Immunoreactive parathyroid hormone in early and advanced renal failure

Immunoreactive parathyroid hormone (iPTH) was measured in the serum of 20 patients with early renal failure (ERF) using three assays with different specificity. Half of these patients had elevated iPTH in one or more assays, up to twice the upper limit of normal. In contrast, 36 patients with a creatinine clearance below less than 20 ml/min had an 80% elevated iPTH, up to 5 times the upper limit of normal. The patients with ERF and elevated iPTH had a lower serum calcium but no higher serum phosphate than those with normal iPTH. The differences in iPTH in early and end-stage renal failure can be explained by known differences in metabolism of different PTH forms in uremia.     

Assessment of renal osteodystrophy in dialysis patients: use of bone alkaline phosphatase, bone mineral density and parathyroid ultrasound in comparison with bone histology

Bone biopsies were studied in 73 patients to determine if a two-site radioimmunometric assay for serum bone alkaline phosphatase (BAP), total serum alkaline phosphatase (ALP), serum intact parathyroid hormone (iPTH), hand X-rays, regional bone mineral density (BMD) measurements and parathyroid enlargement detected by ultrasonography could accurately predict renal osteodystrophy. In the patients studied 57 had hyperparathyroid bone disease, 4 mixed renal osteodystrophy, 3 adynamic bone disease, 1 osteomalacia and 8 normal histology. Serum BAP, ALP and iPTH correlated positively with mineral apposition rate, osteoblastic, osteoid and eroded surface. In the diagnosis of hyperparathyroid bone disease serum iPTH was the most sensitive investigation, detecting 81% of patients at a level > 100 pg/ml but with a specificity of only 66%. Serum BAP was more sensitive, 70% at a level of > 10 ng/ml, than serum total ALP, 30% at a level of 300 IU/l, with similar specificities, 92 and 100%, respectively. Ultrasound detection of an enlarged parathyroid gland had a sensitivity of 64% and a specificity of 100% for the diagnosis of hyperparathyroid bone disease. Hand X-rays had a poor sensitivity, 47%, but a high specificity, 92%, for the detection of hyperparathyroid bone disease. The majority of patients had regional BMD values within the normal reference range and this test was of poor discriminatory value. The non-invasive markers were unable to distinguish between patients with low turnover, mild hyperparathyroidism and patients with normal histology. In conclusion the measurement of serum iPTH is a useful screening tool for the detection of hyperparathyroid bone disease which can be confirmed by the finding of a raised serum BAP or parathyroid enlargement. For definitive diagnosis, however, the gold standard remains bone biopsy and at present one cannot recommend any non-invasive method as an adequate substitute.     

Cicatricial bone (author's transl)

Critical comments were presented in regard to the etiology, frequency, symptomatology and radiological findings in cicatricial bone.     

Lumboscopic renal biopsy (author's transl)

Renal biopsies with a new "lumboscopic" (half-open) technique were performed in 109 patients. Access to the kidney was gained by a small flank incision and biopsies from the renal cortex were taken under vision through the lumboscope. The biopsies were successful in all cases. The advantages of the new technique are convincing and lumboscopy suited to replace the regular open biopsy procedure.     

Suppressive effect of calcium on parathyroid hormone release in adynamic renal osteodystrophy and secondary hyperparathyroidism

