Robert P. Eisinger

Uremic Pleuritis — A Clinicopathological Entity

FIBRINOUS pericarditis is a well known feature of the uremic state. However, fibrinous pleuritis with pleural pain and friction rub in uremia has received little recognition. During the past 18 mon...

Abnormal Response to the Valsalva Maneuver in Patients on Chronic Hemodialysis

A standardized Valsalva maneuver was performed on 18 patients who were being maintained by chronic hemodialysis. Absence of the normal bradycardia after release of forced expiration was observed in 12

The Excretion of Acid in Unilateral Renal Disease in Man

In chronic forms of renal disease the capacity to excrete acid, and in particular ammonia, is reduced (1-5). The mechanisms involved in this reduction, however, are not well understood. The excretion of acid might be decreased by a specific tubular defect in the secretion of hydrogen ions or the formation of ammonia or alternatively by total loss of function in groups of nephrons with normal tubular function in the remaining nephrons. Since the excretion of hydrogen ions is influenced to a considerable extent by extrarenal factors, it is difficult to make comparisons between normal subjects and patients with renal disease, who often have alterations in systemic acid-base equilibrium, solute load, and salt excretion. To overcome such limitations, Morrin, Bricker, Kime, and Klein (6) employed an experimental model of unilateral disease in the dog that allowed examination of the diseased kidney in the same milieu as the normal kidney. In man, except for a few observations in renal arterial stenosis (7-10), the acidifying capacity of the diseased kidney has not been studied in a comparable way. The present investigation was undertaken to examine the mechanism of acid excretion in forms of human renal disease confined to one kidney or involving one kidney to a greater extent than the other. Patients with predominantly

Glomerular Sclerosis in Adults with Nephrotic Syndrome

Abstract Ten adults with the nephrotic syndrome and sterile pyuria are described. On biopsy they had varying degrees of glomerular sclerosis without proliferation. Interstitial inflammation and fib...

Functional Aortic Insufficiency — A Feature of Renal Failure

PRESENCE of an aortic diastolic murmur generally signifies organic valvular disease. Functional aortic insufficiency is unusual; its occasional occurrence has been attributed to such hemodynamic st...

Successful Intravenous Pyelography in Advanced Uremia — Visualization in the Post-Dialytic State

Abstract In eight patients with chronic renal disease (creatinine clearance of 0.4 to 10.0 ml per minute and urine-plasma creatinine ratio between 4.0 and 9.0), drip-infusion intravenous pyelograph...

Hemodialysis Using Femoral Vessel Cannulation

600 acute hemodialyses have been performed by a simplified method of percutaneous femoral vessel can nulation utilizing special equipment. Because skin incision was not required, repeated cannulation

Pseudoarrhythmias during Hemodialysis

IN patients undergoing dialysis cardiac arrhythmias may develop because of rapid shifts in electrolyte and fluid balance. We have therefore obtained frequent electrocardiographic tracings in such p...

Augmented Natriuretic Response to Infusion of Saline in Dogs Rendered Acutely Hypertensive with Metaraminol

Summary The mechanism of the exaggerated natriuretic response to saline infusion exhibited by hypertensive subjects is not understood. An attempt was therefore made to reproduce this phenomenon in laboratory animals rendered hypertensive by pharmacologic means. Six mongrel dogs were studied. Their natriuretic response to saline infusion at a rate of 1 ml per minute was determined. The same dogs were restudied while their blood pressure was elevated with metaraminol. An enhanced natriuretic response to normal saline infusion was observed in 5 out of the 6 dogs made acutely hypertensive with metaraminol. The demonstration that exaggerated natriuresis may be induced in a species other than man makes available an experimental model for further study of this phenomenon. The present observations support previous evidence in man that exaggerated natriuresis depends on the presence of elevated blood pressure alone and is independent of the cause of the hypertension. From the acute nature of the present experiment the thesis that exaggerated natriuresis represents the shedding of sodium sequestered during the hypertensive state is rendered untenable.

Influence of posture and diurnal rhythm on the renal excretion of acid: Observations in normal and adrenalectomized subjects

Abstract The influence of posture and diurnal rhythm on the renal excretion of acid was examined in 4 normal and 2 adrenalectomized subjects. Assumption of the recumbent position in normal subjects resulted in inhibition of acid excretion, the extent of inhibition being influenced by the diurnal rhythm. Postural inhibition of acid excretion was also observed at high levels of acid excretion following methionine loading. In adrenalectomized subjects assumption of the recumbent position resulted in postural natriuresis but not in any decrease in acid excretion. The postural inhibition of acid excretion occurring in normal subjects could not be restored in adrenalectomized subjects by administration of hydrocortisone, methylprednisolone or aldosterone. It is suggested that (1) postural inhibition of acid excretion is dependent on adrenal function but not directly on the presence of glucocorticoid hormone or aldosterone, (2) that the mechanism of postural and diurnal variations in acid excretion may share a common factor.