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Biomedical subjects

W G Wortham

Publications and source records attributed to W G Wortham.

8 recordsLinked to original sources
PubMed2002

Diabetic nephropathy with interstitial nephritis presenting with a false-positive anti-GBM antibody.

A 56-year-old male with DM and HTN presented with flank pain and nausea. Review of systems was negative, physical examination was notable for mild hypovolemia and laboratory revealed BUN 51 mg/dl, creatinine (Cr) 5.1 mg/dl (baseline 1.5), Westergren ESR 122 mm/h, fractional excretion of sodium 0.2% and UA positive for blood and protein. Despite volume resuscitation the Cr continued to rise. Urine sediment analysis revealed granular casts, renal tubular epithelial cells and a negative Hansel's stain. Hemodialysis was initiated with Cr 13.7 mg/ dl for dyspnea and dysgeusia. Subsequent laboratory data revealed 2 separate positive anti-GBM antibody titers and prednisone therapy was initiated. Renal biopsy was performed for further diagnostic, therapeutic and prognostic information and demonstrated interstitial nephritis with linear IgG and albumin deposition consistent with diabetic nephropathy. Follow-up antibody titers were negative. prednisone was discontinued and Cr stabilized with conservative therapy. Anti-GBM antibody disease is characterized by circulating IgG antibodies directed against the glomerular basement membrane, specifically the alpha-3 (IV) collagen chain. Anti-GBM nephritis is a rapidly progressive, isolated glomerulonephritis in association with circulating anti-GBM antibodies. A positive immunofluorescence (IF) test is considered diagnostic in the appropriate clinical setting. Therapies include immunosuppressive agents to suppress new antibody production and plasmapheresis to eliminate circulating antibodies. Anti-GBM antibody is not rapidly cleared by steroid therapy and the recovery of renal function is rare if initiation Cr is greater than 7 mg/dl. This case demonstrates that the current ELISA for alpha-3 (IV) collagen is not pathognomonic for anti-GBM nephritis and that renal biopsy with IF for IgG and albumin may be indicated to prevent administration of potentially toxic treatment.

Anti-Glomerular Basement Membrane Disease↗
PubMed1994

Peritoneal dialysis to induce hypothermia in a head-injured patient: case report.

Hypothermia is of proven benefit in cerebral ischemia, and may be of benefit in blunt head injury. Peritoneal dialysis is a fast, effective method of inducing generalized hypothermia. A case is reported in which peritoneal dialysis was used to induce mild hypothermia (34.5-36 degrees C) in a patient who sustained a severe head injury, with intracranial hypertension unresponsive to hyperventilation, osmotic diuresis, and barbiturate coma. Hypothermia was associated with prompt control of temperature and intracranial pressure. Peritoneal dialysis is a useful method for inducing hypothermia in the blunt head-injured patient.

Adult↗
PubMed1994

Hypothermia in acute blunt head injury.

Mild to moderate hypothermia has been employed since the 1940s in the treatment of acute blunt head trauma. The utility of hypothermia in ischemic injury has been confirmed, by both animal studies and clinical experience, in cardiovascular and neurological surgery. In blunt injury, though, only one prospective, randomized study has shown a statistically significant improvement in long term outcome. Clinical experience, animal data, proposed mechanisms, technical considerations, and potential risks are reviewed. Hypothermia remains controversial in the setting of blunt head injury but may prove to be a useful treatment modality.

Acute Disease↗
PubMed1994

Ultrasonographic unilateral hydronephrosis with bladder outlet obstruction.

Renal ultrasonography plays an important role in the evaluation of azotemic patients. Knowledge of its limitations is crucial for the proper evaluation of obstructive uropathy. Two cases are presented in which screening ultrasonography detected unilateral hydronephrosis despite lower urinary tract obstruction. Both patients had markedly asymmetrical renal function, with the hydronephrosis found in the better functioning kidney. The importance of searching for asymmetry of renal function in the azotemic patient with atypical ultrasonogram findings is emphasized. Other clinical factors which would heighten suspicion for obstructive uropathy and lead to further investigation despite a minimally abnormal or even normal renal ultrasonogram are also discussed.

