The effects of cisplatin (5 mg/kg BW given intraperitoneal^) on renal concentration mechanism were evaluated initially by clearance studies in rats 5–7 days after cisplatin administration and compared to normal rats. During hypotonic saline infusion, cisplatin rats showed a lower inulin clearance (0.56 ± 0.07 vs. 1.12 ± 0.09 ml/min/100gBW, p < 0.01), a higher fractional distal delivery (CNa + CH20/Cin) (36.3 ± 4.4 vs. 22.8 ± 4.5%, p < 0.05), and lower CH20/CNa + CH20 (33.6 ± 5.8 vs. 56.5 ± 5.0%, p < 0.01). During hypertonic saline infusion the TcH20/Cosm was lower in cisplatin (18.3 ± 1.1%) than in normal rats (33.4 ± 3.5%, p < 0.01). These results suggest a defect in NaCl transport in the thick ascending limb of Henle and proximal tubule. In order to characterize these tubular defects, we measured Na-K-ATPase activity {\iM Pi/mg protein/h). In the renal cortex of cisplatin rats the ATPase activity was lower (18.1 ± 3.2) than in normal rats (33.4 ± 6.4, p < 0.05), also in the inner strip of the outer medulla of cisplatin rats Na-K-ATPase was reduced (26.0 ± 5.7) when compared with normal rats (67.3 ± 9.2, p < 0.01), presumably representing a decrease in enzyme activity in the thick ascending limb. In vitro measurements of diffusional water permeability (Pdw) and urea permeability (Purea) of the perfused papillary collecting duct isolated from polyuric cisplatin rats showed that vasopressin (200 uU/ml) added to the bath increased the PDw from 65.4 ± 11.2 to 104.4 ± 12.7 X 10-5cm/s(p < 0.01) and the Purea from 20.1 ± 5.7 to 30.3 ± 8.2 X 10”5cm/s(p < 0.05), as observed in the papillary collecting duct of normal rats. These findings suggest that the polyuric effect of cisplatin is due, at least in part, to impaired NaCl transport of the proximal tubule and thick ascending limb of Henle’s loop. The data rule out the possibility of ADH resistance in the papillary collecting duct.
The effect of serum obtained from rats with acute and chronic renal failure on phagocytosis was evaluated in macrophages cultured "in vitro". The erythrophagocytosis of these cells was lower after incubation with serum from rats with acute and chronic renal failure when compared to normal plasma. This inhibitory process persisted when the serum was previously filtered through a Millipore filter PM-30, but it was abolished when the serum was filtered through a Millipore filter PM-10. These data suggest that uremic plasma displays a inhibitory factor of phagocytic cells of a molecular weight between 10.000 and 30.000 daltons.
This is a report of a 25 years old black woman from the city of São Paulo, Brazil, who developed acute obstructive cholangitis of Ascaris lumbricoides with septicemia and multiple hepatic abscesses. The patient had sickle cell trait and normal delivery 3 months ago. Massive infestation of the biliary tract by Ascaris lumbricoides was diagnosed by abdominal ultrasonography and endoscopic retrograde cholangiography. Sixty worms were removed from the common bile duct and hepatic abscesses were drained by surgery. The infectious process was polymicrobial. The patient's recovery was complete after a long evolution with a wide spectrum antibiotic therapy. New surgeries were needed to remove residual worms in the biliary tract. The diagnostic methods, clinical-biochemical features and also the clinical and surgical management are presented. The biliary ascariasis pathophysiology is commented.
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