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Biomedical subjects

W M Trebbin

Publications and source records attributed to W M Trebbin.

15 recordsLinked to original sources
PubMed1998

Hepatitis C viral infection is associated with fibrillary glomerulonephritis and immunotactoid glomerulopathy.

The most common form of glomerular disease seen in association with hepatitis C virus (HCV) infection is membranoproliferative glomerulonephritis, with or without associated cryoglobulinemia. This study examines four cases of fibrillary glomerulonephritis and two cases of immunotactoid glomerulopathy in association with HCV infection. Findings at presentation included proteinuria, renal insufficiency, and hematuria. Renal biopsy revealed a membranoproliferative pattern of glomerular disease in five cases, and a membranous glomerulopathy with mesangial proliferative features in one. On immunofluorescence, all cases stained with IgG and C3. Electron microscopy revealed fibrils of the expected diameter, 16 to 28 nm in fibrillary glomerulonephritis and 33 to 45 nm in immunotactoid glomerulopathy. In only one case were cryoglobulins detected (at low titer and on only one of three assays). Antiviral therapy was not given in any of the six cases. Outcomes were mixed, with progression to renal failure occurring in two patients and persistent proteinuria with stable or improved renal function in three. Follow-up is not available on the sixth case. Both fibrillary glomerulonephritis and immunotactoid glomerulopathy have features that overlap with cryoglobulinemic glomerulonephritis. The relatedness of these three entities in a subset of patients with HCV infection suggests a common pathogenic mechanism of glomerular deposition of organized deposits.

Adult↗
PubMed1986

Urinary kininogen: a possible regulator of kinin formation in normal individuals and subjects with essential hypertension, end-stage renal and liver disease.

Most previous studies have not significantly correlated urinary kallikrein to urinary kinins. We investigated whether urinary kininogen might influence kinin formation within the urine. On an ad-lib diet the 24 hour excretion of total and intact kininogen, kinins and kallikrein was determined in 24 control subjects, 20 untreated essential hypertensives, 12 with end-stage renal disease and 8 subjects with liver disease. Kallikrein and kinins were measured by a direct radioimmunoassay. Total kininogen was determined from the sum of preformed kinins and kinins generated after trypsin (intact kininogen). Cross reactivity between purified human low molecular weight kininogen and bradykinin antiserum was 3%. Total and intact kininogen were significantly correlated with kinins in controls, essential hypertension and liver disease. In essential hypertension, end-stage renal and liver diseases kinins were significantly decreased. This was associated with a reduction in kininogen but not kallikrein in essential hypertension and liver disease, and a reduction in kallikrein but not kininogen in end-stage renal disease. Thus, renal kinin generation in various states may be affected by either or both kininogen and kallikrein.

Humans↗
PubMed1985

The role of urinary kininogen in the regulation of kinin generation.

The kallikrein-kininogen-kinin system has been postulated to play a role in the regulation of blood pressure and modulation of renal salt and water transport. The activity of this system has usually been determined by measurements of urinary kallikrein excretion. However, urinary kallikrein rarely correlates with simultaneously measured urinary kinins. To further evaluate the factors influencing urinary kinin excretion, we evaluated the role of urinary kininogen in this system. Urines were analyzed from normal subjects and individuals with untreated essential hypertension and end-stage renal disease. Intact urinary kininogen was significantly correlated with urinary kinins in normal subjects (r = 0.65, P = 0.003) and essential hypertensives (r = 0.52, P = 0.026). In both essential hypertension and end-stage renal disease, urinary kinins were significantly decreased (8.00 +/- 1.93, 0.90 +/- 0.18, P less than 0.05, respectively) compared to controls (23.73 +/- 5.20). In essential hypertensives, the reduction in urinary kinins was paralleled by a reduction in intact kininogen with a normal excretion of kallikrein. In end-stage renal disease, the reduction in kinins was paralleled by a reduction in kallikrein with a normal excretion of intact kininogen. This data suggests that kininogen may be an important determinant of urinary kinin excretion in various disease states.

Aldosterone↗
PubMed1985

Pathologic involvement of the urinary bladder in progressive systemic sclerosis.

We describe 2 patients with progressive systemic sclerosis (PSS) who manifested characteristic pathologic abnormalities in the urinary bladder. Increased connective tissue deposition in the lamina propria and between smooth muscle bundles was demonstrated in both patients and endovascular proliferation in small arteries of the bladder was noted in one patient. Both patients had persistent unexplained microscopic hematuria; one patient manifested urinary frequency and incontinence. The relationship of these clinical abnormalities to the pathologic findings in the bladder is unclear. Structural or functional abnormalities of the urinary bladder may develop in patients with PSS.

Adult↗
PubMed1984

Elevated nicotine levels in patients undergoing hemodialysis. A role in cardiovascular mortality and morbidity?

