Endothelin-1 levels and renal function in newborns of various gestational ages.

BACKGROUND: Renal failure is common in the NICU; Acute Kidney Injury (AKI) occurs in 8-24% of admissions. Although AKI is preventable with early diagnosis, no reliable AKI biomarkers exist. Endothelin-1 (ET-1) has been implicated in renal pathogenesis, and elevated urinary ET-1 (uET-1) levels may correlate with progression of renal dysfunction. The study objectives were to determine whether uET-1 levels correlate with renal function parameters and/or fetal growth restriction, and if uET-1 is a potential neonatal AKI biomarker. METHODS: Sixty-three neonates were enrolled and divided into gestational age (GA) groups by weeks: 1) (24-30 6/7; n = 24); 2) (31-36 6/7; n = 26); and 3) (37-42; n = 13). Additional preterm subgroups for fetal growth restriction analysis included: 1) Appropriate for GA (AGA; n = 40), and 2) Small for GA (SGA; n = 10). ET-1 levels, measured using enzyme linked immunosorbent assay, were collected at birth (cord blood) and 24 h ( ± 4) of life (blood/urine). RESULTS: No correlation was found between uET-1 and blood plasma levels at birth (r = 0.15; p > 0.05) or 24 h (r = 0.17; p > 0.05). uET-1 negatively correlated with GA (r = -0.44; p < 0.001) and GFR (r = -0.34; p < 0.01). uET-1 levels did not correlate with creatinine (r = 0.13; p > 0.05), BUN (r = 0.19; p > 0.05), BUN/Cr ratio (r = 0.15; p > 0.05), or urinary output (r = 0.12; p > 0.05). In fetal growth restriction subgroup analyses: uET-1 levels negatively correlated with GFR in the PT-AGA subgroup (r = -0.38; p = 0.017), but not with PT-SGA (r = 0.01; p > 0.05). CONCLUSION: Plasma and uET-1 levels did not correlate; therefore, renal ET-1 excretion may reflect renal ET-1 production. uET-1 levels correlated negatively with GA and GFR. uET-1 may be a marker of impaired neonatal circulatory regulation and consequent renal injury.

Prenatal Oxycodone Exposure Alters CNS Endothelin Receptor Expression in Neonatal Rats.

Prenatal opioid exposure such as oxycodone is linked to significant adverse effects on the developing brain. Endothelin (ET) and its receptors are involved in normal development of the central nervous system. Opioid tolerance and withdrawal are mediated through ET receptors. It is possible that adverse effect of oxycodone on the developing brain is mediated through ET receptors. We evaluated brain ETA and ETB receptor expression during postnatal development in rats with prenatal oxycodone exposure. Timed pregnant Sprague-Dawley rats received either oxycodone or placebo throughout gestation. After birth, male rat pups were sacrificed on postnatal day (PND) 1, 7, 14 or 28. Brain ETA and ETB receptor expression was determined by Western blot analysis. Oxycodone pups compared to placebo demonstrated congenital malformations of the face, mouth, and vertebrae at the time of birth [4/69 (5.7%) vs. 0/60 (0%); respectively] and intrauterine growth retardation [10/69 (15%) vs. 2/60 (3.3%); respectively]. On PND 28, oxycodone pups compared to placebo had lower body and kidney weight. ETA receptor expression in the oxycodone group was significantly higher compared to placebo on PND 1 (p=0.035), but was similar on PND 7, 14, or 28. ETB receptor expression decreased in oxycodone compared to placebo on PND 1 and 7 (p=0.001); and increased on PND 28 (p=0.002), but was similar on PND 14. Oxycodone-exposed rat pups had lower birth weight and postnatal weight gain and greater congenital malformations. ETB receptor expression is altered in the brain of oxycodone-treated rat pups indicating a possible delay in CNS development.

[A case of malignant intestinal lymphoma following a successful kidney transplant]. / Sluchai na malignen chreven limfom sled uspeshna bubrechna transplantatsiia.

