Abnormal function of renal tubules in patients with simple renal cysts

The present study aimed to assess the function of proximal and distal tubules in patients with simple renal cysts. Thirty-one patients with simple renal cysts and 10 healthy subjects were examined. Based on the cyst fluid/plasma sodium ratio, 25 cysts were found to be of proximal origin and 6 of undetermined origin. In all patients cyst fluid and plasma concentrations of beta-2-microglobulin (beta-2-MG), sodium, potassium, calcium, phosphorus and total protein were assessed. Urinary excretions of sodium, potassium, calcium, phosphorus, beta-2-MG and Tamm-Horsfall protein (THP) were also estimated. Fractional excretion of beta-2-MG was calculated. The concentrations of beta-2-MG in fluid obtained from cysts of proximal origin were significantly higher than in fluid from cysts of undetermined origin (2.26 +/- 0 36 vs. 0.65 +/- 0.13 mg/l, p = 0.0004). Concentrations of THP (6.85 +/- 1.21 vs. 3.14 +/- 1.06 micrograms/ml, p < 0.05), and potassium (4.39 +/- 0.07 vs. 3.13 +/- 0.44 mmol/l, p < 0.05) were also higher in fluid from proximal cysts than in fluid from cysts of undetermined origin. Plasma beta-2-MG concentration was significantly higher in patients with proximal and undetermined cysts than in the control group (4.35 +/- 0.34 and 4.11 +/- 0.74 vs. 1.89 +/- 0.1 mg/l, p < 0.001). Urinary beta-2-MG excretion was also significantly higher in both groups of patients than in healthy subjects (474.8 +/- 165.9 and 346 +/- 94 vs. 100.2 +/- 19.6 micrograms/24 h, p < 0.05). Urinary THP excretion was significantly higher in patients with proximal cysts than in healthy subjects (31.0 +/- 5.1 vs. 16.3 +/- 2.5 mg/24 h, p < 0.05). From the results obtained in this study it seems that patients with simple renal cysts of proximal origin are characterized by abnormal tubular handling of beta-2-MG, and calcium and THP excretion. Thus, in patients with proximal cysts presence of a latent renal tubulopathy seems to be likely.

[Concentrations of B2-microglobulin and Tamm-Horsfall protein in cyst fluid and urinary excretion of these proteins in patients with simple renal cysts]

The existing classifications of simple renal cysts are based on cyst fluid sodium concentration or cyst fluid/plasma sodium ratio. The present study aimed to assess: 1) the usefulness of cyst fluid concentrations of beta-2-microglobulin (beta-2-MG) as a marker of proximal tubules function and Tamm-Horsfall protein (THP) as a marker of distal tubules function to define the origin of renal cysts (proximal or distal); and 2) the function of proximal and distal tubules in patients with simple renal cysts. 31 patients with simple renal cysts and 10 healthy subjects were examined. Basing on the cyst fluid/plasma sodium ratio, 25 cysts were classified as of proximal origin and 6 as of undetermined origin. In all patients cyst fluid and plasma concentrations of beta-2-MG, erythropoietin, sodium, potassium and total protein were assessed. Urinary excretion of beta-2-MG and THP was also estimated and fractional excretion of beta-2-MG was calculated. The concentration of beta-2-MG in fluid obtained from cysts of proximal origin were significantly higher than in fluid from cysts of undetermined origin (2.26 +/- 0.36 vs. 0.65 +/- 0.13 mg/l, p = 0.0004). Concentrations of THP (6.85 +/- 1.21 vs. 3.14 +/- 1.06 micrograms/ml, p < 0.05), erythropoietin (500.6 +/- 176.8 vs. 42.0 +/- 17.7 mU/ml, p < 0.05) and potassium (4.39 +/- 0.07 vs. 3.13 +/- 0.44 mmol/l, p < 0.05) were also higher in fluid from proximal cysts than in fluid from cysts of undetermined origin.(ABSTRACT TRUNCATED AT 250 WORDS)

[Renal trauma]

An analysis is presented of 70 patients treated for renal trauma in the I Department of Urology in Katowice in the years 1974-1989. Renal damage was evaluated according to a three-grade scoring system. Conservative treatment was given to 43 patients (61.4%), including 14 patients with I degree trauma, 12 with II degrees, and 17 with III degrees trauma. Nephrectomy was performed in 17 cases, and 10 sparing operations were carried out--one combined with splenectomy.

