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Biomedical subjects

S B Kurtz

Publications and source records attributed to S B Kurtz.

At least 37 records · Page 2Linked to original sources
PubMed1984

Results of treatment of center hemodialysis patients.

Four hundred eighty-three patients were maintained by hemodialysis in an outpatient hemodialysis center at the Mayo Clinic between 1963 and 1977. Although only 18 patients had experienced a myocardial infarction and 6 had had a cerebral infarction before beginning dialysis, 30 subsequently had acute myocardial infarction and 45 had a stroke. These two complications accounted for 48 of the 98 deaths that occurred during maintenance dialysis. Despite such complications, 183 patients were employed, 124 remained active at home or at school, and 115 were totally disabled. Survival of patients maintained solely by dialysis was 52% at 5 years. For the group as a whole, including patients who received their first allograft, the survival rate at 5 years was 65%.

Adolescent↗
PubMed1983

Continuous ambulatory peritoneal dialysis. Three years' experience at the Mayo Clinic.

From January 1979 through January 1982, 69 patients with end-stage renal failure of various causes were treated by continuous ambulatory peritoneal dialysis. The dialysis was adequate and stable in all except four patients; two of these four became irreversibly uremic, and the other two had inadequate ultrafiltration. Hemoglobin levels increased initially and remained stable in all but two patients. In our experience, metabolic problems included control of secondary hyperparathyroidism, adequate protein nutrition, progressive neuropathy, abnormal lipoprotein profiles, and excessive weight gain. Technical problems included recurrent peritonitis, maintenance of adequate peritoneal access, and development of abdominal hernias. In general, all but two patients remained enthusiastic about this type of therapy despite inherent problems. The long-term potential of continuous ambulatory peritoneal dialysis remains uncertain at this point, but for most patients, adequate short-term treatment by this method is a reasonable alternative to hemodialysis.

Adult↗
PubMed1983

Acute renal failure treated by slow continuous ultrafiltration. Preliminary report.

We report our initial experience with the use of slow continuous ultrafiltration in the treatment of acute renal failure. Advantages of slow continuous ultrafiltration over conventional hemodialysis are greater blood pressure stability, no need for systemic anticoagulation, augmented fluid input and removal, and enhanced ease of operation. Our results in two patients confirm other reports that this method can be successfully performed in hemodynamically unstable patients with acute renal failure.

Acute Kidney Injury↗
PubMed1981

Renal toxicity during therapy with gentamicin or tobramycin.

Twenty-seven patients who had normal pretherapy renal clearance by the [125I]iothalamate test were randomly assigned either gentamicin or tobramycin for therapy of infections due to susceptible bacteria. No patients were critically ill or had evidence of bacteremia. Mean age and duration of therapy were 51 years and 14 days, respectively, for 15 patients treated with gentamicin, and 45 years and 13 days for 12 patients treated with tobramycin. At the completion of therapy, six (40%) gentamicin and seven (58%) tobramycin patients had a decrease in renal clearance of at least 14% below baseline. The mean decrease was 26% in the gentamicin group and 23% in the tobramycin group. Simultaneous increases in serum creatinine concentrations (greater than or equal to 0.2 mg/dl) occurred in only 4 (31%) of the 13 patients. Of four patients who had renal clearance studies repeated 3 weeks to 6 months after therapy, two had stable function, but at 16 to 19% below baseline. Mean urinary concentration of N-acetyl glucosaminidase and alanine aminopeptidase increased faster and to higher levels with gentamicin than with tobramycin. However, on an individual patient basis, they were not predictive of a decrease in renal clearance in either therapy group.

Acetylglucosaminidase↗
PubMed1980

The progression of vesicoureteral reflux nephropathy.

