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Certain amino acids such as glycine, L-aspartic acid, L-glutamic acid, L-glutamine, L-histidine and L-arginine taken orally by normal adults or patients with renal failure increase glomerular filtration rate (GFR). Twelve nondiabetic patients suffering from glomerulonephritis confirmed by renal biopsy previously, with creatinine clearances ranging from 15 to 24 ml minute/1.73, and on low protein diet 0.6 g/kg/day, received an amino acid supplement daily in 2 or 3 doses for 1 year. At 4, 8 and 12 months creatinine clearance increased slightly (NS, NS, NS), 24 hour urine volume increased (P ≤ 0.001, 001, 0.001), 24 hour albuminuria decreased (P < 0.001, 0.001, 0.001), serum urea increased (NS, NS, NS) serum albumin increased (NS, 0.05, 0.05), total cholesterol decreased slightly (NS, NS, 0.01), HDL increased slightly (0.05, 0.05, 0.05), LDL decreased (NS, 0.001, 0.001) triglycerides decreased (0.001, 0.001, 0.001), Apo B remained unchanged (NS, NS, NS), ROS/H2O2 decreased (0.001, 0,001, 0.001), Hct increased (NS, 0.01, 0.01) Hb increased (0.05, 0.05, 0.05) and serum phosphate decreased (0.01, 0.01, 0.01). After removal of supplements at the end of the year all parameters remained unchanged. We believe that a large controlled study should be undertaken to confirm these most encouraging findings. © 2004 Kluwer Academic Publishers.

This article reviews current knowledge on the usefulness of glycylglycine in preparing single stable hemodialysis (HD) and peritoneal dialysis (PD) solutions containing bicarbonate. The coexistence of bicarbonate and glycylglycine in a dialysis solution renders it a potent, stable buffer in which the well known reactions between bicarbonate and calcium and magnesium, and the subsequent formation of insoluble neutral calcium and magnesium carbonate salts, are avoided. Single stable bicarbonate-glycylglycine (BiGG) solutions for HD and PD have been successfully prepared and studied, both experimentally and clinically. These studies have demonstrated the advantages of BiGG solutions in terms of simplicity, stability, convenience, tolerance, biocompatibility, protection of the peritoneum, and higher ultrafiltration, compared to standard acetate or lactate solutions, and on-line prepared bicarbonate solutions. Progressive accumulation of glycylglycine or glycine, even after prolonged use, side effects, or signs of toxicity were not observed. In conclusion, BiGG solutions ensure a physiologic dialysis both from the theoretic and practical points of view.

This paper describes the use of glycylglycine to prepare dialysis solution containing bicarbonate, calcium and magnesium. Bicarbonate with glycylglycine form a buffer with a constant pH of 7.35, which prevents reaction with calcium or magnesium and the formation of insoluble carbonate salts. This bicarbonate-based solution is stable over long periods and can be used with the same simplicity and convenience as lactate solution for peritoneal dialysis (PD) in humans.

In two earlier publications we reported excellent therapeutic results in patients with recurrent calcium nephrolithiasis, using oral or intravenous i.v. sodium thiosulfate on the one hand, and on treatment of tumorus-soft periarticular tissues calcifications on the other. Thus, we considered useful to measure endogenous thiosulfaturia, using a specific HPLC method, in 25 healthy adult males and 25 patients with recurrent calcium nephrolithiasis. Healthy adult males excreted between 11 and 16 μ M/24 hour of endogenous thiosulfate, while patients with recurrent calcium nephrolithiasis excreted significantly lower amounts of 6 and 10 μ M/24 hour, except one patient, who did not excrete endogenous thiosulfate, reflecting probably a genetic abnormality. Thiosulfate is a unique agent for treatment of recurrent calcium nephrolithiasis as well as some other abnormal calcium depositions. Two doses of 5 mM sodium thiosulfate daily are therapeutically sufficient. © 2004 Kluwer Academic Publishers.

Urinary calcium excretion increases by 1-2-fold during gestation in normal, uncomplicated pregnant women. Hypercalciuria occurs in all trimesters and elevates urine supersaturation with regards to calcium oxalate. However, crystalluria has not been a frequent clinical finding and stone formation is not a common complication of pregnancy. To elucidate this discrepancy we measured various chemical entities (i.e. calcium, oxalate, uric acid, phosphorous, magnesium, citrate, sulfate and thiosulfate) in urine at the end of each trimester of 25 pregnant women. Twenty-five healthy women served as controls. Our observations show that endogenous thiosulfate, a natural component of urine, increased considerably during pregnancy to approximately 36, 38 and 40 μ M/24 hour at the end of each three trimesters. One month after delivery, endogenous thiosulfaturia and hypercalciuria, in parallel, returned to initial normal values. Consequently, it seems that gestational hyperthiosulfaturia protects hypercalciuric normal pregnant women from the risk of nephrolithiasis. © 2004 Kluwer Academic Publishers.

According to Herodotus, the use of charcoal was introduced in ancient Egypt; however only in 1773 Carl Willhelm Scheele utilized it for adsorbing gases. Finally, Hippocrates Yatzidis in 1963 demonstrated its binding capacity for toxic substances of endogenous or exogenous origin and used it for hemoperfusion systems.

