Total Body Potassium in Non-Dialysed and Dialysed Patients with Chronic Renal Failure

Total body potassium was studied in 33 patients with chronic renal failure, 18 of whom had been receiving regular dialysis therapy for 1 to 48 months. In nondialysed patients body potassium was not significantly different from normal in the group as a whole, but was significantly greater than normal in three patients, and significantly less than normal in two patients. In 14 of the dialysed patients, both as individuals and as a group, body potassium was not significantly different from normal but in the remaining four it was less than normal.Potassium transfer during dialysis was studied in two patients. Uptake by these two patients of ⁴³K added to the dialysate (1 mEq K/litre) was measured by whole-body monitoring. Transfer of administered ⁴³K from the patients to the dialysate was measured by whole-body monitoring and by radioactive and chemical assay of the dialysate. A negative balance due to twice-weekly dialysis of 178 and 244 mEq K/week was found, which with weekly faecal and urine losses of 20-30 mEq K approximately equals the dietary intake of 210-315 mEq K.     

Exchangeable Potassium Study in Patients Undergoing Chronic Haemodialysis

Seven patients with chronic renal failure treated with haemodialysis for 4 to 24 months were found to have low exchangeable potassium levels. Before dialysis the plasma potassium was normal or somewhat raised (possibly owing to acidosis), though the exchangeable potassium was low. Acidosis was corrected during dialysis; plasma potassium levels fell, but clinical and electrocardiographic changes of hypokalaemia were absent. The level of 1 mEq/litre in the dialysate fluid may be too low for use in prolonged haemodialysis.     

Deterioration in Renal Function after Beta-blockade in Patients with Chronic Renal Failure and Hypertension

Treatment of hypertension with beta-blocking agents in three patients with moderately severe chronic renal failure was followed by rapid deterioration of renal function. In two of the patients the need for maintenance haemodialysis was accelerated but renal function in the third reverted to pretreatment levels after the drug was stopped. These findings suggest that until more is known about the effects of beta-blocking drugs they should not be given to patients with moderately severe renal failure.     

乳清蛋白质制剂改善慢性肾功能衰竭透析患者营养状况的效果观察

目的用乳清蛋白质制剂作为蛋白质补充营养制剂,观察其对慢性肾功能衰竭透析患者营养改善的效果。方法 60例接受透析治疗的慢性肾功能衰竭患者,平均年龄(59.3±6.7)岁,随机分为试验组和对照组,每组30例。试验组每天除常规饮食外,按0.6g/kg补充乳清蛋白质制剂,共15 d,对照组为正常治疗饮食。在干预前、后分别检测营养相关的指标。结果根据身高和体重进行营养评价,干预开始前试验组、对照组的患者均有不同程度营养不良,15 d后体重与干预前相比,虽有所改善,但无显著性差异(P>0.05)。体重、上臂肌围、三头肌皮褶厚度在干预后变化均不明显,无显著性差异(P>0.05)。血红蛋白有所升高,但无统计学意义(P>0.05)。干预前后,试验组血清白蛋白、前白蛋白均有升高,前白蛋白与对照组相比有显著性差异(P<0.05)。干预后试验组血清磷与对照组比较无显著性差异(P>0.05)。试验组和对照组血清尿素氮、肌酐在干预后,均降低非常显著(P<0.05)。干预前患者血清氨基酸,特别是必需氨基酸和组氨酸含量降低明显(P<0.05),用乳清蛋白质制剂后血清氨基酸谱有所变化,支链氨基酸-亮氨酸、异亮氨酸和缬氨酸含量明显增高,苏氨酸、酪氨酸、组氨酸也有所升高,其余氨基酸血清含量无明显改变。结论乳清蛋白质制剂对慢性肾功能衰竭透析患者有明显的改善蛋白质营养状况的效果。     

Hypergastrinaemia in Chronic Renal Failure

Fasting serum gastrin was measured by radioimmunoassay in 89 patients with chronic renal failure. When the serum creatinine level was used as an index of the degree of renal impairment serum gastrin rose proportionately with the degree of renal failure. Haemodialysis did not significantly alter serum gastrin levels but renal transplantation tended to return them towards normal. This study indicates that the kidney has a role in the degradation of gastrin.     

