Biomedical subjects
Publications and source records attributed to S Caglar.
Spontaneous perirenal haematoma (SPH) is an unusual but serious complication of polyarteritis nodosa (PAN). We present 3 patients with PAN-associated SPH. One was diagnosed pre-operatively and underwent emergency nephrectomy in order to stop the persistent bleeding; the second patient had surgical drainage of the haematoma and the third recovered without undergoing surgery. The diagnosis is discussed.
Patients with nephrotic syndrome are unusually susceptible to infections, including primary peritonitis. In this study, we have evaluated nine adult patients with nephrotic syndrome and ascites for ascitic fluid bactericidal activity, complement and immunoglobulin concentrations. Eight of nine patients had diminished ascitic fluid bactericidal activity while twelve control peritoneal fluids had normal bactericidal activity. Complement (C3 and C4) and immunoglobulin (IgG and IgM) concentrations were significantly lower in nephrotic syndrome ascitic fluid than peritoneal fluid from normal subjects. These findings may explain the high occurrence rate of primary peritonitis in nephrotic patients with ascites.
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Healthy adult dogs were subjected to stepwise reduction of nephron population so as to create the transition from normal renal function to advanced renal insufficiency. Studies were performed at each level of renal function. Glomerular filtration rate (GFR), renal phosphate clearance, and serum radioimmunoassayable parathyroid hormone (PTH) levels were measured. Two groups of animals were studied. In one, phosphorous intake was maintained at 1200 mg/day. As GFR declined, fractional phosphate excretion rose reciprocally, and PTH levels increased over 20-fold. In the second group, phosphorous intake was maintained at less than 100 mg/day. As GFR fell, fractional phosphate excretion changed little, and no increment in PTH levels occurred. The data suggest that the control system regulating phosphate excretion contributes importantly to the pathogenesis of secondary hyperparathyroidism in advancing renal insufficiency.
An effort to examine certain aspects of the adaptation in potassium excretion associated with nephron reduction was made in dogs with unilateral remnant kidneys. A constant intake of potassium was maintained by tube feeding and studies were performed before and after removal of the intact control kidney. The removal of the intact kidney created the need for the remaining nephrons of the remnant kidney to increase their rate of potassium excretion markedly. Sodium intake was held constant either at a normal or a low level. Mineralocorticoid hormone activity was maintained either at a high level by the administration of 0.2 mg 9-alpha-fluorohydrocortisone daily or at a low level by performing bilateral adrenalectomy and administering a minimal maintenance dose of deoxycorticosterone acetate (DOCA) and cortisol. Potassium excretion per nephron increased strikingly within 18 hr of contralateral nephrectomy and by 7 days, excretion rates were 600% of control values for the remnant kidney. More potassium was excreted in the first 5 hr after administration of a test dose of potassium by the remnant kidney alone in the postnephrectomy state than by both the remnant and intact kidneys in the prenephrectomy state. 24 hr excretion of potassium by the remnant kidney postnephrectomy averaged 92% of the administered load of potassium. The adaptation in potassium excretion was independent of the concurrent rate of sodium excretion and of mineralocorticoid hormone activity and persisted during constriction of the renal artery, a stimulus which presumably decreased distal delivery of sodium. The adaptation and the continued modulation of potassium excretion could not be explained adequately by an increase in impermeant anion excretion per nephron. Finally, known changes in hydrogen ion excretion per nephron associated with nephron reduction are in a direction opposite to those which would explain the acquired kaliuresis per nephron.
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