F. del Greco

Rationale and Application of Beta-2-Microglobulin Measurements to Detect Acute Transplant Rejection

Serum and urinary concentrations of beta 2-microglobulin were measured for the first 21 days after renal transplantation to aid in diagnosis of acute rejection. Criteria developed after study of 15 patients were applied to the entire group of 31 consecutive cases. 29 instances meeting our criteria were identified in 651 days at risk and were associated with a mean maximal increase of serum creatinine of 74.8%. beta 2-Microglobulin methods may make possible detection of what is now subclinical rejection. beta 2-Microglobulin methods, however, are an adjunct to, not a replacement for classical methods for detecting acute rejection.

Comparative Effects of Valine-5 Angiotensin II Amide and Pitressin on Renal Excretory Function in Diabetes Insipidus.

SummaryAngiotensin II (valine-5 angiotensin II amide) and pitressin were administered intravenously during mannitol and water diuresis to subjects with diabetes insipidus. Angiotensin II in doses of 0.0025 to 0.0050 μg per kg per minute caused a small but definite increase in blood pressure in 5 of 7 experiments, a decrease in endogenous creatinine clearance of about 11%, and a decrease in urine flow and water clearance of about 40%. The rate of sodium excretion was depressed by nearly 50%, while that of potassium decreased much less. Pitressin produced changes of water excretion qualitatively similar to those caused by angiotensin II. However, this effect was achieved without alteration in blood pressure, although filtration rate decreased. Further, pitressin did not consistently affect excretion of sodium and potassium. The results suggest that angiotensin II at the dose-ranges examined inhibits water and salt excretion by direct tubular action.Summary Angiotensin II (valine-5 angiotensin II amide) and pitressin were administered intravenously during mannitol and water diuresis to subjects with diabetes insipidus. Angiotensin II in doses of 0.0025 to 0.0050 μg per kg per minute caused a small but definite increase in blood pressure in 5 of 7 experiments, a decrease in endogenous creatinine clearance of about 11%, and a decrease in urine flow and water clearance of about 40%. The rate of sodium excretion was depressed by nearly 50%, while that of potassium decreased much less. Pitressin produced changes of water excretion qualitatively similar to those caused by angiotensin II. However, this effect was achieved without alteration in blood pressure, although filtration rate decreased. Further, pitressin did not consistently affect excretion of sodium and potassium. The results suggest that angiotensin II at the dose-ranges examined inhibits water and salt excretion by direct tubular action.

Serum Renin Activity in Human Renal Homotransplantation

Serial determinations of serum renin activity (RA) have been made in 19 patients recipient of 21 allografts. Five patients received kidneys from 4 related and from 1 unrelated living donors; 13 patients received allografts from 15 adult cadavers, and 1 from an anencephalic newborn. During the first post transplant month observations were made in 18 recipients. RA was found increased transiently in 7 and persistently in 10 recipients. The increase in RA was associated with acute tubular necrosis, 5; occlusive vascular lesions of the graft artery or its branches and infarction of the graft, 4; cortical necrosis, 2; and acute rejection, 3. In 2 recipients no apparent cause for the rise in RA could be found, and in 1 the increase was probably related to diuretic therapy. During the late post transplant period, from 2 months to 2 years and 8 months, observations were made in 10 recipients. RA remained increased in 2 recipients with occlusive vascular lesions and rejection of the allograft, respectively. In 6 other recipients RA increased in association with rejection, 4; development of graft artery stenosis, 1; and diuretic therapy, 1. In 2 recipients with uneventful course RA remained normal. There was no statistically significant correlation between changes in RA and endogenous creatinine clearance, or body weight. However, there was a significant negative correlation between RA and sodium excretion, and a small positive correlation between RA and diastolic blood pressure.

Effects of valine-5 angiotensin II on excretion of water and salt in primary and secondary hypertension.

