Serum Creatinine Levels In Group Research Articles

Effect of Vitamin E on Serum Creatinine level on Gentamicin Induced Nephrotoxicity in Long Evans rats

Background: The kidneys are one of the vital organs of our body to excrete metabolic waste products, drugs and chemicals in the form of urine. Objectives: This study was carried out to observe the effect of Vitamin E on gentamicin-induced nephrotoxicity by assessing serum creatinine level in Long Evans rats. Materials and Methods: The experimental study was carried out on 40 Long Evans rats of both sex with the weight ranges from 172-255 gm and the age ranges from 7 to 10 weeks. The rats were divided into four groups- Group A (control) received normal saline, group B, C and D received gentamicin for 6 days, rats of group C received vitamin E capsule for 9 days with gentamicin whereas, group D received vitamin E capsule with gentamicin for total 10 days. Serum creatinine level was measured at the end of experiment. Results: The mean (mean+ SD) serum creatinine levels in group A, B, C and D were 0.98+0.34, 2.36+ 0.44, 1.39+0.18 and 1.30+0.18 respectively. The differences between the groups were highly significant (p<0.001) in group A&B, B&C and B&D whereas the difference between C&D was not significant (p>0.50). Serum creatinine level on the normal saline control (group A) was within normal limit (0.98mg/dl). Serum creatinine level in gentamicin treated (group B) rats were more in comparison to gentamicin and vitamin E treated rats (group C&D) and pretreatment with longer duration group (group D) showed lower serum creatinine level than the shorter one (group C) though there was no significant difference. Conclusion: Vitamin E treatment showed some protective effects against gentamicin induced nephrotoxicity. The results also indicated that effectiveness of vitamin E depends on a suitable duration of pretreatment for better protection against gentamicin-induced nephrotoxicity. KYAMC Journal Vol. 13, No. 03, October 2022: 149-152

Role of Serum Creatinine Levels in Prognostic Risk Stratification of Prostate Cancer Patients.

BackgroundStudies on the relationship between serum creatinine and the prognosis of prostate cancer have been very limited. The aim of this study was to investigate the role of serum creatinine in the prognostic risk stratification of patients with prostate cancer.Material/MethodsWe identified 1134 eligible patients from the “Prostate Cancer Data Set” in the National Clinical Medical Science Data Center. Patients with prostate cancer were divided high- and low-risk prognostic groups according to prostate-specific antigen levels and Gleason scores and were divided into 5 groups according to serum creatinine quintile: Q1 (<70.1 umol/L), Q2 (70.1–76.8 umol/L), Q3 (76.8–83.4 umol/L), Q4 (83.4–92.1 umol/L), and Q5 (>92.1 umol/L). Multivariate logistic regression and a multiple restricted cubic spline method were used to evaluate the relationship between serum creatinine level and the level of prostate cancer prognostic risk.ResultsOf the 1134 patients with prostate cancer, 134 (11.8%) had a high-risk prognosis. Compared with the Q2 group (the reference group), the lowest serum creatinine levels in the Q1 group and the highest serum creatinine levels in groups Q5, Q3, and Q4 were associated with a high-risk prognosis, and this association remained significant after adjusting for confounders. The multiple restricted cubic spline regression model showed the relationship between serum creatinine level and high-risk prognosis was U-shaped.ConclusionsSerum creatinine level was an independent predictor of high-risk prognosis. Controlling serum creatinine levels between 70.1 and 76.8 umol/L in patients with prostatic cancer may benefit the prognosis of patients with prostatic cancer.

Efficacy of brain natriuretic peptide vs. nicorandil in preventing contrast-induced nephropathy: a network meta-analysis.

