Severe hypophosphatemia in hospitalized patients.

Although severe hypophosphatemia has been associated with significant morbidity, little quantitative information is available on the magnitude of the risk. The objective of this study was to determine the frequency and timing of severe hypophosphatemia, the relative risk associated with various medical diagnoses, and the choice of therapy. Among 10,197 patients hospitalized over a 1-year period, the incidence of severe hypophosphatemia (serum phosphate less than or equal to 0.

Insulin in the acute renal adaptation to dietary phosphate restriction in the rat.

Dietary phosphate restriction produces a rapid increase in tubular reabsorption of phosphate. To evaluate whether insulin is important in the acute renal adaptation following a low phosphate meal, four groups of conscious rats were studied by renal clearance methods, following a single meal by gavage. Group A received a normal (0.

Tubulointerstitial nephritis due to vancomycin.

Vancomycin was used to treat a patient with Staphylococcus aureus endocarditis. After 3 weeks of therapy, the patient developed a diffuse maculopapular rash, which resolved upon stopping the drug. Rechallenge with vancomycin several days later resulted in reappearance of the rash and rapid onset of acute anuric renal failure.

Protein S and C antigen levels in proteinuric patients: dependence on type of glomerular pathology.

The cause of the thrombotic tendency in nephrotic patients is unknown. Recent reports of thrombotic complications in patients with deficiencies of protein C or protein S (natural inhibitors of coagulation) have raised the possibility that decreased levels of these proteins may play a role in the hypercoagulable state of nephrotic patients. We measured the levels of protein C, total protein S, and free protein S antigens in 42 patients (21 nephrotic and 21 non-nephrotic) with one of four types of glomerular pathology: diabetic nephropathy (DM), focal glomerular sclerosis (FGS), membranous glomerulonephritis (MGN), and chronic renal failure due to hypertension (CRF).

Indomethacin in the treatment of lithium-induced nephrogenic diabetes insipidus.

Nephrogenic diabetes insipidus (NDI) is a frequent complication in patients receiving long-term lithium therapy. Both thiazide diuretics and amiloride may reduce the polyuria, but the use of each is associated with problems. We report the results of a clinical trial using the nonsteroidal anti-inflammatory drug indomethacin to treat a patient with well-documented lithium-induced NDI that persisted following cessation of lithium treatment.

Nebulized albuterol for acute hyperkalemia in patients on hemodialysis.

Study Objective: To determine the efficacy and safety of nebulized albuterol in the acute treatment of hyperkalemia in patients on chronic hemodialysis.

Design: Prospective, double-blind, and placebo-controlled study.

Setting: Outpatient hemodialysis clinic at a university medical center.

Effects of physiologic hyperinsulinemia on renal phosphate handling in the rat: a role for calcium.

In a recent study in acutely parathyroidectomized, fasted rats, infused with parathyroid hormone (PTH), superimposition of euglycemic hyperinsulinemia within the physiologic range completely reversed the decline in tubular reabsorption of Pi (TRPi) induced by PTH. As an extension of these observations on insulin as a counterregulator of Pi homeostatis, the present results demonstrated that similar insulin administration prevented a decrease in TRPi when PTH infusion was superimposed. This was, moreover, observed in the fed state and at doses of insulin which did not stimulate renal cortical Na-K-ATPase activity.

Effects of nonsteroidal antiinflammatory drugs on renal function in sickle cell anemia.

Renal hemodynamics and solute and water handling were evaluated in 19 sickle cell patients and 8 matched normal subjects during water diuresis, before and after acute oral administration of a nonsteroidal antiinflammatory drug (NSAID). Baseline GFR and RPF were higher in the patients compared to the normals. In contrast to normals, indomethacin and sulindac induced a 16% and 14% decrease in GFR, respectively.

Minimal change glomerulonephropathy and interstitial infiltration with mycosis fungoides.

The nephrotic syndrome developed in a patient with mycosis fungoides shortly after systemic involvement by his tumor occurred. Renal biopsy examination revealed atypical lymphocytic interstitial infiltration and changes consistent with minimal change glomerulonephropathy. The patient's proteinuria decreased following steroid therapy.

Complications with permanent peritoneal dialysis catheters: experience with 154 percutaneously placed catheters.

A prospective study evaluated the complications in 154 patients in whom a permanent peritoneal dialysis catheter was inserted percutaneously from April 1982 to June 1986. Obstruction to flow and fluid leakage occurred in 9.2 and 2.

Prolonged hypotension after initial minoxidil dose.

Severe prolonged hypotension developed in a hypertensive patient several hours after the initial doses of minoxidil therapy. Hemodynamic measurements revealed a markedly low systemic vascular resistance and a markedly high cardiac output. Other causes of hypotension were ruled out.