==================================HSR44================================== 44. Laboratory tests for end-stage renal disease patients. 1 UI - 87097464 AU - Beaufils M ; Lantz B ; Paillard F ; Richet G TI - Effects of tertatolol in hypertensive patients with chronic renal failure. AB - Chronic renal failure (CRF) is often associated with hypertension, as a cause or a consequence. We studied the changes in blood pressure (BP), heart rate (HR), renal function (as measured by creatinine clearance), and plasma renin activity (PRA) in 19 hypertensive patients with CRF before, during and after oral administration once a day for at least 30 days of 5 mg tertatolol, a new beta-blocker. All patients were free of any antihypertensive medication for at least 1 month before administration of tertatolol. The dose of tertatolol given in this study was the same as that commonly used in patients with normal renal function. From day 0 to day 30 of tertatolol, measurements in the supine position were as follows: systolic BP (SBP) decreased from 168.4 +/- 4.6 to 145.3 +/- 4.3 mm Hg (p less than 0.01); diastolic BP (DBP) decreased from 106.1 +/- 2.4 to 87.1 +/- 2.0 mm Hg (p less than 0.01); HR decreased from 77.9 +/- 1.6 to 63.2 +/- 1.7 b.p.m. (p less than 0.01); PRA decreased from 1.816 +/- 0.521 to 1.052 +/- 0.323 ng/ml/h (p less than 0.01). Creatinine clearance remained stable: 37.1 +/- 4.1 versus 37.1 +/- 4.7 ml/min/1.73 m2 (not significant). Similar results (for SBP, DBP, HR and PRA) were obtained in the erect position. It is concluded that tertatolol in hypertensive patients with CRF: significantly lowers BP and HR without excessive bradycardia, significantly lowers PRA, the most important decrease being observed for the highest initial PRA, does not alter renal function, and has a good clinical acceptability. MH - Adrenergic Beta Receptor Blockaders/*PHARMACODYNAMICS ; Adult ; Female ; Glomerular Filtration Rate/DRUG EFFECTS ; Human ; Hypertension/*DRUG THERAPY/PHYSIOPATHOLOGY ; Kidney Failure, Chronic/*PHYSIOPATHOLOGY ; Male ; Middle Age ; Propanolamines/*PHARMACODYNAMICS/THERAPEUTIC USE ; Renal Circulation/DRUG EFFECTS ; Renin/BLOOD SO - Am J Nephrol 1986;6 Suppl 2:50-4 2 UI - 87074421 AU - Nesbitt JC ; McDougal WS ; Lowe W ; Abumrad NN ; Nylander WA TI - A new model to study acute and chronic renal failure. AB - Many models have been developed to study renal function following injury. Two types of studies have evolved: acute--to define the acute renal injury and chronic--to determine the pattern of recovery. Current models allow either study alone to be performed, but they lack the flexibility to combine the studies. In this study of renal ischemia, a model was designed which solved this problem. The authors constructed a model for performing a unilateral nephrectomy and episiotomy on female dogs. Catheters were placed in the renal vein, vena cava, and aorta, and a renal artery flow cuff was applied. The catheters and wires were buried in a subcutaneous pocket and were exteriorized after a recovery of several weeks. The episiotomy allowed easy intermittent Foley catheterization. With the animals awake and in a harness, parameters of renal function were measured: renal extraction, filtration fraction, fractional excretion, osmolar clearance, and free water clearance. Glomerular filtration rate and renal plasma flow were calculated by inulin and paramino hippurate clearances. The animals were studied in diuretic and antidiuretic states. In addition, renal artery flow was determined by the Doppler flow cuff. All parameters were determined every half hour in the acute setting, then every day in the chronic setting. The model was easily reproducible and functioned well in the authors' renal ischemia studies. Initial experiments with 1 hour of warm ischemia produced a greater than 50 per cent reduction in GFR acutely. Chronic studies showed a GFR with a return toward normal. All model construction purposes and plans were met.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Animal ; Disease Models, Animal ; Dogs ; Female ; Kidney Failure, Acute/ *ETIOLOGY ; Kidney Failure, Chronic/*ETIOLOGY ; Kidney Function Tests ; Renal Artery Obstruction/ETIOLOGY ; Renal Circulation SO - Am Surg 1986 Dec;52(12):651-3 3 UI - 87073429 AU - Brater DC ; Anderson SA ; Brown-Cartwright D ; Toto RD TI - Effects of nonsteroidal antiinflammatory drugs on renal function in patients with renal insufficiency and in cirrhotics. AB - We have assessed the effects of acute and chronic administration of etodolac, ketoprofen, and indomethacin on renal function in patients with mild to moderate chronic renal insufficiency (CRI). We studied 18 normal volunteers and 24 patients with CRI due to hypertension and/or diabetes mellitus with creatinine clearances between 19 and 83 mL/min/1.73 m2. Clearance studies were performed with the first dose of nonsteroidal antiinflammatory drug (NSAID) to compare acute effects of the agent with a no-drug control. Subjects then received the NSAID for three to five days and, on the last day of study, underwent another clearance study to assess the effects of a single dose of NSAID superimposed on chronic dosing. With each dose of each NSAID, inulin and paraaminohippurate (PAH) clearances and fractional excretion of NA+ decreased. However, the baseline control collections after chronic dosing did not differ from the no-drug control periods. Hence, the decline in renal function with each dose is transient, and no overall adverse effect on renal function occurred with chronic dosing. In five patients with cirrhosis, we assessed the renal sparing effects of sulindac. After equilibration on a fixed sodium intake, they received a 200-mg dose of sulindac. In one patient, no adverse effect occurred; the remaining patients suffered declines in creatinine clearance of 29%, 87%, 37%, and 37%, respectively. This effect was transient and returned to control values six to eight hours after sulindac administration. At the time of maximal depression of renal function, serum concentrations of sulindac sulfide were comparable to those in subjects with normal hepatic function.