[Are prosecuted parents allowed the benefit of the doubt in cases of child abuse?]. / Skal tvilen komme tiltalte til gode også i barnemishandlingssaker?

The justified campaign against child abuse has unfortunately had a side effect. It has ruined the lives of some innocent parents of children with undiagnosed osteogenesis imperfecta. For 15 years, Colin Paterson and co-workers have studied a large number of patients with type IV of osteogenesis imperfecta, and have found that more than 50 per cent of them have normal radiographs of the bones at the time of the first fracture. Paterson and co-workers have also found that fractures of the ribs and skull are by no means uncommon in osteogenesis imperfecta type IV. These important observations should help, in the future, to prevent prosecution of innocent parents of children with osteogenesis imperfecta type IV, provided that the observations are not overlooked by pediatricians.

[Treatment of chronic kidney failure with dialysis and transplantation. Development, need and organization in Norway]. / Behandling av kronisk nyresvikt med dialyse og transplantasjon. Utvikling, behov og organisering i Norge.

Treatment of chronic renal failure by dialysis and renal transplantation has been developed over the last 20 years in Norway. 17 local nephrological units with dialysis departments cooperate with one transplantation center in Oslo. The number of new patients starting renal replacement therapy has increased only slightly during the last five years. The mean number of new patients in the period was 52 per million inhabitants per year. The proportion of elderly patients accepted for renal replacement therapy was high (39% above 60 years of age) and approximately 15% of the patients had diabetic nephropathy. Due to an active transplantation policy, the proportion of patients alive on dialysis is low (18%), compared with 82% alive with a functioning graft. The number of patients on dialysis has declined slightly the last four years. The proportion of patients on chronic ambulatory peritoneal dialysis (CAPD) is low (13%), and the number of patients on home hemodialysis has declined in the last five years. Predialytic transplantation has been performed in 18% of the patients starting renal replacement therapy during the last five years. Due to a high transplantation rate and a large number of predialytic transplantations, it has not been necessary to increase the capacity for dialysis in the last five years.

Seasonal variations in serum aluminum concentrations.

During 1984 and 1985 we performed frequent measurements of serum aluminum (Al) in patients with moderate chronic renal failure, and healthy controls, all living in the Oslo region. The results demonstrated seasonal variations with high levels in the autumn. During the peak periods serum Al increased by a factor greater than four. Outside the peaks patients using Al-containing phosphate binders had higher serum Al levels than non-users, a difference not seen during the peaks. Serum Al levels were unrelated to parathyroid hormone (PTH) concentrations and to calcitriol intake. Urinary excretion and the glomerular filtration rate was stable during the period with high serum Al in the autumn 1984. Increased gastrointestinal absorption of Al, possibly caused by a waterborne factor with chelating properties, may explain the seasonal variations.

Long-term blood pressure and renal function in kidney donors.

We have reexamined 68 (92%) of 74 donors accepted at this center nine to 15 years ago. There was a moderate but significant increase in BP, and ten donors (15%) were hypertensive at the follow-up. Twenty-six donors (38%) had albumin excretion over 10 micrograms/min or excretion of total protein over 185 mg/24 hr. In four of 16 with increased excretion of total protein, this exceeded 400 mg/24 hr, and in three donors this could be due to an intercurrent disease. Ccr averaged 78.4% of preoperative values, and was less than 50% (range 32 to 49%) in eight donors. The compensatory increase (median 30.5 mliter/min/1.73m2) was inversely correlated with age and BP. Aspects of tubular function were assessed by the diluting capacity during water diuresis and by urinary excretion of beta 2-microglobulin and N-acetyl-beta-glucosaminidase. No consistent abnormalities were observed. A subgroup of donors (N = 32) was compared with a matched control group. Urinary albumin excretion among the donors was significantly higher compared to the controls, both in absolute terms (5.4 vs. 3.3 micrograms/min, P less than 0.002) and as percent of total protein excretion (7.6 vs. 5.7%, P less than 0.05). Otherwise no consistent differences were observed. The development of BP over time warrants further observations, but there is no evidence that uninephrectomy represents a long-term risk to the donors' health.

The many faces of Goodpasture's syndrome.

