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[Effect of kanamycin on kidney function in children with suppurative, inflammatory diseases].

The effect of kanamycin on the kidney function and the possibility of decreasing its side effect of pyrimidines were studied in240 children at the age of 2 month to 14 years (161 children with acute and chronic osteomyelitis and 79 children with staphylococcal destruction of the lungs). Kanamycin used in doses of 15000 and 25000 Units/kg of the body weight for 6 to 7 days in treatment of the children with staphylococcal destruction of the lungs, acute and chronic osteomyelitis had no nephrotoxic effect. Combination of kanamycin with pentoxyl, pryimidine derivative significantly improved the kidney function, which was evident from the content of the residual nitrogen in the blood serum and increased glomerural filtration. Combined use of kanamycin with pentoxyl promoted a decrease in albuminuria and leucocyturia. The data of the study provided recommendation of increased therapeutic doses of kanamycin, up to 15000--25000 Units/kg of the body weight in accordance with the recommendations under conditions of constant control of the kidney function.

Acute Disease

Acute renal failure in critically ill patients: prognosis for recovery of kidney function after prolonged dialysis support.

OBJECTIVE: To clarify the prognosis for eventual recovery of kidney function in patients who experience prolonged dialysis dependence after acute renal failure (ARF). DESIGN: Retrospective, chart review. SETTING: Inpatients of a large, referral-based hospital. PATIENTS: Twenty-six consecutive survivors of ARF who required greater than 4 wk of dialysis support. RESULTS: All 26 patients were critically ill and developed ARF during treatment in an ICU. The clinical course of these patients was characterized by multiple episodes of renal ischemia or nephrotoxin exposure during dialysis dependence. However, despite multiple renal insults and prolonged dialysis support (mean duration 8.4 +/- 0.7 wk), 23 (88%) of the 26 patients recovered sufficient kidney function to discontinue dialysis. Preexisting renal impairment was associated with a greater risk of irreversible renal failure, and, in patients able to discontinue dialysis, renal recovery was often incomplete. CONCLUSIONS: Despite some renal damage, most critically ill patients who survive ARF requiring prolonged dialysis support recover life-sustaining kidney function.

Acute Kidney Injury

The influence of angiotensin infusion on the urine composition in individual kidney function tests.

Thirty-two patients with hypertension were given a pressor dose of angiotensin in the course of individual kidney function tests. In eight patients with unilateral renal artery stenosis the differences in urine sodium and creatinine concentration between the affected and the nonaffected kidney did not become greater with angiotensin infusion. In four patients with unilateral pyelonephritis and falsely positive individual kidney function tests, these tests became normal following angiotensin infusion. It is concluded that angiotensin infusion is not a useful means of improving the results of individual kidney function tests.

Adult

Kidney function and lead: relationships in several occupational groups with different levels of exposure.

Potential kidney function decrement with long term lead exposure is important in the overall assessment of adverse health effects of lead in industrial workers or other exposed groups. Two clinical field studies of secondary lead smelter workers have shown that a significant proportion of workers had slightly to moderately elevated blood urea nitrogen (BUN) and creatinine levels; the prevalence was higher in those with longer lead exposure. Since a decrement of kidney function with age has been documented, and since duration of lead exposure may also be strongly related to age, it was necessary to assess the age dependent renal function decrement in control (non-lead-exposed) populations. BUN and creatinine levels in the lead exposed workers showed a much more significant correlation with age than that which was found in the non-exposed populations; the correlation remained statistically significant after correcting for the age-dependent decrement derived from the control populations. Moreover, highly significant correlations between BUN and creatinine and the biological indicator of lead absorption, zinc protoporphyrin, were found. The results indicate a sizeable and significant decrement in kidney function in the secondary lead smelter workers studied; by removing its age-dependency, this effect was found to be lead-induced. In other occupational groups, with lesser and/or shorter lead exposure, a significant effect on renal function as reflected in BUN and creatinine levels could not be detected.

Adult

Reconsideration of split kidney function tests in hypertension: a new technique.

