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S J Rosansky

Publications and source records attributed to S J Rosansky.

17 recordsLinked to original sources
PubMed1992

Rate of change of end-stage renal disease treatment incidence 1978-1987--has there been selection?

End-stage renal disease (ESRD) treatment rates in the United States have increased steadily since 1973. Decreasing selection against elderly patients with a poor prognostic primary cause of ESRD (i.e., diabetic nephropathy) may partly account for this increase in rates. To test this hypothesis, we calculated log ESRD treatment incidence (ESRDI) rates by four major primary causes of ESRD (diabetic nephropathy (DN), hypertensive nephropathy (HN), glomerulonephritis (GN), and cystic kidney disease (PC); two age groups (old (O), greater than 65 and young (Y), 15 to 44 yr of age) for black and white, male and female, new ESRD patients from 1978 to 1987. As predicted, summary log ESRDI slopes (produced by analysis of covariance) occurred in the following decreasing order, ODN (0.19), OGN = OHN = YDN (0.134). YHN = YPC = YGN (in white patients) = slope not significantly different from 0. Log ESRDI slopes for young black males and females with GN increased significantly between 1978 and 1987, possibly as a result of an increased incidence of GN. In conclusion, decreasing selection may be a factor in the continuing increase in the U.S. ESRD population.

Adolescent↗
PubMed1991

Effect of osmolar changes on plasma arginine vasopressin (PAVP) in dialysis patients.

The effect of changes in plasma osmolality and changes in plasma arginine vasopressin (PAVP) were analyzed in 10 stable chronic hemodialysis patients utilizing four protocols. During regular hemodialysis opposing influences on PAVP (decrease in blood pressure and intravascular volume and increase in serum calcium) resulted in no significant change in PAVP (by analysis of variance). In the second protocol low dialysate calcium (2.5 meq/l) isovolemic hemodialysis was used. PAVP and serum osmolality levels declined from 2.0 +/- 0.4 to 1.4 +/- 0.2 microU/ml (p less than 0.05), and 285 +/- 2.5 mOsm/l to 275 +/- 3.2 mOsm/l respectively. Removal of PAVP by hemodialysis did not occur as evidenced by no difference in arterial-venous PAVP levels and no "rebound" of PAVP for three hours after completion of dialysis (second protocol). Isovolemic low calcium high dialysate sodium (145 meq/l) hemodialysis was utilized in the third protocol. Serum osmolality and PAVP did not change. Addition of a very high dialysate sodium (155 meq/l) to isovolemic low calcium hemodialysis resulted in an increase in plasma sodium, osmolality and AVP (139.7 +/- 0.62 to 144 +/- 0.67 meq/l, 294 +/- 2.79 to 304.3 +/- 2.4 mOsm/l and 1.8 +/- 0.3 to 2.7 +/- 0.5 microU/ml (p less than 0.05 for each) respectively. In conclusion, PAVP responds to changes in plasma osmolality in chronic hemodialysis patients.

Analysis of Variance↗
PubMed1990

Comparative incidence rates of end-stage renal disease treatment by state.

End-stage renal disease (ESRD) treatment rates vary significantly between states in the United States. Much of this variation relates to the much higher rate of ESRD in blacks and the differences in race, age, and sex composition of various states. Even after adjusting for race, age, and sex differences utilizing data from new patients reported to Medicare with ESRD between 1980 and 1983, marked variation in treatment incidence rates per million population were still present. Overall rates varied from 45 in North Dakota to 99 in New Jersey. Regional rate patterns were demonstrated with very high rates in southwestern states (Texas, New Mexico, Arizona, and California: 87-91/million). In contrast, several south-central states had lower rates (Arkansas, Louisiana, Mississippi, Alabama, and Tennessee: 66-75/million). By state the rates for blacks were consistently higher than for whites. After adjustment for sex and age differences, the rates for blacks varied from 125 in Arkansas to 242 in New Jersey. Several north-eastern states (Massachusetts, Connecticut, Rhode Island, New Jersey) had higher rates of ESRD in blacks (197-242 million) as compared with several south-central states (Arkansas, Louisiana, Mississippi, Tennessee, Alabama) where rates varied from 125 to 180 million. ESRD rates by primary etiologies by state showed marked variation of the major primary etiologies of ESRD: diabetic nephropathy rates were most predictive of overall ESRD rates, with much higher rates in the southwestern states (28.1-33.2) as compared with the south-central states (12.8-16.3).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

The association of blood pressure levels and change in renal function in hypertensive and nonhypertensive subjects.

