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Biomedical subjects

D Scholz

Publications and source records attributed to D Scholz.

At least 127 records · Page 7Linked to original sources
PubMed1983

Urinary excretion of calcium, magnesium, oxalate and citrate in duodenal ulcer patients. Preliminary results before and up to five years after highly selective vagotomy.

The urinary excretion of calcium, oxalate, citrate and magnesium, and the relative saturation products in urine of either calcium oxalate or calcium phosphate, were determined in male duodenal ulcer (DU) patients preoperatively (n = 60), and 1 and 5 years following highly selective vagotomy (HSV), and in male healthy controls (n = 30). In DU before HSV citrate and magnesium were lowered, oxalate was in the low normal range and calcium was normal. The calcium oxalate product was lower than in controls, while the calcium phosphate product was unchanged. Within 5 years HSV normalized urinary citrate and oxalate, but not urinary magnesium, and the median urinary pH was lower than pre-operatively. There thus results a normal product for calcium oxalate, but a reduced one for calcium phosphate. It is suggested that: (1) unoperated DU patients have a urine composition similar to that exhibited in normocalciuric recurrent calcium urolithiasis; (2) this spectrum of urinary constituents may be changed by HSV.

Adult↗
PubMed1983

Lecithin:cholesterol acyltransferase activity and HDL composition in serum of patients with kidney transplants.

In comparison with a control group, lecithin:cholesterol acyltransferase activities and HDL-cholesterol concentrations in serum of patients with kidney transplants were unchanged, while apolipoprotein A and HDL-triglyceride concentrations were increased. This constellation shows that the cholesterol metabolism in patients with kidney transplants differs from that of patients undergoing chronic haemodialysis.

Apolipoproteins↗
PubMed1983

[Primary cytomegalovirus infection as a risk factor following kidney transplantation].

Of 201 patients who received cadaver kidneys in the kidney transplant centre in Berlin between June 1978 and December 1981 114 (56.7%) already had complement-binding antibodies against cytomegaloviruses (CMV) before transplantation, 87 (43.3% were seronegative. After transplantation a recurring CMV infection was detected in 36/114 patients and a primary CMV infection in 27/87 patients (31.6% and 31.0% respectively). At dismissal from ward care these patients already had a significantly higher rate of transplant failure than those free of CMV infection. This negative effect of the infection was reinforced by the additional administration of a Prednisolone bolus for the treatment of the rejection crisis associated with CMV. At the same time immunological protection was further suppressed. Thus, in comparison with patients with primary CMV infection not treated with Prednisolone bolus, those with primary CMV infection and parallel treatment with a Prednisolone bolus had a higher rate of T-lymphocytopenia and a significantly delayed humoral immune response to CMV. Together with the usually present leukocytopenia, these findings explain the especially high risk of potentially fatal superinfections in this period. Diagnosis of CMV infection on the basis of clinical symptoms and haematological changes must be speedy. A therapy which is effective with regard to life (although symptomatic) comprises the temporary reduction of the azathioprine dose, the administration of antibiotics and the infusion of human gamma-globulin. It might be possible to avoid primary CMV infection, which presents a particularly great risk, by vaccination of the potential transplant recipient.

Adolescent↗
PubMed1983

[Pregnancy after kidney transplantation. Report of 6 successful cases with multiple risk factors].

The long-term course before, during and after successful pregnancy in six women 3 to 6 years after receiving CD-kidney transplants from dead donors is described. Multiple risk factors such as hypertension, considerable proteinuria, preceding rejection crises etc. have been taken into account. The analysis includes the observation of a pregnancy which began already in the 1st month after transplantation. With the exception of a patient with hydronephrosis, whose functional data remained normal, the transplants of all patients showed better functional data after delivery than before pregnancy (maximum period of observation: 5 years 3 months post delivery). The patients mainly received alternating prednisolone therapy. Immunosuppression was generally reduced in the second trimester and was temporarily increased above the maintenance dosage after delivery. All children were eutrophic at birth and developed normally without complications. Important factors leading to the good overall clinical result were intensive out-patient care and the cooperation between nephrologists, urologists, gynecologists and neonatalogists. Despite our very good experience with 6 pregnancies successfully carried to full term by women with kidney transplants, the risk for mother and child should only cautiously be estimated, taking into account the results of future larger studies.

Adolescent↗
PubMed1983

[The significance of sex determined antigens for kidney transplantation prognosis--an analysis of 500 transplantations at a center].

