[An increase in bile acids in the serum of patients with chronic kidney failure]. / Incremento degli acidi biliari nel siero dei pazienti affetti da insufficienza renale cronica.

Measurement of serum bile acids was performed in 86 uremic patients without any liver or bile tract diseases. Thirty-six patients (23 males and 13 females, aged 21-60 years) were on conservative dietary treatment, whereas 50 uremics (31 males and 19 females, aged 23-82 years) were on maintenance hemodialysis. The assays were made by means of enzymatic procedure and confirmed by RIA method too. Elevated serum concentrations of bile acids (> 6 mumol/L) were found in 24 out of the 86 uremics (27.9%), and the prevalence was similar in patients on conservative (10/36, 27.7%) and on dialysis treatment (14/50, 28%). Then, abnormally elevated concentrations of circulating bile acids are present in a quite high percentage of uremics both on hemodialysis and on conservative dietary therapy. The existence of a subclinical liver disease or an abnormal entero-hepatic cycle of bile acids might explain these findings.

Safety and efficacy anticoagulation in extracorporeal hemodialysis by simultaneous administration of low-dose prostacyclin and low molecular weight heparin.

BACKGROUND: The aim of this work is to describe an approach allowing extracorporeal hemodialysis (HD) with administration of low molecular weight heparin (LMWH) and to compare the dialyzer efficiency of this approach versus infractionated heparin (UFH) used alone. METHODS: Low molecular weight heparin (Nadroparin, molecular weight 4500 d) administered in a single injection (dose 3075 IU AXa) plus prostacyclin (Epoprostenol sodium salt, molecular weight 375 d) by continuous infusion (3 ng/kg/min) have been used as anticoagulants during hemodialysis in 8 patients. In comparison, standard continuous heparinization by unfractionated heparin was used. Hemodialysis efficiency (dialyzer clearance for urea, creatinine, uric acid and phosphate), coagulation (activated partial thromboplastin time, antithrombin III, fibrinogen platelet count, prothrombin time) and hemodynamic parameters (blood arterial pressure and heart rate) were also evaluated during dialysis. RESULTS AND CONCLUSIONS: Simultaneous infusion of low molecular weight heparin plus prostacyclin allowed safe and effective anticoagulation without affecting hemodialysis efficiency.

[Uremic encephalopathy and oligo-elements]. / Encefalopatia uremica e oligo-elementi.

The author reports the probable pathogenetic connexions between oligo-elements and uremic encephalopathy. Acquired data concerning this rare pathology of the CNS are reported as well as those of more doubtful scientific validity. The behavior of the neuro-psychic sphere and the symptomatology deriving from both deficit and excess of Al, As, Mg, Cr, Mn, Se, etc. are subject to special attention. The result of these changes is a complex of syndromes that are difficult to identify, also because uremia is beset by a large number of complications which more or less directly involve the central and peripheral nervous system.

Urinary excretion of oxalate in renal failure.

The daily urinary excretion of oxalate has been found to be lower than normal in patients with renal failure and the decrease to be directly proportional to the impairment of renal function. It has also been found that the gut flora from uremic patients destroys oxalate 'in vitro' more efficiently than the gut flora from normal people. It is postulated that an adaptation occurs in the gut flora of uremics to 'metabolize' oxalate, and this enteric elimination may account for its decreased urinary excretion.