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Acetic Acids/PHARMACODYNAMICS ; Anti-Inflammatory Agents, Non-Steroidal/ ADMINISTRATION & DOSAGE/ADVERSE EFFECTS/*PHARMACODYNAMICS ; Creatinine/ URINE ; Human ; Indomethacin/PHARMACODYNAMICS ; Ketoprofen/ PHARMACODYNAMICS ; Kidney Failure, Chronic/*PHYSIOPATHOLOGY ; Kidney Function Tests ; Kidney/*DRUG EFFECTS/PHYSIOPATHOLOGY ; Liver Cirrhosis, Alcoholic/*PHYSIOPATHOLOGY ; Prostaglandins E/URINE ; Sulindac/ PHARMACODYNAMICS ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. SO - Am J Kidney Dis 1986 Nov;8(5):351-5 4 UI - 87073421 AU - Verpooten GA ; Giuliano RA ; Pattyn VM ; Scharp:e SL ; De Broe ME TI - Renal cortical uptake kinetics of gentamicin in rats with impaired renal function. AB - The renal cortical uptake kinetics of the aminoglycoside antibiotic gentamicin was determined in the remnant kidney model. Renal failure was induced by partial ablation of the right kidney followed by left nephrectomy in female Wistar rats. The animals received a six-hour gentamicin infusion at a constant rate yielding steady-state serum concentrations ranging from 0.5 to 150 micrograms/mL. The renal cortical gentamicin concentrations were determined and related to the serum concentrations achieved. This relationship was nonlinear and followed Michaelis-Menten kinetics. Gentamicin cortical uptake rate, however, did not show clear saturation in the range of gentamicin serum levels studied as was observed in rats with normal renal function. The Michaelis-Menten parameters determined by nonlinear regression were Km = 15.0, 73.9, and 135.7 micrograms/mL; and Vmax = 149.9, 213.7, and 239.2 micrograms/g cortex/h, respectively, for controls, rats with serum creatinine levels between 0.9 and 1.2 mg/dL, and those with levels between 1.3 and 1.8 mg/dL. It is concluded that at serum levels below 100 micrograms/mL, the gentamicin renal cortical uptake is diminished in rats with renal failure. This decrease in renal cortical uptake is more pronounced in the group of rats with more severe renal failure. MH - Animal ; Creatinine/METABOLISM ; Female ; Gentamicins/*METABOLISM ; Glomerular Filtration Rate ; Kidney Cortex/*METABOLISM ; Kidney Failure, Chronic/*METABOLISM/PHYSIOPATHOLOGY ; Kinetics ; Rats ; Rats, Inbred Strains ; Support, Non-U.S. Gov't SO - Am J Kidney Dis 1986 Nov;8(5):304-7 5 UI - 87065313 AU - Fr:ohling PT ; Birnbaum M ; Halle H ; Lindenau K TI - Successful pregnancy of a woman with advanced renal failure on nutritional treatment. AB - A case is reported of a successful pregnancy of a woman with advanced renal failure treated nutritionally. The importance of an intensive interdisciplinary medical co-working is stressed, and the individual adaptation of the dietary treatment to the special nutritional requirements in pregnancy is discussed. MH - Adult ; Case Report ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Human ; Infant, Newborn ; Kidney Failure, Chronic/*COMPLICATIONS/ DIET THERAPY ; *Nutrition ; Pregnancy Complications/*DIET THERAPY ; Pregnancy ; Pyelonephritis/COMPLICATIONS SO - Nephron 1986;44(3):195-7 6 UI - 87062081 AU - Toto RD ; Anderson SA ; Brown-Cartwright D ; Kokko JP ; Brater DC TI - Effects of acute and chronic dosing of NSAIDs in patients with renal insufficiency. AB - Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) to patients with chronically impaired renal function has been reported to cause abrupt and sustained reductions in renal plasma flow (RPF), glomerular filtration rate (GFR), and solute and water excretion in association with decreased renal prostanoid production. However, the time course of these acute effects and whether they are sustained during chronic exposure to the NSAIDs are unknown. Accordingly, using standard clearance and balance techniques, we investigated the effects of acute (zero to four hours) and chronic (five days) oral administration of two different NSAIDs on renal function in patients with stable, mild to moderate chronic renal insufficiency (CRI) and in normal subjects. In patients, acute oral administration of ketoprofen (K) and indomethacin (I) resulted in significant decreases in GFR (K: from 36 +/- 3 to 20 +/- 4 ml/min, P = 0.001; I: from 37 +/- 6 to 30 +/- 7 ml/min, P = 0.032; in RPF (K: from 194 +/- 21 to 146 +/- 21 ml/min, P = 0.002; I: from 222 +/- 33 to 147 +/- 18 ml/min, P = 0.016); and in urinary PGE2 excretion (K: from 0.60 +/- 0.25 to 0.08 +/- 0.02 ng/min, P = 0.05; I: from 0.34 +/- 0.06 to 0.18 +/- 0.06 ng/min, P = 0.042). Fractional excretion of sodium chloride and fractional free water clearance (CH2O/CIn) also decreased significantly after both agents. In normal subjects, GFR and RPF were not significantly decreased after acute dosing, whereas urinary PGE2 and fractional excretions of NaCl and free water decreased significantly.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS ; Female ; Glomerular Filtration Rate/DRUG EFFECTS ; Hemodynamics/DRUG EFFECTS ; Human ; Indomethacin/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS ; Ketoprofen/ ADMINISTRATION & DOSAGE/ADVERSE EFFECTS ; Kidney Failure, Chronic/*DRUG THERAPY/PHYSIOPATHOLOGY ; Kidney/*DRUG EFFECTS/PHYSIOPATHOLOGY ; Male ; Middle Age ; Renal Circulation/DRUG EFFECTS ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. SO - Kidney Int 1986 Nov;30(5):760-8 7 UI - 87054185 AU - van Kalken CK ; van der Meulen J ; Oe PL ; Vriesendorp R ; Donker AJ TI - Pharmacokinetics of trimazosin and its effects on blood pressure, renal function and proteinuria during short-term therapy of patients with impaired renal function and hypertension. AB - The kinetics and short-term (10 weeks) effects of trimazosin, an alpha 1-adrenoreceptor antagonist, on renal function and blood pressure in patients with moderate chronic renal insufficiency and hypertension, have been studied for the first time. Eight patients in whom the blood pressure was not normalized with a diuretic alone underwent pharmacokinetic studies and assessment of the renal function during a 10-week period of trimazosin therapy. Trimazosin significantly lowered blood pressure (recumbent and upright) without significantly altering renal function. Renal vascular resistance was decreased by 14%. Fractional sodium excretion, proteinuria and laboratory serum tests remained unchanged. Neither body weight nor pulse rate were affected. Moderate renal insufficiency did not modify the pharmacokinetics of the drug. Thus, trimazosin, as second-step antihypertensive agent, appeared to be safe and effective in patients with moderate renal insufficiency and hypertension, without exerting favourable or adverse renal effects during short-term therapy. MH - Adult ; Aged ; Antihypertensive Agents/METABOLISM/*THERAPEUTIC USE ; Blood Pressure/DRUG EFFECTS ; Female ; Glomerular Filtration Rate/DRUG EFFECTS ; Human ; Hypertension, Renal/*DRUG THERAPY/ETIOLOGY ; Iodine Radioisotopes/DIAGNOSTIC USE ; Kidney Failure, Chronic/*COMPLICATIONS ; Kidney/DRUG EFFECTS ; Kinetics ; Male ; Middle Age ; Piperazines/ METABOLISM/*THERAPEUTIC USE ; Proteinuria/*DRUG THERAPY ; Renal Circulation/DRUG EFFECTS SO - Eur J Clin Pharmacol 1986;31(1):63-8 8 UI - 87035903 AU - Wolfson M ; Laidlaw SA ; Flugel-Link RM ; Strong CJ ; Salusky IB ; Kopple JD TI - Effect of vitamin B-6 deficiency on plasma amino acid levels in chronically azotemic rats. AB - Chronic renal failure is associated with many abnormalities in plasma amino acids. Since patients with renal failure are frequently deficient in vitamin B-6, this study examined whether vitamin B-6 deficiency may be a cause of any of the abnormal plasma amino acid concentrations observed in chronic renal failure. Sham-operated and chronically azotemic rats were pair-fed diets deficient in or replete with vitamin B-6 for 21 d. By the end of 21 d, the EGOT index rose significantly in the B-6-deficient rats but not in the B-6-replete animals. There were several differences in plasma amino acid concentrations between azotemic and control rats. Azotemia and B-6 deficiency each lowered the plasma serine concentration and raised the glycine-to-serine ratio. Plasma glycine was affected by a two-way interaction between azotemia and vitamin B-6 deficiency whereby the highest values were found in the sham-operated vitamin B-6-deficient animals. Plasma alanine and asparagine were reduced by B-6 deficiency and unchanged by azotemia. These results suggest that vitamin B-6 deficiency may contribute to several of the abnormalities in the plasma aminograms observed in chronic renal failure. MH - Amino Acids/*BLOOD ; Animal ; Body Weight ; Kidney Failure, Chronic/ *BLOOD/COMPLICATIONS ; Kidney Function Tests ; Male ; Rats ; Rats, Inbred Strains ; Vitamin B Deficiency/*BLOOD/COMPLICATIONS SO - J Nutr 1986 Oct;116(10):1865-72 9 UI - 87034298 AU - Nath KA ; Kren SM ; Hostetter TH TI - Dietary protein restriction in established renal injury in the rat. Selective role of glomerular capillary pressure in progressive glomerular dysfunction. AB - Dietary protein restriction imposed before renal injury is established in the remnant kidney model in the rat reduces glomerular hypertension and hyperperfusion and renal injury. We demonstrate that dietary protein restriction (6% vs. 20%) imposed on a background of established renal injury in the remnant model leads to a greater preservation of renal function as measured by glomerular filtration rate and fractional clearances of albumin and IgG, despite the persistence of systemic hypertension. In similarly prepared rats, dietary protein restriction (6% vs. 20%) led to a lower glomerular capillary hydraulic pressure, a higher ultrafiltration coefficient, and similar single nephron filtration rates. In addition, less impairment of glomerular permselectivity was demonstrable after protein restriction. Our data demonstrate that the preservation of renal function with dietary protein restriction after established glomerular injury follows upon reduction of glomerular capillary hydraulic pressure, despite constancy of single nephron filtration rate and plasma flow and persistence of arterial hypertension. MH - Animal ; Blood Pressure ; *Dietary Proteins ; Disease Models, Animal ; Glomerular Filtration Rate ; Hypertension, Renal/PREVENTION & CONTROL ; Kidney Failure, Chronic/*DIET THERAPY/PHYSIOPATHOLOGY ; Kidney Glomerulus/ BLOOD SUPPLY/*PHYSIOPATHOLOGY ; Male ; Rats ; Rats, Inbred Strains ; Regional Blood Flow ; Renal Circulation ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. SO - J Clin Invest 1986 Nov;78(5):1199-205 10 UI - 87026450 AU - van der Meulen J ; Reijn E ; Heidendal GA ; Oe PL ; Donker AJ TI - Comparison of the effects of penbutolol and propranolol on glomerular filtration rate in hypertensive patients with impaired renal function. AB - Penbutolol and propranolol were administered orally in a dosage of 40 mg once daily and 80 mg twice daily, respectively to 12 patients with hypertension and impaired renal function. Both drugs caused a significant decrease in mean arterial pressure and heart rate. Serum creatinine concentration increased significantly by 10% during therapy with propranolol without concomitant decrease in creatinine clearance. No such effect was seen with penbutolol. GFR measured with [125I]-iothalamate showed no significant changes with both drugs. MH - Blood Pressure/DRUG EFFECTS ; Clinical Trials ; Comparative Study ; Creatinine/BLOOD/METABOLISM ; Double-Blind Method ; Glomerular Filtration Rate/*DRUG EFFECTS ; Human ; Hypertension/*COMPLICATIONS/DRUG THERAPY ; Kidney Failure, Chronic/*COMPLICATIONS ; Penbutolol/*PHARMACODYNAMICS/ THERAPEUTIC USE ; Propanolamines/*PHARMACODYNAMICS ; Propranolol/ *PHARMACODYNAMICS/THERAPEUTIC USE ; Random Allocation SO - Br J Clin Pharmacol 1986 Oct;22(4):469-74 11 UI - 87026113 AU - Lewandowski A ; Kozaczek W ; Orlowski T ; Weuta H TI - Kidney function of pyelonephritis patients with impaired renal function treated with mezlocillin. AB - Ten patients with pyelonephritis and impaired renal function were treated with 2.0 g mezlocillin (Baypen) 8-hourly. They all recovered from urinary tract infection and showed a distinct improvement of their kidney function measured by blood urea nitrogen, serum creatinine and creatinine clearance. No side effects were seen and the blood coagulation remained within normal limits. An overview of the literature on urinary tract infections treated in patients with impaired kidney function is given. MH - Adult ; Aged ; Female ; Human ; Kidney Failure, Chronic/*COMPLICATIONS/ PHYSIOPATHOLOGY ; Kidney Function Tests ; Male ; Mezlocillin/*THERAPEUTIC USE ; Middle Age ; Pyelonephritis/COMPLICATIONS/*DRUG THERAPY/ PHYSIOPATHOLOGY ; Urinary Tract Infections/COMPLICATIONS/*DRUG THERAPY/ PHYSIOPATHOLOGY SO - Arzneimittelforschung 1986 Jul;36(7):1148-50 12 UI - 86311508 AU - Adler AJ ; Berlyne GM TI - Silicon metabolism. II. Renal handling in chronic renal failure patients. AB - In 36 patients suffering from chronic renal failure (mean creatinine clearance 26 ml/min), serum silicon levels were significantly increased (mean 0.52 microgram/ml compared with 0.265 microgram/ml in normals; p less than 0.005). Urinary silicon excretion per 24 h was significantly decreased (15.71 mg/24 h compared with 21.4 mg/24 h in normals; p less than 0.001). Fractional excretion of silicon (FESi) was significantly increased in chronic renal failure (p less than 0.001), with overall tubular secretion of silicon in 33% of patients. Urinary excretion of silicon was significantly related to urinary calcium excretion (p less than 0.0001) urinary magnesium