Effect of Cyclosporine on the Rate of Renal Function Recovery After Renal Transplantation

To assess the effect of cyclosporine therapy on the rate of renal function recovery after renal transplantation, patients with no clinical evidence of rejection and who were treated with either cyclosporine or azathioprine in addition to steroid therapy were studied (n = 74). Of the patients with immediate renal function (n = 57), those receiving organs from living, related donors had a faster recovery rate of glomerular filtration than patients with cadaveric grafts (azathioprine, 15 ± 2 versus 7 ± 1 mL/min/day, P = 0.0001; cyclosporine, 14 ± 3 versus 6 ± 1 mL/min/day, P = 0.001). Recipients of cadaveric grafts with delayed renal function (n = 17) had a decreased recovery rate of allograft function when treated with cyclosporine as compared to those treated with azathioprine (4 ± 2 versus 6 ± 1 mL/min/day, respectively; P = 0.026). Patients on azathioprine achieved better renal function (P = 0.01) than those on cyclosporine (recipients of organs from living, related donors, 59 ± 5 versus 52 ± 3 mL/min; recipients of cadaveric grafts, 52 ± 5 versus 40 ± 2 mL/min). Thus, even in this early period, cadaveric-graft recipients treated with cyclosporine demonstrate an apparent reduction in creatinine clearance when compared to patients treated with azathioprine

Body composition analysis in chronic dialysis patients: a longitudinal study

AbstractObjectiveNutritional status is an important determinant of morbidity and mortality in dialysis patients. Body composition analysis bioelectrical impedance techniques are becoming commonplace in the clinical setting. Our objective is to report our clinical experience using bioelectrical impedance analysis for the prospective nutritional surveillance of dialysis patients.MethodsA total of 204 patients, 157 on hemodialysis and 47 on peritoneal dialysis were followed for a median of 21 months. Values from the first trimester were averaged and compared to those obtained in the last trimester. Bioelectrical impedance values were obtained using a single frequency (50 kHz) bioimpedance analyzer.ResultsBaseline values for body weight, height, body mass index and body surface area were similar in both treatment modalities. Hemodialysis patients lost a discreet amount of body weight (1.5%, p=0.0334). Body weight did not change in peritoneal dialysis patients. Significant decreases in resistance (p=0.l0023) and phase angle (p=0.0481) were noted in hemodialysis but not peritoneal dialysis patients. A small but significant decrease in fat free (1.8%; p=0.0028) and body cell free (3.3%; p=0.0036) mass was noted in hemodialysis but not peritoneal dialysis patients.Conclusions1. Bioelectrical impedance analysis may detect losses in fat free mass and body cell mass that are not apparent by body weight monitoring. 2. Bioelectrical impedance analysis is a practical clinical tool for evaluating body composition in dialysis patients

De novo pyrimidine nucleotide biosynthesis in isolated rat glomeruli

De novo pyrimidine nucleotide biosynthesis in isolated rat glomeruli. Uracil ribonucleotide–sugars and aminosugars are required for glomerular basement membrane (GBM) biosynthesis. Since these nucleotides are metabolic derivatives of uridine 5′-triphosphate (UTP), we have studied the cellular pools of uridine 5′-diphosphoglucose (UDPG), uridine 5′-diphosphoglucuronic acid (UDPGA), uridine 5′-diphospho-N-acetyl glucosamine (UDPAG) and UTP, and measured UTP synthesis de novo in isolated glomeruli incubated in vitro. Improved techniques for nucleotide quantitation were established and the optimal conditions for glomerular isolation and incubation determined. Substantial quantities of uracil ribonucleotide coenzymes and an active utilization of orotate for the synthesis of pyrimidine nucleotides were demonstrated. UTP synthesis and the pools of UDPG and UDPG A varied markedly with changes in the experimental conditions. The adverse effects of suboptimal conditions were more apparent in glomeruli from diabetic animals than in controls. The use of suboptimal conditions could provide misleading information on GBM metabolism in isolated glomeruli since uracil ribonucleotide coenzyme availability might be reduced

Racial Differences in the Incidence of Steroid Diabetes in Renal Transplant Patients

We have studied the development of steroid-induced diabetes in a population of 143 renal allograft recipients who were nondiabetic before transplantation. Steroid-induced diabetes developed In 9.8% of patients. However, in blacks its incidence was significantly higher than in whites (17.3% vs 5.5% respectively; p \u3c .01). The development of steroid-induced diabetes was not associated with a higher frequency of HLA-B8 or HLA-Bw15 in either race. In black graft recipients, HLA-B14 was significantly more frequent (p \u3c .001) among those who developed steroid-induced diabetes than in insulin-dependent diabetic (Type I) and nondiabetic recipients. The clinical course of patients with steroid-induced diabetes has been similar to that of noninsulin-dependent diabetics (Type II)

Serum Creatinine Concentrations in Healthy Newborns: Reference Ranges During the First Five Days of Life

