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The present report describes a case of potassium-wasting nephropathy with the physiological and endocrinological findings that are typical for Bartter's syndrome (BS). However, the renal juxtaglomerular apparatus shawed no hyperplasia at two renal biopsies two years apart. The short-term (9 days) effect of indomethacin in combination with spironolactone was a suppression of hyperreninemia and hyperaldosteronism and an increase in vascular sensitivity to angiotensin II associated with potassium and sodium retention. Subsequently, on indomethacin alone, potassium balance was obtained on a lower level with persistent hypokalemia and persistent renal potassium leakage. Hypokalemia persisted during long-term (9 months) treatment with indomethacin despite normalization of the activity of the renin-aldosterone system. The results indicate that indomethacin as long-term treatment may be ineffective in maintaining a normal potassium balance in BS.

A case is reported of hemolytic-uremic syndrome with irreversible renal failure in a young girl who had received a renal transplant 20 months previously. Splenectomy and high-dose steroid therapy were without effect on hemolysis and thrombocytopenia. Removal of the anuric kidney graft was followed by cessation of hemolysis and disappearance of thrombocytopenia. The microscopic lesions in the graft revealed microvascular disease, while histological signs of rejection were absent.

(1950). A Method for the Chemical Determination of Phospholipid-Choline in Plasma. Scandinavian Journal of Clinical and Laboratory Investigation: Vol. 2, No. 1, pp. 14-19.

(1950). The Concentration of Total Phospholipids, Lecithin, Sphingomyelin and Cephalin in Plasma. Scandinavian Journal of Clinical and Laboratory Investigation: Vol. 2, No. 1, pp. 44-47.

The present study was designed to determine the participation of a decreased insulin binding versus that of a post-binding defect in uraemic insulin resistance and to examine the possible effect of dialysis treatment. This was done by constructing an in vivo insulin dose-response curve using the euglycaemic clamp technique. We found that the maximal responsiveness to insulin was decreased in uraemic patients. Long-term dialysis treatment improved the maximum glucose metabolism significantly (7.7. +/- 0.7 mg/kg/min versus 10.7 +/- 0.6 mg/kg/min, p less than 0.01). On the contrary we found no clearcut alteration of the half-maximal insulin concentrations in relation to dialysis. In conclusion, this report indicates that the insulin resistance in uraemia is primarily due to post-binding defects, i.e. an impaired intracellular glucose metabolism or an abnormal glucose transport system.

Forty percent of patients with insulin-dependent diabetes will develop nephropathy during the course of their disease, thus being the most important single disorder leading to end-stage renal failure (ESRF). Intensive metabolic control delays onset of diabetic nephropathy, the first omen of which is appearance of subclinical albuminuria, also termed microalbuminuria. Moreover, it is now established that intensive treatment of hypertension reduces rate of decline in GFR and thus postpones ESRF. When uremia eventually sets in, a range of biochemical and endocrine abnormalities can be included among those characteristics of diabetes mellitus per se. These include elevated plasma levels of growth hormone, glucagon and free fatty acids, which may participate in the uremic insulin resistance superimposed on the preexisting diabetic carbohydrate intolerance. Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) are two established modalities of renal replacement therapy in diabetes mellitus. Controlled clinical trials for comparison of CAPD versus HD treatment of diabetics are, however, still needed. The survival rate is approximately 80 and 65-95% in insulin-dependent diabetic patients at 1 year during treatment with HD and CAPD, respectively. However, it is general experience that diabetics on CAPD exhibit a glycemic control, superior to that attained during HD. It has not been proved that patient survival after cadaveric renal transplantation is better than on dialysis. The degree of vascular heart disease seems to be the major determinant for survival of kidney-transplanted diabetic patients.

Summary. Total phospholipide, sphingomyelin, cephalin, and lecithin have been determined in rat brain homogenate and in the various cellular fractions obtained by differential centrifugation in isotonic sucrose. It was found that the concentration of all phospholipide fractions, expressed per mg total nitrogen, was considerably lower in the supernatant fluid than in any of the particle fractions. Sphingomyelin and cephalin were localized mainly in the mitochondria (large granules), whereas the concentration of lecithin was highest in the microsomes (small granules). The phospholipide composition of the nuclei could not be established satisfactorily, since this fraction was too impure. Comparison between brains from normal rats and rats in insulin coma revealed no differences in the phospholipide composition of the various cellular fractions.