Renal Failure, 12(1), 41-74 (1990)
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ABSTRACTS
Conference on Newer Aspects in the Treatment of Renal Failure
September 8-10, 1989 Intercontinental Hotel Geneva, Switzerland
Directors: Professor H. E. Eliahou and Professor E. Ritz
CONTENTS Alexopoulos, E.,Leontsini, M, Daniilidis, M.,Sakellariou, G., Visvardis, G., and Papadimitriou, M.: [49]Differentiationbetween acute rejection and acute cyclosporin nephrobxicity in rend transplantation in man
66
Antiga, G., Battini, G., Fabbri, C.,Ferrario, G. M., Giordano, F., Meroni, M., Volpi, A., and Sessa, A.: [Ol]Acute renal failure in Churg and Strauss syndrome: Report of a case
46
Aparicio, M., and Bouchet, J. L.: [lo]Effects of low-protein diet on several metabolic disorders of chronic renal failure
50
Aswad, S. M., and Babiker, M. A.: [02]Hemodialysis in Saudi Arabia
46
Barbiano di Belgiojoso, G., Bertoli, S., Scorza, D., and Genderini, A. : [04] Disodiumchromoglicate protection of bronchospasm induced by a cuphrophan membrane in patients in chronic hemodidy sis
47
41 Copyright 0 1990 by Marcel Dckker, Inc.
Abstracts
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42
Barril, G., Bernis, C.,Hdz-Jaras, J., Alvarez, V.,Paraiso, V.,Canton, C. G., Rincon, B., and Traver, J. A.: [03] Recombinant human erythropoietin, an effective treatment in correction of anemia of patients on HD
47
Bernadet, Pa., Joffre, F., Cerene, A., Durand, D., and SUC,J-M.: [05] Atherosclerotic renal ischemia due to bilateral or solitary kidney stenosis: Surgical and/or radiologic management
47
Bernis, C., Baml, G., Alvarez, V., Hdez-Jaras, J., Herrero, E., Caton, C. G.,Paraiso, V., Rincon, B., and Traver, J. A.: [MI Hypertension, gout, renal insufficiency, and lead
48
Bianchi, M. L., Colantonio, G., Montesano, A., Rossi, R., and Guccianti, G.: [07] IBW doses of 1,25(OH)2D3and calcium carbonate therapy for renall ostiodystrophy in early chronic renal failure
48
Blau, A., Herzog, D., Schecter, P., Ugalde, A., and Eliahou, H. E.: [08] Ambulatory blood pressure measurements during nisoldipine thenipy
49
Brenner, B . M ,: [111 If the kidney in essential hypertension is abnormal, what is the abnormality?
50
Cirillo, D., Casiem, D., Maione, S., Nuzzi, F., Manzo, M., and Raiola, P.: [41] 24-Month follow-up patients with idiopathic GNMP I in treatment with CyA and MP
62
Davies, S. P., Reaveley, D. A., Kox, W., and Brown, E. A.: [12] Potential losses of small and large solutes in patients with acute renal failure treated by continuous arteriovenous hemodialysis
50
Dobracka, A.: [131 The correction of magnesium concentration in nephrotic syndrome in children by means of Livex-animal blood preparation
51
Eliahou, H.E., Serban, I., Blau, A., Herzog, D., Sachs, D., and Erdberg, A.: [14] Calcium channel blockers in chronic renal failure (calcium content in skin punch biopsies)
51
Epstein, M.: [15] Chlcium antagonists and the kidney: Future directions in the management of ARF
52
Erman, A,, vanDyk, D. J., Wittenberg, C., Pansky,R., Boner, G., and Rosenfeld, J . B. : [65] The influence of glucose on determination of inulin clearance in normals and insulindependent diabetes mellitus patients
72
Finn, W. F., Dillon, J. J., and Grossman, S. H.: [16] Free-radical scavengers in ischemic and nephrotoxic acute renal failure (allopurinol and oxypurinol)
52
Fouque, D., Laville, M., Beaufrere, B., Pozet, N., Hadj-Aissa, A., Labeeuw, M., and Zech, P. : [171 13C-Leucineturnover for evaluation of low-protein diets in chronic renal failure
53
Galeas, Th.,Lappro,Chr., Papadopoulos, A., and Founta, P.: [ 181 Strategies in the treatment of hypertension in unknown etiology end stage nephmpathy
53
43
Abstracts
Gallieni, M., Padovese, P., Anelli, A., Del Prete, M., Tarolo, G. L., and Brancaccio, D.: [19] Intravenous 1,25-dihydroxycholecalciferol is an effective treatment of secondary hyperparathyroidism in hemodialysis patients
54
Garthoff, B., Hirth, C., and Neuser, D. : [20] Renal actions of calcium
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antagonists
54
Gretz, N., Lasserne, J. J., Langer, K., and Strauch, M.: [22] A lowprotein diet protects against the negative sequelae of metabolic acidosis
55
Gretz, N., Lasserre, J. J., and Strauch, M.: [21] Hypertension in remnant kidney models
54
Grunfeld, J. P., Hannedouche, T., Delgado, A., Lazaro, M., Natov, S., Lacour, B., and Boitard, C.: [23] Cyclosporin toxicity: predictive factors
55
Haberal, M., Bulut, O., Sert, S., Gulay, H., Hamaloglu, E., Altunkan, S., and Bilgin, N.: [25l The treatment of steroid-resistant renal allogragt rejection with OKT-3 and plasmapheresis
56
Haberal, M., Gulay, H., Arslan, G., Sert, S., Altunkan, S., and Bilgin, N.: [24] ABO incompatible kidney transplantation with donor-specific skin graft
56
Hannedouche, T., Godin, M., Kleinknecht, D., Beaufils, M., Paillard, F.,and G d e l d , J. P.: [26] Effects of temtolol on renal hemodynamic in patients with chronic renal failure
56
Heaton, A,, Morrison, W. L., Wreghitt, T., Weetman, A. P., Thiru, S., and Evans, D. B.: [27] Epstein-Barr virus induced lymphoma following renal transplantation
57
Heidland, A., Teschner, M., and Schaefer, R. M.: [28] Diabetic nephropathy - Role of glomerular proteinases
57
Honda, N., Yamada,M., and Hishida, A.: [29] Effects of reninangiotensin suppression on nephrotoxic acute renal failure
58
Honkanen, E., Gronhagen-Riska, C., Teppo, A-M., Maury, C. P. J .,and Hiltumn, U. : 1301Acute phase proteins during hemodialysis
58
Hosokawa, S.: [31] Trace elements in uremic rats
59
Jacobs, C. : [32] optimal renal replacement therapies for patients with terminal renal failure
59
Kaloyanides, G. J., Ramsammy, L., Josepovitz, C., and Lane, B.: [33] Polyaspartic acid inhibits gentamicin-induced perturbations of phospholipid metabolism in OK1 cells: Possible mechanism of protection
59
Kleinknecht, D., Fleury, D., and Vanhille, Ph.: [34] Drug-related acute renal failure in the late 1980s: A preventable disease linked to drug misuse
60
Abstracts
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44
Koiwai, T., Oguchi, H., Terashima, M., and Furuta, S.: [35] "he beneficial effect of dibutyryl cyclic AMP on ischemic acute renal failure in the mt
60
A., Agroyannis, B., Tpmatos, H., TSOU~K o u ~ ~ ~D., ~ oS~IXNUOU, s, sos, D., Konstadinidou, I., andphokas, I.: [36] The effect of successful renal trsuwplantation on hormonal status of female recipients
61
Kyriakopoulos, G.,, and Kontogianni K. : [37l Sodium thiosulfate treatment of tumoral calcinosis in patients with end stage renal disease
61
Lameire, N.,Smo'Uich, B. P., Kesteloot, D., and Deridder, L.: [38] Studies on autoregulation of renal blood flow in the ischemic rat kidney
61
Lange, H., Schwilckdi, M., Meierhenrich, R., and Graber, Th.: [39] Measurementof resting metabolic rate in chronic renal failure
62
MacGregor, G. A: [a] Natriuretic hormones, the kidney, and hypertension
62
Manzo, M., Raiohi, P., Quarto, E., Sivero, L., andMenna, F.: [42] 24-h-pH Gastrcesophageal measurement in uremic patient under acetate or bicahnate dialysis
63
Matthys, E., Schwrgers, M., Lamberigts, G., and Lameire, N.: [44] Long-term effects of Simvastatinon the hyperlipidemia in CAPD patients
63
Milly, K. A., and Wit, L. C.: [45] Selenium blood levels in renaldeficient patients
64
Neumeyer, H.-H., Heinrich, M., Schmissas, M., Haller, H., and Wagner, K.: [46] Prevention of postischemic acute renal failure in conscious dcgs by chronic dietary fish oil supplementation
64
Neumeyer, H.-H., Junge, W., Kufoer, A., and Wenning, A.: [47] Prevention of nidiocontrast-media-inducednephrotoxicity by the calcium antagonistnitrendipine: A prospective randomized clinical trial
65
Pagniez, D., Foucher, C., Delvallez, L., Beuscart, R.,M e , R., Dequiedt, P., Vergnes, R.,and Tacquet, A.: [48] Renal gallium scintigraphy in acute renal hilure
65
Porter, G. A. : [50:1Modificationof drug-induced acute renal failure
66
Ragaiolo, M., Bucmxistiani, U., Bruni, F., Pala, E., Petrucci, V., Damiani, C., Lisi, E. and Caselli, A.: [51] Advantages of treating acute renal Eailiire with daily recycled bicarbonate dialysis with polyacrylonitrilte membranes
67
Raij, L. : [52] The role of hypertension in the progression of renal failure
67
Raiola, P., Manzo, M., Perna, A., Maione, S., Nuzzi, F., Lanzetti, N., and Esposiio, R. : [43] Treatment of carpal tunnel syndrome with ultrasonics in hemodialyzed patients
63
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Abstracts
45
Reisin, E., and Huth, M. M.: [53] Weight reduction decreased blood pressure and pmteinuria in spontaneously hypertensive rats
67
Robbins, M., Campling, D., Rezvani, M., and Hopewell, J.: [54] Dietary protein restriction does not ameliorate radiation nephropathy
68
Sela, S., Mashiach, E., Hag, M., Kristal, B. Shkolnik, T., and Shasha, S. M.: [55] Antioxidant enzymes activity in postischemic reperfused rat kidney
68
Schechter, P., Ezra, D., Or, J., Herzog, D., Blau, A,, Serban, I., and Eliahou, H. E.: [09] The beneficial effects of verapamil and nifedipine in acute ischemic renal failure in the rat
49
Simpson, H. K. L., Winstanley, F. P., O’Donnell, J., Allison, M. E. M., and Shenkin, A.: [56] Continuous dialysis in patients with renal and respiratory failure
69
Solez, K., Burdick, J. F., Racusen, L. C., and Olsen, S.: 2571 The role of the renal biopsy in management of renal transplant recipients treated with cyclosporine
69
Splendiani, G., Sturniolo, A., Fulignati, P., Pasquali, M., Camma, M., D’Alessandro, W., Federico, F., and Costanzi S.: [58] Pharmacological management in glomerulonephritis: Cost-benefit
69
Stegmayr, B. G., Persson, L., Kempi, V., and Semb, H.: [60]A study of risk factors for acute renal failure in surgery
70
Stegmayr, B., Wirell, M., Berseus, O., and Bjorsell-Ostling, E.: [59] Plasma exchange in patients with acute renal failue and progressive coagulpathy
70
Stevens, J. M., Hughes, R. T., Oliver, D. O., Strong, C. A., Auer, J., Pippard, M. J., Cotes, P. M., and Winearls, C. G.: [61] Subcutaneous administration of human erythropoietin to continuous ambulatory peritoneal dialysis patients
71
Szylman, P., Winaver, J., and Better, 0. S.: [62] Nonazotemic hyperkalemia with renal and extrarenal defects in potassium transport
71
Terashima, M., Oguchi, H., Koiwai, T., Horiuchi, M., and Furuta, S.: [63] Protective effect of dibutyryl cyclic AMP on ischemic acute renal failure in the rat - Part 2
71
Traindl, O., Franz, M., and Kovarik, J.: [64] Recombinant human erythropoietin in patients with chronic renal insufficiency in the predialysis period
72
Van Dyk, D. J., Ennan, A., Rabinov, M. Kalter-Leibovici O., Boner, G., Karp, M., Laron, Z., andRosenfeld, J. B.: [66] Theinfluence of angiotensin-converting enzyme inhibitor on renal function in insulin-dependent diabetes mellitus patients
73
Verrillo, A,, de Teresa, A. Torello, F., Martino, C., Gattoni, A., di Chiara, G., and Critiano, P.:[67] Microalbuminuria and renal
Abstracts
46
function in type :[ diabetic patients: Evolution and effect of dietary protein restriction
73
Vinhas, J., Santos, J. M., Morais, L., Assis, P., Mourao, L., Sales Luis, A., Prata, M.: [68] Hemodynamic changes during erythropoietintreatment: Influence of blood pressure and myocardial function
74
Zakar, G., and Lehnyi, E.: [69] Successful plasmapheresis treat-
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ment of ARF due to severe copper sulfate poisoning
[l] ACUTE RENAL FAILURE IN CHURG AND STRAUSS SYNDROME (CSS): REPORT OF A CASE. G. Antiga, G. Battini, C. Fabbri, G. M. Ferrario, F. Giordano, M. Meroni, A. Volpi, and A. Sessa, Unita Operativa di Nefologia e Lh'alisi, Ospedale di Vimercate, 20059 Vimercate -- Italy CSS is a systemic arteritis of the polyarteritis group. Clinical hallmarks are asthma, fever, tmsinophils and ANCA in the serum.Histological findingis a~ granulomatous lesions with eosinophils in different tissues. Renal involvementis uncommon and acute renal failure is infrequent. Renal lesions include interstitial nephritis with numerous eosinophils and the gloimerular pattern may be similar to the microscopic form of the polyarteritis nodosa. We have observed a male patient, a 51-year-old with acute renal failure appeared after 2 months the onset of persistent feverish asthma (S-crealtinine: 1 mg/dL to 5.68 mg/dL; BUN: 22 mg/dL to 92 nig/dL). X-ray chest was normal. Blood eosinophils were 2.240/mmc. The sputum showed numerous eosinophils. ANCA were detected in the serum. Renal biopsy studied by light, immunofluorescent and electron microscopy showed a diffuse interstitial nephritis with numerous eosinophils, extracapillary proliferative glomerulonephritis and granulomatous vasculitis. The patient was treated with prednisone 1.5 mg/kg/day for 2 weeks and then 1.5 mg/kg every other day with gradual tapering. After 3 months he was well: Screatinine: 1.29 mg/dL; BUN:21 mlj/dL; normal blood eosinophils. We agree with Churg and Strauss that this syndrome is a particular form of polyarteritis nodosa characterized
74
by an allergic background. We think that in this patient the early treatment of the kidney lesions had been determinant for the favorable outcome of the acute renal failure.
