Fred L. Shapiro

Pericarditis in Chronic Uremia and Its Sequels

Abstract Uremic pericarditis occurred in 25 of 152 patients treated by chronic dialysis. Pyrexia was associated with pericarditis in 96% of the patients. A friction rub was not heard at any time in...

Radiation-induced renal disease: A clinicopathologic study

Radiation injury to the renal parenchyma is an unusual cause of renal insufficiency. Light, immunofluorescence and electron microscopic studies were performed on the renal tissue from two patients in whom renal insufficiency developed within a year after they received abdominal irradiation. The glomerular lesion in both patients was similar. Mild endothelial cell swelling and basement membrane splitting were noted consistently on light microscopy. The electron microscopic examination revealed marked subendothelial expansion with electron-lucent material associated with deposition of basement membrane-like material adjacent to the endothelial cells. In some capillary loops, the endothelial cell lining appeared to be completely lost. The pathogenesis of radiation-induced renal injury is still uncertain. It is speculated that local activation of the coagulation system with consequent thrombosis of the renal microvasculature may be extremely important.

Subdural Hematoma in Regularly Hemodialyzed Patients

Thirteen of 394 (3.3%) regularly dialyzed patients of the Regional Kidney Disease Program developed subdural hematoma. The following factors contributed to formation of subdural hematoma: head trauma, ultrafiltration to control excessive accumulation of fluid and hypertension, anticoagulants, and frequent vascular access infection and clotting. Neurologic symptoms and signs, which may be similar to dialysis disequilibrium, aid only in signifying the presence, not the ultimate localization, of subdural hematoma. Our experience underscores the frequency of bilateral disease, irrespective of neurologic findings. Skull films, lumbar puncture, and electroencephalography were of little diagnostic help. Although valuable and safe, brain scanning was not as useful as desired due to occurrences of false-negative studies and failure to identify bilaterality of lesions. Cerebral angiography was always diagnostic. Surgical intervention yielded disappointing results, and only 2 patients (15%) survived. A review of 9 other patient reports is included.

Methemoglobinemia from Well Water Nitrates: A Complication of Home Dialysis

Abstract Toxic methemoglobinemia developed in a patient on home dialysis after nitrate contamination of well water used to make the dialysate. The patient recovered after treatment with intravenous...

Tolerance of Skin Homografts Induced in Adult Mice by Multiple Injections of Homologous Spleen Cells.

Summary 1. Adult mice of the Z(C3H) strain have been made tolerant of skin homo-grafts of the(A X Z) F1 hybrid strain by repeated intravenous and intraperitoneal injections of homologous spleen cells. 2. Repeated intraperitoneal injections of homologous spleen cells generally failed to induce a tolerant state, although 3/75 recipients accepted the homologous skin homotransplant.

Irreversible Acute Renal Failure in Idiopathic Nephrotic Syndrome

In five adult patients (aged 44 to 74 years) with idiopathic nephrotic syndrome, irreversible acute renal failure developed. Prior renal disease, associated systemic illness or occlusion of major renal vasculature was not present. All patients continued to excrete large amounts of proteins (8.6 to 15 g/24 hours) despite a minimal glomerular filtration rate and severe oliguria. One patient died after five months without recovering renal function. Four patients have required hemodialysis for a period of 12 to 58 months. The failure to recover renal function could not be explained by the light microscopic findings. It is suggested that the irreversibility of the renal failure may be related to either permanent alterations in renal blood flow or ultrastructural changes, or to both. Clinically, adult patients in whom acute renal failure develops during the course of idiopathic nephrotic syndrome seem to have a grave prognosis. Protracted oliguria or irreversible renal failure can be expected to occur.

Osteomyelitis in hemodialysis patients.

Abstract Five patients receiving regular hemodialysis developed osteomyelitis. Rib and thoracic vertebral column were the most common sites of involvement. The diagnosis was made ante mortem in fou...

Immune-Complex Nephritis in Mixed Connective Tissue Disease

Excerpt Mixed connective tissue disease has been recognized as a rheumatic syndrome with features similar to those of systemic lupus erythematosus, progressive systemic sclerosis, and polymyositis,...

Essential duration of parabiosis and development of tolerance to skin homografts in mice.

Summary 1. Parabiosis between Z animals and AZ F1 hybrid animals results in immunological tolerance of the former strain to the latter. 2. When parabiotic union between Z and AZ F1 animals is maintained less than 30 days a tolerant state is not regularly produced, but when maintained 30 days or more, tolerance of Z for AZ F1 hybrid skin grafts is the rule. 3. Tolerance between Z and Ce strain mice may be produced in adult life by maintenance of a parabiotic union between members of these 2 strains. 4. Under these circumstances Z mice more readily become tolerant to the strain of the parabiotic partner than do Ce strain mice. 5. Implications of these findings to the theory of immunological tolerance are discussed.

Protein metabolism in renal failure.

Abstract The concept of severe protein restriction in chronic renal failure is a familiar one. This is a review of some aspects of protein metabolism with particular reference to the use of low-protein diets in undialized patients and some of the problems associated with the management of patients on dialysis or after transplantation.