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T A Rakowski

Publications and source records attributed to T A Rakowski.

36 records · Page 2Linked to original sources

Nail-patella syndrome.

Three cases with collagenation of glomerular basement membrane are presented. The ages of the patients are 8, 13, and 27 years. An 8-year-old boy presented with nephrotic syndrome; a 13-year-old girl presented with recurrent urinary tract infections, proteinuria, and edema; and a 27-year-old woman was noted during the evaluation of a cardiac murmur to have proteinuria and renal insufficiency. The changes on electron microscopy were identical to those observed in nail-patella syndrome, a rare hereditary disease with ectodermal and mesodermal involvement, manifested as bony and nail abnormalities. Nephropathy is now a well established part of this syndrome. Our cases did not have the typical bony and nail changes. We feel these three cases represent a partial gene penetrance or manifestation of only a portion of gene complex involved in this syndrome.

Adolescent↗

Hemodialysis in the eighth and ninth decades of life.

In a review of 45 patients who started receiving hemodialysis (HD) after the age of 70 years (mean, 75 years), compared with a control of 70 HD patients (mean age, 42 years), the two-year survival for elderly patients was 42% and 58% for controls. In the elderly group, age did not correlate with survival. Nine elderly patients were over 80 years old and had a two-year survival of 41%. The elderly patients had a significantly lower mean predialysis blood pressure (BP) (142/73 +/- 3/1 mm Hg) than the controls (158/88 +/- 2/1 mm Hg) (P less than .001). Only 13% of the elderly patients received antihypertensive medication, compared with 41% of controls (P less than .01). The BP showed a significant negative correlation with age in both elderly ( r - .41, P less than .01) and control (r = .35, P less than .001) patients. Glomerulonephritis was less common in the elderly (9%) than control (31%) groups, and pyelonephritis was more common (29% vs 16%).

Aged↗

Myoglobinuria.

Myoglobinuria has a variety of causes, ranging from trauma to heavy exercise. Symptoms usually consist of myalgia and muscle weakness; dark, bloody-looking urine may be noted. Myoglobin can be identified by readily available laboratory techniques. Acute renal failure can be a dangerous consequence of myoglobinuria but, with rapid recognition and strict monitoring, the prognosis in most cases is good.

Crush Syndrome↗

Alport's syndrome representing as crescentic glomerulonephritis: a report of two siblings.

Hereditary nephritis is a disease presenting with hematuria, proteinuria, and systemic findings including ocular lesions and deafness. Renal failure frequently occurs in males who have the disease at a young age. We report the case of a female with hereditary nephritis who presented with the classic clinical and pathologic features of crescentic glomerulonephritis post-pregnancy. A sibling also had a comparable course. It is proposed that crescentic glomerulonephritis may be a heretofore unreported presentation of hereditary nephritis with terminal renal failure.

Adult↗

Evaluation of percutaneous kidney biopsy in advanced renal failure.

As more information is gained on the long-term survival in chronic dialysis and transplant patients, it is unacceptable to be satisfied with a clinical impression of the etiology of the end stage renal failure in each case. It becomes important to know the histological diagnosis in patients who present with terminal renal failure. In the past there was little to offer such individuals in terms of therapeutics, and their prognosis was uniformly poor. Thus, biopsy for other than academic reasons was difficult to justify. This is no longer true and presented here is a series of 28 such patients in whom percutaneous renal biopsy was performed. The complications and diagnostic yield are reported. It is further demonstrated that the added knowledge of histological diagnosis can be of benefit to the individual patient.

Adolescent↗

Nephrotoxicity of cis-diamminedichloroplatinum(II) as measured by urinary beta-glucuronidase.

Urinary beta-glucuronidase activity as a measure of renal tubular damage was studied in 23 patients receiving 43 courses of cis-diamminedichloroplatinum(II) therapy. A 250% increase in urinary beta-glucuronidase activity was noted after therapy, compared with values before therapy. There were no patients who sustained renal insufficiency as evidenced by more commonly used and coarser parameters of renal function. This marked rise in urinary beta-glucuronidase activity was felt to indicate tubular toxicity due to the cis-diamminedichloroplatinum(II) not measured by the usual parameters of renal function.

Cisplatin↗