Treatment Of Uremia Research Articles

Monilial Peritonitis

THE PRESENT report was prompted by the finding of monilial peritonitis in a uremic patient who underwent repeated peritoneal dialyses. Monilial involvement of other organ systems is common but only four cases of monilial peritonitis have been found in a review of the literature. Inasmuch as peritoneal dialysis, now a widely used technique, is presumed to have been the cause of the infection, it was deemed of interest to report this unusual type of moniliasis. Report of a Case A 42-year-old man was transferred to the Bronx Veterans Administration Hospital for treatment of uremia on June 4, 1964. Proteinuria was first noted at age 15, but the patient served in the US Navy from 1942 to 1945 without difficulty though he was given a medical discharge for nephritis. He was well until November 1963, when he was hospitalized with anemia and vomiting which remitted after transfusions and parenteral fluids. Heart

KINETICS OF PERITONEAL FLUID ABSORPTION IN ADULT MAN.

THE peritoneal membrane is used extensively as a dialyzing surface for the treatment of uremia, hyperkalemia, overhydration and poisoning with a variety of drugs.1 , 2 It has also been utilized therapeutically by pediatricians for administration of blood,3 , 4 fluid and electrolytes,4 5 6 particularly in areas of the world where nursing personnel are not available to monitor intravenous infusions.Rate of movement of water and solutes from blood to peritoneal fluid has been studied in detail.1 By contrast, little is known about kinetics of fluid absorption. In the present study absorption of isotonic saline solution from the peritoneal cavity was studied in adult human . . .

慈大式人工腎臓の研究

In order to improve the dialysis efficiency of the Jikei Electro-Dialyzer, the author constructed a new type of electro-dialyzer with many dialysis chambers. This new apparatus consist of three blood chambers and two bath fluid chambers. Each of them is placed alternately and combined with bolt and nut. Then, all the chambers are set into an outer bath fluid chamber with an electric board. The blood chambers are thin in thickness and consist of many more chambers as compared with the D-Type blood chambers. Consequently a larger dialysing surface can be obtained without enlargement in scale. Each chambers is place three dimentionally against the electric field, in order to maintain the characteristic function of the electro-dialysis.The author carried out various in vitro experiments on the fundamental dialysing efficiency of the apparatus with three blood chambers, and for in vivo experiments the author used six nephrectomized dogs to study the practical dialysing efficiency of the apparatus. Six nephrectomized dogs were hemodialyzed for 2 hours respectively, and observation were made on the changes of B. U. N. and blood electrolyte value before and after hemodialysis. Among the six dogs, three were hemodialyzed after 24 hours and two after 48 hours following bilateral nephrectomy. One was hemodialyzed by using two blood chambers after 24 hours following bilateral nephrectomy.The results obtained in vitro experiments are summarized as follows.1) This apparatus has a larger dialysing area as compared with the D-Type Electro-Dialyzer without enlargement of its scale.2) It needs a larger amount of bath fluid than the D-Type Electro-Dialyzer during 2 hours hemodialysis (about 271)3) Limitation of blood flow is 170cc/min, and the suitable flow is 100-120cc/min.4) When the temperature of this apparatus chamber reaches 35-37°C, an electric current density similar to that of D-Type Electro-Dialyzer can be obtained.5) Series connection proved more satisfactory than the parallel method.6) The dialysing efficiency of nonelectrolyte and electrolyte substance was better than the D-Type Electro-Dialyzer.7) Furthermore, there is a possibility that this apparatus can remove the body fluid by ultrafiltration. Ultrafiltration is caused by a rise of inner pressure of the blood chamber.The experimental results of bilaterally nephrectomized dogs are as follows.1) Approximately 15mg/dl B. U. N. can be removed hourly.2) As to the corrective ability of blood electrolyte imbalance, especially hyperpotassemia which was observed all nephrectomized dogs, a return to normal level was found after 2 hours of hemodialysis.3) When two blood chambers are applied, the B. U. N. dialysis efficiency consisted in the capacity to remove 7mg/dl hourly.This new apparatus which has many adventages as an effective artificial kidney can be used clinically for the treatment of uremia.

PERITONEAL DIALYSIS IN THE MANAGEMENT OF CHRONIC RENAL FAILURE.

ALTHOUGH it had been recognized earlier that the peritoneum was a semipermeable membrane, its utilization for dialysis in the treatment of uremia was not described until 1923.^1,2Technical problems and infection prevented popular adoption of peritoneal dialysis for more than 20 years,³although its clinical potentialities were explored.⁴The development of antibiotics and plastic catheters set the stage for Maxwell⁵and Doolan⁶in 1959 to describe simplified procedures for conducting peritoneal dialysis. Peritoneal dialysis has been used primarily in the treatment of acute renal failure. The treatment of chronic renal insufficiency by this method is a more recent development and experience with it is limited.^7-10The purpose of this paper is to report the use of peritoneal dialysis as an adjunct in the management of 54 patients presenting with symptoms due to chronic renal insufficiency and to attempt to assess why certain of these

ONE YEAR'S EXPERIENCE WITH AN INTERMITTENT DIALYSIS PROGRAM.

