Citrate in daily and fasting urine: results of controls, patients with recurrent idiopathic calcium urolithiasis, and primary hyperparathyroidism

In three groups--patients with recurrent calcium urolithiasis (RCU), patients with primary hyperparathyroidism (pHPT), and healthy controls--citrate was measured enzymatically in 24 and in 2-hr urine after an overnight fast. Citrate excretion per 24 hr was significantly lower in RCU than in age and sex matched controls, whereas there was no significant difference in citrate excretion in urines from the 2-hr morning collection. In pHPT citrate was also lower than in controls and fell within the range of RCU of comparable age. Both categories of urines (24 and 2hr) have in common the characteristic that the actual citrate concentration is lower by 50 per cent in RCU and pHPT than in controls, mainly as a result of the higher urine volume. Correction of citrate for creatinine does not disclose further differences among the populations studied but conversely hampers exact interpretation of urinary citrate in the absence of strict separation of individuals according to sex and age. From these data we conclude that (i) a low excretion and concentration of urinary citrate is detectable in calcium lithiasis and may contribute to a deficiency in inhibitory activity against nucleating processes in stone-forming urine; and (ii) the differences in urinary citrate elicited in samples of 24 and 2-hr morning urine are of unknown origin and merit further investigations.

[Differences in sensitivity of T3, T7, T4 and lambda phages to bleomycin and phleomycin]

In contrast to phage lambda the phages T3, T7 and T4 are not inhibited by as much as 150 microgram bleomycin/ml, while the chemically related antibiotic phleomycin increasingly inhibits the propagation of the phages in the order T4-T3-lambda. 20 microgram phleomycin/ml inhibit T3 by 95%. The resistance against bleomycin is surprising, because 10 microgram BM/ml block completely the colony-forming capacity of the host bacterium. The drug resistance of the phage growth correlates with the weak decrease of phage DNA synthesis, while the host cell DNA synthesis ceases rapidly. In accordance with these data is the in vivo inhibition of Escherichia coli cells and the in vitro degradation of their DNA. However, a contradiction exists between the in vivo resistance of T3 and T4 and the in vitro susceptibility of their DNA against nucleolytical fragmentation by bleomycin. The mechanism of the insensitivity of T3, T7 and T4 against bleomycin is unknown.

Late prognosis in acute posttransplant renal failure in 102 patients

An ivestigation was made of the effect of the duration of posttransplant renal failure on the late prognosis of graft as well as patient survival and on the frequency of complications in 102 patients who had a functioning graft at three months after transplantation. A direct correlation was found between duration of acute tubular necrosis (ATN) and the late prognosis of the graft. The creatinine clearance was significantly higher and the frequency of complications was lower in the group with immediate resumption of renal function. The mortality rate increased with the duration of ATN.

Creatine kinase isoenzyme BB in serum of patients undergoing chronic hemodialysis and with kidney transplant

The activity of creatine kinase isoenzyme BB (CK-BB) was determined in serum of healthy adults and in patients undergoing maintenance hemodialysis and with kidney transplant. In the healthy adults examined, an activity of 0.56 +/- 0.16 U/l (mean +/- SD) was found. The arithmetic mean of CK-BB activity in patients with renal insufficiency under hemodialysis was 1.42 +/- 0.87 U/l and differed from that of the healthy group. The CK-BB activity in patients with kidney transplant was not different from that of the control group. The occurrence of CK-BB in serum is discussed from diagnostic and methodological point of view.

[Host range relationship of bacteriophages T3 and T7 with Escherichia coli K 12 strains]

The closely related phages T3 and T7 exhibit different growth patterns on Escherichia coli W hosts cells (E. coli K12 derivatives). T7 grows normally while T3 does not adsorb. T3hw mutants displaying a T7-like host range were isolated and described.