This study aimed to conduct a network meta-analysis (NMA) to compare the efficacy of brain natriuretic peptide (BNP) vs nicorandil for preventing contrast-induced nephropathy (CIN). Databases of Pubmed, Cochrane, Embase, Web of Science were searched by keywords for eligible studies of randomized controlled trials investigating different agents (BNP, nicorandil, nitroglycerin, intravenous saline) for preventing CIN. The outcomes included a change in serum creatinine level at 48 h and the incidence of CIN after percutaneous coronary intervention (PCI) or coronary angiography (CAG). A total of 13 studies with 3,462 patients were included. Compared with intravenous saline alone, except for nitroglycerin (odds ratio [OR]: 1.02, 95% CI [0.36–2.88]), the other drugs significantly reduced the CIN incidence with OR of 0.35 (95% CI [0.24–0.51]) for BNP, 0.52 (0.29, 0.94) for usual-dose nicorandil, 0.28 (0.19, 0.43) for double-dose nicorandil. BNP and double-dose nicorandil significantly decreased the change of serum creatinine (SCr) levels with mean difference (MD) of −6.98, (−10.01, −3.95) for BNP, −8.78, (−11.63, −5.93) for double-dose nicorandil. No significant differences were observed in the change of SCr levels for nitroglycerin (−4.97, [−11.46, 1.52]) and usual-dose nicorandil (−2.32, [−5.52, 0.89]) compared with intravenous saline alone. For double-dose nicorandil, the CIN incidence and the change of SCr level in group of 4–5 days treatment course were more than group of less than or equal to 24 h treatment course (OR of 1.48, [0.63–3.46] and MD of 2.48, [−1.96, 6.91]). In conclusion, BNP and double-dose nicorandil can have effects on preventing the incidence of CIN and double-dose nicorandil performed better than BNP. In double-dose nicorandil groups, a course of less than or equal to 24 h before and after procedure performed with better efficacy than a course of 4–5 days.

The effects of levosimendan on renal functions in open-heart surgery patients with a low ejection fraction

Purpose. This study investigated the effects of levosimendan on renal functions in patients with a preoperative low ejection fraction undergoing open-heart surgery and cardiopulmonary bypass (CPB). Materials and Methods. The study retrospectively evaluated 64 patients with a diagnosis of mitral valve insufficiency and left ventricular dysfunction undergoing open-heart surgery with CPB. Patients were divided depending on the preoperative blood creatinine level less (Group 1) or more than 1.2 mg/dL (Group 2). A bolus dose of levosimendan was administered through the aortic arch at the end of the CPB, preceding an infusion of levosimendan intravenously in all patients. Demographic data, preoperative and 48-hour postoperative echocardiographic studies were done. The blood urea and creatinine levels were collected preoperatively and on postoperative days 1, 3, and 10. The use of inotropic support, intra-aortic balloon pump, and complications were recorded. Results. The demographic data were similar between groups (p&gt;0.05). Preoperative serum creatinine levels were higher in Group 1 in comparison to Group 2 (p=0.01, p&lt;0.001, respectively). The aortic cross-clamp and cardiopulmonary bypass times were similar between groups (p&gt;0.05). Preoperative serum creatinine levels were higher in Group 1 in comparison to Group 2 (p&lt;0.001). On postoperative day 1, serum creatinine levels of Group 1 were significantly lower than Group 2 (p&lt;0.001). On postoperative days 3 and 10, no differences were observed regarding serum creatinine levels between groups (p&gt;0.05). Complications were similar between groups (p&gt;0.05). Conclusions. In patients with low ejection fraction undergoing open-heart surgery, the use of levosimendan intraoperatively and 24 hours postoperatively prevents deterioration of renal functions in patients with or without preoperative disturbance in serum creatinine level.

Ureteral anastomosis with a polyimide stent in rat kidney transplantation

Background Complications associated with ureteral anastomosis in kidney transplantation are highly prevalent, despite the development of various types of stents. The current stent materials and placement methods have several limitations. This study attempts to provide an alternative by investigating ureteral anastomosis with a polyimide stent and a modified placement method in a rat model of kidney transplantation. Methods Sprague–Dawley rats were randomly divided into Group I: sham operation, Group II: autologous ureteral anastomosis, and Group III: isogenic kidney transplantation with ureteral anastomosis. For the anastomosis, a polyimide stent with a previously placed 11-0 silk was inserted into the ureter. The stent and ureter were fixed with 11-0 silk sutures. The kidney weight and serum creatinine were recorded. The ureteral and renal sections were taken for histological analysis. Results None of the stents had migrated. Urethral patency was achieved. Further, there were no evident histological changes in the anastomosed ureters. The serum creatinine level in group III was significantly higher than the other two groups, but there was no significant difference in kidney weight among the groups at postoperative week 12. Finally, the histological structure of kidneys in groups II and III only showed minor changes. Conclusions The current anastomosis method with polyimide stent causes minimal damage to the ureteral walls and minimizes the possibility of stent migration. Therefore, this method of ureteral anastomosis with the polyimide stent should be explored for its potential benefits in more animal kidney transplantation models, thus providing an alternative for the clinical setting.

