Hepatic Metabolism of Aminopyrine in Patients with Chronic Renal Failure

1978 ◽  
Vol 54 (2) ◽  
pp. 133-140 ◽  
Author(s):  
S. Scherrer ◽  
B. Haldimann ◽  
A. Küpfer ◽  
F. Reubi ◽  
J. Bircher
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Renal Insufficiency ◽  
Serum Creatinine ◽  
Hepatic Metabolism ◽  
Normal Subjects ◽  
Hepatic Disease ◽  
Dialysis Treatment ◽  
History Of ◽  
Aminopyrine Demethylation

1. To evaluate potential alterations in hepatic metabolism of drugs occurring in patients with renal insufficiency the fate of aminopyrine was studied in 17 patients with chronic renal failure and in 27 normal subjects. 2. Although patients with chronic renal failure exhibited large variations, their aminopyrine plasma disappearance times (mean 0·62 ± sd 0·24 h−1) were significantly higher than those found in normal subjects (0·30 ± 0·07 h−1, P < 0·002). 3. 14CO2 derived from [dimethylamine-14C]aminopyrine disappeared from breath more rapidly in patients with chronic renal failure and a history of analgesic abuse (0·40 ± 0·04 h−1) than in control subjects (0·22 ± 0·03 h−1, P < 0·01) and in other patients with chronic renal failure (0·24 ± 0·04 h−1). 4. Dialysis treatment and serum creatinine concentrations were not correlated with the rates of aminopyrine metabolism. Two additional patients, however, with combined renal and hepatic disease, exhibited markedly slowed rates of aminopyrine demethylation. 5. Although chronic renal failure by itself might not alter microsomal drug metabolism it is concluded that, in patients with a history of abuse of phenacetin-containing analgesics, marked acceleration in aminopyrine N-demethylation may be observed.

Accumulation of Sulphur-Containing Amino Acids Including Cysteine-Homocysteine in Patients on Maintenance Haemodialysis

1980 ◽  
Vol 58 (5) ◽  
pp. 427-430 ◽  
Author(s):  
D. E. L. Wilcken ◽  
Vatsala J. Gupta ◽  
S. G. Reddy
Keyword(s):  
Amino Acids ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Renal Insufficiency ◽  
Serum Creatinine ◽  
Normal Subjects ◽  
Chronic Haemodialysis ◽  
Maintenance Haemodialysis ◽  
Acidic Amino Acids ◽  
Rate Of Accumulation

1. Plasma sulphur-containing amino acids were measured in 19 patients with renal failure on chronic haemodialysis and in 22 normal subjects, to determine the rate of accumulation of these amino acids in chronic azotaemia. 2. Cysteine-homocysteine mixed disulphide was significantly increased in patients before dialysis and homocystine was detected in low concentration in 10 patients. Cystine and taurine were also increased. Changes in other neutral and acidic amino acids were similar to those reported in chronic renal insufficiency. 3. In 3–4 h of dialysis serum creatinine was decreased by a mean of 55%, cysteine-homocysteine by 41%and cystine by 58.5%(P<0.001 for each). Methionine concentrations were normal throughout. 4. We conclude that sulphur-containing amino acids, except methionine, accumulate in chronic renal failure as rapidly as creatinine.

A multivariate factor analysis of the high plasma concentration of cyclic AMP in patients with chronic renal failure

1980 ◽  
Vol 3 (1) ◽  
pp. 18-22
Author(s):  
F. Marumo ◽  
T. Sakai ◽  
M. Shirataka
Keyword(s):  
Renal Failure ◽  
Factor Analysis ◽  
Chronic Renal Failure ◽  
Plasma Concentration ◽  
Cyclic Amp ◽  
Serum Creatinine ◽  
Clinical Data ◽  
Plasma Concentrations ◽  
Normal Subjects ◽  
Creatinine Concentration

