The objective was to determine whether Hb declines in healthy elderly men and women and if this influences health-related reference intervals. A representative population sample, comprising 30% of all 70-yr-old subjects in a Swedish city with 420,000 inhabitants (n = 1148, participation rate 85%), was followed at 1-5-yr intervals for 18 yr within a longitudinal population study. Age-related changes in Hb were calculated after exclusion of non-healthy probands and by multivariate analyses in the total study group. Mean Hb declined between age 70 and 88 from 149 to 138 g/L in men (annual decline 0.69 g/L, p = 0.000), and from 139 to 135 g/L in women (annual decline 0.06 g/L, n.s.). Healthy men declined from 152 to 141 g/L (annual decline 0.53 g/L, p = 0.038), for women from 140 to 138 g/L (annual decline 0.05 g/L, n.s.). Age and body mass index correlated, in multivariate analysis, independently to Hb in both men and women, as did variables indicating a non-healthy state. Epidemiological decision limits for anaemia declined for men from 128 to 116 g/L, for women from 118 to 114 g/L. Anaemia, thus defined, occurred in 3.2 to 9.7% of the subjects, whereas 28.3% of the 88-yr-old men had anaemia according to the WHO definition. In conclusion, there is a significant age-related decline in Hb from age 70 to 88 among healthy men, and a less pronounced decline among women. This justifies the use of lower epidemiological decision limits for anaemia of about 115 g/L for both men and women from age 80-82.

The glomerular filtration rate (GFR) has been determined in 17 patients with advanced renal insufficiency (GFR less than 15 ml/min) by different clearance techniques using creatinine, inulin and 51Cr-EDTA as filtration markers. With renal inulin clearance as reference method for GFR, endogenous renal creatinine clearance overestimated GFR by an average of 30%. Renal clearance of 51Cr-EDTA and inulin were closely correlated and thus 51Cr-EDTA is a suitable GFR marker even at low filtration rates. However, it was found that the plasma clearance of 51Cr-EDTA overestimated the GFR often by more than 100% in the range 2.6--11.2 ml/min. Renal clearance measured during 24 h was lower than 4 h renal clearance with the patient well hydrated and resting in bed. It is concluded that the precise measurement of low glomerular filtration rates requires the use of renal clearance techniques. Four-hour 51Cr-EDTA renal clearance is a suitable method for measuring and following the development of renal function in advanced renal insufficiency.

, larion H. (1974). British Journal of Industrial Medicine, 31, 113-127. Renal ultrastructure, renal function, and parameters of lead toxicity in workers with different periods of lead exposure. Renal biopsies were obtained from five men with heavy occupational exposure to lead and compared with studies of their renal function and parameters of lead toxicity. Two men had lead exposure of less than one year while three men had been exposed for from four to more than 30 years. In addition, renal function studies were performed in two men from whom renal biopsies could not be obtained. Their lead exposures were five and 12 years, respectively. Significantly lower plasma levels, when compared with non-exposed controls, were found for proline, valine, tyrosine, and phenylalanine although no excessive aminoaciduria was found. Renal function tests were normal in all except for a reduced glomerular filtration rate (GFR) in one worker. Plasma ALA was measured by a new and highly specific method and ALA clearance was found to follow GFR closely. Those workers with prolonged lead exposure showed a lower urinary lead excretion. Typical lead-induced intranuclear inclusion bodies were found only in those with short exposure. The ultrastructural changes were localized to the proximal tubules, while the glomeruli were only nonspecifically affected. Mitochondrial changes were found in all men. Reasons for the decrease in inclusion body formation in chronic lead nephropathy are uncertain but may be due to an increased rate of renal cell turnover or a consequence of chelation therapy.

