Renal Function Test Results Research Articles

Cardiac Transplant Patient at One Year: Cyclosporine vs Conventional Immunosuppression

From March 1, 1979 thru September 30, 1984 we performed 56 cardiac transplants (Tx). The first 32 patients received conventional immunosuppression therapy consisting of azathioprine/prednisone (I/P), while the subsequent 24 patients received cyclosporine/prednisone (C/P). Twenty-one of 32 I/P patients ages 39 +/- 3 years (SEM), and 16 of 24 eligible C/P patients ages 36 +/- 3 years, survived one year with follow-up through September 30, 1985. The one year post-transplant course of these 37 patients was evaluated by chart review. While donor ages are similar, ischemic time was shorter in the conventionally treated patients. The initial hospital stay for I/P vs C/P was 67 +/- 6 vs 33 +/- 3 days (p less than .05), at a total cost of $49,900 +/- $5,800 vs $53,800 +/- $10,000. During the first year following transplantation, the I/P patients required an additional 34 +/- 7 days of hospitalization, while C/P patients required 16 +/- 10 days. Over the first year, the number of infections and rejections differed at 2.8 +/- 0.6 per I/P patient vs 1.2 +/- 0.3 per C/P patient, and 2.5 +/- 0.4 per patient vs 1.5 +/- 0.3 per patient respectively (p less than .05). Renal function test results were better in the I/P group. Results of cardiac catheterization performed at one year were similar except for cardiac index and stroke volume index, both being higher in the C/P group. Coronary anatomy was considered normal in all. These data indicate that while overall survival is similar, a shortened post-transplant hospital course with fewer necessary hospitalizations, rejection episodes and infection episodes characterizes the first year in survivors receiving C/P immunosuppression. While both groups had multiple hemo-dynamic abnormalities as compared to normal subjects, cardiac index and stroke volume index were improved in the C/P group. Therapy with C/P represents an advance in immunosuppression for cardiac transplantation as compared to I/P; however, decreased renal function and diastolic hypertension were problems in the C/P group.

Treatment of acute gout with oxaprozin

Fifty patients with acute gouty arthritis entered into an 8-day multicenter open study designed to evaluate the efficacy and safety of Oxaprozin, a new nonsteroidal antiinflammatory drug (NSAID). Patients received 1,800 mg of Oxaprozin daily in two divided doses (1,200 mg in the morning and 600 mg in the evening) for 2 days, followed by 1,200 mg daily until pain was relieved. Based on evaluation of pain intensity recorded on patient diary cards, 84% of the patients ( P < .001) showed improvement during the 24 hours after receiving at least 2 doses (1,800 mg) of Oxaprozin. At the final clinical visit, 93% reported improvement ( P < .001 ). Fourteen patients reported adverse effects, but only two discontinued treatment for that reason. Five patients discontinued because of an unsatisfactory response. A significant decrease ( P < .001) from baseline occurred in mean total leukocyte count by the eighth day, probably due to the antiinflammatory effect of Oxaprozin. No clinically significant changes in renal or hepatic function test results or vital signs were observed. Oxaprozin was found to be effective and safe in the treatment of patients with acute gout.

EFFECTS OF TRIAMTERENE AND AMILORIDE ON URINARY SEDIMENT IN HYPERTENSIVE PATIENTS TAKING HYDROCHLOROTHIAZIDE

In a crossover study of 26 hypertensive patients, the effects of triamterene (50 mg/day) and amiloride (5 mg/day) on urinary sediment were compared. Each drug was given for one month and all patients also received hydrochlorothiazide (50 mg/day). An abnormal urinary sediment—evident grossly as a reddish-brown precipitate after routine staining procedures and microscopically as characteristic reddish-brown crystals and casts, as previously described—was identified in 14 of 26 (54%) triamterene urine samples but in none of the amiloride samples. Results of renal function tests were similar for both drugs. In a clinic population of more than 1000 hypertensive patients over 4 years, interstitial nephritis was diagnosed in 4, all of whom were taking a triamterene-containing combination diuretic. It is possible that triamterene is a factor in the aetiology of interstitial nephritis.

Reversible Renal Failure

To the Editor. —We read with interest the article by Chrysant et al in the MarchArchives(1983;143:437-441). We also recently observed the development of acute reversible renal failure in a patient. Report of a Case. —A 30-year-old woman had high-grade bilateral renal artery stenosis. She was judged inoperable in December 1976, and she was treated conservatively for four years with 10 mg of minoxidil three times a day, 40 mg of propranolol hydrochloride three times a day, 10 mg of amiloride hydrochloride, and 50 mg/day of hydrochlorothiazide. With this drug regimen her BP ranged between 140 to 160 mm Hg (systolic) and 85 to 95 mm Hg (diastolic) and renal function test results were in the normal range. In January 1983, because of severe hirsutism, the minoxidil dosage was tapered to 2.5 mg three times a day, and therapy with captopril (25 mg twice a day) was added. Seven

Evaluation of exocrine pancreatic function by oral administration of N-benzoyl-L-tyrosyl-p-aminobenzoic acid (PFD test) in primary diabetes mellitus.

