Gk Vanderhem

The effect of indomethacin on kidney function and plasma renin activity in man.

125Iothalamate and 131I-hippuran clearances, sodium excretion and plasma renin activity (PRA) before and during indomethacin administration in an oral dose of 3 x 50 mg/day were studied in volunteers with a normal or reduced kidney function, as well on non-sodium-restricted as on sodium-restricted diet. Indomethacin induced a temporary sodium and water retention and a decrease in glomerular filtration rate. It also lowered PRA. The latter phenomenon did not depend on sodium retention and was present within 2 h after an oral dose of 50 mg. The results may be explained by indomethacin-induced inhibition of prostaglandin synthesis.

Acute effects of cis-diamminedichloroplatinum (CDDP) on renal function

SummaryTen previously untreated patients with metastatic non-seminomatous testicular carcinoma received cis-diamminechloroplatinum (CDDP). Renal function studies were performed before and following the first CDDP infusion. A decrease in effective renal plasma flow (ERPF) and an increase in filtration fraction (FF) was found in all patients. These findings suggest primary changes in renal hemodynamics during CDDP infusion.

Treatment of the Nephrotic Syndrome with Indomethacin

In 25 patients with nephrotic syndromes of different origin, indomethacin caused an immediate decrease in glomerular filtration rate (GFR) and urinary protein excretion. This effect of indomethacin on GFR and proteinuria was more pronounced when the renin-angiotensin system was stimulated by a low-sodium diet and 50 mg hydrochlorothiazide daily, and resulted in a significant rise in serum albumin. Withdrawal of indomethacin after 1--3 years of administration was followed by an increase in proteinuria to pretreatment levels in 9 out of 15 patients. A harmful renal effect of long-term indomethacin administration was found to be unlikely. The results suggest that the steroid-resistant nephrotic syndrome can be treated symptomatically by indomethacin.

SYSTEMIC AMYLOIDOSIS - A CLINICAL SURVEY OF 144 CASES

The aim of this paper is to provide a framework for the evaluation of AA and AL amyloid disease based on our experience with 162 well defined cases seen up to December 1986. We will discuss the associated conditions, presenting manifestations, results of biopsy procedures, immunohistochemical classification, aspects of system involvement, scintigraphy, prognosis and therapeutic approach.

Diuretic effects of angiotensin-converting enzyme inhibition: comparison of low and liberal sodium diet in hypertensive patients.

Inhibitors of the angiotensin-converting enzyme (ACE) acutely increase sodium excretion. Whether or not continued treatment induces net negative sodium balance is not clear, and may depend on initial sodium balance. We therefore investigated the effects of 8 days of treatment with enalapril, 10 mg b.i.d., on sodium balance in 10 subjects with uncomplicated essential hypertension, in balance on a low (50 mmol sodium/24 h) and a liberal (200 mmol sodium/24 h) sodium intake. Sodium excretion exceeded intake during the first days of treatment, amounting to sodium losses of 101 ± 24 and 112 ± 15 mmol in the low and the liberal sodium diets, respectively. The sodium loss was accompanied by a fall in body weight with both regimens. The blood pressure response to enalapril was potentiated by the sodium-restricted diet. The net increase in sodium excretion after enalapril administration, however, was similar for both diets. This was particularly true for individual patients, suggesting an individual response pattern to ACE inhibition.

Restenosis Prevalence and Long-Term Effects on Renal Function after Percutaneous Transluminal Renal Angioplasty

We studied the frequency of restenosis and the effects of percutaneous transluminal renal angioplasty (PTRA) on blood pressure (BP) and particularly on renal function in all patients in whom successful dilatation was performed. Restenosis was found in 42% of the patients with an atherosclerotic renal artery stenosis and in 22% of the patients with fibromuscular dysplasia. BP improvement was seen in 70-80% of the patients with unilateral stenosis or with successful bilateral dilatation (group I) whereas only seldom was an effect on BP observed in patients with more complicated disease, such as those with an occlusion of the contralateral artery (group II). Remarkably, however, both in group I and in group II, in about half of the patients an improvement in renal function was found, even 2-3 years after the procedure. Our results thus indicate that PTRA can be useful in preservation or even improvement of renal function, even if no effect on blood pressure can be expected.

