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Biomedical subjects

C Wanner

Publications and source records attributed to C Wanner.

At least 145 records · Page 8Linked to original sources
PubMed1987

[An incidental finding of renal cysts: routine occurrence or a finding deserving clarification?].

Since the introduction of new non-invasive diagnostic techniques such as abdominal ultrasound and computerized tomography, simple renal cysts are diagnosed with increasing frequency. Over 30% of patients over 50 years of age are found to have simple renal cysts of different size. A cystic renal mass may represent a simple renal cyst without clinical relevance, a cystic renal carcinoma, early evidence of polycystic kidney disease in a young patient, a rare cause of renal hypertension, a source of infection in a symptomatic patient (infected renal cyst), or a manifestation of an infectious disease (renal abscess, echinococcus cyst). The differential diagnosis and management of a cystic renal mass therefore remain a clinical problem. In the past, surgical exploration of a cystic renal mass was frequently performed. Today, modern diagnostic techniques such as ultrasound-guided percutaneous cyst puncture with cytological analysis of the cyst content, or computerized tomography, are considered the methods of choice. They are particularly useful in case of doubt about the dignity of a cystic renal mass. The determination of renal venous renin levels may be useful in differentiating the causal role of a renal cyst in a patient with hypertension. The management of a cystic renal mass depends on the underlying disease.

Diagnosis, Differential↗
PubMed1987

Unilateral hydronephrosis and hypertension: cause or coincidence?

In the present study, the frequency and the mechanism of hypertension associated with unilateral hydronephrosis (UHY) were investigated in 115 patients. Hypertension (blood pressure greater than 140/90 mm Hg) was found in 20% of 101 consecutive patients with UHY. Twenty-six patients with UHY and hypertension were followed for 35 months and the effect of surgery on blood pressure was analyzed. Blood pressure fell from 178 +/- 4/108 +/- 4 to 135 +/- 2/84 +/- 2 mm Hg after surgery. Hypertension was cured in 62%, improved in 19% and unchanged in 19%. In 73% of the cured patients the PRA-ratio was greater than or equal to 1.5, while all unchanged patients had a value of less than 1.5. Hypertensive patients were significantly older than normotensive patients, but did not differ in kidney function, underlying cause of hydronephrosis, incidence of urinary tract infection or frequency of interstitial nephritis. We conclude that in UHY the incidence of hypertension is not particularly high. However, in a substantial number of patients, high blood pressure is reversible by surgery. In most of these patients the renin-angiotensin-aldosterone system seems to play an important role in sustaining high blood pressure, although in some patients other mechanisms might be operative as well. Since the overall incidence of hypertension is not particularly high in UHY, this secondary form of hypertension appears to be rare.

Adult↗
PubMed1986

Potential role of carnitine in patients with renal insufficiency.

Carnitine metabolism is altered in renal insufficiency and influenced by the treatment modalities. Chronically uremic patients with end-stage renal disease under conservative therapy, hemodialysis, or peritoneal dialysis show low, normal, or elevated serum levels of TC and a distorted pattern of FC, SCAC, and LCAC. HD induces a marked depletion of FC, while predialytic elevated SCAC and LCAC are in the normal range at the end of dialysis treatment. All carnitine fractions rapidly return to predialysis levels 6 h after HD due to a transport of carnitine from muscle stores to plasma pool. Muscle carnitine content is elevated in chronic uremic patients under conservative therapy. Normal or decreased levels are observed in patients on long-term HD treatment. In addition, weekly losses of carnitine in patients undergoing HD or peritoneal dialysis do not exceed urinary carnitine excretion of CO. Supplementation with currently recommended doses (1-2 g L-carnitine i.v. at the end of each HD) is followed by a marked rise in plasma carnitine levels, suggesting limited carnitine utilization in uremia. Therefore, lower carnitine doses and modified application regimens should be considered to avoid exaggerated plasma levels of carnitine and carnitine esters. Furthermore, carnitine application has been reported to show beneficial, worsening, or no effect on the deranged lipid metabolism of the uremic patients. In patients undergoing CAPD or IPD predominantly normal serum carnitine levels have been reported. On the other hand, SCAC and LCAC esters are markedly elevated in these patients. After kidney transplantation the pattern of carnitine fractions is fully normalized in patients with plasma creatinine less than or equal to 120 mumol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylcarnitine↗
PubMed1986

Detection of a metalloproteinase in patients with acute and chronic renal failure.

