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Minimal change nephrotic syndrome resulting from ehrlichiosis
1996
SPRING
COMPUTER
CLINICAL
NEPHROLOGY
SIMULATION OF BLOOD DIALYZER/HEMOFILTER
MEETINGS FLOW
THROUGH
A7 A
Alexander Goldfarb-Rumvantzev. M.D., Chaim Charytan, M.D., Bruce Spinovitz,
M.D.
A mathematical model which can simulate fluids/solute dynamics along the length of a hemodialyzer would be of clinical and research interest. The goal of this project was to employ a computer model which t?om an initial set of measurements would predict the value of a number of variables (Hydraulic Pressure, Blood Flow Rate, Ultra Filtration, Viscosity, Flow Resistance, Back Filtration, Hematocrit and
Protein concentration) at any point along the length of the dialyzer. The following AP = f(R,p,Qb);
are functions !J = f(T,
used in the program. H,
C,,;
C,,
H = f(.$,,P,P,,rU
where P, R, p, Qb, T, H, C,, L,, Pd, lI are hydraulic pressure, resistance, viscosity, blood flow rate, temperature, hematocrit, plasma protein concentration, hydraulic permeability, dialysate pressure, and oncotic pressure, respectively. These simple formulas produce accurate results when applied to very short dialyzer segments (S). Multiple computer generated iterations (Sl+S....Sn+S) produce very accurate values along the length of the dialyzer without resorting to multiple progressive differential equations. Increasing accuracy is attained by increasing the number of iterations, i.e., decreasing the initial segment length. The program can calculate the values for eight variables at any point along the dialyzer for up to thirteen different starting values. Alternatively, the program can predict the point at which a particular value will occur. This approach will allow better analysis and understanding of the dialysis/ filtration process, the selection of the most appropriate membrane for different clinical purposes, and/or changes of operating conditions to avoid undesirable effects.
UPREGULATION OF Na+,K+-ATPase (NKA) ACTIVITY IN THE NEWBORN GUINEA PIG PROXIMAL TUBULE, Edward N. Gu&ry, David J. Huss and Leslie C. Klein, Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, Premature infants may experience salt-wasting due to immaturity of tubular transport fimctions. We studied the activity of NKA in basolateral membranes (BLM) from proximal tubules of term fetal, 3-5 day old newborn and adult guinea pigs. There was a 4-5 fold greater Vmax in newborns than in fetuses (fetuses, 0.40+0.05; newborns 1.95+0.17, adults 3.41*0.53 mm01 PO,/mg protein/min., P
LONG-TERM FOLLOW-UP OF PATIENTS WITH NEPHRITIS.L.Grcevska and ISOLATED C3 M.Polenakovic, Department of Nephrology, Faculty of Medicine, Skopje, RMacedonia. 44 patients with isolated C3 nephritis, 31 male and 13 female, aged 15-57 years(31+-12) are presented. Serum levels of creatinine were normal at biopsy in all cases (64+-15 micromol/l), proteinuria was l,l+-0,lS g/l and nephrotic range of proteinuria was noted in 3/44(6,8%) patients. Erythruria or attacks of hematuria were present in all cases and hypertension in one. Degree of mesangial proliferation on optical microscopy was found as follows:+- in 14(3 I$%), + in 21(47,7%), ++ in 7(15,4%) and +++ in 2(4,6%) patients.Besides glomernlar deposition, C3 deposits were also noted in afferent arterioles of 10(22,7%) cases and in the walls of other intrarenal blood vessels in 12(27,3%). Followup period was 1 - 14 years(7+-3).There was not noted apppearance of chronic renal failure during follow-up and proteinuria was not changed signiiicantly (p=O,9904). Rebiopsies were not done. It can be concluded that isolated C3 deposition is benign disorder in our material, without development of chronic renal failure or nephrotic syndrome.It remains unclear what happened with more severe mesangial proliferation(++, +++) found in some of our patients.Rebiopsies will be necessary to explain this question.On the other hand, complete restitution and disappearance of proteinuria and &ythruriaihematuria were not noted in any of the patients.
MINIMAL
CHANGE
NEPHROTIC
SYNDROME
RESULTING FROM EHRLICHIOSIS. Leonard C. m, Fernando Scaglia, Anton Maki Jr, Larry B. Vogler. Emory Univ, Dept. of Pediatrics, Atlanta, and Phoebe Putney Memorial Hospital, Albany, Ga. Ehrlicbiae are rickettsial organisms that infect dogs and other animals, and since 1987 have been known to cause disease in humans. The infection, acquired from a tick vector, elicits an inflammatory response whose disease spectrum is broad. In dogs, minimal change nephrotic syndrome (MCNS) has been described, but MCNS has not been reported in human ehrlichiosis. We report a 16 year old male with ehrlichiosis and MCNS. The patient presented with an acute febrile illness, pericarditis, peritonitis, hepatitis,and nephrotic syndrome (BUN 32 mg/dl, creatinine 0.9 mg/dl, protein 3.8 g/dl, albumin 1.7 g/dl, cholesterol 307 mg/dl, urine proteidcreatinine ratio 19.6). Serologic studies were negative for HIV, CMV, EBV, Hepatitis A,B,and C, RMSF, Parvovirus B19, RPR, ANA, native DNA, anti-SSA/Ro, ANCA, RF and ASO. IgG titers to Ehrlicbia canis were elevated at I:2560 and then declined to 1:320 by 2 weeks. He received 20 days of doxycycline. Renal biopsy was compatible with MCNS with tision of foot processes and negative IF and dense deposits by EM. KS resolved with :‘;.liy coticosteroids, and the patient remains in ren&sion at 2 months post-steroid tapering. We suggest that ebrlichiosis may be an unrecognized cause of MCNS and that serologic studies be considered in the appropriate clinical setting.
