Postprandial alterations in heart rate and arterial pressure control during hemodialysis in chronic uremics

In order to assess the effect of standard meal on heart rate and arterial pressure during hemodialysis in chronic uremics, 15 patients with a mean age of 42 +/- 7 years were enrolled in this study. No patient had evidence of cardiovascular diseases and no drugs that may affect the autonomic nervous system were being administered. After autonomic function had been assessed each patient's heart rate and blood pressure were studied twice, during two standard hemodialysis sessions, control hemodialysis [HD] and snack hemodialysis [HD]. Blood and dialysate flows as well as ultrafiltration rate were kept identical during the two study days. Arterial blood pressure fell significantly during both the control HD and the snack HD, heart rate showed significant increase during snack HD, while during control HD it did not so. There was no significant difference between control HD and snack HD regards heart rate and arterial blood pressure. However, cases with evidence of sympathetic dysfunction [who experienced postural hypotension during autonomic function assessment] showed more marked fall in arterial pressure after the snack than during the corresponding period in the control HD. Hence these patients with sympathetic dysfunction specifically should be advised to avoid food ingestion two hours before and also during hemodialysis

Captopril versus nifedipine in controlling diabetic nephropathy

This study was conducted on 28 insulin-dependent diabetic patients with diabetic nephropathy. All of them were normotensive and under two doses of intermediate insulin therapy [40-60 IU/day]. 13 patients treated by captopril in a dose of 25 mg/day and the other 15 were treated by nifedipine in a dose of 30 mg/day. Urinary protein, urinary protein/creatinine ratio, serum creatinine, blood urea, blood glucose and mean arterial blood pressure were examined before treatment as well as after 3 months of this regimen. Results revealed a significant decreased in proteinuria and protein/creatinine ratio with either captopril or nifedipine therapy. Also, a significant improvement in glucose tolerance was noticed after captopril therapy but not with nifedipine. No significant difference was observed for serum creatinine, blood urea and mean arterial blood pressure with captopril or nifedipine therapy. Comparing the effects of captopril and nifedipine on protein excretion by the kidney, there was no significant difference. Hence, it was concluded that both captopril and nifedipine are equally effective in controlling protein excretion in diabetic nephropathy and it may be through a different mechanism rather than control of blood glucose and/or blood pressure

Some polymorph nuclear leukocytic functions in patients with transfusional iron overload

Phagocytosis and peroxidase activity of PMNLs were evaluated in eleven polytransfused patients [mean age 6.5 +/- 2.5 years] with high serum ferritin [mean 1390 ng/ml S.D. 219.3 ng/ml] and high serum iron [mean 196.9 ug/100ml, S.D. 20.5 ug/100 ml] and in 10 normal controls of matched age and sex. The patients were, 6 cases of B. thalassemia major, 2 cases with diamond-Blackfan anaemia, one case of sickle cell thalassemia, one case of sidroblastic anaemia and one case of chronic renal failure. Phagocytic index [P.I.], phagocytic percentage [P.P] and peroxidase activity were highly significantly reduced in patients than controls. Also patient's serum exerted highly significant inhibitory effect on phagocytic functions of patient's and control's PMNLs. After 10 - 12 weeks of desferrioxamin treatment, the studied PMNL function parameters were returned to normal in all patient's and the inhibitory effect of patient's serum was lost. These data suggest that patients receiving multiple blood transfusions have a reversible impairment of their neutrophil functions which is most probably due to iron overload