Daniel Levitan

Disturbances in the Hypothalamic-Pituitary-Gonadal Axis in Male Patients with Acute Renal Failure

The function of the hypothalamic-pituitary-gonadal (HPG) axis was examined in 20 male patients with acute renal failure. During the oliguric phase of the disease, the serum concentrations of follicle stimulating hormone (FSH) and total and unbound testosterone were markedly reduced, those of prolactin were elevated while those of luteinizing hormone (LH) were normal. The serum concentrations of sex hormone binding globulin were normal. During the diuretic phase of the illness, the serum levels of FSH and testosterone remained low but those of prolactin fell towards normal. After recovery of renal function, the abnormalities in the serum concentrations of these hormones were reversed. The responses of LH and FSH to gonadotropin releasing hormone and of prolactin to thyrotropin releasing hormone were abnormal and became normal after recovery of renal function. The results demonstrate that: (1) abnormalities in HPG axis occur early in the course of acute renal failure; (2) many features of these derangements are similar to those seen in chronic renal failure, and (3) the alterations in the function of the HPG axis are reversible when renal function is restored. The data suggest that loss of renal function, uremia per se and/or a metabolic consequence of uremia such as secondary hyperparathyroidism are responsible for these derangements.

Alterations of Thyroid Hormone Indices in Acute Renal Failure and in Acute Critical Illness with and without Acute Renal Failure

The present study evaluated thyroid hormone indices of patients with acute renal failure without other systemic illnesses (n = 12), as compared to patients with critical illnesses in the presence (n = 16) and absence (n = 6) of acute renal failure. Abnormalities in the group with acute renal failure alone included decreased serum levels of total T4 and T3, and elevated levels of free rT3. Serum levels of free T4 by equilibrium dialysis and the enzyme immunoassay, T3 uptake ratios, TSH and total rT3 were normal. These findings are consistent with the presence of decreased binding of T4 and rT3 to their serum carrier proteins. Critically ill patients with acute renal failure differed in that they had lower total T4 and T3 levels and elevated T3 uptake ratio values. As in the group with acute renal failure alone, total rT3 levels were normal and free rT3 values were elevated. The group with critical illness alone differed only in that the total rT3 concentrations were elevated in all patients. The alterations of thyroid hormone indices in acute renal failure are similar to those of other nonthyroidal illnesses with the exception of the normal total rT3 levels. This suggests that the failing kidney or the metabolic consequences of uremia specifically affect rT3 metabolism.

Autonomic Nervous System Dysfunction and Impotence in Uremia

The relationship between abnormalities in nocturnal penile tumescence (NPT) and autonomic function, measured by the Valsalva maneuver, was evaluated in 25 uremic patients and 22 normal subjects. NPT in uremic patients (45 +/- 6.8 min/night) was lower (p less than 0.01) than in normals (85 +/- 10.4 min/night). Valsalva ratio in uremics (1.58 +/- 0.07) was also lower (p less than 0.01) than in normal subjects (2.05 +/- 0.11). NPT and Valsalva ratio were significantly correlated in uremic patients (r = 0.62, p less than 0.01). The 12 uremic patients with abnormal Valsalva maneuver had NPT of 22 +/- 5.2 min/night, a value lower (p less than 0.01) than that (67 +/- 8.7 min/night) observed in the 13 uremic patients with normal Valsalva maneuver. There was also a significant correlation (r = 0.56, p less than 0.05) between the Valsalva ratio and the frequency of intercourse per month in the uremic patients, who had steady and active sexual partners. The data suggest that a dysfunction of the autonomic nervous system may be an important factor in the genesis of erectile abnormalities in patients with uremia.

Mechanism of gastrointestinal hemorrhage in a case of mushroom poisoning by Chlorophyllum molybdites.

Abstract A twenty-seven year old female evaluated for gastrointestinal bleeding following ingestion of C. molybdites was found to have hematologic abnormalities consistent with disseminated intravascular coagulation. We suggest that the gastrointestinal hemorrhage was due to disseminated intravascular coagulation, a toxic effect of the mushroom.

Autonomic Nervous System Dysfunction in Patients with Acute Renal Failure

Dysfunctions of the autonomic nervous system (ANS) are frequent complications of chronic renal failure. It is not clear, however, whether these dysfunctions occur in patients with acute renal failure.

Use of Noninvasive Laboratory Testing in the Prediction of Thrombosis in the Nephrotic Syndrome

A noninvasive method for diagnosing thrombosis in the nephrotic syndrome could be useful clinically. We measured hematocrit, fibrinogen, creatinine, antithrombin III, plasminogen, and alpha-2-plasmin inhibitor levels in 20 patients with nephrotic syndrome objectively studied for the presence of thrombosis, and found that by using combinations of three or more of these variables good discrimination could be obtained between those patients with and without thrombosis. We conclude that it is possible to predict risk of thrombosis in nephrotic syndrome using relatively simple noninvasive laboratory tests.