[Secondary hyperlipemia caused by chronic kidney failure in chronic pyelonephritis in childhood].
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In 50 patients (10 anephric, 10 with chronic renal failure, and 30 with acute renal failure) the correlation was studied between basal PG levels and basal and stimulated gastric acid secretion. a) The mean PG level in all 3 groups was significantly higher than in the control group, with the highest values in the anephric, which decreased to normal after kidney transplantation. b) In the patients with ARF and after transplantation there was a very positive correlation between PG levels and kidney function. c) Hemodialysis decreased PG levels moderately but significantly. d) Gastric acid studies showed in all groups a very low BAO and basal intragastric pH, with a significant release of gastric acid after pentagastrin stimulation, especially in the anephric.
Residual kidney function was examined in 10 patients with chronic renal insufficiency under balance conditions and in 30 outpatients on the basis of urea clearance (Curea) and potassium clearance (CK). Protein intake was 35-40 g/day (0.5 g/kg/day) and potassium intake was 30-40 mmol/day. Under these conditions the critical values of residual kidney function were as follows: 1) plasma urea concentration (Purea) did not exceed 30 mmol/l if Curea did not drop below 3.8 ml/min; 2) plasma potassium concentration (PK) did not exceed 5 mmol/l if CK did not decrease below 4.1 ml/min. Clinical examination of Curea and CK provides additional information to the examination of creatinine clearance (Ccr) or its plasma concentration (Pcr). Our results suggest that the critical value of residual kidney function cannot be defined only on the basis of examination of Ccr or Pcr. Examination of Curea and CK can help in the interpretation of very high Purea and hyperkalemia in patients with chronic renal insufficiency.
Sixty patients with chronic renal failure (CRF) were studied for the rates of lipid peroxidation (LPO), the state of the antioxidative system (AOS) as well as for the morphofunctional state of biomembranes in renal tubules measured by excretion of low-molecular compounds tested in urine x by means of proton nuclear magnetic resonance spectroscopy. The control group numbered 35 patients with glomerulonephritis free of functional disturbances in the kidneys. The increased values of malonic dialdehyde levels in red blood cells and blood serum and those of diene conjugates in red blood cell membranes provide evidence for a significant increase of the LPO levels. Furthermore, depression of the AOS was revealed, manifested by the decreased levels of blood serum alpha-tocopherol as well as by unstable levels of superoxide dismutase in red blood cells. In the presence of the high LPO levels significant tubular dysfunctions were progressing, parallel with aggravation of renal function. Disturbances detected in excretion and reabsorption of amino acids (leucine, alanine, glycine, valine, histidine), thin organic acids and ketone bodies in CRF patients point to the existence of disturbances in tubular membranes. Tubular dysfunction appears to be caused by the disturbances of the biomembrane morphofunctional states induced by the high levels of free radical oxidation as well as by the AOS function failure.
A state of the kallikrein-kinin system, activity of proteolysis inhibitors were studied simultaneously with the functional activity of neutrophils and content of lysozyme in blood serum of 21 patients with chronic kidney insufficiency. Two types of alterations in the kallikrein-kinin system were found in 13 patients maintained on hemodialysis: in four patients content of kallikrein was increased 8-fold as compared with normal level with a decrease in content of prekallikrein, while in nine patients activity of kallikrein was similar to control values but content of prekallikrein was still further decreased. Content of alpha 1-proteinase inhibitor (PI) was distinctly decreased (2-2.5-fold) in these patients, however, the decrease of the inhibitor was not observed in four patients; activity of alpha 2-macroglobulin tended to decrease. The ratio of active neutrophils and content of lysozyme were increased in blood serum of the majority of the patients. Hemodialysis, activation of the kallikrein-kinin system and stimulation of neutrophils appear to be responsible for a decrease in PI activity. The decrease in the PI activity and stimulation of the kallikrein-kinin system suggest that impairments in regulation of proteolysis could be corrected by means of exogenous proteinase inhibitors. In crisis of allogenic kidney rejection activities of PI and prekallikrein were decreased. Drastic, uneven alterations of the patterns studied were detected in pyo-inflammatory complications not related to the rejection crisis.
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In a series of 296 patients treated in our centre by dialysis and/or renal transplantation over the last 15 years, the actuarial survival rates at 5, 10 and 15 years were 79, 68 and 57 percent respectively. Comparing the influence on survival of each of these two treatments separately should avoid two methodological biases represented by the sequential risk due to the succession of treatments and by different pretherapeutic situations. We therefore analysed these patients' survivals by the unbiased Mantel-Byar method, using a comparison of multiple survival factors (Cox's technique). We showed that treatment was an independent factor of survival and that transplantation had a more beneficial effect than dialysis. However, these replacement techniques seem to have less influence on survival than the pretherapeutic situations.
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The authors investigated in patients with renal disease the lactoferrin content in duodenal aspirate. The aspirate was obtained after previous stimulation of the pancreas with pancreozymin. Lactoferrin estimation is described in the literature as a sensitive examination of changes of exocrine pancreatic secretion. The authors provided evidence that by assessing lactoferrin it is possible to detect initial changes of reduced exocrine pancreatic capacity already in subjects who are on the waiting list of chronic intermittent haemodialyzation programmes (CHIDP); maximum increase of the lactoferrin content in the duodenal aspirate corresponds with the severity of chronic renal failure. Transplantation of the kidneys leads to normalization of the amount of lactoferrin secreted by the pancreas which is evidence of normalization of pancreatic secretion. In patients with chronic renal failure lactoferrin is a sensitive marker of developing uraemic pancreatopathy.
Decreased factor VIII von Willebrand activity in contrast with increased factor VIII procoagulant activity and increased concentrations of factor VIII related antigen, were found in the plasma of patients with chronic renal failure. This functional abnormality of the factor VIII protein is not improved by haemodialysis, but it is no longer found in patients with normally functioning grafted kidneys. It may at least partly explain the prolonged bleeding time commonly found in chronic renal failure.
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Ageing does not spare the kidneys but, remarkably, renal impairment is virtually asymptomatic as homaeostasis remains ensured. Nevertheless, in routine practice physicians must take into account the "physiological" renal insufficiency of the elderly. In old people with chronic renal impairment the diagnostic and therapeutic approaches are special, owing to the age-related risks attached to both paraclinical examinations and treatments. Yet in certain subjects treatment can be remarkably effective and prevent the progression to terminal uraemia, and this justifies the detection and exploration of renal insufficiency in elderly patients. In the last few years, iterative dialysis programmes have been made available to third or even fourth age patients who had reached the so-called end-stage renal failure. The results are encouraging, but there are still purely medical questions concerning the measures to be taken in priority and the numerous organization problems to be solved for optimal management of these patients.