ABSTRACT
In a 12-month prospective study of the initial management of patients with acute renal failure (ARF) in East Kent (population 593 000), we evaluated the initial management of ARF and assessed what proportion of ARF may have been preventable. Patients were seen and assessed on a daily basis, and were followed until discharge from hospital or death; survivors were subsequently followed for 3 years. Overall, 288 patients developed ARF (486 per million population/year). Mean age at presentation was 73 years (range 14-96). Initial assessment was often suboptimal, and key features in investigation and initial management were often lacking. In 108 cases, ARF was iatrogenic and/or potentially preventable (53 preventable, 99 iatrogenic, 44 both). Overall survival was 56% at discharge from hospital, 35% at 1-year follow-up, 31% at 2 years, and 28% at 3 years. In discharged patients, recovery of function was complete in 69%. A significant proportion of ARF is preventable. Clear guidelines, easily accessible at the point of care, could aid the diagnostic evaluation of the patient with ARF and indicate where referral for a specialist opinion is appropriate.
Subject(s)
Acute Kidney Injury/therapy , Iatrogenic Disease/prevention & control , Acute Kidney Injury/etiology , Acute Kidney Injury/mortality , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Creatine/blood , England/epidemiology , Female , Follow-Up Studies , Humans , Iatrogenic Disease/epidemiology , Male , Middle Aged , Prognosis , Prospective Studies , Survival RateSubject(s)
Acute Kidney Injury/etiology , Malaria, Falciparum/complications , Rhabdomyolysis/complications , Acute Disease , Adolescent , Antimalarials/therapeutic use , Drug Combinations , Humans , Malaria, Falciparum/drug therapy , Male , Pyrimethamine/therapeutic use , Sulfadoxine/therapeutic useABSTRACT
The date of onset of 360 acute renal transplant rejection episodes from 1969 to 1973 have been compared with the prevalence of various common viral infections and infections due to Mycoplasma pnuemoniae. A positive correlation was found for influenza B infections (r=0.43, p less than 0.01) up to 5 months before transplantation and for adenovirus infections (r=0.32, p less than 0.05) at 1 month before kidney grafting.
Subject(s)
Graft Rejection/etiology , Kidney Transplantation , Postoperative Complications , Virus Diseases/complications , Acute Disease , Adenoviridae Infections/complications , Graft Rejection/microbiology , Humans , Influenza, Human/complications , Mycoplasma Infections/complications , Transplantation, HomologousABSTRACT
After oral ingestion of a free amino acid mixture by three cystinuric patients, plasma increments of lysine and arginine were lower and those of many other amino acids were significantly higher than those found in control subjects. Similar results were obtained in control subjects after amino acid imbalance had been artificially induced by the omission of cystine, lysine, and arginine from the amino acid mixture. Especially high increments of alanine and proline provided the best evidence of amino acid imbalance caused by a temporary lysine and, to a lesser extent, arginine and cystine deficit. No such amino acid imbalance was found to occur in the cystinuric patients after ingestion of whole protein, indicating that absorption of oligopeptides produced by protein digestion provided a balanced physiological serum amino acid increment. This is considered to explain the lack of any unequivocal nutritional deficit in cystinuric patients despite poor absorption of the essential free amino acid, lysine.
Subject(s)
Amino Acids/metabolism , Cystinuria/metabolism , Adult , Amino Acids/blood , Arginine/blood , Arginine/urine , Dietary Proteins/metabolism , Humans , Isoleucine/blood , Lysine/blood , Lysine/urine , Methionine/blood , Valine/bloodSubject(s)
Dipeptides/metabolism , Ileum/metabolism , Intestinal Absorption , Jejunum/metabolism , Alanine/metabolism , Aldehydes/urine , Animals , Biological Transport , Diffusion , Dipeptides/urine , Glycine/metabolism , Hydrolysis , Indoleacetic Acids/urine , Indoles/urine , Intestinal Mucosa/enzymology , Leucine/metabolism , Liver/enzymology , Male , Molecular Weight , Peptide Hydrolases/metabolism , Phenylalanine/metabolism , Rats , Stereoisomerism , Tryptophan/metabolismSubject(s)
Amino Acids/metabolism , Intestinal Absorption , Peptides/metabolism , Vitamin B 6 Deficiency/metabolism , Alanine/metabolism , Animals , Dipeptides/metabolism , Glycine/metabolism , Jejunum/metabolism , Leucine/metabolism , Male , Methanol , Penicillamine , Phenylalanine/metabolism , Pyridines , Rats , Tyrosine/metabolism , Vitamin B 6 Deficiency/chemically inducedABSTRACT
Separate tolerance tests involving oral intake of the dipeptide, L-arginyl-L-aspartate, and of a corresponding free amino acid mixture, were carried out in a single type 2 cystinuric patient. Absorption of aspartate was within normal limits, whilst that of arginine was normal after the peptide but considerably reduced after the amino acid mixture. The results are compared with the increments of serum arginine found in eight normal subjects after the oral intake of the free amino acid mixture. Analyses of urinary pyrrolidine and of tetramethylenediamine in urine samples obtained after the two tolerance tests in the patient support the view that arginine absorption was subnormal after the amino acid mixture but within normal limits after the dipeptide.
