Transient Renal Impairment Research Articles

An aid to renal preservation during repair of suprarenal abdominal aortic aneurysms

Suprarenal abdominal aortic aneurysms (SAAA), though rare, can pose considerable operative problems. Of particular importance is the avoidance of prolonged warm ischaemia of the kidneys in preventing postoperative renal failure, 1' 2 which may become more likely should the need for an interposition graft between the main graft and renal artery arise. We have recently found that the combined Meadox occlusion and irrigation catheter (MEADOX UK, Dunstable) may be of assistance in this situation. A 62-year-old male underwent repair of a 7 cm SAAA with reimplantation of the left renal artery. The catheter was inserted into the left renal artery and the balloon inflated. This prevented troublesome backbleeding and enabled continuous irrigation of the kidney with ice-cold saline (Fig. 1) while the upper anastomosis (to aorta and orifice of the right renal artery) was performed. In addition, the catheter acted as a useful stent for rapid anastomosis of the interposition graft to the left renal artery. After restoration of flow, the left kidney pinked up rapidly, but the right was cyanosed despite a palpable pulse in the renal artery. Exploration revealed an occluding embolus and it is therefore likely that the true warm ischaemia time was about 60min and probably explains the transient postoperative renal impairment that occurred in this patient. While a conventional embolectomy catheter is occasionally used to prevent backbleeding and act as a stent for anastomosis in vascular surgery, the recent inclusion of an irrigation channel offers the additional potential for continuous renal perfusion. Although our patient suffered some postoperative renal impair

Transient renal impairment occurs in nontransplant recipients of cyclosporin

Transient renal impairment occurs in nontransplant recipients of cyclosporin

Transient renal impairment in rats after oral exposure to diethylene glycol.

Volume, specific gravity, creatinine, lactate dehydrogenase (LDH), leucine aminopeptidase (LAP), beta-galactosidase (GAL), leucocytes, erythrocytes, nitrite, protein (albumin), glucose, ketone, urobilinogen, bilirubin and pH were estimated in urine of rats after single (by gavage) or repeated (via drinking water) oral administration of diethylene glycol (DEG). Following single or repetitive doses (daily over 90 days) of 0.2 g DEG kg-1 body weight, no change in renal function was observed (no effect level). In urine of rats treated once with 0.7 g DEG kg-1 body weight, LDH activity was significantly enhanced one day after treatment. A single dose of 2.0 g DEG kg-1 body weight resulted in an additional rise in urinary GAL activity two days after treatment, a significant rise of urinary volume and a decrease in creatinine concentration and pH on the first day. One day following a single dose of 8.0 g DEG kg-1 body weight, in addition to the changes mentioned before, LAP activity was significantly elevated and the specific gravity decreased. However, in all experiments the wet weight of the kidneys remained normal as compared to controls. The results thus show dose-dependent changes in several renal parameters, indicating a slight-to-moderate and reversible renal impairment.

Intra-arterial continuous infusion of cis-diamminedichloroplatinum in untreated head and neck cancer patients.

The authors report the final analysis of a prospective phase I-II study in 53 previously untreated patients with squamous cell carcinoma (48 patients) and other histologic classifications (5 patients) of the head and neck region. Treatment consisted of cisplatin 10 mg infused intra-arterially in a 12-hour period, twice a day for 5 to 10 days via an external infusion pump. After a rest period of 5 to 7 days treatment could be restarted, with the same schedule, until a maximal total dose of 400 mg or toxicity. Patients who received at least 200 mg of cisplatin were considered evaluable for response. In 3 patients catheterization was not performed because of technical difficulties, in 9 treatment was stopped before reaching the total dose of 200 mg, (because of catheter-related toxicity in 7 patients, drug toxicity in 1, and both toxicities in 1); therefore, the patients evaluable for response, drug toxicity and catheter toxicity were 41, 43, and 49 respectively. Overall, 8 patients (19.5%) obtained a complete response (CR) and 20 (48.8%) a partial response (PR) with an objective response rate (RR) of 68.3%. Eleven patients obtained a minor response (MR), whereas only 2 (4.8%) developed a progressive disease (PD). The figures, limited only to squamous cell carcinoma of oral cavity and oropharinx (33 patients), are as follows: CR 8 (24.2%), PR 17 (51.5%), MR 7 (21.2%), and PD 1 (3.0%) for an objective RR of 75.7%. No grade IV and only 5 grade III toxicity were observed; whereas the most frequent grade I and II drug-related toxicities were anemia, transient renal impairment, and thrombocytopenia. Catheter-related toxicity accounted for five central nervous system complications (three transient motor weaknesses, one hemiparesis, one embolism) and six local problems (one coagulation of the catheter, one displacement, and four local extravasations). Intra-arterial cisplatin is, in our experience, an effective treatment and further trials employing cisplatin combination chemotherapy are needed in order to establish the exact role of the intra-arterial approach before definitive local treatments.

