Dual effects of lisinopril on puromycin aminonucleoside nephrosis in unilaterally nephrectomized rats.
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The therapeutic effects of angiotensin converting enzyme inhibitor, lisinopril, on puromycin aminonucleoside (PAN)-induced nephrosis were investigated using unilaterally nephrectomized rats. Lisinopril showed potent dual effects on PAN nephrosis. Lisinopril treatment (50 mg/l in drinking water) from day 5 or day 9 reduced urinary protein excretion and suppressed the development of glomerular sclerosis at 8 weeks after PAN injection (150 mg/kg, i.p.), indicating a therapeutic effect on the nephrosis. Recovery of decreased anionic charge sites on the glomerular basement membrane was involved, at least in part, in the therapeutic action of lisinopril against proteinuria. On the other hand, oliguria and progressive azotemia derived from continuous deterioration of the renal function was induced if the treatment of lisinopril was started on the same day as PAN injection. The renal dysfunction induced by simultaneous administration of lisinopril with PAN could be abolished by combination dosing with sarcosine, an angiotensin II (AII)-receptor agonist. These results indicate that lisinopril treatment attenuates proteinuria by ameliorating the anionic charge barrier on the glomerular basement membrane and that it also protects against the development of chronic renal disease with segmental glomerular sclerosis, although AII depletion during the acute nephrotic stage exacerbates the renal damage in PAN nephrosis of unilaterally nephrectomized rats. (+info)
Leptospirosis: prognostic factors associated with mortality.
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To determine the prognostic factors for leptospirosis, we conducted a retrospective study of data collected in the emergency department of our hospital between 1989 and 1993. Sixty-eight patients, for whom the diagnosis of leptospirosis was based on pertinent clinical and epidemiological data and positive serology, were included in this study. Fifty-six patients (82%) were discharged from the hospital, and 12 (18%) died. Multivariate logistic regression demonstrated that five factors were independently associated with mortality: dyspnea (odds ratio [OR], 11.7; 95% confidence interval [CI], 2.8-48.5; P < .05), oliguria (OR, 9; CI, 2.1-37.9; P < .05); white blood cell count, >12,900/mm3 (OR, 2.5; CI, 1.8-3.5; P < or = .01), repolarization abnormalities on electrocardiograms (OR, 5.9; CI, 1.4-24.8; P < or = .01), and alveolar infiltrates on chest radiographs (OR, 7.3; CI, 1.7-31.7; P < or = .01). Identification of these factors on admission might provide useful selection criteria for patients who need early transfer to the intensive care unit. (+info)
Severe burns in children, 1964-1974.
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580 children were admitted to the paediatric burns unit of Guy's Hospital between 1964 and 1974, of which 97 had burns exceeding 20% of the surface area, and 33 died (34% mortality). 80% of those with burns exceeding 50% of the surface area died. Young children died after less extensive burns. Respiratory failure, sepsis, and malnutrition were the most lethal complications. The prompt use and careful control of intravenous fluids had reduced the immediate complications associated with shock, and acute renal failure is now uncommon. Respiratory failure resulted in many deaths during the first week after injury. The need for intensive respiratory care involving paediatric, anaesthetic, and surgical staff is stressed. Sepsis and malnutrition remain major threats to survival. Improved methods of bacteriological control by laminar air flow units and topical antibacterial agents may help to reduce infection in the future. Reduction of energy expenditure by temporary skin coverings and a high environmental temperature, combined with a high calorie intake by oral and intravenous routes, may improve the outlook for severly burned children in the next decade. (+info)
Immune complex infusion in the rat. Renal functional and morphological changes.
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Immune complexes were precipitated from pooled goat antisera to human Cohn Fraction II. After washing the complexes were solubilized in antigen excess. When complexes containing 10 mg of antibody were infused into saline-loaded rats an episode of oligoanuria lasting 4-6 hr resulted followed by transient proteinuria. By 24 hr after complex infusion protein excretion had returned to pre-infusion levels. With infusion of 5 mg of antibody similar functional alterations, though of lesser severity, occured. Control animals infused with Cohn fraction II alone in an amount and protein concentration equal to the experimental groups exhibited none of these features. Changes in blood pressure did not occur. Immune complex deposition was not detectable in the glomeruli by immunofluorescence microscopy. A mild microangiopathy affecting mainly interstitial vessels, with some glomerular endothelial cell swelling, was evident on light microscopy. It is suggested that circulating factors resulting from complex infusion rather than glomerular complex localization account for the changes observed. (+info)
A multicenter comparison of dialysis membranes in the treatment of acute renal failure requiring dialysis.
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The mortality of patients with acute renal failure (ARF) remains high, and in several large studies approaches 60%. This mortality is particularly high in patients with ARF who require dialysis and has not changed substantially over several years, despite the introduction of major advances in monitoring and treatment. Increasing prevalence of comorbidities has been suggested as the major factor in this persistently high mortality. This study investigates the potential role of the dialysis membrane on patient outcome in a prospective multicenter study of 153 patients with ARF requiring dialysis. The membrane assignment was made in alternating order and was limited to membranes with low complement activation (Biocompatible [BCM]) and cellulosic, high complement activation (Bioincompatible [BICM]). Both types of membranes were low-flux membranes. Patients were dialyzed with the assigned membrane until recovery, discharge from hospital, or death. The severity of illness of each patient was assessed using the APACHE II score at the time of initiation of dialysis. A logistic regression analysis was used to adjust for the APACHE II score. The results of the study showed a statistically significant difference in survival (57% in patients on BCM, 46% in patients on BICM; P = 0.03) and in recovery of renal function (64% in patients on BICM and 43% in patients on BICM; P = 0.001). These differences were particularly marked in the patients who were nonoliguric (>400 ml/d of urine output) at initiation of the study. In the subset of patients who were nonoliguric at the start of dialysis, a larger fraction (70%) became oliguric after initiating dialysis on a BICM membrane, in contrast to 44% who were initiated on a BCM membrane (P = 0.03). It is concluded that the biocompatibility of the dialysis membrane plays a role in the outcome of patients with ARF, particularly those who are nonoliguric at the time of initiation of dialysis. (+info)
Dialysis modality and delayed graft function after cadaveric renal transplantation.
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The purpose of this investigation was to compare outcomes in the immediate posttransplant period for hemodialysis (HD) and peritoneal (PD) dialysis patients who received cadaveric renal transplantation. Data were obtained from the United Network of Organ Sharing on all cadaveric graft recipients who were dialysis-dependent at the time of transplantation between April 1994 and December 1995. Baseline characteristics were compared between groups, and multivariate logistic regression was performed with outcome measures including urine production in the first 24 h posttransplantation (U24), requirement for dialysis in the first week posttransplant (FWDIAL), and treatment for acute rejection during the initial hospitalization. The odds of oliguria (not producing urine in the first 24 h) were 1.49 (1.28 to 1.74) times higher in HD versus PD patients. After adjustment for other comorbid conditions including age, gender, race, HLA mismatch, time on dialysis, panel-reactive antibodies, and cold and warm ischemia time, the odds of oliguria were 1.60 (1.14 to 2.25) times higher in black HD patients compared with PD patients and 1.29 (1.06 to 1.57) times higher in white HD patients. In a similar manner, after adjustment for significant comorbid conditions, the odds of requiring dialysis in the first week were 1.56 (1.22 to 2.0) times higher in black HD patients versus PD patients and 1.40 (1.21 to 1.60) times higher in white HD patients. The rate of acute rejection was similar during the first hospitalization. These results suggest that there is an association between hemodialysis and delayed graft function. Differences in biocompatibility between the two modalities could potentially be responsible. (+info)