The role of the split kidney function tests in the diagnosis of renal hypertension is reviewed, and a new technique is described which is designed to diminish the number of false negative results sometimes encountered in unilateral pyelonephritis and segmental renal arterial stenosis. Split kidney function tests still have an important role in diagnosis of renal hypertension, particularly when the results of other investigations are equivocal and when facilities for differential renal renin assay are not available.

Aortography

[Hypothermic storage under aerobic conditions--the effect of different flushing solutions on kidney functional recovery].

Canine kidneys (n = 17) were flushed with COLLINS (C2), SACKS II, LAMBOTTE (KMgS), ROSS (hypertonic citrate), or RINGER glucose-mannitol solution following a 30-min period of normothermic ischemia. After 24 h hypothermic preservation with retrograde oxygen persufflation (ROP) and autotransplantation, the immediate functional recovery was determined using inulin and PAH clearance methods and compared with the normal contralateral kidney. While a good functional recovery was found in the COLLINS group, significantly exceeding results from hypothermic ischemic storage preservation, in experiments using other flush solutions ROP preservation resulted in only a small immediate function. Thus the experiments indicate that COLLINS solution C2 is the optimal flush solution for ROP preservation.

Aerobiosis

Identification of Genetic Variations in HLA Region for Kidney Functions.

HLA allelic polymorphisms are associated with a variety of kidney-related traits in different populations. Although Taiwanese-specific genetic variants associated with kidney function have been reported, the role of HLA alleles is unclear. In this study, the association between eGFR and genetic variations in the HLA region was explored in a cohort of 59,448 Taiwanese subjects. A total of 448 genetic variations in the HLA region are significantly associated with eGFR. HLA-C*03 is associated with decreased eGFR, while HLA-DQA1*03, HLA-DQB1*03:03 and HLA-DQB1*03:03:02 demonstrated protective effects. Moreover, amino acid changes on HLA-C and HLA-DRB1 are significantly associated with eGFR. Finally, the eGFR-associated single nucleotide variations (SNVs) and insertions and deletions (indels) are enriched in the HLA-DQB1 gene. After conditional analysis, we identified two independent signals, including rs2853941, rs3830060. In summary, this study highlights the role of HLA-C, HLA-DQA1, HLA-DQB1 and HLA-DRB1 variations in kidney function in the Taiwan Han Chinese population.

Adult

Quantitative renal scintigraphic determination of the glomerular filtration rate in cats with normal and abnormal kidney function, using 99mTc-diethylenetriaminepentaacetic acid.

The nuclear imaging technique known as quantitative renal scintigraphy was validated as a means to assess the kidney function of cats. Renal function tests were performed in 6 healthy cats and 3 cats with clinical manifestations of kidney failure. In addition, the nephrotoxic drugs, gentamicin sulfate, or amphotericin B were used in an attempt to induce renal failure in 4 cats. Using linear regression analysis, equations were derived to estimate the glomerular filtration rate (GFR) on the basis of the renal percent uptake of 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA). One-way ANOVA and Student's t test were used to evaluate treatment effects on clearances of inulin and creatinine, percent uptake of 99mTc-DTPA, and serum creatinine concentrations. The results show that the percent uptake of 99mTc-DTPA by the kidneys correlated well with the GFR obtained through the clearance of inulin. Thus, it was concluded that quantitative renal scintigraphy, using 99mTc-DTPA as a marker of kidney function, is an adequate technique to estimate the kidney function of healthy cats and cats with functional renal impairment. The best estimate of the GFR of cats, using the percentage dose of 99mTc-DTPA, was obtained on the 1- to 3-minute postinjection interval of the marker, using data that was background-subtracted, but not corrected for tissue absorption of gamma rays or binding of 99mTc-DTPA to plasma proteins. There was no significant difference in the mean inulin clearance, creatinine clearance, or percent uptake of 99mTc-DTPA between the 3 treatment groups of this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury

The interplay between impaired kidney function and hypertension in dementia: A 13-year longitudinal study.