excretion (p less than 0.0001) creatinine clearance (p less than 0.05) and sodium excretion (p less than 0.05). It is suggested that urinary silicon is in the form of orthosilicate, principally bound to calcium and magnesium; and that in chronic renal failure the increase in FESi, and the decrease in absorbed Si from the gastrointestinal tract, moderate the increase in plasma silicon levels and prevent excessive entry of silicon into the tissues. MH - Adult ; Aged ; Comparative Study ; Glomerular Filtration Rate ; Human ; Kidney/*METABOLISM ; Kidney Failure, Chronic/*METABOLISM ; Male ; Middle Age ; Reference Values ; Silicon/BLOOD/*METABOLISM/URINE SO - Nephron 1986;44(1):36-9 13 UI - 86295149 AU - Teschan PE TI - Clinical estimates of treatment adequacy. AB - Adequacy of rapid, high-efficiency therapies (RHET) in patients with end-stage renal failure involves comparisons with hemodialysis, the primary reference standard. However, the latter's adequacy is also insecurely rendered in descriptive, subjective terms that often embrace outcomes beyond legitimate expectations of the dialysis process. Many measurable abnormalities in renal failure contribute little to patients' clinical illness and respond poorly to dialysis. It is therefore proposed that adequacy for all proposed clinical treatment modalities, including RHET, be based on objective, quantitative measures of what such treatments actually do: control volume and dialyzable solute composition of the body fluids, and suppress the uremic illness. Recognition of the dialysis-responsive--and also disabling--uremic illness as an encephalopathic, neurobehavioral (NB) disorder logically led to objective documentation of quantitative NB impairments that varied inversely with the amount of hemodialysis and improved following renal transplantation. Similar objective documentations of RHET are needed. MH - Blood Urea Nitrogen ; Dietary Proteins/METABOLISM ; Electroencephalography ; Hemodialysis ; Human ; Kidney Failure, Chronic/ *THERAPY ; Male ; Time Factors ; Ultrafiltration SO - Artif Organs 1986 Jun;10(3):201-4 14 UI - 86292945 AU - Feinfeld DA ; Briscoe AM ; Nurse HM ; Hotchkiss JL ; Thomson GE TI - Myoglobinuria in chronic renal failure. AB - Serum and urine myoglobin levels were determined on 14 patients with stable chronic renal failure. Serum myoglobin ranged from 38 to 350 ng/mL. Eleven patients had myoglobinuria between 15 and 250 ng/mL; none developed myoglobinuric renal failure. Fractional excretion of myoglobin in the myoglobinuric patients increased as creatinine clearance decreased, although there was no correlation between filtered load and excretion rate of myoglobin. This confirms that renal failure leads to hypermyoglobinemia and usually to myoglobinuria. Surviving nephrons tend to reabsorb less of the filtered load of myoglobin as renal function diminishes. MH - Glomerular Filtration Rate ; Human ; Kidney Failure, Chronic/BLOOD/ *COMPLICATIONS/PHYSIOPATHOLOGY/URINE ; Myoglobin/BLOOD ; Myoglobinuria/ BLOOD/*ETIOLOGY/PHYSIOPATHOLOGY ; Rhabdomyolysis/*ETIOLOGY SO - Am J Kidney Dis 1986 Aug;8(2):111-4 15 UI - 86292284 AU - Christensen S ; Ottosen PD TI - Lithium-induced uraemia in rats: survival and renal function and morphology after one year. AB - Chronic renal failure was induced in Wistar rats by administration of a LiCl-containing (40 mmol/kg) diet from birth until an age of 55-65 weeks. The 55 weeks mortality was 51% in Li-uraemic rats versus 6% in control rats. In surviving rats the mean plasma Li levels were 0.6-0.7 mmol/l after 16 weeks and 1.0-1.1 mmol/l after 48 weeks. The mean plasma urea level was 14 mmol/l after 16 weeks and 22 mmol/l after 48 weeks of treatment compared with 8 mmol/l in the controls rats. In 55 weeks old Li-uraemic rats inulin clearance was reduced by 62% and Li clearance by 39%. Thus, fractional Li excretion was increased (from 20 to 34%) in rats with chronic Li-uraemia. Li-uraemic rats also had polyuria and failed to concentrate their urine in response to exogenous vasopressin. Systolic and mean arterial blood pressures were not significantly changed in rats with Li-uraemia. Morphological examinations of the kidneys showed large cortical cysts formed by dilated distal tubules and collecting ducts and widespread interstitial fibrosis. Proximal tubular mass was reduced by 50% and glomerular volume was also significantly reduced. The results indicate that in rats with Li-induced uraemia renal function and morphology deteriorate during Li-exposure up to an age of one year, associated with increased mortality. MH - Animal ; Blood Pressure/DRUG EFFECTS ; Glomerular Filtration Rate/DRUG EFFECTS ; Kidney/PATHOLOGY/*PHYSIOPATHOLOGY ; Kidney Concentrating Ability/DRUG EFFECTS ; Kidney Failure, Chronic/*CHEMICALLY INDUCED/ PHYSIOPATHOLOGY ; Lithium/BLOOD/*TOXICITY ; Rats ; Rats, Inbred Strains ; Sodium/METABOLISM ; Uremia/*CHEMICALLY INDUCED/PHYSIOPATHOLOGY SO - Acta Pharmacol Toxicol (Copenh) 1986 May;58(5):339-47 16 UI - 86268170 AU - Rubin J ; Ball R TI - Continuous ambulatory peritoneal dialysis as treatment of severe congestive heart failure in the face of chronic renal failure. Report of eight cases. AB - Eight patients with severe heart failure and renal insufficiency whose conditions were refractory to diuretics were treated by continuous ambulatory peritoneal dialysis. Seven of the eight patients died. Although the patients no longer had uncontrolled congestive heart failure, hospitalization rates failed to improve due to dialysis complications and underlying heart disease. The one long-term survivor was being treated with diuretics alone after peritoneal dialysis was used to control heart failure. Although survival was short after initiation of dialysis (median survival, 225 days), this therapy may merit further study in patients less ill. MH - Aged ; Body Weight ; Female ; Heart Failure, Congestive/COMPLICATIONS/ MORTALITY/PHYSIOPATHOLOGY/*THERAPY ; Human ; Kidney Failure, Chronic/ *COMPLICATIONS/PHYSIOPATHOLOGY ; Kidney Function Tests ; Male ; Middle Age ; *Peritoneal Dialysis, Continuous Ambulatory SO - Arch Intern Med 1986 Aug;146(8):1533-5 17 UI - 86255150 AU - Lucas PA ; Meadows JH ; Roberts DE ; Coles GA TI - The risks and benefits of a low protein-essential amino acid-keto acid diet. AB - Twelve patients with progressive renal failure were placed on a very low protein diet supplemented by an essential amino acid-keto acid mixture for six to twelve months. Total daily intake was 0.04 g nitrogen/kg and 50 kcal/kg. Eight subjects had a significant change in the slope of