BASAL AND TRH-STIMULATED THYROID AND PITUITARY HORMONES IN VARIOUS DEGREES OF RENAL INSUFFICIENCY

ABSTRACT Abnormalities of thyroid and pituitary function are well recognized in patients with end-stage renal failure. We have investigated the influence of varying degrees of renal insufficiency on serum thyroid (total thyroxine, TT4; total 3,5,3′-triiodothyronine, TT3, and 3′,5′,3′-triiodothyronine, reverse T3) and pituitary (thyrotrophin, TSH; growth hormone, GH; prolactin, PRL) hormone levels before and after 200 μg thyrotrophin releasing hormone (TRH) iv administration. Patients with mild renal insufficiency (= group 1, plasma creatinine (Cr) > 1.3 mg% but < 3.0 mg%) had normal basal and TRH-stimulated hormone concentrations. In patients at a more advanced stage of the disease (= group 2; Cr > 3.0 mg % but < 7.0 mg %) basal hormone concentrations were also normal. In contrast to the normal group, where no GH reaction to TRH could be detected, GH serum concentrations increased in these patients after TRH. The TT3 and PRL response to TRH remained normal. The TSH reaction to TRH was blunted in four, normal in two and exaggerated in one patient. Patients with end-stage renal failure (= group 3; Cr > 7.0 mg%) had significantly decreased basal TT3 concentrations but a normal TT3 response to TRH. Basal TT4, TT3 and TSH concentrations were normal. The TSH reaction was blunted in four and normal in three patients. The mean basal GH was elevated, albeit not significantly different from the control mean value. The GH increase after TRH was even more pronounced than in group 2. Basal PRL concentrations were significantly increased, but maximal differences between basal and TRH-stimulated concentrations were not significantly different from control. Our data suggest that changes in the pituitary and hypothalamic control of GH are an early consequence of renal insufficiency. Alterations in thyroid function occur simultaneously on the pituitary – hypothalamic and peripheral level at a more advanced stage of the disease. PRL basal levels increase with decreasing renal function. In contrast to other studies we could not observe any significant influence of uraemia on the TRH-stimulated PRL reserve of the pituitary.

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END-STAGE RENAL FAILURE AFTER IRBESARTAN PRESCRIPTION IN A DIABETIC PATIENT WITH PREVIOUSLY STABLE CHRONIC RENAL INSUFFICIENCY

Renal Failure ◽

10.1081/jdi-100101967 ◽

2000 ◽

Vol 22 (6) ◽

pp. 815-821 ◽

Cited By ~ 11

Author(s):

Eric Descombes ◽

Gilbert Fellay

Keyword(s):

Renal Failure ◽

Renal Insufficiency ◽

Diabetic Patient ◽

Chronic Renal Insufficiency ◽

End Stage Renal Failure ◽

End Stage

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How Many Patients with Renal Insufficiency Survive Until End-Stage Renal Failure?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/6.8.600 ◽

1991 ◽

Vol 6 (8) ◽

pp. 600-600 ◽

Cited By ~ 6

Author(s):

D. Fliser ◽

C. Schweizer ◽

E. Ritz

Keyword(s):

Renal Failure ◽

Renal Insufficiency ◽

End Stage Renal Failure ◽

End Stage

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Vascular access for hemodialysis: creation, functioning, and complications (Data of the Hospital of Kaunas University of Medicine)

Medicina ◽

10.3390/medicina46080079 ◽

2010 ◽

Vol 46 (8) ◽

pp. 550 ◽

Cited By ~ 1

Author(s):

Sondra Kybartienė ◽

Inga Skarupskienė ◽

Edita Žiginskienė ◽

Vytautas Kuzminskis

Keyword(s):

Renal Failure ◽

Vascular Access ◽

Ischemic Brain ◽

End Stage Renal Failure ◽

Arteriovenous Fistulas ◽

The Mean ◽

Group 2 ◽

End Stage ◽

Complications Rate ◽

Mean Time

Background. There are no data about arteriovenous fistulas (AVF) formation, survival, and complications rate in patients with end-stage renal failure in Lithuania. Material and methods. We analyzed the data of patients (N=272) with end-stage renal failure, dialyzed at the Hospital of Kaunas University of Medicine from January 1, 2000, until March 30, 2010, and identified 368 cases of AVF creation. The patients were divided into two groups: group 1 included the patients with an AVF that functioned for <15 months (n=138) and group 2 included patients with an AVF that functioned for ≥15 months (n=171). Results and conclusions. Less than half (47%) of the patients started planned hemodialysis and 51% of the patients started hemodialysis urgently. The mean time of AVF functioning was 15.43±8.67 months. Age, gender, the kidney disease, and time of AVF maturation had no influence on AVF functioning time. AVFs of the patients who started planned hemodialysis functioned longer as compared to AVFs of the patients who started hemodialysis urgently (P<0.05). Hospitalization time of the patients who started hemodialysis urgently was longer as compared that of the patients who had a matured AVF (37.63±20.55 days vs. 16.54±9.43 days). The first vascular access had better survival than repeated access. AVF survival in patients with ischemic brain vascular disease was worse than in patients without this comorbidity.

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Cardiac Troponin T and I in End-Stage Renal Failure

Clinical Chemistry ◽

10.1093/clinchem/46.9.1345 ◽

2000 ◽

Vol 46 (9) ◽

pp. 1345-1350 ◽

Cited By ~ 102

Author(s):

Diana Wayand ◽

Hannsjörg Baum ◽

Gabriele Schätzle ◽

Julia Schärf ◽

Dieter Neumeier

Keyword(s):

Renal Failure ◽

Cardiac Troponin ◽

Troponin T ◽

Cardiac Complications ◽

Cardiac Troponin T ◽

End Stage Renal Failure ◽

History Of ◽

Group 2 ◽

End Stage ◽

Group 1

Abstract Background: In patients suffering from end-stage renal failure, cardiac troponin T (cTnT) and I (cTnI) may be increased in serum without other signs of acute myocardial damage. Whether these increases are specific to myocardial injury or nonspecific is not completely clear. Methods: We investigated time courses of cTnT and cTnI over 1 year and the clinical outcome over 2 years in 59 patients with end-stage renal failure undergoing chronic hemodialysis. At the start of the study, we divided the patients into two groups, group 1, without history of cardiac failure, and group 2, with history of cardiac failure, and looked for differences between the groups in later adverse outcome. cTnT was measured using the Enzymun® troponin T assay on an ES 700 analyzer (Roche). cTnI was measured on a Stratus® II analyzer (Dade Behring). Creatinine and blood urea nitrogen were measured on a Vitros® 950 IRC (Ortho). Results: Dialysis acutely increased cTnT (P <0.01) and decreased cTnI (P <0.001) regardless of the dialysis membrane used. Although statistically not significant, cTnT but not cTnI was increased more frequently in group 2 than in group 1, in some cases over the whole study period. Five patients (8.5%) died of cardiac complications within 2 years; all of them had mostly increased cTnT and, in one or more samples, increased cTnI. Conclusions: Dialysis alters measured cTnT and cTnI concentrations in serum. In patients suffering from end-stage renal failure, sporadic or persistently increased cTnT and cTnI appear to predict cardiac complications. Because of the effects of the dialysis procedure on troponin values, we recommend that blood be collected before dialysis.

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