Complications of percutaneous renal biopsy: a review of 37 years' experience.

Over a period of 37 years we performed renal biopsies 1812 times in 1638 subjects. Tissue adequate for interpretation was obtained in 1593 subjects (88%). Complications occurred in 7% of the total biopsies performed, consisting of gross hematuria lasting for more than 12 hours (3%), pain lasting for more than 12 hours (4%), a palpable hematoma (1%), infection (0.2%), and death (0.2%). Complications were higher when the biopsy yielded unsatisfactory samples (9.5%), although there were no deaths. Complications were not related to age but an elevated BUN appeared to be associated with a higher rate of complications, although this was not statistically significant. Deaths appeared to occur at unpredictable intervals and in retrospect could not have been foreseen.

Adenosine nucleotide utilization in subtotally nephrectomized rabbits.

Two- to three-kilogram albino rabbits were subtotally nephrectomized and compared with sham-operated normal rabbits for the muscle content of adenosine mono (AMP)-, di (ADP)- and triphosphate (ATP) and inosine monophosphate (IMP) before and after exercise. Analysis of snap-frozen, lyophilized soleus muscle showed lower levels of AMP, ATP and total adenosine nucleotide (TAN) (p less than 0.01) and ATP/ADP (p less than 0.02) in the subtotally nephrectomized animals. IMP levels following exercise were higher in the experimental animals. Muscle adenosine nucleotide concentrations in the experimental animals were significantly different for normals, thus suggesting that minimal azotemia could adversely affect muscle function in these animals.

Oxygen uptake in exercising subjects with minimal renal disease.

Patients with varying degrees of renal failure were studied for their blood lactate response to exercise on either a treadmill or a bicycle ergometer. In the group exercised on a treadmill, blood lactate and alanine levels were measured, and in the group exercised on the bicycle ergometer blood lactate levels and oxygen uptake were measured. In both groups regardless of the method of exercise or the degree of azotemia, a rapid rise in blood lactate similar to that previously reported with exercise was observed. Blood alanine levels, which were low in subjects with renal disease, did not change with exercise even with a rise in blood lactate levels. There was no difference in the oxygen uptake between normal controls and subjects with renal disease. We conclude that blood alanine levels are low in renal disease, and that with the degree of exercise studied the rise in blood lactate in patients with renal disease is not accompanied by a change in oxygen uptake and does not evoke a rise in blood alanine levels. The mechanisms for the abnormal rise in blood lactate in these patients does not appear to be due to anoxia.

The effect of minimal exercise on the blood lactate in azotemic subjects.

Forty-one subjects, including 16 non-azotemic and 25 azotemic individuals, were studied during minimal exercise walking on a treadmill. Blood lactate levels rose dramatically in those with renal failure (maximum 2.05 +/- 1.22 mM/l above resting levels) but not in those who were not azotemic (0.25 +/- 0.22 mM/l above resting levels). Blood lactate/pyruvate ratios also increased in azotemic subjects (from 11.2 at rest to 21.0 after 10 minutes of minimal activity) as compared with non-azotemic controls (from 10.9 at rest to 9.8 after 10 minutes of minimal exercise). These findings suggest an abnormality in the muscle handling of lactate during exercise in individuals with renal failure. The abnormality may pose a problem in the rehabilitation of individuals with renal failure.

Staphylococcus aureus carriage rate of patients receiving long-term hemodialysis.

We studied the carriage rate of Staphylococcus aureus in patients receiving long-term hemodialysis and also noted the incidence of shunt infections, bacteremia, and septicemia in colonized patients. Thirty-one of 50 patients (62%) carried S aureus in the nose, throat, or on the skin, of whom 20 patients developed shunt infections; nine infections resulted in episodes of bacteremia. Patients with chronic renal failure not undergoing hemodialysis had a 21% carriage rate. Thus, there is a high carriage rate of S aureus in asymptomatic patients receiving hemodialysis that is probably related to an increased incidence of shunt infections and bacteremia.