We compared the changes in serum creatinine levels over time after a mean follow-up of 9.8 years in essential hypertensive (EH, n = 56) and control (n = 59) male veteran subjects. All subjects had normal serum creatinine levels (62 to 124 mumol/L) and "normal" urinalysis results on entry into the study. Subjects with comorbid renal diagnoses and diabetes mellitus were eliminated from the analysis. Although not statistically significant, the rate of change in the serum creatinine concentration over time was greater in the EH cohort compared with the control cohort (1.08 +/- 4.8 vs 0.027 +/- 3.5 mumol/L per year). The difference was especially marked in black EH subjects vs black control subjects (1.60 +/- 6.2 mumol/L per year vs -0.21 +/- 3.3 mumol/L per year). When age, race, body mass index, and a diagnosis of EH were entered into a logistic regression analysis, EH subjects had a statistically significantly greater rate of decline in renal function than did control subjects (1.5 +/- 8.3 mumol/L per year). When mean time-averaged systolic blood pressure for each subject was also included in the logistic regression analysis, only systolic time-averaged blood pressure was statistically significant (0.063 +/- 0.029 mumol/L per year). We conclude that in the absence of clinically detected parenchymal renal disease, EH subjects have a greater rate of decline in renal function than do nonhypertensive subjects. Time-averaged blood pressure is predictive of the change in serum creatinine concentration not only in EH subjects but also in nonhypertensive subjects. Thus, preservation of renal function may require a blood pressure lower than the currently accepted normotensive range.

Blood Pressure↗
PubMed1986

Procainamide toxicity in a patient with acute renal failure.

A patient developed acute renal failure while receiving oral procainamide (PA). This lead to severe PA and N-acetyl procainamide (NAPA) toxicity. Rebound of NAPA plasma levels postdialysis prolonged the toxicity, which was treated with hemodialysis, hemoperfusion, and combined hemodialysis-hemoperfusion. Because of the potential for PA and NAPA toxicity in patients with renal insufficiency, especially in patients with changing renal function due to acute renal failure, it is recommended that the use of PA be curtailed in this population and that another substitute antiarrhythmic agent be used.

Acecainide↗
PubMed1985

Use of peritoneal dialysis in the treatment of patients with renal failure and paraproteinemia.

The effect of alterations in dwell time, dialysate dextrose concentration, and nitroprusside on immunoglobulin removal during peritoneal dialysis and a comparison of plasmapheresis versus peritoneal dialysis on immunoglobulin removal was studied. 1 h of plasmapheresis removed approximately 100 times as much IgG and 50 times as much IgM and IgA as 1 h of peritoneal dialysis. Nitroprusside added to peritoneal dialysate doubled the hourly removal rate of IgG using 1- and 8-hour cycles and increased IgA and IgM removal by 25 and 10%, respectively, using 8-hour cycles. It was estimated that peritoneal dialysis with nitroprusside added to peritoneal dialysate augments intact immunoglobulin clearance (above endogenous clearance) by approximately 10%. We hypothesized that peritoneal dialysis could significantly increase light-chain removal and thereby may be efficacious in the treatment of light chain related amyloid formation and light chain induced renal failure.

Adult↗
PubMed1983

Choosing therapy for end-stage renal disease.

Patients with end-stage renal disease must decide which form of therapy they want--hemodialysis, peritoneal dialysis or transplant. Each method has advantages and disadvantages. Home dialysis and related donor transplantation are generally the preferred modes of therapy, because they allow for maximum patient rehabilitation and survival. The informed family physician can help the patient choose the most appropriate treatment.

Graft Rejection↗
PubMedDate not supplied

Multiple cholesterol emboli syndrome after angiography.

Multiple cholesterol emboli syndrome (MCES) after angiography has been reported infrequently. Seven patients (from five reports) who developed MCES after angiography are reviewed. An eighth case is described. All patients had evidence of extensive atherosclerosis. Following angiography of the eight patients, six demonstrated livedo reticularis below the umbilicus; technical difficulties were reported in four; four became febrile and/or hypertensive; and only one survived. Since therapy has been unsuccessful, careful angiographic technique is essential to prevent this syndrome.

Aged↗