[Use of gen5 and gen6 ts-mutants of phage T3 as indicators of inhibitors of DNA synthesis]

In an enzyme-specific drug screening system nalidixic acid and 3'-FTdR, inhibitors of DNA synthesis, both reduce the growth of wild type and temperature-sensitive point mutants of phage T3 with different efficiencies. The wild type shows the strongest sensitivity against the drugs, while an exonuclease mutant is the most insensitive variant. The DNA polymerase mutants exhibit an intermediate degree of inhibition. The anthracycline antibiotics violamycin BI and adriblastin which preferentially inhibit RNA synthesis show the same degree of inhibition for all mutants. This is true also for the RNA synthesis inhibitor lambdamycin, which is identical with chartreusin. The protein synthesis inhibitors chloramphenicol and o-phenanthroline, a chelating agent, impair all mutants to the same extent. Our data confirm the hypothesis that structural variants of essential viral enzymes, when compared with the wild type should reveal different sensitivities against specific inhibitors and show that this T3 system could be used for the indication of specific inhibitors of DNA synthesis.

Clinical experiences in the Gambro-preservation unit: analysis of 101 human cadaver kidneys

101 human cadaver kidneys were preserved by means of hypothermic pulsatile perfusion in the Gambro perfusion unit with human albumin as perfusate. Perfusate flow and some biochemical parameters were assessed during perfusion and correlated with renal function after transplantation. There is a good correlation between perfusate flow and recovery of physiological renal function. LDH released to the perfusate as viability test is of limited value: a direct correlation was only found between LDH activity and perfusion time, and LDH activity and ischemia time. Determination of pH and lactic acid level 1 h after beginning of perfusion is without practical value according to our experience. The quality of albumin in perfusion solution influences the immediate graft function.

Urate metabolism and gastric ulcerations in rats as influenced by stress and allopurinol

Stress and allopurinol (ALL) were investigated in rats with regard to their influence on serum uric acid and glucose concentration, gastric secretion, microcirculation (MBF) and stress ulcer index. There is a non-competitive type of interaction between severe stress and ALL-mediated xanthine oxydase inhibition (= per cent fall in serum uric acid) as compared with control conditions (= mild stress). Vmax is different (84.6 +/- 1.9 and 92.3+/-2.26; P less than 0.05), but not Km (0.39 +/- 0.09 and 0.68 +/- 0.08 mg/kg/h ALL). Serum uric acid is higher in rats with draining gastric fistula than those with closed fistula suggesting that already mild stress is associated with an increase in uricemia in this species. ALL does not significantly alter gastric acid and uric acid secretion but improves markedly gastric ulcer index during mild and severe stress. Since MBF is significantly elevated by ALL during the latter circumstances, a dissociation between MBF and acid secretion is one feature of ALL actions and might become a primary aim in treatment of this disorder.

[Hallson and Rose enzymatic determination of urinary oxalate (author's transl)]

Urine oxalate was determined by the enzymatic method, quality criteria were established, and 24h oxalate excretion measured in healthy control subjects and in patients suffering from calcium urolithiasis. The technique is highly reliable and can be practiced in every conventional clinical laboratory. There is no increase in 24h urine oxalate in calcium urolithiasis when related to body weight or lean body mass.

[Evaluation of renal cyclic adenosine monophosphate, serum parathyroid hormone and phosphate reabsorption in recurrent calcium urolithiasis, healthy controls and hyperparathyroidism (author's transl)]

