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Biomedical subjects

F P Brunner

Publications and source records attributed to F P Brunner.

At least 55 records · Page 3Linked to original sources
PubMed1990

Kidney transplantation in primary oxalosis: data from the EDTA Registry.

This paper reports the results of 98 first kidney transplantations in patients with oxalosis as the primary renal disease as recorded by the EDTA Registry. There were 79 patients who received a cadaveric (CAD) graft and 15 patients with a living related donor (LRD) graft; the type of donor was not recorded for four patients. Initial graft survival appeared to be better after LRD as compared to CAD grafts but at 3 years the poor survival was similar with 23% for LRD and 17% for CAD grafts. CAD graft survival did not differ between children and adults and was not affected by the waiting time on dialysis. A slight improvement was observed in grafts performed in the years 1983-1986 as compared to grafts performed in earlier years. The causes of failure reported were mainly rejection (33%) and recurrence of primary renal disease (31%). In view of the poor results related to recurrence of oxalosis in the graft, the potential of combined kidney and liver transplantation is discussed.

Adolescent↗
PubMed1990

Case control study on dialysis arthropathy: the influence of two different dialysis membranes: data from the EDTA Registry.

In a retrospective case control study the prevalence of signs and symptoms of dialysis osteoarthropathy was analysed. Cases and controls had received over 9 years of maintenance haemodialysis uninterrupted by peritoneal dialysis or transplantation. The cases comprised 55 patients treated predominantly with polyacrylonitrile (AN69) dialysers. They were compared to a matched group dialysed exclusively with cellulosic membranes. Over 60% of all patients, cases and controls, showed one or more signs of disabling osteoarthropathy, with joint pains occurring more frequently in the older age groups. Twenty-seven of the 55 cases who had received less than 2 years of cellulosic membrane dialysis followed by 7-12 years of AN69 dialysis tended to have a lower prevalence of joint pains, carpal-tunnel syndrome and bone cysts. However, no statistically significant differences were obtained compared to the matched control group dialysed exclusively on cellulosic membranes (mostly cuprophane). The remaining 28 cases, who had been treated for more than 2 years with cellulosic membranes preceding the longer treatment period with polyacrylonitrile dialysers, showed a prevalence similar to that of their cellulosic controls. This study thus shows little, if any, influence of the two types of membranes on the prevalence of signs and symptoms of beta 2-microglobulin amyloidosis.

Acrylic Resins↗
PubMed1989

[Long-term management of patients with chronic renal failure].

Any type of chronic renal disease is associated with functional deterioration of the kidney due to progressive glomerulosclerosis with interstitial fibrosis and tubular atrophy. This process is thought to be predominantly due either to glomerular hyperfiltration or mesangial overload with macromolecules. Antihypertensive therapy, particularly with ACE inhibitors, and protein restriction have been found to retard progressive glomerulosclerosis in animal experiments. There is no doubt that patients with renal disease benefit from antihypertensive therapy through both preservation of renal function and prevention of secondary organ damage due to hypertension. However, the value of protein restricted diets with or without supplements of essential amino acids or ketoacids is less clear. A patient treated with protein restriction is presented and the investigations necessary to monitor compliance, renal function and nutrition are discussed. Monthly to quarterly controls of renal function, blood pressure and mineral metabolism are suggested, particularly in the case of severe hypertension and of prophylactic treatment for renal osteodystrophy with phosphate binders and vitamin D metabolites. Finally, guidelines are provided for planning of renal replacement therapy by dialysis and renal transplantation in the individual patient.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1989

Contribution of toxic nephropathies to end-stage renal failure in Europe: a report from the EDTA-ERA registry.

In countries which reported to the registry of the European Dialysis and Transplant Association (EDTA)-European Renal Association, 2.4% of 147 092 treated patients were recognized as having analgesic nephropathy (AN) as the cause of end-stage renal failure (ESRF) on 31 December 1986. A small number of patients had other specific drug nephropathies, but these do not yet make an important contribution to ESRF treatment programmes. It is possible that more patients have ESRF due to AN, and evidence from studies of age distribution, the demography of urothelial malignancies, a special study of diagnostic criteria, data on sales of analgesics, and a study of regional areas of high incidence lend some support to that view. Changes in prescription and self-medication practices over the last 20 years have almost eradicated analgesic nephropathy from the U.K. and Sweden, two countries in which there was previously a high frequency of ESRF due to AN. In other countries where action has been taken more recently, cases are still reported fairly frequently, and this seems likely to continue for several years to come.

Adolescent↗
PubMed1989

Twenty-three years of dialysis and transplantation in Europe: experiences of the EDTA Registry.

