Comparison of estimated creatinine clearance among five formulae (Cockroft-Gault, Jelliffe, Sanaka, simplified 4-variable MDRD and DAF) and the 24hours-urine-collection creatinine clearance.

BACKGROUND: GFR estimation is of major importance in everyday clinical practice. Usually it is done using one of the many eGFR equations available. In this study we compared in our population four widespread eGFR equations and our own empirical eGFR, with creatinine clearance calculated through a timed urine collection. PATIENTS AND METHODS: We collected laboratory data of 907 patients from our clinic and outpatient department through a ten-year period and statistically compared the eGFR results between them and with the timed urine collection creatinine clearances. RESULTS: All eGFR equations gave acceptable approximations to the timed urine collection creatinine clearances. However, in different subpopulations some equations did better than others, without any clear advantage of any equation overall. Surprisingly, our empirical equation named DAF also gave acceptable approximations regardless of age, weight and sex of the patient. CONCLUSIONS: In our population our empirical eGFR method (DAF) gave satisfactory results regarding the monitoring of renal function, compared with four other eGFR methods. We suggest that it could provide a very fast and easy to use means of eGFR calculation.

Evolution of Fabry disease in male patients: the Greek experience.

Fabry disease is a progressive metabolic disorder with a clinical course characterized by different phases and a variety of disease manifestations. The first symptoms generally appear in childhood or early adolescence and are followed by late life-threatening complications involving vascular, renal, cardiac, and cerebral systems. We report the clinical and biochemical characteristics of 16 male patients from 10 unrelated families who represent almost the entire cohort of known Fabry patients in Greece. Despite the presence of early symptoms in almost every patient (mean age at onset of symptoms 15.6 years), the diagnosis was delayed for a mean of about 18 years (mean age of diagnosis 36 years). Patients are currently monitored and the majority (15 out 16 patients) treated with Enzyme Replacement Therapy.

Human and ape: the legend, the history and the DNA.

A vast amount of papers is published every year about species evolution, the most interesting being those recently published in the journal "Nature", concerning the human-ape relationship. The results and the new theories generated from this research are sometimes astonishing, raising not only biological, but also social, religious and cultural questions. One of the new questions concerns the role of species interbreeding as a means of evolution. In the subject of species interbreeding between human and ape we found some interesting historical and mythical information that sort of back-up this theory of interbreeding, with a historical and cultural side view.

HPRT deficiency as the cause of ESRD in a 24-year-old patient: a very rare presentation of the disorder.

A 24-year-old male with end-stage renal disease (ESRD) and disproportionately high uric acid plasma concentration was admitted to our unit. After studying the patient's medical history, as well as that of the entire family, hyperuricemia was discovered in his brother, while microscopic examination of his brother's and mother's urine revealed abundant uric acid crystals. After performing purine metabolic studies, it was determined that the two siblings suffered from partial hypoxanthine-guanine phosphoribosyltransferase (HPRT) deficiency (Kelley-Seegmiller syndrome). This report highlights the importance of clinical awareness and a thorough examination of the patient's medical history for establishing an early diagnosis and commencing treatment for such rare inherited metabolic disorders to prevent renal failure.

"You can't make a monkey out of us": Galen and genetics versus Darwin.

The views on the biological relationship between human and ape are polarized. One end is summarized by the axiom that "man is the third chimpanzee", a thesis put forward in an indirect way initially by Charles Darwin in the 19th century. The other is a very modern concept that although similar, the human and ape genomes are distinctly different. We have compared these two views on the subject with the stance of the ancient medical writer Galen. There is a striking resemblance between current and ancient opinion on three key issues. Firstly, on the fact that man and apes are similar but not identical. Secondly, on the influence of such debates on fields much wider than biology. And finally, on the comparative usefulness of apes as a substitute for human anatomy and physiology studies.

Substitution of renal function through skin catharsis: evidence from the classical period to the Middle Ages.

The skin's cleansing capacity has been known for centuries and has been used therapeutically and extensively for a great number of diseases. We studied the historical evolution of the methods used for catharsis through the skin, particularly for those in renal failure, by reviewing most of the existing ancient Greek and Byzantine codices dealing with the skin's cleansing capacity. From the fragments cited in this article, it is evident that the ancient medical writers were well aware of the mechanism of perspiration, and through this process the excretion of several body toxins, they knew about renal failure as well as the influence of environmental temperature on blood purification via the skin. To validate their views, we reviewed the seasonal variation of the average values for blood urea, creatinine, and electrolytes for 161 regular dialysis treatment (RDT) patients in four dialysis units in southern Greece. The estimations were carried out during the winter/summer 1997, 1998, and 1999 terms and included three winter months and three summer months. We traced an unexpectedly large number of references in the ancient and medieval Greek medical literature concerning detoxification through the skin, mainly regarding patients in renal failure. This seasonal variation hypothesis is supported by the results of our retrospective study: there was a difference of 16 mg/dL in the average blood urea (mean winter urea 182 mg/dL, mean summer urea 166 mg/dL). We suggest that the ancients had a vivid idea about the substitution of renal function by the skin's cleansing ability in renal failure. The previously mentioned phenomenon may be due to the elimination of blood urea through excessive perspiration. Our clinical results seem to verify their notions, and hence, the skin (like the peritoneum) may be considered a natural membrane for dialysis. We were unable to trace a similar report in the literature on the seasonal fluctuation of blood urea in dialysis patients.

