Clin Nephrol
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One hundred and fourteen women presenting during pregnancy with an abnormally high blood pressure and/or proteinuria had a renal biopsy usually on the 8th day following delivery. The pathological specimens were examined by light and/or electron and/or immunofluorescence microscopy. Forty-one cases were studied with all three techniques. ⋯ The remaining 62 women (four groups) had isolated hypertension, and, of these, 42 had a renal pathological pattern similar to that of preeclampsia. These 42 patients also had persistent hyperuricemia. Thus in pregnancy, hypertension and persistently elevated uric acid levels are indicative of glomerular lesions of "pregnancy induced nephropathy".
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We present 3 patients with chronic renal failure who had postoperative paralysis due to the administration muscle relaxants. One of them received gallamine, a non-depolarizing blocking agent that is mainly excreted by the kidney (70--90%). Two of them received pancuronium bromide, also a non-depolarizing blocking agent which is partially excreted by the kidneys (37--44%). ⋯ These active metabolites are excreted by the kidney. These patients serve as examples of the importance of considering the route of excretion of drugs and their metabolites in clinical situations involving the renal failure patient. The pharmacology of drugs administered relative to surgical procedures is reviewed.
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Lactic acid is generated as the end product of anaerobic metabolism of glucose and is disposed by gluconeogenesis or oxidation. Changes in the lactate pyruvate ratio are not necessarily indicative of tissue hypoxia. The plasma lactate concentration is the result of lactate production and lactate removal (hepatic and renal gluconeogenesis; oxidation by muscle, liver and kidney). ⋯ Lactic acidosis has been described in association with phenformin therapy, hereditary enzymatic defects, hematological malignancy, prolonged fasting, shock with or without septicemia and occasionally without any underlying disease ("idiopathic" lactic acidosis). The therapy of lactic acidosis consists of administration of sodium bicarbonate and restoration of adequate tissue perfusion; hemodialysis may be helpful to control sodium excess and possibly to remove phenformin. The effectiveness of methylene blue, glucose and insulin are not yet established.
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Comparative Study
Intradialytic measurement of cardiac output by thermodilution and impedance cardiography.
Impedance cardiography was compared with thermodilution cardiography in the measurement of cardiac output serially during maintenance hemodialyses in ten chronic uremic patients. Measurements were carried out pre-dialysis and post-dialysis as well as hourly during dialysis. The results demonstrated statistical identity between impedance and thermodilution cardiography at all times of measurement. The study confirms the validity of the non-invasive technique in measuring cardiac output in the uremic patient.
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Five life threatening complications of percutaneous femoral vein catheterization for hemodialysis (Shaldon Technique) are presented. They occurred over a period of five years during which 700 uneventful catheterizations were carried out. ⋯ In two other instances perforation of the inferior vena cava occurred with profuse bleeding. These complications can be aboided by early removal of the catheters after dialysis and by cautiously manipulating the wireguide when resistance or obstruction is encountered during insertion.