Monocytes and peritoneal macrophage functions in patients undergoing peritoneal dialysis

Complement C2 and lysozyme produced by cultured peritoneal macrophages from 17 patients undergoing chronic ambulatory peritoneal dilaysis in the presence of dialysis fluid showed progressively less increase with culture time indicating the presence of a macrophage's inhibitory factor in patient's dialysis fluid. There was a significant reduction of C2 production by cultured patient's moncytes in day six of culture compared with normal subjects monocytes. The addition of dialysis fluid caused more reduction of C2 levels in monocytes culture from patients and normal control subjects. Lysozyme levels produced by cultured patients monocytes showed progressively reduced levels compared with normal subjects. The addition of different concentrations of dialysis fluid or patient's serum to normal monocyte culture did not change C2 or lysozyme production

Post-renal transplant proteinuria, incidence and prognostic value

The present study was designed to evaluate post-renal transplant proteinuria regarding its incidence and its relation to graft outcome, type of immunosuppression, nature of the native kidney disease and the pathological changes in the allograft. Eighty renal transplanted patients were the subjects of this study. Fifty five of these patients experienced proteinuria while 25 of them didn't develop it and served as control subjects. These cases had been chosen from 390 patients who had under went renal transplantation in Mansoura Urology and Nephrology Centre from January 1982 to August 1990. All cases were subjected to thorough history, full clinical examination, urine analysis with special stress on proteinuria and serum creatinine. Kidney biopsy was performed to 31 patients with proteinuria. Our study showed that 14.1% of renal transplant recipients developed proteinuria where chronic rejection [42% of cases] and graft glomerulopathy [11%] were the commonest pathology encountered in these patients. The degree of proteinuria was significantly higher in patients with chronic rejection when compared to patients with graft glomerulopaty. It was evident from this study that post-transplant proteinuria was a good parameter for prediction of graft function. This was inferred from the finding that there was significant deterioration of the graft function in patients with higher degree of proteinuria as well as significant deterioration of the kidney function when compared with control cases. Eight patients with proteinuria developed graft failure and returned to dialysis. Lastly this study showed that type of immunosuppression, nature the native kidney disease and donor or recipient age had no significant effect on the degree of proteinuria

Atrial natriuretic peptide[ANP] in hemodialysis: effect of dialysate sodium concentration and duration of dialysis

This work was planned to Study the effect of duration of chronic renal failure and hemodialysis on cardiac release of atrial natriuretic peptide [ANP]. Twenty patients with end stage renal failure were categorized into two groups group I included 10 patients on-regular hemodialysis for more than five years duration and group II comprised 10 patients on regular hemodialysis for less than one year; patients in group II were dialyzed under high sodium dialysate and low sodium dialysate. Predialysis levels of ANP in group I and II were higher than that of the control group, however, higher levels were observed in group II. At the end of dialysis, both groups [I, II] showed significant ANP decrease compared to predialysis levels but did not return to normal control values. Group II, dialyzed under high sodium dialysate, showed higher predialysis ANP levels than those dialyzed under low sodium dialysate. On the other hand postdialysis decrease in ANP was more evident in those under low sodium dialysate. It could be concluded that ANP is elevated in chronic renal failure, long term hemodialysis might lead to blunted response of atrial cardiocytes to release ANP. Early renal transplantation in end stage renal failure is mandatory to keep a constant internal enviroment

Lumbar epidural analgesia and utero-placental blood flow in pregnancies complicated by hypertension

Eighteen parturient patients [15 with severe pre-eclampsia and 2 patients with chronic essential hypertension] were studied before and after lumbar epidural analgesia during first stage of labour using 10ml of 0.25% of bupivacaine. The utero-placental perfusion was evaluated by determining the systolic/diastolic [A/B] ratio in the uterine and umbilical arteries using Doppler velocimetry waveform analysis. The uterine artery systolic/diastolic [A/B ratio] decreased significantly from 1.95 + 0.45 before analgesia to 1.36 + 0.20 after it [p < 0.01]. The umbilical artery systolic/diastolic [A/B ratio] also decreased from 2.85 + 0.45 before analgesia to 2.22 + 0.53 after it [p < 0.01]. These results suggest improved utero-placental perfusion and improved intervillous blood flow after epidural analgesia which mades it the the obstetric analgesia method of choice in cases of sever pre-eclampsia

Utero-placental perfusions after epidural analgesia for cesarean section

The blood flow resistance in the maternal utero-placental and fetal umbilical artery circulation were studied in 20 pregnant patients with uneventful pregnancy undergoing elective lower segment Caesarean section. The systolic/diastolic [A/B] ration for utero-placental and fetal umbilical circulation were determined by Doppler velocimetry waveform analysis and were used as an index blood flow resistance. Each patients received 1 liter intravenous crystalloid infusion before an epidural bupivacaine infection. Epidural anaesthesia resulted in significant decease in the maternal utero-placental systolic/diastolic [A/B] ration associated with a decrease in fetal umbilical artery [A/B] ratio. This study suggests a beneficial fetal effect from the improved maternal uterine perfusion after epidural anaesthesia