In a retrospective analysis of survival after 587 kidney transplants from dead donors performed in one centre, the influence of incompatibilities in the HLA-A-B system and the influence of the sex of the donor were analysed. The survival curves for 0, 1, 2, 3 and 4 incompatible antigens of the A and B loci showed no significant differences from the 1st to the 4th years after transplantation. The best survival rate was found among 212 men with kidneys from male donors, despite other disadvantageous factors in this group, whereas 155 women with kidneys from male donors (with a histoincompatibility of the H-Y antigen) had statistically significant low survival rates between 10.1 and 21% (p less than 0.001 - less than 0.003). The survival rates of kidneys from female donors showed no significant differences between men and women (p less than 0.05). The findings indicate that the incompatibility of the histoincompatibility antigen Y can be important for the results of clinical kidney transplantation.

Adult↗
PubMed1983

Prevention of osteonecrosis following renal transplantation by using vitamin D2 (ergocalciferol).

Osteonecrosis is a frequently disabling complication of renal transplantation. Thirty-one of 244 patients (12.7%), who received cadaver renal transplants from 1968 to 1978 developed an osteonecrosis. An analysis of 14 possible risk factors suggested that only the following were significantly more frequent in the osteonecrosis group: greater than 3 pulse doses of 1.2 g prednisolone, serum creatinine greater than 133 mumol/L, steroid-induced diabetes mellitus and second and subsequent transplantation. An important decline in the incidence of osteonecrosis (26.7 per cent to 6.5 per cent) was seen with prophylactic vitamin D2 treatment and the onset of osteonecrosis was on average one year later. Dangerous side effects of the large doses of vitamin D2 were minimal. Hypercalcaemia due to overdosage with vitamin D2 during simultaneous prednisolone therapy was usually mild and returned to normal in a few days by dose reduction.

Ergocalciferols↗
PubMed1983

Mineral metabolism and vitamin D status before and up to five years following highly selective vagotomy in duodenal ulcer patients.

The influence of highly selective vagotomy (HSV) upon mineral metabolism was investigated in patients with duodenal ulcer (DU). Data obtained before HSV were compared with those from healthy control subjects and, additionally, with data from pre- and post-HSV observations. In DU the function of the parathyroid glands is unsettled because of decreased renal phosphate threshold, normal serum parathyroid hormone and decreased nephrogenous urinary cAMP. HSV decreases the phosphate threshold further, but does not change parathyroid hormone, calcitonin, or nephrogenous cAMP. Conversely, besides hypergastrinemia, HSV accounts for a decrease in total calcium in serum in the presence of an increase of the intestinal calcium absorption, while the bone mineral content is stable up to 5 years following HSV. Moreover, HSV normalizes the decreased serum concentration of 25-hydroxyvitamin D found pre-operatively in DU, while that of 24,25-dihydroxyvitamin D, known to be effective upon bone and gut, remains unaltered. A classification according to pre-operative gastric acid secretion (normo- and hypersecretors) does not provide further insights into variables of mineral metabolism encountered in DU pre- and post-HSV.

Adult↗
PubMed1982

Mineral metabolism during prolonged oral calcium substitution after jejuno-ileal bypass for morbid obesity.

The influence of jejuno-ileal bypass surgery on mineral metabolism was studied in patients with morbid obesity before operation, and 2 and 5 years after-wards. When calcium and potassium were orally substituted post-operatively, in serum calcium fractions, parathyroid hormone, phosphate, potassium and the bone mineral content remained unchanged, while serum magnesium decreased. Serum 25-hydroxyvitamin D was already low before bypass operation, and did not change thereafter. Post-operatively, the urinary excretion of oxalate rose into the upper normal range, while that of calcium, magnesium and citrate was markedly reduced. The urinary activity product of calcium oxalate rose slightly, but that of brushite decreased. Since these changes were manifest in the urine of all patients, the reasons for the post-operative formation of renal stones in 4 of 19 patients remain unclear at the moment. We conclude that the recommendation for precise oral calcium substitution after jejuno-ileal bypass operation seems justified in order to avoid serious disturbances of calcium metabolism in the long term, and to reduce intestinal oxalate absorption.

Adult↗
PubMed1982

Double-blind study with thiazide in recurrent calcium lithiasis.