[Complications after extracorporeal shock wave lithotripsy (ESWL) and methods of management of such cases]

The authors presented the complications which occurred in patients after extracorporeal shock wave lithotripsy (ESWL), and discussed the methods of management of such patients. It was found that the most common complications were: renal colic, fever, "calculus route", and, less frequently, subcapsular and perirenal haematomas. In most patients conservative treatment was adequate. Some of these patients required admission to hospital and proper specialized management.

Endopyelotomy for ureteropelvic junction stenosis

The authors review their experience with percutaneous endopyelotomy in the treatment of ureteropelvic junction (UPJ) stenosis. The method was used in 64 patients of whom 59 had also renal stones. There was only one patient with secondary UPJ stenosis following pyeloplasty. The total success rate was 61%. It is pointed out that the results depend in a great part on the skill of the surgeon.

Long-term results of treatment of male urethral strictures using direct vision internal urethrotomy

This study presents long-term results of treatment of urethral strictures in 178 men who underwent direct vision cold urethrotomy between January 1, 1979 and December 31, 1984. Satisfactory urodynamic results were achieved in 69.7% of cases.

Endocrine function of the pancreas and gastrin secretion in patients with a kidney transplant

In 24 patients with a kidney transplant and in 10 healthy subjects the test meal response of immunoreactive insulin (IRI), glucagon (IR-G), pancreatic polypeptide (IR-PP) and gastrin (IR-Ga) was studied. Patients with a kidney transplant showed significantly elevated basal plasma glucagon levels but normal levels of plasma IRI, IR-PP and IR-Ga. After administration of a test meal a significantly suppressed response of IRI, IR-PP and IR-Ga secretion was observed both in the patients treated with azathioprine as well as those treated with ciclosporin. In patients of the ciclosporin group the compromised response of IR-Ga and IRI secretion was significantly more marked than in subjects in the azathioprine group. From the results obtained in this paper it follows that the type of immunosuppressive drugs (azathioprine or ciclosporin) seems to be of minor importance in the pathogenesis of the described endocrine abnormalities.

Does the kind of immunosuppressive therapy influence plasma renin activity, aldosterone and vasopressin in patients with a kidney transplant?

In 24 patients with a functioning kidney transplant and in 33 healthy subjects plasma renin activity (PRA), plasma aldosterone and vasopressin (AVP) levels were assessed under basal conditions and after dietary sodium restriction. Twelve patients were treated with azathioprine and another 12 with cyclosporine A. From the results obtained it seems that immunosuppressive drugs used in transplanted patients ar involved in the pathogenesis of endocrine abnormalities and that the kind of immunosuppressive therapy is of minor importance in their development of maintenance. Transplanted kidneys show a preserved reaction pattern of renin secretion to sodium deprivation and upright position.

Influence of type of immunosuppressive therapy on secretion of somatotropin and function of the pituitary-adrenal and pituitary-gonadal axis in patients with a kidney transplant

In 24 patients with a functioning kidney transplant, hypoglycemia-induced somatotropin (STH), adreno-corticotropin and cortisol secretion was studied. In a further 24 transplanted patients, secretion of lutropin, follitropin and testosterone after the intravenous administration of luliberin was assessed. Data obtained in this paper suggest the presence of abnormal function of the pituitary-adrenal and pituitary-gonadal axis and abnormal STH secretion in patients with a functioning transplant. Type and duration of immunosuppressive therapy seem to influence the intensity of the above-mentioned endocrine abnormalities.

[3 experimental contributions to the regeneration of the ureter]

In this paper three experimental series were described in which on dogs the regeneration of the ureter from a longitudinal stripe of its wall was investigated on several conditions. The variations concerned permanently lacking or beginning at different moments after operation urinary flow, immobilisation of the margins of the stripe by sutures, splinting by means of ureteral catheter, suturing of the stripe with one side of the mucous membrane on the serosa of the large intestine, transverse cutting of the stripe with following uniting of the stumps, applications of prednisone and immuran for pre- and aftertreatment. The results were tested radiologically, autoptically and histologically. In their majority they were good and may partly be used clinically.