Accelerated hypertriglyceridemia in patients on continuous ambulatory peritoneal dialysis - a preventable abnormality

Increasing hypertriglyceridemia is a recognised complication of CAPD. To investigate the etiology lipid clearance studies using the intravenous fat tolerance test were performed in control subjects and in uremic patients before and after six months CAPD treatment. Oral carbohydrate intake was restricted and the use of hypertonic dialysate kept to a minimum. Although serum triglycerides were elevated in the uremic patients before CAPD (3.1 +/- 0.3 mMol/L) no further increase occurred during therapy. Oral carbohydrate intake was restricted to 240-250 Gms/24 hrs and hypertonic dialysate to 5.7 +/- 4.1% of the total. There were no significant changes in fractional removal rate of lipid. Therefore further increases in serum triglycerides in CAPD may be prevented by simple dietary manoeuvres.

Recurrent proteinuria in chronic lymphocytic leukemia

A case of chronic lymphocytic leukemia complicated by the nephrotic syndrome (due to membranoproliferative glomerulonephritis) is reported. There was complete remission of the proteinuria on two occasions in response to treatment of the leukemia. Possible etiological mechanisms are discussed and review of the literature is presented.

Renal transplantation--a tale of two cities

In 1974 three members of the transplant team from the Western Infirmary in Glasgow moved to the new medical school in Leicester. The initial experience with 33 patients transplanted in Glasgow was published in 1972 and this paper compares the results of that series with the first 21 patients grafted in Leicester.

Despite improvements in tissue typing, better quality donor kidneys and fewer complications, there has been a failure to improve on the levels of graft survival. The overall one year graft survival rate in the Glasgow series was 79 per cent compared to 52 per cent in Leicester. In these two series the difference in results appears to be explained by blood transfusion. All the Glasgow patients had been poly-transfused but of the Leicester patients the 10 transfused pre-transplant had a one year graft survival of 90 per cent while in the 11 non-transfused patients the one year graft survival was only 18 per cent.

Evaluation of the intravenous fat tolerance test in chronic renal disease

The intravenous fat tolerance test (IVFTT) was performed on 17 controls, 25 patients with non dialyzed, non nephrotic chronic renal failure and 32 patients on hemodialysis. The fractional removal rate of triglyceride (K2) from plasma is decreased to the same degree in renal disease whether treated by hemodialysis or not. There was an inverse relationship between K2 and both serum triglyceride and fasting blood sugar, which were significantly increased compared to controls. The IVFTT also separated patients with renal disease and hypertriglyceridemia into two groups. One, where there was a low K2, suggesting that defective clearance of triglyceride was the major etiological factor in the hypertriglyceridemia and two, those patients with a normal K2 value, where other factors appear to be more important.

Persistent anemia associated with reduced serum vitamin B12 levels in patients undergoing regular hemodialysis therapy

Four patients on regular hemodialysis therapy with a persistent anemia and reduced serum vitamin B12 levels are discribed. In each case a significant improvement occurred with B12 therapy and it is suggested that the vitamin B12 content of a 70 g protein/day diet may not be adequate to maintain stores of the vitamin.

Fulminant psittacosis

Two patients died of psittacosis after presenting with generalised toxaemia, acute renal failure, and evidence of pancreatitis. Death was attributed to the virulence of the chlamydial strain and the delay in antemortem diagnosis. In one case Chlamydia psittaci was isolated from necropsy lung tissue. A third case of psittacosis suggested person-to-person or fomite spread, which is rarely reported. Infection was acquired from an apparently healthy, imported and quarantined cockatiel. Import restrictions on psittacines should thus be tightened and psittacosis should be made a notifiable disease.