A rare case (the first one described in Bulgaria) of malignant intestinal lymphoma, developing in a 50-year-old patient 9 years after transplantation of a normally functioning corpse kidney, is reported. Basic predisposing factor for the lymphoma was the long-term maintenance immunosuppressive therapy with azathioprine and corticosteroids. Apart from this finding, a dissecting aneurysm of the abdominal aorta with partially obliterating thrombus was found. The patient died in a state of severe toxemia of suppurative peritonitis after perforation of the intestines heavily affected by the lymphoma.

["De novo" glomerulonephritis in the transplanted kidney]. / Glomerulonefrit "de novo" v transplantiran bubrek.

A case of an 11-year-old boy is presented who had developed a severe nephrotic syndrome with massive edema, ascites, hydrothorax (protein loss with the urine up to 19 gr/24 h) 7 months after a successful kidney transplantation from a 16 years dead donor and a successfully treated crisis of transplant rejection by a good tissue compatibility. The needle renal biopsy revealed membranous glomerulonephritis I-II histological stage with data of rejection crisis by a basic disease of vesicoureteral refluxes and chronic pyelonephritis. Treatment with heparin, dipyridamole, human albumin, diuretics, sandimun and prednisolone led to a substantial improvement--mastered nephrotic syndrome, lowered to 1 g/24 h proteinuria and normal renal function.

[Clinico-therapeutic and microbiological research on the preparation Monaspor in patients with active pyelonephritis]. / Kliniko-terapevtichni i mikrobiologichni prouchvaniia na preparata monaspor pri bolni s aktiven pielonefrit.

The urinary antiseptic efficacy of cefsulodin (Monaspor--Ciba) was studied in 22 patients with active pyelonephritis. The results were considered very good in 81.8% of the patients with urologic infections caused by P. aeruginosa, P. mirabilis and E. Coli. The drug was well tolerated. The microbiological studies in vitro of the urinary antiseptic efficacy of Monaspor on 575 bacterial strains isolated from patients with active pyelonephritis showed that the antibiotic was most active against Pseudomonas sp., beta-streptococcus, Staph. aureus, P. mirabilis.

[Our experience of treating urological infections with a single dose of gentamycin]. / Nashiiat opit pri lechenie na uroinfektsiite s ednokratna doza gentamitsin.

31 patients with a urological infection caused by a bacterial strain susceptible to gentamycin were treated by a single injection of 240 mg of gentamycin. 11 patients (35.5%) fully recovered, the infection was eliminated and the clinical symptoms and signs disappeared. Better results were achieved in patients with infection of the lower urinary tract without pyelonephritis, 7 out of 15 patients (46%) recovered. Out of 16 patients with pyelonephritis only 4 were cured (25%). Of 10 patients with nephrolithiasis only 1 was cured, in the remaining 9 patients the treatment was without effect. In the group of patients who recovered the patients with E. coli infection prevailed while in the group of unsuccessfully treated patients other bacteria prevailed. No side effects were found. The conclusion is that the treatment with a single gentamycin dose could be applied successfully in patients with an infection of the lower urinary tract without pyelonephritis, morphologic changes in the urinary system or nephrolithiasis.

[An acute recurrence of focal-segmental glomerulosclerosis in a kidney transplanted from mother to son with a rapid decline in kidney function]. / Ostur retsidiv na ognishtno-segmentna glomeruloskleroza v transplantiran bubrek ot maika na sin s burzo otpadane na bubrechnata funktsiia.

A case is presented of a 19-year-old man suffering from focal-segmental glomerulosclerosis with terminal chronic renal failure to whom a kidney taken from his mother was transplanted. There was high blood-group and tissue compatibility between mother and son. The initial result was good, the transplanted kidney functioned well-diuresis of 3300 ml with high proteinuria. Gradually the diuresis fell to 100-200 ml. From the 29th day following the transplantation pulse urbason therapy was applied for 3 days but without effect. This led to the resumption of hemodialysis and removal of the transplanted kidney. The microscopic examination of the kidney revealed massive focal-segmental glomerulosclerosis which had led to terminal chronic renal failure. The rapid severe relapse of the disease in the transplanted kidney is explained with the malignancy of the disease and the very high compatibility between donor and recipient. It is recommended that renal transplantation in patients with focal-segmental glomerulosclerosis should not be performed with a kidney taken from a parent.

