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North Carolina Medical Journal Owned and Published by The Medical Society of the State of North Carolina Volume 6 February, 1945 Number 2 COMPENSATION OF RENAL METABOLIC DYSFUNCTION Treatment of Kidney Disease and Hypertensive Vascular Disease with Rice Diet, III Walter Kempner, M.D. Durham In kidney disease, there may be impairment of both the excretory and the metabolic functions of the kidney, or of either one alone. In previous papers(1), experiments with the Warburg technique were published which show that the metabolic reactions of surviving isolated kidney cells—for example, de-amination of amino acids, formation of ammonia, oxidation of keto-acids — can be altered quantitatively or qualitatively, re-versibly or irreversibly (as by changes in the oxygen concentration of the cell milieu). On the basis of these experiments, the impairment of the renal metabolic function was emphasized as an important factor in conditions such as uremic azotemia and acidosis. This view seems to be supported by clinical observation. Two case histories may serve as examples. A 21 year old girl with mercury bichloride poisoning, who subsequently made a very good recovery, was completely anuric for four days, and from the fifth to the seventh day passed an average of only 128 cc. of urine per day. In spite of the very limited excretion (a total of 385 cc. of urine in seven days), the non- From the Department of Medicine, Duke University School of Medicine, Durham, N. C. 1. Kempner, W.: (a) Anoxemia of the Kidney as a Cause of Uremic Acidosis: Inhibitory Effect of Low Oxygen Tension on the Deamination of Amino Acids in Kidney Tissue, Am. J. Physiol. 123:117-118 (July) 1938; (b) Verminderter Sauerstoffdruck in der Niere als Ursache der "reversiblen" uraemischen Acidose, Klin. Wehnschr. 17:971-973 (July 9) 1938; (c) Inhibitory Effect of Low Oxygen Tension on the Deamination of Amino Acids in the Kidney. J. Biol. Chem. 124:229-235 (June) 1938; (d) The Role of Oxygen Tension in Biological Oxidations, Cold Spring Harbor Symposia on Quantitative Biology 7:269-283. New Bedford, Mass., The Darwin Press, 1939. protein nitrogen, which was measured daily during these seven days, averaged only 87 mg. per 100 cc. of blood and was never higher than 120 mg. (on the seventh day). The second patient, who subsequently died, had chronic glomerulo-nephritis. He had a urine output of 1200-1500 cc. per day, but his nonprotein nitrogen was more than 200 mg. per 100 cc. of blood. In the first patient, there was no impairment of the metabolic function of the kidney, though the excretion of urine was almost completely suppressed. There was no rise in blood pressure, no retinopathy. In the second patient, the excretory function of the kidney was relatively satisfactory; with a protein intake of about 20 Gm. in twenty-four hours, the urinary excretion in twenty-four hours was 3.7 Gm. of urea nitrogen, 5 Gm. of total nitrogen. The metabolic function of the kidney, however, was inadequate, and there resulted hypertension, retinopathy and a nonprotein nitrogen level considerably higher than that of the first patient, whose urinary nitrogen excretion was 0. That renal excretory insufficiency does not play a decisive role in the production of renal hypertension was shown by the experimental work of Goldblatt(2). Constriction of the main renal arteries may cause persistent hypertension without disturbance of renal 2. (a) Goldblatt, H., Lynch, J., Hanzal, R. F., and Summer-ville, W. W.: Studies on Experimental Hypertension I, J. Exper. Med. 59:347-379 (March) 1934: (b) Goldblatt, H.: Experimental Hypertension Induced by Renal Ischemia; Harvey Lecture, Bull. New York Acad. Med. 1 1:523-553 (Sept.) 1938.
