Autoantibodies against parathyroid hormone in a patient with terminal renal insufficiency.

An autoantibody against mid-C-regional, possibly mid-regional, parathyroid hormone was detected in the plasma of a patient with terminal renal insufficiency who was on intermittent haemodialysis. 43-68(Tyr)hPTH and 42-55(Tyr)hPTH were selectively bound by his IgG fraction. 43-68(Tyr)hPTH had the highest affinity for the autoantibody; intact parathyroid hormone did not displace radiolabelled 42-55(Tyr)hPTH or 43-68(Tyr)hPTH. As concentrations of circulating antibodies against mid-C/mid-regional parathyroid hormone fell rises in intact and mid-C-regional parathyroid hormone levels and in alkaline phosphatase activity were observed. This autoantibody directed against the middle portion of the parathyroid hormone molecule seemed to have some protective properties against the osteoblast-stimulating activity of the hormone, implying that the mid-C-region or middle region of the molecule has some biological importance.

[The diuretic activity of bumetanide in a controlled comparison with furosemide in patients with various degrees of impaired renal function (author's transl)]. / Die diuretische Effektivität von Bumetanid im kontrollierten Vergleich zu Furosemid bei chronischer Niereninsuffizienz unterschiedlichen Schweregrades.

The effect of bumetanide (6 and 12 mg) was compared with that of furosemide (250 and 500 mg) in 13 patients with chronic renal insufficiency in a double-blind study using each patient as his own control. In the dose ratio of 1:40 previously obtained in normal subjects furosemide showed a significantly higher diuretic response than bumetanide. Comparing the relative natriuretic effects in chronic renal insufficiency a ratio of 1:10 to 1:12 (B:F) seemed to be adequate. More than 12 mg bumetanide cannot be recommended because of the severe muscle pains which occurred in all patients with that dosage.

[Effect of Co-trimoxazole on renal creatinine excretion in man (author's transl)]. / Zur Kreatininausscheidung beim Menschen nach Gabe von Co-Trimoxazol.

Clinical observations have shown, that administration of Co-trimoxazole (Trimethoprim-Sulfamethoxazole) may result in an elevation of the serum-creatinine level. In 27 subjects the endogenous creatinine- and inulinclearance were measured before and during oral or parenteral application of Co-trimoxazole. The inulinclearance showed no significant differences (p greater than 0,05). But the endogenous creatinine clearance showed a reduction of 18% during the oral and of 13% during the parenteral treatment (p less than or equal to 0,05). These observations indicate a functional inhibition of the tubular creatinine secretion by Co-trimoxazole.

[Renal vein thrombosis: a complication of the nephrotic syndrome? (author's transl)]. / Nierenvenenthrombose: Komplikation des nephrotischen Syndroms?

The nephrotic syndrome is complicated by an increased thromboembolic risk. This is related to changes in one or more factors of the Virchow triad (vessel wall, blood flow, coagulation). The hypercoagulability may be enhanced by iatrogenic manipulations as for instance vessel punctures, application of steroids and diuretics. The preferential location of thrombus formation are the veins of the leg, pelvis, kidney, and the cerebral sinuses. In contrast the "primary" renal vein thrombosis has long been considered not as a complication of the nephrotic syndrome but as its cause. In the meantime there have been accumulated histological, experimental and clinical facts showing the nephrotic syndrome causative for the renal vein thrombosis. This is revealed too by our own cases.

Disposition of digitoxin in renal failure.

The disposition of digitoxin was studied for a period of 8 days in 6 uremic patients given a single oral dose of 1 mg 3H-digitoxin. In plasma, the time-course of radioactivity indicated a diminished absorption velocity of tritium compared to that of control subjects already reported and, after reaching of a pseudostate-equilibrium at 24 hr, an exponential decline with a mean half-life of 8.0 days. In urine, smaller amounts of tritiated compounds were eliminated in uremic patients (8.7% of the dose) than in controls (22.5%). The average fecal excretion of digitoxin and its metabolites was not significantly increased. Chloroform extraction and thin-layer chromatography in plasma, urine and feces suggested no qualitative alteration in the metabolism of digitoxin. Calculations of the total body tritium content (body stores) after each 24-hr interval and its pharmacokinetic behavior showed that the elimination of digitoxin is determined by the transfer constant from tissue to plasma. The differences in elimination kinetics of digitoxin and its metabolites of uremic patients and healthy subjects were not significant.

[Effect of naftidrofuryl on creatinine serum concentration and on PAH/inulin clearance in peripheral arterial occlusive diseases]. / Untersuchunger uber den Einfluss von Naftidrofuryl auf die Kreatinin-Konzentration im Serum und die PAH/Inulin-Clearance bei peripher arteriellen Durchblutungsstörungen

The effect of 200 mg 3-(1-naphthyl)-2-tetrahydrofurfurylpropionic acid beta-diethylaminoethylester (naftidrofuryl, Dusodril) administered as a single i.v. infusion, on serum creatinine was investigated in 10 patients with occlusive disease of the peripheral arteries (average age 58.6 years). In a second group of similar patients (average age 60.5 years) determinations of PAH/inulin clearance and serum creatinine were performed prior to and immediately after treatment with 400 mg naftidrofuryl per day over a period of two weeks. Creatinine concentration did not change following acute or chronic administration of naftidrofuryl; glomerular filtration rate and renal plasma flow were not affected by prolonged treatment (2 alpha less than 0.05). An obligatorily nephrotoxic effect of naftidrofuryl can therefore be ruled out.