B. Hood

Renal Hemodynamics and Limitations of Creatinine Clearance in Determining Filtration Rate in Glomerular Disease

A series of 160 Inulin/PAH clearances in 126 subjects was performed with the main emphasis on glomerular disorders. In 90 observations (67 subjects) simultaneous creatinine clearances were available. Earlier findings of the occurrence of high and supernormal CPAH in some cases of glomerulonephritis have been supported and extended to systemic lupus erythematosus. Low filtration fractions in various types and stages of glomerulonephritis and systemic lupus erythematosus even at rather advanced renal impairment were observed and contrasted against the findings in cryptogenetic (essential) hypertension. High CCr/CIn ratios have been observed not only in cases of advanced renal insufficiency but also in glomerular disorders in subjects with a mild or moderate reduction in Cm and a maintained or high CPAH at serum creatinine levels from 0.7 to 1.5 mg per 100 ml. Here, CCr/CIn ratios may be as high as 2.0 to close to 4. In some glomerular disorders, notably S.L.E., membranous glomerulonephritis, and transplant ...

Fifty Uremic Patients Treated with Renal Homotransplantation

Fifty uremic patients were treated with kidney homotransplantation between January 1965 and August 1967. Twenty-three patients received a kidney from a living donor, twenty-seven from a cadaveric donor. Six patients had to be retransplanted because of failure of the first transplant. At the present time 34 patients are alive. Three of these are on hemodialysis, the others have functioning transplants. The general condition and level of activity of these patients is on the whole very good. The results are discussed particularly with regard to the type of donor and the age of the recipient, and the causes of death.

Blood Flow in Kidney Transplants: A Clinical Evaluation of the 133Xenon Method

(1) The xenon method has been used to measure renal blood flow in 60 of the first 67 kidney transplants carried out in this department. (2) The method has proved to be of definite clinical value as a check of the perfusion of the kidney at the time of transplantation. (3) Persistently low flow values or values that decline markedly during the course of the operation are bad prognostic signs. With a flow value below approximately 100 ml/min/100 g there has been no eventual function. (4) A high flow value has been associated with either immediate or later renal function.

Glomerulopathy in the transplanted kidney.

One-hundred-and-twenty-four renal transplantations were performed in 109 patients between January 1965 and November 1968. Thirty-seven patients have died. the present analysis concentrates upon 56 transplants in 53 patients surviving 6-43 months. the relative number of patients surviving 6 months has increased with increasing experience of the team.The limited validity of creatinine clearance and thus serum creatinine in assessing filtration rate at different levels of inulin clearance have been studied. the single injection inulin test (SIIT) parallelled closely the result of conventional inulin clearance at all levels but gave a somewhat low estimation of filtration rate.A disproportionate decrease in inulin clearance in relation to PAH-clearance, leading to low or sometimes very low filtration fractions, was common. This usually preceded the onset of a nephrotic syndrome, but in some cases such a development has not been seen as yet.A filtration rate of 50 ml/min or above at 6 and particularly at 12 mo...

Renal Artery Stenosis and Hypertension: II. Mortality in Operated Patients Compared with the Mortality in Individually Matched Medically Treated Patients with Cryptogenetic Hypertension

Sixty-four patients, operated for renal artery stenosis and with observation times varying between 1 and 10 years, were individually matched against 64 partners selected from a medically treated series of 461 patients with the diagnosis of essential hypertension, where treatment had been initiated 1957-1960. The matching characteristics were age, sex, eye-grounds, serum creatinine, highest and lowest systolic and diastolic blood pressures, heart volume and ECG. Only 21 of the 64 operated patients had observation times longer than four years. During this time, there was no such difference in the number of deaths as to counter-balance the deaths occurring immediately postoperatively. The twelve deaths in the operated series occurred entirely in the two thirds of the material in which the stenosis was considered of atherosclerotic origin. This demonstrable atherosclerosis in one or two arteries is estimated to imply a higher risk for occlusive vascular disease in other areas, irrespective of the careful matc...