SummaryAngiotensin II was administered at rates of 0.3 to 0.6 μg per minute over 6 to 24 hours to 6 subjects with hypertension of various etiologies under conditions of positive and negative sodium balance. Angiotensin produced hypernatriuresis under condition of positive sodium balance. The effect was most marked in those subjects having a diastolic blood pressure above 110 mm Hg.Miss S. Goodman, Mrs. S. Beacher and Miss M. E. Novotny provided technical assistance. Angiotensin II (Hypertensin Ciba) and aldosterone (d-aldosterone Ciba) were obtained through the courtesy of Dr. W. E. Wagner, Summit, N. J.Summary Angiotensin II was administered at rates of 0.3 to 0.6 μg per minute over 6 to 24 hours to 6 subjects with hypertension of various etiologies under conditions of positive and negative sodium balance. Angiotensin produced hypernatriuresis under condition of positive sodium balance. The effect was most marked in those subjects having a diastolic blood pressure above 110 mm Hg. Miss S. Goodman, Mrs. S. Beacher and Miss M. E. Novotny provided technical assistance. Angiotensin II (Hypertensin Ciba) and aldosterone (d-aldosterone Ciba) were obtained through the courtesy of Dr. W. E. Wagner, Summit, N. J.

Maintenance dialysis for diabetic nephropathy with uremia.

Abstract Fourteen patients, aged 28–61 yr, with diabetic nephropathy and uremia were observed on maintenance dialysis for a total of 156.5 dialysis patient months (range: 1.5–30 months per patient). Clinical course on dialysis was eventful in most cases, though nitrogen retention and acidosis were readily controlled. Bouts of circulatory congestion and severe fluid retention were frequent in nine patients, six of whom died of acute myocardial infarction or intractable heart failure. Septic complications and hepatitis caused or contributed to the demise of four patients, and thromboembolic complications to that of one patient. Rehabilitation on dialysis was limited in nine cases, and five remained disabled. Retinopathy was not improved. Emotional problems were common in nine patients, five of whom required psychiatric care. Ten patients died between 1.5 and 21 months after the start of dialysis, and only one survived over 30 months. Three patients underwent renal transplantation 6 to 18 months after inception of dialysis. They all died 10 days to 3 months after surgery of overwhelming septic complications. Survival rate on maintenance dialysis for the whole group was 54.8 per cent at 1 yr, and 16.4 per cent at 2 yr.

Antihypertensive and Hemodynamic Effects of Ticrynafen Compared with Hydrochlorothiazide

A double-blind study was performed in 33 ambulatory men, 27 black and 6 white, with mild to moderate essential hypertension to evaluate antihypertensive effects of ticrynafen (Ty) versus hydrochloroth

Symptomatic Acinetobacter Calcoaceticus Peritonitis “A Complication of Peritoneal Dialysis”

Acinetobacter Calcoaceticus peritonitis was seen during the course of peritoneal dialysis in two patients with end-stage kidney disease within a 3-month period. In one patient, the isolate was A. Calcoaceticus Varient Anitratus (formerly Herellea Vaginicola) and in the other it was A. Calcoaceticus Lwoffi (formerly Mima Polymorpha). Both were successfully treated with continuous peritoneal antibiotic lavage.

Production of Urea Nitrogen and Creatinine in Chronic Azotemia And Effect of Hemodialysis.

Summary 1. The daily rate of urea nitrogen and creatinine production was determined in 7 patients with chronic stable azotemia and 3 normal subjects, maintained on a reduced protein intake. In addition, the effect of hemodialysis on urea nitrogen and creatinine production was observed in all the azo-temic patients. 2. In 7 cases predialysis urea nitrogen production was similar to that found in normal subjects and averaged 55% of the nitrogen intake. In 2 cases urea nitrogen production was elevated, being equal to or exceeding the dietary nitrogen. The rate of creatinine production in the azotemic patients was slightly lower than that found in normal subjects. 3. Postdialysis urea nitrogen production increased significantly in 5 cases whose predialysis PUN ranged from 42 to 73 mg%, and decreased in 4 cases with predialysis PUN of 87 to 192 mg%. Creatinine production decreased in all but one case.