No abstract

A man with Fabry’s disease received a renal allograft from a heterozygous sister. Renal allograft dysfunction necessitated an allograft biopsy 5.5 years after transplantation. Extensive accumulation of Fabry’s disease deposits in the glomeruli, tubules, blood vessels and interstitium was noted.

Patients who had undergone gastric resection were studied with blood glucose and serum insulin levels during oral glucose tolerance testing. The symptoms which appear two to three hours after a glucose load follow a marked rise in serum insulin and are accompanied by hypoglycemia. By appropriate elevation of the blood glucose, high serum insulin levels and a similar secondary hypoglycemic syndrome can be produced in normal individuals. DIABETES 74:526-28, August 1965.

No abstract

Disseminated Mycobacterium kansasii infection associated with pancytopenia was diagnosed in a 40-year-old man found to have granulomata in kidney and liver biopsy specimens. The M. kansasii was isolated from the urine and tissue obtained by renal biopsy. Serial renal biopsies and renal tissue obtained at autopsy showed severe interstitial fibrosis which was thought to represent a tissue response to the M. kansasii infection. The periportal and parenchymal fibrosis found in the liver at autopsy were consistent with a similar response in the liver.

Glucose intolerance in uremia is well known. In response to the elevated blood glucose, serum insulin rises. We have again demonstrated this rise in serum insulin, especially after the first hour during glucose tolerance testing. Regardless of the mechanism or appropriateness of the insulin response, plasma FFA in uremic patients are markedly depressed when glucose is elevated or small amounts of insulin are infused. The low concentration of FFA accompanying glucose intolerance may be a significant abnormality in the metabolic economy of the uremic patient. DIA-BETES 22:111-14, February, 1973. Many studies have demonstrated glucose intolerance in uremic patients. 1 " 13 The mechanism of this abnormality remains obscure, although a number of factors have been proposed as having a role. Insulin insensitivity related to growth hormone, acidosis, potassium depletion, and nitrogenous toxins have been suggested as contributing to glucose intolerance. Recent studies have focused attention-on the lipemia of uremia. 14 " 20 Hypertriglyceridemia is well documented in uremia and may be an integral part of the metabolic processes involving carbohydrate intolerance and insulin insensitivity. Little has been written concerning the levels of FFA during glucose loading. This study was undertaken to evaluate the effects of glucose elevation and of insulin infusion on the concentration of FFA in the uremic patient. METHODSEleven uremic male patients and five normal subjects were studied after overnight fasting. They were given carbohydrate orally in an amount equivalent to 75 gm. glucose. Chilled Glucola was used as the source of carbohydrate because it is well tolerated by uremic patients. Patients selected for study were able to take a 5P-to 60-gm. protein diet with adequate carbohydrate intake; each specifically denied recent vomiting. Blood samples were drawn before administration as well as From the fifteen and thirty minutes and at one, two, and three hours after Glucola. Blood samples were collected in heparinized tubes and immediately chilled, and the plasma was separated by centrifugation and frozen. Aliquots of plasma were analyzed for glucose (SomogyiNelson), 21 insulin (radioimmunoassay) 22 ' 23 and FFA (Ko-Royer). 24 In additional studies, six normal subjects and six uremic patients were given an infusion of Regular insulin after overnight fasting. Iletin (Lilly) was diluted in 0.9 per cent saline to make a solution containing 1 U. per milliliter. The patients and subjects were given a slow drip infusion of 0.9 per cent saline. Regular insulin was introduced directly into the intravenous tubing at the venipuncture site with a constant infusion pump; the amount was 0.005 U. per kilogram body weight followed by an infusion of 0.0005 U. per kilogram per minute for thirty minutes.* Dilutions of insulin were made in the same manner for each study and were used immediately. Blood specimens were drawn from the opposite arm prior to infusion and at five, ten, twenty, and thirty minutes for estimation of glucose, insulin, a...

No abstract

No abstract