Article1 September 1964One Year's Experience with an Intermittent Dialysis ProgramE. A. GOMBOS, M.D., T. H. LEE, M.D., M. R. HARTON, M.D., J. W. CUMMINGS, PH.D.E. A. GOMBOS, M.D.Search for more papers by this author, T. H. LEE, M.D.Search for more papers by this author, M. R. HARTON, M.D.Search for more papers by this author, J. W. CUMMINGS, PH.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-61-3-462 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe feasibility of treatment of uremia in chronic irreversible renal disease by intermittent chronic peritoneal or hemodialysis is an established fact. Practicality of such an approach within the framework of the Veterans Administration is being explored, and in March, 1963, we initiated a pilot program for this purpose. Only four of five selected patients admitted to the program are described since one patient died shortly after initiation of intermittent dialysis when, during the night, he pulled his arteriovenous shunt apart and exsanguinated.SELECTION OF PATIENTSPatients have been accepted for treatment on a "first come, first served" basis, but we...

Diet in the Treatment of Impaired Kidney Function (“Nephritis”) in Dogs

Abstract— The rationale of dietary treatment of uraemia, arising from impaired kidney function is discussed. A diet containing a strictly limited quantity of very high quality protein is advocated.

Artificial kidney in the treatment of uremia associated with acute glomerulonephritis (with a note on regional heparinization).

Excerpt There has been some reluctance in using the artificial kidney to treat uremia associated with acute glomerulonephritis because it was feared that dialysis might cause or aggravate hypertens...

Uraemia and its treatment by arginase inhibitor.

URAEMIA is retention of urea in the body, and is due to renal insufficiency. It has been proved beyond doubt that the kidney is the only organ through which urea can be eliminated from the body1. Therefore renal insufficiency of an organic or a functional type will reverse the clearance of urea from the body, with consequent retention. The methods involving intestinal and peritoneal dialysis, artificial kidney and possibilities of a successful kidney homotransplant for the treatment of uraemia are mainly based on the principle of eliminating urea from the body. The problem becomes very much simplified if technique can be evolved checking the synthesis of urea, which obviously could cause least damage to the patient.

Treatment of renal failure with the disposable artificial kidney: Results in fifty-two patients

The results of treatment with the coil (disposable artificial) kidney in ninety dialyses in fifty-two patients described in this paper establish this type of artificial kidney as a useful tool for the treatment of uremia. The prefabricated coil kidney is more convenient to set up and easier to use than any other type of artificial kidney yet devised, and is now commercially available. Of twenty-nine patients with acute renal failure, fifteen recovered. Three more might have survived if the present concept of earlier dialysis had been fully applied to them. We now believe that a patient with severe trauma, crushing injury, fulminant infection or intoxication should be given the benefit of dialysis before chemical changes in the blood indicate impending danger. Such a patient may have to be dialyzed every two or three days. Of twenty-three patients with chronic renal failure, thirteen were in improved condition when they were discharged from the hospital. Among the symptoms and signs of uremia that improved during or after dialysis were twitching, convulsions, disturbances in sensorium, vomiting and Kussmaul respiration. Changes in blood pressure during dialysis could not always be avoided. Decreases in blood pressure, when they occurred, were controlled by transfusion of small amounts of blood. Increases in blood pressure, when they occurred, sometimes required the administration of a ganglionic-blocking agent. In five of six patients with intractable hypotension before dialysis, the increase in arterial pressure during dialysis was beneficial and could be maintained. Hemorrhages due to heparin caused no serious problems in this series. (Nasal administration of oxygen and manipulation of other tubes through the nose should be avoided.) Electrolytes were corrected in a manner that could be pre-determined by the composition of the rinsing fluid; the use of standardized rinsing fluids proved satisfactory. Urea clearance rates were determined during eleven dialyses at flow rates of 200 ml. per minute. The average clearance of 105 ml. per minute was lower than that found experimentally (130 to 140 ml. per minute). Larger blood flows, up to 340 ml. per minute, have recently been used, with an increase in clearance After dialysis a decrease of urinary output was insignificant in the patients with acute uremia but was pronounced in some of the patients with chronic uremia. The rate of ultrafiltration with the coil kidney approximates 300 ml. per hour of dialysis but it can be increased to 700 ml. Ultrafiltration is considered advantageous as most patients with uremia are edematous. Four typical case reports are presented: (1) A man in acute uremia due to crush syndrome, whose clinical condition improved after dialysis. (2) A woman with anuria following an extensive abdominoperineal operation in whom early dialysis facilitated management. (3) A woman who was maintained for sixty-three days of virtual anuria; the course in this patient proves that the artificial kidney can replace excretory renal function amazingly well. (4) A man with chronic uremia who after a single dialysis was restored to useful life for six months. The course in this patient demonstrates the possibility of worthwhile temporary improvement with one dialysis, but it also demonstrates the ultimate impotence of all measures in chronic renal disease.