In three groups (n = 12 each) of male controls (22--43 years), patients with recurring calcium urolithiasis (21--36 years) and hyperparathyroidism (HPT; 17--71 years) proven by surgery renal cyclic adenosine monophosphate (RcAMP), fractional tubular phosphate reabsorption and serum parathyroid hormone (PTH) were measured during endogenous creatinine clearance. RcAMP (muMol/g creatinine) was: controls 1.48 +/- SEM 0.27; stone formers 2.037 +/- 0.343 (not significantly different); HPT 6.234 +/- 0.454 (p less than 0.001). There is no overlap between HPT and controls. Phosphate reabsorption is least in HPT (0.84 +/- 0.015), higher in controls (0.924 +/- 0.004) and stone formers (0.941 +/- 0.007). All differences are statistically significant. Under the conditions selected (moderate hydration of individuals) Serum PHT (pg-equiv/ml) is lowest in stome formers (less than 100--339), higher in controls (less than 100--933) and HPT (400--1150). there is no overlap in PHT between the former and the latter group but a marked one between controls and HPT. For clinical purposes the resulting diagnostic uncertainty in a given patient can be overcome by additional determinations of RcAMP and ionised serum calcium: when referring to serum PTH HPT patients fall outside, RCU patients within 2 standard deviations of either parameter in control subjects. This procedure presently appears superior to those proposed in the past (urinary cAMP etc.) but requires confirmation in larger patient populations. Moreover, since HPT prevails in middle and upper age decades, their RcAMP values and those of RCU patients should be related to a range seen in closely age- and sex-matched controls.

[T-rosette and rosette inhibition test with antilymphocyte globulin following kidney transplantation]

263 examinations with the rosette-test with sheep erythrocytes and the rosette inhibition test with antilymphocyte globulin in 42 normal persons and 56 patients after transplantation of a kidney showed in 10 patients a significnat decrease of the rosette-forming T-lymphocytes in the peripheral blood under conditions of rejection. On the other hand the number of rosettes significantly increased in 4 patients. The valency of the rosette inhibition test for the rejection diagnostics is restricted by technical difficulties and wrong positive results (11%). The results are discussed on the basis of the receptor synthesis rates for sheep erythrocytes and of the electric superficial potentials of the T-lymphocytes and in relation to the HLA-A/B/C/D-system.

[Clinical aspects of glomerulonephritis]

With the help of 260 bioptically ascertained cases of glomerulonephritis clinical characteristics for individual forms of glomerulonephritis are explained. Specific laboratory findings and functional tests are correlated to the bioptic findings and their valency for the individual groups of diagnosis discussed. As a result of the investigation 99% of all cases of disease may be recognized only by the examination of the urine, taking into consideration the interference of the individual symptoms.

[Treatment of glomerulonephritis]

Issuing from the importance of the glomerulonephritis and the different spontaneous course of the certain morphological forms of glomerulonephritis recommendations are given for the indication of a therapy of glomerulonephritis. For the prednisone, indomethazin, azathioprin and cyclophosphamide treatment therapeutic schemata proved in practice are recommended. The results of the therapy of 32 cases of glomerulonephritis treated with prednisone and of 125 cases treated with indomethazin are described. Two observations of a five-year-course in a rapid progressive glomerulonephritis and in a Goodpasture syndrome refer to a probably favourable therapeutic effect of azathioprin. Finally it is referred to the advantages of an additional immunofluorescence-histological examination of the renal tissue in 50 cases of glomerulonephritis observed during the course.

Studies on the calcemic effect of intravenous secretin in humans

In healthy controls (n = 7), patients with duodenal ulcer (n = 7), primary hyperparathyroidism (n = 7), and 1 case of excluded gastric antrum the effects of intravenous secretin ("Karolinska"; 3 U/kg/h for 90 min) upon serum calcium fractions, total protein, and the integrated response of gastrin and glucagon were investigated. In all groups total calcium, total protein, and protein-bound calcium fraction rose significantly but the inonized calcium fraction remained stable. Since serum concentration of gastrin and glucagon could not be altered in any of the groups a direct interference of these hormones with calcium homeostasis during secretin infusion can be ruled out. Hyperparathyroid patients had higher baseline glucagon values (209 +/- 30 pg/ml) than normals (127 +/- 6 pg/ml) and ulcer patients (138 +/- 11 pg/ml) and maintained a higher hormone output throughout the experiment. Together with data on the patient with excluded antral parts it is concluded that the hypercalcemic effect of secretin is not mediated by calcium-regulating hormones but must be of an unspecific nature.