Four cases of antiglomerular basement membrane (antiGBM) antibody mediated disease with unusual features are presented. Lung involvement was absent in one patient whereas the other 3 had Goodpasture's syndrome. Recognition of the nature of the disease was delayed in all cases, due to occurrence during pregnancy in one case and due to the indolent course of the renal injury in the other 3 cases. The therapeutic approach to these variant forms of antiGBM antibody mediated disease is discussed.

Relationship between pharmacokinetics and bioavailability of cefroxadine (CGP 9000) and renal function.

The pharmacokinetics and bioavailability of cefroxadine were studied in 15 patients with different renal functions after administration of 0.5 g as oral capsules and as intravenous infusions. Microbiological assays by agar diffusion and high-pressure liquid chromatography may both be used for this agent since no metabolite can be found. The bioavailability is near 100% of the oral dose regardless of renal function. Urinary recovery varied from about 50% in renal glomerular filtration rates (GFR) of less than 7 ml/min to nearly 100% in normal renal function. The serum concentrations, serum elimination half-life and total body clearance were significantly influenced by reduced renal function. Nonrenal elimination occurred in reduced renal function; the maximum serum elimination half-life was 24.6 h. Dose modifications according to renal function are suggested with from three doses/24 in normal renal function to one dose/24 h in patients with GFR of 10 ml/min. The relative distribution volume corresponded to approximately 30% of the body weight. Tubular secretion of cefroxadine took place. The concentrations in urine remained above 32 mg/l for 12 h in all subjects regardless of renal function.

A renal biopsy study with light and immunofluorescent microscopy in rheumatoid arthritis.

REnal biopsies were performed on 14 patients with active rheumatoid arthritis an proteinuria of whom 7 patients had reduced creatinine clearance. Glomerular hypercellularity was found in six and amyloid in seven biopsies. Immunofluorescence microscopy revealed glomerula deposits of immunoglobulins and complement in 10 of 12 biopsies, indicating an active immunologic process causing the impaired renal function.

Pharmacokinetics of cefapirin in patients with normal and impaired renal functions.

The pharmacokinetics of 3-hydroxymethyl-7-[2-(4-pyridyl-thio)acetamido]-2-cephem-2-carboxylic acid acetate (cefapirin) was evaluated after 1.0 g i.m. to 14 patients with different glomerular and tubular functions. Peaks in normal renal function ranged between 9--17 micrograms/ml and was 3--4 times higher in patients with glomerular filtration rates below 30 ml/min. The serum half-life in normal renal function was 0.8 h and was somewhat increased in renal impairment. The distribution volume was little influenced by renal capacity. Recommendations for dosage are given.

Kidney transport of cefapirin in normal and impaired renal function.

The renal transport of cefapirin has been assessed in thirteen patients after one dose of 1.0 g i.m. In normal glomerular filtration rate, approximately 50-60% of the dose is recovered in the urine in active form. The corresponding figure in functions below 30 ml/min was 10-30%. In normal function, tubular secretion accounts for ca. 1/4-1/3 of the amount appearing in the urine.

Goodpasture's syndrome. A report of seven patients including long-term follow-up of three who received a kidney transplant.

Seven patients with Goodpasture's syndrome are presented. Bilateral nephrectomy was performed in five patients, and postnephrectomy pulmonary hemorrhage occurred in three. Three nephrectomized patients underwent a successful renal transplant, renal transplantation being postponed until circulating antiglomerular basement membrane antibody had disappeared. The argument is made that pretransplant bilateral nephrectomy in patients with Goodpasture's syndrome is indicated.

Pharmacokinetics of the new broad spectrum penicillin CP-33994-2.

1.0 g of the new broad spectrum penicillin CP-33994-2 ws given i.m. to volunteers with varying renal function levels. Peak values of 40-50 microgram/ml were commonly observed in serum. The serum half-life was 1.1-1.5 h in normal renal function and increased to 7.0-17.0 h in patients with inulin clearance values of 12-14 ml/min. There was an appreciable lag before apparent absorption. Absorption rates and protein binding were uninfluenced by renal function. The renal clearance of the penicillin was less than the glomerular filtration rate. This may be due to either chemical instability of the compound such that it is inactivated before assay, or a substantial portion is changed (instability, metabolism) before excretion. A minor adjustment in dosage schedule is necessary in reduced renal function. Even patients with an inulin clearance of 12-14 ml/min have urine concentrations which are of antibacterial interest, at least in acute urinary tract infections without anatomical or other particular problems.