The relations among renal function, proteinuria, and glomerular lesions were studied in 54 patients with reflux nephropathy. The clinical course to end-stage renal disease was not appreciably altered by late surgical correction of the reflux, occurrence of urinary tract infection, or hypertension. All patients with progressive renal disease had significant proteinuria. Mesangial glomerular lesions can occur in the absence of proteinuria detectable by routine analysis, whereas lesions similar to those seen in idiopathic focal sclerosing glomerulopathy were present in the renal biopsies from proteinuric patients. Deposition of immunoproteins was limited to glomeruli undergoing sclerosis. Similarly, electron-dense deposits were confined to areas of mesangial alterations. Our results suggest that mesangial alterations occur early in the course of reflux nephropathy and may lead to the development of focal sclerosis. At later stages, counterproductive mechanisms of adaptation to the loss of viable nephrons might result in an acceleration of the clinical course to renal failure.

Adolescent↗
PubMed1980

In search of marker for genetic susceptibility to reflux nephropathy.

The frequency of 40 HLA antigen specificities was determined in 44 patients with end-stage renal disease secondary to reflux nephropathy and compared with those observed in 526 control subjects. Higher than normal frequencies were observed for HLA-B12 in female patients, and HLA-B8 in combination with HLA-A9 or HLA-BW15 in male patients, and HLA-BW15 in patients of both sexes. A comparison of the frequency of HLA antigens in the reflux patients with a history of hypertension versus those without a history of hypertension revealed that HLA-A3 was found with higher frequency and HLA-A1 and HLA-B8 with lower frequency in association with hypertension. These results suggest that the major histocompatibility antigens might be in linkage disequilibrium wih a gene (or genes) determining the susceptibility to renal damage by vesicoureteral reflux and that this linkage, or the clinical expression of this linkage, might be influenced by variations in relation to the sex of the patients.

Child↗
PubMed1979

Use of combined plasmapheresis and immunosuppression in the treatment of Goodpasture's syndrome.

Five consecutive patients with well-documented Goodpasture's syndrome were treated with plasmapheresis and immunosuppression. In all patients, the antiglomerular basement-membrane antibody titers decreased with treatment. In three patients, hemoptysis responded promptly to plasmapheresis. Two patients presenting with severe renal failure required chronic dialysis, and three patients who had serum creatinine levels less than 2.1 mg/dl before treatment improved or had stabilization of their renal function. We confirm that the use of plasmapheresis and immunosuppression is a promising method of treatment in some patients with Goodpasture's syndrome.

Adult↗
PubMed1978

Bilateral localized amyloidosis of the ureter presenting with anuria.

A patient with bilateral localized amyloidosis of the ureters is described. This is the first case to be reported in which anuria was the presenting symptom, the second case with bilateral involvement and the thirteenth case of amyloidosis localized to the ureter. Careful urologic and hematologic followup is indicated.

Amyloidosis↗
PubMed1978

Ultrafiltration followed by haemodialysis. A longterm trial and acute studies.

Separate ultrafiltration followed by haemodialysis (U.F.-H.D.) using Gambro Major or Cordis-Dow hollow-fiber dialyzers were evaluated in 10 dialysis patients over a mean period of 4 1/2 months and 455 U.F.-H.D. procedures. Fluid control was facilitated in oedematous patients but the number of hypotensive episodes during the combined procedure requiring intravenous 5% saline did not significantly decrease. No significant improvement in hypertension was noted. Ultrafiltration (U.F.) alone for acutely water overloaded, azotaemic patients proved very useful. Two to five liters of oedema fluid could be removed asymptomatically in one to three hours using transmembrane pressures of 250 to 500 mmHg and U.F. rates of 10 to 42 ml/min. Two patients became acutely and symptomatically hypotensive. One was an insulin dependent diabetic in whom 3800 ml were removed in 75 minutes and the other a hypertensive patient undergoing treatment with Minoxidil and propranolol.

Diabetes Mellitus, Type 1↗
PubMed1978

Chronic peritoneal dialysis in juvenile-onset diabetes mellitus: a comparison with hemodialysis.