The human skin: a meeting ground for the ideas about macrocosm and microcosm in ancient and Medieval and Greek literature.

We have been interested in the cleansing capacity of skin during the recent years. In a paper of ours (1) we presented a few references to Hippocrates' and Galen's ideas on the subject, while the main body of the article was based on the 17th-20th centuries' relative practices. In a second paper (2), we were mainly testing the ancient and Medieval Greek ideas on skin catharsis against some clinical work of ours. In this paper we now present the ideas of the pagan and Byzantine Greek authors (5th cent. BC - 10th cent. AD) on the relationship of the human body to the natural and man-made world. Special emphasis is given to the relationship between purification through the skin and world purification. Based on the similarity of the Empedokles' concept of the four elements and Hippocrates' thesis concerning the four humours, the Earth itself was personified and became a living organism that felt cold, perspired and became dry. Man started to seek a natural explanation for his diseases and alterations of his body functions. Hence, perspiration, fever, urination, headache, stroke, were explained in cosmological terms. Extracts from many medical and non-medical writers, like Empedocles, Hippocrates, Aristotle, Galen, the Fathers of the Church, Meletius latrosophista, Theophilus Protospatharius, Michael Psellus and other sources are presented, in order to show the close relationship between an abundance of diseases and an array of natural phenomena.

Nephrology, a newly rich speciality, is looking for an illustrious ancestry: what about a famous grandfather?

Nephrology is a newborn speciality compared to the other medical specialities. However, the study of the urinary tract's physiology and pathology had begun simultaneously with the birth of medicine. The scientific revolution of the renaissance and enlightenment eras caused an intense contestation of earlier theories and methods as if all knowledge had evolved suddenly from parthenogenesis after the dark (?) medieval years and human intellect suddenly exploded to huge intelligence quotients after the 15th century while before that humans were mentally deprived. Indeed most of the scientific knowledge did evolve impressively during renaissance and enlightenment years but not through parthenogenesis. Some observations, discoveries and inventions of this era were actually reobservations, rediscoveries and reinventions. Such an example is that of the experiments of Sanctorius Santorii of the 16th century AD and of Erasistratus of the 3rd century BC. Sanctorius and Erasistratus carried out an experiment with the same basic principles, similar methodology and proportional results with an almost 2000 years lag phase. With our paper we wish to give credit to earlier researchers of physiological and medical knowledge who, despite the lack of technological support, often concluded in extremely accurate observations.

Exorcisms used for treatment of urinary tract diseases in Greece during the Middle Ages and Renaissance.

Using an unpublished 16th century manuscript as a pilot case, we examined the role of the formal Christian rituals and of hybrid semi-Christian semi-pagan exorcistic writings in curing renal ailments. It was found that in spite of the changing religious and cultural orthodoxy in the lands around the Eastern Mediterranean Basin, people did adhere to their belief in divine intervention when they were suffering from renal and/or other afflictions. We traced the origin of these beliefs at least to the preclassical period, and its continuation well beyond the Renaissance. The same practice applied both to nephrological diseases of humans (clergy and laymen alike) and of animals. We also present several interesting works of art from the palaeo-Christian to the post-Byzantine era supporting our theses.

A neolithic case of Down syndrome.

The aim of the study is to draw attention to the existence of a Neolithic figurine from Greece with characteristics compatible with Down syndrome. We have reviewed the relevant medical and archaeological literature, and we have compared photographs of the figurine with photographs of a patient with typical Down syndrome (DS). From the above data we conclude that the 7000 years old artefact may well be the most ancient representation of the disease in Western civilisation.

The survival of the ritualistic over the 'scientific' element of hydrotherapy in Greece.

In this paper we present some elements of the history of 'scientific' psychiatric hydrotherapy and, moreover, of a particular form of the water-purifying ritual--that is, foot washing--among the populations living in Greece and in Orthodox communities in the Balkans. We speculate on the reasons that caused the virtual disappearance of the former, while the latter still flourishes.

Uroscopy in Byzantium.

Macroscopic examination of the urine has been used since time immemorial for the diagnosis and prognosis of nearly every disease. Although the great fathers of antiquity, such as Hippocrates and Galen, were involved in the practice, it reached its heights during the Middle Ages. This article divides the Middle Ages into three periods--early, middle and late--and studies the use of the method and the contributions of its particular practitioners in the eastern part of the former east Roman Empire (Byzantium). Uroscopy achieved there a more scientific status than in Western Europe, at least during the first two periods of the Middle Ages, and it also influenced heavily Arabic and Jewish medicine. However, Byzantine urosocopy was mainly based on ancient Greek knowledge and was open to progressive influences by medical progress in all its neighboring countries.

A history of natural membranes in dialysis.

Nature uses various natural membranes to eliminate toxic substances from the blood, mainly in renal failure. The membranes used for this purpose are predominantly those of the gastrointestinal system and the skin. Humans tried to imitate nature, and employed the same membranes for blood purification in patients with renal failure. The beginning of the practice can be dated to at least 4,000 years ago. However, the initiative for such clearing maneuvers was given by the human mind's conception for purifying the cosmos, the polis and the soul. This article traces similarities between such metaphysical tactics and procedures of the applied sciences. It also describes the historical evolution of the use of natural membranes for medical reasons in nephrological patients.