Total chromogen, true, and AutoAnalyzer methods of measuring serum and urine creatinine by the Jaffe reaction were investigated. Some factors influencing this reaction were examined. These included wavelength, blank, linearity, and conditions of color development. Modifications of the three methods were made and their precision, recovery, and sample stability determined. The interference of ketones and glucose were measured. Finally, the values obtained by the three methods on the same samples of serum and urine were compared statistically.
In this paper we describe an experimental model designed for studies of continuous ambulatory peritoneal dialysis (CAPD) in uremic rabbits. We preferred the study of uremic animals because it is not known whether peritoneal membrane differs between normal and uremic animals. Animals made uremic after bilateral nephrectomy could not survive on dialysis. Instead, partial nephrectomy of one kidney and partial (5/6) destruction of the cortex of the remaining kidney by electrocauterization provided a simple and reproducible model. CAPD resulted in adequate control of uremia but the animals showed significant decreases in total plasma proteins and weight. This model is suitable for studies of the metabolic complications of CAPD.
Patients receiving long term parenteral nutrition may develop metabolic bone disease. In all 11 patients studied, histologic studies of bone showed excessive unmineralized bone tissue despite normal plasma 25-hydroxyvitamin D levels. Three patients also had bone pain and fractures and severe urinary loss of calcium and phosphate. Withdrawal of vitamin D from parenteral nutrition solutions was associated with improved histologic findings of bone in all patients, shown by a decrease in osteoid tissue and an increase in tetracycline uptake. In the three patients with symptoms, bone pain subsided, fractures healed, and urinary loss of calcium and phosphate decreased. Thus, vitamin D may be a factor in the genesis of parenteral nutrition-induced metabolic bone disease.
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