The effect of different dialyzer membrane materials (cuprophan, cellulose hydrate, polyacrylonitrile, polymethylmethacrylate, ethylene-vinyl alcohol copolymer) on the ultrafiltrate proteinase activity was investigated in 26 patients with acute renal failure (ARF) and 40 patients undergoing regular hemodialysis treatment (RDT). Furthermore, the proteinase activity was characterized in vitro using azocasein and phosphorylase kinase as substrates in the absence and presence of different proteinase inhibitors. Proteinase activity of ultrafiltrates obtained from ARF patients was significantly enhanced with the dialyzer KF 101 (ethylene-vinyl alcohol copolymer). The digestion pattern of phosphorylase kinase revealed an identical type of proteinases in ultrafiltrates of ARF and RDT patients. The pH optimum of this proteinase was at alkaline pH. The proteinase activity could be inhibited in the presence of EDTA, whereas serine proteinase inhibitors were ineffective. Furthermore, the inactivated proteinase after Sephadex G-10 chromatography (in order to separate ultrafiltrate electrolytes and trace elements from protein) could be reactivated after the addition of Mg++ and/or Ca++. We conclude that a metalloproteinase can be found in ARF and RDT patients, and that KF 101 is more effectively eliminating the proteinase activity in ARF patients than other dialyzer membranes.

Acute Kidney Injury↗
PubMed1986

Serum free carnitine, carnitine esters and lipids in patients on peritoneal dialysis and hemodialysis.

Serum free and esterified carnitine levels as well as lipids were investigated in patients undergoing regular hemodialysis (HD) treatment before and during 12 weeks of treatment with L-carnitine (1 g i.v.) at the end of each HD. The results were compared with those obtained in patients on continuous ambulatory peritoneal dialysis (CAPD; n = 15) or intermittent peritoneal dialysis (IPD; n = 3) and healthy controls (CO; n = 20). In HD patients (n = 23) total carnitine (TC) was 49.9 +/- 3.9 (CO: 46.0 +/- 2.5; NS), free carnitine (FC) was 31.6 +/- 2.8 (CO: 37.4 +/- 1.3; p less than 0.05), short-chain acylcarnitine (SCC) was 17.0 +/- 1.8 (CO: 7.2 +/- 0.9; p less than 0.0001) and long-chain acylcarnitine (LCC) was 1.2 +/- 0.2 mumol/l (CO: 0.6 +/- 0.1; p less than 0.05). FC was in the normal range in CAPD (35.6 +/- 3.2) and IPD (44.5 +/- 8.0 mumol/l) patients, whereas SCC (30.1 +/- 3.5) and LCC (2.9 +/- 0.2) levels were maximal elevated in IPD patients (11.8 +/- 0.8 and 1.5 +/- 0.2 on CAPD). Therefore, TC was higher in IPD than in CAPD patients (77.5 +/- 5.0 vs. 49.0 +/- 3.5 mumol/l). 12 weeks after L-carnitine supplementation in HD patients, TC was 313.9 +/- 22.6, FC was 207.7 +/- 12.4, SCC was 99.6 +/- 12.1 and LCC was 7.1 +/- 0.6 mumol/l. TC and FC were significantly lower in females compared with males. Total cholesterol and ketone bodies were normal, HDL cholesterol was significantly decreased before and after L-carnitine supplementation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Urinary proteinase activity in patients with multiple traumatic injuries, sepsis, or acute renal failure.