The history of the Registry of the European Dialysis and Transplant Association-European Renal Association (EDTA-ERA) is outlined. The development of this Registry, which is run by physicians for physicians, the progress from analyses by hand to computerization, the generation of financial support, and the contribution to the annual congresses of the EDTA-ERA are described. In view of the many smaller countries in Europe, the importance of multicenter research that is organized by a registry serving a large population base is stressed.

Europe↗
PubMed1989

Long-term enalapril and verapamil in rats with reduced renal mass.

The effect of long-term treatment with either enalapril or high dose verapamil on survival, proteinuria, blood pressure and renal morphology was studied in female Wistar rats with markedly reduced renal mass. Four weeks were allowed for remnant kidney hypertrophy before determining the response to renal ablation of individual animals regarding proteinuria and hypertension. At this time, five groups of 18 rats were formed with equal levels of proteinuria and hypertension. Groups E1 and E2 were treated with enalapril, groups V1 and V2 with verapamil, and one group served as control. The daily food allowance was 14 g/rat of a standard rat diet, containing 30% protein and 100 mmol NaCl/kg food in groups E1 and V1. NaCl content was reduced to 20 mmol/kg food in groups E2, V2 and control. The drugs were added to the drinking water, enalapril at a dose of 0.1 g/liter, verapamil at 0.5 to 0.7 g/liter. Drug intake thus amounted to 10 to 25 mg/kg for enalapril and 50 to 140 mg/kg for verapamil. Treatment was continued for 15 weeks. Three of the 18 control rats did not survive up to 15 weeks. Mortality was lower in the enalapril treated groups with a single nonsurvivor in group E1. In contrast, mortality was higher in the verapamil treated animals with seven nonsurvivors in group V1 and eight in group V2. Blood pressure control was excellent in both enalapril treated groups. and proteinuria decreased in most animals of group E1 and all of group 22. Glomerulosclerosis did not develop in the majority of the enalapril treated animals. Despite the high dose, verapamil barely lowered blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

EDTA Registry centre survey, 1986. Report from the European Dialysis and Transplant Association Registry.

This paper summarises the information given on the 1986 EDTA Registry centre questionnaire which was returned by 82% of the 2,065 known dialysis and transplant centres in 33 European countries. Information is given on the number of patients alive on haemodialysis according to the type of dialysis facilities available where the patient was receiving dialysis and the number of patients receiving special types of dialysis. The centre questionnaire also included questions on testing for HIV infection, serological evidence or symptoms of AIDS and the diagnosis of hepatitis B in patients and staff. The data given in response to these questions are presented together with data on the involvement of dietitians and social workers in the treatment of patients with end stage renal failure. Finally, information on transplant activity in Europe and the treatment policies of transplanting centres is provided.

AIDS Serodiagnosis↗
PubMed1989

[The role of continuous ambulatory peritoneal dialysis in the treatment of chronic end-stage uremia. Registration Committee of the European Dialysis and Transplant Association-European Renal Association].

By the end of 1986, about 9% of the patients with TU submitted in Europe to maintenance dialysis therapy (MDT) were treated with CAPD. According to data collected by the EDTA Registry in 6 Western European Countries, the proportion of dialysis centres which in each country developed an active CAPD program has remained virtually unchanged from 1981 through 1986. In all countries CAPD is used preferably in diabetics and in patients aged more than 65 years. The 3 year technical survival is higher for the patients who started CAPD in 1983 than for those who did so in 1981 and is heavily influenced by an overall treatment strategy of TU which integrates a CAPD-renal transplantation program. In several countries the slow development of CAPD can be mainly accounted for by a weak motivation of nephrologists for implementing this efficient mode of RRT.

Adult↗
PubMed1988

The angiotensin converting enzyme inhibitor enalapril in acute ischemic renal failure in rats.

The influence of the renin-angiotensin system on renal hemodynamics, tubular pressure and tubulo-glomerular feedback was investigated with the angiotensin converting enzyme inhibitor MK 421 (enalapril), in uninephrectomized rats with and without ischemia-induced acute renal failure. In animals with normal renal function proximal tubular pressure and tubulo-glomerular feedback response were lowered by enalapril long-term treatment, whereas glomerular filtration rate and renal blood flow were not influenced by the drug. After 45 and 70 minutes ischemia there was no difference between treated and untreated animals in the severely impaired glomerular filtration rate. Renal blood flow remained unaffected by the treatment. The histological damage due to ischemia (tubular casts, tubular necrosis and medullary capillary congestion) was not influenced by enalapril. As tubulo-glomerular feedback had been significantly inhibited during renin-angiotensin inhibition, its importance in mediating acute renal failure remains doubtful; other factors such as tubular obstruction and medullary congestion may be crucial.

