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Biomedical subjects

T H Mathew

Publications and source records attributed to T H Mathew.

15 recordsLinked to original sources
PubMed1992

Drug-induced renal disease.

OBJECTIVE: To review drug-induced renal disease with emphasis on current issues and practical problems with commonly used agents. DATA SOURCES: English language literature search using MEDLINE, Index Medicus, textbook articles and relevant reviews. STUDY SELECTION: Drugs in common use were reviewed in detail. Uncommonly used drugs or those with only a few reports of nephrotoxicity were excluded from this review. DATA SYNTHESIS: The clinical patterns of nephrotoxicity include an episode of acute deterioration of renal function, chronic renal failure and proteinuria which may be severe enough to cause the nephrotic syndrome. Diagnosis is made by clinical suspicion, distinctive clinical patterns and usually improvement in renal function on drug withdrawal. CONCLUSION: A high index of suspicion is necessary to detect drug-induced renal disease particularly with increasing availability of over-the-counter drugs. Drugs should always be suspected of causing renal disease where no alternative cause is obvious. When any doubt exists the agent in question should be withdrawn.

Acetaminophen↗
PubMed1979

Acute post-streptococcal glomerulonephritis in adults: a long-term study.

The long-term outcome after acute post-streptococcal glomerulonephritis was studied in 57 patients (52 aged 16 or over) followed for a period of one to 14 years (mean seven years). All patients presented with hypertension, haematuria and proteinuria. The antistreptolysin-0 titre was raised or the serum complement was low in all cases at the initial episode. All patients had histological evidence of a diffuse proliferative and exudative glomerulonephritis at onset. Follow-up renal biopsy was performed in 33 patients; in 18 patients this was carried out five years or more after the initial illness. Five patients died beyond two years, only two having had abnormal renal function at the time or death. Four patients were found to be mildly hypertensive without other clinical abnormalities. Eleven patients had proteinuria, haematuria or abnormal renal function; in three of these repeat renal biopsy was normal, incomplete resolution was reported in five, obsolescent glomeruli in one, and two others were not biopsied. No patient who had normal renal function at the time of follow-up had abnormal renal histology on biopsy. Obsolescent glomeruli were present in two other biopsies in association with evidence of incomplete resolution. It was concluded that the majority of patients with acute PSGN have a good prognosis. Histological resolution of the renal lesion may not occur for nine years.

Acute Disease↗
PubMed1977

Preservation of cadaver of renal allografts: comparison of ice storage and machine perfusion.

Preservation of cadaveric renal allografts by ice storage and by machine perfusion after a preliminary flush with a hypertonic citrate solution has been compared in a prospective clinical trial between matched pairs of kidneys from the same cadaver donor. Over a two-year period, ice storage after flushing with the new solution gave results comparable with machine perfusion. Times of warm ischaemia and total times of storage were similar in ice-stored and machine-perfused kidneys and averaged about 16 hours. In each group of recipients, more than half of the kidneys had good early function and one-year survival times were also similar.

Cadaver↗
PubMed1977

Risks of vesicoureteric reflux in the transplanted kidney.

The risk to the transplanted kidney of vesicoureteric reflux was evaluated in 150 consecutive first cadaveric renal allografts surviving for over three months. Of the 119 (79 per cent) allografts studied by micturating cystography 29 (24 per cent) were shown to reflux. The presence of reflux was associated with urine leakage and reoperation, and with ureteric insertion involving a short intramural tunnel. Graft failure (graft nephrectomy or death from renal failure) occurred in 14 of 29 refluxing grafts as compared to 14 failures in 90 nonrefluxing grafts (P less than 0.01). Graft failure in the refluxing group was typically slow, and commonly associated with proteinuria, microscopic hematuria, hypertension and a biopsy appearance of mesangiocapillary glomerular change. Urinary infection, though frequent (69 per cent), was not more common in the group with than in that without reflux. Vesicoureteric reflux is an important cause of late renal-graft failure.

Cadaver↗
PubMed1976

Primary oxalosis with myocardial involvement and heart block.

An unusual case is described of primary oxalosis with renal failure and cardiac involvement with complete heart block. Although cardiac involvement rarely occurs, it nevertheless requires evaluation because of the therapeutic implications.

Heart Block↗
PubMed1976

The conservative management of chronic renal failure.