Renal Hypoplasia: Clinical features and survival

Clinical data are given on 76 subjects, predominantly women, with a unilaterally small or focally hypoplastic kidney. in the material as a whole, hypertension was very frequent, all men and about 75% of the women being hypertensive. A history of signs of toxemia during pregnancy was common. the frequency of urinary tract infections was analyzed. About 20% of the men and 40% of the women showed signs of infection at examination. It appeared, however, that hypertension—not urinary tract infection—was the most dangerous feature. Hypoplasia was present as frequently in the left as in the right kidney. Seventeen cases with radiological changes corresponding to those described by Ask-Upmark on autopsy material are presented. Some data from a follow-up study of the material as well as an analysis of the causes of death in the material are given. the difficulty in making a sharp delineation between the congenitally hypoplastic kidney and a small kidney subsequent to pyelonephritic shrinkage is emphasized.

The Living Donor in Renal Transplantation: Availability, Preoperative and Postoperative Renal Function

Primarily volunteering related donors appeared for 39 out of 51 uremic patients considered suitable for kidney transplantation. A donor examination reduced the donor population so that ultimately only 24 patients (47 per cent) had suitable living donors. An age-dependent reduction of filtration rate was found among donors of both sexes. The likelihood of finding a donor with a filtration rate above 90 ml/min diminishes as donor age passes 50 years. In the remaining kidney of the donor there is a 10 to 40 per cent rise in filtration rate immediately after nephrectomy. A further slow and inconsistent rise occurs after donation. A brief report is given of the characteristics of a number of unrelated volunteers answering a newspaper advertisement for kidney donors.

Hyperacute Rejection of a Kidney Allograft

The serological, clinical and pathoanatomical problems involved in hyperacute rejection are discussed in relation to a case. the patient had moderately strong lymphocytotoxic antibodies against the donor, and the titres decreased during a prolonged and intense preoperative immunosuppression. in spite of this a very severe hyperacute rejection developed, starting within minutes after transplantation.

Two Causes of Hypertension in a Subject with Generalized Neurofibromatosis

Absrract. A25-year-old male, with cutaneous neurofibromatosis, admitted with a history of intermittent headache, vomiting and hypertension for several years and attacks of palpitation and sweating for one year. Provocation tests with glucagon and histamine indicated a pheochromocytoma. Angiography of the renal artery revealed a pheochromocytoma in the left adrenal and a stenosis with an aneurysm of the right renal artery. Split renal function studies corresponded to a stenosis of the right renal artery. After removal of the tumour and vascular reconstruction of the right renal artery the patient was discharged in a normotensive state. Split renal function studies, sixteen months later, indicated a stenosis of the left renal artery which a renal angiography could not verify at least not in the main branches. As a result of the vascular reconstruction of the right renal artery, a remarkable increase in the size of the right kidney was noted roentgenologically. A possible explanation of the bewildering steno...

Renal Artery Stenosis: III. Follow-up Observations in Operated and Non-operated Patients

Of 240 hypertensives with arteriographically defined renal artery stenosis, 74 were operated upon. Excluding 7 patients operated with the chief objective of relieving uremia, and 6 who died within 3 weeks after the operation, 61 patients remained for a follow-up study. Follow-up times in the operated and non-operated patients varied between 1 and 10 years. The dominating effect of atherosclerosis on mortality was clearly evident in both series. Of 9 late deaths in the operated group, 6 consistently had diastolic levels of < 100 mm Hg. Several striking instances of complete normotension without drugs were observed, particularly in hypertensives with eye grounds Grades IV and III. The material was divided into patients with signs of extrarenal major artery disease, and patients without. The operated group clearly represented a selection of the least damaged of the group with definite extrarenal disease signs. In the group without such signs, the operation lead to somewhat better control and fewer deaths. Th...