Spicular arrangement of amyloid in renal biopsy.

A spicular arrangement of amyloid on the epithelial aspect of the glomerular basement membrane has been seen to a variable degree in silver-stained sections of renal biopsies in eight of 38 patients with amyloidosis. Electron microscopical examination revealed a spectrum of appearances of the amyloid fibrils which would account for this finding. Only two of these eight patients had amyloidosis secondary to chronic infection, a much lower proportion than in the group as a whole. The possibility of confusion with membranous nephropathy is discussed with relevance to possible modes of treatment.

Development of a lymphocytic lymphoma during immunosuppressive therapy with azathioprine for systemic lupus erythematosus with renal involvement induced by phenylbutazone.

A case of systemic lupus erythematosis (SLE) with renal involvement after the administration of phenylbutazone is described. The patient subsequently developed a lymphocytic lymphoma following two years treatment with azathioprine and prednisone. Although the association between SLE, immunosuppressive therapy and the development of lymphomas is well documented, the increased incidence of malignant disease in uremic patients is less well recognized. The varied factors that may have contributed to the development of the lymphoma in this case are discussed, together with a review of the literature.

Clinical use of minoxidil (Loniten).

The powerful peripheral vasodilator minoxidil, in a dose of 5-40 mg daily, controlled the previously refractory blood pressure in 45 out of 47 patients for periods up to fifty-seven months. The majority of the previous polypharmacy was withdrawn, leaving most of the patients taking a beta-blocking drug, minoxidil and a diuretic. Severe sodium retention leading to congestive cardiac failure necessitated the withdrawal of the drug in 3 patients. In one patient the drug was discontinued because of postural hypotension, and it was withdrawn in 2 female patients because of hirsutism. Five patients were removed from the trial as they were started on chronic maintenance haemodialysis or received a renal transplant. Significant glucose intolerance developed in one patient, requiring the addition of an oral hypoglycaemic agent. The 4 deaths that occurred were not directly related to treatment. Following the oral administration of 5 mg minoxidil, an obvious reduction in both the systolic and diastolic pressure was seen in two hours.

Acute haemodynamic effects of labetalol and its subsequent use of an oral hypotensive agent.

1 Fourteen patients whose lying diastolic blood pressure was persistently 110 mmHg or greater were given labetalol 0.5--1 mg/kg intravenously. 2 The maximum hypotensive effect developed between 20 and 40 min, and on average lasted 3 h. The lying systolic mean blood pressure fell by 30 mmHg and the lying diastolic blood pressure by 17 mmHg (P less than 0.001). 3 This acute hypotensive effect was associated with a significant reduction in the peripheral resistance (P less than 0.02). The hypotension was not associated with significant secondary changes in the stroke volume or pulse rate. 4 The above 14 patients plus 1 additional subject received labetalol orally at a daily dose ranging from 150-2400 mg. The mean lying systolic blood pressure fell by 22 mmHg (P less than0.01) and the mean lying diastolic blood pressure by 26 mmHg (P less than 0.001). The standing values were similar and postural hypotension at this dose did not develop. There was no significant change in the pulse rate. 5 Renal function was monitored by estimates of plasma creatinine and creatinine clearance. Some patients were followed for 2 yr and others for a few months. With the long-term patients, there was no significant reduction in either measurement although in a few patients a slight reduction in creatinine clearance was observed.

Gas exchange in renal failure. I. Dangers of hyperkalaemia during anaesthesia.

Failure to maintain compensatory hyperventilation during anaesthesia in patients with metabolic acidosis results in an increase in PaCO(2), fall in blood pH, and a possible rise in plasma potassium. This sequence of events may account for unexplained operative deaths in patients in renal failure.

Gas exchange in renal failure. II. Pulmonary gas exchange during peritoneal dialysis.

Blood gas analysis studies have been made in patients undergoing peritoneal dialysis. It has been shown that oxygen tensions are reduced when fluid has been run into the peritoneal cavity and that this fall in Pao(2) is reversed after running out the dialysate. The change in Pao(2) is greater with 2-litre than with 1-litre cycles.

