Association of ethylene-oxide-induced IgE antibodies with symptoms in dialysis patients.

IgE-type antibodies to human serum albumin/ethylene oxide conjugates were determined in 153 patients (140 unselected, 13 selected for presence of eosinophilia) on regular dialysis treatment by radioallergosorbent test (RAST) techniques. In 10.7% of unselected patients and 30.8% of selected patients, RAST values suggested ethylene oxide sensitisation. High RAST values were commonly associated with anaphylactoid reactions during dialysis and with chronic asthma. Ethylene oxide antibodies should be sought routinely in patients presenting with these symptoms and the necessity of ethylene oxide sterilisation of disposable dialysis equipment should be re-evaluated.

[Hypersensitivity phenomena in dialysis patients. Incidence of eosinophilia, raised IgE and ethyleneoxide-induced antibodies]. / Hypersensitivitätsphänomene bei Dialysepatienten. Häufigkeit von Eosinophilie, IgE-Erhöhung und Ethylenoxid-induzierten Antikörpern.

The hypersensitivity parameters eosinophil count, serum IgE and IgE-type antibodies to ethylene oxide-albumin conjugates (ETO-antibodies), were determined in 182 dialysis patients. Eosinophilia was seen in 21.7% of patients, IgE elevation in 21.4% and ETO-antibodies in 12.4%. A pathological change in at least one of the measured parameters was present in 33.1%. The appearance of ETO-antibodies was frequently associated with severe clinical symptoms, especially asthma and anaphylactic shock. Sensitisation is apparently common in dialysis patients. Since ETO-antibodies are often associated with severe clinical symptoms, their presence should be sought in those dialysis patients showing incompatibility reactions or asthma.

[Determination of lead in hydride form in bone biopsies of patients with long past lead poisoning]. / Der Nachweis von Blei als Hydrid in Knochenbiopsieproben von Patienten mit lange zurückliegenden Bleivergiftungen.

Disturbances in the determination of lead by means of flameless atomic absorption by highly pure CaCl2-solutions were demonstrated. To avoid such disturbances a new method for estimation of lead in bone specimens is introduced. Lead is separated in hydride form by adding NaBH4 to the specimens in an acid solution containing tartaric acid and sodium dichromate in a so called metal-hydride-system and then identified by atomic absorption spectrophotometry. For higher concentrations or for mass spectrometric determination of the lead isotope proportions the lead hydride may also be frozen. The hydride method has been used with the estimation of lead in biopsy specimens from the iliac crests of 14 patients who suffered from nephropathies of unknown origin. In addition flameless AAS was employed and the results were controlled. The lead contents in bone specimens from 13 patients with a long history of occupational exposure to lead varied between 126 mumol/kg (26 micrograms/g) and 1,97 mmol/kg (410 micrograms/g) of dried substance. In five control specimens the corresponding values ranged from 19 mumol/kg (4 micrograms/g) to 87 mumol/kg (18 micrograms/g). These findings suggest that nephropathy results from body burden of lead. Additionally hair specimens and nail clippings from several of the above patients were analysed. Control analyses were carried out. The question of lead release from deposits in bone and the connections between nephropathy and exposure to lead are discussed.

[The effect of indomethacin on basal and stimulated plasma renin activity in normal subjects (author's transl)]. / Die Wirkung von Indomethacin auf die basale und stimulierte Plasmareninaktivität beim Menschen

The influence of indomethacin, a potent inhibitor of prostaglandin synthesis, on basal and stimulated plasma renin activities in normal human subjects was determined. Stimulation of the renin activity was achieved by orthostasis or by furosemide. Indomethacin led to a considerable decrease of both basal and stimulated plasma renin activity in chronic and acute experiments. Our experiments provide no evidence that major changes in the sodium balance are responsible for the effects observed. It is concluded that some antagonistic function of the renin angiotensin system and prostaglandins seems probable. These antagonistic actions might play a role in the regulation of the kidney circulation or the arterial blood pressure.

The effect of indomethacin on plasma renin activity in man under normal conditions and after stimulation of the renin angiotensin system.

1) The influence of oral indomethacin on basal and stimulated plasma renin activity in normal human subjects was determined. 2) Indomethacin lowers the basal plasma renin activity in man. 3) The response of the plasma renin activity after indomethacin to physiological and pharmacological stimuli is maintained at a lower level. 4) There is no evidence from our experiments that major changes in the sodium balance are responsible for the effects observed.

Ultrafiltration for middle molecules in uraemia.

An ultrafiltration system for the purification of toxic substances is demonstrated. Using this system, it is possible to eliminate substances with a molecular weight up to 5,000 in the same amount as smaller molecules. The clearances for smaller molecules are lower and for larger molecules higher compared to haemodialysis and they depend mainly on the ultrafiltrate flow. Amino acid loss did not exceed the amount which was eliminated by plate haemodialysers. Side effects, such as excessive haemolysis, platelet or fibrinogen depletion, were not to be found.

Fluid reabsorption in Henle's loop and urinary excretion of sodium and water in normal rats and rats with chronic hypertension.

The function of the short loops of Henle was investigated by micropuncture technique in normal rats, in rats with spontaneous hypertension, and in the untouched kidney of rats with experimental renal hypertension. All animals received a standard infusion of 1.2 ml of isotonic saline per hr. With increasing arterial blood pressure (range from 90 to 220 mm Hg), a continuous decrease in transit time of Lissamine green through Henle's loop from 32 to 10 sec was observed. Fractional water reabsorption along the loop declined progressively from 26 to 10%, and fractional sodium reabsorption decreased from 40 to 36% of the filtered load. The fluid volume in Henle's loop calculated from transit time and mean flow rate also decreased with increasing blood pressure. There was no change in superficial single nephron filtration rate but there was a slight increase in total glomerular filtration rate (GFR). Sodium and water reabsorption in the proximal tubule remained unchanged. Urine flow rate, sodium excretion, osmolar clearance, and negative free water clearance increased with increasing blood pressure. The osmolal urine to plasma (U/P) ratio declined but did not fall below a value of 1.5. It is concluded that the increase in sodium and water excretion with chronic elevation of arterial blood pressure is caused by a decrease of sodium and water reabsorption along the loop of Henle, presumably as a consequence of increased medullary blood pressure.