Effect of fluoride on major organs with the different time of exposure in rats

BackgroundHigh fluoride levels in drinking water in relation to the prevalence of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka were investigated using rats as an experimental model.MethodThe effects of fluoride after oral administration of Sodium fluoride (NaF) at levels of 0, 0.5, 5 and 20 ppm F− were evaluated in adult male Wistar rats. Thirty-six rats were randomly divided into 4 groups (n = 9), namely, control, test I, II, and III. Control group was given daily 1 ml/rat of distilled water and test groups I, II, and III were treated 1 ml/rat of NaF doses of 0.5, 5, and 20 ppm, respectively, by using a stomach tube. Three rats from the control group and each experimental group were sacrificed after 15, 30, and 60 days following treatment. Serological and histopathological investigations were carried out using blood, kidney, and liver.ResultsNo significant differences were observed in body weight gain and relative organ weights of the liver and kidney in fluoride-treated groups compared to control group. After 60 days of fluoride administration, group I showed a mild portal inflammation with lytic necrosis while multiple areas of focal necrosis and various degrees of portal inflammation were observed in groups II and III. This was further confirmed by increased serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) activities. As compared with control and other treated groups, group III showed a significantly higher serum AST activity (p < 0.05) and ALT activity (p < 0.05) after 60 days and ALP activity with a significant difference (p < 0.05) after 15, 30, and 60 days. The renal histological analysis showed normal histological features in all groups with the elevated serum creatinine levels in group III compared to those in the groups I and II (p < 0.05) after 60 days. Significantly elevated serum fluoride levels were observed in group II of 30 and 60 days and group III after 15, 30, and 60 days with respective to control groups (p < 0.05).ConclusionTaken together, these findings indicate that there can be some alterations in liver enzyme activities at early stages of fluoride intoxication followed by renal damage.

Effect of alprostadil combined with Diammonium glycyrrhizinate on renal interstitial fibrosis in SD rats.

To observe effect of alprostadil combined with Diammonium glycyrrhizinate on renal interstitial fibrosis in SD rats. A total of 75 SD rats were randomly divided into A, B, C, D, E groups with 15 in each group. Rats in group A served as the control group received just only but tissue separation without modeling operation, while model of unilateral ureteral obstruction (UUO) was established in B, C, D, E groups. Rats in A, B group were given saline lavage placebo treatment, while rats in C, D, E groups were given diammonium glycyrrhizinate and alprostadil injection. Five rats were sacrificed 1, 2, 3 weeks after modeling, serum creatinine level of femoral venous blood was determined. Transforming growth factor - β1 (TGF - β1) and concentration of connective tissue growth factor (CTGF) were also detected by using ELISA. Line renal interstitial tissue was taken after HE staining, renal interstitial TGF - β1 and CTGF expression were detected by using immunohistochemical method. Serum creatinine levels of B, C, D, E group at different time points in were significantly higher than that of group A (P<0.05); serum creatinine levels in group B were significantly higher than that of C, D, E group at each time point (P<0.05). Serum creatinine level of Group E was significantly lower than C, D group after 2, 3 weeks (P<0.05). Rats in A group at each time point showed no significant changes in TGF - β1 and CREA concentration in serum and kidney tissues (P>0.05); while serum and kidney tissue TGF - β1, concentration of CREA, expression of rats in B, C, D, E groups showed a gradual increasing trend over time. TGF - β1 and CREF of Group B in serum and kidney tissues at each time point were significantly higher than that of the other groups (P<0.05). TGF - β1 and CREF of Group E in serum and kidney tissues at each time point were significantly lower than that of B, C, D group at all time points in serum and kidney tissues (P<0.05). Alprostadil combined with diammonium glycyrrhizinate can significantly lower the expression of TGF - β1 and CTGF in serum and tissues of SD rat with renal interstitial fibrosis, thus inhibit rat renal interstitial fibrosis process. It has synergy protective effect.