Summary Background and aim It has been shown that aspartate and glutamate inhibit mononuclear cell adhesion to the endothelium and formation of foam cells in the intima of thoracic aorta in cholesterol-fed rabbits. The purpose of the present study was to investigate whether a high cholesterol diet supplemented with aspartate and glutamate may alter lipoproteins cholesterol and apolipoproteins A-1 and B levels in rabbits. Methods and results Serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoprotein A-1 (apoA-1), apolipoprotein B (apoB), atherogenic index (AI) and apoA-1/apoB ratio were determined in 17 male New Zealand white rabbits fed a cholesterol plus corn oil diet (control group) or the same diet supplemented with aspartate and glutamate (Asp + Glu group) for 4 weeks. Both diets were found to increase TC, LDL-C, apoB and AI, while apoA-1/apoB ratio was decreased compared to baseline values. TG did not seem to be affected in the 4 weeks time in both groups. There was a significant increase of HDL-C in Asp + Glu group and a marked decrease of apoA-1 in control group during the study. Conclusions Oral administration of aspartate and glutamate has been shown to inhibit fatty streak initiation in cholesterol-fed rabbits. The two amino acids did not have any effect on serum TC, LDL-C, TG and apoB concentrations. However, they increased HDL-C and maintained apoA-1 levels. Their antiatherogenic effect probably may be explained by different mechanisms than these related to the atherogenic lipids lowering, and it is possible to involve HDL-C and apoA-1.

Objective The aim of the study was to investigate net ultrafiltration (NUF) with a new bicarbonate glycylglycine (BiGG) peritoneal dialysis solution compared to the standard lactate (La) solution. Design In six groups of 12 normal rabbits each we measured NUF after a 2-,4-, and 6–hour peritoneal dialysis with a BiGG solution (pH 7.35) and a standard La solution (pH 5.5) of similar glucose, electrolyte, and osmolality formulation. Furthermore, we studied the phosphatidylcholine concentration in the effluent of the two solutions. Results NUF volume was significantly greater with the BiGG rather than with the La solution by approximately 15% (pConclusion It is concluded that the BiGG solution, which has a stable pH, 7.35, due to the potent buffering capacity of bicarbonate and glycylglycine, enhances peritoneal NUF by maintaining a higher osmotic gradient and retarding lymphatic absorption through an increase in PC concentration in the peritoneal cavity.

A specified stable bicarbonate/glycylglycine dialysate for hemodialysis (HD) analogous to those introduced by us for continuous ambulatory peritoneal dialysis (CAPD) is described. HD with this single dialysate is simple, easy, safe and of reasonable cost. Results obtained from 6 HD patients proved its superiority against acetate dialysate. Bicarbonate/glycylglycine dialysate is also more stable, harmless and easier to use than bicarbonate dialysate prepared on-line.

Determination of serum creatinine by the Jaffé reaction may give erroneous results because of interfering noncreatinine chromogens. Studies of the Jaffé reaction in alkaline picrate media of various pH demonstrated that creatinine, proteins, and certain chromogens have characteristic properties as regards the appearance and intensity of the color reaction. Thus a method for determining "true" creatinine has been developed in which simple spectrophotometric measurements are made at 500 nm in two alkaline picrate reagents, buffered at pH 9.65 and 11.50. Results agree well with those obtained by the use of an ion-exchange method. The proposed method is easy and rapid and offers the advantages of increased specificity and direct analysis of serum and urine.

Five patients on maintenance hemo dialysis for more than five years, who had tumoral calcifications, were treated by sodium thiosulfate for three to IS months. Four patients with periarticular and soft-tissue calcifications achieved regression of varying degrees and the motion of the adjacent joints was considerably improved. The fifth patient had calcification of penis; sodium thiosulfate produced early relief of symptoms and later complete disappearance of the calcification.

In 32 patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and in 56 healthy subjects, ferroxidase I (ceruloplasmin) and ferroxidase II activity were estimated in serum; in 12 of the 32, it was also measured in peritoneal fluid. Serum ferroxidase I was normal, while ferroxidase II was significantly increased. Peritoneal fluid contains appreciable amounts of ferroxidase I, but no ferroxidase II. The serum ferroxidase profile of patients on CAPD differs from that of hemodialysis (HD) patients; in the latter, both ferroxidases are significantly increased. This difference could be accounted by the loss offerroxidase I in the peritoneal fluid.

To the Editor.— We had the opportunity to observe a case of extremely severe barbiturate poisoning characterized by the early appearance of multiple bullous lesions on the ocular conjunctiva and skin. We were not able to find a previous report of bullous lesions on the ocular conjunctiva. The patient was a 23-year-old man. Ten hours after taking 17.5 gm of phenobarbital he was in profound coma with shallow respiration and cyanosis, with a temperature of 37.8 C; pulse rate, 120 beats per minute; and blood pressure, 100/80 mm Hg. Corneal, tendon reflexes, and reaction of the pupils to light were absent. There was no response to painful stimuli and no bowel sounds were heard. The eyelids were swollen. There were bullae of considerable size on the ocular conjunctiva (Figure). Similar lesions developed on the skin of the heels four to eight hours later. Details of treatment, clinical course, and laboratory