The management of patients with chronic renal failure is complicated and demanding for both physician and patient, but is frequently rewarding. When specific treatment of the underlying cause is not possible, therapy is aimed at making the maximum use of existing nephrons and preventing further loss of nephrons through hypertension and infection. Careful attention to salt and water balance is necessary, and all patients and all drugs prescribed must be considered with care. Special problems exist with regard to anaemia, bone disease, pericarditis and hyperkalaemia. An important aspect of care at this time is the education of patients about the next major phase of management, dialysis and transplantation.

Anemia↗
PubMed1976

Clinical evaluation of a dialysate regeneration system for maintenance haemodialysis.

A commercially available sorbent-based dialysate regeneration system has been compared to conventional single-pass dialysate delivery systems for treatment periods of six weeks in 13 patients on maintenance dialysis. The results of treatment were virtually identical in comparing sorbent and conventional systems except that seven of the eight patients using 2-5 M2 dialysers for 3--4 hours thrice per week developed asymptomatic metabolic acidosis with the dialysate regeneration system. This complication was not seen in the five patients using 1-3 M2 dialysers and having a 6--7 hour treatment thrice weekly. Dialysate regeneration systems are particularly suited for use when water supplies are limited or of insufficient purity for single-pass dialysis, and when a portable artificial kidney is required. To avoid metabolic acidosis with this system, using currently available disposable cartridges, each dialysis treatment should be of at least 4-5 hours duration.

Acidosis↗
PubMed1976

Analgesic nephropathy.

Analgesic nephropathy occurs most commonly in Australia, where it is the second most frequent cause of renal failure. Whilst the reasons for widespread abuse of analgesics are poorly understood, the consequences of abuse are now well recognised. Increasing emphasis is being placed on the analgesic syndrome and on the accelerated atherosclerosis seen in these patients. Attention in the article is drawn to ways in which the analgesic syndrome can be recognised and analgesic abuse ceased. A therapeutic approach is presented which allows the successful withdrawal of analgesic in almost all patients.

Acidosis↗
PubMed1975

Integrated programme of dialysis and renal transplantation. Results in 155 patients.

155 patients were referred for treatment of irreversible renal failure between Jan. 1, 1970, and Oct. 31, 1974. 8 (5%) patients were not accepted for treatment. An integrated programme of dialysis and transplantation (based on finding a cadaver transplant for every patient) has achieved an actuarial survival-rate of 88% at 1 year and 79% at 4 years. Of those surviving at 4 years, 85% are maintained by a functioning transplant. Only 4/122 transplants have been from living related donors. It is suggested that these results demonstrate that cadaveric transplantation, closely integrated with dialysis, offers an acceptable chance of life and full rehabilitation while not demanding from the community an unacceptable percentage of health resources.

Adolescent↗
PubMed1975

Glomerular lesions after renal transplantation.

Significant changes in glomeruli on light microscopy has been observed in 27 of 109 cadaveric renal allografts which functioned beyond 6 months. Tissue was available for study from all but two allografts. The histologic lesions were classified as follows: recurrent glomeruloneophritis, 9 cases (3 focal scierosis, 2 mesangial immunoglobulin A[IgA] disease, 2 mesangiocapillary glomerulonephritis, 1 dense deposit disease, 1 familial nephritis); de novo glomerulonephritis, 1 case (diffuse proliferative glomerulonephritis with crescents); and glomerular change of uncertain etiology, 17 cases (10 mesangiocapillary, 5 focal scierosis, 1 focal proliferative and 1 mesangial proliferative). These lesions were not distinguishable on light, fluorescent and electron microscopy from those in patients with spontaneous renal disease. All patients with glomerular lesions had proteinuria, and all but 3 had microscopic hematuria. Glomerular lesions were not significantly associated with early clinical rejection episodes or HLA compatibility. Presensitization of HLA antigens was significantly related to the occurence of a nonrecurrent glomerular lesion. Vescoureteral reflux was significantly more frequent in those with glomerular change (14 of 24) than in those without (13 of 48). Glomerular lesions were associated with a higher rate of graft loss due to renal transplant failure; renal function in survivors was significantly worse than in those without glomerular lesions.

Adolescent↗
PubMed1975

Goodpasture's syndrome: normal renal diagnostic findings.

A patient with Goodpasture's syndrome is described in whom pulmonary manifestations were dramatic, but in whom renal abnormalities were minor and only found on fluorescent and electron microscopy. His urine showed no proteinuria and no increase in cells in quantitative counts, and renal function was normal. It is suggested that there may be an indication for carrying out renal biopsies in patients with idiopathic pulmonary haemosiderosis and that this may lead to an early diagnosis of Goodpasture's syndrome.

Adolescent↗