[Arterial stenosis in kidney transplant patients]. / Arterialna stenoza pri bolni s transplantiran bubrek.

A short literary review is presented on the frequency and characteristics of the stenosis of the arterial anastomosis or of sections next to it in patients with transplanted kidney. The histories of three patients are reported. In two of the patients in the 6th and 7th month following the transplantation a severe arterial pressure appeared and a systolic murmur could be heard medially from the transplanted kidney. By renal vasography a marked stenosis of the anastomosis of the renal artery with the hypogastric artery was found. The stenosis was not corrected in time which led to its thrombosis and explantation of the kidney. In the third patient the renal vasography did not reveal stenosis of the anastomosis. In this case the symptoms were due to a chronic crisis of rejection of vasal type. The appearance of severe persistent arterial hypertension 6-7 months after a kidney transplantation is a signal for possible stenosis of the arterial anastomosis which requires timely examination and surgical correction if found.

[Plasma levels and the antihypertensive effect of the preparation celiprolol]. / Plazmeni niva i antikhipertenziven efekt na preparata tseliprolol.

The antihypertensive activity of the new cardioselective adrenergic blocker celiprolol in hypertonic disease, stage I-II, according to WHO as compared with the preparation acebutolol was assessed under the conditions of double blind study. Thirty patients with arterial hypertension were included in the study if after one week placebo period, met the criteria for inclusion. Blood samples from each patient, were collected for the determination of plasma concentrations of celiprolol before the beginning, by 2, 15 and 29 day of the treatment, 24 hour after the last intake and before the following intake. At the same time, each patient was subjected to complete physical and clinical-laboratory investigation. At a level of significance 99%, celiprolol and acebutolol reduced the systolic and diastolic arterial blood pressure to normal values by the end of the second and fourth week without any statistically significant difference between their antihypertensive activity. No significant difference was established between the values of blood pressure, recorded by the end of second and fourth week, in the patients treated with celiprolol and acebutolol. The analysis of the dependence of the reduced diastolic blood pressure on the value of plasma celiprolol concentration by the end of 14-day dose interval established a significant negative correlation (r = -0.737, p less than 0.1). The reduction of systolic blood pressure does not correlate with statistical significance, with the plasma levels of the preparation. The results from the study revealed that the preparations celiprolol and acebutolol have equivalent therapeutic effectiveness in the treatment of hypertonic disease, stage I-II according to WHO.(ABSTRACT TRUNCATED AT 250 WORDS)

[Systemic lupus erythematosus in elderly patients]. / Sistemen lupus erythematodes pri bolni v naprednala vuzrast.

Two patients are described with lupus erythematosus, aged over 60. A brief literature survey is presented of the characteristics of SLE in advanced age, analyzed, in the light of the communications by other authors, were the manifestations in the described patients--fever, accelerated ESR, onset with preceding articular syndrome, skin changes as well as the complications--fresh myocardial infarction with the signs of activation of lupus in one of the patients.

[Treatment with Pharmachim's Chlophazolin of hypertension and symptomatic hypertonia]. / Lechenie s Chlophazolin "Pharmachim" na khipertonichnata bolest i simptomatichnite khipertonii.

A total of 127 patients with arterial hypertension--64 with symptomatic and 63 with essential, were treated with chlophazolin "Pharmachim" at the Clinic of Therapy of Internal Diseases and Clinical Pharmacology for a period of one year. The drug was used alone in part of the patients and in the rest--in combination with other drugs. Satisfactory effect on the clinical symptoms and the level of blood pressure was attained in all patients treated and in only a small part of them diuretics and beta-blockers were necessary so as to attain better effect in coping with the arterial hypertension. In all patients the drug gave no toxic and allergic reactions, the most frequent adverse affects being the dryness of the mouth and sleepiness.

[Clinical studies of celiprolol in the treatment of arterial hypertension]. / Klinichni prouchvaniia na tseliprolol pri lechenie naarterialna khipertoniia.

