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Nephrotoxicity : Otoxicity of Drugs. Ce livre rassemble les textes des communications présentées au symposium de Rouen (mai 1981) ayant pour thème l'étude de la néphrotoxicité des antibiotiques. La majeure partie de l'ouvrage est réservée à la néphrotoxicité des aminoglycosides. Sont détaillés les aspects morphologiques, les résultats d'études autoradiographiques, d'études de fractionnement cellulaires permettant l'analyse du comportement des mitochondries ou des lysosomes. Une large part est réservée aux variations de multiples enzymes urinaires excrétées sous l'action des médicaments. Le rôle de nombreux facteurs est largement discuté : influence des doses injectées, du rythme d'administration, de la durée du traitement, de l'âge, de l'existence d'une néphropathie antérieure. À la lecture des différentes études présentées, le clinicien pourra juger des différences de potentiel néphrotique des antibiotiques qui lui sont proposés pour le traitement des infections sévères. La place consacrée à l'otoxicité des aminoglycosides est plus restreinte mais les études de variations de potentiels pour détecter les signes d'otoxicité, les études de pharmacocinétique des aminogly¬cosides sont des contributions fort intéressantes et très originales.
L'utilisation d'antibiotiques contenant notamment des aminoglycosides pour com¬battre les affections bactériennes, est très répandue. Or, à long terme, elle pose sou¬vent des complications dont la néphrotoxicité est la plus fréquente. Si les manifes¬tations de ces complications rénales sont connues, les mécanismes de ces altérations le sont moins. Ces communications apportent donc des éclaircissements sur ces mécanismes et les effets de ces substances dans les néphrons, le transport et la pénétration dans les cellules labyrinthiques du rein, l'influence sur la structure cellulaire, les effets au niveau de l'appareil de Colgi et notamment les réactions des organites intracellulaires : lysosomes-mitochendria.
Infectious and non-infectious tubulointerstitial nephropathies are old subjects but there is enough confusion and disagreement on terminology and etiopathogenesis to warrant a new look at these problems. We were fortunate in having at the Pediatric Nephrology Seminar 6 and as contributors to this volume, the representative- or shall I say "originators"? - of each of the three most identifi able positions: Dr. Renee Habib - congenital anomalies, Dr. John Hodson - reflux, and Dr. Robert Heptinstall - infection. Although some tend to hold onto one position and exclude others, in this case there was overlapping of perception. Dr. Habib accepts a role for infection in reflux and for infection in the presence of obstruc tion; Dr. Hodson accepts infection and congenital anomalies as modi fiers; and Dr. Heptinstall takes an overall position whicm encompas ses the three. Thus the first part of the book emphasizes the complexity of something as seemingly simple as UTI and demonstrates awareness of disagreement even among the pros about meanings, interpretations, and treatment. Drs. Gustavo Gordillo, Jorge de la Cruz and their associates emphasize the importance of predisposing factors for UTI; Dr. Materson focuses on the workup of the patient, Dr. Zillerueloon bacteriological aspects, and Dr. Gorman on treatment approaches. Dr. Vaamonde reviews nephrotoxic agents. Finally, Drs. Andres and Noble review the immunological aspects of various tubulointer stitial nephritides.
First Published in 1984, this book offers a full, comprehensive guide into the applications of Aminoglycoside Antibiotics in therapy. Carefully compiled and filled with a vast repertoire of notes, diagrams, and references this book serves as a useful reference for Students of Medicine, and other practitioners in their respective fields.
Chronic renal disease has received increasing attention and concern since the passage in 1972 of PL 92-603, which provided coverage for end-stage renal disease (ESRD) treatment by the federal government. The human and economic costs of the ESRD program serve to emphasize the need to prevent or to arrest those diseases resulting in chronic renal failure, since none of the available treatments is without complications and/or side effects. The ESRD program, the only federal one that provides coverage for a catastrophic illness for almost the entire population (those qualifying under Social Security), cost almost $2 billion in 1983. The escalating costs of the ESRD program are attributed to the increasing number of patients requiring treatment and have focused concerns of the United States Government, both Congress and the administration, on ESRD. The National Institutes of Health (NIH), especially the Kidney, Urology, and Hematology Division of the National Institutes of Arthritis, Diabetes, and Digestive and Kidney Diseases (NIADDK), supports a sizable research program that bears on chronic renal disease and in association with this has sponsored many conferences and workshops on research on and causes and complications of chronic renal failure. This book is an outgrowth of the issues addressed by participants at a number of NIH conferences held in the 1980s.
Interest and research in urinary enzymology were incited about three decades ago by reports that urinary enzymes are elevated in diseases of the kidney and urinary tract. Of the more than 40 hydrolases, oxidoreductases, transferases, and lyases identified in human and animal urine, only ten or so are being used as diagnostic indicators. Recognition of the quantitative distribution of enzymes in the various anatomical and functional parts of the nephron and advances in our understanding of the handling of proteins by the kidney have made it possible to associate urinary enzyme activity patterns with physiological and pathophysio logical functions of the nephron. Confidence in the diagnostic value of urinary enzymes is not unanimous among clinicians and among scientists. The main reason for the difference in opinion may well be that the variability in data exceeds the variability one is accustomed to in the diagnostic enzymology of blood plasma enzymes. In contrast to plasma enzymes, which are protected by an "enzyme friendly" milieu, enzymes released into the urine encounter an "enzyme hostile" environ ment: no or little protective protein, variable pH, variable volume, variable metabolite and salt concentrations, variable concentrations of enzyme in hibitors. Through advances in methodology some of these factors can now be controlled; standardization of urine collection periods and preanalytical treat ment are as important as optimization of assay methods.