Summary: Artificial subtraction of fluids and solutes was evaluated in the course of acute and chronic heart failure when it became refractory to standard intensive medical treatment. A group of 19 patients (mean age 57 years), 9 with ischemic, 2 arnyloidotic, 4 valvular, and 4 idiopathic cadiomyopathy, were treated. In 17 patients extracorporeal ultrafiltration (UF) by means of a polysulfonate ultrafilter was adopted along 125 sessions (105 assisted by a roller pump and 20 as a slow continuous ultrafiltrate). In two patients continuous peritoneal dialysis was adopted. In every case UF was well tolerated. Ultrafiltmte volumes ranged from 1680 to 3500 ml for every session with corresponding Na losses ranging from 194 to 434 mEq/session. Improved clinical and functional status with reduction of edema was observed in 17 of 19 patients. In 12 patients UF could be discontinued due to restored response to diuretics; 5 of these patients could subsequently undergo heart surgery (1 transplant, 3 valve nplacement, 1 coronary bypass). The remaining 7 patients survived od medical therapy alone for an average of 228 days. In 7 of 19 cases, UF could not be discontinued, and these patients died after an average of 23 days of treatment. In conclusion, UF proved to be effective in eliminating salt-fluid overload and restoring response to medical treatment. Patients who are potential surgical candidates !kern to be the most suitable for UF.
The urinary protein excretion rate, the glomerular localization of cationic proteins (CP) derived from platelets and polymorphonuclear neutrophils (PMN) and the loss of fixed anionic charges were studied in rabbits infused with synthetic 1-0-octadecyl-2-acetyl-sn-glyceryl-3-phosphorylcholine [platelet activating factor (PAF), 1.5 micrograms/kg in 2 ml of saline containing 0.25% bovine serum albumin (BSA)]. The urinary protein excretion rate, unaffected by diphenhydramine, an antihistaminic agent, reached its maximum at 180 min and decreased 24 hr after PAF infusion. The localization of CP derived from platelets and PMN was investigated by immunofluorescence using specific antisera. Platelet-derived CP were detectable in glomeruli at 15 min and, particularly, at 180 min after PAF infusion. Cells positive for CP derived from PMN accumulated within 15 min in the glomerular capillaries and, later (180 min), cytoplasmic depletion and localization in glomerular capillary walls occurred. CP deposits were associated with the loss of fixed anionic charges as detected by ruthenium red and colloidal iron staining. Rabbits infused with 1-0-octadecyl-sn-glyceryl-3-phosphorylcholine (lyso-PAF) or saline-BSA alone had none of the alterations described above. The development of proteinuria, the glomerular localization of platelet- and PMN-derived CP and the concomitant loss of fixed anionic charges suggested the possibility that, once CP were released in the circulation from PAF-stimulated platelets and PMN, they bound to, and neutralized, fixed anionic charges, resulting in enhanced glomerular permeability.
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