Serum creatinine concentrations were studied in 52 healthy, full-term infants (29 males and 23 females) during the first five days of life. At birth, mean serum creatinine concentration was 0.76 ± 0.13 mg/dL. At 6 hours of life, values increased to 0.97 ± 0.11 mg/dL (P \u3c 0.001) and remained elevated for 24 hours. Values then returned to baseline so that serum creatinine concentrations were 0.81 ± 0.15 mg/dL at 48 hours and 0.6l ± 0.15 mg/dL at 3 to 5 days of age. At birth, serum creatinine concentrations were higher in males than in females (0.80 ± 0.13 versus 0.71 ± 0.11 mg/dL, respectively; P \u3c 0.009). However, the increases in serum creatinine concentration observed after birth were similar in both sexes. This is the first report of a prospective longitudinal study of serum creatinine concentrations between birth and 3 to 5 days of age in a Hispanic population. In addition, data were analyzed by sex. The results are a useful reference for normal serum creatinine concentrations in early life

Renal Involvement in Type 2 Diabetes Mellitus: A Clinicopathologic Study of the Henry Ford Hospital Experience

To better understand renal dysfunction in type 2 diabetes mellitus, we studied the clinical and autopsy findings in comparable cohorts of 108 diabetic and 77 nondiabetic patients. In the diabetic group, no differences were noted between black and white patients in blood glucose concentrations, mean blood pressure, or the prevalence of diabetic glomerulosclerosis. However, the prevalence of renal insufficiency was significantly greater (P = 0.002) in black diabetics (58%) than in white diabetics (35%). black controls (28%), and white controls (20%). Logistic regression analysis demonstrated a significant association of renal insufficiency with diabetes (P = 0.006) and race (P = 0.032). butnot with mean blood pressure, age, or sex. An additional nonspecific glomerular lesion commonly found was global sclerosis. The occurrence of this lesion was significantly greater (P = O.OOI) in black diabetics (42% ± 5%) than in white diabetics (26% ± 5%), black controls (19% ± 4%), and white controls (21% ± 4%), and was highly correlated (P = O.OOI) to serum creatinine concentrations. In patients with serum creatinine concentrations lower than 1.6 mg/dL, kidney weight was significantly greater (P = 0.03) in diabetics with diabetic glomerulosclerosis (405 ± 32 g) as compared to those without it (300 ± 25 g) or to control patients (329 ± 13 g). This study demonstrates that the overall prevalence of diabetic glomerulosclerosis in this group of type 2 diabetics is 45%, and that renal enlargement is present in these patients prior to the development of significant renal insufficiency. In addition, renal insufficiency and end-stage renal failure are more common in black than in white diabetics

Treatment of Uremic Diabetic Patients: Hemodialysis or Transplantation?

Eighty-one patients with chronic renal failure associated with or secondary to diabetic nephropathy were treated with dialysis and/or transplant. Twenty-five had juvenile diabetes and 56 had adult onset diabetes. Juvenile diabetics did poorly on hemodialysis with 13 patients having a 19% four-year survival rate, whereas those who had cadaveric transplantation did well with a four-year patient and graft survival rate of 56% in nine patients. The three juvenile diabetics who received related kidney grafts are presently alive with good function. Patients with adult onset diabetes did well on hemodialysis with a four-year survival rate of 63% in 45 patients. In this last group 11 patients received cadaveric transplants, but none survived 18 months

The Wolbachia Genome of Brugia malayi: Endosymbiont Evolution within a Human Pathogenic Nematode

Complete genome DNA sequence and analysis is presented for Wolbachia, the obligate alpha-proteobacterial endosymbiont required for fertility and survival of the human filarial parasitic nematode Brugia malayi. Although, quantitatively, the genome is even more degraded than those of closely related Rickettsia species, Wolbachia has retained more intact metabolic pathways. The ability to provide riboflavin, flavin adenine dinucleotide, heme, and nucleotides is likely to be Wolbachia's principal contribution to the mutualistic relationship, whereas the host nematode likely supplies amino acids required for Wolbachia growth. Genome comparison of the Wolbachia endosymbiont of B. malayi (wBm) with the Wolbachia endosymbiont of Drosophila melanogaster (wMel) shows that they share similar metabolic trends, although their genomes show a high degree of genome shuffling. In contrast to wMel, wBm contains no prophage and has a reduced level of repeated DNA. Both Wolbachia have lost a considerable number of membrane biogenesis genes that apparently make them unable to synthesize lipid A, the usual component of proteobacterial membranes. However, differences in their peptidoglycan structures may reflect the mutualistic lifestyle of wBm in contrast to the parasitic lifestyle of wMel. The smaller genome size of wBm, relative to wMel, may reflect the loss of genes required for infecting host cells and avoiding host defense systems. Analysis of this first sequenced endosymbiont genome from a filarial nematode provides insight into endosymbiont evolution and additionally provides new potential targets for elimination of cutaneous and lymphatic human filarial disease