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ABSTRACT: Uncoated adsorbent charcoal may regenerate the ultrafiltrate suggesting its use as an endogenous substitution fluid. The objective of this study was to assess the safety and the long-term clinical results.
Thirty-three chronic uraemic patients were dialysed for 1 year using two haemodialysers in series in order to separate convection from diffusion. At the outflow of the convective haemofilter, a cartridge containing 130 g of uncoated charcoal was inserted. The regenerated ultrafiltrate was then infused at the entrance of the diffusive dialyser. Ex vivo and in vitro studies were performed to analyse the adsorption characteristics and the release of aluminium, other trace elements, and microparticles.
Passage through the charcoal left urea, phosphate, potassium, calcium, and bicarbonate concentrations unchanged. Creatinine, uric acid and beta 2-microglobulin were almost completely absorbed by the charcoal. Aluminium release was dependent upon time of storage, as inferred from studies on inter-lot variability. Washing with bicarbonate buffer (pH 7.0) allowed reduction of aluminium levels to within the pharmacopoeia requirements for intravenous fluids. No significant pre- or post-charcoal differences were observed for several trace elements such as manganese, selenium, arsenic, cadmium, mercury, lead, chromium and zinc. Copper was completely retained in the charcoal. Regenerated ultrafiltrate infused at the entrance of the diffusive dialyser was free of microparticles, bacteria, and endotoxin. Clinical tolerance was excellent and blood pressure control satisfactory. A significant decrease in serum values of beta 2-microglobulin was observed at 6 and 12 months of treatment.
Reinfusion of ultrafiltrate through an uncoated charcoal cartridge proved to be a safe, well-tolerated and simple technique. Further potential benefits of regenerated ultrafiltrate may also include the maintenance of acid-base balance with reinfusion of endogenous bicarbonate.
Nephrology Dialysis Transplantation 04/1997; 12(3):528-34. · 3.40 Impact Factor
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Revista Clínica Española 02/1980; 156(2):129-31. · 2.01 Impact Factor
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Revista Clínica Española 07/1979; 153(5):367-9. · 2.01 Impact Factor
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ABSTRACT: The clinical course of 73 patients with nephrotic syndrome due to minimal histologic lesions was studied. A renal biopsy was performed in all of the cases; 23 biopsies were studied by immunofluorescence and two renal biopsies were carried out in eight cases. The follow-up period varied from 6 months to 10 years. The following treatment were used: 23 patients received prednisone alone, 48 were given prednisone plus chlorambucil, and 2 were treated only with chlorambucil. Sixty-five patients achieved a complete remission; a total of 39 recurrences occurred in 23 of them. The relapses took place 16 months on the average following complete remission. Twenty-three patients (32.4 percent) cured with only prednisone. Forty-eight required the association with chlorambucil, 8 percent of whom experienced recurrences before being completed cured. Two individuals were treated with chlorambucil alone and ach;eved a complete and stable remission. Eight patients (10.95 percent) could not be cured. Five of them showed a glomerular focal hyalinosis in the second renal biopsy. Six patients had hematuria at the onset: two of them achieved complete remission with recurrences; four did not. Three of the latter had glomerular focal hyalinosis. There were small foci of immunoglobulin deposits in 13 cases; 11 of them obtained complete remission with relapses and 2 achieved partial remission.
Medicina Clínica 06/1979; 72(10):401-4. · 1.38 Impact Factor
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