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Biomedical subjects

G Keusch

Publications and source records attributed to G Keusch.

At least 73 records · Page 4Linked to original sources
PubMed1984

[Acute kidney failure in patients with multiple injuries].

19 patients suffering from posttraumatic acute renal failure were treated by hemodialysis at least three times a week and sometimes daily. In addition to trauma and acute renal failure (arf), all patients had various other posttraumatic complications. The overall mortality within 12 months from trauma was 84%. The high mortality rate was due mainly to the extent of injury and the occurrence of life-threatening complications, above all sepsis. Whether or not these basic problems are aggravated by arf, the overall results of the treatment call for careful establishment of the indications for these laborious and expensive therapeutic measures.

Acute Kidney Injury↗
PubMed1984

[Circulating immune complexes before and after kidney allotransplantation].

In a prospective study circulating immune complexes (CIC) were analyzed before and serially after renal transplantation in 141 consecutive patients. CIC were measured using the Raji cell assay as originally described by Theofilopoulos and Dixon. The amount of CIC was expressed as microgram heat aggregated human immunoglobulin G (IgG) equivalent/ml serum. The upper limit of normal sera was 25 micrograms/ml. The values are expressed as geometric means (- 1 SD/ + 1 SD). In 86 of 133 rejection episodes a renal biopsy was performed and the histopathologic changes were semiquantitatively assessed and classified in a cellular or vascular type of rejection. Before transplantation CIC were detected in 104 of 141 patients (73.8%) and the mean value was 65.6 (27.8-154.9) micrograms/ml. The level of CIC was positively correlated with the number of grafts (r: 0.43; P less than 0.01) and the occurrence of chronic active hepatitis (r: 0.31; P less than 0.01). No correlation was found between CIC and the underlying kidney disease, the number of blood transfusions prior to transplantation, and the pre-existing lymphocytotoxic antibodies. Graft survival and number of rejection episodes were not influenced by the level of CIC prior to transplantation. After transplantation CIC were elevated in 60 patients (41%), appeared transiently in 49 patients (35%) and were never detectable in 32 patients (23%). In patients with a graft survival less than or equal to 11 months the average and peak post-transplant CIC levels were significantly higher than patients with a graft survival of 12 months: 64.4 (21.8-191.0); 87.7 (26.0-295.8) versus 39.6 (18.4-85.3); 56.8 (21.0-150.1) micrograms/ml; P less than 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Pharmacokinetics of phenytoin in continuous ambulatory peritoneal dialysis. 2 cases and brief review of the literature].

The pharmacokinetics of phenytoin are studied in 2 patients on CAPD treatment. Free and protein bound phenytoin are lost in the dialysate. The peritoneal clearance of phenytoin varies from 1.6 to 2.4 ml/min. The peritoneal mass transfer varies from 0.022 to 0.059 mumol/min, depending on the phenytoin dose given. The dialysate concentrations of phenytoin reach 40% of the serum levels. Peritoneal losses of phenytoin may be 5% of the daily intake. The clinical significance of serum level measurements in monitoring of phenytoin therapy is discussed. Beside clinical symptoms, the serum free phenytoin level is of most importance. In uremic patients the albumin-bound fraction of phenytoin is reduced.

Adult↗
PubMed1983

[Treatment of chronic kidney failure in diabetes mellitus].

27 patients suffering from end stage diabetic renal failure were treated by hemodialysis (HD) [8], continuous ambulatory peritoneal dialysis (CAPD) [13] or kidney allotransplantation after previous dialysis (KT) [13]. The mean age of the patients was 39.8 +/- 9.8, 44.8 +/- 11.3 and 33.8 +/- 5.7 for HD, CAPD and KT groups respectively. The cumulative patient survival after 1 and 2 years of treatment was 24%/0%, 56%/0% and 70%/50% for HD, CAPD and KT treatment. The cumulative allotransplant survival amounted to 40% after 1 year and to 20% after 2 and 3 years. Causes of death included cardiovascular complications in 7 patients, especially during HD treatment; infections occurred in 6 patients during CAPD treatment and after kidney allografting. Hypertension persisted during HD treatment and disappeared in 1/3 of the patients after KT. Nonlethal cardiovascular problems were observed during all treatment regimens and were more prominent in HD patients. In 2 patients, 3 amputations of the legs had to be performed after KT. Visual power deteriorated in more than half of the patients on HD and in one third during CAPD; it remained stable in half of the patients after KT. Neuropathy deteriorated during HD, was stable during CAPD and improved after KT. Rehabilitation was better during CAPD or after KT than during HD. The results of kidney replacement therapy in diabetics are worse than in non diabetic patients due to extrarenal organ damage. Early renal transplantation might prove to ameliorate this situation.

Adult↗
PubMed1983

[Glomerular changes in reflux nephropathy].

Two patients with bilateral vesicoureteral reflux are presented. In both cases renal insufficiency progressed despite surgical correction of the vesicoureteral reflux and proteinuria persisted. Biopsy specimens from both patients revealed interstitial damage and segmental and focal glomerulosclerosis. These glomerular lesions in association with reflux nephropathy may be an important cause of renal function deterioration.

Adult↗
PubMed1983

Diazoxide and labetalol in acute hypertension during haemodialysis.