[2J HEMODIALYSIS IN SAUDI ARABIA S. M. Aswad and M. A. Babiker, National Kidney Foundation, Riyadh, Saudi Arabia
The first dialysis session in Saudi Arabia was done in 1971. The incidence of chronic renal failure in Saudi Arabia is estimated at 50-70 cases/million inhibitat/year. The number of hernodialysis centers is 63,providing 444 dialysis machines. The number of patients on hemodialysis is 1,945. About 350,000 dialysis sessions are done annually. The ratio of males to females in hemodialysis patients is 59.1:N.g. 27% of the patients are non-Saudian. 60% of the doctors working in hemodialysis centers are nephrologists, 12% are physicians, and 28 % are medical officers. 81 % of the patients are under the care of the Ministry of Health. The rest belong to the military and other sectors: The incidence of hepatitis in hemodialysis patients is 8.9%. The mean age of the patients is 32.4 years. A major computer system has been established connecting terminals in hemodialysis centers in the main hospitals; all data about hemodialysis patients are entered and registered in the computer program. We concluded that the hernodialysis facilities within a short period of time became available all over the Kingdom of Saudi Arabia, and all information about the hemodialysis patients has been computerized.
Abstracts
[3] RECOMBINANT HUMAN ERYTHROPOIEl" (EPO),AN EFFECTIVE TREATMENT IN CORRECTION OF ANEMIA OF PATIENTS ON HD
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G. Barril, C. Bemis, J. Hdz-Jam, V. Alvarez, V. Paraiso, C. G.-cbnton, B. Rincon, J. A. Traver, S.Nefrologica, UniversidadAutonoma, Hospital de la Princesa, Madrid, Spain
Eighteen patients-10 men and 8 women, age 52.05 (range 17-74), time on HD 38.94 (range 8-141)received EPO 50 U/kg/i.v. every session HD. Hematological, chemical, iron, irontransferrin saturation, serum ferritin, aluminum, and dialysis efficiency controls were performed monthly. In 10patients EPO serum levels were determined by RIA. EPO induced significant rises in Hb (7.74 f 0.67/10.36 f 1.56), Hct (22.8 f 2.24/32.36 f 4.49), platelets (169 f 451200 f 28), and reticulocytes (12.9 f 7.7/29 f 12.25) with p < .001. Serum iron and ferritine concentrations decreased significantly (p < .01) after treatment. Aluminum levels decrease (p < .05). Blood transfusions decreased 2.5 units patiats/6 months before treatment to zero after treatment. EPO appears to be remarkably free of serious side effects. No fistulacomplicationsoccurred. Potassiumtended to increase, probably due to the better appetite. In 2 patients hypertensive medication was increased to achieve better blood pressure control. All patients tolerated the medication well during a 5-month observation period. Subjective improvement was accompanied with an increase in appetite and physical activity. concluions:Therapy with EFQ ameliorated the anemia of patients in HD. This therapy is free of serious side effects. Aluminum and iron levels decreaseprobably in relation to modification of iron transferrin levels. Increases in appetite, physical activity, and work capacity permitted better rehabilitation of HD patients.
[4] DIWDIUMCHROMOGLICATE (DSCG) PROTECTION OF BRONCHOSPASM INDUCED BY A CUPHROPHAN MEMBRANE IN PATIENTS (PTS) IN CHRONIC HEMODIALYSIS (HD) G. Barbiano di Belgiojoso, S. Bertoli, D. Scorza, and A. Genderini. Renal and Pheumlogy Units, L. Sacco Hospital, Milan, Italy
We have studied 2 groups (g) Of 7 patients @ts) in chronic HD. The first (mean age 61 f 14years) used cuphrophan
41
(C) membrane filters; the second (mean age 59 f 7) used polyacrilonitrile (PAN). All pts were clinically free from cardiopneumopathy and did not suffer during the last weeks from acute episodes of airways infections. In both groups vital capacity (VC); expiiatory volume per second (PEVl), instantaneous flux at 75%, 50%, and 25% of VC; percent relation of FEVWC; airways resistance (RawT); inspiratory and expiratory resistence (Raw1 and RawE); and specific conductance(SGAW) were measured before and after a HD sitting. In basal conditions the 2 g did not show significant differences in various respiratory parameters. After HD in the g treated with PAN membranes significant differences in various respiratory pameters were not found when compared with basal values, while in the g treated with C, SCAW were reduced of 3 1% in comparison with basal values (p = .05). For this secondg the study was repeated after medication with DSCG (20 mg by inalation): After HD the above mentioned variations, SGAW included, disappeared. Our data showed a C-induced bronchoconstriction,corrected by DSCG, through the inhibition of chemical mediators release or activity.
[SJ
ATHEROSCLEROTIC RENAL ISCHEMIA DUE TO BILATERAL OR SOLITARY KIDNEY STENO!3IS: SURGICAL AND/OR RADIOLOGIC MANAGEMENT (17 CASES)
Pa. Bernadet,F. Jo$re, A. Cerene,D. Durand, and J-M. Sue, Service de Nkphrologie - CHU Rangueil, 31054 Toulouse cedex, France
Bilateral atherosclerotic renal artery stenosis is frequent and even elderly patients with clinical features suggestive of renovascular disease or azotemia of unknown cause must be evaluated (Maxwell MH. Cooperative study of renovascular hypertension: current status, Kidney Int 1975; 8:153-60). We report on 17 severely hypertensive patients, average age of 64 years, with bilateral atherosclerosic re81 disease (n = 15) or stenosis of the main artery of solitary functioning kidney (n = 2) in whom percutaneous transluminal angioplasty (PTA) or surgical renovascularisation(SR) was performed in an effort to lower blood pressure and to preserve renal function. 15/17 patients had renal insufficiency with a cratinine clearawe < 80 mL/mn. The effects of the treatment on the blood pressure and renal function were evaluated for a mean period of 6 months (ranging from 1 to 12 months). 10 patients underwent uni- (n = 5 ) or
Abstracts
48
or bilateral (n = 5 ) PTA; 7 patilants underwent SR (autotransplantation,aortorenal bypass, and controlateral nephrectomy). See table.
Renal function
PSA
Outcome PTA
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SR
n
Outcome
n
C
1
I
4
I
9
S
C
1
I
6
I S A
6 2 3
2
C: cured, I: improved, S:stabilized,A: altered.
These results are in agreement with a substantialnumber of studies who report a relatively high1 success rate of renal revasculatlza * tion in stabilizingHTA and preserving renal function. Even for the elderly patients an “aggressive” management is frequently successful.
[q
HYPERTENSION, WCUT, RENAL INSUFFICIENCY, AND LEAD
C. Bemis, G. 3am.1, V. Alvare;:, J. Hdez-Jaras, E. Herrero, C. G. Canton, K Paraiso, B. Rincon, and J. A. Traver Eleven patients with gout, HT, and renal insufficiency were studied for possible lead nephropathy by measuring stimulated urinary lead excretion. Occult lead was assessed using the Emmerson-Baturnan protocol. On the 1st day, each patient emptied the bladder and received 1 g of EDTA. A 2nd dose of 1 g was given 12 h later. Three consecutive24-h urine collections for measurement of lead and creahine excretion were begun simultanmusly with the 1st injection. Response to the chelating agent was determined as the sum of urinary lead excretion for the entire 72-h study period. A excretion 600 Pb/72 h was considered positiye. All the patients had a possible history of lead exposure, 1 from illegal alcohol, 8 from industrial sources, and 3 from pottery. Five patients had a positive test. Two cases
with proteinuria 1 g/24 h were biopsed, finding 1 case of IgA with positive test and 1 case of malignant HT with negative test. The patient with IgA had an improvement of his renal function after being separated of lead exposure. Conclusions. (1) The test was positive in the 45 % , in association with advanced age (mean 56), male sex, and low uric clearance. (2) The history of lead exposure is difficult to evaluate. (3) A positive test can be associated with other pathology.