Fourteen juvenile-onset diabetic patients accepted for renal transplantation and maintained on chronic peritoneal dialysis during a 3-year period were compared with a similar group of 43 patients accepted for renal transplantation and maintained on hemodialysis. The 1-year survival in each group was similar (52% on chronic peritoneal dialysis; 55% on hemodialysis), but there was a striking difference in progressive morbidity. Seven patients on chronic peritoneal dialysis were blind in one or both eyes at the onset, and visual acuity improved in two, including one bilaterally blind patient who achieved 20/35 vision bilaterally; none worsened. In the hemodialysis group, 12 patients were totally blind in one or both eyes and 11 additional patients became blind or had severe deterioration in vision; none improved. Neuropathy progressed in only 1 patient on chronic peritoneal dialysis, whereas it worsened in 17 patients on hemodialysis--9 to the extent that they needed braces or canes or were nonambulatory. All patients on chronic peritoneal dialysis were home trained and were dialyzed at night, with seven being able to work full or part time; virtually none of the patients on hemodialysis were able to work. Chronic peritoneal dialysis was relatively free of technical complication, and no significant difficulty was encountered in diabetic control, in the anephric state, or during abdominal surgery. Chronic peritoneal dialysis appears to have less associated morbidity than does hemodialysis in the treatment of chronic renal failure of juvenile-onset diabetes mellitus.

Adult↗
PubMed1978

Recurrent Goodpasture's syndrome.

A 49-year-old woman had three distinct episodes of pulmonary hemorrhage over a 11-year period separated by symptom-free intervals of 6 and 5 years. The first and third episodes were associated with mild glomerulonephritis and linear deposition of IgG along glomerular/tubular basement membranes. The first episode was associated with a rising influenza A2 titer. Investigation of the third episode revealed circulating antiglomerular basement membrane antibodies detected by radioimmunoassay but not by indirect immunofluorescence. Antilung basement membrane antibodies were detected by both direct and indirect immunofluorescence. Recovery from each hemorrhage followed blood transfusion and oxygen therapy. This case demonstrates that (1) Goodpasture's syndrome, predominantly manifest by pulmonary hemorrhage, may have circulating antibodies with greater affinity for lung membrane compared with glomerular basement membrane, and (2) the antiglomerular basement membrane antibody response is not necessarily an acute self-limited event but may be a chronic or recurrent phenomenon.

Anti-Glomerular Basement Membrane Disease↗
PubMed1978

Accuracy of antibody-coated-bacteria test in recurrent urinary tract infections.

Antibody coating of urinary bacteria was compared with results of ureteral catheterization studies in order to localize the site of recurrent urinary tract infections in 32 patients. The antibody-coated-bacteria test reliably detected infections in patients with upper urinary tract infection (16 of 17 patients), but false-positive results occurred frequently in patients with lower urinary tract infection (5 of 15 patients). The antibody-coated-bacteria test appears to be a useful screening test for localization of infection in patients with recurrent urinary tract infections.

Antibodies, Bacterial↗
PubMed1977

Clinical features and management of cystinuria.

Cystinuria is a complex hereditary disorder that affects both sexes with equal frequency and severity. Symptoms usually begin early (children and young adults) but may develop at any age. Stature is normal and there are no clinical nutritional abnormalities. The morbidity of cystine urolithiasis is considerable. Hyperuricemia is a frequent associated finding and is probably the result of multiple factors. No other abnormalities are consistently related to this disease. Treatment with adequate oral fluids to ensure a copious urine volume and with oral alkali to keep the urine alkaline is most successful when used prophylactically in the stone-free patient. However, dissolution of existing calculi is unlikely with this regimen alone. The addition of D-penicillamine often results in dissolution of stones and prevention of recurrent calculi in patients who have continued stone growth despite the use of oral fluids and alkali. Because toxic reactions with D-penicillamine are frequent and sometimes severe, this drug should be used only when necessary and then as an adjunct to rather than a substitute for increased oral fluids and alkali. Failure of treatment in spite of adequate therapy should alert the physician to the possibility of coexisting complicating problem.

Adolescent↗