Acute Kidney Injury↗
PubMed1988

Renal replacement therapy in patients with diabetic nephropathy, 1980-1985. Report from the European Dialysis and Transplant Association Registry.

Diabetic nephropathy, a rarely listed cause of end-stage renal failure (ESRF) among patients starting renal replacement therapy (RRT) in the early seventies, has progressively gained in importance and become one of the major reasons for the continuous growth of the patient population on RRT in most European countries. Amongst new patients commencing RRT in 1985, the acceptance rate varied between 3 and 12 per million population for type I diabetes mellitus and between one and four per million population for type II diabetes mellitus. Nordic countries, particularly Sweden and Finland, had the highest acceptance rate of young patients with type I diabetes mellitus whose median ages were 38-42 years. In most central and southern European countries the median age of patients with type I diabetes mellitus varied between 50 and 58 years. The high number of young patients with type I diabetes mellitus and ESRF in Nordic countries point to a different natural history of this disease. It cannot be excluded, however, that the higher median age in other countries might result from doctors mistakenly diagnosing type I disease in patients with type II disease who need insulin treatment. Patients with type II diabetes mellitus had a similar age distribution at start of RRT throughout Europe and their median ages clustered around 60 years in most countries. The contribution of haemodialysis, peritoneal dialysis and renal transplantation was analysed for diabetic compared to non-diabetic ESRF. Despite large geographical differences in the proportional use of methods of treatment, a general trend to apply CAPD more frequently in diabetic as compared to non-diabetic patients was observed, and this was true for countries with both predominant haemodialysis and predominant transplant programmes. Transplantation without prior dialysis was performed in 17% of Swedish and 30% of Norwegian patients with type I diabetes mellitus. In order to better explain the mortality of patients with diabetic ESRF, the proportional distribution of causes of death was analysed. Myocardial ischaemia and infarction was confirmed to be the leading cause of death in patients with diabetes mellitus on RRT. The coronary death rate was estimated to be 10 times greater in young patients with type I diabetes mellitus as compared to their non-diabetic counterparts. Other cardiovascular as well as infectious causes were recorded in a similar proportion of deaths in diabetics as in non-diabetics. Cancer deaths, however, appeared to be definitely less frequent in patients on RRT due to diabetic nephropathy.

Adult↗
PubMed1988

Case-control study to determine the cause of sclerosing peritoneal disease.

This paper presents the results of a case control study based on 55 patients identified with sclerosing peritoneal disease through the 1984 centre questionnaire. For each case with a confirmed finding of small bowel enclosed in a bag or 'cocoon' of thickened peritoneum, three controls were selected from the main EDTA Registry patient file. Questionnaires were sent out on cases and controls in order to compare exposure to a number of factors implicated in the aetiology of sclerosing peritoneal disease. These included a history of peritonitis, use of agents to sterilise the tubing connection, use of bacterial filters and buffers, drugs added to the dialysate, and history of medication with beta-blockers. Questionnaires were returned for 82% of cases and 74% of controls. Analysis of the returns using McNemar's test showed a significantly higher exposure to chlorhexidine in cases compared with controls. On the basis of this strong association, it seems advisable that the use of chlorhexidine to sterilise tubing connections for peritoneal dialysis patients should be halted.

Chlorhexidine↗
PubMed1988

Survival on renal replacement therapy: data from the EDTA Registry.

Extensive survival data are presented from the EDTA Registry's files for patients who started renal replacement therapy in 1970-1974 compared to 1980-1984. The contribution of the different treatment modalities (haemodialysis, continuous peritoneal dialysis, and transplantation) to the survival of patients according to geographical region is also shown. Survival on renal replacement therapy, irrespective of treatment modality and of primary renal disease, was best in the 10-14-year-old patients, with 58% at 10 years and 52% at 15 years, and decreased with rising age to 28% at 10 years and 16% at 15 years in patients aged 45-54 when they commenced therapy in 1970-1974. When comparing the 0-4-year-old with the 10-14-year-old cohort of the paediatric patients, 5-year survival rates for patients starting renal replacement therapy in the early eighties declined from 85% to 70% with decreasing age. Treatment policy, as reflected by the proportion of patients on different modes of therapy, varied markedly between European regions but affected survival to a small extent only. The large population with diabetic nephropathy incurred annual mortality rates 2-3 times greater than those observed in patients with 'standard' primary renal diseases. Haemodialysis and continuous peritoneal dialysis, although not comparable because of important differences in selection policy, yielded similar survival rates. Patients and graft survival rates have improved markedly when comparing patients starting renal replacement therapy in the early seventies with the eighties; particularly for cadaveric transplantation. Patient survival after second grafting was similar to that after first grafting, with 83% at 5 years after second cadaveric grafting in the 15-44-year-old cohort, vs 85% after first cadaver transplantation in 1980-1984. Second cadaveric graft survival was superior to average first-graft survival for those recipients whose first graft had been functioning for more than 1 year. However, second-graft survival in rapid rejectors of a first graft as well as third cadaveric graft survival were curtailed by the large number of early losses, with only 52% of third grafts functioning at 1 year. For living related donor transplantation, parents were mostly used in children whilst identical siblings predominated in adults older than 45. In the early eighties, patient survival was 92% at 5 years for recipients younger than 15, 87% for the 15-45 year old cohort and 72% for those aged 45 or older.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1987