THE EFFECT OF PHLEBOTOMY ON RENAL-FUNCTION AND PROTEINURIA IN A PATIENT WITH CONGENITAL CYANOTIC HEART-DISEASE

The Effect of Phlebotomy on Renal Function and Proteinuria in a Patient with Congenital Cyanotic Heart Disease P.E. de Jong J.J. Weening A.J.M. Donker G.K. van der Hem P. E. de Jong, Department of Medicine, Division of Nephrology, Department of Pathology, State University Hospital, Groningen (The Netherlands), Nephron 1983;33:225-226 Sir, With interest we read the paper of Wilcox et al. [1] on renal function in patients with cor pulmonale and secondary polycythaemia. Effective renal plasma flow (ERPF) was found to be reduced and filtration fraction (FF) to be increased. A few days after haematocrit (Hct) reduction, FF fell in 5 out of 7 patients. Parallel with the decrease in FF, a fall in body weight was seen. The authors suggest that, at least temporarily, the increased postglomerular capillary resistance – which is present in these patients [2] -can be corrected by Hct reduction. We now show another effect of phlebotomy in a patient with congenital cyanotic heart disease. It is known that glomerular lesions can occur in these patients [3, 4]. Spear and Vitsky [3, 4] described glomerular enlargement, congestion and capillary dilatation. There was mesangial hyper-cellularity and focal glomerular sclerosis on light microscopy. On electron microscopy, diffuse thickening of the glomerular basement membrane was found [5]. Besides the abovementioned renal functional abnormalities also proteinuria is a common finding in these patients [4,5], probably as a consequence of the glomerular functional and morphological abnormalities. We recently observed a 36-year-old man, known with tetralogy of Fallot, who underwent a Blalock operation at the age of 6. He was admitted to our hospital because of nephrotic syndrome and hypertension. Hct was 67%. Phlebotomy was carried out and he was instituted on digoxin. Body weight decreased and oedema disappeared but proteinuria persisted. From this period no accurate renal function studies are available. The patient was transmitted to the department of nephrology. At this moment no clinical signs of fluid overload were present and blood pressure was 140/95 mm Hg. Further investigations did not reveal any other abnormality known to cause nephrotic syndrome. Hct was 55%, proteinuria amounted to 4–5 g/ Table I. The effects of phlebotomy in our patient During After 8 weeks observation phlebotomy3, after discharge Body weight, kg 56.7 55.3 59 Haematocrit, % 55 44 59 Serum creatinine, μmol/l 86 77 91 Serum urea, mmol/l 7.7 5.0 5.3 GFR, ml/min 73 101 78 ERPF‚ml/min 132 223 155

Influence of Combination Chemotherapy with cis-Diamminedichloroplatinum on Renal Function: Long-Term Effects

Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined in 8 patients with disseminated testicular carcinoma before, during and 1 year after termination of a combination chemotherapy with cis-diamminedichloroplatinum (CDDP). The decrease in median GFR in comparison with the pretreatment value was 15.5% at the start of the maintenance therapy, 23% at the end of the maintenance therapy and 15.5% 1 year after termination of therapy. The comparable reduction in ERPF at those instants was 15.5, 19 and 23.5%, respectively. At all intervals the changes in GFR were significantly reduced in comparison with pretreatment values. No significant change in both GFR and ERPF was found either during or after discontinuation of maintenance treatment. The fall in ERPF was significant during the total period of treatment as well as during the total time of observation. Thus, no cumulative nephrotoxicity during therapy, nor improvement in renal function thereafter was found. Serum levels of creatinine and beta-2-microglobulin did not express the changes in renal function.

Effect of Indomethacin in Two Siblings with a Renin-Dependent Hypertension, Hyperaldosteronism and Hypokalemia

Two siblings are described with hypertension, hyperreninism, hyperaldosteronism and hypokalemia. Propranolol therapy lowered blood pressure markedly, but failed to normalize serum potassium. Indomethacin orally decreased blood pressure and normalized all biochemical abnormalities. We suggest that in these patients there exists a renin-dependent hypertension in combination with a state of hyperprostaglandinism. It is likely from our studies in these 2 patients, that the state of hyperprostaglandinism is secondary to a hypertension with increased sympathetic tone.

Loss of Amino Acids during Hemodialysis: Effect of Oral Essential Amino Acid Supplementation

The aim of this study was to investigate the effect of amino acid (AA) supplementation on the loss and its time course of free AA, during hemodialysis. 2 uremic patients on regular hemodialysis received an increasing number of essential AA tablets during the dialysis. The loss and its time course of 6 essential and 7 nonessential free AA during dialysis was assayed in the dialysate. The loss per dialysis treatment of the administered essential AA increased almost proportionally with the doses of AA tablets. For the nonessential AA, no definite relationship between doses of AA tablets and losses was observed. At all levels of supplementation, methionine was retained best: 90% of the amount present in the tablets. Threonine showed the lowest retention: 15-55%.