The concentration of cyclic AMP which is known as an intracellular mediator of hormone action increased in the plasma of patients with chronic renal failure (CRF). In the present study, the plasma concentration of cyclic AMP significantly correlated not only with serum, creatinine, and urea levels, but also with plasma PTH and glucagon in patients with CRF. Furthermore, plasma concentrations of PTH and glucagon correlated with the serum creatinine concentration to a significant extent. To discuss the cause of the increased cyclic AMP concentration in plasma of patients with CRF, multivariate analyses were carried out on the obtained clinical data from patients and normal subjects. In the factor analysis on the clinical data from 61 subjects, cyclic AMP, creatinine and BUN correlated with the first factor and PTH correlated with the second factor. The cumulative contribution ratio by the second factor was 76%. The results of the cluster analysis indicated that cyclic AMP, creatinine, and BUN formed a cluster and PTH glucagon made another cluster. These results suggest that the elevated plasma concentration of cyclic AMP in patients with CRF was mainly introduced not by overproduction but by the retention of cyclic AMP due to the decreased renal function.

Creatinine Metabolism in Chronic Renal Failure

1980 ◽  
Vol 58 (4) ◽  
pp. 327-335 ◽  
Author(s):  
W. E. Mitch ◽  
V. U. Collier ◽  
M. Walser
Keyword(s):  
Renal Failure ◽  
Body Weight ◽  
Chronic Renal Failure ◽  
Serum Creatinine ◽  
Renal Clearance ◽  
Average Rate ◽  
Specific Radioactivity ◽  
Normal Subjects ◽  
Volume Of Distribution ◽  
Metabolism Rate

1. Creatinine metabolism was studied in nine patients with severe chronic renal failure who were nevertheless in a nearly steady state with respect to their creatinine pool. Labelled creatinine was injected intravenously and the specific radioactivity of creatinine in urine was measured during the ensuing 5–7 days. 2. In each patient, the decline in specific radioactivity with time was a single exponential function after 12 h. The volume of distribution of creatinine averaged 49.1 ± 2.8% body weight. The average rate of creatinine production was 148 μmol day−1 kg−1, which is similar to predicted values for normal subjects of the same age, weight and sex. Creatinine metabolism rate/kg body weight, estimated as the difference between production rate/kg body weight, determined radioisotopically, and creatinine appearance rate (excretion plus accumulation), averaged 42 μmol day−1 kg−1. 3. Total creatinine metabolism rate/kg body weight was correlated with serum creatinine. Thus, as serum creatinine rises, an increasing fraction of the produced creatinine was metabolized rather than excreted. This relationship could account for the diminished creatinine excretion commonly seen in patients with chronic renal failure. 4. Extrarenal clearance (metabolism/serum creatinine) of this magnitude (approximately 31% of renal clearance in these patients) would be an undetectably small fraction of normal renal clearance. This could explain the absence of demonstrable creatinine metabolism in normal subjects. 5. Two pathways of metabolism were identified: a recycling of creatinine to creatine and an irreversible degradation of creatinine to products other than creatine.

Using Acetylcysteine to Prevent Radiographic-Contrast-Media-Induced Nephropathy in a Patient with Chronic Renal Failure

2001 ◽  
Vol 36 (7) ◽  
pp. 795-797
Author(s):  
Kevin E. Burns
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Serum Creatinine ◽  
Contrast Media ◽  
Stress Test ◽  
Chronic Hypertension ◽  
Baseline Serum ◽  
Radiographic Contrast ◽  
Radiographic Contrast Media ◽  
History Of

Clinical Pearls Each of these special features conveys an idea, concept, or fact that may be useful in your pharmaceutical practice, but may not be widely known, published, or taught. An 84-year-old male with a history of chronic renal failure secondary to nephrectomy and chronic hypertension was admitted for elective coronary angiography following complaints of midsternal chest pain and an abnormal thallium stress test. The patient was found to have other risk factors for radiographic-contrast-media-induced nephropathy, including hyponatremia and hypoalbuminemia. Mild volume expansion was initiated and acetylcysteine 600 mg was administered orally every 12 hours on the day before the procedure. The patient's baseline serum creatinine was found to be 2 mg/dL. A total of 125 mL of nonionic, low-osmolality contrast media was infused during the procedure. An additional two doses of acetylcysteine 600 mg were administered on the day of the procedure. The patient's recovery was uneventful and he was discharged. The postprocedure serum creatinine was stable at 2 mg/dL 48 hours after the procedure. It appears that orally administered acetylcysteine can prevent radiographic-contrast-media-induced nephropathy.