Urinary proteinase activity was measured and partly characterized in 29 patients, most of whom had multiple traumatic injuries and 14 of whom had sepsis. Seven of these 29 patients also had acute renal failure. When they were compared with healthy controls, a significant increase of urinary proteinase activity measured with azocasein as a substrate could be found 1 day after admission (15.3 +/- 4.8 vs. 4.8 +/- 1.0 U/ml; P less than 0.05). In urine fractions of patients with sepsis, significantly higher proteolytic activities were measured than in patients without septicemia (20.5 +/- 4.2 vs. 12.3 +/- 2.2 U/ml; P less than 0.05). Patients with sepsis and acute renal failure showed higher urinary proteinase activity than patients with sepsis and normal kidney function (37.7 +/- 4.9 vs. 20.5 +/- 4.2 U/ml; P less than 0.05). During recovery from sepsis urinary proteinase activity decreased to normal values. Phosphorylase kinase was used to characterize the type of urinary proteinase(s). A predominant splitting of the alpha and gamma subunits of the enzyme was observed after trauma and sepsis. However all three subunits, alpha, beta, and gamma, were rapidly digested in the case of posttraumatic acute renal failure and sepsis, indicating the presence of different urinary proteinases. We conclude that proteolytic enzymes are present in urine fractions after traumatic injuries. Sepsis, acute renal failure, or both induce a further increase in urinary proteolytic activity caused by different proteinases.

Acute Kidney Injury↗
PubMed1986

Simple renal cyst and hypertension: cause or coincidence?

Hypertension and simple renal cysts are frequent clinical diagnoses. With the widespread use of new non-invasive diagnostic technics such as abdominal ultrasound and computer-assisted tomography renal cysts are diagnosed with increasing frequency. In patients 50 years or older renal cysts of various size may be found in nearly one third. Similarly, the incidence of hypertension increases with age. Thus, the coexistence of a simple renal cyst and hypertension in a patient may represent a pure coincidence or be a cause of high blood pressure. The effect of cyst removal upon hypertension has been documented in 22 patients in the literature. Surgical cyst removal or percutaneous cyst aspiration caused a significant fall in blood pressure in most patients. The drop in blood pressure was closely related to an activation of the renin angiotensin system in the involved kidney. Fifteen patients (68%) were considered cured and 2 improved after the intervention. All patients had large cysts. It is suggested that in patients with large renal cysts the lesion may, through local tissue and/or renal arterial compression, cause ischemia and in turn activate the renin angiotensin system. Since most of the renal cysts are 2 cm or less in diameter this may represent a very rare event. In patients with large renal cysts and hypertension percutaneous needle aspiration of the cyst and/or renal venous renin determination may be useful tools to determine a causal rather than a coincidental relation between the 2 lesions.

Adolescent↗
PubMed1986

Granulocyte activation during hemodialysis.

Plasma levels of granulocyte lactoferrin, myeloperoxidase, and elastase in complex with alpha 1-proteinase inhibitor (E-alpha 1PI) during hemodialysis were investigated in patients undergoing maintenance hemodialysis with dialyzers made from cellulose hydrate, polymethylmethacrylate, cuprophan, ethylene-vinyl alcohol copolymer, polycarbonate, polyacrylonitrile or polysulfone. Polymethylmethacrylate membrane caused markedly elevated plasma lactoferrin (712.5 +/- 165.9 ng/ml) and E-alpha 1PI (681.8 +/- 102.6 ng/ml). Lower levels were observed in patients dialyzed with cuprophan or polycarbonate dialyzers, while cellulose hydrate membrane caused a maximal increase of the E-alpha 1PI levels (1,6590 +/- 256.8 ng/ml). Polyacrylonitrile membrane provoked minimal E-alpha 1PI formation (267.6 +/- 79.6 ng/ml) but markedly elevated plasma levels of lactoferrin. However, polysulfone dialyzers displayed only very modest increases of the plasma E-alpha 1PI and lactoferrin levels. Plasma levels of myeloperoxidase were unchanged comparing the effects of the different dialyzers. We conclude that granulocyte activation during hemodialysis does not necessarily need anaphylatoxin formation.