Serum parathyroid hormone (PTH) levels are markedly lower in patients with the adynamic lesion (AD) of renal osteodystrophy than in those with secondary hyperparathyroidism (2 degrees HPT), but serum PTH values are often moderately elevated in AD when compared to subjects with normal renal and parathyroid gland function (NL). To study the inhibitory effect of calcium on PTH release in AD and in 2 degrees HPT, the response to two-hour intravenous calcium infusions was examined in 6 patients with AD, in 31 patients with 2 degrees HPT and in 20 NL. Basal serum PTH levels were 88 +/- 51, 536 +/- 395, and 26 +/- 6 pg/ml, respectively, in AD, 2 degrees HPT and NL, whereas basal ionized calcium levels did not differ. When expressed as a percentage of pre-infusion values, PTH levels at the end of two-hour calcium infusions were higher both in AD (23.2 +/- 5.6%) and in 2 degrees HPT (27.8 +/- 12.3%) than in NL, (11.9 +/- 5.8%, P < 0.001). Both the amplitude of suppression (%) and the rate of decline (min-1) in serum PTH were less in AD and 2 degrees HPT than in NL, P < 0.05 for each parameter; corresponding values for each group, with 95% confidence intervals, were 77% (73 to 82) and 0.039 min-1 (0.030 to 0.048) in AD, 72% (68 to 76) and 0.031 min-1 (0.025 to 0.036) in 2 degrees HPT and 87% (84 to 89) and 0.070 min-1 (0.058 to 0.089) in NL. Neither variable differed between AD and 2 degrees HPT. Basal and nadir serum PTH levels were highly correlated: r = 0.95 and P < 0.05 in AD; r = 0.90 and P < 0.01 in 2 degrees HPT; r = 0.75 and P < 0.01 in NL. The slope of this relationship was less, however, both in AD and in 2 degrees HPT than in NL, P < 0.05 by analysis of co-variance. Thus, serum PTH levels fell below 20% of pre-infusion values in fewer subjects with AD (1 of 6) or 2 degrees HPT (9 of 31) than in NL (17 of 20) (chi 2 = 17.81, P < 0.005). The results indicate that the inhibitory effect of calcium on PTH release in vivo does not differ in AD and 2 degrees HPT despite marked differences in basal serum PTH levels. Variations in functional parathyroid gland mass rather than disturbances in calcium-sensing by the parathyroids probably account not only for the lower basal serum PTH levels in patients with AD compared to those with 2 degrees HPT, but also for the moderately elevated serum PTH values commonly seen in patients with AD.     

Radiation therapy in renal adenocarcinoma (author's transl)

Sole irradiation treatment for renal carcinoma or its metastases has to be regarded as only a palliative therapy, whereas postoperative radiation therapy brings about a distinct diminution of the frequency of local recurrences, and, at least in advanced tumor stages, an improvement of the 5-year survival rate. Long-term preirradiation (ca 3000 rd TD within 3 weeks, and operation after another three weeks) or short-term pre-irradiation (ca 1200 to 2000 rd TD within 2 or 4 days, and operation the next day) are tolerated well and do involve no disturbances of the wound healing. Surgical treatment is not complicated by short-term irradiation, but often is easier following long-term irradiation; beyond this, the latter may just render possible a radical extirpation of the renal tumor. It appears from first results that decrease of distant spread and improvement of recovery rates in advanced tumor stages may be within reach, particularly in connection with post-operative irradiation.     

Intrauterine renal vein thrombosis (author's transl)

One case of renal venous thrombosis in a male foetus, born of a diabetic mother is reported. The intrauterine origin and the long age of the thrombosis were confirmed by pathologic studies. Some speculation about the etiopathogenic mechanisms of intrauterine renal venous thrombosis are made.     

Total parathyroidectomy and autologous parathyroid transplantation in secondary hyperparathyroidism (author's transl)

In a 17-year-old female patient with marked secondary hyperparathyroidism and progressive bone changes all four parathyroid glands were removed. Part of the endocrine tissue was reimplanted into the muscles of the forearm. The transplant took successfully and showed a satisfactory function. Total parathyroidectomy and autologous parathyroid transplantation has a number of advantages as compared with subtotal parathyroidectomy: The function of the transplant can be directly observed and tissue can be easily removed in the further course of the disease. It is thus possible to regulate parathormone secretion over long periods in patients with chronic renal failure.     

Plasma hydroxyproline in chronic renal failure (author's transl)

The plasma concentration of hydroxyproline fractions were determined in 50 adult patients with renal insufficiency and 19 patients receiving maintenance hemodialysis treatment. Free and peptide bound hydroxyproline fractions (total hydroxyproline) were elevated, the protein bound hydroxyproline (hypro-protein) was only slightly increased without significant correlation to the degree of renal insufficiency. The total hydroxyproline correlated only with the level of the alkaline phosphatase. The validity of the single fractions of hydroxyproline in plasma as parameter of the renal osteodystrophy is discussed.     