Increased Plasma Histamine Levels in Uraemic Pruritus

1990 ◽  
Vol 79 (5) ◽  
pp. 477-482 ◽  
Author(s):  
Felix Stockenhuber ◽  
Robert W. Kurz ◽  
Kaspar Sertl ◽  
Georg Grimm ◽  
Peter Balcke
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Renal Insufficiency ◽  
Serum Creatinine ◽  
Plasma Levels ◽  
Control Population ◽  
Plasma Histamine ◽  
Histamine Concentration ◽  
Maintenance Haemodialysis ◽  
Plasma Histamine Concentration

1. We determined plasma levels of histamine in uraemic patients and examined their correlation with the presence of pruritus. 2. In 27 patients with chronic renal failure, plasma histamine levels were analysed by radioimmunoassay and were compared with those of 40 healthy adult subjects. The control population showed plasma histamine concentrations of 185 ∓ 33 pg/ml, which were significantly lower than those of the patients with renal insufficiency. The highest levels (552 ± 116 pg of histamine/ml) were found in 16 patients with chronic renal failure (mean serum creatinine 5.1 ∓ 1.0 mg/dl) and severe itching. 3. Twelve patients with pronounced pruritus who were on maintenance haemodialysis (serum creatinine 9.2 ±1.2 mg/dl) had a mean plasma histamine concentration of 515 ± 81 pg/ml. Fifteen patients on regular haemodialysis (serum creatinine 9.0 ± 1.5 mg/dl) and who experienced itching had plasma histamine levels (322 ±40 pg/ml) which were significantly lower (P < 0.01) than those of the patients with pruritus but which were elevated compared with those of the control population (P < 0.01). 4. No correlation could be found between increased plasma histamine levels and the type of dialysis membrane used or the method of sterilization of the membrane. 5. Haemodialysis alone did not reduce plasma histamine concentrations, although high concentrations could be detected in the ultrafiltrate. In six patients a rapid decrease in plasma histamine concentration from 565 ∓ 134 pg/ml to within the normal range could be detected after 60 min of combined haemodialysis and haemoperfusion. 6. Our results show that increased plasma levels of histamine are found in patients with renal insufficiency and pruritus, and we conclude that this mediator might be involved in the genesis of uraemic pruritus.

Pre-renal azotemia mimicking chronic renal failure in a hypotensive patient.

1979 ◽  
Vol 25 (11) ◽  
pp. 1978-1980 ◽  
Author(s):  
J R Darm ◽  
N V Bhagavan ◽  
A G Scottolini
Keyword(s):  
Atrial Fibrillation ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Serum Creatinine ◽  
Serum Urea ◽  
Urea Nitrogen ◽  
Urinary Creatinine ◽  
Serum Urea Nitrogen ◽  
History Of

Abstract A 56-year-old Samoan man with a documented history of hypertension, who presented with atrial fibrillation and hypotension, quickly developed renal failure with a serum urea nitrogen of 1.370 g/L and a serum creatinine of 92 mg/L. After hydration of the patient, the creatinine value became normal in two days, the urea nitrogen in four days. The urinary creatinine output during the first 24 h of hospitalization was 3.7 g. This case illustrates the rapidity with which unusually large amounts of creatinine (more commonly seen in chronic renal failure) can accumulate and be excreted in pre-renal failure. It also reaffirms the usefulness of the urea nitrogen/creatnine ratio in evaluating the causes of azotemia.

scholarly journals Renal sodium and water handling in hypothyroid patients: the role of renal insufficiency.

