Progression of kidney disease in chronic renal transplant rejection.

The rate of progression of renal insufficiency was quantitated from reciprocal of serum creatinine versus time plots in patients with clinical and histologic evidence of chronic renal transplant rejection. The plots were evaluated by the breakpoint test. This method identifies breakpoints in a linear plot and compares the statistical significance of the fit provided by two intersecting lines with that of a single straight line. The breakpoint test when applied to the 22 patients with a significant linear correlation between the reciprocal of serum creatinine versus time detected a change in the slope in 20 cases (90.9%) indicating the presence of a breakpoint. The average diastolic, systolic, and mean arterial pressures before the breakpoint were significantly correlated with the value of the serum creatinine at the time of the change of the slope (r = 0.45, P less than 0.05; r = 0.58, P less than 0.01; r = 0.56, P less than 0.05, respectively) demonstrating more severe hypertension in those patients with the more severe renal dysfunction. The slope after the breakpoint was significantly correlated with the mean diastolic blood pressure values after the breakpoint (r = 0.48, P less than 0.05) with higher pressures being found in those patients with faster rates of decline in renal function. Both before and after the breakpoint occurred, the rate of progression of the renal disease, as estimated by the reciprocal of serum creatinine versus time plot, was greater when the mean diastolic blood pressure was higher than 90 mmHg. In conclusion, the vast majority of patients with proven chronic rejection progress linearly although a change in the rate of progression was frequent. Higher levels of blood pressure correlate with greater rates of progression of renal insufficiency, and a faster progression associates with a diastolic blood pressure greater than 90 mmHg.

Sensitivity, specificity and predictive accuracy of Q wave, QX/QT ratio, QTc interval and ST depression during exercise testing in men with coronary artery disease.

One hundred forty-three subjects (107 with coronary artery disease [CAD], 23 without CAD [evaluated by coronary angiography] and 13 athletes) were selected for this study. All subjects underwent exercise testing to evaluate sensitivity, specificity and predictive value of Q wave, QX/QT ratio, QTc interval and ST depression. The Q-wave analysis revealed less sensitivity (49%) and less specificity (83%) than ST depression (71% and 97%, respectively). The QTc criterion had greater sensitivity (80%) than ST depression but less specificity (11%). The QX/QT criterion was no different in sensitivity (74%) but had less specificity (69%). To establish the statistical evaluation of the positive predictive value in CAD, variations in the prevalence of the disease were considered. A 90% prevalence gives the best positive predictive value on all evaluated measurements, between 100% for ST depression and 89% for the QTc criterion. A 5% prevalence, however, gives an acceptable positive predictive value only on ST-segment depression (57%).

Reduction in urinary prostaglandin excretion in the premenstrual syndrome.

The purpose of the present work was to study some factors involved in renal handling of salt and water in the premenstrual syndrome (PMS), in which salt and water retention is frequently observed. In 18 women with PMS and in 18 healthy women we studied the levels of cyclic adenosine monophosphate, aldosterone, prostaglandin E2, prostaglandin F2 alpha and kallikrein in urinary samples collected during the luteal phase. There was no difference between the two groups regarding sodium, aldosterone and kallikrein urinary excretion. In the PMS group there was a significant reduction in urinary excretion of cyclic adenosine monophosphate, prostaglandin E2 and prostaglandin F2 alpha with respect to the control group. At multivariate analysis sodium urinary excretion proved not to be the same as the model validated in healthy women. There may be different renal handling of water and electrolytes during the luteal phase of the menstrual cycle in women with PMS.

Serum aluminium level in the veneto chronic haemodialysis population: cross-sectional study on 1,026 patients.

A total of 1,026 patients undergoing haemodialysis as the only chronic treatment were studied in all the dialysis units of the Veneto region, Italy. Aluminium was determined in water, dialysis fluids, and patients' serum. Aluminium mean concentration was 9.1 micrograms/l in tap water and 13.3 and 15.7 micrograms/l in bicarbonate and acetate haemodialysis fluids, respectively. Patients' serum aluminium mean level was 52.0 micrograms/l with the following frequency distribution: 59.2% below 60 micrograms/l, 25.5% between 60 and 100 micrograms, and 15.3% above 100 micrograms/l. The mean serum aluminium level was higher in patients undergoing haemodialysis with aluminium concentration in fluids over 10 micrograms/l. This was true also in patients not receiving aluminium hydroxide. Furthermore, we found higher average serum aluminium in those treated with aluminium hydroxide more than 3 g/day. No relationship was found between serum aluminium and sex, age, dialytic age, parathyroid hormone, and vitamin D treatment. Moreover, the patients with serum aluminium above 100 micrograms/l had higher serum alkaline phosphatase and lower mean cell volume values. Thus, in our haemodialysis population aluminium overloading occurred in spite of low concentration in water and fluid, and it was a result more of fluid pollution (over 10 micrograms/l) than aluminium hydroxide ingestion (over 3 g/day).

Clustering of albumin excretion rate abnormalities in Caucasian patients with NIDDM. The Italian NIDDM Nephropathy Study Group.

Proteinuria and nephropathy have been found to cluster in families of non-insulin-dependent diabetic (NIDDM) Pima Indian, and in Caucasian insulin-dependent diabetic (IDDM) patients. No information is at present available for Caucasian NIDDM patients. The aim of the present study was to determine whether micro-macroalbuminuria (AER+) is associated with albumin excretion rate abnormalities in diabetic and non-diabetic siblings of probands with NIDDM and AER+. We identified 169 Caucasian families with one NIDDM proband (the patient with longest known NIDDM duration) (101 families with only NIDDM siblings, 33 families with both NIDDM and non-NIDDM siblings and 35 families with only non-NIDDM siblings). Of the probands 56 had AER+ [Prob-NIDDM-(AER+)], 78 had AER-[Prob-NIDDM-(AER-)], 74 siblings of Prob-NIDDM-(AER+), and 113 siblings of Prob-NIDDM-(AER-) also had NIDDM. Data on albuminuria and retinopathy from multiple sibling pairs when the size of the sibship was more than two was adjusted according to a weighting factor. The odds ratio for AER+, in siblings of Prob-NIDDM-(AER+) adjusted for age, hypertension, glycated haemoglobin A1c and other confounding variables was 3.94 (95% confidence intervals: 1.93-9.01) as compared to siblings of Prob-NIDDM-(AER-). The 74 siblings of Prob-NIDDM-(AER+) had higher prevalence of proliferative retinopathy than siblings of Prob-NIDDM-(AER-) (14 vs 2%; p < 0.01). We also identified 66 non-diabetic siblings of 41 NIDDM probands with AER+ and 36 non-diabetic siblings of 27 NIDDM probands with AER-. Albumin excretion was two times higher, although still within the normal range, in the non-diabetic siblings of Prob-NIDDM-(AER+) than in siblings of Prob-NIDDM-(AER-) [median = 13.5 (range 0.5-148) vs 6.6 (range 1-17) micrograms/min (p < 0.05)]. In conclusion higher rates of albumin excretion aggregate in Caucasian families with NIDDM. Proliferative retinopathy is more frequently observed in families showing a clustering of AER+ and NIDDM. These findings suggest that familial factors play a role in the pathogenesis of renal and retinal complications in NIDDM.