The effect of 25 mg. hydrochlorothiazide twice daily on the meta-phylaxis of recurrent calcium lithiasis was compared to placebo in a double-blind study during 1 year in 51 patients. A distinct and continuous decrease in urinary calcium excretion occurred only in patients given hyrochlorothiazide. On the other hand, both groups showed a slight increase in total serum calcium levels, unchanged values for ionized and ultrafilterable calcium, and decreased urinary excretion of oxalate during the study. The activity products of calcium oxalate and calcium phosphate also were decreased in both groups but remained within the metastable range. Spontaneous passage of renal stones occurred during treatment in 6 patients given placebo and in 6 treated with hydrochlorothiazide despite decreased urinary calcium excretion in the latter group. The findings show the specific effect of hydrochlorothiazide treatment to be a decrease in urinary calcium excretion in patients with calcium lithiasis, while other changes appear to be nonspecific effects of treatment.

Adult↗
PubMed1982

Citrate in urine and serum and associated variables in subgroups of urolithiasis. Results from an outpatient stone clinic.

Outpatient renal stone formers belonging to the established urolithiasis subgroups and controls were examined with respect to urinary and serum citrate (Cit) and several associated variables. Only in the normocalciuric majority of calcium and in uric acid stone formers was Cit in 24-hour urine decreased, but was normal in 2-hour fasting morning, and in 3-hour postprandial urine following a Cit-free test meal. Serum Cit was elevated in normocalciuria, renal and resorptive hypercalciuria. This Cit constellation was associated with either normal (absorptive, renal hypercalciuria) or low (normocalciuria, uric acid stone formers) parathyroid gland function as assessed by serum parathyroid hormone and nephrogenous urinary cyclic AMP, except in patients with primary hyperparathyroidism. In 2-hour morning urine the magnesium/creatinine ratio (normocalciuria) and ammonia excretion (uric acid stone formers) were decreased, while ammonia in 24-hour urine was low in all stone formers. It is suggested that Cit metabolism is altered in renal stone disease in general, and that in normocalciuria, stone inhibitors (Cit; magnesium) may be deficient.

Adult↗
PubMed1982

Ultrafiltrable serum citrate and the relationship between serum and urinary citrate results in controls and renal calcium stone formers.

The total and ultrafiltrable citrate of serum were measured in healthy controls, and in patients with calcium-containing kidney stones classified into the various calciuria types (normocalciuria, renal, absorptive, resorptive hypercalciuria). The total citrate in two subgroups (normocalciuria, renal hypercalciuria) was significantly higher than in controls. Two independent analyses showed a mean ultrafiltrable fraction of 0.86 (controls and stone formers, with the exception of resorptive hypercalciuria) and 0.95 (resorptive hypercalciuria), i.e., the calculated extent of binding of citrate to serum macromolecules (greater than 10 000 Daltons). The differences in the fraction of free citrate between controls and renal stone formers are not significant. The apparent mean association constants are (1/mol) 0.24 x 10(2) (controls) and 0.29 x 10(2) (normocalciuria). There is a high correlation between the ultrafiltrable fraction and total citrate in the serum, and also between the ratios urinary/serum creatinine and urinary/serum total citrate, during a 2 h endogenous creatinine clearance in the morning (fasting). These findings suggest that 1) there is citrate binding in the serum, 2) the normal portion of free citrate in total serum citrate of normocalciuric stone formers cannot explain the decreased citrate excretion in 24 h urine of these subjects, 3) under defined conditions of examination (morning; fasting) urinary citrate is determined largely by the filtered load of citrate in the proximal renal tubule.

Adult↗
PubMed1982

Urinary enzyme excretion by renal-transplant recipients in relation to interval after transplantation.

We determined the urinary excretion of the enzymes aminopeptidase (EC 3.4.11.2), alkaline phosphatase (EC 3.1.3.1), gamma-glutamyltransferase (EC 2.3.2.2), and N-acetyl-beta-glucosaminidase (EC 3.2.1.30) in two groups of renal-transplant recipients at different times after transplantation (1.8 months and 52 months, respectively). Both groups of patients showed a higher rate of enzyme excretion than did a reference group of healthy persons. More aminopeptidase and N-acetyl-beta-glucosaminidase were excreted during the early period after transplantation than later. The time-dependence of urinary enzyme excretion was confirmed in six renal-transplant recipients studied during the course of 15 months after transplantation. There was a general correlation between the extent of urinary enzyme excretion and both the time after transplantation and the daily dose of prednisolone. Therefore, it is necessary to take into account this influence on the extent of urinary enzyme in renal-transplant recipients if urinary enzyme excretion is used as an indicator of renal disorder and especially as an early predictor of transplant rejection.

Acetylglucosaminidase↗