[Microalbuminuria as predictor of atherosclerotic cardiovascular disease in IDDM]. / Mikroalbuminuri som praediktor af aterosklerotisk kardiovaskulaer sygdom ved IDDM.

The aim of this follow-up study was to assess whether slightly elevated urinary albumin excretion, i.e., microalbuminuria, precedes development of atherosclerotic vascular disease in IDDM. Out of 259 IDDM-patients 30 developed vascular disease during 2,457 person-years. Microalbuminuria was significantly predictive of vascular disease (hazard ratio (95% confidence interval) 1.06 (1.02-1.18) per 5 mg/24 hours increase in urinary albumin excretion; p = 0.002). The predictive effect was independent of age, sex, blood pressure, tobacco smoking, serum concentrations of total-cholesterol, HDL-cholesterol, sialic acid, and von Willebrand factor, and of haemoglobin A1c, insulin dose, diabetes duration, and diabetic nephropathy (hazard ratio (95% confidence interval) 1.04 (1.01-1.08) per 5 mg/24 hours increase in urinary albumin excretion; p = 0.03). It is concluded that slightly elevated urinary albumin excretion is an independent predictor of atherosclerotic vascular disease in insulin-dependent diabetes mellitus.

[Bilateral Achilles tendon rupture in individuals with renal transplantation]. / Bilateral akillesseneruptur hos nyretransplanterede.

Increased incidence of tendinitis and tendon ruptures is reported in recipients of a kidney transplant. Two cases of bilateral achilles tendon rupture after minimal trauma are described. Tendon ruptures are more frequent in individuals with kidney disease in dialysis or after transplantation compared with patients receiving other organ transplantations. It is therefore more likely that tendon ruptures are related to metabolic changes associated with kidney disease rather than with transplantation or with glucocorticoid treatment per se. Clinical symptoms of achilles tendinitis should be considered as warning signs prior to tendon rupture and treated appropriately to avoid further morbidity. There is no contraindication towards surgical suturing of an achilles tendon rupture in patients receiving immunosuppressive treatment including glucocorticoids.

[Microalbuminuria--a valuable diagnostic parameter]. / Mikroalbuminuri--en vaerdifuld diagnostisk parameter.

The concept of microalbuminuria is reviewed. Measuring the urinary albumin excretion rate and testing for microalbuminuria is well established in the control and treatment of patients with insulin-dependent diabetes mellitus. Microalbuminuria predicts nephropathy and early cardiovascular death. In the presence of microalbuminuria, frequent examinations are warranted for early detection of retinopathy, hypertension and for optimizing the glycaemic control. In patients with non-insulin dependent diabetes, the independent value of microalbuminuria as a cardiovascular risk factor is not yet clarified. The urinary albumin excretion rate should be measured at diagnosis, because the indications are that presence of microalbuminuria reinforces the urge to intervene against other well-documented cardiovascular risk-factors (hypertension, dyslipidemia, tobacco and obesity). In the non-diabetic population there is accumulating evidence that an elevated urinary albumin excretion rate is associated with early cardiovascular morbidity and mortality. Large scale cross-sectional and prospective studies are needed in order to further clarify the role of microalbuminuria as an independent risk factor in the background population.

[Screening of microalbuminuria with the Micral-Test. A semi-quantitative urinary dipstick]. / Screening for mikroalbuminuri med Micral-Test. En semikvantitativ urinstix.

Microalbuminuria, defined as a urinary albumin excretion rate of 20-200 micrograms/min, predicts diabetic nephropathy and cardiovascular disease in diabetic patients. An increased urinary albumin excretion rate is probably also associated with cardiovascular disease in non-diabetic subjects. Thus, screening for microalbuminuria is of major importance. A semi-quantitative urinary dipstick method, Micral-Test, has been developed for this purpose. In a urine sample collected overnight from each of 1359 subjects the Micral-Test was evaluated with a quantitative ELISA-method as the standard. Sensitivity, specificity and diagnostic specificity in detecting microalbuminuria was 92, 58 and 12% respectively. The prevalence of microalbuminuria was 5.6%. In conclusion, the Micral-Test is highly sensitive in detecting microalbuminuria, but at the expense of a relatively high number of false positive tests.

[Acute uremia after renal cholesterol embolism]. / Akut uraemi efter renale kolesterolembolier.

A case of acute uraemia caused by cholesterol emboli in the kidneys in a sixty-six year old male with arteriosclerosis is presented. No effective treatment is available, but recognizing the condition may save the patient from otherwise time-consuming extensive diagnostic programmes.

[Severe hypokalemia and hyperglycemia developed during indapamide therapy]. / Svaer hypokaliaemi og hyperglykaemi udviklet under indapamidbehandling.

A case of severe hypokalaemia and hyperglycaemia in connection with indapamide treatment is reported. Indapamide affects plasma potassium and also blood glucose. The significance of regular control of these parameters during treatment is emphasized.

[Cimetidine and creatinine clearance]. / Cimetidin og kreatininclearance.

Cimetidine lowers secretion of creatinine in the renal tubuli in healthy individuals and persons with chronic renal disease. The conditions in patients with renal transplants have hitherto been unknown. The renal clearance of endogenic creatinine (CKrea) was investigated prior to and after an intravenous bolus injektion of cimetidine (5 mg/kg) in nine patients with renal transplants. The rate of glomerular filtration (GFR) was determined by clearance investigation of 125I-thalamate (CTh). CKrea fell 29% from 65 ml/min (median) to 46 ml/min (p less than 0.01), whereas GFR remained unchanged. The fractionated creatinine clearance (CKrea/CTh) fell therefore from 1.43 (median) to 1.03 (p less than 0.01). It is concluded that cimetidine reduces creatinine secretion in patients with renal transplants and this should be borne in mind when the function of the graft is assessed solely with CKrea.

Effect of a mixture of pyridostigmine and atropine on forced expiratory volume (FEV1), and serum cholinesterase activity in normal subjects.

Pyridostigmine 0.143 mg kg-1 (maximum 10 mg) and atropine 0.0143 mg kg-1 (maximum 1 mg) were administered i.v. to six healthy male volunteers. Peripheral venous blood samples were drawn for measurement of serum cholinesterase activity. Maximum inhibition of the enzyme was found 5 min after injection with a decrease to 27 +/- 5% (mean +/- SEM) of the original activity. Forced expiratory volume in the first 1s (FEV1) was measured at fixed time intervals for 90 min. No decrease in FEV1 was observed; on the contrary, there was a small increase. We conclude that atropine effectively antagonizes the muscarinic side-effects of pyridostigmine on bronchial smooth muscle tone and bronchial secretions, when administered in clinical doses to normal human subjects.