RESUMEN
Renal and systemic hemodynamics, plasma arginine vasopressin, plasma renin activity, plasma norepinephrine, blood volume and water loading test were studied in 10 patients with falciparum malaria without renal failure. Six patients responded to water load normally, while 4 patients had a decreased response to water load. The patients with a normal water load response had normal renal and systemic hemodynamics and a normal hormonal profile. The patients with a decreased response to water load had hyponatremia, hypervolemia, high cardiac index, low systemic vascular resistance, high plasma arginine vasopressin, high plasma renin activity, high plasma norepinephrine, low creatinine and p-aminohippurate clearances, low urine sodium and high urine osmolality. They had a lower mean arterial pressure during the acute phase of the disease than during the recovery phase. The findings suggest that a decreased response to water load is due to peripheral vasodilatation which results in a decreased effective blood volume leading to the release of vasopressin and norepinephrine, increased renin activity and decreased renal hemodynamics.
Asunto(s)
Hemodinámica , Malaria Falciparum/fisiopatología , Circulación Renal , Adulto , Arginina Vasopresina/sangre , Volumen Sanguíneo , Creatinina/metabolismo , Femenino , Humanos , Infusiones Intravenosas , Riñón/fisiopatología , Malaria Falciparum/metabolismo , Masculino , Norepinefrina/sangre , Concentración Osmolar , Renina/sangre , Sodio/orina , Agua/administración & dosificaciónRESUMEN
UNLABELLED: Medical complications after renal transplantation cause problems in treatment decision making. To differentiate acute tubular necrosis from acute rejection when it occurs in the early posttransplant period is difficult. Renal scintigraphy offers a noninvasive means for renal blood flow (RBF) and renal function assessment. METHODS: This retrospective study of RBF and renal function evaluation after kidney transplantation is an attempt to calculate the "renal vascular transit time" from the 99mTc-diethylenetriaminepentaaacetic acid renal vascular flow with a deconvolution technique. The results of 102 studies on 38 graft recipients were evaluated. Of these, 19 were diagnosed as acute rejection, 12 as acute tubular necrosis, 4 as chronic rejection, 1 as vesicoureteric reflux, 1 as recurrent immunoglobulin A nephropathy, 1 as iliac vein thrombosis, 1 as cyclosporine nephrotoxicity and 63 as normal. All diagnoses were established by clinical and/or pathologic criteria. RESULTS: With renal vascular transit times more than 12.8 secm the sensitivity and specificity for the detection of acute rejection was 95% and 94%, respectively. The sensitivity and specificity for the differential diagnosis of acute rejection against acute tubular necrosis was 95% and 92%, respectively. CONCLUSION: The use of renal vascular transit time in addition to 131I-labeled hippuran renogram provides a promising diagnostic parameter to differentiate between acute rejection and acute tubular necrosis.
Asunto(s)
Rechazo de Injerto/diagnóstico por imagen , Trasplante de Riñón/diagnóstico por imagen , Necrosis Tubular Aguda/diagnóstico por imagen , Renografía por Radioisótopo , Circulación Renal , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Radioisótopos de Yodo , Ácido Yodohipúrico , Masculino , Curva ROC , Estudios Retrospectivos , Sensibilidad y Especificidad , Pentetato de Tecnecio Tc 99mRESUMEN
The effect of chronic renal failure (CRF) on the pattern of plasma free amino acid concentrations was studied in 22 healthy controls (group 1); 43 CRF patients of which serum creatinine levels were 2-4.9 mg/dl (group 2, n = 11), 5-10 mg/dl (group 3, n = 10), more than 10 mg/dl (group 4, n = 9), and chronically hemodialysed patients (group 5, n = 13). In all renal failure groups, plasma concentrations of eight free essential amino acids-isoleucine, leucine, lysine, methionine, threonine, tryptophan, tyrosine and valine and those of three non-essential amino acids-alanine, glutamate and serine were significantly lower than those in controls. Plasma concentrations of free arginine, cystine, glutamate and serine were significantly higher in CRF patients. Patterns of change of plasma aminogram were similar among CRF patients regardless of the stages of renal function or dialytic treatment. Stepwise changes of some plasma free amino acids were observed as renal function became worse. The molar ratios of plasma free valine/glycine, serine/glycine and tyrosine/phenylalanine were decreased accordingly. Our study confirms the presence of abnormal plasma aminogram, specifically that of essential amino acids, in CRF. Therapeutic intervention is warranted but still needs further investigations.
Asunto(s)
Aminoácidos/sangre , Fallo Renal Crónico/sangre , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , TailandiaRESUMEN
Fifteen patients with chronic renal failure, stabilized on twice weekly hemodialysis, received oral essential amino acid therapy (6.3 g/day) over a period of 12.3 months. Clinical and laboratory improvement was observed with respect to body weight, tricep skin fold thickness, mid upper arm circumference serum albumin, C3 and plasma essential amino acids. Serum triglyceride was decreased. The patients felt well with increased appetite. Essential amino acids were well tolerated without side effects.
Asunto(s)
Aminoácidos Esenciales/administración & dosificación , Fallo Renal Crónico/dietoterapia , Diálisis Renal , Adulto , Peso Corporal , Femenino , Humanos , Fallo Renal Crónico/patología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Evaluación Nutricional , Grosor de los Pliegues CutáneosRESUMEN
We report the first experience in Thailand with the use of OKT3 (monoclonal anti T lymphocyte antibody) in rescuing an acute rejection unresponsive to methylprednisolone pulses in 3 cadaveric renal transplant patients. The treatment regimen was 10 daily 5 mg intravenous injections of OKT3. In the first and second patients OKT3 was started on days 26 and 18 of the rejection episode. In the third one OKT3 was given when he became anuric secondary to severe acute rejection. Within 24 hours of the therapy, urine flow increased. A brisk diuresis and a decline in serum creatinine started within 4 days. The kidney function returned to normal within the 10-day course of therapy. Side effects were fever, conjunctivitis, stuffiness of nose and herpes infection.