Treatment of Uremia by Lavage Through Intestinal Loops in Dogs

Four nephrectomized dogs were treated with lavage of isolated intestinal loops (made prior to nephrectomy). The animals survived for 7–13 days; death was caused by renoprival vascular disease. The ...

Veterans Administration Technical Bulletin, Ser. 10, Vol. 7, 1954.

This collection of eleven monographs is similar in format to the more famous Technical Bulletins distributed by the Armed Forces to its medical officers during World War II. All were prepared by well-qualified persons, and each of the monographs represents a thorough, but frequently not an exhaustive, discussion of its subject. Each has adequate bibliographic annotations. Several of the monographs bring together complete analyses of specific disease entities. Thus, most of the recent advances in knowledge of leprosy are discussed by James A. Doull, while Gerald Klatskin similarly reviews leptospirosis. Another group of monographs discusses broad therapeutic principles which are pertinent to a number of diseases. In this group are a discussion of the general principles of psychotherapy by Edward A. Strecker, a discussion of dialysis in the treatment of uremia by William J. Kolff, a discourse on the pathogenesis and management of dehydration by Louis G. Welt, a review

Dialysis in the Treatment of Uremia: Artificial Kidney

Dialysis in the Treatment of Uremia: Artificial Kidney

The Role of the Artificial Kidney in the Treatment of Uremia

The Role of the Artificial Kidney in the Treatment of Uremia

Electrocardiographic changes during hemodialysis, with observations on contribution of electrolyte disturbances to digitalis toxicity.

Excerpt Extracorporeal hemodialysis is often lifesaving in the treatment of acute renal insufficiency, but the procedure itself is not without danger. Heparinization may be accompanied by hemorrhag...

Forced high-caloric low-protein diet in the treatment of uremia.

Annals of the New York Academy of SciencesVolume 56, Issue 1 p. 107-121 FORCED HIGH-CALORIC LOW-PROTEIN DIET IN THE TREATMENT OF UREMIA W. J. Kolff, W. J. Kolff Research Division of the Cleveland Clinic Foundation and the Frank E. Bunts Educational Institute, Cleveland, OhioSearch for more papers by this author W. J. Kolff, W. J. Kolff Research Division of the Cleveland Clinic Foundation and the Frank E. Bunts Educational Institute, Cleveland, OhioSearch for more papers by this author First published: October 1952 https://doi.org/10.1111/j.1749-6632.1952.tb30210.xCitations: 2 The author is indebted to Dr. A. C. Corcuran for reviewing this manuscript. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume56, Issue1Oral Fat EmulsionsOctober 1952Pages 107-121 RelatedInformation

Forced high caloric, low protein diet and the treatment of uremia

Many of the symptoms of so-called acute uremia are due to overloading the body with salt and fluids. Water restriction and salt deprivation are essential in the treatment of anuria. It is shown that catabolism of the body proteins and urea production can be greatly reduced if the patient's caloric requirements are met with carbohydrates and fat. It is emphasized that the patient should not be allowed to eat as little as he wants but that he should be persuaded or even forced to take the high caloric diet (Borst), hence the term forced high caloric diet. It is demonstrated in several of the cases reported herein that urea excretion (and production) can be reduced to 2 to 5 gm. per twenty-four hours. The patient's serum potassium may be lowered by this diet. Severe intoxication, infections, crushing injuries or necrosis may, however, cause a rapid rise in blood urea and potassium. Some patients were first seen after severe uremia and overhydration had already developed. In those patients dialysis with the artificial kidney or peritoneal dialysis improved their condition so that they were able to take the high caloric diet. Although there is no need to give protein to a patient with acute uremia so long as his caloric requirements are covered, the patient with chronic uremia should be given approximately 20 gm. of protein per day. This is well under the limit of 40 gm. generally advocated in this country, except by Kempner. With rice, butter, sugar, ice cream, potatoes, vegetables and fruits a satisfactory diet is possible. Some suggestions for the diet have been presented. It is the author's impression that patients with chronic, severely impaired kidney function may live longer and more comfortably when using this diet.

Treatment of uremia; use and indications for high caloric low protein diet, dialyzing methods and replacement transfusion.

Treatment of uremia; use and indications for high caloric low protein diet, dialyzing methods and replacement transfusion.

Treatment of uremia by dialysis across the intestinal mucosa

Treatment of uremia by dialysis across the intestinal mucosa

The Treatment of Uraemia with Special Reference to Acute Renal Failure

The Treatment of Uraemia with Special Reference to Acute Renal Failure

The Use of Continuous Gastric Lavage in the Treatment of Uremia Associated with Prostatism

The Use of Continuous Gastric Lavage in the Treatment of Uremia Associated with Prostatism