1990 ◽  
Vol 1 (2) ◽  
pp. 205-210
Author(s):  
M Allon ◽  
A Harrow ◽  
C B Pasque ◽  
M Rodriguez
Keyword(s):  
Renal Failure ◽  
Glomerular Filtration Rate ◽  
Chronic Renal Failure ◽  
Renal Insufficiency ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Normal Subjects ◽  
Sodium Reabsorption ◽  
Water Handling ◽  
Hypothyroid Patients

The mechanism responsible for renal tubular abnormalities in sodium and water excretion in hypothyroid patients is poorly understood. To evaluate the possible contribution of the reduced glomerular filtration rate of hypothyroidism to these abnormalities, tubular function in hypothyroid patients was compared with that in patients with chronic renal failure and in normal subjects. The lithium clearance method and oral water loading were used to evaluate parameters of tubular sodium and water handling, respectively. The hypothyroid and the chronic renal failure patients were selected to have similar reductions in glomerular filtration rate. As compared to the normal subjects, the hypothyroid and chronic renal failure patients had a decrease in proximal sodium reabsorption and an increase in distal sodium reabsorption. The changes in tubular handling of sodium were not different in the hypothyroid and the chronic renal failure patients. Maximal urinary flow rate and free water clearances were similarly reduced in the hypothyroid patients and the chronic renal failure patients. For all subjects studied, proximal sodium reabsorption and maximal urinary volume were directly correlated with the glomerular filtration rate, and distal nephron sodium reabsorption was proportionate to delivery of sodium from the proximal tubule. The results suggest that the abnormalities in tubular sodium and water handling in hypothyroid patients are comparable to those present in other patients with a similar degree of renal insufficiency. Thus, the tubular abnormalities in hypothyroidism may be a consequence of the associated decrease in glomerular filtration rate.

Evidence for an Increased Generation of Prostacyclin in the Microvasculature and an Impairment of the Platelet α-Granule Release in Chronic Renal Failure

1988 ◽  
Vol 60 (02) ◽  
pp. 205-208 ◽  
Author(s):  
Paul A Kyrle ◽  
Felix Stockenhuber ◽  
Brigitte Brenner ◽  
Heinz Gössinger ◽  
Christian Korninger ◽  
...  
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Blood Clotting ◽  
Normal Subjects ◽  
Chronic Uraemia ◽  
Wall Interaction ◽  
End Stage ◽  
Granule Release

SummaryThe formation of prostacyclin (PGI2) and thromboxane A2 and the release of beta-thromboglobulin (beta-TG) at the site of platelet-vessel wall interaction, i.e. in blood emerging from a standardized injury of the micro vasculature made to determine bleeding time, was studied in patients with end-stage chronic renal failure undergoing regular haemodialysis and in normal subjects. In the uraemic patients, levels of 6-keto-prostaglandin F1α (6-keto-PGF1α) were 1.3-fold to 6.3-fold higher than the corresponding values in the control subjects indicating an increased PGI2 formation in chronic uraemia. Formation of thromboxane B2 (TxB2) at the site of plug formation in vivo and during whole blood clotting in vitro was similar in the uraemic subjects and in the normals excluding a major defect in platelet prostaglandin metabolism in chronic renal failure. Significantly smaller amounts of beta-TG were found in blood obtained from the site of vascular injury as well as after in vitro blood clotting in patients with chronic renal failure indicating an impairment of the a-granule release in chronic uraemia. We therefore conclude that the haemorrhagic diathesis commonly seen in patients with chronic renal failure is - at least partially - due to an acquired defect of the platelet a-granule release and an increased generation of PGI2 in the micro vasculature.