BackgroundHypertension and kidney function impairment (KFI) are established risk factors for dementia and may reinforce each other. However, whether their coexistence confers excess dementia risk remains unclear.ObjectiveTo examine the multiplicative and additive interactions between hypertension and KFI in relation to incident dementia and explore potential biological pathways.MethodsWe included 218,858 dementia-free adults followed for a mean of 13.2 years. KFI was defined as an estimated glomerular filtration rate <60&#x2005;mL/min/1.73&#x2005;m2. Cox proportional hazards models assessed independent associations and multiplicative interaction, while additive interaction was evaluated using the relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (SI). Plasma proteomic data on 2911 proteins were available for 6127 participants.ResultsHypertension was associated with dementia risk (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.17-1.31; p&#x2009;<&#x2009;0.001), whereas KFI was not (HR, 1.02; 95% CI, 0.94-1.11; p&#x2009;=&#x2009;0.571). A significant multiplicative interaction was observed (p&#x2009;=&#x2009;0.018). KFI was associated with dementia only among participants with hypertension (HR, 1.15; 95% CI, 1.01-1.29; p&#x2009;=&#x2009;0.023). A positive additive interaction was also observed (RERI, 0.27; 95% CI, 0.05-0.49; AP, 0.17; 95% CI, 0.05-0.29; SI, 1.84; 95% CI, 1.11-3.07), although it was attenuated after full adjustment. Proteomic analyses implicated immune and inflammatory pathways.ConclusionsHypertension may modify the association between impaired kidney function and dementia risk. Their coexistence may identify individuals at higher risk, but further studies are needed to confirm these findings and clarify the underlying mechanisms.

Humans

Renal excretion of sulphamethoxazole and its metabolite N4-acetylsulphamethoxazole in patients with impaired kidney function.

Plasma and urine concentrations of creatinine, sulphamethoxazole and its metabolite N4-acetylsulphamethoxazole were measured in patients with varying degrees of kidney impairment. The plasma elimination half-life of sulphamethoxazole is not influenced by the kidney function, while the half-life of the metabolite is fully dependent on the kidney function. The renal clearances of the metabolites and that of the parent compound under alkaline urine conditions are linearly related to the creatinine clearance. Kidney impairment affects only the renal clearance of the metabolite, whereas sulphamethoxazole is metabolized (acetylated) independently of kidney function.

Acetylation

Effect of saline adaptation and renal portal sodium infusion on glomerular size distributions and kidney function in domestic fowl.

Experiments were designed to evaluate acute and chronic effects of sodium on glomerular size distributions and kidney function of Single Comb White Leghorns. Chicks were raised on either tap water (control) or .6% NaCl (saline) drinking water. Kidney function studies were conducted when the birds reached 14 to 16 weeks of age. Saline-adapted birds had significantly lower glomerular filtration rates and significantly higher sodium and potassium excretion rates when compared with birds raised on tap water. Acute effects of sodium on kidney function were assessed by infusing 25 mM tetrasodium pyrophosphate unilaterally into the renal portal system. For birds raised on tap water, unilateral sodium infusion caused a significant unilateral reduction in the glomerular filtration rate. However, neither the acute nor the chronic reductions in glomerular filtration rates in response to sodium were associated with a reduction in the number of filtering nephrons. Saline-adapted birds had significantly hypertrophied glomeruli.

Animals

Phosphorus-induced nephrocalcinosis and kidney function in female rats.

The question was addressed whether dietary phosphorus-induced nephrocalcinosis in rats is associated with impaired kidney function. Weanling female rats were fed purified diets containing either 0.4 or 0.6% (wt/wt) phosphorus for 28 d. The diet containing 0.6% phosphorus produced marked kidney calcification, as determined both by chemical analysis of kidney calcium and histological examination in kidney sections. Histological examination did not show calcification in stomach, lung, heart or thoracic aorta, which are predisposition sites of metastatic calcification in secondary renal hyperparathyroidism. In rats fed the 0.6% phosphorus diet, phosphorus retention and urinary excretion were greater compared with rats fed the 0.4% phosphorus diet. The following indicators of kidney function were examined: water intake, urinary volume, urine and plasma osmolality, urine and plasma creatinine, urine and plasma urea, urea and creatinine clearance and urinary albumin excretion. Of these indicators, only urinary albumin excretion was significantly increased in rats fed the nephrocalcinogenic diet. In a further experiment, the increase of urinary albumin was reproduced. After pooling the results of the two experiments, in individual rats fed the 0.6% phosphorus diet, the concentration of kidney calcium was found to be positively related with kidney weight expressed relative to body weight (r = 0.82, n = 22) and with albumin excretion in urine (r = 0.79, n = 28). The increased weight of calcinotic kidneys was mainly due to both calcium deposition and tubular hyperplasia. It is concluded that dietary phosphorus-induced nephrocalcinosis is associated with impaired kidney function in rats.