SPRING
COMPUTER
CLINICAL
NEPHROLOGY
SIMULATION OF BLOOD DIALYZER/HEMOFILTER
MEETINGS FLOW
THROUGH
A7 A
Alexander Goldfarb-Rumvantzev. M.D., Chaim Charytan, M.D., Bruce Spinovitz,
M.D.
A mathematical model which can simulate fluids/solute dynamics along the length of a hemodialyzer would be of clinical and research interest. The goal of this project was to employ a computer model which t?om an initial set of measurements would predict the value of a number of variables (Hydraulic Pressure, Blood Flow Rate, Ultra Filtration, Viscosity, Flow Resistance, Back Filtration, Hematocrit and
Protein concentration) at any point along the length of the dialyzer. The following AP = f(R,p,Qb);
are functions !J = f(T,
used in the program. H,
C,,;
C,,
H = f(.$,,P,P,,rU
where P, R, p, Qb, T, H, C,, L,, Pd, lI are hydraulic pressure, resistance, viscosity, blood flow rate, temperature, hematocrit, plasma protein concentration, hydraulic permeability, dialysate pressure, and oncotic pressure, respectively. These simple formulas produce accurate results when applied to very short dialyzer segments (S). Multiple computer generated iterations (Sl+S....Sn+S) produce very accurate values along the length of the dialyzer without resorting to multiple progressive differential equations. Increasing accuracy is attained by increasing the number of iterations, i.e., decreasing the initial segment length. The program can calculate the values for eight variables at any point along the dialyzer for up to thirteen different starting values. Alternatively, the program can predict the point at which a particular value will occur. This approach will allow better analysis and understanding of the dialysis/ filtration process, the selection of the most appropriate membrane for different clinical purposes, and/or changes of operating conditions to avoid undesirable effects.
UPREGULATION OF Na+,K+-ATPase (NKA) ACTIVITY IN THE NEWBORN GUINEA PIG PROXIMAL TUBULE, Edward N. Gu&ry, David J. Huss and Leslie C. Klein, Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, Premature infants may experience salt-wasting due to immaturity of tubular transport fimctions. We studied the activity of NKA in basolateral membranes (BLM) from proximal tubules of term fetal, 3-5 day old newborn and adult guinea pigs. There was a 4-5 fold greater Vmax in newborns than in fetuses (fetuses, 0.40+0.05; newborns 1.95+0.17, adults 3.41*0.53 mm01 PO,/mg protein/min., P
LONG-TERM FOLLOW-UP OF PATIENTS WITH NEPHRITIS.L.Grcevska and ISOLATED C3 M.Polenakovic, Department of Nephrology, Faculty of Medicine, Skopje, RMacedonia. 44 patients with isolated C3 nephritis, 31 male and 13 female, aged 15-57 years(31+-12) are presented. Serum levels of creatinine were normal at biopsy in all cases (64+-15 micromol/l), proteinuria was l,l+-0,lS g/l and nephrotic range of proteinuria was noted in 3/44(6,8%) patients. Erythruria or attacks of hematuria were present in all cases and hypertension in one. Degree of mesangial proliferation on optical microscopy was found as follows:+- in 14(3 I$%), + in 21(47,7%), ++ in 7(15,4%) and +++ in 2(4,6%) patients.Besides glomernlar deposition, C3 deposits were also noted in afferent arterioles of 10(22,7%) cases and in the walls of other intrarenal blood vessels in 12(27,3%). Followup period was 1 - 14 years(7+-3).There was not noted apppearance of chronic renal failure during follow-up and proteinuria was not changed signiiicantly (p=O,9904). Rebiopsies were not done. It can be concluded that isolated C3 deposition is benign disorder in our material, without development of chronic renal failure or nephrotic syndrome.It remains unclear what happened with more severe mesangial proliferation(++, +++) found in some of our patients.Rebiopsies will be necessary to explain this question.On the other hand, complete restitution and disappearance of proteinuria and &ythruriaihematuria were not noted in any of the patients.
MINIMAL
CHANGE
NEPHROTIC
SYNDROME
RESULTING FROM EHRLICHIOSIS. Leonard C. m, Fernando Scaglia, Anton Maki Jr, Larry B. Vogler. Emory Univ, Dept. of Pediatrics, Atlanta, and Phoebe Putney Memorial Hospital, Albany, Ga. Ehrlicbiae are rickettsial organisms that infect dogs and other animals, and since 1987 have been known to cause disease in humans. The infection, acquired from a tick vector, elicits an inflammatory response whose disease spectrum is broad. In dogs, minimal change nephrotic syndrome (MCNS) has been described, but MCNS has not been reported in human ehrlichiosis. We report a 16 year old male with ehrlichiosis and MCNS. The patient presented with an acute febrile illness, pericarditis, peritonitis, hepatitis,and nephrotic syndrome (BUN 32 mg/dl, creatinine 0.9 mg/dl, protein 3.8 g/dl, albumin 1.7 g/dl, cholesterol 307 mg/dl, urine proteidcreatinine ratio 19.6). Serologic studies were negative for HIV, CMV, EBV, Hepatitis A,B,and C, RMSF, Parvovirus B19, RPR, ANA, native DNA, anti-SSA/Ro, ANCA, RF and ASO. IgG titers to Ehrlicbia canis were elevated at I:2560 and then declined to 1:320 by 2 weeks. He received 20 days of doxycycline. Renal biopsy was compatible with MCNS with tision of foot processes and negative IF and dense deposits by EM. KS resolved with :‘;.liy coticosteroids, and the patient remains in ren&sion at 2 months post-steroid tapering. We suggest that ebrlichiosis may be an unrecognized cause of MCNS and that serologic studies be considered in the appropriate clinical setting.