Exocrine pancreatic function was evaluated in patients with primary diabetes mellitus by oral administration of N-benzoyl-L-tyrosyl-p-aminobenzoic acid (pancreatic function diagnostic test, PFD test) and p-aminobenzoic acid (PABA absorption test). In both primary diabetes mellitus and chronic pancreatitis, the mean excretion of PABA in the urine in the PFD test was significantly less than in the controls, and in 19 of 31 (61.3%) patients with primary diabetes mellitus and 11 of 12 (91.7%) patients with chronic pancreatitis there was a low PABA excretion rate. In contrast, the mean excretion of PABA in the urine in the PABA absorption test was significantly less in those with primary diabetes mellitus than in the controls. Therefore, to detect disturbances of pancreatic exocrine function in patients with primary diabetes mellitus, differences in the excretion of PABA in the urine between PFD test and PABA absorption test should be calculated. According to this method, the rate of abnormality was 12.9% in primary diabetes mellitus and 100% in chronic pancreatitis. There was a significant correlation between the excretion of PABA in the urine in the PFD test and results of renal function tests in primary diabetic patients with a normal range of serum creatinine levels. The serum PABA levels in the PFD test remained high in patients with primary diabetes mellitus and decreased in cases of chronic pancreatitis, as compared with the controls.

Effect of multidose therapy on cerebrospinal fluid penetration of cefazolin

The relationship between serum concentrations and cerebrospinal fluid (CSF) concentrations of cefazolin, and the association between these concentrations and neurotoxic reactions, were investigated. Samples of serum and spinal fluid were drawn simultaneously from six patients at the steady state on various dosages of cefazolin sodium for different conditions. The dose, dosing interval, number of doses, results of renal function tests, and signs of neurotoxicity, such as muscle twitches, confusion, and seizures, were recorded. The concentrations of cefazolin in the serum and CSF, total serum protein, and percent albumin were determined. Five of the six patients given multiple doses of cefazolin sodium had notable CSF accumulation of the drug (11.3 +/- 2.7% of the serum concentration). Three patients experienced generalized focal-motor seizures during their therapy. Neurotoxicity was found to be associated with renal dysfunction and multiple-dose therapy leading to serum concentrations greater than 360 micrograms/ml and CFS concentrations greater than 34 micrograms/ml. Cefazolin will penetrate into the CSF in patients receiving multiple-dose therapy of the drug. To avoid neurotoxicity, careful attention should be paid to the recommended dosage regimens, the impact of renal dysfunction on drug clearance should be recognized, and serum assays should be performed when necessary.

Acute and short-term toxicity studies on erythrosine BS in rodents

The 7-day LD 50 values for Erythrosine BS were similar in both sexes of rats and mice at 6·7–7·4 g/kg after a single oral administration and 0·32–0·40 g/kg following an ip injection. Erythrosine BS was given to groups of 15 male and 15 female rats at dietary concentrations of 0 (control), 0·25, 0·5, 1·0 or 2·0% for 13 wk. There were no effects attributable to treatment on the rate of body-weight gain, food intake, results of haematological examinations, serum analyses or renal function tests. The main findings in the study were caecal distension at all treatment levels, an increase in thyroid weight and pigmentation of the kidney tubules. The pigmentation was found in both sexes at the highest level and in males given 0·5 or 1·0% Erythrosine BS. The no-untoward-effect level was 0·25% of the diet, equivalent to an intake of 160–170 mg/kg/day.

Studies on Correlation between Renal Biopsy Findings and Renal Function Tests in Several Diseases.

1. Kidney biopsy findings in 30 patients with essential hypertension, 20 patients with acuteor chronic nephritis and 2 patients with arteriolosclerosis have been compared with clinical and laboratory findings and the results of discrete renal function tests. As the result, particular attension was given to the correlation between glomerular changes and GFR, minimal blood pressure and presence of red cell in urinary sediment ; between arteriolar changes in the kidney and RPF and retinal findings ; between tubular changes and NPN; between glomerular, tubular and arteriolar changes and NPN, retinal findings and serum-mucoprotein. 2. Kidney biopsy findings in 11 patients with diabetes mellitus have been compared with the clinical and laboratory findings and the results of discrete renal function tests. In 7 cases the biopsy specimen revealed solely diffuse glomerular changes ; in 2 cases nodular-diffuse changes ; and in 1 case hyalinized glomeruli with remnants of nodules ; in 1 case the biopsy showed normal renal tissue. Biopsy of the kidney has some diagnostic value in diabetic nephropathy. 3. Kidney biopsy findings in 3 patients with systemic lupus erythematosus (sLE), 2 patients with diffuse scleroderma and 1 patient with multiple exsudative erythema have been compared with the clinical findings and renal function tests. In 1 case of sLE biopsy specimen revealed wire loop lesion ; in 2 cases glomerular changes. In 2 cases of diffuse scleroderma biopsy findings revealed solely glomerular changes ; in multiple exsudative erythema showed normol renal tissue.

Diabetic nephropathy: Kidney biopsy and renal function tests

Kidney biopsy findings in twelve patients with diabetes mellitus have been compared with the clinical and laboratory findings in these cases, and the results of discrete renal function tests. In six cases the biopsy specimen revealed solely diffuse glomerular changes; in four cases nodular-diffuse changes; and in one case completely hyalinized glomeruli with remnants of nodules; in one case the biopsy showed normal renal tissue in a patient in whom the further course of the disease showed that the renal symptoms must have been due to cardiac failure. The kidney biopsy method made possible correction of clinically misdiagnosed diabetic nephropathy in one case, and in four cases which did not show definite clinical signs of diabetic renal disease it revealed the presence of glomerular changes (diffuse in three cases and nodular-diffuse in one case). Biopsy of the kidney, therefore, has some diagnostic value in diabetic nephropathy. Its value in the differential diagnosis of chronic pyelonephritis, on the other hand, seems to be very limited. The present kidney biopsy experience apparently supports the theory that diabetic nephropathy originates as diffuse hyalinization in the basement membranes of the glomerular tufts, and that the nodular changes may be considered a further development of the diffuse form. The discrete renal function tests, which do not per se permit any safe diagnostic conclusions with regard to the degree and nature of diabetic nephropathy, seem to indicate that glomeruli with rather pronounced changes of diabetic origin, at least in some instances, have a higher filtration capacity than might be supposed from the histologic picture.