Biochemical and histopathological changes of intra-abdominal hypertension on the kidneys: Experimental study in rats

This study aimed to evaluate the effects of experimentally induced intra-abdominal hypertension on renal functions, with the combination of biochemical and histopathological properties. Thirty male Wistar albino rats were used in this experimental study. Rats were divided into four groups. Group 1 (control group, n=6) only received anesthesia. After the induction of anesthesia, a 20 G catheter was introduced intraperitoneally to Group 2 (sham group, n=8), Group 3 (n=8) and Group 4 (n=8). The intra-abdominal pressure was not increased in Group 2. We applied 20 mmHg intra-peritoneal pressure to Group 3 and 30 mmHg to Group 4 for 3 hours. After withdrawing 3 mL intracardiac blood from all groups, the kidneys were removed for histopathological examination. Serum urea and creatinine levels were measured in all groups. Biochemical examination showed that blood urea and creatinine levels were statistically different among all groups (p<0.05). Serum creatinine levels in Group 3 and serum urea and creatinine levels in Group 4 were significantly increased. In the histopathological examination, the kidneys in Group 1 and Group 2 were classified as normal. In Group 3, areas with congestion were detected in the glomeruli and interstitial regions. In addition to these findings seen in Group 3, dilatation of the pelvi-caliceal structures and proximal ureters were noticed in Group 4. The levels of serum urea and creatinine are elevated when intra-abdominal pressure is increased due to kidney damage. Foci of hemorrhage in the interstitial area, dilatations in the proximal ureter, renal pelvis, and lymphatics were the pathologic findings seen in the kidneys under such circumstances.

Effect of aqueous extract of Rheum ribes on cisplatin-induced nephrotoxicity in rat

Objective:The purpose of the present study was to examine whether Rheum ribes extract prevents cisplatin-induced nephrotoxicity.Materials and Methods:The animals were divided into three groups: Group A considered as control group, group B were treated with cisplatin (3 mg/kg B.W. for 3 alternative days), and group C further to cisplatin received the aqueous extract of Rheum ribes (150 mg/rat).Results:Blood urea nitrogen (BUN) level increased in group B on days 14 and 42 compared to day 0 (P < 0.001); it was also increased in group B vs. group A on day 14 (P < 0.001). Rheum ribes extract decreased the serum BUN level on day 14 compared to group B (P < 0.001). Serum creatinine level in group B had a similar profile as serum BUN level but Rheum ribes had no effect on blood creatinine level. Serum cholesterol level was increased in group B on days 14 and 42 compared to day 0 (P < 0.001). Also, cholesterol level was significantly increased in group B when compared to group A on day 14 (P < 0.001). Rheum ribes decreased the blood cholesterol level on day 42 in comparison to group B (P < 0.001). Serum glucose level was increased in group B on days 14 and 42 vs. day 0 (P < 0.001). Also, glucose level was significantly increased in group B when compared to group A on day 42 (P < 0.001). Rheum ribes increased the serum glucose level on days 14 and 42 compared to day 0 (P < 0.05). Histology of kidneys exposed to cisplatin showed renal injury, but Rheum ribes had no effect on the kidney architecture.Conclusion:Cisplatin-induced nephrotoxicity was confirmed in our study. Although Rheum ribes had some effects on biochemical parameters; its effect on renal histology in injured kidney was insignificant.

Protective effect of autologous adipose-derived mesenchymal stem cells on renal ischemia reperfu-sion injury in rats

Objective To observe the protective effects of autologous adipose-derived mesenchy- real stem cells （ADMSCs） on the kidney in rats during renal ischemia reperfusion （IR） injury. Methods Adult male Sprague-Dawley （SD） rats （n = 24 ） were equally randomized into group A （sham control ） , group B （IR plus culture medium only） , and group C （IR plus intravenous administration of 1.0 x 106 autologous ADMSCs 1 h after IR）. The duration of ischemia was 1 h, followed by 72 h of reperfusion be- fore the animals were sacrificed. Results After 72 h, serum creatinine levels in groups C and B were （0. 718 _＋0.：003） and （ 1. 277 _＋ 0. 011 ） mg/dL, the urine volume in group C and B was （57. 742 _＋ 0.012） and （23.665 _＋0.027） mL, the ratio of protein and creatinine in group C and B was 1.217 _＋ 0. 033 and 1. 672 _＋ 0. 013 respectively, and the comparison of all above items showed statistically significan difference （ all P 〈 0. 05 ） ; Also, apparently, the renal pathohistological lesions were aggravated in group B as compared with those in group C. Western blotting showed notably higher NAD（P） H quinone oxi- doreductase 1 （NQO1） and heine oxygenase -1 （HO-1） protein expression in group C than in group B. Conclusion ADMSCs therapy minimized kidney damage after IR injury through suppressing oxidative stress. Key words: Acute kidney disease; Adipose-derived mesenchymal stem cells; Cell transplanta- tion