reciprocal plasma creatinine, becoming less steep and in two cases positive. GFR did not improve, but in four patients the decline over twelve months was less than 0.5 mliter/min. There were significant falls in blood and urinary urea, serum phosphate PTH and calcium X phosphate product. Body wt decreased during the first three months. Arm muscle circumference fell by 0.9 cm (P less than 0.005). Serum albumin and transferrin levels did not change significantly. Muscle mass and plasma creatinine fell simultaneously in several patients. Creatinine excretion per kg muscle mass, assessed anthropometrically, declined by 21% in the first three months. This diet may slow the decline in renal function in a proportion of patients. However, muscle mass can be lost. Serum protein levels do not accurately reflect nutritional changes. A fall in plasma creatinine may not be due to improved GFR but instead to altered creatinine metabolism. MH - Adult ; Amino Acids, Essential/*ADMINISTRATION & DOSAGE ; Body Weight ; Creatinine/BLOOD ; Dietary Proteins/*ADMINISTRATION & DOSAGE ; Female ; Glomerular Filtration Rate ; Human ; Keto Acids/*ADMINISTRATION & DOSAGE ; Kidney/PHYSIOPATHOLOGY ; Kidney Failure, Chronic/*DIET THERAPY/ PHYSIOPATHOLOGY ; Male ; Middle Age ; Muscles/ANATOMY & HISTOLOGY ; Risk ; Skinfold Thickness ; Support, Non-U.S. Gov't ; Time Factors SO - Kidney Int 1986 May;29(5):995-1003 18 UI - 86254005 AU - Manley M ; Sweeney J TI - Assessment of compliance in hemodialysis adaptation. AB - Research in hemodialysis adaptation has been facilitated by the use of reliable outcome measures such as BUN, K, and interdialysis weight gain. Their use, however, has at times been impressionistic, without reference to the actual range and distribution of those markers in a large population of dialysis patients over a long period of time. This study is a retrospective review to determine that range and distribution at one center. We found the interdialysis weight gains for most patients to be much higher than the levels used in the literature as cut-off points in determining 'non-compliance'. High levels on non-compliance in previous reports may be inflated. Significant correlations among the three biological markers and between each marker and staff assessment of compliance validate the use of inter-dialysis weight gain. Suggestions are made for interpreting such data in the future. MH - *Adaptation, Psychological ; Adult ; Blood Urea Nitrogen ; Body Weight ; Female ; Hemodialysis/*PSYCHOLOGY ; Human ; Kidney Failure, Chronic/ *PSYCHOLOGY ; Male ; *Patient Compliance ; Potassium/BLOOD ; Seasons SO - J Psychosom Res 1986;30(2):153-61 19 UI - 86253440 AU - Cole BR ; Schwartz D ; Manning PT ; Katsube NC ; Needleman P TI - Atriopeptins: circulating volume regulatory hormones with potential therapeutic role in chronic renal failure. AB - Sprague-Dawley rats given bolus intravenous injections of vasoconstrictors, including 1-deamino-Arg8-vasopressin (dAVP), demonstrated remarkable increases in plasma immunoreactivity (APir) to atriopeptin (AP). These elevations were accompanied by increases in systemic blood pressure, right atrial pressure and urinary volume excretion. Fractionated plasma APir peaks obtained by stimulation with dAVP were identified as primarily AP 28, with a smaller amount of AP 24, suggesting that AP 28 is the predominant circulating atrial peptide. Rats with reduced renal mass have increased single-nephron glomerular filtration rates (GFR). Despite these increases, AP 24 stimulated a marked increase in total GFR and promoted a profound natriuresis and diuresis. Atriopeptin 24 may therefore have potential as a therapeutic tool in the management of volume overload in chronic renal failure. MH - Animal ; Blood Pressure/DRUG EFFECTS ; Comparative Study ; Glomerular Filtration Rate/DRUG EFFECTS ; Kidney Failure, Chronic/*DRUG THERAPY ; Natriuresis/DRUG EFFECTS ; Natriuretic Peptides, Atrial/BLOOD/ *PHARMACODYNAMICS/THERAPEUTIC USE ; Peptide Fragments/BLOOD/ PHARMACODYNAMICS/THERAPEUTIC USE ; Rats ; Rats, Inbred Strains ; Stimulation, Chemical ; Support, Non-U.S. Gov't ; Vasoconstrictor Agents/ PHARMACODYNAMICS SO - J Hypertens [Suppl] 1986 Jun;4(2):S13-6 20 UI - 86246093 AU - Wilkins MR ; Wood JA ; Adu D ; Lote CJ ; Kendall MJ ; Michael J TI - Change in plasma immunoreactive atrial natriuretic peptide during sequential ultrafiltration and haemodialysis. AB - Plasma immunoreactive human atrial natriuretic peptide (Ir-ANP) levels were measured in eight patients with chronic renal failure who were volume-expanded and during treatment by sequential ultrafiltration and haemodialysis. One patient was studied at two separate treatment sessions. Plasma Ir-ANP levels were raised in all patients (mean +/- SE 184 +/- 44 pmol/l, n = 9) compared with healthy controls (11 +/- 1.4 pmol/l), but showed considerable inter-patient variability. Plasma Ir-ANP levels fell with fluid removal during ultrafiltration (123 +/- 30 pmol/l, n = 9, P less than 0.02) and again as fluid was removed during haemodialysis (76 +/- 20 pmol/l, n = 9, P less than 0.02). Seven patients studied 48 h later, before their next dialysis treatment, had regained weight and showed a coincident rise in circulating plasma Ir-ANP (130 +/- 33 pmol/l, n = 7). Our data would support the hypothesis that the secretion of ANP is determined by volume or by a stimulus related to volume. However, it does not exclude the possibility that a factor other than extracellular fluid volume expansion contributes to the raised plasma Ir-ANP levels in chronic renal failure. MH - Adult ; Argipressin/BLOOD ; *Blood ; Blood Pressure ; Blood Urea Nitrogen ; Body Weight ; Female ; *Hemodialysis ; Human ; Kidney Failure, Chronic/ *BLOOD/THERAPY ; Male ; Middle Age ; Natriuretic Peptides, Atrial/*BLOOD ; Osmolar Concentration ; Potassium/BLOOD ; Radioimmunoassay ; Sodium/ BLOOD ; *Ultrafiltration SO - Clin Sci 1986 Aug;71(2):157-60 21 UI - 86239312 AU - Kirschbaum BB TI - Analysis of reciprocal creatinine plots in renal failure. AB - The linearity that has frequently been observed when the reciprocal of the serum creatinine is plotted against time of follow-up has been used to predict the future course of patients with renal disease. In the present study, we have analyzed reciprocal creatinine plots with a computer program that identifies breakpoints in a linear plot and calculates the statistical significance of the fit provided by two intersecting lines instead of a single straight line. When applied to cases of chronic renal failure, the program revealed