Aged ; Aged, 80 and over ; Blood Platelets ; chemistry ; Humans ; Receptor, PAR-1 ; blood ; Receptors, Thrombin ; blood ; Renal Dialysis ; Uremia ; blood ; therapy

The activation of c-fos protein (FOS) in ventrol- ateral preoptic neuron (VLPO) induces sleep (Science 271; 216-219, 1996). Although sleep disturbance are very common in patients with chronic renal failure, its mechahanism of sleep disturbance is not clear. The purpose of this study was to evaluate sleep dissturbance and expression of FOS in VLPO of chronic uremic rats. Chronic uremic rats were induced by 5/6 nephrectomized rnodel. After 4 weeks, blood urea nitrogen and serum creatinine in uremic rats (n=14 were higher than in control (n=17) (blood urea nitrogen; 73.6+/-24.8 mg/dl vs. 23.3+/-2.9 mg/dl, P<0.001 serum creatinine', 1.49+/-0.42 mg/dl vs. 0.66+/-0.12 mg/dl, P<0.001). General activity was counted with infrared during day time (08:00-20:00) and night time (20:00-08:00). Rats were killed at 10:00 or 16:00 during day time (uremic rats 7, control 9) and at 22:00 during night time (uremic rats 7, control 7). The expression of FOS in VLPO was examined with immunohistochernical method. The number of day tirne general activity in uremic rats was significantly higher than in control (458+/-185 vs. 222+/-41, P<0.001), and the number of night time general activity in uremic rats was lower than in control (949+/- 430 vs. 1618+/-261, P<0.001). During day time, the number of FOS immunoreactive cell in uremic rats was lower than in control (18.4+/-5.3 vs. 42.8+/-6.3, P<0.001), but there was no difference between 2 groups at night time (10.8+/-8.4 vs 12.5+/-5.1, P=0.62). There was strong negative correlation between the number of activity and the number of FOS immunoreactive cell in control (r= -0.93, P<0.001), but there was no correlation in uremic rats. This study shows that sleep disturbance in chronic uremic rats might be related to decrease of expression of FOS in VLPO.
Animals ; Blood Urea Nitrogen ; Creatinine ; Humans ; Hypothalamus* ; Kidney Failure, Chronic ; Neurons ; Nitrogen ; Rats* ; Urea ; Uremia

Parenteral reserpine was given intramuscularly to 32 hospitalized hypertensive patients: 10 hypertensive patients without renal insufficiency, 3 hypertensive patients with heart failure, 10 hypertensive patients of malignant phase or with uremia, and 9 hypertensive patients with cerebrovascular accident. Follwoings were the result. 1. In the majority of patients, the effective dose of reserpine was 2 to 3 mg. 2. Reserpine given intramuscularly lowered blood pressure in 2 to 4 hours, had its maximum effect in 3 to 6 hours and had a duration of 3 to more than 24 hours (average 9 hours). 3. When effective dose of reserpine was given, blood pressure was lowered significantly (more than 30mmHg in mean blood pressure) in 18 patients (81.7%) of 22 hypertensive patients without renal insufficiency, and in 4 patients (40%) of 10 hypertensive patients with renal insufficiency. 4. Major side effect was drowsiness which was more evident in the patients with renal insufficiency. 5. Reserpine administered parenterally is an effective and safe agent for the treatment of hypertensive emergencies on a short term basis especially in the patient without renal insufficiency.
Blood Pressure ; Emergencies ; Heart Failure ; Humans ; Renal Insufficiency ; Reserpine* ; Sleep Stages ; Stroke ; Uremia

Two autopsy cases of polycystic disease of kidney were reported, both female,31 and 61 years of age: gravida 2,and 7 respectively. The incidence among autopsies was 0.3%.Both cases were accompanied with congenital polycysts in liver. The blood pressure of the cases was slightly or moderately elevated and hearts were moderately hpertropic. Renal function were not considerably impaired. Clinically the correct diagnosis were subarachnoidal hemorrhage(by rupture of aneurism) in 1st case and uremia after right nephrectomy in 2nd case. Etiology of the condition was discussed.
Autopsy* ; Blood Pressure ; Diagnosis ; Heart ; Incidence ; Kidney ; Liver ; Nephrectomy ; Rupture ; Uremia

