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

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

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

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

OBJECTIVETo investigate the expression of aquaporin-1 (AQP1) in the human peritoneum and to evaluate the effect of peritoneal dialysis (PD) on its expression.

METHODSPeritoneal biopsies were obtained from normal subjects (n = 10), uremic nondialysis patients (n = 12) at catheter insertion and PD patients (n = 10) at the time of catheter removal, reinsertion or renal transplantation. Western blot, immuno-histochemical staining and reverse transcript-polymerase chain reaction (RT-PCR) techniques were used to investigate AQP1 expression.

RESULTSAll peritoneal samples expressed AQP1 at both mRNA and protein levels. Western blot revealed a major band at 28 kD as well as more diffuse bands between 35 and 50 kD. The 28 kD band represents the nonglycosylated form of the protein while the 35 - 50 kD bands correspond to glycosylated AQP1. Immunohistochemical staining found the positive deposits were distributed in the mesothelial cells, endothelial cells of capillaries, venules and small veins, whereas no signal was detected in the arterioles. Semi-quantitative analysis showed that AQP1 expression was remarkably stable in all samples, whatever their origin (P > 0.05).

CONCLUSIONSOur findings suggested that AQP1 is the molecular counterpart of an ultra small pore during PD. Secondly, the peritoneal mesothelial cell might also be involved in peritoneal transcellular water transport. As regards whether or not the structural or distributional alterations of AQP1 in the peritoneum may be more obviously expressed during PD, further study is needed.

Adult ; Aquaporin 1 ; Aquaporins ; analysis ; Blood Group Antigens ; Female ; Humans ; Male ; Middle Aged ; Peritoneal Dialysis ; Peritoneum ; chemistry ; physiology ; Uremia ; physiopathology

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

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

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 have performed experimental bilateral partial nephrectomy in 7 mongrel dogs. The technique of procedure was as follows. Renal capsule in lower renal pole was stripped and then 2-O chromic catgut suture was placed in circumferential manner around the lower pole of the kidney and guillotine amputation(Williams et al., 1967) was performed. Mattress suture, 4-5 stitches, was done on the renal parenchyme 0.2-0.3cm above edge of the guillotine ampution of the lower pole of the kidney. The gross finding of the kidney and possible complications have been observed for 3 weeks after bilateral partial nephrectomy. For microscopic observation, the tissues from the lower pole of the kidney (1x1cm) were fixed in 10% neutral formalin solution. Blood urea nitrogen level was examined on the 3rd, 7th, 14th and 21th days after bilateral partial nephrectomy. 1. The technique was relatively easy, bleeding during operation was scanty and postoperative hemorrhage was not found. 2. Major gross finding of kidney for 3 weeks after the operation was necrosis. 9 out of 14 kidneys were normal but necrosis had occurred in 5 cases. 2cases were locali2ed and minimal but S cases showed wide necrosis in the lower portion of the kidney. Urinary fistula and hemorrhage were not found. 3. Microscopic changes 3 weeks after the operation, showed necrosis, calcification. hemorrhage and fibrosis in the lower portion of the kidney. 4. BUN level was elevated maximally in 3rd or 7th day after the operation but it was decreased end had returned to nearly normal range it 3 weeks after the operation. One case showed finding of uremia by BUN elevation but this had recovered 3 weeks after operation.
Animals ; Blood Urea Nitrogen ; Catgut ; Dogs* ; Fibrosis ; Formaldehyde ; Hemorrhage ; Kidney ; Necrosis ; Nephrectomy* ; Postoperative Hemorrhage ; Reference Values ; Sutures ; Uremia ; Urinary Fistula