Reconsideration of split kidney function tests in hypertension: a new technique.

The role of the split kidney function tests in the diagnosis of renal hypertension is reviewed, and a new technique is described which is designed to diminish the number of false negative results sometimes encountered in unilateral pyelonephritis and segmental renal arterial stenosis. Split kidney function tests still have an important role in diagnosis of renal hypertension, particularly when the results of other investigations are equivocal and when facilities for differential renal renin assay are not available.

Washout urography in the diagnosis of renal hypertension.

Washout urography was used as a screening test for 100 hypertensive patients. Eleven patients had renal hypertension. These were 4 cases of unilateral renal artery stenosis, 6 cases of unilateral pyelonephritis and one case of bilateral pyelonephritis with atherosclerosis of the right renal artery. The increase in size of the affected kidneys after Lasix injection was much restricted relatvie to the normal contralateral kidneys. The test proved valuable for screening cases of renovascular hypertension and unilateral pyelonephritis.

Role of bilateral nephrectomy in the treatment of renal disease and hypertension.

The case summaries of 13 patients who were bilaterally nephrectomized for treatment of various renal diseases and hypertension are described. The present concept concerning the role of bilateral nephrectomy in the treatment of renal disease and hypertension is discussed.

Treatment of uremic pericarditis and pericardial effusion by augmented hemodialysis.

Six out of 21 patients attending maintenance hemodialysis had uremic pericarditis. Three patients had one or more recurrences of pericarditis while under regular intermittent dialysis. Two patients developed pericardial effusion and one of them had ascites. Augmented hemodialysis was successful in treating uremic pericarditis even in patients with pericardial effusion. The single instance of ascites was also controlled by augmented hemodialysis.

Kidney function and histopathological changes in unilateral hydronephrosis with special reference to bilharzial ureter.

Fifty-six patients with unilateral hydronephrosis were the subject of this study. The patients were classified into 4 groups according to the stage of hydronephrosis as assessed by radiological criteria. Split kidney function, histopathological studies, and measurement of intraureteral pressure were performed. Urinary Bilharziasis was held responsible for obstructive nephropathy in 77% of cases. Complicating urinary infection was present in 66%. The study has shown that creatinine excretion was slightly decreased in early, moderate, and moderately advanced hydronephrosis. On the other hand, a marked lowering of urine osmolality was found even in the early stages of hydronephrosis. The hydronephrotic kidney was found to be a salt losing one only in early, moderate, and moderately advanced hydronephroses, but not in the very advanced cases. The histopathological changes were mainly tubular, but some cases showed proliferative changes in the glomeruli. Eradication of urinary Bilharziasis and early treatment of this disease would markedly contribute to the prevention of obstructive nephropathies in countries where this disease is endemic.

Acute glomerulonephritis with bacteriuria: a probable etiologic relationship.

Twenty-one cases of acute glomerulonephritis in children with no previous history of renal disease were studied. Urinary infection with a rising titre of serum agglutinins against the organisms isolated from urine was found in 5 cases. No evidence of previous streptococcal infection was found in these cases. In the meantime all 8 cases with post-streptococcal glomerulonephritis remained without bacteriuria. In one case acute glomerulonephritis followed virus hepatitis, and in the remaining 7 cases the cause of glomerulonephritis was unknown. It is suggested that in predisposed patients the bacteria present in urinary infections might act as antigens starting immunologic reactions in the glomeruli, leading to glomerulonephritis. The final proof of this theory awaits immunofluorescence identification of these antigens in the glomeruli.

A clinical and pathological study of schistosomal nephritis.

In a Cairo clinic 17 of 41 patients with chronic pyelonephritis secondary to urinary schistosomiasis presented with classical features of the nephrotic syndrome, two-thirds being hypertensive and the majority having glomerular filtration rates within the normal range. Hypercholesterolaemia was found in one-third of the patients. Urinary sediments from these patients contained a preponderance of pus cells, red cells, granular casts, or pus casts. In addition to patches of pyelonephritis, the glomeruli showed diffuse and focal glomerulosclerosis. Electron microscopy revealed basement-membrane-like deposits in the hypertrophied axial endothelial cells and electron-dense deposits along the glomerular basement membrane. This variety of nephrotic syndrome associated with schistosomal pyelonephritis was the most common cause of nephrotic syndrome seen in the clinic.

Dialyzability of cefotaxime and mecillinam.

The dialyzability of cefotaxime and mecillinam was studied in 20 patients with end-stage renal failure maintained on regular hemodialysis in the Ain Shams Dialysis Unit. Cefotaxime was found to be a dialyzable antibiotic with a hemodialysis clearance rate of 60.3 +/- 10.4 ml/min. Mecillinam was found to be more dialyzable, with a clearance rate of 118.8 +/- 14.4 ml/min.