[q LOW DOSES OF 1,25(OH)2DS AND CALCIUM CARBONATE THERAPY FOR RENAL OSTEODYSTROPHY IN EARLY CHRONIC RENAL FAILURE M. L. Bianchi, G. Colantonio*,A. Montesanot , R. R o d * , and G. Buccianti, Clin. Med. I, *Osp S. Anna, Corn; and tlst. di Scienze Mediche, Univ. Miluno - Italy This study was aimed at evaluating the efficacy of 1,25(OD),D, (0.25 pg/&y - low doses) and calcium carbonate combined therapy in early chronic renal failure (CW. 17 patients (8 F, 9 M; aged 22-60 yr) were studied for 2 years. All patients hsad an early CRF (mean plasma creatinine 2.9 f 9 mLldL). After therapy, plasma calcium significantly increased (p < .01) plasma alkaline phosphatase (p < .05) and urinary hydroxyproline (p < .01) decreased. Plasma phosphate remained in the normal range. Plasma PTH (MM-PTH) showed some decrease but not statistically significant (275 f 195 to 236 f 176 pg/mL; - 15%). Plasma 1,25(OH)2Dincreased (22.8 f 4.3 to 26.6 f 5.6 pg/mL, p < .05), reaching n o d values in all the patients. Bone mass was measured at forearm (single photon absorptiometry) and lumbar spine (double photon absorptiometry). Forearm bone mass showed a progressively reduced rate of loss (at 12 mos, - 0.9%, at 24 mos, -0.3%). Lumbar bone mass slightly increased (12 mos, +0.9%; at 24 mos, 1.4%).Low doses of 1,25(OH)*Dwere able to control calcium and phosphate levels, to normalize 1,25(OH),D levels, and to reduce bone turnover indexes (alkaline phosphataseand hydroxyproline). However, PTH secretion was not completely controlled, and cortical bone mass showed only a reduced rate of loss.
+
Abstracts
49
[S] AMBULATORY BLOOD PRESSURE (BP)MEASUREMENTS DURING
We conclude that NIS 5 mg b.i.d. is an effective antihypertensive agent reducing moderately elevated BP in ambulatory working patients with EH. At the dosage used it had no demonstrable effect on HR and minimal, if any, side effects.
NISOLDIPINE (NISI THERAPY
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A. Bkau, D. Henog, P. Shechter, A. Ugalde, and H.E. Eliahou, Department of Nephrology, Tel-Aviv University Sackler School of Medicine, Chaim Sheba Medical Center, Tel-Hashomer, Israel The antihypertensiveeffect of NIS was investigated in 12 patients with moderate essential hypertension (EH). Monotherapy with 5 mg b.i.d. NIS for 2 weeks reduced the averageof each patient's mean arterialpressure (MAP) from 110.3 f 6.8 (SD) to 103.2 f 8 mm Hg. Every patient had a reduction in MAP; range: 0.7-16.4 mm Hg. The decrease was both in the systolic (SBP) and in diastolic (DBP) blood pressures. Histograms showed a shift to the left, i.e., to lower readings, during therapy (table).
Frequency of BP readings before and during therapy (%) MAP < 100
SBP < 150 mm Hg
DBP < 90 mm Hg
[91 THE BENEFICIAL EFFECTS OF VERAPAMIL (v) AND MFEDIpINE 0 IN ACUTE ISCHEMIC RENAL FAILURE (ARF)INTHERAT
P. Shechter, D. Eira, J. Or, D. Henog, A. Blau, I. Serban, and H. E. Eliahou, Departments of Nephrology and Clinical Pharmacology, chaim Sheba Medical Center, Tel-Hashomer52621, Israel ARF was induced in Wistar (W) rats and Sprague-Dawley (SD) rats by right nephrectomy and 60 min ischemia of the left kidney. Intravenous V was given in SD rats (IVVSD), W rats (IVVW); and intraarterially in W rats (L4VW). N was given in SD rats (IVN). We used as control SD rats given saline (S). The drugs were given 15 min before ischemia, and for 60 min of ischemia 15 min of reflow (table). Plotting tissue calcium against Ccrreveals a significant linear correlation:
+
Before
After
Before
After
Before
After
24
42.6
42.7
70.1
45.9
65.9
R = -0.534 (p < .0002)
Reductions were greatest in the highest BPs. Circadian variation of BP was demonstrated; BP was low between midnight and 6 a.m. even before therapy.There was no change in heart rate (HR). Untoward symptoms were equal before and during therapy.
Group
s IVN IVVSD
Scr
3.9 f 1.1 (10) 2.3 f 1.4* (6) 3.4 f 0.7
(7)
Iww
2.7 f 1.3 (9) IAVW 2.0 f 1.0* (7) *p < .05 as compared to group S.
S",
291 f 57 (10) 216 f 100 (9) 315 f 70 (7) 253 f 104 (9) 319 f 138 (6)
Tissue calcium was reduced in effectively treated rats in groups IVN and IAVW. We conclude that either verapamil or nifedipine is effective in amelioratingARF in rats. IVN and IAVW seem to give the best results.
CC,
U protein
33 f 30 255 f 147* (5) 55 f 30 (5) 148 f 118* (7) 343 f 253*
14.8 f 6.8 (10) 23.9 f 7.2 (8) 8.7 f 14.8 (7) 35.1 f 11.1 (8) 26.3 f 11.3
(5)
(6)
(7)
Abstracts
50
[lo]
EFFECTS OF LOW-PROTEIN DIET (LPD) ON SEVERAL METABOLIC DISORDERS OF CHR(3NIC RENAL FAILURE (CRF)
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M.Aparicio and J. L Bouchet, Hopital Pellegrin, Place Amilie Raba Lion 33076 Bordeaux Cedex, France This work assessed the effects of LPD on several biochemical abnormalities related to CRF. A LPD providing 0.3 g proteidkg and 5 to 7 mg phosphoruslkgdaily supplemented with essential amino acids and ketoanalogues (Ketosteril-Fresenius FIRG) was proposed for 18 months to 70 patients with advanced renal insufficiency (creatinine > 300 pmol/L). Thc effects of this diet were studied at different times after starting LPD: in the 70 patients at the 18th mcmth, serum phlosphorus decreased from 1.56 f 0.28 to 1.33 f 0.25 mnol/L (p < .001), PTH activity from 192.8 f 124.2 m 139.3 f 151.1 pg/mL (p < .001); serum calcium was not modified. In 25 patients a 50 g oral glucose tolerance test was performed before LPD and 3 month later. Glycemia and insulinemia were significantly reduced (p < .05 and p < .02). Ten of these patients underwent a euglycemic hyperinsulin clamp: The tissue-sensitivity-to-insulinindex improved at the 3rd month (p < -01). In 20 patients Na+ K+ ATPase activity of leukocytes was assessed before and 3,6, and 12 months after starting the diet. The activity improved dramatically from 918 f 38.1 to 148.2 f 38.4 at 3 months (p < .001), to 182 f 66.2 at 6 months (p < .001), and to 227 f 84.3 pmol Pi/h/g of protein at 12 months (p < .001). We conclude that LPD improves some of the metabolic consequences of CRF probably by reducing the production of uremic toxins and inhibitors derived from alimentary protein intake. Ell] IF THE KIDNEY IN ESSENTIAL HYPERTENSION IS ABNORMAL, WHAT IS THE ABNORlVMLITY? Barry M. Brenner, MD, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, U.S.A. Altered renal hmodynamics, reduced ability to excrete sodium, and arterial hypertension characterize the adaptive response to a decrease in the number of functioning nephrons. Whether acquired as a result of intrinsic renal disease or following surgical renal ablation, reduced
nephron number often leads to systemic hypertension. Clinically, inborn deficits in nephron number are also often associated with hypertension. Taken together, these experimental and clinical observations suggest that a deficiency in glomerular filtration surface area contributes to two processes: limited ability to excrete sodium loads, leading to “essential” hypertension, and susceptibilityto accelerated renal failure when fdtration surface area is further reduced by surgical ablation or acquired renal parenchymal disease. Once systemic hypertension is established, factors such as increased systemic vascular resistance and structural alterations in the renal and extrarenal vasculaturetend to perpetuate the process, leading to fixed arterial hypertension. Systemichypertension contributes to glomerular capillary hypertension, which eventuates in glomerular sclerosis. As sclerosis subsumes more and more of the glomerular fdtration bed, glomerular destruction further aggravates systemic hypertension. Since no therapy is yet available to directly increase inborn glomerular number or augment the growth of new glomerular capillaries, presentday interventionsonly seek to control systemic and glomerular capillary hypertension so as to interrupt this cycle and minimize risk in those patients most susceptibleto hypertension and glomerular injury.
El21 POTENTIAL LOSSES OF SMALL AND LARGE SOL^ IN PATIENTS WITH ACUTE RENAL FAILURE (ARF‘) TREATED BY CONTINUOUS ARTERIOVENOUS HEMODIALYSIS (CAVHD)
S. P. Davies, D, A. Reaveley, W. Kox, and E. A. Brown, Charing Cross Hospital, London, U.K. CAVHD is now a well-established technique for the treatment of ARF providing high clearances of small solutes. In order to determinenutritionallosses and potential losses of higher molecular weight solutes, we have performed 8 clearance studies of individual amino acids in 6 patients receiving total parented nutrition (TPN) ,and clearances of B2-microglobulin (B2M; M W 11,800) in 12 patients. All were treated by CAVHD using Hospal AN69S 0.43 m2 filters and Fresenius 1.596 peritoneal dialysis fluid at dialysate flow rates (OJ of 1 and 2 Llh. Daily nitrogen intake in those meiving TPN was 9 g (1 patient), 14 g (2 patients), and 18 g (3 patients). The mean ultrafiltration (UF)rate for all studies was 6.38 f 0.32 mL/min (mean f SEM).
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Abstracts
51
Amino acid clearances ranged from 7.38 f 2.2 (glutamic acid) to 25.18 f 4.81 mL/min (3-methylhistidine) at a Qd of 1 U h and from 13.59 f 1.66 (tryptophan) to 33.69 f 4.31 mL/min (3-methylhistidine) at a Qd of 2 L/h. These results represent daily losses of 1.68 f 0.32% (isoleucine) to 87.51% (tyrosine) at a Qd 1 L/h and 2.09 f 0.58% (glutamic acid) to 98.94 f 1.06% (tyrosine) at Qd 2 L/h. Total protein losses amounted to 9.10 f 1.17% and 11.85 f 2.21%, respectively, ofthe daily input. B2M clearances closely correlated with UF rates (r = 0.66, p = .003), but there was no significant difference between clearances of B2M at a Qd of 1 and 2 L/h (5.54 f 0.49 and 5.39 f 0.81 mL/min, respectively. These studies confirm that CAVHD is highly effective at removing small solutes by diffusion and therefore amino acid losses should be considered when administering TPN to these patients. The clearance of larger molecules, however, depends primarily on convection and therefore losses are unlikely to be significant.
groups: I: 23 children with NS untreated with Livex, LI: 22 children with NS receiving Livex (0.1 g/kg of the body weight per day); control group: 25 healthy children. None of the children received preparations containing magnesium except Livex. Atom absorption spectroscopy was used to determine magnesium concentration. During the acute period of disease, a statistically important decrease of magnesium level in blood serum was found, whereas the level of magnesium in erythrocytes was normal. During the remission magnesium concentration was still low in blood serum, and moreover a statistically important deficiency of magnesium in erythrocytes was observed. Magnesium levels in serum and erythrocytes normalized after a 3-month treatment with Livex (table). Conclusion. Livex might be a valuable agent in treatment of magnesium deficiency in children with NS.
