Outpatient evaluation of dietary intake and nitrogen removal in continuous ambulatory peritoneal dialysis.

Five patients on continuous ambulatory peritoneal dialysis were studied to evaluate dietary intake, glucose absorption from the dialysate, and urinary and dialysate nitrogen removal. The study was done on an outpatient basis, while the patients ingested their usual diets and went about their usual activities. The results indicate that patients greatly overestimated their caloric and protein intake, which was 0.71 to 0.96 g/kg bodyweight per day. Dialysate glucose contributed considerably to total caloric intake, because approximately 75% of of the dialysate glucose was absorbed independent from total glucose administered, providing 20% to 29% of the total caloric intake. We concluded that protein requirement in clinically stable continuous ambulatory peritoneal dialysis patients still needs defining because the patients may be anabolic with lower protein intakes than previously recommended.

Clinical and metabolic aspects of continuous ambulatory peritoneal dialysis (CAPD).

Experience with CAPD in 14 patients, treated for periods of 2-10 months, is presented. Clinical and biochemical control of uremia appeared adequate in all patients except one. Control of extracellular volume and hypertension was easier with CAPD than with intermittent peritoneal dialysis (IPD). Nine episodes of peritonitis occurred in 5 patients (one peritonitis/8 patients months). Mean protein loss was 9.7 +/- 2.7 g per day. In 6 patients on IPD oral glucose tolerance test resulted in a paradoxical rise of HGH, whereas this was not observed after 4 months of CAPD.

Filtration of protein in the anti-glomerular basement membrane nephritic rat: a micropuncture study.

Production on an anti-glomerular basement membrane (anti-GBM) nephritis in the rat results in a 30-fold increase in glomerular membrane permeability to albumin. The concentration of albumin in glomerular filtrate, estimated from proximal tubular fluid samples, is ten times the normal value. Tubular reabsorption of albumin is not enhanced so that essentially the filtered load is excreted. A nephrotic syndrome develops rapidly. Total kidney glomerular filtration rate (GFR) is reduced to 40% of normal with a proportional reduction in filtration fraction. Glomerulo-tubular balance is maintained since proximal fractional reabsorption remains constant near control levels. Calculated efferent arteriolar plasma colloid osmotic pressure (COP) is about one-third normal. Sodium excretion, sharply curtailed in the first days of anti-GBM nephritis, returns to control values after the fourth postinjection day. Restoration of sodium balance despite reduced filtered load and constant proximal fractional reabsorption must be accomplished by adjustments at a distal site in the nephron.

Investigations on Leydig cell function and regulation after renal transplantation.

The hypothalamic-hypophyseal-Leydig cell axis was investigated in 17 male patients following renal transplantation. Plasma levels of testosterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) were determined by radioimmunoassay under basal conditions and after stimulation with chorionic gonadotrophin (HCG) and hypothalamic releasing hormone (LH/FSH-RH) respectively. The investigations were carried out one to five years after renal transplantation. It was demonstrated, that primary dysfunction of Leydig cells may occur after renal transplantation. In some cases however normal Leydig cell function with adequate testosterone secretion may return. It remains uncertain, whether the Leydig cell dysfunction is a result of preexisting toxic uremic damage or whether it is due to immunosuppressive therapy with prednisone and azathioprine.