Lipid and lipoprotein (a) concentrations in renal transplant patients.

Lipid and lipoprotein concentrations, including lipoprotein (a), were measured in 67 clinically stable renal allograft recipients and compared with age- and sex-matched controls. Median lipoprotein (a) concentrations were significantly elevated in the transplant group (P = 0.048), with the distribution of apoprotein (a) isoforms being similar between the two groups. The transplant group also demonstrated significant elevations in cholesterol (P less than 0.0001), triglycerides (P = 0.0007) and low-density lipoprotein cholesterol (P less than 0.0001). There was no significant difference in high-density lipoprotein cholesterol concentrations between the groups although there was the expected tendency for higher values in females. Lipoprotein abnormalities are common following renal transplantation and these patients also demonstrate elevated lipoprotein (a) values. This unique lipoprotein is known to be atherogenic and may contribute to the development of vascular disease, which is a common mode of death in these patients.

Bone disease after jejuno-ileal bypass for morbid obesity.

Fifteen patients who had undergone a 14 inches X 4 inches jejuno-ileal bypass operation for obesity, 3 to 4 years earlier, were investigated by iliac bone biopsy, radiology and routine biochemistry, including 25-hydroxy-vitamin D and parathyroid hormone estimations. Two patients had histological osteomalacia which was mild in one. A further 9 patients had abnormal bone biopsies, there being an excess of trabecular bone surface covered by osteoid with a normal or reduced amount of calcification front. Six of these 9 showed an increase in trabecular resorption, although in none were there excessive numbers of osteoclasts. The likely explanation for these findings is that these 9 patients had early osteomalacia with mild hyperparathyroidism, making a total of 11 patients out of 15 with osteomalacia. Radiology and blood chemistry were poor predictors of histological bone disease.

The effect of aluminium hydroxide orally on calcium, phosphorus and aluminium metabolism in normal subjects.

1. Five normal subjects were given 100 ml of aluminium hydroxide gel per day for 28 days. 2. The phosphorus balance became more positive in one subject, less negative in two and changed from negative to positive in the other two subjects. This was accompanied by a rise in the concentration of the fasting morning plasma phosphorus. Calcium balance did not change. 3. The normal subjects absorbed 0-3-3-6 mmol of aluminium/day, which is significantly less than that absorbed by five patients with chronic renal failure, three of whom were studied before, and two after, the observations on the normal subjects had been completed. 4. In a further five normal subjects on 100 ml of aluminium hydroxide gel/day the 08.00 hours concentration of plasma phosphorus did not fall, though there was a fall at 11.00, 14.00 and 17.00 hours.

Slow sodium: an oral slowly released sodium chloride preparation.

The use of a slowly released oral preparation of sodium chloride is described. It was given to patients and athletes to treat or prevent acute and chronic sodium chloride deficiency. Gastrointestinal side effects were not encountered after the ingestion of up to 500 mEq in one day or 200 mEq in 10 minutes.

Nitrogen balance in patients with chronic renal failure on diets containing varying quantities of protein.

Twenty-four nitrogen balances have been performed in 16 patients with chronic renal failure, with a protein intake of 0.23 to 1.0 g./kg./day. The results show that most patients with chronic renal failure require about 0.5 g./kg./day (35 g. for a 70-kg. man) to remain in nitrogen balance. The proportion of high-quality protein in the diets varied from 40 to 98% and the calorie intake from 23.6 to 59.0 calories/kg./day (1,330 to 3,310 calories/day). Within these ranges the proportion of high-quality protein and the calorie content did not have a detectable effect on the nitrogen balance.It is concluded that when other forms of treatment for renal failure are available, reduced protein diets should be used for only short periods, and that the protein intake should be 0.5 g./kg./day to maintain the patient in nitrogen balance.