To clarify the thrombopoietin (TPO) production in patients with end-stage liver cirrhosis and uremia under hemodialysis, plasma TPO levels in patients with liver cirrhosis (n = 15), uremia under hemodialysis (n = 20) and healthy controls (n = 40) were measured by using a sandwich enzyme linked immunosorbent assay. Relationship between megakaryocytopoiesis and plasma TPO levels was analysed by linear regression. The results showed that the mean plasma TPO concentration in the uremic patients was significantly lower than that in the healthy volunteers, whereas plasma TPO level in end-stage liver cirrhosis was not significantly different from that of normal controls; plasma TPO levels in liver cirrhosis and uremic patients did not significantly influence megakaryocytopoiesis. It is concluded that end-stage liver cirrhosis patients maintained normal plasma TPO levels, but the production of TPO was significantly reduced in renal failure patients. Thrombocytopenia in liver cirrhosis appears to be not related to plasma TPO levels.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Liver Cirrhosis ; blood ; Male ; Middle Aged ; Thrombopoiesis ; Thrombopoietin ; blood ; Uremia ; blood

BACKGROUND: Recent studies of thromboelastograph (TEG) findings have revealed that the hemostatic process is enhanced in uremic patients, suggesting an increased risk of thrombosis formation. The pathogenesis of hypercoagulability appears to be multifactorial in origin, and to involve associated lipid metabolism abnormalities. The purpose of this study was to investigate changes in TEG findings and lipid metabolism after renal transplantation. METHODS: 23 patients scheduled for renal transplantation were included. PT, PT-INR, and aPTT were used as laboratory blood coagulation tests, and concentrations of triglyceride and total cholesterol as indices of lipid metabolism abnormalities. TEG variables were measured before renal transplantation, and again at one and three weeks after transplantation, and then compared with pre-transplantation values. RESULTS: The pre-transplantation values of alpha-angle, maximal amplitude and A60 were above the normal ranges, showing hypercoagulability. They reduced significantly after successful transplantation suggesting that the hypercoagulable tendency is relieved upon correcting uremia (P < 0.05). The lipid metabolism study showed hypertriglyceridemia before transplantation. Triglyceride concentrations reduced significantly to normal levels after renal transplantation (P < 0.05), and were correlated with changes in alpha-angle, maximal amplitude, A60, TEG index, and LY30 (P < 0.01). CONCLUSIONS: Patients with chronic renal failure, associated with hypertriglyceridemia, as a form of lipid metabolism abnormality, showed hypercoagulability on TEG. With the correction of uremia after renal transplantation, the hypercoagulable findings are relieved and triglyceride levels reduce to normal. The normalization of lipid metabolism after renal transplantation might have a participatory role in relieving hypercoagulability.
Blood Coagulation Tests ; Cholesterol ; Humans ; Hyperlipidemias ; Hypertriglyceridemia ; Kidney Failure, Chronic* ; Kidney Transplantation* ; Lipid Metabolism ; Reference Values ; Thrombophilia ; Thrombosis ; Triglycerides ; Uremia

We describe a patient with severe hypernatremia and uremia caused by paranoid adipsia who was treated successfully with hydration and hemodialysis. A previously healthy 40-year-old woman developed the paranoid idea that her water was poisoned, so she refused to drink any water. On admission, her blood urea nitrogen was 208mg/dL, creatinine 4.90mg/dL, serum osmolality 452mOsm/L, serum sodium 172mEq/L, urine specific gravity > or =1.030, urine osmolality 698mOsm/L, and urine sodium/potassium/chloride 34/85.6/8mEq/L. We diagnosed her with uremic encephalopathy and started intravenous dextrose, but the sodium correction was incomplete. She underwent two sessions of hemodialysis to treat the uremic encephalopathy and hypernatremia, and recovered fully without neurological sequelae. Although the standard treatment for severe hypernatremia is hydration, hemodialysis can be an additional treatment in cases of combined uremic encephalopathy.
Blood Urea Nitrogen ; Creatinine ; Female ; Glucose ; Humans ; Hypernatremia ; Osmolar Concentration ; Renal Dialysis ; Sodium ; Specific Gravity ; Uremia ; Water