breakpoints that were not temporally related to recognized major clinical events. The computer program may prove useful for evaluating the validity of data derived from clinical trials of therapies to moderate the course of declining kidney function. MH - Adolescence ; Adult ; Case Report ; Creatinine/*BLOOD ; Female ; Human ; Kidney Failure, Chronic/*BLOOD/DIAGNOSIS ; Kidney Function Tests ; Male ; Middle Age ; Regression Analysis ; Retrospective Studies ; Time Factors SO - Am J Med Sci 1986 Jun;291(6):401-4 22 UI - 86235258 AU - Jacobsen BA ; Fjeldborg P TI - Renal haemodynamics during propranolol treatment in patients with arterial hypertension and chronic renal failure. AB - The effect of propranolol on renal haemodynamics was studied in nine patients with arterial hypertension and moderate to severe chronic renal failure. A reduction of the renal function in this type of patient might have clinical consequence. The patients, whose glomerular filtration rate (GFR) ranged between 17 ml/min/1.73 m2 and 71 ml/min/1.73 m2, were studied during three 4-week periods with alternately placebo, propranolol (40 mg b.i.d.) and placebo treatment. The GFR and the effective renal plasma flow (ERPF) were determined as the plasma clearance of 51Cr-EDTA and 125I-hippurane. The GFR fell on the average 7% (95% confidence limits: 1-12%) during propranolol treatment, and the fall was reversible. No changes were found in ERPF. In conclusion, propranolol treatment in this type of patient causes a modest and reversible fall of GFR. MH - Adult ; Female ; Glomerular Filtration Rate/DRUG EFFECTS ; Human ; Hypertension/*DRUG THERAPY/PHYSIOPATHOLOGY ; Kidney Failure, Chronic/ *DRUG THERAPY/PHYSIOPATHOLOGY ; Male ; Middle Age ; Propranolol/ *THERAPEUTIC USE ; Renal Circulation/*DRUG EFFECTS ; Support, Non-U.S. Gov't SO - Scand J Clin Lab Invest 1986 May;46(3):289-92 23 UI - 86228665 AU - ter Wee PM ; Rosman JB ; van der Geest S ; Sluiter WJ ; Donker AJ TI - Renal hemodynamics during separate and combined infusion of amino acids and dopamine. AB - Healthy volunteers (N = 9) and patients with varying degrees of renal insufficiency (N = 36) were given a low dose of dopamine and/or amino acids intravenously during a simultaneous measurement of the glomerular filtration rate and the effective renal plasma flow. Dopamine infusion led to a rise in the glomerular filtration rate and a fall in the filtration fraction. Infusion of amino acids was accompanied by an increase in the glomerular filtration rate while the filtration fraction remained unchanged or increased slightly. The highest values for the glomerular filtration were obtained during the combined infusion of amino acids and dopamine. A reserve in filtration capacity was not or hardly present in patients with moderate (GFR 30 to 90 mliter/min/1.73 M2) to severe (GFR less than 30 mliter/min/1.73 M2) renal insufficiency. We conclude that dopamine decreases total renal vascular resistance while amino acids mainly reduce the tone of afferent arterioles. As amino acids and dopamine seem to be additive in their effects on the glomerular filtration rate, we recommend the combined infusion of these two stimuli to measure renal reserve filtration capacity. MH - Amino Acids/*THERAPEUTIC USE ; Dopamine/*THERAPEUTIC USE ; Drug Therapy, Combination ; Glomerular Filtration Rate/DRUG EFFECTS ; Hemodynamics/ *DRUG EFFECTS ; Human ; Infusions, Parenteral ; Kidney Failure, Chronic/ *DRUG THERAPY ; Renal Circulation/*DRUG EFFECTS ; Rheology ; Support, Non-U.S. Gov't ; Urodynamics/DRUG EFFECTS SO - Kidney Int 1986 Apr;29(4):870-4 24 UI - 86227842 AU - Cohen JR ; Mannick JA ; Couch NP ; Whittemore AD TI - Abdominal aortic aneurysm repair in patients with preoperative renal failure. AB - The purpose of this study was to determine the effect of preoperative renal failure on the outcome of patients undergoing infrarenal abdominal aortic aneurysm (AAA) repair. Of 251 patients undergoing AAA repair from 1977 to 1984, 10% had evidence of preoperative chronic renal failure. These patients were classified according to their preoperative serum creatinine values; group I had preoperative creatinine levels of 2 to 4 mg/dl, group II had creatinine levels greater than 4 mg/dl but no history of hemodialysis, and group III consisted of patients on chronic hemodialysis before operation. One of 16 patients in group I developed transient high-output renal failure postoperatively. Four of the six patients in group II (67%) developed significant postoperative deterioration of renal function and required acute hemodialysis. Of the four patients in group III maintained on chronic hemodialysis preoperatively, one died of sepsis from an ischemic colon. This experience suggests that patients with mild renal dysfunction (serum creatine value less than 4 mg/dl) can undergo elective AAA repair without additional morbidity. Patients on hemodialysis before operation can also safely undergo surgical repair of their AAAs electively if dialyzed the day before operation. Patients with severe renal dysfunction (serum creatinine greater than 4 mg/dl) who are not on hemodialysis should be considered for dialysis preoperatively in an attempt to reduce the high incidence of serious postoperative renal functional deterioration and subsequent morbidity. MH - Aorta, Abdominal/SURGERY ; Aortic Aneurysm/COMPLICATIONS/*SURGERY ; Creatinine/DIAGNOSTIC USE ; Hemodialysis ; Human ; Kidney Failure, Chronic/*COMPLICATIONS/THERAPY ; Kidney Function Tests ; Postoperative Complications/*ETIOLOGY/THERAPY ; Preoperative Care ; Retrospective Studies ; Risk SO - J Vasc Surg 1986 Jun;3(6):867-70 25 UI - 86191020 AU - Mistry CD ; Lote CJ ; Currie WJ ; Vandenburg M ; Mallick NP TI - Effects of sulindac on renal function and prostaglandin synthesis in patients with moderate chronic renal insufficiency. AB - The renal effects of therapeutic doses of sulindac were studied in nine patients with stable renal insufficiency, mean creatinine clearance 37.0 +/- 2.2 ml min-1 1.73 m-2 (range 24.7-54.6 ml min-1 1.73 m-2). Nine days' treatment with sulindac produced a small, but significant, reduction in the mean creatinine clearance (37.0 +/- 2.2 to 34.7 +/- 2.2 ml min-1 1.73 m-2; P less than 0.02) and 99mTc diethylenetriaminepenta-acetate (DTPA) clearance (35.5 +/- 3.4 to 31.4 +/- 3.6 ml min-1 1.73 m-2; P less than 0.02) without altering body weight, effective renal plasma flow [131I]hippuran clearance), plasma renin activity (PRA), 24 h urinary volume or electrolyte excretion. After discontinuation of sulindac, creatinine clearance returned