Mezlocillin pharmacokinetics in patients with normal and impaired renal functions.

The pharmacokinetics of intravenous bolus doses of 1.0 g of mezlocillin were studied in 13 persons with normal and reduced renal functions. In renal failure a moderate increase was observed for the terminal serum half-life(t1/2 beta). This changed from a mean of 1.1 h at a glomerular filtration rate of 100 ml/min to 1.6 h at 10 ml/min. The difference was not statistically significant. The excretion of unchanged drug in urine during 24 h was reduced from a mean of 59.4% (range, 52 to 77) in subjects with glomerular filtration rate above 50 ml/min to 10% (range, 7.9 to 12.1) in two patients with glomerular filtration rate of 10 to 20 ml/min. The volume of distribution during the beta-phase, Vd,b, was 14% of the body weight. Much of the antibiotic was metabolized, and this proportion increased upon reduction in renal function.

Pharmacokinetics of sulphadiazine, sulphamethoxazole and trimethoprim in patients with varying renal function.

The pharmacokinetics of tablets containing combinations of sulphadiazine (SDZ) and trimethoprim (TMP) (cotrimazine) and tablets with sulphamethoxazole (SMZ) and TMP (co-trimoxazole) were compared in patients with different renal functions. In normal renal function, SMZ is more similar to TMP than in renal impairment. In renal impairment although the serum half-life (t1/2) of both active and total SDZ remains similar to that of TMP, the t1/2 of total SMZ becomes several times higher than the t1/2 of TMP. The unchanged SMZ maintains approximately the same elimination velocity in reduced as in normal renal function. Consequently, for co-trimoxazole there is a buildup of SMZ metabolites which can only contribute to toxicity for co-trimoxazole, whereas the co-trimazine components have t1/2 values of the same order, also in renal dysfunction. The distribution volumes of SDZ, SMZ or TMP are the same regardless of renal function. However, the distribution volume of SDZ is closer to that of TMP, i.e. higher than the SMZ values. More active SDZ is excreted in the urine than SMZ both in normal and in reduced renal function. Thus co-trimazine, in addition to having some advantages in the normal individual, is in many respects distinctly more suitable in patients with renal functional impairment. On the basis of the patients with renal functional impairment. On the basis of the pharmacokinetic properties, dosage schedules are suggested that will give approximately the same plasma levels regardless of renal function.

Determination of renal blood flow by thermodilution method.

The single bolus thermodilution method for measurement of renal vein blood flow was tested. In model experiments the thermodilution method was compared with graduated cylinder measurements over a flow range from 50 to 1050 ml/min. There was a good correlation between the two methods (r = 0.98) with a mean of differences of 5.2%. In eighteen patients measurements were performed in duplicate in thirty-one renal veins. Comparison was made between the first (x) and second (u) measurement--performed within 3 min. The correlation between the two was very good (r = 0.99; y = 1.03x - 11.48). In twelve patients bilateral renal vein blood flow measurements were performed simultaneous to blood flow measurement by PAH clearance. The correlation between total flow measured by thermodilution (y) and by the clearance method (x) was good (r = 0.98; y = 0.79x + 221). It is concluded that the thermodilution method requires catheterization of the renal veins, but is otherwise simple to perform, is inexpensive and gives reliable results. It is particularly advantageous when repeated measurements in the study of acute changes in renal haemodynamics is desirable.

Glomerulonephritis in dermatitis herpetiformis. A case study.

A patient with dermatitis herpetiformis, proteinuria and reduced renal function is described. A renal biopsy studied by light and immunofluorescence microscopy revealed a glomerulonephritis with deposits of predominantly IgA and complement C3. Deposits of IgA and C3 were also demonstrated in a biopsy from normal skin, and a common pathway for the skin and renal lesions is suggested.