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1945 |
Identifier | NCHH-17-006 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 6 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-006.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-006 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Description
Fixed Title * | Page 61 (title page) |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1945 |
Identifier | NCHH-17-006-0073 |
Form General | Periodicals |
Page Type | all; title page; article; article title |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolinamed61945medi_0073.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 6 |
Issue Number | 2 |
Page Number | 61 |
Health Discipline | Medicine |
Full Text | North Carolina Medical Journal Owned and Published by The Medical Society of the State of North Carolina Volume 6 February, 1945 Number 2 COMPENSATION OF RENAL METABOLIC DYSFUNCTION Treatment of Kidney Disease and Hypertensive Vascular Disease with Rice Diet, III Walter Kempner, M.D. Durham In kidney disease, there may be impairment of both the excretory and the metabolic functions of the kidney, or of either one alone. In previous papers(1), experiments with the Warburg technique were published which show that the metabolic reactions of surviving isolated kidney cells—for example, de-amination of amino acids, formation of ammonia, oxidation of keto-acids — can be altered quantitatively or qualitatively, re-versibly or irreversibly (as by changes in the oxygen concentration of the cell milieu). On the basis of these experiments, the impairment of the renal metabolic function was emphasized as an important factor in conditions such as uremic azotemia and acidosis. This view seems to be supported by clinical observation. Two case histories may serve as examples. A 21 year old girl with mercury bichloride poisoning, who subsequently made a very good recovery, was completely anuric for four days, and from the fifth to the seventh day passed an average of only 128 cc. of urine per day. In spite of the very limited excretion (a total of 385 cc. of urine in seven days), the non- From the Department of Medicine, Duke University School of Medicine, Durham, N. C. 1. Kempner, W.: (a) Anoxemia of the Kidney as a Cause of Uremic Acidosis: Inhibitory Effect of Low Oxygen Tension on the Deamination of Amino Acids in Kidney Tissue, Am. J. Physiol. 123:117-118 (July) 1938; (b) Verminderter Sauerstoffdruck in der Niere als Ursache der "reversiblen" uraemischen Acidose, Klin. Wehnschr. 17:971-973 (July 9) 1938; (c) Inhibitory Effect of Low Oxygen Tension on the Deamination of Amino Acids in the Kidney. J. Biol. Chem. 124:229-235 (June) 1938; (d) The Role of Oxygen Tension in Biological Oxidations, Cold Spring Harbor Symposia on Quantitative Biology 7:269-283. New Bedford, Mass., The Darwin Press, 1939. protein nitrogen, which was measured daily during these seven days, averaged only 87 mg. per 100 cc. of blood and was never higher than 120 mg. (on the seventh day). The second patient, who subsequently died, had chronic glomerulo-nephritis. He had a urine output of 1200-1500 cc. per day, but his nonprotein nitrogen was more than 200 mg. per 100 cc. of blood. In the first patient, there was no impairment of the metabolic function of the kidney, though the excretion of urine was almost completely suppressed. There was no rise in blood pressure, no retinopathy. In the second patient, the excretory function of the kidney was relatively satisfactory; with a protein intake of about 20 Gm. in twenty-four hours, the urinary excretion in twenty-four hours was 3.7 Gm. of urea nitrogen, 5 Gm. of total nitrogen. The metabolic function of the kidney, however, was inadequate, and there resulted hypertension, retinopathy and a nonprotein nitrogen level considerably higher than that of the first patient, whose urinary nitrogen excretion was 0. That renal excretory insufficiency does not play a decisive role in the production of renal hypertension was shown by the experimental work of Goldblatt(2). Constriction of the main renal arteries may cause persistent hypertension without disturbance of renal 2. (a) Goldblatt, H., Lynch, J., Hanzal, R. F., and Summer-ville, W. W.: Studies on Experimental Hypertension I, J. Exper. Med. 59:347-379 (March) 1934: (b) Goldblatt, H.: Experimental Hypertension Induced by Renal Ischemia; Harvey Lecture, Bull. New York Acad. Med. 1 1:523-553 (Sept.) 1938. |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-006.pdf |
Document Sort | all; nchh-17 |
Article Title | Compensation Of Renal Metabolic Dysfunction |
Article Author | Walter Kempner |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-006 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
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