis the serum total T4 and free T4 levels were still elevated, but, at this time, serum T3 levels were also higher than before dialysis. The serum TSH levels remain unchanged. Seventy-two hours after the start of the hemodialysis treatment, all thyroid hormone concentrations had returned to their original predialysis levels. Correction for hemoconcentration or dilution did not influence these results. We could not demonstrate any correlation between the changes in serum urea-N and creatinine levels and the observed changes in serum thyroid hormone concentrations. These cyclical changes in serum thyroid hormone levels may be ascribed to the combined effects of heparin administration during hemodialysis and the accumulation and removal of uremic substances, both of which are capable of competitive binding of thyroid hormone binding sites. For practical purposes it is important to specify the time of blood sampling in relation to a hemodialysis treatment when studying serum thyroid hormone levels in CHD patients.

Creatinine↗
PubMedDate not supplied

Effects of peritoneal dialysis with an overnight icodextrin dwell on parameters of glucose and lipid metabolism.

OBJECTIVE: To examine whether a reduced daily glucose load by overnight application of the less-absorbed glucose polymer icodextrin would have favorable effects on lipid profiles of continuous ambulatory peritoneal dialysis (CAPD) patients. STUDY DESIGN: Randomized crossover study with two subsequent periods of 6 weeks. SETTING: Home PD unit of a secondary-care hospital. PATIENTS: Twenty-one nondiabetic CAPD patients (15 male, 6 female; mean age 50.3+/-11.8 years). INTERVENTION: Participants were randomly assigned to receive an overnight dwell with either standard glucose solution or with a 7.5% icodextrin-containing solution. MAIN OUTCOME MEASURES: Relation between reduction in the total amount of intraperitoneal infused glucose and parameters of glucose (plasma glucose, insulin, and HbA1C) and lipid metabolism [free fatty acids, plasma lipids, lipoproteins, and low density lipoprotein (LDL) subfraction profile]. RESULTS: After the icodextrin dwells, a reduction of plasma total cholesterol (from 5.43+/-0.85 to 4.86+/-0.70 mmol/L, p < 0.001) and LDL cholesterol (from 3.38+/-0.87 to 2.93+/-0.73 mmol/L, p = 0.001) was observed. Also, high density lipoprotein (HDL) cholesterol (from 0.95+/-0.27 to 0.90+/-0.24 mmol/L, p = 0.029) was reduced, but the plasma total cholesterol-to-HDL ratio remained similar. Plasma free fatty acids and triglyceride levels tended to decrease (from 0.16+/-0.10 to 0.13+/-0.08 mmol/L, p= 0.06, and from 2.14+/-1.96 to 1.92+/-1.03 mmol/L, respectively). Evaluation of LDL subfraction profiles after ultracentrifugation showed a more buoyant LDL subfraction profile with fewer dense LDL particles in 6 patients and no changes in 14 patients after icodextrin. The effects on lipids were not accompanied by a decrease in fasting plasma glucose (from 5.76+/-1.29 to 5.86+/-0.80 mmol/L) or insulin levels (from 19.5+/-14.4 to 20.3+/-13.0 mU/L). CONCLUSION: These results suggest a beneficial effect on lipid profiles of CAPD patients with the use of an overnight dwell with icodextrin.

Cross-Over Studies↗