Peritoneal Dialysis in Chronic Renal Failure

The long-term results of intermittent peritoneal dialysis in long-term treatment of renal disease have yet to equal those of intermittent hemodialysis. However, further exploration and refinement of this technique is justified.Performed in acute stages of disease, both peritoneal dialysis and hemodialysis relieve the symptoms of uremia and specifically “buy time” for the patient so that proper medical or surgical therapy may be instituted. In acute situations, peritoneal dialysis is the procedure of choice, and is an important adjunct to more conventional treatment for chronic renal disease. It may be useful sometimes even in chronically hemodialyzed patients—for example, when the hemodialysis cannula for one reason or another is inaccessible because of clots, replacement, or infection. It is especially valuable when the hemorrhagic complications of uremia contraindicate hemodialysis treatment.Its use in chronic uremia remains sharply limited in time, but for brief periods chronic peritoneal dialysis appears to be a reasonably satisfactory means of prolonging life while awaiting homotransplant or decision for maintenance hemodialysis therapy.     

血管回声跟踪技术评价慢性肾功能衰竭患者股总动脉内皮功能

目的：应用血管回声跟踪技术（echo-tracking,ET）评价慢性肾功能衰竭患者股总动脉内皮功能,并探讨该技术治疗慢性肾衰患者心血管并发症的临床意义。方法：选择2012年1月至12月在我院就诊的82例慢性肾功能衰竭患者为观察组,另选47例健康体检者为对照组。应用ET技术检测两组患者的左右侧股总动脉血管弹性指标,包括压力应变弹性系数（Ep）,脉搏波传导速度（PWVβ）,增大指数（AI）,硬度指数（β）和脉顺应性（AC）。观察两组患者的检测结果并进行比较。结果：观察组中,压力应变弹性系数（Ep）,脉搏波传导速度（PWVβ）,增大指数（AI）和硬度指数（β）均高于对照组所对应的值;而脉顺应性（AC）值低于对照组,两组差异有统计学意义（P〈0.05）。观察组中,需要透析的患者组β、PWVβ、Ep和AI的值均高于非透析患者组对应的值,AC值低于非透析患者组的值,差异有统计学意义（P〈0.05）。结论：ET对慢性肾功能衰竭患者心血管并发症的早期治疗,改善患者的愈后具有一定的临床指导意义。     

Aluminium in Bone from Patients with Renal Failure

Some samples of bone from patients with renal failure contained more aluminium than others, and the concentration tended to be highest in patients who had been uraemic or on dialysis longest. The significance of the association of raised concentrations of aluminium in bone with renal failure is discussed.     

Peritoneal Dialysis in Acute and Chronic Renal Failure

Clinical experience with peritoneal dialysis in eight cases of acute and four cases of chronic renal failure is presented. Seven of the acute cases survived but in some of these hemodialysis was also employed. The relatively simple technique of peritoneal dialysis was found to be effective, although slower than hemodialysis. In three of the cases it was selected in preference to hemodialysis. Its main advantages are that it does not require elaborate arrangements, or the use of blood or anticoagulants. The authors conclude that when the peritoneum is intact the method can be employed whenever the use of a temporary kidney substitute is indicated.     

Gastric Acid Secretion in Chronic Renal Failure

Contrary to the small amount of published evidence, but in accordance with clinical impression, we have found an increased incidence of peptic ulceration in people with chronic renal failure. Hyperacidic secretion in response to a standard pentagastrin test occurs in patients established on long-term dialysis treatment. The traditional liability of azotaemic patients to peptic ulceration seems not to be decreased by adequate long-term dialysis and indeed may be worsened.     

Pharmacodynamics of Practolol in Chronic Renal Failure

Plasma levels of practolol were measured in advanced chronic renal failure. The plasma half life was found to be markedly prolonged. During haemodialysis considerable shortening of the half life occurred. Therapeutic blood levels of practolol can be achieved in maintenance haemodialysis patients by the administration of 200 mg of the drug by mouth at the beginning and end of each dialysis.     

High Dosage Metolazone in Chronic Renal Failure

Metolazone is a modified quinazolinesulphonamide and in a dose of between 4 and 7·5 mg is an effective diuretic in man with normal renal function. Fourteen patients with non-oedematous stable chronic renal failure (creatinine clearance ranging from 1·2 to 12 ml/min) were given metolazone in doses ranging from 20-150 mg. A noticeable increase in urine flow and sodium excretion occurred, free water clearance increased, and there was a small but significant increase in potassium excretion. No side effects were noted.     