Pathological changes in rat model of urinary calculus induced by melamine

To investigate melamine-induced pathological changes in the kidney. Wistar rats were fed with a diet containing 0, 1% and 2% melamine for 15 weeks. After melamine feeding was stopped, various outcome measures were observed for 4 weeks. Rats fed with melamine showed reduced caloric intake, slower weight gain and impaired renal function. The blood urea nitrogen of group A and B [(13.23 ± 5.10) mmol/L and (18.30 ± 5.90) mmol/L, respectively] and serum creatinine levels of group B [(19.90 ± 2.90) mmol/L] were higher than that of group C [(8.23 ± 2.30) mmol/L and (10.04 ± 1.73) mmol/L](P < 0.01, respectively). Additionally, the kidney coefficients of group A and B were higher than that of group C (P < 0.01, respectively). Crystals, tubular ectasia and interstitial inflammation and fibrosis were found in the kidneys of melamine fed rats. Four weeks after discontinuation of feeding with melamine-contained diet, the caloric intake and weight of the rats increased, the coefficients of the kidney decreased, and the blood urea nitrogen of group A and B [(17.96 ± 2.04) mmol/L and (19.20 ± 3.36) mmol/L, respectively] and serum creatinine levels of group B [(24.20 ± 5.28) mmol/L], which became worse than 4 weeks before (P < 0.01;P < 0.05, respectively), and were still higher than that of group C [(8.30 ± 1.79) mmol/L and (9.87 ± 2.71) mmol/L, P < 0.01, respectively]. Crystals remained inside the kidney, changes in the renal interstitium did not improve. (1) Melamine-induced urinary calculus rat model can be established by feeding 3-week old male Wistar rats with a diet containing 2% melamine for 15 weeks. The main constituent of the urinary calculus was melamine (> 90%), with a little uric acid and traces of cyanuric acid. (2) Melamine damaged the renal function, formed renal crystals, and led to the pathological changes of kidneys. All the influences seemed to be dose-depended and was related with the obstruction of the crystals or calculus in the kidney. (3) The renal function and the pathological changes did not improve 4 weeks after discontinuation of feeding with melamine-contained diet.

The Effect of Graft Nephrectomy on Long-Term Graft Function and Survival in Kidney Retransplantation

We retrospectively evaluated the long-term results of 53 (3.5%) recipients who received second allograft among 1486 kidney transplants between November 3, 1975 and June 30, 2004. Two study groups were patients in Group 1 ( n = 21) who underwent allograft nephrectomy and those in Group 2 ( n = 32) who did not. We assessed demographic features, rejection rates throughout the follow-up period, and serum creatinine levels at 12 months as well as graft and patient survival rates, postoperative complications, time interval between transplantations, and HLA matches. Forty-three patients who underwent retransplantation received kidneys from living-related donors and the remaining 10 from cadaveric donors. Mean serum creatinine levels of Group 1 versus Group 2 were 1.8 mg/dL (range, 0.8 to 6.6 mg/dL) versus 2.1 ± 1.1 mg/dL (range, 1.1 to 7.1 mg/dL). HLA-AB and HLA-DR mismatchs were 1.9 ± 1.1 versus 1 ± 0.6, respectively ( P = .01). Acute rejection rates were not significantly different between Groups 1 (9/21, 43%) and 2 (12/32, 38%) ( P < .05). The average intervals between the first and the second transplantations were 62 ± 26 months in Group 1 ( P = .02) and 32 ± 11 months in Group 2. One-, 3-, and 5-year graft survival rates in Group 1 versus Group 2 were 83% versus 89% ( P > .05); 64% versus 79% ( P > .05), and 45% versus 68% ( P = .04), respectively. In conclusion, we did not observe any advantage of graft nephrectomy before retransplantation. The length of the interval between the first and the second transplantations may have a negative correlation with second graft survival.