Phase I clinical study of 9-hydroxy-2 N-methyl-ellipticinium acetate (NSC-264137) administered on a 5-day i.v. schedule

Twenty-three patients with advanced solid tumors received 9-hydroxy- 2N-methyl-ellipticinium acetate at a single daily i.v. dose of 15–80 mg/m 2 for 5 consecutive days, repeated every 3 weeks. One partial and one minor response were achieved in two patients with breast cancer. Dryness of the mouth was dose-related and dose-limiting. Local phlebitis was also dose-related and frequently severe at the highest dose levels. Other non-hematologic toxic effects were essentially mild to moderate and included nausea, vomiting, diarrhea, stomatitis, fever, weakness, transient renal and hepatic impairment, alopecia and chest pain. Minimal myelosuppression was encountered. It appears that 60 mg/m 2/day is the maximum tolerated dose with a five-day schedule. According to our findings, this schedule does not seem to offer any advantage over the previously tested weekly administrations.

Weekly high-dose methotrexate-citrovorum factor in osteogenic sarcoma.Pre-surgical treatment of primary tumor and of overt pulmonary metastases

Vincristine-high-dose methotrexate-citrovorum factor (VCR-MTX-CF) was administered preoperatively at weekly intervals to eight patients, four with primary tumors and four with pulmonary metastases. These patients had not received prior VCR-MTX-CF treatment. A similar treatment program was administered to five patients with pulmonary metastases who had received prior VCR-MTX-CF. Among the eight patients who had not received prior VCR-MTX-CF, complete responses were obtained in three with primary tumors (this was followed by surgical excision) and two with pulmonary metastases. Partial responses occurred in two additional patients. Partial responses were also obtained in two patients who had received VCR-MTX-CF. Chemotherapy and surgery in one patient with an extremity lesion resulted in preservation of the limb and useful function. The major toxicity was anorexia and weight loss. Other side effects included stomatitis, myelosuppression, hepatitis and transient renal impairment. The weekly program was highly effective when compared to responses obtained with the tri-weekly schedule utilized in previous studies.

Tobramycin in Pediatric Use

The new aminoglycoside antibiotic, tobramycin, was used for treatment of gram-negative and staphylococcal infection in 38 neonates, infants, and children in a pediatric surgical unit. Levels of drug in serum after administration by intramuscular, intravenous, and intraperitoneal routes were monitored, and control of infections was generally good within the therapeutic range of 2.0-10.0 mug/ml with a standard dosage regimen of approximately 5 mg/kg per day. Impairment of renal function and concurrent lincomycin therapy were important factors causing variation of levels in serum outside this range. Levels of tobramycin in cerebrospinal fluid after intraventricular instillation varied greatly in one patient, but were satisfactory in another. Clinical and bacteriological assessment of results indicated only two failures of treatment, although infection with a known resistant organism supervened in three cases. Screening for renal, hepatic, and hematological toxicity revealed only one case of transient and reversible renal impairment. Response to tobramycin therapy was generally rapid and satisfactory in a group of young patients with moderately severe infections, many of which were complicated by the presence of a congenital anomaly.

INDICATION OF INTRINSIC RENAL DISEASE IN AZOTEMIC INFANTS WITH DIARRHEA AND DEHYDRATION

In an effort to differentiate transient renal impairment from more serious forms of renal disease in infants presenting with diarrhea and dehydration, serial blood urea nitrogen (BUN) values were obtained during rehydration. These were plotted against time on semilogarithmic paper. It was found that the BUN fell linearly with time. The half time (HT) of the BUN fall off, the time taken for the admission BUN to fall by 50%, was estimated from the graph. In patients with no intrinsic renal disease the half time was between 6 and 24 hours, mean half time was 15 hours. Of nine children who had half times in excess of 24 hours, six had proven renal disease as manifested by oliguria, hematuria, or obstructive uropathy. This technique, the plotting of serial BUN values during rehydration, is suggested as a clinical method in evaluating the significance of azotemia in infants presenting with diarrhea and dehydration.

Effect of furosemide on antibiotic-induced renal damage in rats.

Cephaloridine is known to be nephrotoxic to man and animals. It has recently been suggested that diuretics may enhance this effect. Experiments in rats were undertaken to explore this relationship further. Rats were given a small dose of glycerol to induce mild, transient renal impairment. Thereafter, they received one of several nephrotoxic antibiotics either alone or in association with the diuretic furosemide. At a standard interval after the administration of the drugs, the animals were sacrificed and their kidneys removed for histologic examination. The resulting data indicate that in the rat with transient renal impairment, the nephrotoxicity of four antibiotics (cephaloridine, cephalothin, colistin, and kanamycin) is enhanced by coincidental administration of furosemide. In the case of cephaloridine, this effect was marked when the concentrations of drug in blood were similar to those attained in humans during routine therapy.