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Biomedical subjects

F P Brunner

Publications and source records attributed to F P Brunner.

At least 37 records · Page 2Linked to original sources
PubMed1992

Renal replacement therapy for end-stage renal failure before 2 years of age.

This report concerns 296 children (67% males and 33% females) from 24 countries who started renal replacement therapy (RRT) for end-stage renal failure between 1969 and 1988. Children under 2 years of age represented 3.6%, 4.4%, and 8.9% of all children under 15 years of age who started RRT in 1978-1982, 1983-1985, and 1986-1988 respectively. During the first 2 years of life, the most frequent causes of end-stage renal failure were renal hypoplasia and dysplasia (24%), and haemolytic-uraemic syndrome (17%). During 1986-1988 the initial therapy for ESRF was continuous ambulatory peritoneal dialysis (CAPD) in 60%, haemodialysis 25%, intermittent peritoneal dialysis 8%, and 7% were transplanted without prior dialysis. Between 1978 and 1988, 139 of these children were grafted; 53 received a graft (39 cadaveric, 10 living donor, 4 donor uncertain) below, and 86 (71 cadaveric, 14 living donor, 1 donor uncertain) above 2 years of age. One-year graft survival was 54% in the 53 children grafted below 2 years of age and 65% in the 86 grafted above 2 years of age. Only two of the 24 living donor grafts were lost during the first year after grafting. These results compare favourably with the 67% 1-year graft survival of all 278 children aged 2 to less than 6 years at grafting in 1978-1988 on the Registry's file. The 3-year survival of all children aged less than 2 years at start of RRT was 65% in 1978-1982 and rose to 78% in 1986-1988. Twenty-three percent of all deaths were caused by infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1992

Rehabilitation of young adults during renal replacement therapy in Europe. 1. The presence of disabilities.

The aim of this study was to analyse rehabilitation during RRT in 617 young adults from different European countries who started dialysis or transplantation before the age of 15 years. The data were derived from the EDTA Registry patient data files and a special questionnaire that was sent to centres reporting to the EDTA Registry. The duration of RRT was more than 10 years in 63% of patients. Fifty-four percent were living with a functioning graft and 46% were on dialysis. The prevalence and severity of motor, hearing, sight, and mental disabilities were analysed retrospectively. They were found to vary according to primary renal disease and method of treatment. One-third of patients had one or more disabilities at the start of RRT. Although disability status had changed in many patients by 31 December 1986, some disability remained in one-third of the patients available for study. Disabilities were recorded as mild in the majority of patients. Both improvement and worsening of motor and mental disability occurred more often than changes of hearing capacity and sight. It is concluded that prevention and treatment of disabilities need special attention in children and young adults on RRT in order to improve rehabilitation.

Adolescent↗
PubMed1992

Rehabilitation of young adults during renal replacement therapy in Europe. 2. Schooling, employment, and social situation.

The educational status, employment rate and social situation were studied in 617 patients between 21 and 35 years of age who started renal replacement therapy (RRT) as children. The data were derived from a special questionnaire concerning disability and rehabilitation sent to dialysis and transplant centres reporting to the EDTA Registry. Fifty-six percent of patients completed secondary school and one in three went on to vocational training. Eleven percent of patients attended university, and 16% were reported to have gone to a special school for the handicapped. Up to one-third of patients who attended different school types failed to complete their education. There were notable geographical differences in schooling and in employment. Fifty-six percent of all patients were employed. Lack of schooling was considered to be a major reason for unemployment. Sixty-one percent of patients with disabilities and 34% without disabilities were receiving invalidity payments. The place of residence of these patients aged 21-35 was usually the parental home. Compared to the general population of similar age, only a few patients were married (13.5% of the total study group) and 8% had children. In summary, the present report shows that the major factors influencing rehabilitation on RRT are the presence of disabilities, the method of treatment, geographical factors, duration of RRT, and the underlying primary renal disease.

Adolescent↗
PubMed1992

Successful pregnancies in women on renal replacement therapy: report from the EDTA Registry.