[13] THE CORRECTION OF MAGNESIUM CONCENTRATION IN NEPHROTIC SYNDROME IN CHILDREN BY
H. E. Eliahou, I. Serban, A. Blau, D. Herzog, D. Sachs, and A. Erdberg, Dept. of Nephrology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel
MEANS OF LIWX-ANJMAL BLOOD PREPARATION Anna Dobracka, Clinic of Pediatric Nephrology, Medical Academy of Wrodaw, Poland
The changes of magnesium concentration in blood serum and erythrocytes of the children suffering from acute phase of nephrotic syndrome (NS) and during the remission of the disease were examined. The deficiency of magnesium was supplemented by Livex-animal blood preparation containing amino acids and trace elements, including magnesium. 45 children (23 girls and 22 boys), age 3- 11, were investigated. The patients were divided into 2
Mean Mg concentration fmddm3) ~
~~~
~ _ _ _
Serum
Erythrocytes
40.56 22.86 20.48
80.89 81.92 52.88
36.99
102.01
~
Control group Acute period of disease Complete remission After 3-month treatment with Livex
[14] CALCIUM CHANNEL BLOCKERS IN
CHRONIC RENAL FAILURE (CALCIUM CONTENT IN SKIN PUNCH BIOPSIES)
Patients with a stable progression of chronic renal failure were randomly assigned to 2 groups of antihypertensive therapy: (1) nisoldipine (NIS) as the only antihypertensive, and (2) antihypertensive drugs without calcium blockers and a placebo (PL) tablet instead of nisoldipine. In the NIS group, the slopes of Userum creatinine versus time in months, improved in 15/20; and in the PL group only in 6/18 (p < .0125). There was a definite correlation between the change in MAP and the change in the slope of progression. The diastolic BP was significantly reduced in the patients whose slopes improved. Thus, BP (especially the diastolic) is important in the progression of renal failure. It is hypothesized that the already dilated glomerular capillary of the failing kidney allows unhindered access of the systemic BP to the glomerular capillary, resulting in glomerulosclerosiswhen BP is high and improvement when BP is lowered. Thus, the improvement obtained by nisoldipine is not through changes in the vascular tone of the glomerular capillary. Preliminary data on the calcium content in the patients' skin, following punch biopsies, was obtained. In the PL group the calcium content of the skin was 20.7 f 4.1 nmole/mg wet tissue (n = 3); and in the NIS-treated
Abstracts
52
group, 6.9 f 3.7 nmole/mg wet tissue (n = 5) (p < .005). This finding suggests an additional mechanism of action of nisoldipine in the amelioration of the progression of renal failure, namely, the prevention of calcium deposition in the renal cortex.
[lq CALCIUM ANTAGONISTS AND THE
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KIDNEY: FUTURE DJRECTIONS IN THE MANAGEMENT OF ARF Murray Epstein, MD, Div. Nephrology, Univ. Miami School of Medicine; VA il4edical Center, Miami, Florida, U.S.A. Previous research and clinical studies have focused primarily on the effects of calcium antagonists (CCBs) on the myocardium and peripheral vasculature. Recently, attention has been directed toward the effects on the renal microvasculatureand renal function. Studies in the isolated perfused kidney indicate that: CCBs reverse afferent arteriolar vasoconstriction in a variety of experimental settings. In contrast, these agents are much less effective in blocking efferent arteriolar vasoconstriction. Taken together these properties result in a striking ability to augment GFR. Thus, in comlmrison with other direct-acting vasodilators, CCBs uniquely maintain or increase GFR in the presence of a vasoconstricting insult. This effect is due, in part, to a regional heterogeneity within the renal microcirculation and to a selective action to reduce afferent arteriolar resistance. The salutary effects of CCBs on renal hernodynamics have important therapeutic implications. Their abiliity to reverse renal ischemia and maintain sodium excretion commends their use in hypertension. Additionalpotential applications include augmentation of renal perfusion in clinical settings in which renal hemodynamics are acutely compromised. Thus, preliminary observations indicate that CCBs protect against acute renal failure following cadaveric renal transplantation and the use of cyclosporine. In summary, the ability of CCBs to prevent or reverse renal vasoconstriction suggests future potentially important therapeutic approaches for their use.
[la
FREE-RADICW SCAVENGERS IN ISCHEMIC AND NEPHROTOXIC ACUTE RENAL FAILURE (ALLOPURINOL AND 0xYPuRIN0L)
William F. Finn, John J. Dillon, and Steven H. Grossman, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, U.S.A. The xanthine oxidase inhibitors allopurinoland oxypurinol (Oxy) reduce renal ischemic injury in animals. Four mechanisms have been proposed: (1) the degradation of ATP may be reduced by preventing the conversion of hypoxanthineto xanthine; (2)the reincorporation of purine metabolites into ATP may be promoted; (3)the formation of oxygen-free radicals may be inhibited; (4)these agents may themselves act as hydroxy radical scavengers. We have administered Oxy in doses of 2.5,5,10,and 20 mg/kg i.v. prior to 20 min of renal ischemia in uninephrectomized rats. At 24 h inulin clearances (Cd were measured. At 5 mg/kg, Oxy lessened ischemic injury (1075 f 632 vs 623 f 257 &/min). The protection was also evident when Oxy was given after 40 min of reperfusion. At 24 h, serum creatinine (Scr) was lower compared to rats not given Oxy (1.1 f 0.3 vs 1.7 f 0.4 mg/dL). The administrationof cyclosporine(CsA) 10 mglkg i.p. 1 h after 20 min of ischemia results in additional injury and a further increase in Scr (2.4 f 0.7 vs 1.7 f 0.4 mg/dL). Oxy given before or after the ischemia minimizes the added toxicity of three daily doses of CsA 10 mg/kg. On days 0, 1, and 3, Ch with and without Oxy pretreatment with 1172 f 326 vs 932 f 234,853 f 403 vs 500 f 420, and 934 f 444 vs 324 f 365 pL/min, respectively. The decline in Ch observed with 20 mg/kg was also seen in normal rats. The Ch before and after the administration of Oxy at doses of 5,10,and 20 mg/kg were 850 f 230 vs 838 f 160,995 f 503 vs 535 f 253, and 993 f 204 vs 362 f 53 pL/min, respectively. The Oxy clearances (Co~y) were 799 f 158,530f 385, and 150 f 65 pL/min, respectively. The fall in the ratio Coxy/Chat 20 mg/kg, along with crystal deposition,
Abstracts
53
suggested that this dose was accompanied by intrarenal precipitation of Oxy. When used in appropriatedoses, Oxy effectively minimizes mild renal ischemic injury and consequentlylessens the added toxicity of CsA. Its effectiveness when given following reperfusion may be related to actions other than free-radical formation.
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[17] C-LEUCINE TURNOWR FOR EVALUATION OF LOW-PROTEIN DIETS IN CHRONIC RENAL FAILURE D. Fouque, M. Laville, B. Beaufiere, N. Pozet, A. Hadj-Aha, M.Labeeuw, and P. Zech, Service de Niphrologie et NSERM U 197, Kopital EdouardHerriot, 69437 Lyon Cedar 03, France
Avoidance of protein malnutrition is a major goal of dietary treatment of chronic renal failure (CRF). Since
Group/period C: 1st month 2nd month
B: 1st month 2nd month
Protein intake (g/kg/d) 0.8 f 0.1
diets are given for long times, even light degrees of protein imbalance could be harmful in long-term-treated patients. A prospective study was designed to compare the effects on protein metabolism of low-protein diets (LPD) with or without ketoacids. In a prelimhary phase, seven CRF patients (plasma creatinine: 318 f 105pmol/L)were enrolled. After a 2-week equilibration period, all of them received a 0.8 g/kg/dayLPD for 1month. They were then randomly allocated to receive for another month 0.5 g/kg/day LPD either supplemented with ketoacids (group C: 5 patients) or not (group B: 2 patients). Protein and calorie intakes were evaluated every 2 weeks by 7day dietary recalls. Fourday N balance and 13C-leucineturnover were measured at the end of the 2 1-month periods (table). These results suggest that in CRF patients even slight reductions of protein intake are often associated with reduced calorie intake both resulting in slightly negative nitrogen balance. However, in our limited experience, these changes are too small to be measured by 13Cleucine turnover studies.
N
0.5
caloric intake (cal/kg/d) 21.1 f 3.3 26.8 f 8.8
balance (g/d) -1.6 f 1.9 -0.09 f 1.0
0.7 f 0.1 0.4
23.3 f 2.4 21.8 f 0.6
-0.3 -1.6
[18] STRATEGIES IN THE TREATMENT
OF HYPERTENSION IN UNKNOWN ETIOLOGY END STAGE NEPHROPATHY l%. Guleas, Chr. Lappas, A. Papadopoulos, and P. Founta, General Hospital of Trikak?.B 'Internal Medicine Clinic, Renal Unit Department Material of this work are facts from a simultaneous investigation on the increased incidence of a nephropathy of unknown etiology. These categories of hemodialyzed patients are: (a)hypertensive; (b) have been residents, for more than 20 years in areas with soils clearly defined as alluvial soils,compared with patients from nonalluvial areas; and (c) they have significantly low serum calcium (Ca) and increased serum magnesium (Mg). The purpose of the work is the investigationof the increased incidence
f 0.7 f 0.2
Leucine appearance 1.39 f 0.29 1.39 f 0.17
Leucine oxidation (pmol/kg/min) 0.16 f 0.04 0.16 f 0.04
Leucine disappear. 1.22 f 0.26 1.23 f 0.15
1.04 f 0.04 1.05 f 0.07
0.12 f 0.01 0.12 f 0.01
0.92 f 0.04 0.94 f 0.08
on unknown-etiology nephropathy in these areas and the strategies in its treatment. The study was focused on the estimationof the correlationbetween Ca, Mg, and hypertension. The elements Ca and Mg were studied in the soil, water supply, and irrigation net of the areas as well as in the blood serum of the hemodialyzed patients. There was an assessment of respective facts from nonalluvial areas. The +test method was used for the statistical analysis of the facts. Two findings were verified: (1) The increased incidence of unknown-etiology nephropathy with hypertension is positively correlated at a statistically significant degree with the low Ca levels and increased Mg levels in the soil, water, and blood serum of the patients. (2) Controlled administration of Ca in this category of hemodialyzed patients obviously improves hypertension, and at the same time, renal function.
Abstracts
54
10 mg/dL and phosphate < 6 mg/dL. Eight out of 12 patients were previously under oral calcitriol therapy with poor control of PTH levels. After a wash-out of 12 weeks, i.v. calcitriol was started at the dose of 0.02pg/kg b.w.; 4 weeks of treatment were followed by 12 additional weeks of observationwithout calcitriol. Total calcium was monitored at each dialysis session and calcitriol was temporarily discontinuedwhen Ca exceeded 11 mg/dL. Midfragment PTH (PTH-mm), intact FTH (FTH-I), Alk phophatase (AP),total and ionized calcium phosphate (P) , magnesium (Mg), and aluminum (Al) levels were evaluated throughout the study (table). AP, Mg, P, and Al levels did not change significantly. This study confirms the effectiveness of i.v. calcitriol in treating secondary hyperPTH in HD patients, with minimal plasma CaZ+ increase. Further long-term investigationsshould clarify its clinical advantages over oral calcitriol.