This study describes blood pressure and renal function, as well as indices of renal disease, in females with and without renal scarring followed from their first urinary tract infection (UTI) in childhood. Of the 111 patients with a median follow-up time of 15 years, 54 had renal scarring (reflux nephropathy) on urography, which was severe in 19 and moderate in 35. The glomerular filtration rate was lower in patients with severe renal scarring and correlated with renal area on urography. However, the filtration rate was decreased below the lower reference limit in only 7 patients, with a lowest value of 70 ml/min per 1.73 m2. The diastolic blood pressure was higher in women with severe scarring. Hypertension of at least 140/90 mmHg was diagnosed in 3 of 54 (5.5%) females with renal scarring, 2 before and 1 at the follow-up examination. The excretion of albumin in urine was low and not correlated to filtration rate. Tubular enzymes in urine were similar in all groups. Thus the renal function was well preserved and the incidence of hypertension low. Within this range of renal function, the level of albumin in urine did not predict the degree of renal scarring.

Sensitivity and negative predictive values for a latex assay (D-dimer latex-B) was similar to that of a D-dimer ELISA: With a sensitivity of 94% (100% for proximal DVTs) such a latex assay may be included in a screening strategy for DVT at an emergency unit. However, the safety of such an approach has to be tested in other prospective studies.

SUMMARY Thirteen patients with ileopathy were studied under metabolic ward conditions, first on a 100-g fat diet and later on a 40-g fat diet. Ten of the patients were studied after three to 27 months on a fat-reduced diet. Ten of the patients had a high urinary oxalate excretion on the high-fat diet compared with a control group. The patients with a faecal fat output of more than 15 g a day showed a reduction in oxalate excretion when the fat intake was decreased and in the follow-up study the oxalate excretion was low in all patients except in one with a remaining steatorrhoea. There was a correlation between urinary oxalate excretion and faecal output of fatty acids. It is postulated that a low intraluminal calcium ion concentration, mainly caused by the high fatty acid content, explains the hyperoxaluria. The low fat diet, which also reduced the diarrhoea and increased the urinary output, was acceptable to the patients. The diet is recommended for patients with ileopathy in order to reduce the risk of formation of renal calculi.Hyperoxaluria and nephrolithiasis may occur in patients with ileopathy (Smith, Hofmann, McCall, and Dowling, Rose, and Sutor, 1971;Admirand, Earnest, and Williams, 1971). Abnormalities in the bile salt metabolism Smith, Fromm, and Hofmann, 1972), a preferential conversion of glyoxylate to oxalate in the liver (Admirand et al, 1971), and an increased absorption of dietary oxalate (Chadwick, Modha, and Dowling, 1973;Stauffer, Humphreys, and Weir, 1973) have been proposed to explain this secondary form of hyperoxaluria. These theories have resulted in different therapeutic applications. A decrease in urinary oxalate after oral taurine has been found in some

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The incorporation of [¹⁴C]leucine and [¹⁴C]threonine into kidney cortex proteins was studied during 6 days’ hypothermic perfusion of dog kidneys at 8–10 °C and during in vitro incubation of dog kidney cortex slices at 37 °C. Leucine carbon was incorporated into proteins at a higher rate than threonine carbon both during in vitro incubation of kidney cortex slices and during hypothermic kidney perfusion. The incorporation of leucine and threonine during hypothermic perfusion was linear for 6 days but 50–100 times lower than the incorporation of leucine and threonine in kidney cortex slices at 37 °C. During hypothermic perfusion there was a decrease in specific activity of leucine and threonine in the perfusate corresponding to a degradation of proteins which was greater than protein synthesis as calculated from the incorporation of label into proteins. Leucine carbon was recovered in CO₂ during hypothermic perfusion and in vitro incubation of kidney cortex slices at 37 °C. The incorporation of threonine carbon into CO₂ was about 10% of the corresponding value for leucine both during hypothermic kidney perfusion and during in vitro incubation of kidney cortex slices at 37 °C. It is concluded that there is a turnover of kidney proteins during hypothermic perfusion with a perfusate containing amino acids.