Aged↗
PubMed1992

Clustered bacteremias in a hemodialysis unit: cross-contamination of blood tubing from ultrafiltrate waste.

OBJECTIVE: To determine the cause of clustered bacteremias occurring among chronic hemodialysis patients. DESIGN: A retrospective investigation of clinical and laboratory records with direct observation of dialysis facilities and technique. Bacterial blood isolates were identified and compared with environmental isolates. SETTING: The 11-station chronic hemodialysis unit that serves approximately 50 patients in a 450-bed military hospital. PATIENTS: Hemodialysis unit patients with aerobic gram-negative bacillus or Enterococcus casseliflavus blood isolates between April 1988 and February 1990. RESULTS: The recovery and species identification of the unique isolate, E casseliflavus, from 2 index cases of bacteremia in February 1990 helped identify the cluster and demonstrated its protracted course. Dialysis blood tubing was contaminated with ultrafiltrate waste during dialyzer setup. INTERVENTION: Bacteremias were controlled by halting the practice of attaching the venous tubing directly to a waste container while priming the membrane, by emphasizing glove changes and handwashing after contact with ultrafiltrate waste and by daily decontamination of ultrafiltrate waste bags. CONCLUSIONS: We recommend that other hemodialysis units institute these interventions.

Bacteremia↗
PubMed1989

Food restriction retards body growth and prevents end-stage renal pathology in remnant kidneys of rats regardless of protein intake.

The objectives of this study were to evaluate the effects of food restriction (without protein or phosphorus restriction) and protein restriction (without the restriction of other nutrients or calories) on the outcome of the remnant kidney model of chronic renal failure in rats. After 5/6 nephrectomy, rats were assigned to one of the following dietary groups: group I (control-ad libitum) consumed a 21% casein diet ad libitum; group II (food restriction with protein restriction) consumed 36% less calories, protein and minerals than group I; group III (food restriction without protein restriction) consumed 36% less calories and minerals than group I, but equivalent amounts of protein; group IV (protein restriction) consumed 38% less protein than group I, but equivalent amounts of calories and minerals; group V (NaCl restriction) consumed 40% less sodium chloride than group I, but equivalent amounts of all other nutrients. All groups consumed equivalent amounts of calcium, phosphorus and vitamins. Groups II and III experienced retardation of growth in comparison to groups I, IV and V. The food-restricted groups II and III, but not groups IV and V, had less proteinuria than group I 20 weeks postablation. By 21 weeks postablation, the kidneys from group I showed severe parenchymal damage, characteristic of end-stage renal pathology. These changes were prevented in the food-restricted groups II and III, but not in groups IV and V. The percentage of glomeruli with severe structural damage was less in groups II (27.3 +/- 8.8) and III (26.9 +/- 7.5) compared with group I (72.4 +/- 7.8). In contrast, the corresponding values in groups IV and V were not significantly different from group I. Interstitial volume (the percentage of tubulointerstitium which is interstitium) which was proportional to the severity of tubular damage was significantly lower in groups II (25.1 +/- 4.5) and III (20.4 +/- 2.8) when compared with groups I (48.1 +/- 3.0), IV (44.4 +/- 6.6), or V (41.9 +/- 4.2). An interstitial volume less than 30 correlated with well preserved renal histology, whereas a value greater than 40 was indicative of end-stage renal pathology. These results indicate that the restriction of carbohydrate, fat, and minerals (except for calcium and phosphorus) retarded growth and prevented the development of end-stage renal pathology in the remnant kidney model of chronic renal failure in rats, regardless of whether protein was restricted or not.(ABSTRACT TRUNCATED AT 400 WORDS)

Animal Feed↗