Enalapril-associated acute renal failure in renal transplants: possible role of cyclosporine.

Acute deterioration of renal function occurred shortly after the angiotensin-converting enzyme (ACE) inhibitor, enalapril, was administered to two renal transplant patients who were also receiving cyclosporine. Renal function recovered completely in both cases upon discontinuation of enalapril. Neither patient had evidence of transplant artery stenosis or chronic rejection, conditions known to predispose to renal failure during ACE inhibitor therapy. The possibility that afferent vasoconstriction induced by cyclosporine may have predisposed these patients to renal failure from enalapril is discussed.

Long-term evaluation of the hepatitis B vaccine (Heptavax-B) in hemodialysis patients.

Hemodialysis patients were screened for hepatitis B surface antibody (anti-HBs) prior to immunization at two teaching hospitals. Thirty-one of 111 patients (28%) had baseline sera positive for anti-HBs, while anti-HBs was found in 30 of 420 (7.1%) health care employees (P less than 0.001). A total of 72 hemodialysis patients (mean age, 55.7), received the hepatitis B vaccine (Heptavax-B, Merck Sharp & Dohme, West Point, PA). The responder rates (34 of 72; 47%) and nonresponder (38 of 72; 53%) rates were similar to previous reports. Neither age (P greater than 0.05) nor injection site (P greater than 0.05) appeared to influence results. Nonresponders (16 of 17; 94%) who were given a fourth vaccine dose also failed to mount an antibody response. Of the 34 responders, 18 were followed by serial anti-HBs determinations. Seven transient responders (7 of 18; 39%) were identified, and anti-HBs fell below 10 S/N (sample/control counts per minute) within 12 to 15 months of the first vaccine dose. A fourth dose was administered to this group and it extended the presence of serum anti-HBs (S/N greater than or equal to 10) in four of six patients for another 2, 8, 10, and 15 months, respectively. Antibody persisted but declined over the study period in the remainder of responders followed serially (11 of 18; 61%). When compared with those responders who lost anti-HBs, those with persistent antibody had higher anti-HBs values at 7 (P less than 0.02) and 12 months (P less than 0.005) after the first injection, and were younger (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of a radiographic contrast agent on renal function in the rat. Comparison with equiosmolar mannitol.

The renal effects of the radiographic contrast agent meglumine iothalamate (Conray; C) were evaluated in rats. C produced a 42% fall in glomerular filtration rate (p less than 0.05) and a 44% fall in effective renal plasma flow (p less than 0.05). The effects of C were blunted by both acute and chronic volume expansion. Equiosmolar mannitol produced similar hemodynamic responses as C. The fractional excretions of sodium and potassium were similar in rats given C or mannitol. The renal effects of C appear to be due to its hypertonicity. These effects may be modified by volume expansion.

Adulterants in heroin/cocaine: implications concerning heroin-associated nephropathy.

Heroin-associated nephropathy (HAN) is a complication of the intravenous use of heroin or cocaine. It has been postulated that one of the substances used to adulterate these drugs may be responsible for the renal injury. We examined data provided by the Drug Enforcement Administration (DEA) concerning the laboratory analysis of 12 366 samples of heroin/cocaine. These street-grade drugs were analyzed for the presence of various adulterants or secondary substances. Eleven adulterants were identified with a frequency of occurrence that exceeded 5%. Quinine, mannitol, lactose and procaine were the non-narcotic compounds most commonly found. Other substances found included caffeine, inositol, lidocaine, starches, methapyrilene, sucrose, acetylprocaine and dextrose. No specific substance including heroin or cocaine has yet been definitely implicated as causative of HAN. These data suggest that further animal research is needed to determine the effects of repeated intravenous injections of each of these commonly found substances on the kidney.

Heroin-associated nephropathy. A nationwide problem.

Heroin-associated nephropathy (HAN) is a common cause of end-stage renal disease (ESRD) among 18- to 45-year-old patients in the Buffalo area. To assess the importance of HAN nationwide, a questionnaire was sent to 130 dialysis units or sections of nephrology throughout the United States. Fourteen metropolitan areas represented by 23 respondents reported 98 cases of HAN. Ninety-two patients (93.9%) were black. Black men made up the single largest group, with 77 patients (78.6%). The ESRD had already developed in 66 (67.3%) of the patients with HAN. The occurrence of HAN was high in those units that responded to the questionnaire. These figures, however, do not represent the prevalence of HAN in the United States. The economic impact of treating HAN may be striking. The estimated cost of maintaining just the 66 addicted patients with renal failure on dialysis would be greater than $ 1 million yearly.

Effect of end-stage renal disease on responsiveness to calmodulin and thyroid hormone of calcium-ATPase in human red blood cells.

Red blood cell membrane Ca2+-ATPase, a calcium-pump-associated enzyme, has been studied in a series of 10 patients with ESRD and in a group of normal volunteers. Basal enzyme activity was significantly reduced in cells from ESRD patients (0.189 +/- 0.018 vs. controls, 0.274 +/- 0.021 mumoles of Pi per milligram of membrane protein per 90 min; P less than 0.001). Calcium efflux from intact red cells, a functional correlate of Ca2+-ATPase activity, was also decreased in ESRD patients. Normal erythrocytes have recently been shown to have membrane Ca2+-ATPase activity that can be stimulated in vitro by physiologic concentrations of thyroid hormone (10(-10) M). In the present studies, ESRD red cell membrane Ca2+-ATPase activity was found to be unresponsive to thyroid hormone. In addition, calcium efflux from intact ESRD cells, in contrast to normal red cells, could not be stimulated by thyroid hormone. ESRD membrane Ca2+-ATPase was also poorly-responsive in vitro to purified calmodulin, the activator protein of the enzyme. This reduction in activity of Ca2+-ATPase in ESRD red cells is similar to previously described alterations in sodium-potassium-ATPase, another membrane-linked cation pump.

The impact of heroin abuse on a regional end-stage renal disease program.

The causes for end-stage renal disease (ESRD) in 148 consecutive patients 18-45 years of age were analyzed over a five-year period in the Buffalo-SMSA. Incidence, diagnostic category specific, prevalence, age patterns, and life expectancy are provided by sex, race, and heroin abuse status. A striking correlation between heroin abuse, glomerulonephritis, and ESRD among Blacks was discovered, demonstrating the impact of heroin abuse on both the cost and statistical interpretation of the causes for ESRD.

Heroin nephropathy. A clinicopathologic and epidemiologic study.

The existence of a nephropathy secondary to intravenous narcotic use remains a matter of debate. To determine whether heroin use and renal disease are associated, a clinicopathologic and epidemiologic study was undertaken in the Buffalo Standard Metropolitan Statistical Area (Buffalo-SMSA). Over the past 10 years, 23 addicts presented with the nephrotic syndrome and/or renal insufficiency. All patients were black men 18 to 45 years of age. Kidney biopsies performed on 21 patients uniformly showed sclerosing glomerulonephritis. End stage renal disease (ESRD) developd in 15 of these patients. In the epidemiologic evaluation which spanned four and a half years, heroin use was highly correlated with both sclerosing glomerulonephritis and ESRD. A history of intravenous heroin use was found in 26 per cent of the new cases of sclerosing glomerulonephritis and in 13 per cent of the new cases of ESRD in patients aged 18 to 45 years (p less than 0.000001). This investigation confirms the existence of heroin-associated sclerosing glomerulonephritis in black men. Heroin use appears to be a major risk factor for ESRD in the Buffalo-SMSA.