Interstitial nephritis in a case of phenylbutazone hypersensitivity

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Carnitine-palmityl-transferase deficiency

An increasing number of cases of myopathy due to disordered lipid metabolism have recently been recognised and these appear to fall into two contrasting clinical and biochemical categories. Some patients present with steadily prograssive proximal weakness which sometimes responds to steroid therapy and which is due to carnitine deficiency in skeletal muscle. In the second category, patients usually present with muscle cramps on exertion then followed by myoglobinuria without established proximal myopathy and their symptoms are associated with deficiency of carnitine palmityl transferase in skeletal muscle. In this paper we report a patient who has well-documented carnitine palmityl transferase deficiency, whose symptoms were triggered by violent exercise after fasting and in whom there was variable histochemical and ultrastructural evidence of lipid accumulation in muscle biopsy samples. Development of the patient's symptoms was suppressed by a high carbohydrate diet.

Nephrotic syndrome in vesicoureteric reflux

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Renal function studies after nephrectomy in renal donors

Two to six years after they had donated a kidney the 24-hour creatinine clearances of five women and four men had recovered to 85% and 87% respectively of prenephrectomy performance. The male donors had a lower 24-hour creatinine clearance than age-matched controls, but during dextrose and inulin infusion they had similar values for inulin clearance, creatinine clearance, and glucose reabsorption. By contrast, the female donors had significantly reduced clearances both over 24 hours and during infusion, as well as impaired ability to reabsorb glucose. This suggests that potential female donors should be more vigorously investigated before nephrectomy.

Nature of the acidifying defect after the relief of ureteral obstruction

Nature of the acidifying defect observed after relief of ureteral obstruction. The acidifying capacity of the normal and experimental kidney was studied in rats three hours after release of complete unilateral ureteral obstruction or after unilateral release of unilateral ureteral obstruction, mean plasma bicarbonate concentration was 23.5 mEq/liter, and plasma pH, 7.45. Urine pH from the postreleased kidney was 7.47 and 6.01 from the control side. Net acid escretion averaged 0.97 muEq/min in the experimental kidney. Fractional excretion of bicarbonate averaged 0.02% in the control and 3.17% in the experimental kidney. In eight animals with unilateral release of bilateral ureteral obstruction, mean plasma bicarbonate was 16.9 mEq/min and plasma pH was7.35. Mean urine pH in the postreleased Kidney was 6.11, net acid excretion averaged 2.01 plus or minus 0.69 muEq/min and fractional bicarbonate excretion averaged 0.84%.

Effects of acetazolamide on the urinary excretion of cyclic AMP and on the activity of renal adenyl cyclase

Acetazolamide, an inhibitor of the enzyme carbonic anhydrase, increased the urinary excretion of cyclic AMP in normal and parathyroidectomized rats. The increase was greater in rats with intact parathyroid glands than in parathyroidectomized rats. This rise in the urinary excretion of cyclic AMP was not due to an increase in urine flow or a change in urine pH. Furosemide caused an increase in urine flow, but did not affect the excretion of cyclic AMP or phosphate. Alkalinization of the urine with bicarbonate did not increase the urinary excretion of phosphate or cyclic AMP. Acetazolamide increased the productionof cyclic AMP by rat renal cortical slices in vitro. This effect was dose-dependent. Acetazolamide also stimulated the activity of renal cortical adenyl cyclase in a dose-dependent manner but had no effect on the activity of cyclic nucleotide phosphodiesterase. The pattern of urinary excretion of cyclic AMP and phosphate after administration of acetazolamide was similar to that observed in rats given parathyroid hormone. It is suggested that acetazolamide stimulates the renal production of cyclic AMP by activating adenyl cyclase and that this may be the mechanism by which this inhibitor of carbonic anhydrase produces phosphaturia.

Prolonged oliguria with survival in acute bilateral cortical necrosis

Survival is uncommon in cases of acute bilateral cortical necrosis. Three cases admitted to the renal unit at Newcastle have regained useful renal function after oliguric phases of 38, 46, and 120 days.Prolonged periods of intermittent dialysis are justified in patients in whom a firm diagnosis of acute cortical necrosis is made.

Blood flow in arteriovenous shunts: observations and measurements

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