Albumins

Kidney function in heart-lung transplant recipients: the effect of low-dosage cyclosporine therapy.

The indices of kidney function of all discharged heart-lung transplant survivors were examined before and after the introduction of a triple-drug immunosuppressive regimen comprised of low dosages of cyclosporine (to maintain a trough serum level of 75 to 100 ng/ml by radioimmunoassay), azathioprine (1 to 1.5 mg/kg/day), and prednisone. A comparison of survivors treated with either high dosages of cyclosporine (n = 19) or low dosages of cyclosporine (n = 8) revealed a lower early creatinine level postoperatively (1.84 versus 0.96 mg/dl), a higher creatinine clearance (46.33 versus 62.47 ml/min), and a lower cyclosporine level (337.96 versus 204.30 ng/ml) in the latter group. The findings from the outpatient period were similar to the above, and all findings were statistically significant (p less than or equal to 0.05). Another comparison of a subgroup of survivors (n = 11) before and after conversion to the low dosage cyclosporine triple-drug regimen demonstrated no significant difference in kidney function for nine patients and equivocal evidence of improvement in the other two patients for creatinine levels and creatinine clearance. Overall, despite the lower cyclosporine dosage used, we have not encountered an increased prevalence of acute heart or lung rejection. We conclude that early implementation of low dosages of cyclosporine, as part of a triple-drug immunosuppression regimen, is associated with preservation of kidney function while maintaining adequate immunosuppression. Patients with chronic azotemia from long-term cyclosporine therapy may still reap some benefit from this regimen.

Creatinine

Effect of arginine depletion on glomerular and tubular kidney function: studies in isolated perfused rat kidneys.

The effect of L-Arg depletion on glomerular hemodynamics and tubular function of isolated rat kidneys perfused with a medium containing 21 amino acids has been studied. A cyclooxygenase inhibitor was added throughout for blockade of prostaglandin synthesis. Arg depletion caused significant (approximately 30%) reductions in renal perfusion flow rate (PFR, 13.9 +/- 1.2 vs. 19.8 +/- 0.6 ml.min-1.g (kidney wt-1), glomerular filtration rate (GFR, 598 +/- 79 vs. 924 +/- 42 microliters.min-1.g kidney wt-1), and urine flow rate (139 +/- 38 vs. 192 +/- 13 microliters.min-1.g kidney wt-1) compared with control kidneys, which were perfused with a physiological concentration of Arg (200 microM). Filtration fraction (FF) increased with Arg depletion (5.1 +/- 0.4 vs. 4.4 +/- 0.4%). Arg-depleted kidneys had a lower absolute sodium (TNa, 75.7 +/- 8.8 vs. 107.9 +/- 6.0 mumol.min-1.g kidney wt-1) and glucose reabsorption (T glucose, 3.7 +/- 0.6 vs. 5.6 +/- 0.5 mumol.min-1.g kidney wt-1), corresponding to a lower sodium and glucose filtration. Potassium handling and reabsorption of free water were not changed. Oxygen consumption (QO2) was lower in Arg-depleted kidneys (4.6 +/- 0.3 vs. 5.5 +/- 0.5 mumol.min-1.g kidney wt-1). The effects of Arg depletion were completely reversed by the addition of Arg (1 mM) at 120 min and partly reversed by the addition of citrulline (1 mM). Ornithine depletion or addition had no effect on PFR, GFR, FF, TNa, T glucose, and QO2. N omega-methyl-L-arginine, a specific inhibitor of nitric oxide endothelium-derived relaxing factor, produced the same effect as Arg depletion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals