Plasma atrial natriuretic peptide and natriuretic response to water immersion in patients with nephrotic syndrome

Eight nonnatriuretic (daily Na excretion less than 50 mEq), 4 natriuretic (daily Na excretion greater than 50 mEq), and 4 steroid-responsive nephrotic patients, and 12 normal controls were studied with a 4-hour water immersion with measurements of electrolytes, plasma atrial natriuretic peptide (ANP), plasma renin activity (PRA), and plasma aldosterone (PA) [corrected]. Four nonnatriuretic patients further received 25 g albumin infusion, with a subsequent 2-hour water immersion study. The results are as follows: (1) In the nonnatriuretic patients, the extremely low basal Na excretion rate, high PRA, and PA levels indicated a state of active Na retention. In spite of the water-immersion induced suppression of PRA and PA and a comparable magnitude of plasma ANP increment, the natriuretic response to water immersion was blunted in the nonnatriuretic patients. (2) In the natriuretic patients, water immersion resulted in a similar magnitude of natriuresis but a higher degree of plasma ANP increment in comparison to the normal controls. (3) Natriuretic and plasma ANP responses to water immersion were not different between the steroid-responsive patients and normal controls. (4) The increase in plasma ANP and the suppression of PRA and PA after 25 g albumin infusion did not result in natriuresis until the further suppression of PRA and PA and the further stimulation of plasma ANP by subsequent water immersion. The above results indicate that the natriuretic and plasma ANP responses to water immersion are related to the basal Na status in nephrotic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Photochemical and Thermal Decomposition of Bis(3-chloro-2-methylphenyl)diazomethane

The reactions of diarylcarbene (2c) generated from the photolytic and thermal decomposition of diaryldiazomethane (1c) were investigated. The effect of steric hindrance in (2c) was insufficient to stabilize the carbene under the photolytic conditions to allow direct dimerization to form the olefin. In the thermal decomposition of (1c), only the azine (3c) was obtained. Both these observations are different from those reported for dimesitylcarbene (2b), and indicate that (2b) undergoes reactions (dependent largely on severe steric hindrance) which are not generally applicable to di-o-tolylcarbene and its derivatives.

Epidermal growth factor in renal hypertrophy in streptozotocin-diabetic rats

Epidermal growth factor (EGF) concentrations in the plasma, kidneys and urine of 31 streptozotocin-diabetic rats and 21 insulin-treated diabetic rats were measured to study the role of EGF in initiating renal hypertrophy in the diabetic rats. Renal hypertrophy occurred from day 7 in the diabetic rats, but not in the insulin-treated rats. Renal EGF was not different between the diabetic and control rats, while that in the insulin-treated rats was significantly less than in the diabetic rats. There were no significant changes in plasma EGF in any of the rats. Urine EGF was 119 +/- 7.9 ng/day at day 7 in the control rats but it was significantly increased from day 2 in the diabetic rats (320 +/- 52.9 ng/day at day 2 and 298 +/- 18.4 ng/day at day 7), while in the insulin-treated rats it was significantly less than that in the diabetic rats (134 +/- 8.34 ng/day at day 2 and 220 +/- 15.2 ng/day at day 7). Since the kidney is the main source of urine EGF and EGF has been shown to induce renal growth both in vitro and in vivo, we conclude that EGF may have initiated renal hypertrophy in diabetic rats.

Comparisons of peritoneal function between diabetic and nondiabetic patients with end stage renal disease

Peritoneal function is the major determinant of the efficiency of peritoneal dialysis. To understand whether diabetes affects the peritoneal function, we performed the peritoneal clearance study in 9 diabetic and 16 nondiabetic patients with end stage renal disease. The ultrafiltration volume tended to be lower in diabetics after infusion of 1.5% Dianeal, although there were no statistically significant differences between them. The same results were obtained after infusion of 4.25% Dianeal. The glucose uptake after infusion of both 1.5% and 4.25% Dianeal was not significantly different between the two groups. The dialysate/plasma(D/P) concentration ratio was also not significantly different between the two groups, however the D/P ratio for BUN and uric acid was slightly higher in the diabetic group. The peritoneal clearance of smaller molecules such as BUN, creatinine, uric acid and phosphate also tended to be higher in diabetics after infusion of 1.5% Dianeal for 4 hours. The peritoneal clearance became higher when more hyperosmotic dialysate were used in both diabetics and nondiabetics. The above results indicated that diabetic patients with end stage renal disease might have a normal peritoneal function compared to nondiabetics.

Plasma atrial natriuretic peptide in patients with chronic renal failure

Plasma atrial natriuretic peptide (ANP) levels were measured in non-dialyzed and dialyzed chronic renal failure (CRF) patients and in normal subjects. Changes in plasma ANP in response to hemodialysis (HD) and to isolated ultrafiltration (UF) were also investigated in dialyzed CRF patients. Plasma ANP levels were significantly higher in 28 non-dialyzed CRF patients than in 27 normal subjects (mean +/- SEM, 174.0 +/- 25.9 vs 25.0 +/- 1.9 pg/ml, p less than 0.001). Plasma ANP levels did not correlate with blood urea nitrogen or serum creatinine, however patients with advanced renal failure (creatinine clearance less than 10 ml/min) with cardiomegaly (cardiothoracic ratio greater than 50%) or hypertension (BP greater than 140/90 mmHg) had significantly higher plasma ANP levels than those who were not. A 6-hour HD significantly decreased the plasma ANP level (423.4 +/- 71.3 to 220.6 +/- 40.0 pg/ml, p less than 0.001) and body weight in 21 dialyzed CRF patients, and the decrement in plasma ANP showed a positive correlation with the decrement in body weight (r = 0.425, p = 0.056). In 8 dialyzed CRF patients, we further performed a 1-hour isolated UF for removal of isoosmotic intravascular fluid without changes in the solute concentrations, followed by a subsequent 5-hour HD. The decrease in plasma ANP during the 1-hour UF period was 68% of the total ANP decrement for the whole 6-hour study. The average plasma ANP level was decreased with 94.6 +/- 42.5 pg/ml/kg/h in the UF period compared to 3.5 +/- 1.4 pg/ml/kg/h in the HD period (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Neuroelectrophysiological study in patients on long-term hemodialysis]

Uremic neuropathy is a common complication in patients on hemodialysis. Although there are still controversies over the pathogenesis of uremic neuropathy, neuroelectrophysiological study offers an objective and quantitative method of detecting this neuropathy, whether it is a question of axonal degeneration vs demyelination, sensory vs motor type, or distal vs proximal involvement. We also used the segmental latency of the median nerve to differentiate polyneuropathy from the carpal tunnel syndrome. Furthermore, this study also may serve as an important parameter for planning changes in different hemodialysis programs. Via the Medelec Mystro machine, we carried out an electrophysiological study of 38 hemodialysis patients. This study included motor and sensory nerve-conduction velocity studies and an H-reflex study of the tibial nerve. The incidence of polyneuropathy in patients on hemodialysis was 73.68%. Compared with normal controls, the velocity and amplitude of all tested nerves decreased significantly (P less than 0.01). The highest abnormal rate was the tibial nerve (73.7%). We found the severity of neuropathy did not closely correlate with the duration of hemodialysis (P greater than 0.05). Prolonged distal latency of the median motor and sensory nerves was about 50.0% and 31.6% respectively but prolonged segmental latency of the median sensory nerve was around 20% only. H-reflex of the tibial nerve was also significantly prolonged (P less than 0.01). We drew the following conclusions. First, polyneuropathy and carpal tunnel syndrome are common complications in patients on hemodialysis. Secondly, adequate hemodialysis can prevent the progression of uremic neuropathy. Thirdly, neuroelectrophysiological study may be used as one of the parameters for determining adequate hemodialysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Survey of public awareness, understanding, and attitudes toward epilepsy in Henan province, China

The awareness, understanding, and attitudes toward epilepsy in 1,278 men and women were surveyed in Henan, China in 1988. Results showed that 93% had read or heard about epilepsy; 77% knew someone who had epilepsy; 72% had seen someone who was having a seizure; 57% would object to having their children associate with persons with epilepsy in school or at play; 87% would object to having their children marry a person with epilepsy; 53% believed that epileptic persons should not be employed in jobs as other persons are; 16% believed that epilepsy was a form of insanity; 40% did not know the cause of epilepsy; 10% did not know what an epileptic attack was like; and 17% did not know what to recommend if their friends or relatives had epilepsy. The relationship between the responses and the respondents' age, sex, marital status, number of offspring, level of education, occupation, and residence was analyzed. Education reduced the respondent's prejudice against play and employment, but did not change their objection to marriage and appeared to have reinforced their linking epilepsy with insanity. As compared with the surveys conducted in Western countries, our survey showed that awareness of epilepsy in China was greater, if not the same, but the attitudes toward epilepsy were much more negative.

Renal changes in heterozygous Fabry's disease--a family study

Two sisters, one with a long history of proteinuria and the other of hematuria, came for examination. Physical examination and routine laboratory workups did not show any significant abnormalities. The renal ultrastructural changes in case 1 showed marked enlargement and foamy vacuolation of all the glomerular capillary visceral epithelial cells, which was not found in other glomerular cells. The renal changes in case 2 showed similar lesions but with fewer cells involved and also with less severity, but the involved cells showed marked lamellation within the vacuoles. The serum alpha-galactosidase activity was 4.9 and 3.0 nmol/h/mL serum, respectively (normal values, 12.1 +/- 1.6 nmol/h/mL serum, mean +/- SD, n = 11), thus confirming the heterozygous variety of Fabry's disease. Our findings in these two cases reveal that patients with heterozygous Fabry's disease may present with renal symptoms only, which may be either proteinuria or hematuria.

Synthesis of 9-Methoxymethyl-18-methyl-2,11-dithia[3.3]metacyclophane: a Dithia[3.3]metacyclophane With a Protected Internal Benzylic Functional Group

A synthetic route to a dithia [3.3] metacyclophane with a benzylic functional ( methoxymethyl ) group at C9 is described. The benzylic function however had to be introduced at a later stage in the synthetic scheme to optimize the overall yield. Only the anti isomer of the desired dithiacyclophane (7) was isolated. The entire methoxymethyl group lies within the shielding zone of the opposite benzene ring as indicated in the 1H n.m.r. spectrum. Attempts to convert anti-(7) into the novel aromatic system (5b) by a rearrangement-elimination sequence however failed.

Anterior pituitary functions in patients with uremia tested by stimulation with four combined hypothalamic releasing hormones

Seven cases with uremia (6 men, 1 woman, mean age = 55.6 +/- 2.2 years) were studied with four combined hypothalamic releasing hormones (corticotropin-releasing hormone, CRH; luteinizing hormone-releasing hormone, LHRH; thyrotropin-releasing hormone, TRH; and growth hormone-releasing hormone, GHRH) for assessment of anterior pituitary functions. The mean basal levels of corticotropin (ACTH, 22.4 +/- 5.2 pg/ml), thyrotropin (TSH, 2.4 +/- 0.6 microU/ml), and follicle stimulating hormone (FSH, 26.0 +/- 3.4 mIU/ml) in uremic patients were not significantly different from those (34.0 +/- 3.5 pg/ml, 2.0 +/- 0.4 microU/ml, and 23.2 +/- 6.4 mIU/ml) of controls (5 men, 1 woman, mean age = 54 +/- 2.5 years), but the ACTH and TSH responses to the releasing hormones were significantly lower than those of the controls. The mean basal levels of luteinizing hormone (LH, 70.7 +/- 16.3 mIU/ml), cortisol (9.8 +/- 1.2 micrograms/dl) and prolactin (109.3 +/- 23.2 ng/ml) in uremic patients were significantly higher than those of normals (27.3 +/- 6.6 mIU/ml, 6.5 +/- 0.7 micrograms/dl and 15.7 +/- 3.4 ng/ml), while suppressed LH, cortisol and prolactin responses to the releasing hormones were observed in the uremic group. The mean basal growth hormone (GH) level in uremic patients (3.1 +/- 0.4 ng/ml) was not significantly different from that (2.8 +/- 0.7 ng/ml) of normals, but the GH response to the releasing hormones was significantly higher than that of controls. These results show pituitary dysfunction, such as blunted ACTH, TSH, LH and prolactin response, exists in uremic patients.(ABSTRACT TRUNCATED AT 250 WORDS)