BACKGROUND: Hydroxychloroquine(HCQ) is known to inhibit proinflammatory cytokine production from stimulated mononuclear cells and to have anti-fibrotic effect. The aim of this study was to investigate if HCQ could ameliorate renal injury in chronic uremic rats. METHODS: Using Sprague-Dawley rats, chronic uremia was induced by 5/6 nephrectomy. The rats were divided into 4 groups : normal control rats(NC), uremic control rats(UC) and uremic rats treated with HCQ 10 mg/kg/day(HCQ10) and 20 mg/kg/day (HCQ20). Blood pressure, renal functions, proteinuria and histological changes were followed up for 12 weeks. The glomerular monocyte/macrophage infiltration was evaluated by immunohistochemistry and mRNA expression of MCP-1 and TGF-beta1 was analyzed by RT-PCR. RESULTS: Blood pressure was higher in UC than that in NC from 4 to 12 weeks, and it was lower in HCQ10(from 4 to 12 weeks) and HCQ20(at 4 week) than that in UC. BUN and serum creatinine levels were significantly higher in UC than those in NC from 4 to 12 weeks, and those were significantly decreased in HCQ10 and HCQ20 compared to UC. Creatinine clearance was significantly lower in UC than that in NC from 4 to 12 weeks, and it was increased in HCQ10 and HCQ20 compared to UC. 24 hour proteinurea was significantly increased in UC from 4 to 12 weeks compared to NC, and it was decreased in HCQ10 at 4 and 12 weeks compared to UC. Glomerulosclerosis score was minimal in NC, but was significantly increased in UC from 4 to 12 weeks. It was significantly decreased in HCQ10 and HCQ20 at 8 and 12 weeks compared to UC. Interstitial fibrosis score was also significantly increased in UC from 4 to 12 weeks compared to NC, and it was significantly decreased in HCQ10 and HCQ20 only at 4 weeks compared to UC. The number of glomerular infiltrated monocyte/macrophage in UC was higher than that in NC from 4 weeks, and was peak at 8 weeks. But it was comparable among NC, HCQ10 and HCQ20. MCP-1 mRNA expression were significantly increased in UC compared to NC at 4 and 8 weeks, and it was significantly decreased in HCQ10 at 8 weeks compared to UC. TGF-beta1 mRNA expression were significantly increased in UC compared to NC at 4 and 8 weeks, and it was significantly decreased in HCQ20 at 4 and 8 weeks compared to UC. CONCLUSIONS: Our results suggest that HCQ inhibits MCP-1 and TGF-beta1 mRNA expression in renal cortical tissue and attenuates progression of glomerulosclerosis and interstitial fibrosis in chronic uremic rats, which lead to amelioration of renal function and decrease in proteinuria in chronic uremic rats.
Animals ; Blood Pressure ; Creatinine ; Fibrosis ; Hydroxychloroquine* ; Immunohistochemistry ; Nephrectomy ; Proteinuria ; Rats* ; Rats, Sprague-Dawley ; RNA, Messenger ; Transforming Growth Factor beta1 ; Uremia

Adequate dialysis is essential for improving dialysis therapies and reducing all-cause mortality in end-stage renal disease (ESRD) patients. Efficient removal of the uremic toxins in the blood remains the fundamental role of dialysis therapies. Therefore, urea clearance as assessed by urea kinetic modeling (Kt/Vurea) is a surrogate marker for dialysis adequacy in ESRD patients undergoing dialysis, and the NKF-DOQI recommends a Kt/Vurea of no less than 1.2. The current status of dialysis adequacy in Korea has not been fully investigated. Our Clinical Research Center for End Stage Renal Disease revealed that the mean Kt/Vurea in maintenance hemodialysis patients was 1.49+/-0.28, and 91.5% of patients satisfied the target level of Kt/Vurea. In addition to Kt/Vurea, clinical parameters such as the volume status, residual renal function, blood pressure, acid-base disorders, anemia, nutrition, inflammation, mineral metabolism, and middle molecule clearance are important for determining adequate dialysis treatment. Further evaluation of clinical parameters is needed to improve dialysis adequacy.
Anemia ; Biomarkers ; Blood Pressure ; Dialysis ; Humans ; Inflammation ; Kidney Failure, Chronic ; Korea ; Renal Dialysis ; Renal Insufficiency ; Urea ; Uremia

Hemorrhagic complications in patients with end stage renal disease (ESRD) are common. These abnormal bleeding tendencies are caused by several factors including anticoagulation during hemodialysis, anemia, and uremic platelet dysfunction. The most common clinical manifestation of uremic bleeding is hemorrhage of the gastrointestinal tract from gastric ulcer disease. Mediastinal bleeding, however, is rare in ESRD patients. Here, we report a case of spontaneous mediastinal bleeding in a patient with hemodialysis. A huge periesophageal hematoma was observed on the chest CT scan and the bleeding time representing platelet function was prolonged. This case underlies the diversity of uremic bleeding.
Anemia ; Bleeding Time ; Blood Platelets ; Gastrointestinal Tract ; Hematoma ; Hemorrhage ; Humans ; Kidney Failure, Chronic ; Mediastinum ; Renal Dialysis ; Stomach Ulcer ; Thorax ; Uremia