Harry E. Sarles

The nephrotic syndrome associated with neoplasia: An unusual paraneoplastic syndrome: Report of a case and review of the literature

The nephrotic syndrome complicating malignancy in the absence of renal vein thrombosis, amyloid or neoplastic infiltration of the kidney is an unusual occurrence. A case of diffuse, well differentiated, lymphocytic lymphoma and lipoid nephrosis documented by light microscopy, electron microscopy and immunofluorescent studies is reported. A review of the literature revealed 76 case reports in which the nephrotic syndrome was associated with neoplasia. The most frequently associated neoplasms are Hodgkins disease, various carcinomas, nonHodgkins lymphoma and leukemia in descending order. The most frequent renal lesion in patients with the nephrotic syndrome associated with various carcinomas is membranous glomerulonephritis (81 per cent) as opposed to patients with lymphomas or leukemias who have predominantly lipoid nephrosis (60 per cent). The evidence is reviewed suggesting that the lesions in membranous nephropathy are immunologically mediated by tumor or viral antigen-antibody complexes and in lipoid nephrosis perhaps by a defect in t-lymphocyte function.

The Risk of Anticoagulation in Hemodialysis Patients

The risks of intermittent anticoagulation with heparin for hemodialysis and longterm anticoagulation with warfarin to prevent clotting of arteriovenous shunts were assessed in a group of 125 home dialysis patients. Over a 7-year period, there were nine bleeding complications attributable to heparin anticoagulation for an incidence of one complication for every 40 patient year on dialysis. In contrast, 20 of 48 patients anticoagulated with warfarin for an average of 2 years each, had a total of 50 hemorrhagic complications requiring 542 days in the hospital and 15 operative procedures. Concersion to an alternative form of vascular access, the internal arteriovenous fistula, obviated the need for warfarin therapy and its unacceptably high complication rate in this population of patients.

Acute Renal Failure after the Administration of Iopanoic Acid as a Cholecystographic Agent

ACUTE renal failure after the ingestion of iopanoic acid† has previously been reported.1 However, from this report it is difficult to implicate iopanoic acid as the sole cause of renal injury, for ...

Sodium excretion patterns during and following intravenous sodium chloride loads in normal and hypertensive pregnancies

Abstract Exaggerated natriuresis is consistently found in hypertension following parenteral sodium chloride loads. To the contrary, during pregnancy patients with essential hypertension and pre-eclampsia have been reported to retain sodium abnormally. This discrepancy could be explained by negative sodium balance preceding the study of pregnant patients with hypertension in previous investigations. Twenty-six pregnant patients were studied during the last trimester of pregnancy: 5 normal controls, 9 with pre-eclampsia, 8 with essential hypertension, and 4 patients with mild chronic proliferative glomerulonephritis. All subjects received a diet containing 120 mEq. of sodium daily. On day 11, base-line sodium excretion was established. One liter of 2 ½ per cent sodium chloride was infused at a rate of 12 c.c. per minute. Urine collections were obtained during and for 24 hours following the infusion. The patients with essential hypertension exhibited striking natriuresis during and immediately following the infusion. The pre-eclamptic, glomerulonephritic, and normal subjects had similar sodium excretion patterns during and following the sodium chloride infusion and were clearly separated from the patients with essential hypertension.

Hereditary nephritis, retinitis pigmentosa and chromosomal abnormalities.

Abstract A family afflicted with hereditary nephritis, retinitis pigmentosa and pendular nystagmus is described. On the maternal side of the family, six members have had serious chronic renal disease which histologically resembles chronic pyelonephritis. The proband and a sibling also had retinitis pigmentosa and pendular nystagmus. The paternal side of the family demonstrates several chromosomal abnormalities which can best be explained as a familial tendency to nondysjunction with mosaicism.

Follicular Carcinoma of the Thyroid Metastatic to the Kidney 37 Years After Resection of the Primary Tumor

A case is described of thyroid carcinoma presenting as renal metastases 37 years after initial resection of the primary. Thyroid carcinoma metastatic to the kidney detected during life is rare, only 2 cases having been reported to date. An additional feature of this case is that the patient had donated the contralateral kidney for transplantation before discovery of the metastases. Metastatic thyroid carcinoma is reviewed and the implication of organ donation in patients with thyroid carcinoma is discussed.

Intrarenal Arteriovenous Fistula and Systemic Hypertension Following Percutaneous Renal Biopsy

A patient with intrarenal arteriovenous fistula and the development of severe diastolic hypertension following percutaneous renal biopsy is presented in detail. The fistula was discovered by auscultat

Albumin Kinetics and Nutritional Rehabilitation in the Unattended Home-Dialysis Patient

Abstract Forty-six patients with chronic renal failure were trained in a home-dialysis program and followed for six to 42 months. All were given a diet containing 80 g per day of protein. They carried out dialysis three times a week for a total of 24 to 30 hours. After six to 42 months, 41 had gained 1 to 45 per cent of their initial weight, four had no change in weight, and one had lost weight. Mean albumin concentration increased from 3.3 to 4.4 g per 100 ml during the period of observation. Changes from normal as measured by 125l-labeled albumin in eight patients included an increased plasma volume (58 vs. 41 ml per kilogram), increased intravascular albumin (2.6 vs. 1.7 g per kilogram), and a total exchangeable albumin (6.2 vs. 3.7 g per kilogram). The albumin half-life and albumin turnover rates were normal. Thirty-six patients returned to full activity, and 10 resumed part-time activities. nutritional rehabilitation thus was possible with frequent dialysis and a relatively normal protein intake.

Renal transplantation after thoracic duct drainage

Forty-seven patients treated by at least 28 days of thoracic duct drainage (TDD) before cadaveric renal transplant are compared with 63 patients treated with standard immunosuppression. The TDD patients were begun on half the dosage of steroids, and at 30 days were receiving approximately two-thirds the dose that the non-TDD patients received. Acute rejection occurred in 35% of the TDD group, as compared with 61% of the non-TDD group. Graft survival in the TDD patients was twice as good as the non-TDD patients at all time intervals. The patient survival rates were not significantly different between the two groups. TDD pretransplant favorably affects cadaveric renal allograft survival for at least five years.

Preparation of chronic thoracic duct lymph fistulas in man and laboratory animals

Abstract Thoracic duct lymph fistulas were maintained from 20 to 150 days in 13 patients. The indications for long-term lymph fistulas were lymph dialysis for chronic renal failure in 11 patients and lymph decompression for ascites in 2. The important technical features are the use of a Teflon tip in the thoracic duct and Silastic tubing for both the lymphatic drainage cannula and venous reinfusion cannula. Both cannulas exit through a Silastic skin exit device implanted in the chest wall, which has largely prevented the complication of accidental removal. The average lymph flow per patient ranged between 3.2 and 9.8 liters per 1.73 sq. m. per day, and the total lymph drained varied between 130 and 1,125 liters. Short-term lymph fistulas were prepared in 7 other patients for study purposes. With the same equipment, 9 calves were studied with lymph fistulas remaining open from 5 to 23 days. Lymph fistulas prepared by this method eventually failed because of lymph clotting in the cannula tip. Clotting was enhanced by hematochylia and decreased lymph flow rates. Successful long-term fistulas can be prepared in man and laboratory animals. Studies of lymphocyte dynamics, cellular immunity, and other physiological phenomena are greatly facilitated by the ability to maintain long-term lymph fistulas.