The incidence of cardiovascular disease in patients with end-stage renal disease undergoing long-term maintenance hemodialysis is excessively high. The reason for this excess morbidity and mortality has remained unclear. Cigarette smoking is one factor that has been associated with increased cardiovascular risk. To learn more about the effects of tobacco smoking in these patients, nicotine levels were assayed in the serum of 10 patients with end-stage renal disease undergoing maintenance hemodialysis. Specimens were obtained before and after smoking one cigarette and following dialysis or an equivalent period in control subjects. Serum nicotine levels (+/-SEM) in control subjects measured 19.0 +/- 7.2 ng/ml initially, 36.1 +/- 8.2 ng/ml after smoking, and 9.3 +/- 3.5 ng/ml after a period of 4.35 hours. These compare with respective values of 76.6 +/- 16.8 ng/ml (p less than 0.004), 132.9 +/- 19.7 ng/ml (p less than 0.001), and 51.9 +/- 10.5 ng/ml (p less than 0.001) in patients undergoing hemodialysis. These data demonstrate markedly higher nicotine levels in hemodialysis patients compared with control subjects, which may have serious implications regarding morbidity and mortality.

Adult↗
PubMed1984

Thallium-201 myocardial imaging in patients on chronic hemodialysis.

10 long-term hemodialysis patients had immediate and redistribution thallium-201 myocardial imaging performed after a course of hemodialysis. Subjects had EKGs done on the same day before and after dialysis. 3 of the 10 subjects had resting thallium-201 myocardial imaging obtained on non-dialysis days. 60% of the electrocardiograms showed changes with dialysis. All 13 thallium studies were abnormal, showing multiple transient filling defects at rest. Most subjects had permanent filling defects as well. It is concluded that hemodialysis patients have a high frequency of abnormal thallium-201 myocardial images at rest. The cause of these abnormal studies is uncertain.

Adult↗
PubMed1982

Phantom urinary symptoms in hemodialysis patients.

Phantom urinary symptoms were reported by 12 or 24 hemodialysis patients surveyed. The symptoms were present in all age groups. The absence of any correlation between the occurrence of these symptoms and length of time and dialysis suggest that urinary phantoms in hemodialysis patients may persist over time in contrast to the gradual disappearance of phantoms symptoms resulting from amputation. No correlation was found between occurrence of phantom symptoms and sexual impairment, actual voiding of urine or symptoms of peripheral neuropathy.

Adult↗
PubMed1981

Electrocardiographic changes following dialysis.

We investigated electrocardiographic changes occurring after hemodialysis in 20 male patients with chronic renal failure. Changes in the configuration of T wave, ST segment and R wave consistent with ischemia were found in 30, 45, and 75%, respectively. Contrary to prior speculation the R wave height did not vary with the volume changes of body fluid occurring in dialysis. It is concluded that ischemic-appearing changes of uncertain significance are common in the postdialysis population.

Adult↗
PubMed1979

Hemodialysis and pregnancy.

When severe renal failure requiring hemodialysis complicates pregnancy, there is hesitation to continue the pregnancy. However, successful hemodialysis in pregnancy is being reported with growing frequency. Fetal survival and even conception is possible in patients undergoing dialysis.

Acute Kidney Injury↗
PubMed1978

Polycystic kidneys without radiologic enlargement.

Polycystic kidneys in adults usually appear in the middle years and are described as large kidneys with most of their parenchyma displaced by a large number of cysts. Often the diagnosis is excluded if the intravenous pyelogram reveals kidneys of normal size. This report describes a patient with normal sized polycystic kidneys discovered at an advanced age.

Aged↗
PubMedDate not supplied

The significance of beta-2 microglobulinuria associated with gentamicin therapy.

Gentamicin is a nephrotoxic agent known to damage the proximal tubule,--a site of low molecular weight (LMW) protein reabsorption and catabolism. The effect of gentamicin was investigated on three LMW proteins--amylase, light chains, and beta 2 microglobulin--and the effects were correlated on the latter to renal function as determined by creatinine clearance (GFR). The renal excretion of beta 2 microglobulin (beta 2M) was studied in 18 patients receiving gentamicin and eight control patients. Both gentamicin and control patients had similar mean ages and serum beta 2M. Twelve of the 18 gentamicin treated patients had marked increases in beta 2M excretion. The mean daily 2 beta microglobulin excretion for the gentamicin treated group was 10,511 microgram while that of the control group was 102 microgram. Serial determinations in 10 of the gentamicin treated patients revealed an increase in beta 2M excretion within 48 hours of starting therapy. No deterioration of GFR was seen in any patient. In four patients, beta 2M excretion decreased while still receiving gentamicin. The renal handling of amylase was found to be normal in four patients and mildly abnormal in three patients receiving gentamicin who also had increased beta 2M excretion. Urinary light chains were determined in four of these seven patients and found to be normal. It is concluded that gentamicin induces an early and often transient tubular proteinuria. This tubular proteinuria is not associated with clinical nephrotoxicity.

Aged↗