to pretreatment values. In five female patients, pretreatment urinary excretion of the 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha), a stable breakdown product of prostacyclin (PGI2), was significantly reduced (P less than 0.02) when compared with four healthy controls, whereas prostaglandin E2 (PGE2) was unchanged. Administration of sulindac did not significantly alter the excretion rate of PGE2 or 6-ketoPGF1 alpha in this group of patients. In chronic renal disease with moderate renal impairment, reduced renal prostacyclin synthesis may be an important predisposing factor to the renal toxicity associated with the use of non-steroidal anti-inflammatory drugs (NSAID). Short term use of sulindac in therapeutic doses does not appear to influence the excretion of prostaglandins and produces only a minor reversible change in renal function; used cautiously it may have advantages over other NSAID in these patients. MH - Adult ; Creatinine/URINE ; Female ; Glomerular Filtration Rate ; Human ; Indenes/*THERAPEUTIC USE ; Kidney/BLOOD SUPPLY/PHYSIOPATHOLOGY ; Kidney Failure, Chronic/*DRUG THERAPY/PHYSIOPATHOLOGY ; Male ; Prostaglandins/ *URINE ; Prostaglandins E/URINE ; Renin/BLOOD ; Sulindac/*THERAPEUTIC USE ; Support, Non-U.S. Gov't ; 6-Ketoprostaglandin F1 alpha/URINE SO - Clin Sci 1986 May;70(5):501-5 26 UI - 86214888 AU - Craswell PW ; Price J ; Boyle PD ; Heazlewood VJ ; Baddeley H ; Lloyd HM ; Thomas BJ ; Thomas BW ; Williams GM TI - Chronic lead nephropathy in Queensland: alternative methods of diagnosis. AB - Indices of past lead absorption were measured and compared in patients with chronic renal failure from many causes, including some with chronic lead nephropathy. X-ray fluorescence (XRF) yielded finger bone lead concentrations by a new in vivo method. These correlated significantly with excess urinary lead following calcium di-sodium EDTA (ethylenediamine tetra-acetate) and erythrocyte lead concentration. Discriminant function analysis demonstrated that the patients in the study could be separated into two groups without any reference to the EDTA lead excretion test using the following variables, all of which contributed significantly to the discrimination. In order of importance, these were: a childhood history of acute lead poisoning, a history of gout, a family history of gout and detectable XRF finger bone lead. Although the XRF finger bone lead measurement is convenient and non-invasive, its lack of sensitivity (48%) limits its usefulness as a screening test for chronic lead nephropathy. MH - Aged ; Bone and Bones/ANALYSIS ; Comparative Study ; EDTA/DIAGNOSTIC USE ; Female ; Gout/FAMILIAL & GENETIC ; Human ; Kidney/METABOLISM/ PHYSIOPATHOLOGY ; Kidney Failure, Chronic/CHEMICALLY INDUCED/*DIAGNOSIS/ METABOLISM ; Kidney Function Tests ; Lead/ANALYSIS/METABOLISM ; Lead Poisoning/*DIAGNOSIS/METABOLISM/PSYCHOLOGY ; Male ; Middle Age ; Psychological Tests ; Spectrometry, X-Ray Emission ; Support, Non-U.S. Gov't SO - Aust NZ J Med 1986 Feb;16(1):11-9 27 UI - 86212748 AU - Friend R ; Singletary Y ; Mendell NR ; Nurse H TI - Group participation and survival among patients with end-stage renal disease. AB - All 126 End-Stage Renal Disease (ESRD) patients who entered dialysis between 1971 and 1981 at the Harlem Hospital Center, New York City, were separated into those who had participated in a patient support group and those who had not done so. Patients who engaged in the group activities survived considerably longer than non-participants. Family history of renal disease, psychiatric illness, blood urea nitrogen (BUN), and creatinine were also related to survival, but, education, religion, marital status, and age were not. When 13 psychosocial and physiological covariates were controlled for in a Cox proportional hazard analysis, the group participation effect remained substantial. MH - Blood Urea Nitrogen ; Comparative Study ; Creatinine/ISOLATION & PURIFICATION ; Educational Status ; Female ; *Hemodialysis ; Human ; Kidney Failure, Chronic/COMPLICATIONS/ETIOLOGY/*PSYCHOLOGY/THERAPY ; Longevity ; Male ; Mental Disorders/COMPLICATIONS/FAMILIAL & GENETIC ; Middle Age ; Prognosis ; *Social Environment ; *Social Support ; Urban Population SO - Am J Public Health 1986 Jun;76(6):670-2 28 UI - 86205594 AU - Eknoyan G TI - Chronic renal failure. The primary care physician's role. AB - Recent developments in understanding of the pathophysiology of chronic renal failure have provided a sound basis for several measures which, when instituted early in the course of renal disease, can delay progression to end-stage kidney disease and considerably improved the symptoms of uremic syndrome. This article outlines the key role that the primary care physician plays in early diagnosis of chronic renal disease and institution of appropriate therapy well before the nephrologist's services are needed. MH - Absorption ; Blood Urea Nitrogen ; Calcium/THERAPEUTIC USE ; Creatinine/ ISOLATION & PURIFICATION ; Dietary Proteins/ADMINISTRATION & DOSAGE ; Glomerular Filtration Rate ; Hemoglobins ; Homeostasis ; Human ; Hypertension/ETIOLOGY ; Kidney Failure, Chronic/COMPLICATIONS/ETIOLOGY/ *PHYSIOPATHOLOGY/THERAPY ; Kidney Glomerulus/PATHOLOGY ; Patient Education ; Social Support ; Uremia/ETIOLOGY/PHYSIOPATHOLOGY SO - Postgrad Med 1986 May 1;79(6):221-6, 228-30 29 UI - 86201321 AU - Kopple JD ; Monteon FJ ; Shaib JK TI - Effect of energy intake on nitrogen metabolism in nondialyzed patients with chronic renal failure. AB - Dietary energy requirements were evaluated during 16 studies that were carried out in six clinically stable nondialyzed chronically uremic patients who lived in a clinical research center and were fed diets providing 45, 35, 25 or 15 kcal/kg/day. Each diet was fed for 23.7 +/- 5.7 SD days and provided about 0.55 to 0.60 g protein/kg/day. Nitrogen balance after equilibration and adjusted for changes in body urea nitrogen, and change in body weight each correlated directly with energy intake. Correcting for estimated unmeasured nitrogen losses of about 0.58 g/day, nitrogen balance was negative in one of four patients fed 45 kcal/kg/day, one of five patients receiving 35 kcal/kg/day, three of five patients ingesting 25 kcal/kg/day and both patients fed 15 kcal/kg/day. The urea nitrogen appearance (UNA), the UNA divided by nitrogen intake, and several plasma amino acids, determined after an overnight fast, each correlated inversely with dietary energy intake. Resting energy expenditure measured by indirect calorimetry did not differ from normal and averaged 0.012 +/- 0.0033 