[19] INTRAVENOUS 1,S-DIlHYDROXYCHOLECALCIFEROL (CALCITRIOL) IS AN EFFECTIVE TREATMENT OF SECONDARY HYPERPARA~KYROIDISM IN HEMODIALYSIS PKL'IENTS
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M. Gullieni, P. Padovese, A. Anelli, M. Del Prete, G. L. Tarolo*, and D. Brancaccio, Renal Unit and Lkpt. of Nuclear Medicine*, Ospahle San Pmlo, University of Milano, Italy
Calcitriol has recently become available for intravenous (i.v.) use in h e d a l y s i s (HD) patients. We evaluated the effects of 4 weeks of i.v. dcitriol in suppressing secondary hyperFTH. Twelve HD patients were selected on the basis of the following criteria: imid fragment FTH levels > 2.5 ng/mL (n.v. 0.2-Oh), total plasma calcium Beginning of observation
PTH-mm PTH-I Ca CaZ+
3.1 f 1.3 9.1 f 0.4
End of treatment
Beginning of treatment 3.2 f
1.3
2.4 f 1.0****
167 f 103 8.9 f 0.2
4.84 f
96 f 70*** 9.4 f 0.7**
0.16
End of observation 4.0 f 2.0 9..3 f 0.6
4.99 f 0.25*
9:NS, *+p < .Cn, *** p < .01, **** p
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ABSTRACTS
Conference on Newer Aspects in the Treatment of Renal Failure
September 8-10, 1989 Intercontinental Hotel Geneva, Switzerland
Directors: Professor H. E. Eliahou and Professor E. Ritz
CONTENTS Alexopoulos, E.,Leontsini, M, Daniilidis, M.,Sakellariou, G., Visvardis, G., and Papadimitriou, M.: [49]Differentiationbetween acute rejection and acute cyclosporin nephrobxicity in rend transplantation in man
66
Antiga, G., Battini, G., Fabbri, C.,Ferrario, G. M., Giordano, F., Meroni, M., Volpi, A., and Sessa, A.: [Ol]Acute renal failure in Churg and Strauss syndrome: Report of a case
46
Aparicio, M., and Bouchet, J. L.: [lo]Effects of low-protein diet on several metabolic disorders of chronic renal failure
50
Aswad, S. M., and Babiker, M. A.: [02]Hemodialysis in Saudi Arabia
46
Barbiano di Belgiojoso, G., Bertoli, S., Scorza, D., and Genderini, A. : [04] Disodiumchromoglicate protection of bronchospasm induced by a cuphrophan membrane in patients in chronic hemodidy sis
47
41 Copyright 0 1990 by Marcel Dckker, Inc.
Abstracts
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42
Barril, G., Bernis, C.,Hdz-Jaras, J., Alvarez, V.,Paraiso, V.,Canton, C. G., Rincon, B., and Traver, J. A.: [03] Recombinant human erythropoietin, an effective treatment in correction of anemia of patients on HD
47
Bernadet, Pa., Joffre, F., Cerene, A., Durand, D., and SUC,J-M.: [05] Atherosclerotic renal ischemia due to bilateral or solitary kidney stenosis: Surgical and/or radiologic management
47
Bernis, C., Baml, G., Alvarez, V., Hdez-Jaras, J., Herrero, E., Caton, C. G.,Paraiso, V., Rincon, B., and Traver, J. A.: [MI Hypertension, gout, renal insufficiency, and lead
48
Bianchi, M. L., Colantonio, G., Montesano, A., Rossi, R., and Guccianti, G.: [07] IBW doses of 1,25(OH)2D3and calcium carbonate therapy for renall ostiodystrophy in early chronic renal failure
48
Blau, A., Herzog, D., Schecter, P., Ugalde, A., and Eliahou, H. E.: [08] Ambulatory blood pressure measurements during nisoldipine thenipy
49
Brenner, B . M ,: [111 If the kidney in essential hypertension is abnormal, what is the abnormality?
50
Cirillo, D., Casiem, D., Maione, S., Nuzzi, F., Manzo, M., and Raiola, P.: [41] 24-Month follow-up patients with idiopathic GNMP I in treatment with CyA and MP
62
Davies, S. P., Reaveley, D. A., Kox, W., and Brown, E. A.: [12] Potential losses of small and large solutes in patients with acute renal failure treated by continuous arteriovenous hemodialysis
50
Dobracka, A.: [131 The correction of magnesium concentration in nephrotic syndrome in children by means of Livex-animal blood preparation
51
Eliahou, H.E., Serban, I., Blau, A., Herzog, D., Sachs, D., and Erdberg, A.: [14] Calcium channel blockers in chronic renal failure (calcium content in skin punch biopsies)
51
Epstein, M.: [15] Chlcium antagonists and the kidney: Future directions in the management of ARF
52
Erman, A,, vanDyk, D. J., Wittenberg, C., Pansky,R., Boner, G., and Rosenfeld, J . B. : [65] The influence of glucose on determination of inulin clearance in normals and insulindependent diabetes mellitus patients
72
Finn, W. F., Dillon, J. J., and Grossman, S. H.: [16] Free-radical scavengers in ischemic and nephrotoxic acute renal failure (allopurinol and oxypurinol)
52
Fouque, D., Laville, M., Beaufrere, B., Pozet, N., Hadj-Aissa, A., Labeeuw, M., and Zech, P. : [171 13C-Leucineturnover for evaluation of low-protein diets in chronic renal failure
53
Galeas, Th.,Lappro,Chr., Papadopoulos, A., and Founta, P.: [ 181 Strategies in the treatment of hypertension in unknown etiology end stage nephmpathy
53
43
Abstracts
Gallieni, M., Padovese, P., Anelli, A., Del Prete, M., Tarolo, G. L., and Brancaccio, D.: [19] Intravenous 1,25-dihydroxycholecalciferol is an effective treatment of secondary hyperparathyroidism in hemodialysis patients
54
Garthoff, B., Hirth, C., and Neuser, D. : [20] Renal actions of calcium
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antagonists
54
Gretz, N., Lasserne, J. J., Langer, K., and Strauch, M.: [22] A lowprotein diet protects against the negative sequelae of metabolic acidosis
55
Gretz, N., Lasserre, J. J., and Strauch, M.: [21] Hypertension in remnant kidney models
54
Grunfeld, J. P., Hannedouche, T., Delgado, A., Lazaro, M., Natov, S., Lacour, B., and Boitard, C.: [23] Cyclosporin toxicity: predictive factors
55
Haberal, M., Bulut, O., Sert, S., Gulay, H., Hamaloglu, E., Altunkan, S., and Bilgin, N.: [25l The treatment of steroid-resistant renal allogragt rejection with OKT-3 and plasmapheresis
56
Haberal, M., Gulay, H., Arslan, G., Sert, S., Altunkan, S., and Bilgin, N.: [24] ABO incompatible kidney transplantation with donor-specific skin graft
56
Hannedouche, T., Godin, M., Kleinknecht, D., Beaufils, M., Paillard, F.,and G d e l d , J. P.: [26] Effects of temtolol on renal hemodynamic in patients with chronic renal failure
56
Heaton, A,, Morrison, W. L., Wreghitt, T., Weetman, A. P., Thiru, S., and Evans, D. B.: [27] Epstein-Barr virus induced lymphoma following renal transplantation
57
Heidland, A., Teschner, M., and Schaefer, R. M.: [28] Diabetic nephropathy - Role of glomerular proteinases
57
Honda, N., Yamada,M., and Hishida, A.: [29] Effects of reninangiotensin suppression on nephrotoxic acute renal failure
58
Honkanen, E., Gronhagen-Riska, C., Teppo, A-M., Maury, C. P. J .,and Hiltumn, U. : 1301Acute phase proteins during hemodialysis
58
Hosokawa, S.: [31] Trace elements in uremic rats
59
Jacobs, C. : [32] optimal renal replacement therapies for patients with terminal renal failure
59
Kaloyanides, G. J., Ramsammy, L., Josepovitz, C., and Lane, B.: [33] Polyaspartic acid inhibits gentamicin-induced perturbations of phospholipid metabolism in OK1 cells: Possible mechanism of protection
59
Kleinknecht, D., Fleury, D., and Vanhille, Ph.: [34] Drug-related acute renal failure in the late 1980s: A preventable disease linked to drug misuse
60
Abstracts
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44
Koiwai, T., Oguchi, H., Terashima, M., and Furuta, S.: [35] "he beneficial effect of dibutyryl cyclic AMP on ischemic acute renal failure in the mt
60
A., Agroyannis, B., Tpmatos, H., TSOU~K o u ~ ~ ~D., ~ oS~IXNUOU, s, sos, D., Konstadinidou, I., andphokas, I.: [36] The effect of successful renal trsuwplantation on hormonal status of female recipients
61
Kyriakopoulos, G.,, and Kontogianni K. : [37l Sodium thiosulfate treatment of tumoral calcinosis in patients with end stage renal disease
61
Lameire, N.,Smo'Uich, B. P., Kesteloot, D., and Deridder, L.: [38] Studies on autoregulation of renal blood flow in the ischemic rat kidney
61
Lange, H., Schwilckdi, M., Meierhenrich, R., and Graber, Th.: [39] Measurementof resting metabolic rate in chronic renal failure
62
MacGregor, G. A: [a] Natriuretic hormones, the kidney, and hypertension
62
Manzo, M., Raiohi, P., Quarto, E., Sivero, L., andMenna, F.: [42] 24-h-pH Gastrcesophageal measurement in uremic patient under acetate or bicahnate dialysis
63
Matthys, E., Schwrgers, M., Lamberigts, G., and Lameire, N.: [44] Long-term effects of Simvastatinon the hyperlipidemia in CAPD patients
63
Milly, K. A., and Wit, L. C.: [45] Selenium blood levels in renaldeficient patients
64
Neumeyer, H.-H., Heinrich, M., Schmissas, M., Haller, H., and Wagner, K.: [46] Prevention of postischemic acute renal failure in conscious dcgs by chronic dietary fish oil supplementation
64
Neumeyer, H.-H., Junge, W., Kufoer, A., and Wenning, A.: [47] Prevention of nidiocontrast-media-inducednephrotoxicity by the calcium antagonistnitrendipine: A prospective randomized clinical trial
65
Pagniez, D., Foucher, C., Delvallez, L., Beuscart, R.,M e , R., Dequiedt, P., Vergnes, R.,and Tacquet, A.: [48] Renal gallium scintigraphy in acute renal hilure
65
Porter, G. A. : [50:1Modificationof drug-induced acute renal failure
66
Ragaiolo, M., Bucmxistiani, U., Bruni, F., Pala, E., Petrucci, V., Damiani, C., Lisi, E. and Caselli, A.: [51] Advantages of treating acute renal Eailiire with daily recycled bicarbonate dialysis with polyacrylonitrilte membranes
67
Raij, L. : [52] The role of hypertension in the progression of renal failure
67
Raiola, P., Manzo, M., Perna, A., Maione, S., Nuzzi, F., Lanzetti, N., and Esposiio, R. : [43] Treatment of carpal tunnel syndrome with ultrasonics in hemodialyzed patients
63
Ren Fail Downloaded from informahealthcare.com by McMaster University on 10/28/14 For personal use only.
