SECOND RENAL BIOPSY IN PREVIOUS NEPHROTIC SYNDROME TREATED PATIENTS

肾病综合征的营养治疗--我们发现一种非常 低蛋白质饮食，辅以必需氨基酸，可能会导致长时间的 肾病综合征的长期缓解，即使它是由 糖尿病或局灶性节段性肾小球硬化( 肾病综合征很少自发缓解)，前提是治疗 是在肾功能严重恶化之前开始的。这一机制 这一令人惊讶的结果还有待于对其他 病人。 使用酮康唑延缓慢性肾功能衰竭-A进展 酮康唑(抑制皮质醇)的随机交叉研究 生产)加小剂量强的松(以防止脑下垂体前叶 逃逸)在进行性慢性肾功能衰竭患者中的各种 类型已完成。在糖尿病肾病、肾小球疾病和 间质性肾炎，肾小球滤过率下降率 显著减慢；在多囊肾病中，下降率 加速了。20%的人因副作用或毒性而停药 病人。 补充极低剂量维持性血液透析患者的存活率 透析前的蛋白质饮食--扩展了我们之前发表的发现 接受治疗的患者一般都是在血清正常的情况下进行透析 白蛋白水平，与全国经验相反，我们确定了 46例此类患者透析后存活。在头两年， 与全国相比，透析的存活率显著提高。 经验，根据年龄、性别和诊断进行修正。无论这是 因为这些患者在透析期间有较高的血清白蛋白水平 无法确定。 应用脱氢表雄酮延缓慢性肾功能衰竭进展 -基于我们未发表的发现，进步是负面的 与血清脱氢表雄酮-S浓度相关，我们推测脱氢表雄酮 补充剂可能会减缓病情进展。因此，一个随机的、双重的- 肾小球滤过率序贯的盲法交叉研究 所有类型的慢性肾功能衰竭患者服用安慰剂或 已有足够的脱氢表雄酮将血清脱氢表雄酮-S水平提高到约12微克/毫升 开始了。 肾脏产生一氧化氮作为进展的决定因素--我们有 以抽象的形式报道，级数与 24硝酸盐(硝酸盐的稳定最终产物)的排泄率 氧化物)。我们已经开发了一种方法来确定肾脏(与 系统)硝酸盐的生产，基于硝酸盐和氯化物的测量 口服负荷前后的清除量和肾小球滤过率 我们计划扩大这些测量，并确定是否 肾脏NO的来源可诱导一氧化氮合酶(AS) 与构成的一氧化氮合酶相反)，在给出后重复这些测量 一种几乎特异的诱导型一氧化氮合酶(氨基胍)的抑制剂。

Nutritional therapy of the nephrotic syndrome - We have found that a very low protein diet, supplemented by essential amino acids, may induce long- term remission of the nephrotic syndrome, even when it is caused by diabetes or by focal segmental glomerulosclerosis (disorders in which the nephrotic syndrome rarely remits spontaneously), provided that treatment is started before renal function has deteriorated severely. The mechanism of this surprising result remains to be determined by study of additional patients. Use of ketoconazole to slow progression of chronic renal failure - A randomized cross-over study of ketoconazole (to suppress cortisol production) plus low-dose prednisone (to prevent anterior pituitary escape) in patients with progressive chronic renal failure of various types has been completed. In diabetic nephropathy, glomerular disease, and interstitial nephritis, rate of decline of glomerular filtration rate slowed significantly; in polycystic kidney disease, rate of decline accelerated. Side effects or toxicity caused drug withdrawal in 20% of patients. Survival on dialysis of patients treated with a supplemented very low protein diet before dialysis - Extending our previously published finding that patients so treated generally enter dialysis with normal serum albumin levels, in contrast to the national experience, we determined the survival on dialysis of 46 such patients. During the first two years, survival on dialysis was markedly improved, compared with the national experience, correcting for age, sex, and diagnosis. Whether this was because these patients had higher serum albumin levels during dialysis could not be determined. Use of dehydroepiandrosterone to slow progression of chronic renal failure - Based on our unpublished finding that progression is negatively correlated with serum DHEA-S concentration, we hypothesized that DHEA supplementation may slow progression. Accordingly, a randomized, double- blind crossover study of sequential glomerular filtration rates in patients with all types of chronic renal failure given either a placebo or enough DHEA to raise serum DHEA-S level to about 12 ug/ml has been started. Renal production of nitric oxide as a determinant of progression - We have reported in abstract form that progression is positively correlated with the 24 excretion rate of nitrate (the stable end-product of nitric oxide). We have developed a method to determine renal (as opposed to systemic) production of nitrate, based on measuring nitrate and chloride clearances and glomerular filtration rate before and after an oral load of NaNO 3. We plan to extend these measurements and to determine whether the source of renal NO production is inducible to nitric oxide synthase (as opposed to constitutive NOS) by repeating these measurements after giving a nearly specific inhibitor of iNOS (aminoguanidine).