Journal of the American Society of Nephrology : JASN
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J. Am. Soc. Nephrol. · Dec 1994
Comparative StudyOvert proteinuria and microalbuminuria in autosomal dominant polycystic kidney disease.
The amount of proteinuria is a prognostic indicator in a variety of glomerular disorders. To examine the importance of urinary protein excretion in autosomal dominant polycystic kidney disease, this study determined the clinical characteristics of autosomal dominant polycystic kidney disease patients with established proteinuria and the frequency of microalbuminuria in hypertensive autosomal dominant polycystic kidney disease patients without proteinuria. In 270 autosomal dominant polycystic kidney disease patients, mean 24-h urinary protein excretion was 259 +/- 22 mg/day. ⋯ Forty-nine patients with hypertension and left ventricular hypertrophy without established proteinuria were examined for microalbuminuria; 41% demonstrated microalbuminuria. Those with microalbuminuria had higher mean arterial pressure, larger renal volumes and increased filtration fraction. Therefore, established proteinuria and microalbuminuria in autosomal dominant polycystic kidney disease patients are associated with increased mean arterial pressure and more severe renal cystic involvement.
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J. Am. Soc. Nephrol. · Nov 1994
Case ReportsHepatic venous outflow obstruction in autosomal dominant polycystic kidney disease.
To discuss the clinical presentation, diagnosis, and treatment of hepatic venous outflow obstruction as a complication of polycystic liver disease, four cases diagnosed and treated at our institution have been reviewed and the information from six previously published case reports has been summarized. Eight of the 10 patients were women. All presented with severe ascites. ⋯ On the other hand, five of the six patients without thrombosis recovered after alcohol sclerosis of a large dominant cyst (one patient) or after hepatic resection and cyst fenestration (four patients). Hepatic venous outflow obstruction probably has been underrecognized as a cause of portal hypertension, ascites, and liver dysfunction in polycystic liver disease. The diagnosis can be reliably established with current imaging techniques, especially magnetic resonance imaging.(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Am. Soc. Nephrol. · Nov 1994
Review Case ReportsNephrogenic ascites: a poorly understood syndrome.
Nephrogenic ascites is a condition characterized by the presence of massive ascites in a patient with ESRD. Neither the exact cause nor the pathogenesis of ascites formation is clearly understood. Patients frequently present with hypertension, moderate to massive ascites, minimal extremity edema, cachexia, and a history of dialysis-associated hypotension. ⋯ Although treatment options are limited, continuous ambulatory peritoneal dialysis, peritoneovenous shunt placement, and renal transplantation appear to be effective in controlling ascites formation. Nephrogenic ascites is associated with a grave prognosis, especially if treatment is not instituted. One patient with nephrogenic ascites is described here.
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J. Am. Soc. Nephrol. · May 1994
Case ReportsStopping dialysis of an incompetent patient over the family's objection: is it ever ethical and legal?
Decisions to stop dialysis or other life-sustaining treatments for incompetent patients are among the most difficult ethical problems faced by physicians and families. This observation is verified by the large number of court cases and the increasing frequency of ethics consultations on these issues. In such instances, in the absence of an advance directive, the usual practice for physicians is to turn to the patient's family for direction on whether to start, continue, or withdraw the treatment. ⋯ It is asserted that, in such situations, after thorough conversation with the family, consultation, documentation, and an unsuccessful attempt to transfer the patient's care to another physician, nephrologists have an ethical obligation and legal right to override the family's decision and to stop dialysis. The ethical obligation is supported by the principles of respect for persons, beneficence, and nonmaleficence. The legal right is grounded in common law and state statutes.
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J. Am. Soc. Nephrol. · Apr 1994
Pair-tested renal reserve filtration capacity in kidney recipients and their donors.
Subjects after kidney donation manifest an adaptive rise in GFR. In uninephrectomized rats, progressive glomerulosclerosis, which is induced by the compensatory glomerular hyperfiltration, develops. It has been assumed that testing the existence of renal reserve filtration capacity (RRFC) might be used to demonstrate such glomerular hyperfiltration in humans. ⋯ Likewise, the RRFC tested with the amino acids of the recipients was similar to that of the donors before kidney donation. In contrast, in kidney recipients and donors, both short and long term after donation, RRFC tested with dopamine was approximately halved compared with that of the donors before donation. It was concluded, first, that testing RRFC cannot be used to test the existence of maladaptive glomerular hyperfiltration in subjects with a single kidney: Second, GFR increases for years after kidney donation, probably because of the compensatory hypertrophy of the remaining kidney.