Polymerase chain reaction for the diagnosis of human polyomavirus-associated nephropathy in renal transplant recipients

Human polyomavirus type BK may be related to interstitial nephropathy or renal-allograft dysfunction. Patients with nephropathy due to infection with human polyomavirus may be identified early using the polymerase chain reaction(PCR). We attempted to evaluate whether the positive response in the PCR test of BK virus DNA in the plasma of renal transplant recipients affects the function of the renal allograft. Seventy-seven patients were prospectively analyzed according to the operative sex, age, sources of allograft, serum creatinine levels during PCR test for BK virus, postoperative type of immunosuppressant, and presence of graft rejection. Two groups were distinguished according to the PCR result for BK virus: group 1 ( n = 12) positive PCR reaction and group 2 ( n = 65) negative reaction. The mean follow-up was 32.6 weeks. The incidence of positive PCR tests for BK virus replication after renal transplantation was 15.6%. Decoy cells in the urine were detected in 20.7%. The incidence of BK virus nephropathy was 1.3%. The mean serum creatinine levels of group 1 and 2 at the time of the PCR tests were 1.34 and 1.22, respectively. The rejection rates in group 1 and 2 were 8% and 4.5%, respectively ( P > .05). We consider that a PCR assay to detect BK virus in renal recipients blood may be useful to identify patients at risk for nephropathy. It may serve as a noninvasive indicator of BK virus replication, although this study is limited by the short follow-up and small numbers.

IMPROVED RESULTS WITH SELECTIVE USE OF SPLENECTOMY AND ANTI-CD20 FOR POSITIVE CROSSMATCH TRANSPLANTS

O71 Aims: Thirty percent of the kidney transplant waiting list is sensitized to HLA molecules. These patients endure disproportionately long waiting times and inferior graft survival. Many of these patients have a live donor who has been excluded due to a positive crossmatch (+XM). Methods: A total of 63 renal transplants were performed during the study period (2/1998 – 2/2004) utilizing our plasmapheresis/low dose CMVIg (PP/CMVIg) protocol. The first 41 patients (Group 1) were preconditioned with a one-size-fits-all protocol using PP/CMVIg and standard immunosuppression. Results from this group were compared to the most recent 22 patients for whom the therapeutic plan was individualized to match the level of risk of graft loss. Results: Mean follow-up times for Groups 1 and 2 were 30.1 ± 21.1 months and 7.1 ± 3.2 months, respectively. Death-censored graft survival for Group 1 was 87.8%. Group 2 patients who were determined to be at high risk for graft loss (wide breadth of HLA reactivity, previous transplants and early graft losses, multiple repeat mismatches, rising or rebounding donor specific antibody titers) underwent enhanced preconditioning therapy with splenectomy and/or anti-CD20 therapy. Death-censored graft survival in Group 2 was 100%. Of the graft losses in Group 1, immunologic graft loss accounted for 4 of the 5 events. Current serum creatinine levels in Group 1 and 2 are 1.9 ± 1.8 and 1.1 ± 0.4. Overall patient survival in Group 1 and Group 2 is 87.8% and 100%. Three patients in Group 1 died with a functioning graft. Conclusions: Lower rates of graft loss can be achieved in patients preconditioned for a +XM with their donor when the treatment plan is crafted to match the immunologic risk of the recipient. Transplantation, Volume 78, Number 2, July 27, 2004

Long-term renal function in cyclosporine-treated renal allograft recipients

Objectives The purpose of this study was to analyze the factors affecting long-term renal function in cyclosporine-treated kidney transplants. Methods The study population comprised 167 patients with more than 5 years of graft function on cyclosporine therapy. Patients were subdivided into those with a serum creatinine level 2.0 mg/dL or less (group I, n = 123) versus those with a level more than 2.0 mg/dL (group II, n = 44) at 5 years post-transplant. Patient survival, graft survival, rejection episodes, renal function, cyclosporine dose and trough level, and proteinuria were compared in these two groups. Results There was no significant difference between groups I and II in terms of race, sex, donor source, donor age, primary renal disease, retransplants, transfusions, presensitization, histocompatibility locus antigen match, or initial nonfunction. At 6 months post-transplantation, the mean serum creatinine level in group II was significantly higher than group I ( P = 0.00001), and this difference increased at subsequent follow-up intervals. The incidence of proteinuria was significantly higher in group II compared with group I ( P < 0.001). Renal allograft survival beyond 5 years post-transplant was significantly better in group I compared with group II ( P = 0.005). There was no significant difference in the mean cyclosporine dose or the mean cyclosporine trough level between groups I and II at any time following transplantation. The most important difference between groups I and II was the finding of significantly more early ( P < 0.001) and late ( P < 0.001) rejection episodes in group II. Conclusions These data suggest that long-term renal function in cyclosporine-treated kidney transplant patients is primarily influenced by the occurrence of early and late rejection episodes rather than by the dosage or duration of cyclosporine therapy.