The bone scintigraphy in eosinophilic granuloma (author's transl)

The significance of bone scintigraphy using 99mTc-polyphosphate or 99mTc-diphosphate in the diagnosis of eosinophilic granuloma was discussed on the basis of our experience with four cases. The summary is following: 1. On diagnostic procedure of eosinophilic granuloma, it was found that abnormal RI accumulation in the bone scintigram was more marked than that in the ordinary brain scintigram. 2. The bone scintigram of eosinophilic granuloma showed more accurately the extent of skull involvement of cellular infiltration than the plain skull X-rays or brain scintigram. Accordingly, the bone scintigram was helpful for neurosurgeon in planning the operative procedure and determining the extent of removal of the involved skull. 3. The plain skull X-rays show the size of skull defect, and the brain scintigram reveals the size of the size of granuloma per se, as well as soft tissue involvements. We can conjecture the stage of the diseases by comparison between the findings of bone scintigram and those of above procedures: plain skull X-rays and brain scintigram. Viz, the bone scintigram showed more extensive areas of RI accumulation including the surrounding cellular infiltration in the acute stage, but the same size of the lesions shown by the ordinary brain scintigram and plain skull X-rays is chronic stage. Furthermore, we discussed the possibility of the differential diagnosis between eosinophilic granuloma and other neoplastic bone diseases, such as intracranial metastatic tumors and multiple myelomas etc., by further experience with the bone scintigram.     

Variation of morphometric measurements in bone biopsies (author's transl)

The variation of histomorphometric data in a bone biopsy cylinder of the iliac crest was determined in order to derive a rule of the sampling procedure in such a biopsy specimen. Measurements in different cylinders of a biopsy zone in the right and the left iliac crest were obtained in order to determine the magnitude of change necessary for the recognition of therapeutic or spontaneous alterations performing sequential biopsies.     

Diagnosis and treatment of renal traumas in childhood (author's transl)

The diagnosis of a kidney trauma is discussed and the great importance of angiography besides i. v. urography and retrograde pyelogram is pointed out. In surgical treatment exact urinary diversion and wound drainage are most important points to avoid later complications.     

Problems of infections following renal transplantation (author's transl)

Infections arising as a complication of immunosuppressive therapy were analyzed in more than 40 renal transplant patients. Bacterial infections were observed in 78.0%, viral in 68.3% and mycotic infections in 56.3% of cases seen during a 3-year investigation. Infection was the cause of death in 5 out of 8 cases with fatal complications. Bacterial infections of the lungs were amongst the gravest post-transplant complications. Hepatitis B, herpes simplex and cytomegalovirus were the most common viral infections. Simultaneous bacterial, viral and Candida albicans infections--so-called "triple infections"--with a very poor prognosis were diagnosed in 25% of the investigated cases. The data show that after cadaveric kidney transplantation special emphasis should be laid on careful prophylaxis of infections and diagnostic measures for the early recognition of possible infections arising as a complication of immunosuppressive therapy.     

Study on cephaloridine concentration in bone marrow (author's transl)

Cephaloridine (CER) concentration in the bone marrow of tibia was examined 1, 2, and 3 hours after intramuscular injection of 1 g. CER concentration in the bone marrow of tibia 1 hour after injection was 26.0+/-8.927 microng/ml. Ratio to serum was 78.5%. CER concentration in the bone marrow of tibia 2 hours after injection was 20.6+/-5.003 microng/ml. Ratio to serum was 87.3%. CER concentration of bone marrow of tibia 3 hours after injection was 14.8+/-4.79 microng/ml. Ratio to serum was 91.9%. Difference of concentration between in bone marrow and serum was not statistically significant. Penetration capacity of CER into the bone marrow of tibia was excellent.