Journal of the American Society of Nephrology : JASN
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J. Am. Soc. Nephrol. · Mar 2000
Randomized Controlled Trial Comparative Study Clinical TrialEffect of intravenous fluids on blood pressure course during hemodialysis in hypotensive-prone patients.
Hypertonic and hyperoncotic solutions are generally used as acute treatment for symptomatic hypotension during dialysis. Administration of hydroxyethylstarch (HES) was recently shown to be an effective substitution fluid in preserving blood volume (BV) and systolic BP (SBP) in a group of stable dialysis patients during dialysis. In this study, in nine cardiac-compromised dialysis patients with frequent symptomatic hypotensive episodes, the efficacy of three fluids (hypertonic saline [3%], albumin [20%], and HES [10%]) was assessed during three treatment sessions with combined ultrafiltration and hemodialysis, which only differed in the type of fluid administered intravenously. ⋯ Between albumin and HES there were no significant differences. When the values at t = end were compared with those at t = iv, BV decreased, although not significantly, with saline and albumin, but remained unchanged with HES. It is concluded that HES is an effective fluid in maintaining SBP and preserving BV in hypotensive-prone dialysis patients, comparable to albumin but superior to hypertonic saline.
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J. Am. Soc. Nephrol. · Feb 2000
Ischemic acute renal failure induces differential expression of small heat shock proteins.
AlphaB-crystallin and heat shock protein (hsp) 25 are structurally and functionally related small stress proteins induced by a variety of insults, including heat and ischemia. Cytoprotection by these two hsp is thought to result from molecular chaperoning and/or cytoskeletal stabilization. Because renal ischemia is characterized by disruption of the renal tubular cell actin cytoskeleton, this study was conducted to determine the localization and quantify the expression and phosphorylation of both hsp in renal cortex, isolated glomeruli, outer medulla, and inner medulla of rats after bilateral renal ischemia. ⋯ In sham-operated kidneys, hsp25 localized to glomeruli, vessels, and collecting ducts, with alphaB-crystallin primarily in medullary thin limbs and collecting ducts. After ischemia, hsp25 accumulated in proximal tubules in cortex and outer medulla, while alphaB-crystallin labeling became nonhomogeneous in outer medulla, and increased in Bowman's capsule. It is concluded that: (1) There is striking differential expression of hsp25 and alphaB-crystallin in various renal compartments; and (2) Renal ischemia results in differential accumulation of hsp25 and alphaB-crystallin, with hsp25 part of a generalized stress response in renal proximal tubular cells, which may play a role in recovery from ischemia-induced actin filament disruption.
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J. Am. Soc. Nephrol. · Feb 2000
Comparative StudyRenal transplantation from non-heart beating donors: a promising alternative to enlarge the donor pool.
The aim of this study was to compare the survival and midterm function of kidneys from non-heart beating donors (NHBD) with those of kidneys from heart beating donors (HBD). From 1989 to 1998, 144 kidneys were procured from NHBD at the Hospital Clínico San Carlos in Madrid, of which 95 were transplanted. The kidney grafts were maintained from the moment of the diagnosis of cardiac arrest until the time of procurement by cardiopulmonary bypass. ⋯ Fifty-four of these kidneys were transplanted and all showed primary function. When a strict protocol is adhered to, the outcome of renal transplant from NHBD compares well with that from HBD. It is believed that the high number of organs obtained from subjects undergoing irreversible cardiac arrest on the street might encourage the adoption of new criteria for the management of this type of pathology with the ultimate goal of kidney donation.
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J. Am. Soc. Nephrol. · Feb 2000
Effects of tetrahydrobiopterin on endothelial dysfunction in rats with ischemic acute renal failure.
The role of nitric oxide (NO) in ischemic renal injury is still controversial. NO release was measured in rat kidneys subjected to ischemia and reperfusion to determine whether (6R)-5,6,7,8-tetrahydro-L-biopterin (BH4), a cofactor of NO synthase (NOS), reduces ischemic injury. Twenty-four hours after bilateral renal arterial clamp for 45 min, acetylcholine-induced vasorelaxation and NO release were reduced and renal excretory function was impaired in Wistar rats. ⋯ However, it was restored by BH4 (control 5.0 +/- 0.9, ischemia 2.2 +/- 0.4, ischemia + BH4 4.3 +/- 1.2 pmol/min per mg protein). Immunoblot after low-temperature sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed that the dimeric form of endothelial NOS decreased in the ischemic kidney and that it was restored by BH4. These results suggest that the decreased activity of endothelium-derived NO may worsen the ischemic tissue injury, in which depletion of BH4 may be involved.
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J. Am. Soc. Nephrol. · Jan 2000
Randomized Controlled Trial Comparative Study Clinical TrialLack of renoprotective effects of dopamine and furosemide during cardiac surgery.
Because development of acute renal failure is one of the most potent predictors of outcome in cardiac surgery patients, the prevention of renal dysfunction is of utmost importance in perioperative care. In a double-blind randomized controlled trial, the effectiveness of dopamine or furosemide in prevention of renal impairment after cardiac surgery was evaluated. A total of 126 patients with preoperatively normal renal function undergoing elective cardiac surgery received a continuous infusion of either "renal-dose" dopamine (2 microg/kg per min) (group D), furosemide (0.5 microg/kg per min) (group F), or isotonic sodium chloride as placebo (group P), starting at the beginning of surgery and continuing for 48 h or until discharge from the intensive care unit, whichever came first. ⋯ It was shown that continuous infusion of dopamine for renal protection was ineffective and was not superior to placebo in preventing postoperative dysfunction after cardiac surgery. In contrast, continuous infusion of furosemide was associated with the highest rate of renal impairment. Thus, renaldose dopamine is ineffective and furosemide is even detrimental in the protection of renal dysfunction after cardiac surgery.