Abstracts
45
Reisin, E., and Huth, M. M.: [53] Weight reduction decreased blood pressure and pmteinuria in spontaneously hypertensive rats
67
Robbins, M., Campling, D., Rezvani, M., and Hopewell, J.: [54] Dietary protein restriction does not ameliorate radiation nephropathy
68
Sela, S., Mashiach, E., Hag, M., Kristal, B. Shkolnik, T., and Shasha, S. M.: [55] Antioxidant enzymes activity in postischemic reperfused rat kidney
68
Schechter, P., Ezra, D., Or, J., Herzog, D., Blau, A,, Serban, I., and Eliahou, H. E.: [09] The beneficial effects of verapamil and nifedipine in acute ischemic renal failure in the rat
49
Simpson, H. K. L., Winstanley, F. P., O’Donnell, J., Allison, M. E. M., and Shenkin, A.: [56] Continuous dialysis in patients with renal and respiratory failure
69
Solez, K., Burdick, J. F., Racusen, L. C., and Olsen, S.: 2571 The role of the renal biopsy in management of renal transplant recipients treated with cyclosporine
69
Splendiani, G., Sturniolo, A., Fulignati, P., Pasquali, M., Camma, M., D’Alessandro, W., Federico, F., and Costanzi S.: [58] Pharmacological management in glomerulonephritis: Cost-benefit
69
Stegmayr, B. G., Persson, L., Kempi, V., and Semb, H.: [60]A study of risk factors for acute renal failure in surgery
70
Stegmayr, B., Wirell, M., Berseus, O., and Bjorsell-Ostling, E.: [59] Plasma exchange in patients with acute renal failue and progressive coagulpathy
70
Stevens, J. M., Hughes, R. T., Oliver, D. O., Strong, C. A., Auer, J., Pippard, M. J., Cotes, P. M., and Winearls, C. G.: [61] Subcutaneous administration of human erythropoietin to continuous ambulatory peritoneal dialysis patients
71
Szylman, P., Winaver, J., and Better, 0. S.: [62] Nonazotemic hyperkalemia with renal and extrarenal defects in potassium transport
71
Terashima, M., Oguchi, H., Koiwai, T., Horiuchi, M., and Furuta, S.: [63] Protective effect of dibutyryl cyclic AMP on ischemic acute renal failure in the rat - Part 2
71
Traindl, O., Franz, M., and Kovarik, J.: [64] Recombinant human erythropoietin in patients with chronic renal insufficiency in the predialysis period
72
Van Dyk, D. J., Ennan, A., Rabinov, M. Kalter-Leibovici O., Boner, G., Karp, M., Laron, Z., andRosenfeld, J. B.: [66] Theinfluence of angiotensin-converting enzyme inhibitor on renal function in insulin-dependent diabetes mellitus patients
73
Verrillo, A,, de Teresa, A. Torello, F., Martino, C., Gattoni, A., di Chiara, G., and Critiano, P.:[67] Microalbuminuria and renal
Abstracts
46
function in type :[ diabetic patients: Evolution and effect of dietary protein restriction
73
Vinhas, J., Santos, J. M., Morais, L., Assis, P., Mourao, L., Sales Luis, A., Prata, M.: [68] Hemodynamic changes during erythropoietintreatment: Influence of blood pressure and myocardial function
74
Zakar, G., and Lehnyi, E.: [69] Successful plasmapheresis treat-
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ment of ARF due to severe copper sulfate poisoning
[l] ACUTE RENAL FAILURE IN CHURG AND STRAUSS SYNDROME (CSS): REPORT OF A CASE. G. Antiga, G. Battini, C. Fabbri, G. M. Ferrario, F. Giordano, M. Meroni, A. Volpi, and A. Sessa, Unita Operativa di Nefologia e Lh'alisi, Ospedale di Vimercate, 20059 Vimercate -- Italy CSS is a systemic arteritis of the polyarteritis group. Clinical hallmarks are asthma, fever, tmsinophils and ANCA in the serum.Histological findingis a~ granulomatous lesions with eosinophils in different tissues. Renal involvementis uncommon and acute renal failure is infrequent. Renal lesions include interstitial nephritis with numerous eosinophils and the gloimerular pattern may be similar to the microscopic form of the polyarteritis nodosa. We have observed a male patient, a 51-year-old with acute renal failure appeared after 2 months the onset of persistent feverish asthma (S-crealtinine: 1 mg/dL to 5.68 mg/dL; BUN: 22 mg/dL to 92 nig/dL). X-ray chest was normal. Blood eosinophils were 2.240/mmc. The sputum showed numerous eosinophils. ANCA were detected in the serum. Renal biopsy studied by light, immunofluorescent and electron microscopy showed a diffuse interstitial nephritis with numerous eosinophils, extracapillary proliferative glomerulonephritis and granulomatous vasculitis. The patient was treated with prednisone 1.5 mg/kg/day for 2 weeks and then 1.5 mg/kg every other day with gradual tapering. After 3 months he was well: Screatinine: 1.29 mg/dL; BUN:21 mlj/dL; normal blood eosinophils. We agree with Churg and Strauss that this syndrome is a particular form of polyarteritis nodosa characterized
74
by an allergic background. We think that in this patient the early treatment of the kidney lesions had been determinant for the favorable outcome of the acute renal failure.
[2J HEMODIALYSIS IN SAUDI ARABIA S. M. Aswad and M. A. Babiker, National Kidney Foundation, Riyadh, Saudi Arabia
The first dialysis session in Saudi Arabia was done in 1971. The incidence of chronic renal failure in Saudi Arabia is estimated at 50-70 cases/million inhibitat/year. The number of hernodialysis centers is 63,providing 444 dialysis machines. The number of patients on hemodialysis is 1,945. About 350,000 dialysis sessions are done annually. The ratio of males to females in hemodialysis patients is 59.1:N.g. 27% of the patients are non-Saudian. 60% of the doctors working in hemodialysis centers are nephrologists, 12% are physicians, and 28 % are medical officers. 81 % of the patients are under the care of the Ministry of Health. The rest belong to the military and other sectors: The incidence of hepatitis in hemodialysis patients is 8.9%. The mean age of the patients is 32.4 years. A major computer system has been established connecting terminals in hemodialysis centers in the main hospitals; all data about hemodialysis patients are entered and registered in the computer program. We concluded that the hernodialysis facilities within a short period of time became available all over the Kingdom of Saudi Arabia, and all information about the hemodialysis patients has been computerized.
Abstracts
[3] RECOMBINANT HUMAN ERYTHROPOIEl" (EPO),AN EFFECTIVE TREATMENT IN CORRECTION OF ANEMIA OF PATIENTS ON HD
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G. Barril, C. Bemis, J. Hdz-Jam, V. Alvarez, V. Paraiso, C. G.-cbnton, B. Rincon, J. A. Traver, S.Nefrologica, UniversidadAutonoma, Hospital de la Princesa, Madrid, Spain
Eighteen patients-10 men and 8 women, age 52.05 (range 17-74), time on HD 38.94 (range 8-141)received EPO 50 U/kg/i.v. every session HD. Hematological, chemical, iron, irontransferrin saturation, serum ferritin, aluminum, and dialysis efficiency controls were performed monthly. In 10patients EPO serum levels were determined by RIA. EPO induced significant rises in Hb (7.74 f 0.67/10.36 f 1.56), Hct (22.8 f 2.24/32.36 f 4.49), platelets (169 f 451200 f 28), and reticulocytes (12.9 f 7.7/29 f 12.25) with p < .001. Serum iron and ferritine concentrations decreased significantly (p < .01) after treatment. Aluminum levels decrease (p < .05). Blood transfusions decreased 2.5 units patiats/6 months before treatment to zero after treatment. EPO appears to be remarkably free of serious side effects. No fistulacomplicationsoccurred. Potassiumtended to increase, probably due to the better appetite. In 2 patients hypertensive medication was increased to achieve better blood pressure control. All patients tolerated the medication well during a 5-month observation period. Subjective improvement was accompanied with an increase in appetite and physical activity. concluions:Therapy with EFQ ameliorated the anemia of patients in HD. This therapy is free of serious side effects. Aluminum and iron levels decreaseprobably in relation to modification of iron transferrin levels. Increases in appetite, physical activity, and work capacity permitted better rehabilitation of HD patients.
[4] DIWDIUMCHROMOGLICATE (DSCG) PROTECTION OF BRONCHOSPASM INDUCED BY A CUPHROPHAN MEMBRANE IN PATIENTS (PTS) IN CHRONIC HEMODIALYSIS (HD) G. Barbiano di Belgiojoso, S. Bertoli, D. Scorza, and A. Genderini. Renal and Pheumlogy Units, L. Sacco Hospital, Milan, Italy
We have studied 2 groups (g) Of 7 patients @ts) in chronic HD. The first (mean age 61 f 14years) used cuphrophan
41
(C) membrane filters; the second (mean age 59 f 7) used polyacrilonitrile (PAN). All pts were clinically free from cardiopneumopathy and did not suffer during the last weeks from acute episodes of airways infections. In both groups vital capacity (VC); expiiatory volume per second (PEVl), instantaneous flux at 75%, 50%, and 25% of VC; percent relation of FEVWC; airways resistance (RawT); inspiratory and expiratory resistence (Raw1 and RawE); and specific conductance(SGAW) were measured before and after a HD sitting. In basal conditions the 2 g did not show significant differences in various respiratory parameters. After HD in the g treated with PAN membranes significant differences in various respiratory pameters were not found when compared with basal values, while in the g treated with C, SCAW were reduced of 3 1% in comparison with basal values (p = .05). For this secondg the study was repeated after medication with DSCG (20 mg by inalation): After HD the above mentioned variations, SGAW included, disappeared. Our data showed a C-induced bronchoconstriction,corrected by DSCG, through the inhibition of chemical mediators release or activity.
[SJ
ATHEROSCLEROTIC RENAL ISCHEMIA DUE TO BILATERAL OR SOLITARY KIDNEY STENO!3IS: SURGICAL AND/OR RADIOLOGIC MANAGEMENT (17 CASES)
Pa. Bernadet,F. Jo$re, A. Cerene,D. Durand, and J-M. Sue, Service de Nkphrologie - CHU Rangueil, 31054 Toulouse cedex, France
Bilateral atherosclerotic renal artery stenosis is frequent and even elderly patients with clinical features suggestive of renovascular disease or azotemia of unknown cause must be evaluated (Maxwell MH. Cooperative study of renovascular hypertension: current status, Kidney Int 1975; 8:153-60). We report on 17 severely hypertensive patients, average age of 64 years, with bilateral atherosclerosic re81 disease (n = 15) or stenosis of the main artery of solitary functioning kidney (n = 2) in whom percutaneous transluminal angioplasty (PTA) or surgical renovascularisation(SR) was performed in an effort to lower blood pressure and to preserve renal function. 15/17 patients had renal insufficiency with a cratinine clearawe < 80 mL/mn. The effects of the treatment on the blood pressure and renal function were evaluated for a mean period of 6 months (ranging from 1 to 12 months). 10 patients underwent uni- (n = 5 ) or
Abstracts
48
or bilateral (n = 5 ) PTA; 7 patilants underwent SR (autotransplantation,aortorenal bypass, and controlateral nephrectomy). See table.
Renal function
PSA
Outcome PTA
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SR
n
Outcome
n
C
1
I
4
I
9
S
C
1
I
6
I S A
6 2 3
2
C: cured, I: improved, S:stabilized,A: altered.
These results are in agreement with a substantialnumber of studies who report a relatively high1 success rate of renal revasculatlza * tion in stabilizingHTA and preserving renal function. Even for the elderly patients an “aggressive” management is frequently successful.
[q
HYPERTENSION, WCUT, RENAL INSUFFICIENCY, AND LEAD
C. Bemis, G. 3am.1, V. Alvare;:, J. Hdez-Jaras, E. Herrero, C. G. Canton, K Paraiso, B. Rincon, and J. A. Traver Eleven patients with gout, HT, and renal insufficiency were studied for possible lead nephropathy by measuring stimulated urinary lead excretion. Occult lead was assessed using the Emmerson-Baturnan protocol. On the 1st day, each patient emptied the bladder and received 1 g of EDTA. A 2nd dose of 1 g was given 12 h later. Three consecutive24-h urine collections for measurement of lead and creahine excretion were begun simultanmusly with the 1st injection. Response to the chelating agent was determined as the sum of urinary lead excretion for the entire 72-h study period. A excretion 600 Pb/72 h was considered positiye. All the patients had a possible history of lead exposure, 1 from illegal alcohol, 8 from industrial sources, and 3 from pottery. Five patients had a positive test. Two cases
with proteinuria 1 g/24 h were biopsed, finding 1 case of IgA with positive test and 1 case of malignant HT with negative test. The patient with IgA had an improvement of his renal function after being separated of lead exposure. Conclusions. (1) The test was positive in the 45 % , in association with advanced age (mean 56), male sex, and low uric clearance. (2) The history of lead exposure is difficult to evaluate. (3) A positive test can be associated with other pathology.