Monotherapy with labetalol for hypertensive patients with normal and impaired renal function.

1 Labetalol was given to 41 hypertensive patients in a divided dosage of 150-2,400 mg daily for periods ranging from 1-64 months. 2 Monotherapy with labetalol was adequate in 12 out of 19 patients with essential hypertension and in 15 out of the 22 with renal hypertension. 3 Following a single dose of labetalol 200 mg orally a hypotensive response was seen between 1.5 and 2 hours. 4 In the doses used there was no exercise or postural hypotension. 5 No reduction in overall renal function attributable to labetalol was seen.

Monotherapy with labetalol for hypertensive patients with normal and impaired renal function.

1 Labetalol was given to 41 hypertensive patients in a divided dosage of 150--2,400 mg daily for periods ranging from 1--64 months. 2 Monotherapy with labetalol was adequate in 12 out of 19 patients with essential hypertension and in 15 out of the 22 with renal hypertension. 3 Following a single dose of labetalol 200 mg orally a hypotensive response was seen between 1.5 and 2 hours. 4 In the doses used there was no exercise or postural hypotension. 5 No reduction in overall renal function attributable to labetalol was seen.

Multiple renal silica calculi.

Investigation of a patient with a history of renal colic, who had taken the equivalent of 2 g magnesium trisilicate after every meal for many years, showed that he was forming silica calculi. The nature of the stone was diagnosed only after quantitative analysis.

Pharmacodynamics of propranolol in renal failure.

The pharmacodynamics of propranolol were studied in patients with renal functional impairment. (14)C-labelled propranolol was given either intravenously or by mouth and the disappearance rates of propranolol, 4-hydroxypropranolol, and total radioactive metabolites measured. The renal clearance of total radioactive compounds is directly related to renal function. The half-life of total radioactivity is greatly lengthened in the presence of severe renal failure while the half-lives of the pharmacologically active propranolol and 4-hydroxymetabolite are slightly reduced. There is a suggestion that the absorption of propranolol is delayed in renal failure. No known pharmacological action or side effects from the other metabolic products of propranolol have been recognized. There is still too little well-documented evidence concerning the beta-blocking activity of the unidentified major metabolites of propranolol to suggest any alteration in the dosage regimen used in renal failure.

Some haemodynamic effects of compound AH 5158 compared with propranolol, propranolol plus hydrallazine, and diazoxide: the use of AH 5158 in the treatment of hypertension.

1. Intravenous administration of compound AH 5158, which possesses alpha- and beta-adrenergic receptor-blocking properties, produces haemodynamic effects similar to those seen from the combined effects of propranolol and hydrallazine. 2. Chronic oral administration has demonstrated that compound AH 5158 is an effective hypotensive agent capable of controlling the blood pressure in patients previously requiring large doses of drugs such as methyldopa. Some postural and exercise hypotension may be seen with larger doses.

Rapid correction of red-cell nucleotide abnormalities following successful renal transplantation.

Erythrocyte levels of 5' mono-, di- and triphosphates of adenosine, inosine and guanosine, together with NAD+ (H) and NADP+ (H) were measured before and serially after renal transplantation. The high levels of ATP and guanosine triphosphate (GTP) fell to normal within 3 d of achieving a normal plasma creatinine. The decline in ATP and GTP levels paralleled the fall in plasma creatinine. Acute graft rejection was accompanied by a rise in ATP and GTP, both of which returned rapidly to normal with resolution of the rejection episode. Radiolabelling of red cells confirmed that the metabolism of the existing red-cell population was corrected so that observed changes in nucleotide concentrations were not due to a new cohort of cells.

Single sample estimates of renal clearances.

Thirty adult patients were investigated with 36 125I Hippuran and 40 51Cr EDTA single injection clearance studies. "Volumes of distribution" obtained from single samples have been correlated with the slope clearances and regression equations have been determined. From these equations it is possible to determine glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) from single plasma samples and the method is sufficiently accurate for routine application.