ABSTRACT
The knowledge of renal function in the course of BMT is poor. We prospectively investigated glomerular and tubular function in 42 children who underwent BMT because of malignancy. Seventeen children were transplanted autologously. Investigations were performed before and immediately after the conditioning regimen. Inulin and creatinine clearance, albuminuria, urine excretion of alpha 1-microglobulin, beta-N-acetylglucosaminidase, alanine-aminopeptidase, intestinal alkaline phosphatase, and Tamm-Horsfall-Protein as well as sodium- and phosphatreabsorption were measured. The patients were classified regarding use of total body irradiation (tTBI) in the conditioning regimen. BEFORE CR: Glomerular filtration rate (GFR) was not influenced by the underlying diagnosis or previous treatment. Mean GFR was elevated compared with the reference group. Microalbuminuria was elevated in 15% of patients, and mean levels were higher than in the reference group. Proximal tubular dysfunction was indicated by an elevated excretion of alpha 1-MG in 54%, of beta-NAG in 66%, of AAP in 40%, and of IAP in 47%. Fractional sodium excretion was abnormal in 21%, phosphate reabsorption in 5% and THP-excretion in 7% of the patients. AFTER CR: Creatinine clearance was not affected by CR. After CR alpha 1-MG, beta-NAG, FENa, AAP, and IAP were increased compared with values before CR. TP/Clcr was decreased. Excretion of THP was not altered by CR. In patients without fTBI there was a greater increase in alpha 1-MG excretion and decrease in phosphate reabsorption after CR compared with patients conditioned with fTBI. We conclude that significant proximal tubular dysfunction is present in about 50-60% of patients before and in nearly all alter CR. Distal tubular function was less severely affected. Severity of nephrotoxicity after CR did not correlate with pre-existing abnormalities.
Subject(s)
Bone Marrow Transplantation , Glomerular Filtration Rate , Kidney Tubules/physiopathology , Transplantation Conditioning , Whole-Body Irradiation , Adolescent , Adult , Child , Child, Preschool , Female , Glomerular Filtration Rate/radiation effects , Humans , Kidney Tubules/radiation effects , Male , Prospective Studies , Reference ValuesABSTRACT
Andreas Vesalius was born in Brussels on December 31, 1514 from a long line of physicians. He died in Zante in 1564. He was a typical son of the Renaissance. In 1543, his two most important books were published: De Humani Corporis Fabrica, Libri Septum and the Epitome. The former was a book of over 700 pages with several illustrations, highly systematically composed and fully indexed. Andreas Vesalius was the first modern anatomist who based his anatomical descriptions on personal observation. The kidney was a fascinating organ to Vesalius, whose function, particularly regarding the production of urine, he did not fully grasp. He makes short work of the 'perforated membrane theory' which was the current conception of the origin of urine in the kidney. Andreas Vesalius broke with the established rigid and fabricated way of teaching anatomy, and introduced the modern concept of learning based on personal observations, using illustration combined with a critical spirit and sense of experiment.
Subject(s)
Anatomy/history , Kidney/anatomy & histology , Anatomy, Artistic/history , Belgium , History, 16th Century , Humans , Italy , Manuscripts, Medical as Topic/historyABSTRACT
The pharmacokinetics of imipenem and cilastatin after repeated doses have been studied in six patients with severe renal impairment (mean creatinine clearance 10.4 ml/min/1.73 m2). The patients received nine iv injections of imipenem/cilastatin sodium (500/500 mg) at 12-hour intervals. The imipenem plasma concentration-time profile and the pharmacokinetic parameters on day 5 were similar in all respects to those on day 1. Therapeutic plasma levels of imipenem (greater than or equal to 4 mg/l) were maintained for 8-10 h after administration. Most pharmacokinetic parameters of cilastatin were similar on both days. However, the area under the plasma concentration curve (AUC) was significantly increased on day 5, as a result of some accumulation, but the trough levels stabilized after the third injection. Twice daily administration of imipenem/cilastatin 500/500 mg was felt to be a well tolerated and optimal dose regimen in patients with severe renal failure.