[q LOW DOSES OF 1,25(OH)2DS AND CALCIUM CARBONATE THERAPY FOR RENAL OSTEODYSTROPHY IN EARLY CHRONIC RENAL FAILURE M. L. Bianchi, G. Colantonio*,A. Montesanot , R. R o d * , and G. Buccianti, Clin. Med. I, *Osp S. Anna, Corn; and tlst. di Scienze Mediche, Univ. Miluno - Italy This study was aimed at evaluating the efficacy of 1,25(OD),D, (0.25 pg/&y - low doses) and calcium carbonate combined therapy in early chronic renal failure (CW. 17 patients (8 F, 9 M; aged 22-60 yr) were studied for 2 years. All patients hsad an early CRF (mean plasma creatinine 2.9 f 9 mLldL). After therapy, plasma calcium significantly increased (p < .01) plasma alkaline phosphatase (p < .05) and urinary hydroxyproline (p < .01) decreased. Plasma phosphate remained in the normal range. Plasma PTH (MM-PTH) showed some decrease but not statistically significant (275 f 195 to 236 f 176 pg/mL; - 15%). Plasma 1,25(OH)2Dincreased (22.8 f 4.3 to 26.6 f 5.6 pg/mL, p < .05), reaching n o d values in all the patients. Bone mass was measured at forearm (single photon absorptiometry) and lumbar spine (double photon absorptiometry). Forearm bone mass showed a progressively reduced rate of loss (at 12 mos, - 0.9%, at 24 mos, -0.3%). Lumbar bone mass slightly increased (12 mos, +0.9%; at 24 mos, 1.4%).Low doses of 1,25(OH)*Dwere able to control calcium and phosphate levels, to normalize 1,25(OH),D levels, and to reduce bone turnover indexes (alkaline phosphataseand hydroxyproline). However, PTH secretion was not completely controlled, and cortical bone mass showed only a reduced rate of loss.
+
Abstracts
49
[S] AMBULATORY BLOOD PRESSURE (BP)MEASUREMENTS DURING
We conclude that NIS 5 mg b.i.d. is an effective antihypertensive agent reducing moderately elevated BP in ambulatory working patients with EH. At the dosage used it had no demonstrable effect on HR and minimal, if any, side effects.
NISOLDIPINE (NISI THERAPY
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A. Bkau, D. Henog, P. Shechter, A. Ugalde, and H.E. Eliahou, Department of Nephrology, Tel-Aviv University Sackler School of Medicine, Chaim Sheba Medical Center, Tel-Hashomer, Israel The antihypertensiveeffect of NIS was investigated in 12 patients with moderate essential hypertension (EH). Monotherapy with 5 mg b.i.d. NIS for 2 weeks reduced the averageof each patient's mean arterialpressure (MAP) from 110.3 f 6.8 (SD) to 103.2 f 8 mm Hg. Every patient had a reduction in MAP; range: 0.7-16.4 mm Hg. The decrease was both in the systolic (SBP) and in diastolic (DBP) blood pressures. Histograms showed a shift to the left, i.e., to lower readings, during therapy (table).
Frequency of BP readings before and during therapy (%) MAP < 100
SBP < 150 mm Hg
DBP < 90 mm Hg
[91 THE BENEFICIAL EFFECTS OF VERAPAMIL (v) AND MFEDIpINE 0 IN ACUTE ISCHEMIC RENAL FAILURE (ARF)INTHERAT
P. Shechter, D. Eira, J. Or, D. Henog, A. Blau, I. Serban, and H. E. Eliahou, Departments of Nephrology and Clinical Pharmacology, chaim Sheba Medical Center, Tel-Hashomer52621, Israel ARF was induced in Wistar (W) rats and Sprague-Dawley (SD) rats by right nephrectomy and 60 min ischemia of the left kidney. Intravenous V was given in SD rats (IVVSD), W rats (IVVW); and intraarterially in W rats (L4VW). N was given in SD rats (IVN). We used as control SD rats given saline (S). The drugs were given 15 min before ischemia, and for 60 min of ischemia 15 min of reflow (table). Plotting tissue calcium against Ccrreveals a significant linear correlation:
+
Before
After
Before
After
Before
After
24
42.6
42.7
70.1
45.9
65.9
R = -0.534 (p < .0002)
Reductions were greatest in the highest BPs. Circadian variation of BP was demonstrated; BP was low between midnight and 6 a.m. even before therapy.There was no change in heart rate (HR). Untoward symptoms were equal before and during therapy.
Group
s IVN IVVSD
Scr
3.9 f 1.1 (10) 2.3 f 1.4* (6) 3.4 f 0.7
(7)
Iww
2.7 f 1.3 (9) IAVW 2.0 f 1.0* (7) *p < .05 as compared to group S.
S",
291 f 57 (10) 216 f 100 (9) 315 f 70 (7) 253 f 104 (9) 319 f 138 (6)
Tissue calcium was reduced in effectively treated rats in groups IVN and IAVW. We conclude that either verapamil or nifedipine is effective in amelioratingARF in rats. IVN and IAVW seem to give the best results.
CC,
U protein
33 f 30 255 f 147* (5) 55 f 30 (5) 148 f 118* (7) 343 f 253*
14.8 f 6.8 (10) 23.9 f 7.2 (8) 8.7 f 14.8 (7) 35.1 f 11.1 (8) 26.3 f 11.3
(5)
(6)
(7)
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50
[lo]
EFFECTS OF LOW-PROTEIN DIET (LPD) ON SEVERAL METABOLIC DISORDERS OF CHR(3NIC RENAL FAILURE (CRF)
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M.Aparicio and J. L Bouchet, Hopital Pellegrin, Place Amilie Raba Lion 33076 Bordeaux Cedex, France This work assessed the effects of LPD on several biochemical abnormalities related to CRF. A LPD providing 0.3 g proteidkg and 5 to 7 mg phosphoruslkgdaily supplemented with essential amino acids and ketoanalogues (Ketosteril-Fresenius FIRG) was proposed for 18 months to 70 patients with advanced renal insufficiency (creatinine > 300 pmol/L). Thc effects of this diet were studied at different times after starting LPD: in the 70 patients at the 18th mcmth, serum phlosphorus decreased from 1.56 f 0.28 to 1.33 f 0.25 mnol/L (p < .001), PTH activity from 192.8 f 124.2 m 139.3 f 151.1 pg/mL (p < .001); serum calcium was not modified. In 25 patients a 50 g oral glucose tolerance test was performed before LPD and 3 month later. Glycemia and insulinemia were significantly reduced (p < .05 and p < .02). Ten of these patients underwent a euglycemic hyperinsulin clamp: The tissue-sensitivity-to-insulinindex improved at the 3rd month (p < -01). In 20 patients Na+ K+ ATPase activity of leukocytes was assessed before and 3,6, and 12 months after starting the diet. The activity improved dramatically from 918 f 38.1 to 148.2 f 38.4 at 3 months (p < .001), to 182 f 66.2 at 6 months (p < .001), and to 227 f 84.3 pmol Pi/h/g of protein at 12 months (p < .001). We conclude that LPD improves some of the metabolic consequences of CRF probably by reducing the production of uremic toxins and inhibitors derived from alimentary protein intake. Ell] IF THE KIDNEY IN ESSENTIAL HYPERTENSION IS ABNORMAL, WHAT IS THE ABNORlVMLITY? Barry M. Brenner, MD, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, U.S.A. Altered renal hmodynamics, reduced ability to excrete sodium, and arterial hypertension characterize the adaptive response to a decrease in the number of functioning nephrons. Whether acquired as a result of intrinsic renal disease or following surgical renal ablation, reduced
nephron number often leads to systemic hypertension. Clinically, inborn deficits in nephron number are also often associated with hypertension. Taken together, these experimental and clinical observations suggest that a deficiency in glomerular filtration surface area contributes to two processes: limited ability to excrete sodium loads, leading to “essential” hypertension, and susceptibilityto accelerated renal failure when fdtration surface area is further reduced by surgical ablation or acquired renal parenchymal disease. Once systemic hypertension is established, factors such as increased systemic vascular resistance and structural alterations in the renal and extrarenal vasculaturetend to perpetuate the process, leading to fixed arterial hypertension. Systemichypertension contributes to glomerular capillary hypertension, which eventuates in glomerular sclerosis. As sclerosis subsumes more and more of the glomerular fdtration bed, glomerular destruction further aggravates systemic hypertension. Since no therapy is yet available to directly increase inborn glomerular number or augment the growth of new glomerular capillaries, presentday interventionsonly seek to control systemic and glomerular capillary hypertension so as to interrupt this cycle and minimize risk in those patients most susceptibleto hypertension and glomerular injury.
El21 POTENTIAL LOSSES OF SMALL AND LARGE SOL^ IN PATIENTS WITH ACUTE RENAL FAILURE (ARF‘) TREATED BY CONTINUOUS ARTERIOVENOUS HEMODIALYSIS (CAVHD)
S. P. Davies, D, A. Reaveley, W. Kox, and E. A. Brown, Charing Cross Hospital, London, U.K. CAVHD is now a well-established technique for the treatment of ARF providing high clearances of small solutes. In order to determinenutritionallosses and potential losses of higher molecular weight solutes, we have performed 8 clearance studies of individual amino acids in 6 patients receiving total parented nutrition (TPN) ,and clearances of B2-microglobulin (B2M; M W 11,800) in 12 patients. All were treated by CAVHD using Hospal AN69S 0.43 m2 filters and Fresenius 1.596 peritoneal dialysis fluid at dialysate flow rates (OJ of 1 and 2 Llh. Daily nitrogen intake in those meiving TPN was 9 g (1 patient), 14 g (2 patients), and 18 g (3 patients). The mean ultrafiltration (UF)rate for all studies was 6.38 f 0.32 mL/min (mean f SEM).
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Abstracts
51
Amino acid clearances ranged from 7.38 f 2.2 (glutamic acid) to 25.18 f 4.81 mL/min (3-methylhistidine) at a Qd of 1 U h and from 13.59 f 1.66 (tryptophan) to 33.69 f 4.31 mL/min (3-methylhistidine) at a Qd of 2 L/h. These results represent daily losses of 1.68 f 0.32% (isoleucine) to 87.51% (tyrosine) at a Qd 1 L/h and 2.09 f 0.58% (glutamic acid) to 98.94 f 1.06% (tyrosine) at Qd 2 L/h. Total protein losses amounted to 9.10 f 1.17% and 11.85 f 2.21%, respectively, ofthe daily input. B2M clearances closely correlated with UF rates (r = 0.66, p = .003), but there was no significant difference between clearances of B2M at a Qd of 1 and 2 L/h (5.54 f 0.49 and 5.39 f 0.81 mL/min, respectively. These studies confirm that CAVHD is highly effective at removing small solutes by diffusion and therefore amino acid losses should be considered when administering TPN to these patients. The clearance of larger molecules, however, depends primarily on convection and therefore losses are unlikely to be significant.
groups: I: 23 children with NS untreated with Livex, LI: 22 children with NS receiving Livex (0.1 g/kg of the body weight per day); control group: 25 healthy children. None of the children received preparations containing magnesium except Livex. Atom absorption spectroscopy was used to determine magnesium concentration. During the acute period of disease, a statistically important decrease of magnesium level in blood serum was found, whereas the level of magnesium in erythrocytes was normal. During the remission magnesium concentration was still low in blood serum, and moreover a statistically important deficiency of magnesium in erythrocytes was observed. Magnesium levels in serum and erythrocytes normalized after a 3-month treatment with Livex (table). Conclusion. Livex might be a valuable agent in treatment of magnesium deficiency in children with NS.