Alport's syndrome as a cause of renal failure in Europe.

We studied the geographical distribution, male to female ratio, and age at the start of renal replacement therapy (RRT) for end-stage renal failure (ESRF) in 600 patients with hereditary nephritis with nerve deafness (Alport's syndrome) reported to the European Dialysis and Transplant Association Registry since 1975. Annual age- and sex-specific acceptance rates for RRT showed a variable peak incidence according to country, ranging between, 0 and 2.4 patients per million population in males aged 15-24 years, but with only about half this incidence in females. In Scandinavian countries there were very few females who started RRT, and males were older than in the rest of Europe. The overall male to female ratio was 4:1. The median age at the start of RRT was: males (n = 479) 24.3 years (1st quartile 19.5 years; 3rd quartile 31.5 years); females (n = 121) 31.5 years (1st quartile 23.0 years; 3rd quartile 43.2 years). Our study provided confirmation that males reach ESRF earlier than females. In addition, we detected previously unrecognized geographical differences.

Adolescent↗
PubMed1986

[Cyclosporin A and hyperlipidemia after kidney transplantation. Prospective study].

Hyperlipidemia is common after renal transplantation and has been attributed, at least in part, to corticosteroid therapy. We therefore studied serum lipids in a group of nondiabetic transplant recipients on conventional immunosuppression with azathioprin and prednisone (Aza/P), in comparison with a transplanted group on cyclosporin A monotherapy (CyA) without steroids. Frequency and degree of hyperlipidemia in the two groups showed no significant difference. Atherogenic hypercholesteremia was found as frequently in patients on CyA as in those on Aza/P. Possible factors preventing normalization are discussed.

Adult↗
PubMed1986

[Glomerular erythrocytes in urine. Identification and significance].

The glomerular origin of microhematuria can often be identified by typical changes in erythrocyte morphology when the urinary sediment is examined with a phase contrast microscope. The so-called "glomerular erythrocytes" appear in uneven annular shape (ring forms) or as fragmented, crushed and ruptured cells (destroyed forms). Non-glomerular erythrocytes originating from the urinary tract have different morphological characteristics. The occurrence of only a few glomerular erythrocytes (0-2 per high power field) is a normal finding. The morphological characteristics of the erythrocytes should be analyzed as the first step in the work up of microhematuria. In the case of clearcut glomerular microhematuria, unnecessary urological or radiographical investigation can thus be avoided.

Erythrocytes↗
PubMed1986

Mannitol potentiates cyclosporine nephrotoxicity.

A possible drug interaction between cyclosporine (CyA) and mannitol was tested for in female Wistar rats infused continuously with CyA 10 mg (40-50 mg/kg BW) in 24 ml mannitol 20% daily for 3 to 4 days (group CIM). For comparison, two other groups of rats were infused either with the same amount of CyA in 24 ml NaCl 0.9% (group CINa) or with the same amount of mannitol without CyA (group M). No animal of groups CINa or M, but 6 out of 10 group CIM rats developed severe oligo-anuric acute renal failure (ARF). Histologically massive vacuolisation of proximal tubular epithelia was found in the kidneys of CIM rats with ARF, while CIM rats without ARF showed minor to moderate degrees of vacuolisation. No vacuolisation was seen in groups CINa and M. Moderate amounts of tubular inclusion bodies and microcalcifications were detected in the kidneys of CIM rats without ARF and in those of CINa rats. To elucidate the mechanism of ARF, renal blood flow, creatinine clearance and proximal tubular pressures were measured in the kidneys of another series of CIM rats infused for 48-96 hours with CyA and mannitol. Renal blood flow and proximal tubular pressures in the kidneys of animals that had not or not yet developed ARF did not differ from those in rats infused with mannitol alone despite histological alterations with minor to moderate degrees of vacuolisation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