Intermittent Hemodialysis in Terminal Chronic Renal Failure

Seven patients with chronic renal failure underwent intermittent hemodialysis for five to 37 months (111 patient-months on a twice-weekly basis) employing arteriovenous Teflon-Silastic cannulas and the modified two-layer Kiil hemodialyzer. A single-pass 37° C. dialysate system has been used. One patient died of an indirectly related cause. All other patients have been successfully rehabilitated and now carry on normal activity of moderate sedentary type. Complications included recurring infection and clotting of arteriovenous cannulas. Hypertension and anemia were common complications requiring careful control. Peripheral neuropathy was noted in five of the seven patients but was of clinical significance in only one patient. Metastatic calcification, osteoporosis and urolithiasis also occurred in this patient. Peptic ulcers with hemorrhage developed in two patients. The degree of rehabilitation and psychological adjustment achieved by this group of patients strongly indicates the need for expansion of dialysis facilities and further research into the medical and economic aspects of dialysis.     

Body Water and Electrolyte Composition in Acute Renal Failure

Body water and electrolyte contents have been measured by means of muscle biopsy analysis in 11 patients with untreated acute renal failure and in one patient during the diuretic recovery phase of his illness. Patients with acute oliguric renal failure show two main types of imbalance. One group shows evidence of a reduction in extracellular sodium and chloride with normal intracellular water and electrolytes. These findings are thought to be due to a combination of excess urinary salt loss during the development of oliguric renal failure, and inadequate replacement of extrarenal electrolyte losses. A second group shows overhydration of both extra- and intracellular phases, associated with an excess of sodium and chloride. The intracellular potassium concentration is reduced, owing to the intracellular water excess. The patient studied during the diuretic recovery phase of acute renal failure showed a marked loss of sodium and chloride, which emphasizes the necessity to replace urinary electrolyte losses at this stage of the illness. It is often extremely difficult to assess fluid and electrolyte balance in patients presenting with acute renal failure, and muscle biopsy analysis or isotope dilution studies may be required before accurate replacement therapy is possible.     

Chronic Hemodialysis for Terminal Renal Failure

Ten terminal uremic patients seen over the period of one and one-half years have been kept alive by repeated hemodialysis using a modification of the Seattle system, carried out for the most part by nurses and technicians. All the patients had creatinine clearance values below 5 ml./min., and blood urea nitrogen values which ranged between 156 and 453 mg. % before beginning the first dialysis.Selection was based on their ability to co-operate with and to tolerate the regimen. Nine patients were fully rehabilitated.The major complications were those related to shunt-site infections, including septicemia, bacterial endocarditis, septic arthritis, septic pulmonary embolism and mycotic aneurysm.Nevertheless, all patients except one were rehabilitated and resumed their full-time occupations and have continued to lead happy and useful lives.     

甲状腺功能减退症合并慢性肾功能衰竭5例临床分析

目的：提出一些关于早期诊治甲状腺功能减退症合并慢性肾功能不全的建议。方法：回顾性分析我科2000-2006年住院患者中甲状腺功能减退症合并肾功能衰竭病例5例,比较其临床表现和相关检查并分析其诊疗经过。结果：二种疾病不仅在其发生发展上有一定联系,而且在临床表现和相关检查上也有相似之处。二种疾病都可出现浮肿、贫血、乏力、纳差、心包积液、蛋白尿和不同程度的肾功能不全。二者合并出现时临床表现更加复杂多样,增加了临床诊断的难度。结论：在诊治此类疾病时要注意临床表现的一些细节,如心力衰竭时的相对缓脉、与肾功能不全不相适应的贫血、难治性心包积液、不明原因的肾功能损害等,以便早期正确诊治,提高诊疗水平。     

Changes of Blood Pressure,Renin, and Angiotensin after Bilateral Nephrectomy in Patients with Chronic Renal Failure

Circulating levels of renin, angiotensin I, and angiotensin II were increased in six patients with chronic renal failure and hypertension uncontrolled by dialysis and hypotensive drugs. Lower and often normal levels were found in 10 patients whose blood pressure was controlled by dialysis treatment. For a variety of reasons all patients were subjected to bilateral nephrectomy. The logarithm of the decrease in plasma concentrations of renin and angiotensin II was significantly related to the fall of blood pressure after operation. Plasma renin concentration correlated significantly with blood angiotensin I concentration and with plasma angiotensin II in samples taken before and after nephrectomy. Renin, angiotensin I, and angiotensin II were measurable in samples of blood taken 48 hours or more after the operation.     

Drug Intoxication and Neurological Episodes in Chronic Renal Failure

Of 178 episodes of neurological derangement in 103 patients with renal failure, only about 40% were due to known causes such as hypertension or electrolyte failure. One-third were due to drug intoxication and no definite aetiology was found for the remainder. Drug intoxication is due partly to the accumulation of a drug normally excreted by the kidney and partly to a greater susceptibility of the central nervous system in uraemic patients. The prognosis is favourable.