[13] THE CORRECTION OF MAGNESIUM CONCENTRATION IN NEPHROTIC SYNDROME IN CHILDREN BY
H. E. Eliahou, I. Serban, A. Blau, D. Herzog, D. Sachs, and A. Erdberg, Dept. of Nephrology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel
MEANS OF LIWX-ANJMAL BLOOD PREPARATION Anna Dobracka, Clinic of Pediatric Nephrology, Medical Academy of Wrodaw, Poland
The changes of magnesium concentration in blood serum and erythrocytes of the children suffering from acute phase of nephrotic syndrome (NS) and during the remission of the disease were examined. The deficiency of magnesium was supplemented by Livex-animal blood preparation containing amino acids and trace elements, including magnesium. 45 children (23 girls and 22 boys), age 3- 11, were investigated. The patients were divided into 2
Mean Mg concentration fmddm3) ~
~~~
~ _ _ _
Serum
Erythrocytes
40.56 22.86 20.48
80.89 81.92 52.88
36.99
102.01
~
Control group Acute period of disease Complete remission After 3-month treatment with Livex
[14] CALCIUM CHANNEL BLOCKERS IN
CHRONIC RENAL FAILURE (CALCIUM CONTENT IN SKIN PUNCH BIOPSIES)
Patients with a stable progression of chronic renal failure were randomly assigned to 2 groups of antihypertensive therapy: (1) nisoldipine (NIS) as the only antihypertensive, and (2) antihypertensive drugs without calcium blockers and a placebo (PL) tablet instead of nisoldipine. In the NIS group, the slopes of Userum creatinine versus time in months, improved in 15/20; and in the PL group only in 6/18 (p < .0125). There was a definite correlation between the change in MAP and the change in the slope of progression. The diastolic BP was significantly reduced in the patients whose slopes improved. Thus, BP (especially the diastolic) is important in the progression of renal failure. It is hypothesized that the already dilated glomerular capillary of the failing kidney allows unhindered access of the systemic BP to the glomerular capillary, resulting in glomerulosclerosiswhen BP is high and improvement when BP is lowered. Thus, the improvement obtained by nisoldipine is not through changes in the vascular tone of the glomerular capillary. Preliminary data on the calcium content in the patients' skin, following punch biopsies, was obtained. In the PL group the calcium content of the skin was 20.7 f 4.1 nmole/mg wet tissue (n = 3); and in the NIS-treated
Abstracts
52
group, 6.9 f 3.7 nmole/mg wet tissue (n = 5) (p < .005). This finding suggests an additional mechanism of action of nisoldipine in the amelioration of the progression of renal failure, namely, the prevention of calcium deposition in the renal cortex.
[lq CALCIUM ANTAGONISTS AND THE
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KIDNEY: FUTURE DJRECTIONS IN THE MANAGEMENT OF ARF Murray Epstein, MD, Div. Nephrology, Univ. Miami School of Medicine; VA il4edical Center, Miami, Florida, U.S.A. Previous research and clinical studies have focused primarily on the effects of calcium antagonists (CCBs) on the myocardium and peripheral vasculature. Recently, attention has been directed toward the effects on the renal microvasculatureand renal function. Studies in the isolated perfused kidney indicate that: CCBs reverse afferent arteriolar vasoconstriction in a variety of experimental settings. In contrast, these agents are much less effective in blocking efferent arteriolar vasoconstriction. Taken together these properties result in a striking ability to augment GFR. Thus, in comlmrison with other direct-acting vasodilators, CCBs uniquely maintain or increase GFR in the presence of a vasoconstricting insult. This effect is due, in part, to a regional heterogeneity within the renal microcirculation and to a selective action to reduce afferent arteriolar resistance. The salutary effects of CCBs on renal hernodynamics have important therapeutic implications. Their abiliity to reverse renal ischemia and maintain sodium excretion commends their use in hypertension. Additionalpotential applications include augmentation of renal perfusion in clinical settings in which renal hemodynamics are acutely compromised. Thus, preliminary observations indicate that CCBs protect against acute renal failure following cadaveric renal transplantation and the use of cyclosporine. In summary, the ability of CCBs to prevent or reverse renal vasoconstriction suggests future potentially important therapeutic approaches for their use.
[la
FREE-RADICW SCAVENGERS IN ISCHEMIC AND NEPHROTOXIC ACUTE RENAL FAILURE (ALLOPURINOL AND 0xYPuRIN0L)
William F. Finn, John J. Dillon, and Steven H. Grossman, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, U.S.A. The xanthine oxidase inhibitors allopurinoland oxypurinol (Oxy) reduce renal ischemic injury in animals. Four mechanisms have been proposed: (1) the degradation of ATP may be reduced by preventing the conversion of hypoxanthineto xanthine; (2)the reincorporation of purine metabolites into ATP may be promoted; (3)the formation of oxygen-free radicals may be inhibited; (4)these agents may themselves act as hydroxy radical scavengers. We have administered Oxy in doses of 2.5,5,10,and 20 mg/kg i.v. prior to 20 min of renal ischemia in uninephrectomized rats. At 24 h inulin clearances (Cd were measured. At 5 mg/kg, Oxy lessened ischemic injury (1075 f 632 vs 623 f 257 &/min). The protection was also evident when Oxy was given after 40 min of reperfusion. At 24 h, serum creatinine (Scr) was lower compared to rats not given Oxy (1.1 f 0.3 vs 1.7 f 0.4 mg/dL). The administrationof cyclosporine(CsA) 10 mglkg i.p. 1 h after 20 min of ischemia results in additional injury and a further increase in Scr (2.4 f 0.7 vs 1.7 f 0.4 mg/dL). Oxy given before or after the ischemia minimizes the added toxicity of three daily doses of CsA 10 mg/kg. On days 0, 1, and 3, Ch with and without Oxy pretreatment with 1172 f 326 vs 932 f 234,853 f 403 vs 500 f 420, and 934 f 444 vs 324 f 365 pL/min, respectively. The decline in Ch observed with 20 mg/kg was also seen in normal rats. The Ch before and after the administration of Oxy at doses of 5,10,and 20 mg/kg were 850 f 230 vs 838 f 160,995 f 503 vs 535 f 253, and 993 f 204 vs 362 f 53 pL/min, respectively. The Oxy clearances (Co~y) were 799 f 158,530f 385, and 150 f 65 pL/min, respectively. The fall in the ratio Coxy/Chat 20 mg/kg, along with crystal deposition,
Abstracts
53
suggested that this dose was accompanied by intrarenal precipitation of Oxy. When used in appropriatedoses, Oxy effectively minimizes mild renal ischemic injury and consequentlylessens the added toxicity of CsA. Its effectiveness when given following reperfusion may be related to actions other than free-radical formation.
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[17] C-LEUCINE TURNOWR FOR EVALUATION OF LOW-PROTEIN DIETS IN CHRONIC RENAL FAILURE D. Fouque, M. Laville, B. Beaufiere, N. Pozet, A. Hadj-Aha, M.Labeeuw, and P. Zech, Service de Niphrologie et NSERM U 197, Kopital EdouardHerriot, 69437 Lyon Cedar 03, France
Avoidance of protein malnutrition is a major goal of dietary treatment of chronic renal failure (CRF). Since
Group/period C: 1st month 2nd month
B: 1st month 2nd month
Protein intake (g/kg/d) 0.8 f 0.1
diets are given for long times, even light degrees of protein imbalance could be harmful in long-term-treated patients. A prospective study was designed to compare the effects on protein metabolism of low-protein diets (LPD) with or without ketoacids. In a prelimhary phase, seven CRF patients (plasma creatinine: 318 f 105pmol/L)were enrolled. After a 2-week equilibration period, all of them received a 0.8 g/kg/dayLPD for 1month. They were then randomly allocated to receive for another month 0.5 g/kg/day LPD either supplemented with ketoacids (group C: 5 patients) or not (group B: 2 patients). Protein and calorie intakes were evaluated every 2 weeks by 7day dietary recalls. Fourday N balance and 13C-leucineturnover were measured at the end of the 2 1-month periods (table). These results suggest that in CRF patients even slight reductions of protein intake are often associated with reduced calorie intake both resulting in slightly negative nitrogen balance. However, in our limited experience, these changes are too small to be measured by 13Cleucine turnover studies.
N
0.5
caloric intake (cal/kg/d) 21.1 f 3.3 26.8 f 8.8
balance (g/d) -1.6 f 1.9 -0.09 f 1.0
0.7 f 0.1 0.4
23.3 f 2.4 21.8 f 0.6
-0.3 -1.6
[18] STRATEGIES IN THE TREATMENT
OF HYPERTENSION IN UNKNOWN ETIOLOGY END STAGE NEPHROPATHY l%. Guleas, Chr. Lappas, A. Papadopoulos, and P. Founta, General Hospital of Trikak?.B 'Internal Medicine Clinic, Renal Unit Department Material of this work are facts from a simultaneous investigation on the increased incidence of a nephropathy of unknown etiology. These categories of hemodialyzed patients are: (a)hypertensive; (b) have been residents, for more than 20 years in areas with soils clearly defined as alluvial soils,compared with patients from nonalluvial areas; and (c) they have significantly low serum calcium (Ca) and increased serum magnesium (Mg). The purpose of the work is the investigationof the increased incidence
f 0.7 f 0.2
Leucine appearance 1.39 f 0.29 1.39 f 0.17
Leucine oxidation (pmol/kg/min) 0.16 f 0.04 0.16 f 0.04
Leucine disappear. 1.22 f 0.26 1.23 f 0.15
1.04 f 0.04 1.05 f 0.07
0.12 f 0.01 0.12 f 0.01
0.92 f 0.04 0.94 f 0.08
on unknown-etiology nephropathy in these areas and the strategies in its treatment. The study was focused on the estimationof the correlationbetween Ca, Mg, and hypertension. The elements Ca and Mg were studied in the soil, water supply, and irrigation net of the areas as well as in the blood serum of the hemodialyzed patients. There was an assessment of respective facts from nonalluvial areas. The +test method was used for the statistical analysis of the facts. Two findings were verified: (1) The increased incidence of unknown-etiology nephropathy with hypertension is positively correlated at a statistically significant degree with the low Ca levels and increased Mg levels in the soil, water, and blood serum of the patients. (2) Controlled administration of Ca in this category of hemodialyzed patients obviously improves hypertension, and at the same time, renal function.
Abstracts
54
10 mg/dL and phosphate < 6 mg/dL. Eight out of 12 patients were previously under oral calcitriol therapy with poor control of PTH levels. After a wash-out of 12 weeks, i.v. calcitriol was started at the dose of 0.02pg/kg b.w.; 4 weeks of treatment were followed by 12 additional weeks of observationwithout calcitriol. Total calcium was monitored at each dialysis session and calcitriol was temporarily discontinuedwhen Ca exceeded 11 mg/dL. Midfragment PTH (PTH-mm), intact FTH (FTH-I), Alk phophatase (AP),total and ionized calcium phosphate (P) , magnesium (Mg), and aluminum (Al) levels were evaluated throughout the study (table). AP, Mg, P, and Al levels did not change significantly. This study confirms the effectiveness of i.v. calcitriol in treating secondary hyperPTH in HD patients, with minimal plasma CaZ+ increase. Further long-term investigationsshould clarify its clinical advantages over oral calcitriol.
[19] INTRAVENOUS 1,S-DIlHYDROXYCHOLECALCIFEROL (CALCITRIOL) IS AN EFFECTIVE TREATMENT OF SECONDARY HYPERPARA~KYROIDISM IN HEMODIALYSIS PKL'IENTS
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M. Gullieni, P. Padovese, A. Anelli, M. Del Prete, G. L. Tarolo*, and D. Brancaccio, Renal Unit and Lkpt. of Nuclear Medicine*, Ospahle San Pmlo, University of Milano, Italy
Calcitriol has recently become available for intravenous (i.v.) use in h e d a l y s i s (HD) patients. We evaluated the effects of 4 weeks of i.v. dcitriol in suppressing secondary hyperFTH. Twelve HD patients were selected on the basis of the following criteria: imid fragment FTH levels > 2.5 ng/mL (n.v. 0.2-Oh), total plasma calcium Beginning of observation
PTH-mm PTH-I Ca CaZ+
3.1 f 1.3 9.1 f 0.4
End of treatment
Beginning of treatment 3.2 f
1.3
2.4 f 1.0****
167 f 103 8.9 f 0.2
4.84 f
96 f 70*** 9.4 f 0.7**
0.16
End of observation 4.0 f 2.0 9..3 f 0.6
4.99 f 0.25*
9:NS, *+p < .Cn, *** p < .01, **** p
