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Key words: intraperitoneal insulin; osmotic agents; peritonitis [ABSTRACT FROM PUBLISHER]

The feasibility and reliability of a short dialysis technique performed with standard dialysis equipment and a modified cuprammonium rayon hollow-fibre filter has been studied. The hydraulic response of the filter and membrane to high blood flows and transmembrane pressures were tested in vitro and the maximal clearances of different solutes achievable during high-flux bicarbonate dialysis were studied in vivo. Clinical studies were undertaken to evaluate the longterm effects of the short, highly efficient dialysis therapy. Six patients were treated for more than a year with singlepass bicarbonate dialysis with a blood flow of 500 ml/min, dialysate flow of 700 ml/min, and average duration of 150 mm/session three times weekly. The treatment showed an adequate efficiency with an average KT/V greater than 1. All patients obtained an average blood urea nitrogen during the study of less than 80 mg/dl and an average protein catabolic rate of 0.9 g/kg per 24h. The treatment was well tolerated by all patients and, on echocardiography, no significant changes in myocardial function were detected after one year of therapy. The treatment is efficient, well tolerated, simple to monitor and does not require the use of synthetic membranes or machines with advanced technology. Thus the reduction of dialysis treatment time is feasible in all centres at a relatively low cost. [ABSTRACT FROM PUBLISHER]

Creatinine clearance has been evaluated under baseline conditions and after acute protein load in five normal and 29 pregnant women at different stages of pregnancy without evidence of renal disease. After a 3-h period in which creatinine clearance was measured hourly (resting GFR), a meal containing 80 g of proteins was administered and creatinine clearance was measured hourly for 4 h (test GFR). Resting GFR in normal sub jects averaged 104±22.5 ml/min per 1.73m, the wide variation being due to different dietary, protein intake (from 0.3 to 1.2 g of protein per kg body weight). In the pregnant women the resting GFR increased progressively from the first month (99.8±12.8m1/min per l.73m) to the last month of gestation (149.6±12.5 ml/min per 1.73 m) All subjects showed a significant increase of GFR after protein load although the greatest difference between the resting and the test GFR was detected in the first trimester. Inulin clearance was also measured in seven subjects after protein loading to compare creatinine and inulin clearance values. The two clearance values did not differ significantly, showing that creatinine can be safely used as a reliable marker for measuring GFR. Test GFR averaged 163.3±4.1 mI/min per 1.73 in normal subjects and l63.8±6.5 ml/min per l.73m in pregnant women without any relationship with the stage of pregnancy. The identity of test GFR both in normal subjects and in pregnant women suggests that this parameter is likely to be related to the functioning renal mass, and represents the filtration capacity of the kidney. The difference between the test GFR and the resting GFR represents the renal functional reserve. The progressive increase of the resting GFR during pregnancy suggests a progressive utilisation of the renal functional reserve under the stimuli of gestation. It is evident that only subjects with intact renal functional reserve may increase their GFR during pregnancy, under specific metabolic requirements. Acute protein load might be used, therefore, as a simple test to evaluate renal functional reserve and to predict the renal response during future pregnancies. Since the test may detect the existence of renal disease even in the early phases when the reduction of the functioning nephrons is not clinically evident, it might be utilised in some cases to prevent or predict possible pregnancies at risk. [ABSTRACT FROM PUBLISHER]

In 21 uraemic subjects not yet requiring dialysis, the serum values of citrate, fumarate, oxalacetate and malate were significantly increased, so that the sum of the concentrations of the TCA-cycle intermediates were increased threefold compared to that of 18 control subjects. The replenishment of TCA intermediates could, in theory, occur by several anaplerotic reactions, mainly those catalysed by pyruvate-carboxylase and malic enzyme. The overall pattern detected in uraemic patients is similar to that observed in rat skeletal muscle during exercise, in which increased acetyl CoA has been found. [ABSTRACT FROM PUBLISHER]