Avaliação da Resiliência em Pacientes com Insuficiência Renal Crônica Submetidos à Hemodiálise / Assessment of Resilience in Patients With Chronic Kidney Disease Undergoing Hemodialysis

1970 ◽  
Vol 6 (1) ◽  
pp. 5-13
Author(s):  
Renata Izabel dos Santos ◽  
Otávia Regina Souza Costa
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Health Status ◽  
Chronic Renal Failure ◽  
Kidney Disease ◽  
Renal Insufficiency ◽  
Social Economic ◽  
Descriptive Study ◽  
Psychological Resilience ◽  
Resilience Scale

RESUMOObjetivo: Avaliar o nível de resiliência dos portadores de insuficiência renal crônica em tratamento de hemodiálise. Materiais e Métodos: Estudo prospectivo, quantitativo e de abordagem descritiva. A amostra foi constituída por 61 pacientes em tratamento dialítico. Para obtenção dos resultados, foi utilizada a escala de resiliência, desenvolvida por Wagnild e Young (1993) e adaptada por Pesce et al., (2005). Foi aplicado, também, um questionário para caracterização pessoal, familiar, social, econômica e de saúde do grupo. Resultados: Foi constatado que 61% dos pacientes apresentaram tendência à resiliência. O gênero masculino obteve maior pontuação, sugerindo maior tendência à resiliência, bem como os pacientes que são praticantes de uma religião.  Conclusão: Os resultados assinalam que os pacientes em tratamento dialítico no hospital apresentam capacidade à resiliência, o que sugere melhor adaptação ao tratamento.Palavras-chave: Avaliação, Resiliência psicológica, Insuficiência renal crônica.ABSTRACTObjective: To evaluate de the level of resilience in patients with chronic renal failure undergoing dialysis. Materials and Methods: Prospective, quantitative and descriptive study. The sample consisted of 61 patients on dialysis. To obtain the results we used Resilience Scale developed by Wagnild and Young (1993) and adapted by Pesce et al., (2005). A questionnaire to characterize personal, familiar, social, economic and health status was applied. Results: It was found that 61% of patients showed trend to resilience. Males had higher scores, suggesting more likelihood to resilience, as well as patients who were practitioners of a religion. Conclusion: The results indicate that the majority of patients on dialysis have capability of resilience, which suggests better adaptation to treatment.Keywords: Evaluation, Psychological resilience, Chronic renal insufficiency.

scholarly journals Survival on dialysis among chronic renal failure patients treated with a supplemented low-protein diet before dialysis.

1995 ◽  
Vol 6 (5) ◽  
pp. 1379-1385
Author(s):  
J Coresh ◽  
M Walser ◽  
S Hill
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Mortality Rate ◽  
Serum Creatinine ◽  
Dietary Treatment ◽  
Mortality Rates ◽  
Protein Restriction ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein

Concerns have been raised about the possibility of protein restriction resulting in malnutrition and poor subsequent survival on dialysis. However, no studies have examined patients treated with protein restriction to determine their subsequent survival on dialysis. This study prospectively monitored 67 patients with established chronic renal failure (mean initial serum creatinine of 4.3 mg/dL) who were treated with a very low-protein diet (0.3 g/kg per day) supplemented with either essential amino acids or a ketoacid-amino acid mixture and observed closely for clinical complications. Forty-four patients required dialysis. Once dialysis was started, dietary treatment was no longer prescribed. The cumulative mortality rate during the first 2 yr after starting dialysis was 7% (95% confidence interval, 0 to 16%). During this period, only two deaths occurred compared with 11.5 deaths expected on the basis of national mortality rates adjusted for age, sex, race, and cause of renal disease (P = 0.002). However, the protective effect was limited to the first 2 yr on dialysis. Thereafter, mortality rates increased, resulting in a total of 10 deaths during 96.4 person-years of follow-up, which was not significantly lower than the 14.9 deaths expected (P = 0.25). Extrapolation of sequential serum creatinine measurements made before dietary treatment suggests that the improved survival cannot be due to the early initiation of dialysis. Although the lack of an internal control group and data on dialysis lends uncertainty, the large difference in mortality rate between these patients and the nationwide experience indicates that protein restriction and close clinical monitoring predialysis does not worsen and may substantially improve survival during the first 2 yr on dialysis. These findings point out the importance of studying predialysis treatments as a means for lowering mortality on dialysis.

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