The antihypertensive effect of the preparation celiprolol was studied in a double blind experiment versus acebutolol in 60 patients (30 males and 30 females), with an average age 40 years. Only patients with hypertonic diseases, stage I-II, according to WHO classification were included in the study. The treatment Lasted 4 weeks. The criteria for a good effect were the normalization of the blood pressure and the absence of adverse effects. There was no statistically significant difference between the percentages of the reduced blood pressure, attained by both preparations. By the end of 4th week, 56.7 per cent of the treated with celiprolol were with normalized blood pressure, and 46,7 per cent--with acebutolol. The following adverse effects were observed: light gastrointestinal manifestations, weakness, dizziness, tremor, impotence. In some of the patients those effects were transitory but in 4 patients, treated with acebutolol, the treatment was discontinued because of the adverse effects.

[Prognostic and differentiating value of cellular nonspecific immune monitoring following kidney allotransplantation]. / Prognostichna i diferentsirashta stoinost na kletuchniia nespetsifichen imunen monitoring pri bubrechna alotransplantatsiia.

On the background of a brief literature survey, the effect of renal allotransplants on immune state was studied in 22 recipients during posttransplantation period. Non-specific immune monitoring was used in follow up the cellular immune reactivity to 2 types of cells--atypical mononuclears (ATM) and spontaneous blast-transformed lymphocytes (SBT/Ly). It was established that the appearance and increase of ATM in peripheral blood could serve the prognosis of one crisis in rejecting the allotransplant, and SBT/Ly, is accepted as a sign for concomitant infection or originating in the course of immunosuppressive therapy. The differentiation of those two types of cells is of significance for the early diagnosis of the crises for rejection and aid the proper treatment of the patients with renal allotransplantation.

[Acute papillary necrosis in transplanted kidney]. / Ostra papilarna nekroza v transplantiran bubrek.

After a short literature survey, indicating the rarity of acute papillary necrosis in transplanted kidneys, the authors reported one of their patients, aged 32, with transplanted dead body kidney from a male, aged 30, with blood group compatibility and compatibility of two antigens in locus A. Two hemodialysis were necessiated because of acute tubular necrosis in the transplant. After the second one, performed 10 days after the transplantation, the patient felt very strong pains in the region of the transplant, edema around it and hypovolemic shock. The kidney was explanted and necrosis of the majority of the papillae in it--established, and around it--blood collection. After that incidence, the patients had three severe gastrointestinal hemorrhages with shocks, that necessitated profuse transfusion of blood. Their cause was a small erosion, about a lentil seed, at the pyloric opening, resulting from the cortico-therapy and periodic heparinization for dialysis. The patients was reanimated and returned to programmed chroniodialysis. The possible causes for papillary necrosis are discussed, most acceptable being two of them them--urostasis from 1200 ml urine in the urinary bladder, that required catheterization before the incidence and/or compression and ischemia of the transplanted kidney by the blood collection around it.

[Acute recurrence of focal-segmental glomerulosclerosis in the kidney transplanted from mother to son with rapidly progressing failure of renal function]. / Ostur retsidiv na ognishtno-segmentna glomeruloskleroza v transplantiran bubrek ot maika na sin s burzo rukhvane na bubrechnata funktsiia.

After a brief survey, stressing upon the high susceptibility of the focal-segmental glomerulosclerosis to recurrences in transplated kidney, the authors announced one of their own observations on a youth, aged 19, that was transplated a kidney from a living donor--his mother. The basic disease in the acceptor led to chroniodialysis after 20 months of the first clinical signs. In spite of the high diuresis, that was observed after the transplantation of the maternal kidney, proteinuria persisted as early as the first days after the transplantation, creatinine did not reach the normal values and after I month chroniodialysis was again included, followed by detransplantation. The cause of that malignant course of the disease and in the transplanted kidney, the authors admitted to be the high tissue compatibility between the donor-mother and acceptor--son, one antigen in locus A and two antigens in loci B and DR. They think that with a malignant course of the focal segmental glomurolosclerosis, living donor for kidney transplantation should not be used and on no account--in case of high tissue compatibility.