Acrylic Resins↗
PubMed1985

Curable renal parenchymatous hypertension: current diagnosis and management.

Unilateral parenchymatous kidney disease associated with high blood pressure represents a potentially curable form of hypertension. Surgery may normalize blood pressure in a substantial number of these patients. Curable renal parenchymatous hypertension includes unilateral tubulointerstitial kidney diseases such as chronic pyelonephritis, reflux nephropathy, segmental hypoplasia and radiation nephritis, hydronephrosis, simple renal cysts, traumatic kidney lesions and renal tumors associated with high blood pressure. Renal ischemia and in turn activation of the renin angiotensin system is involved in the pathogenesis of hypertension in most of these patients. In patients with unilateral kidney disease and hypertension, both an operative and a medical therapeutic approach have a high success rate. Good candidates for nephrectomy are young patients with severe hypertension, strict unilateral disease, normal plasma creatinine levels and minimal function of the involved kidney. In unilateral hydronephrosis reconstructive surgery or nephrectomy may cure or improve hypertension in the vast majority of the patients. Surgically correctable hypertension has also been reported in some patients with large renal cysts and renal tumors (hemangiopericytoma, Wilm's tumor, hypernephroma, renal pelvic tumor).

Antihypertensive Agents↗
PubMed1985

Unilateral parenchymatous kidney disease and hypertension: results of nephrectomy and medical treatment.

In the present study 43 patients with unilateral parenchymatous kidney disease and hypertension were investigated. 20 patients were nephrectomized, 23 treated with antihypertensive drugs. Both therapeutic approaches showed an excellent and sustained blood pressure-(BP)-lowering effect. BP fell from 185 +/- 27/116 +/- 13 to 138 +/- 20/86 +/- 10 mm Hg in the operated and from 194 +/- 32/116 +/- 13 to 149 +/- 22/95 +/- 12 mm Hg in the medically treated patients after 2 and 6 weeks, respectively (p less than 0.001). BP was 142 +/- 16/89 +/- 11 and 136 +/- 16/90 +/- 10 mm Hg at the long-term follow-up in the 2 subgroups. In the operated group 70% (n = 14) were cured, 20% (n = 4) were improved and 10% (n = 2) unimproved. In the medically treated group 65% (n = 15) were normotensive, 26% (n = 6) improved and 9% (n = 2) treatment resistant. No significant correlation between postoperative BP reduction and lateralization of renin secretion (PRA-ratio greater than or equal to 1.5) was found. Although cured patients showed a higher mean PRA-ratio, 4 patients with a PRA-ratio less than 1.5 were cured (n = 2) or improved (n = 2) postoperatively. Our results document an excellent and sustained antihypertensive effect of both nephrectomy and medical treatment in patients with unilateral parenchymatous kidney disease and hypertension. They further limit the predictive value of renal venous renin determination in the preoperative workup.

Adolescent↗
PubMed1983

Role of proteases in hypercatabolic patients with renal failure.

Proteolytic enzymes exist in plasma ultrafiltrates, concentrated dialysates, and urine fractions of patients with posttraumatic acute renal failure (ARF), as well as in urine fractions of patients with nephrotic syndrome and in concentrated dialysates of patients or routine dialysis therapy (RDT). Differences in the digestion pattern of phosphorylase kinase suggest the existence on different proteases. Plasma trypsin-binding capacity is reduced in RDT patients and is markedly decreased in patients with posttraumatic ARF compared with healthy subjects. Protein catabolism of plasma fractions of patients with posttraumatic ARF is inhibited in vitro by alpha 2-macroglobulin. Urinary alpha 1-antitrypsin inactivates added kallikrein in urine fractions of patients with posttraumatic ARF or nephrotic syndrome. Proteases may also be involved in the disturbances of carbohydrate metabolism of uremic patients. The role of proteolytic degraded phosphorylase kinase, muscle contractile proteins, hormone receptors, or pancreas islets on the pathogenesis of altered carbohydrate metabolism in uremia is discussed.

Acute Kidney Injury↗