kcal/kg/min with the different diets. These observations suggest that although some clinically stable nondialyzed chronically uremic patients ingesting 0.55 to 0.60 g protein/kg/day may maintain nitrogen balance with energy intakes below 30 kcal/kg/day, a dietary intake providing approximately 35 kcal/kg/day may be more likely to maintain neutral or positive nitrogen balance, maintain or increase body mass, and reduce net urea generation. MH - Amino Acids/BLOOD ; Blood Proteins/METABOLISM ; Blood Urea Nitrogen ; Body Weight ; *Caloric Intake ; Dietary Proteins/*ADMINISTRATION & DOSAGE ; Energy Metabolism ; Female ; *Hemodialysis ; Human ; Kidney Failure, Chronic/*DIET THERAPY/METABOLISM ; Male ; Middle Age ; Nitrogen/ *METABOLISM ; Skinfold Thickness ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, Non-P.H.S. ; Support, U.S. Gov't, P.H.S. SO - Kidney Int 1986 Mar;29(3):734-42 30 UI - 86201311 AU - Lumlertgul D ; Burke TJ ; Gillum DM ; Alfrey AC ; Harris DC ; Hammond WS ; Schrier RW TI - Phosphate depletion arrests progression of chronic renal failure independent of protein intake. AB - Following 5/6 nephrectomy, 18 rats were fed a normal diet. After 30 days, serum creatinine (SCr), urine protein excretion and urine volume were increased compared to pre-nephrectomy (0.27 +/- 0.1 vs. 1.62 +/- 0.6 mg/deciliter, 17.0 +/- 10.3 vs. 257.6 +/- 13.4 mg/24 hr, and 16.6 +/- 4.4 vs. 39.2 +/- 11.7 ml/24 hr, respectively, all P less than 0.001). At this time, when serum phosphorus (SPi) and serum calcium (SCa2+) were normal, the rats were separated into two groups, matched and paired by body weight and SCr, and housed separately in metabolic cages. Animals of one group ingested a normal diet supplemented with dihydroxyaluminum aminoacetate (DHAAA), 15 g%, to induce phosphate depletion (PD). The second group ingested the same diet supplemented with 7.5% glycine and was the phosphate replete (PR) group. All rats were pair fed throughout the study to maintain similar caloric, protein, carbohydrate, vitamin, and mineral intakes. At six weeks after separation, SPi was decreased in PD vs. PR group (2.85 +/- 0.8 vs. 6.71 +/- 1.2 mg/deciliter, P less than 0.001) and SCa2+ was increased in the PD group (11.98 +/- 0.7 vs. 10.03 +/- 0.7 mg/deciliter, P less than 0.001). Urine urea nitrogen, body weight, and sodium, potassium and solute excretion were similar between the groups.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Aluminum Hydroxide/ADMINISTRATION & DOSAGE ; Animal ; Blood Pressure ; Blood Urea Nitrogen ; Calcium/BLOOD ; Cholesterol/BLOOD ; Creatinine/ BLOOD ; Dietary Proteins/*ADMINISTRATION & DOSAGE ; Food ; Glycine/ ANALOGS & DERIVATIVES/ADMINISTRATION & DOSAGE ; Kidney Failure, Chronic/ BLOOD/*DIET THERAPY ; Male ; Nephrectomy ; Phosphates/*ADMINISTRATION & DOSAGE ; Phosphorus/BLOOD ; Rats ; Rats, Inbred Strains ; Serum Albumin/ ANALYSIS ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, Non-P.H.S. ; Triglycerides/BLOOD SO - Kidney Int 1986 Mar;29(3):658-66 31 UI - 86196850 AU - Garg DC ; Baltodano N ; Jallad NS ; Perez G ; Oster JR ; Eshelman FN ; Weidler DJ TI - Pharmacokinetics of ranitidine in patients with renal failure. AB - The pharmacokinetics of ranitidine were studied in ten patients with renal failure (creatinine clearance, 6-54 mL/min) after intravenous (IV) (50 mg) and oral doses (150 mg). After oral administration, peak plasma concentrations of 378-808 ng/mL were obtained in two to six hours. Plasma concentrations declined very slowly and concentrations greater than 100 ng/mL were obtained for 16 to 20 hours after the dose. The elimination half-life following oral administration was 8.5 +/- 2.8 hours (standard deviation [SD]), and the bioavailability of ranitidine was 43.3% +/- 10.5%. After IV administration, the elimination half-life, plasma clearance, renal clearance, and volume of distribution were 7.0 +/- 1.0 hours, 170 +/- 38 mL/min, 36.0 +/- 25.0 mL/min, and 1.3 +/- 0.4 L/kg, respectively. About 20% of the IV dose and 9% of the oral dose were recovered unchanged in urine. There was a significant correlation between the renal clearance of ranitidine and creatinine clearance (r = .74, P less than .05) after IV administration. The elimination half-life in patients with renal insufficiency is about three times greater than that reported in the literature for healthy subjects. Similarly, the plasma clearance in these patients is about 20% of that reported in healthy subjects. The results indicate that ranitidine elimination is appreciably reduced in renal failure and that an adjustment of dose in patients with renal failure is warranted. A dose of 75 mg bid may be adequate in maintaining the therapeutic plasma concentrations that are required for adequate H2-blocking activity. MH - Aged ; Biological Availability ; Blood Urea Nitrogen ; Creatinine/BLOOD ; Half-Life ; Human ; Infusions, Parenteral ; Kidney Failure, Chronic/ *BLOOD ; Kinetics ; Male ; Metabolic Clearance Rate ; Middle Age ; Ranitidine/*BLOOD SO - J Clin Pharmacol 1986 Apr;26(4):286-91 32 UI - 86190714 AU - Yamauchi A ; Fujii M ; Shirai D ; Mikami H ; Okada A ; Imai E ; Ando A ; Orita Y ; Kamada T TI - Plasma concentration and peritoneal clearance of oxalate in patients on continuous ambulatory peritoneal dialysis (CAPD). AB - Accumulation of oxalate, resulting in high plasma levels, is a common finding in end-stage renal disease. We investigated plasma concentration and peritoneal clearance of oxalate in 14 patients on continuous ambulatory peritoneal dialysis. The plasma oxalate levels in these patients (30.2 +/- 11.2 mumol/l) were as high as those in hemodialysis patients before dialysis (31.9 +/- 11.1 mumol/l). There was a significant correlation between plasma oxalate and urea nitrogen appearance (UNA). Dietary protein seems to be an important oxalate source in these patients, because the UNA reflects protein intake in stable patients. The mean peritoneal oxalate clearance was 6.64 +/- 1.56 l/day, close to the creatinine clearance. These results suggest that the plasma oxalate levels in CAPD patients may be sufficiently high to induce calcium oxalate deposition, and that methods of increasing oxalate removal and reducing oxalate burden are necessary for CAPD patients. MH - Adolescence ; Adult ; Aged ; Blood Urea Nitrogen ; Comparative Study ; Dietary Proteins/ADMINISTRATION & DOSAGE ; Female ; Hemodialysis ; Human ; Kidney Failure, Chronic/BLOOD/*THERAPY ; Male ; Middle Age ; Oxalates/ *BLOOD/METABOLISM ; *Peritoneal Dialysis, Continuous Ambulatory SO - Clin Nephrol 1986 Apr;25(4):181-5