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Acquired renal cysts and multiple renal cell and urothelial tumors.

This paper reports two cases of acquired renal cysts and multiple renal cell tumors in end-stage kidneys with a discussion of the pathogenesis of these lesions. The first patient had been on maintenance dialysis for approximately three years when he was found to have multiple renal cysts and renal cell tumors. He subsequently developed multifocal urothelial carcinomas of the lower urinary tract. The second patient had progressive renal failure due to hypertensive vascular disease when he underwent left nephrectomy because of multiple renal cysts and renal cell carcinoma. He later developed terminal renal failure and was maintained on chronic dialysis. He expired three years later. At autopsy, the right kidney also demonstrated multiple cysts and renal cell tumors.

Adenocarcinoma, Papillary↗

Renal pathology of essential hypertension.

Microscopic analysis of over 2,000 renal biopsies taken at surgical sympathectomy operations has been correlated with blood pressures in essential hypertension. Statistically significant relationships exist between the average diastolic pressure and the degree of afferent renal arteriolar thickening and narrowing. Postoperative prognosis was favorable with all but the most severe and diffuse arteriolar sclerosis, and vascular fibrinoid necrosis did not affect survival. Juxtaglomerular cell hyperplasia and inferred renin hypersecretion were significantly involved in the kidney biopsies of essential hypertension. Diabetic juxtaglomerular cell atrophy and sclerosis reduced this component of hypertension. After age 80, kidneys at autopsy showed no evident relation between arteriolar lesions and hypertension.

Aged↗

Lead nephropathy, gout, and hypertension.

The EDTA (calcium disodium edetate) lead mobilization test revealed lead as the probable cause of renal disease in industrial lead workers and in patients with gout or essential hypertension. The data reviewed here demonstrate persistence of lead nephropathy in the contemporary scene despite the introduction of modern industrial and environmental exposure standards. Renal function and biopsy studies showed that lead nephropathy is a chronic tubulointerstitial renal disease with modest proteinuria which frequently presents with hyperuricemia, gout and hypertension. Only evaluation of body lead stores by either the EDTA lead mobilization test or by x-ray fluorescence is helpful in diagnosing lead nephropathy. While chelation therapy is safe and helpful in reversing early lead nephropathy, the best treatment is prevention. These studies further raise the possibility that chronic environmental lead poisoning and associated renal disease and hypertension may be a more widespread problem than suspected. Assessment of the true extent of chronic lead poisoning requires large scale epidemiological studies.

Animals↗

The effects of sevoflurane and isoflurane anesthesia on renal tubular function in patients with moderately impaired renal function.

Increasing evidence indicates that sevoflurane anesthesia does not impair renal function in healthy patients despite higher concentrations of plasma inorganic fluoride. However, whether sevoflurane further affects renal tubular function in patients with impaired renal function is not known. We compared the effect of sevoflurane anesthesia with that of isoflurane anesthesia on renal tubular function in patients with moderately impaired renal function. Fourteen patients with creatinine clearance between 10 and 55 mL/min were anesthetized with either sevoflurane or isoflurane using a semiclosed circuit system. Plasma inorganic fluoride concentrations and urine N-acetyl-beta-D-glucosaminidase (NAG), gamma-glutamyltranspeptidase (gamma-GTP), and beta 2-microglobulin (beta 2MG) excretions were measured up to post-anesthetic day 14. Although both the peak plasma inorganic fluoride concentrations and the areas under the curve of plasma inorganic fluoride concentration versus time were significantly greater in the sevoflurane group than in the isoflurane group, urine NAG, gamma-GTP, and beta 2MG excretions per day did not differ between the two groups. These results indicate that sevoflurane and isoflurane may have similar effects on the renal tubules in patients with moderately impaired renal function.

Acetylglucosaminidase↗

D-xylose kinetics and hydrogen breath tests in functionally anephric patients using the 15-gram dose.

Malabsorptive evaluation in renal failure is difficult because most absorptive testing requires urinary collections. Kinetic analysis of d-xylose absorption and d-xylose breath testing were performed in an effort to establish an effective absorption test in functionally anephric patients. We studied 13 fasting renal failure patients with no diarrhea or symptoms suggesting malabsorption on two separate nondialysis days after they received 15 g oral d-xylose on day 1 and 10 g IV on day 2. Serum collections were used to calculate the kinetic rate constants and extent of d-xylose absorption. After the oral d-xylose, end expiratory breaths were collected every 15 minutes for 3 hours and were analyzed for H2 with gas chromatography. Five subjects also allowed upper endoscopy and duodenal biopsy. The mean absorption rate constant (Ka) and bioavailability (F) were similar to published values for normal subjects using the 15-g dose (0.936 min(-1); range, 0.227-1.96; and 74%, range 46-99, respectively). Of the patients, 12 had normal 1-hour serum d-xylose concentrations (>20 mg/dL). There was no clear inverse correlation between the rate constant for absorption or bioavailability and peak breath hydrogen or the area under the curve for breath H2 versus time. Using 15 g oral d-xylose, mean bioavailability and absorption rate constants are normal in functionally anephric patients with no clinical evidence of malabsorption. Three patients had elevated breath peak H2 concentrations, but there was no clear inverse correlation between bioavailability and the breath H2 values. A 1-hour serum dxylose concentration >20 mg/dL may be considered normal in this patient group, similar to patients with normal renal function.

Adult↗