Poststreptococcal glomerulonephritis with the nephrotic range of proteinuria

In order to characterize the clinical features in poststreptococcal glomerulonephritis (PSGN) in relation to the range of proteinuria, 27 patients with PSGN were divided into 3 groups according to the amount of urinary protein excretion; Group I: with proteinuria over 3.5 g/day (n = 8), Group II: with proteinuria between 1.0 and 3.4 g/day (n = 9) and Group III: with proteinuria less than 1.0 g/day (n = 10). Bed-rest was ordered until proteinuria decreased to less than 1.0 g/day. The serum creatinine levels in Group I were significantly higher than in Group III both on admission and at discharge, although the duration of hospitalization was longer in the former than in the latter group. Furthermore, the durations of proteinuria and hypocomplementaemia were longer in the former than in the latter. In addition, the former showed a higher systolic blood pressure and a greater expanded extracellular fluid volume expressed as body weight change during hospitalization. However, none of the patients in this study demonstrated any persistent proteinuria or renal function impairment. In conclusion, bed-rest in the acute phase of PSGN might improve the short-term prognosis of PSGN.

Protective Effects of Enalaprilat against Postischernic Renal Failure

Prolonged intraoperative renal ischemia requires modalities to reduce the incidence of acute tubular necrosis, but there exists no definitive prophylactic regimen. We studied the effects of enalaprilat, an angiotensin-converting enzyme inhibitor, in an attempt to identify such a protective drug. Thirty-four mongrel dogs underwent 90 min of bilateral renal pedicle clamping. Group I was a control of 6 animals. Group II comprised 10 animals who received 12.5 g iv mannitol 15 min prior to clamping and 1 mg/kg iv furosemide immediately after clamp removal. Group III also comprised 10 animals who received enalaprilat 1 mg/kg iv enalaprilat each 15 min prior to clamp placement. Group IV consisted of 8 dogs, each of which received 12.5 g mannitol and 1 mg/kg iv enalaprilat 15 min prior to clamping and 1 mg/kg iv furosemide immediately upon removal of the clamps. Serum blood urea nitrogen (BUN) and creatinine levels were drawn preoperatively and at 12, 24, 48, and 72 hr postoperatively in each animal. The serum BUN levels in group III were significantly lower than those in group I at all times postoperatively (P < 0.05) and were not significantly different from those of group II at any time postoperatively. Similarly, the serum creatinine levels in group III were significantly lower than those of group I (P < 0.05) and were not significantly different from those in group II at any time postoperatively. Neither the serum BUN nor the serum creatinine levels in group IV were different from those of group I at any time postoperatively. We conclude that intravenous enalaprilat offers significant protection against postischemic renal failure and is as effective as a regimen of mannitol and furosemide. However, the combination of all three offers no protection whatsoever relative to controls.

Renal Toxicity of Enalapril in Very Elderly Patients with Progressive, Severe Congestive Heart Failure

We evaluated the safety of enalapril administration in 20 very old (76 +/- 7 years) patients with rapidly progressive congestive heart failure (deteriorating from New York Heart Association class 2 to class 4 on admission). They were all given increasing doses of enalapril regardless of concomitant diuretic therapy and state of hydration. Renal function deteriorated in four patients (group A) and remained unchanged in 16 (group B). The mean pretreatment serum creatinine level in group A was significantly higher than that in group B (2.4 vs 1.3 mg/dl, p less than 0.001). No patient with a serum creatinine level less than 1.9 mg/dl on admission had further impairment of renal function. Groups A and B did not differ by age, concomitant diseases (including hypertension and diabetes mellitus), or medications (including diuretics) or by in-hospital serum electrolyte concentrations and blood pressure. Renal damage was noted during the initial four days of the study and was reversible following discontinuation of enalapril. Our data suggest that enalapril can be safely administered to very old patients with rapidly progressive congestive heart failure provided that the initial serum creatinine level is below 1.9 mg/dl. In patients with a higher serum creatinine level, careful monitoring and prompt discontinuation of enalapril administration can prevent irreversible renal damage.