ABSTRACT
Glucose tolerance and tissue sensitivity to insulin were examined in 19 renal failure patients on chronic regular hemodialysis (group U) and in 6 matched control subjects with normal renal function (group A). Based on glucose tolerance as assessed by an oral glucose tolerance test (OGTT), glucose tolerance was normal in 5 (group U:N), borderline in 5 (group U:BL) and decreased in 9 uremic subjects (group U:D). Compared with group A the uremics demonstrated significantly (p less than 0.01) impaired insulin sensitivity as assessed by a continuous mixed infusion of somatostatin, insulin and glucose (SIGIT). In addition 19 non-diabetic subjects with normal fasting blood glucose and normal renal function, matching the uremic patients with respect to glucose tolerance as assessed by OGTT, were studied (group B). In group B impairments in both insulin secretion and insulin sensitivity tended to be more pronounced in subjects with decreased OGTT as compared with those with borderline OGTT. In contrast, insulin resistance was present to a similar degree in uremic subjects of group U:N, U:BL and U:D. During SIGIT endogenous insulin, glucagon and growth hormone (GH) were suppressed in both uremic and control subjects. This implies that insulin resistance in uremia is most likely not due to hyperglucagonemia or abnormal GH metabolism. During OGTT subjects of group U:N had significantly higher insulin response than subjects of group U:BL (p less than 0.02) and group U:D (p less than 0.01). Insulinogenic index was significantly higher in group U:N than in group U:BL (p less than 0.02) and group U:D (p = 0.01) and was higher in group U:BL than in group U:D (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Glucose/metabolism , Insulin Resistance , Insulin/metabolism , Islets of Langerhans/metabolism , Uremia/metabolism , Adult , Aged , Blood Glucose/metabolism , Female , Glucagon/blood , Glucose Tolerance Test , Growth Hormone/blood , Humans , Male , Middle Aged , Somatostatin/metabolismABSTRACT
Report is given on a 68-year-old man who suffered primarily from progressive weight loss and repeated episodes of fever and arthralgia. Later, liver dysfunction and renal insufficiency developed. Liver and kidney biopsies disclosed granulomatous hepatitis and nephritis. Because of the morphologic and clinical findings, the diagnosis of Boeck's disease was made. Shortly before death, diarrhea developed. Autopsy revealed a massive systemic involvement in Whipple's disease proven by light and electron microscopy and immunofluorescence. Tuberculoid and epitheloid cell granulomas and isolated giant cells were found in addition to the biopsy findings in skeleton muscles, the small intestine, lymphnodes and bronchi. At autopsy, the kidney showed chronic interstitial nephritis. The literature of kidney involvement in Whipple's disease is reviewed. This is the first case with granulomatous interstitial nephritis and chronic renal insufficiency in an inadequately treated Whipple's disease.
Subject(s)
Nephritis, Interstitial/etiology , Whipple Disease/complications , Aged , Diagnosis, Differential , Heart Failure/etiology , Humans , Kidney/pathology , Liver/pathology , Male , Nephritis, Interstitial/pathology , Sarcoidosis/diagnosis , Whipple Disease/diagnosisSubject(s)
Blood Volume , Diabetes Complications , Diuretics/therapeutic use , Hypertension/drug therapy , Sodium/metabolism , Adult , Aged , Angiotensin II/pharmacology , Blood Pressure/drug effects , Chlorthalidone/therapeutic use , Diabetes Mellitus/metabolism , Diabetes Mellitus/physiopathology , Female , Humans , Hypertension/complications , Hypertension/physiopathology , Male , Middle Aged , Norepinephrine/pharmacology , PlacebosABSTRACT
Early acute rejection with oligo-anuria was observed in 9 cases among 103 cadaver kidney allografts transplanted between January 1969 and May 1977. According to our experience this type of rejection crisis occurs between the 6th and 9th day after transplantation. It is characterized by a typical clinical course. The beginning is acute with high fever and swelling of the graft, followed by oligo-anuria demanding treatment with hemodialysis. In all cases except one there was total restoration of graft function after an oligo-anuric period of 4--16 days. The late prognosis was good in 5 cases. The other 4 patients lost their grafts during the first 4 months after transplantation as a consequence of a second irreversible rejection reaction. The pathogenesis of this early acute and reversible failure of the transplant is discussed, together with the histologic findings in one case.
Subject(s)
Graft Rejection , Kidney Transplantation , Adult , Anuria/therapy , Female , Glomerulonephritis/therapy , Humans , Male , Middle Aged , Prognosis , Pyelonephritis/therapy , Renal Dialysis , Transplantation, HomologousABSTRACT
By means of a photon densitometer utilizing a 125I-source, bone mineral content was measured in 15 chronic renal failure patients on conservative management, 46 patients on maintenance hemodialysis and 20 patients after renal transplantation. The determinations were made at 4 sites in both radius and tibia. In patients with chronic renal failure on conservative treatment the bone mineral content did not differ significantly from that in normals. Patients on hemodialysis showed a low bone mineral content in 61 percent of females and 53 percent of males. Especially low values were obtained from 5 females who had undergone bilateral nephrectomy. After renal transplantation all female patients showed low values, whereas 50 percent of male patients showed decreased values. No correlations were found between bone mineral content and serum parameters (calcium, phosphate, alkaline phosphatase, creatinine), duration of renal failure, hemodialysis treatment or steroid medication.
