212 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (M.D.)--University of Adelaide, Dept. of Medicine, 1973

No description available.

published_or_final_version / Medicine / Master / Doctor of Medicine

published_or_final_version / Medicine / Master / Doctor of Medicine

The effects of the biological cross-linker transglutaminase, the neutrophil oxidant hydrogen peroxide, and neutrophil proteinases on glomerular basement membrane permeability have been examined using an in vitro model of glomerular ultrafiltration. The main focus of the study lies in determining whether any of the test agents were able to render glomerular basement membrane more permeable to protein. Guinea pig liver transglutaminase was used as a model enzyme to test for the effect of biological cross-linkers on glomerular basement membrane permeability. It cross-linked glomerular basement membrane proteins, caused membrane contraction, and rendered glomerular basement membrane less permeable both to water and the low molecular weight protein marker myoglobin but had no effect on the membrane permeability to the high molecular weight marker protein bovine serum albumin or serum protein. The pathophysiological relevance of the effect is discussed. Hydrogen peroxide increased glomerular basement membrane permeability to water and proteins but the effect depended on hydrogen peroxide concentration and incubation time. The minimum concentration needed to render glomerular basement membrane more permeable to bovine serum albumin and serum protein was 1 M and the minimum incubation time needed was 6 hrs. A respiratory burst analysis of activated neutrophils showed that the average concentration of hydrogen peroxide that could be generated by the neutrophils was less than 50 mM and the time taken for extracellular hydrogen peroxide concentration to fall off to zero was less than 1 hr. Therefore, neutrophils seemed unable to generate and sustain a sufficiently high hydrogen peroxide concentration to render glomerular basement membrane more permeable to protein in vivo. Proteinases extracted from pig neutrophil granules were used to assess their effect on glomerular basement membrane permeability. The extract showed activity against glomerular basement membrane and the activity was primarily attributed to the serine proteinases elastase and cathepsin G, judged from substrate and inhibitor analyses. The proteinase extract also contain latent metalloproteinases, activatable by the organomercurial 4-aminophenyl mercuric acetate and calcium ions. Once activated, they also showed activity against glomerular basement membrane. The extract rendered glomerular basement membrane more permeable to water, myoglobin, bovine serum albumin, and serum protein. The increase in membrane permeability to water and proteins was due to membrane thinning and an increase in the intrinsic porosity of the membrane. When the serine and metalloproteinases were allowed to act in concert, they synergistically degraded glomerular basement membrane and increased the membrane permeability to serum protein and water. The study provides the first direct evidence that pathophysiological amounts of serine and metalloproteinases are able to render glomerular basement membrane more permeable to protein and suggests they may be capable of promoting proteinuria in neutrophil-dependent forms of immune glomerulonephritis.

Title page, table of contents and abstract only. The complete thesis in print form is available from the University of Adelaide Library. / This study demonstrates that dendritic cell (DC) defects are common in chronic renal failure, dialysis and transplant recipients and this is likely to contribute to their underlying immune deficiency and high risk of infections and malignancies. Simple and effective clinical strategies (e.g. improvement in dialysis efficiency) which aim to correct DC deficiencies could potentially lead to direct improvement in patient outcome. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1277089 / Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2006

Title page, table of contents and abstract only. The complete thesis in print form is available from the University of Adelaide Library. / This study demonstrates that dendritic cell (DC) defects are common in chronic renal failure, dialysis and transplant recipients and this is likely to contribute to their underlying immune deficiency and high risk of infections and malignancies. Simple and effective clinical strategies (e.g. improvement in dialysis efficiency) which aim to correct DC deficiencies could potentially lead to direct improvement in patient outcome. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1277089 / Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2006

No description available.

Nephrology nursing requires a specific set of clinical skills and knowledge. When a professional nurse with no previous dialysis experience enters the field of nephrology nursing he or she has no nephrology related paradigms from past experiences to use as a point of reference. As a result of the rapid growth of the private dialysis company experienced over the past 10 years, many management and support service positions became available. Internal promotions resulted in the movement of experienced professional nurses from the clinical field into management and support services positions, resulting in a sudden loss of skilled individuals from the clinical field. To mitigate this effect, a training intervention was started. The newly appointed managers were all required to work in the clinical field for sixteen hours per month to expose the less experienced professional nurses to the more experienced professional nurses in order to assist them with skill acquisition thus enabling the advanced beginner and competent nurse to become a proficient nurse and/or an expert in the field of nephrology nursing. Experiential learning is not a spontaneous process but depends on many factors that could either hinder or facilitate skill acquisition. This study aimed to explore and describe the aspects that facilitate or hinder skill acquisition during the training intervention that was implemented in private chronic haemodialysis units and to write guidelines to optimize skill acquisition during the training intervention. The study followed a quantitative, descriptive, exploratory, contextual, survey design. Data was collected using a tool based on the theory of nursing accompaniment by Kotze, Kolbs theory on experiential nursing, a framework of strategies that facilitate skill acquisition by King and a generalized tool, the Learning Transfer Skills Inventory (LTSI) that was developed by Holton and Bates to measure learning transfer and factors that contribute and hinder training interventions. Data was analysed with the support of a statistician. The findings were reported and discussed in relation to the current literature. Measures were put in place to ensure validity and reliability, and ethical principles were adhered to throughout the study. Guidelines to optimize skill acquisition were developed. The limitations of the study were the sample size and the response rate. There was a paucity in existing research regarding skill acquisition in Nephrology nursing and limited statistical variance amongst the aspects that facilitate or hinder skill acquisition. It is recommended that the guidelines be implemented to measure the impact they have in the organization.

The proximal tubule of the renal cortical nephron is highly susceptible to intoxication by chemical agents. An in vitro system was developed to study directly the effects of nephrotoxic chemicals on this renal sub-organ fraction without the complication of extrarenal factors. Segments of proximal tubules were isolated by a mechanical method from the kidneys of young rabbits. Tubules obtained by this method retained biochemical, functional, and morphological features comparable to those existing in vivo. Preliminary acute susceptibility studies demonstrated that the isolated proximal tubule segments were sensitive to a variety of known nephrotoxic agents that target the proximal tubule. These agents include halogenated hydrocarbons, heavy metals, and a halogenated vinyl cysteine conjugate. Incubation conditions were optimized to maintain the viability of proximal tubule suspensions for up to four hours. Longer incubation times made it possible to establish a chronology of early tubule responses to chemical intoxication. Long term incubation of proximal tubule suspensions with two model nephrotoxins, cadmium chloride and S-(trans-1,2-dichlorovinyl)-L-cysteine, produced in vitro tubule response patterns similar to those reported in vivo for these agents. While not entirely representative of in vivo exposure conditions, suspensions of isolated proximal tubules are an easily obtained system that proved equally applicable as a screening technique for nephrotoxic compounds or as an in vitro system for delineating proximal tubule response to chemical insult.