This study reports the geographical incidence of successful pregnancies in women on renal replacement therapy (RRT) and related information on gestation and clinical status of newborns. The impact of successful pregnancy on graft function was assessed by means of a retrospective case-control study. Since 1977 special questionnaires have been sent to each dialysis and transplant centre which reported babies born to mothers on RRT on the yearly centre questionnaire. After 10 years of data collection, a total of 490 pregnancies and 500 babies were available for analysis. A percentage of 88.4 of the babies were born to mothers with a functioning graft, 11.2% to mothers on chronic haemodialysis, and the remaining 0.4% to mothers on CAPD. Almost 50% of all successful pregnancies were reported from the UK. The number of successful pregnancies increased steadily and in parallel with the increasing number of females of childbearing age with a functioning renal transplant. The majority of mothers delivered at age 24-32. For transplanted mothers delivery occurred most commonly during the 3rd and 4th year after successful transplantation. In approximately 85% of cases the duration of pregnancy was shorter than the lower 10th percentile of normal. Birthweight was reduced in accordance with gestational age. Newborn mortality was 1.8%. Fifty-three mothers with a successful pregnancy in 1984-1987 were computer matched with controls according to a number of criteria. The serum creatinine concentration recorded in coded form at the end of each year on the individual EDTA patient questionnaire was used to assess changes in graft function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Risks and benefits of graft biopsy in renal transplantation under cyclosporin-A.

261 patients who received a kidney transplant under cyclosporin-A immunosuppression were reviewed in order evaluate the benefits and the risks of renal graft biopsies. 240 graft biopsies were performed in 124 of the 261 patients. The biopsy diagnoses were 103x rejection, 90x cyclosporin-A toxicity, 8x acute tubular necrosis, 8x glomerulonephritis, 9x different biopsy results, and 12 cases of normal renal tissue. In 214 cases the clinical course was well explained by the biopsy result. The histological results led to therapeutical changes in 199 cases. 221 of the 240 biopsies were performed without any complications. There was only one biopsy with irreversible and there were 19 biopsies with reversible complications.

Biopsy↗
PubMed1991

Renal transplantation in diabetic patients with or without simultaneous pancreatic transplantation 1986: data from the EDTA Registry.

This report summarises the outcome of 90 combined kidney/pancreatic grafts performed in Europe in 1986. Data for the combined kidney/pancreas grafts were obtained by a special questionnaire. The one-year patient and kidney graft survival is compared to the results of a group of 389 patients with diabetic nephropathy on the EDTA Registry data file who received kidney grafts alone. The recipients of combined kidney-pancreas grafts were younger, whereas a greater proportion of males received kidney graft alone. Patient survival at one year after transplantation was similar: 89% in recipients of combined transplants compared to 90% in recipients of kidney grafts alone. Kidney graft survival was 78% at one year for recipients of combined grafts versus 76%. It is concluded that pancreas transplantation has little effect on the fate of concomitant kidney grafts. The procedure should-in experienced hands and in selected patients-be almost as safe as kidney grafting alone.

Adult↗
PubMed1991

Control of hypertension by verapamil enhances renal damage in a rat remnant kidney model.

The effect of calcium channel blockers on the progression of renal failure is controversial. In contrast with earlier studies, we recently reported that moderately large doses of verapamil significantly accelerated chronic renal failure in the rat remnant kidney model. Studies reporting beneficial effects of verapamil were characterised by a much lower dose of verapamil and by the start of treatment immediately after renal ablation, which potentially interfered with the initial phase of remnant kidney hypertrophy. We therefore studied the effects of a high, fully antihypertensive oral dose of verapamil (100-150 mg/kg/per day; group Vera high) and a low, haemodynamically almost ineffective dose (10-15 mg/kg per day; group Vera low), on the progression of chronic renal failure in female Wistar rats with 5/6 nephrectomy. The treatment was started no earlier than 5 weeks after renal ablation, and matched groups of 20 animals were followed for 16 weeks thereafter. High-dose verapamil reduced systolic blood pressure to median values of 130-140 mmHg throughout the experimental period, whereas blood pressure in Vera low animals remained elevated at median values of 165-172 mmHg similar to non-treated rats with 172-185 mmHg median systolic blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Failure of verapamil to protect from ischaemic renal damage.

To reassess the reported protective effects of verapamil in renal ischaemia, we perfused the left kidney of uninephrectomized female Wistar rats with verapamil (0.1 and 1.0 mg/kg) immediately prior to clamping the renal artery for 60 min. When compared to controls, both doses of verapamil failed to afford protection with respect to urine flow, plasma creatinine, creatinine clearance or histology 24 and 48 h after ischaemia, whereas the purine nucleotide inosine (200 mg/kg) was partially protective: mean plasma creatinine 48 h after ischaemia (+/- SEM) was 547 +/- 54 mumol/l in controls, 686 +/- 38 mumol/l with 0.1 mg/kg verapamil, 491 +/- 68 mumol/l with 1.0 mg/kg verapamil and 374 +/- 45 mumol/l with inosine (p less than 0.05 vs. controls). Using the same model, the effect of verapamil 1.0 mg/kg on renal blood flow, creatinine clearance, urine flow and arterial pressure was studied in the first 2 h after ischaemia. Although significant amounts of verapamil were present in the kidney during ischaemia as evidenced by decreases in systemic blood pressure and in renal vascular resistance after unclamping the renal artery, the early course of renal failure was not altered when compared to controls. In conclusion, we have been unable to confirm earlier reports of a protective effect of verapamil in this rat model of ischaemic renal failure. If there is such an effect, its demonstration appears to depend on very specific experimental circumstances. Based on the results of this and other studies, verapamil is unlikely to afford an impressive overall benefit in the clinical setting of ischaemic renal failure.

Animals↗
PubMed1990

Results of renal replacement therapy in Europe, 1980 to 1987. Registration Committee of the EDTA-ERA.

The characteristics of the patient populations accepted for and undergoing renal replacement therapy (RRT) in Europe in 1980 to 1987 are presented. Acceptance rates have increased in most countries reporting to the EDTA Registry and have reached from between 50 to over 80 per million population in the more affluent Western European countries in 1987. Increasing acceptance rates were due to the inclusion of patient groups at a higher risk of dying, such as the elderly and those with diabetic nephropathy. Despite the acceptance of a growing proportion of high-risk patients, no increase in overall mortality was apparent. Gross mortality (some 10% annually) changed little between 1980 and 1987 for patients on hemodialysis, decreased sharply from 1980 to 1984 for patients on continuous ambulatory peritoneal dialysis (CAPD), and improved continuously from 4.2% in 1980 to 2.4% in 1987 for patients with a functioning kidney graft. In order to determine mortality more accurately, actuarial survival rates and annual death rates per thousand patient years at risk were computed according to age groups and to primary renal disease groups, both for the total patient data file and for selected countries. Actuarial 5-year survival on hemodialysis for all patients starting treatment between 1982 and 1987 varied according to age, being 84% in patients age 15 to 24 years and 20% in those age 75 to 84 years. Patients with "standard" primary renal diseases had slightly better survival, while of the group with diabetic nephropathy only 51% age 25 to 34 and no more than 3% of those age 75 to 84 survived the 5-year mark. To recognize trends in the mortality between 1980 and 1987, annual death rates for all patients on record, age 45 to 54 and 55 to 64 at the beginning of 1980, 1983, 1985, and 1987 were computed both for the total Registry and for the FRG. Despite an increasing acceptance rate of patients with diabetic nephropathy, the annual death rates on hemodialysis decreased or remained stable both for the total Registry and for the FRG. Death rates in patients with a functioning graft decreased. It is concluded that, during the last decade, survival on RRT has continued to improve not only because of decreasing mortality after transplantation and on CAPD, but also due to improving survival on hemodialysis. The latter is not readily apparent because of the increasing acceptance rate in older patient groups and a rapidly rising proportion of patients with diabetic nephropathy in most European countries.

Adolescent↗
PubMed1990

The use of continuous peritoneal dialysis in Europe for the treatment of children with end-stage renal failure: data from the EDTA Registry.

The demographic data on the use of continuous peritoneal dialysis in Europe for children starting renal replacement therapy under the age of 15 years was obtained from data collected by the Registry of the European Dialysis and Transplant Association--European Renal Association (EDTA Registry) on individual patient questionnaires 1980-1986. Continuous ambulatory peritoneal dialysis (CAPD) and its variants appeared to be increasingly utilised as treatment for children with end-stage renal failure (ESRF) and accounted for approximately 25% of all renal replacement therapy (RRT). Important differences in its use in various European countries are demonstrated. The proportional contribution of CAPD to treatment was higher during the first year of RRT and gradually decreased thereafter. No significant sex differences existed in the use of this treatment. Approximately 70% of all patients on CAPD were older than 6 years of age, but it is in those under 6 years that the highest proportion are put on CAPD as first method of treatment for end-stage renal failure. The most common cause of abandonment of this treatment was peritonitis, which contributed 50% of the drop-out rate.

Adolescent↗