The antihypertensive effect of the peripheral vasodilator diazoxide in 13 patients and the alpha-beta adrenoceptor blocking agent labetalol in 12 patients were compared in 46 severe acute hypertensive episodes during haemodialysis. A single dose of diazoxide 150 mg or labetalol 50 mg was effective in 74% and 70% of the hypertensive episodes, respectively. In the diazoxide-treated patients blood pressure fell from 192 +/- 3/115 +/- 4 mmHg to 141 +/- 8/85 +/- 4 mmHg 2 h after injection. In 7 hypertensive episodes a second dose of diazoxide 150 mg was given 60 +/- 11 min after the first injection. The reduction in mean arterial blood pressure at the end of haemodialysis was 21.5 +/- 2.6% in patients treated with a single dose and 24.8 +/- 3.5% in patients treated with the repeated dose of diazoxide. In the labetalol-treated patients blood pressure in 17 instances fell from 198 +/- 5/104 +/- 4 mmHg to 143 +/- 7/89 +/- 5 mmHg 180 min following injection of labetalol 50 mg. In 6 episodes a second dose labetalol 50 mg was given 41 +/- 9 min after the first injection. At the end of haemodialysis the decrease in mean arterial blood pressure was 17.2% in patients treated with a single dose and 18 +/- 5% in patients given the repeated dose of labetalol. The reduction in blood pressure caused by diazoxide was slightly greater than that due to labetalol. At the end of haemodialysis the percentage reduction in mean arterial blood pressure was 23 +/- 2% in the diazoxide-treated group and 17 +/- 2% after labetalol.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Antihypertensive mechanism of diuretic treatment with chlorthalidone. Complementary roles of sympathetic axis and sodium.

Twenty-three patients with untreated mild to moderate essential hypertension had on the average an abnormally increased cardiovascular pressor responsiveness to exogenous norepinephrine (NE), while plasma and urinary NE, exchangeable body sodium and blood volume were normal. An increased pressor responsiveness to angiotensin II in these patients was associated with a tendency for low plasma renin activity (PRA). Compared to placebo conditions, treatment with chlorthalidone, 100 mg/day, for 6 weeks significantly decreased blood pressure and exchangeable sodium in these hypertensive patients but not in ten normal subjects; blood volume and heart rate were unchanged in both groups. Chlorthalidone induced a marked increase in PRA, but only a mild increase in angiotensin II pressor dose. In contrast, the diuretic caused a greater increase in NE pressor dose than in plasma NE in the hypertensive group, thus improving the disturbed relationship between plasma NE and NE responsiveness in these patients. No significant modification of plasma NE and NE responsiveness occurred in diuretic-treated normal subjects. In addition to sodium and the renin-angiotensin system, the sympathetic regulatory axis seems to be involved in the antihypertensive mechanism of chlorthalidone. Thiazide-like diuretics may decrease blood pressure in essential hypertension in part by lowering an abnormally high cardiovascular NE responsiveness without causing an equivalent increase in circulating NE.

Adult↗
PubMed1983

Correction of altered noradrenaline reactivity in essential hypertension by indapamide.

Fourteen patients with untreated mild to moderate essential hypertension had, on average, an abnormally high cardiovascular reactivity to exogenous noradrenaline and angiotensin II, while plasma noradrenaline, renin activity, exchangeable body sodium, and blood volume were normal. Treatment with a low dose of indapamide (2.5 mg/day) for 6 weeks decreased blood pressure by 10% in these hypertensive patients but not in 13 normal control subjects. Plasma or blood volume and exchangeable sodium were not changed significantly; nevertheless, the latter, and body weight, tended to be decreased slightly. Though a mild reduction in extracellular sodium in both normal and hypertensive subjects appears possible, it may not fully explain per se the blood pressure-lowering effect of indapamide in essential hypertension. Indapamide induced a mild decrease in angiotensin II pressor responsiveness in normal or hypertensive subjects, but a possible depressor influence from this change was probably antagonized by a concomitant pronounced increase in plasma renin activity. In hypertensive patients, the abnormally high noradrenaline reactivity was corrected by indapamide without an accompanying increase in endogenous plasma noradrenaline levels. Indapamide-induced changes in blood pressure correlated with those in noradrenaline pressor dose. It was concluded, therefore, that indapamide may decrease blood pressure in essential hypertension at least in part by lowering an abnormally high cardiovascular noradrenaline reactivity without causing an equivalent increase in adrenergic nervous activity.

Adolescent↗
PubMed1983

Effect of pindolol and propranolol on plasma renin and aldosterone in patients with renal allograft.

To investigate the effect of propranolol and pindolol on renin and aldosterone secretion, blood samples of 12 nephrectomized kidney transplant recipients were taken after 1 hour in supine position and 30 and 60 minutes after posture change. This procedure was repeated after 4 days under pindolol (3 X 5 mg/day) or propranolol (4 X 40 mg/day). Both pindolol and propranolol suppressed the significant orthostatic rise of plasma renin activity (PRA) seen without medication. Pindolol increased basal PRA markedly, whereas basal PRA under propranolol was the same as without betablockers. Plasma aldosterone (PA) showed significant orthostatic rise under all conditions and thus did not parallel PRA under betablockers. Suppression of PRA response to posture change by betablockers indicates that circulating catecholamines may be involved in orthostatic PRA regulation. The intrinsic sympathetic activity of pindolol results in an increase of basal PRA. In nephrectomized renal transplant recipients, postural PA changes do not seem to be triggered by PRA.

Adult↗
PubMed1982

[Plasma exchange in progressive lupus nephritis].

The clinical course in 8 patients with systemic lupus erythematosus (SLE) complicated by sever lupus nephritis (LN) with progressive renal insufficiency was investigated to evaluate the therapeutic role of plasma exchange in this disease. In 6 patients treated with corticosteroids and immunosuppressive drugs, only a creatinine level exceeding 4.0 mg% resulted in hemodialysis or death. In 2 patients under additional plasma exchange the creatinine value fell below 4.0 mg% and was stabilized at that level over a now lengthy period of time. It cannot yet be concluded that additional plasma exchange definitely prevents hemodialysis. However, stabilization of renal function could optimize conventional therapy, thereby limiting side effects as well as risk of infection.

Adolescent↗
PubMed1982

[Drug-induced kidney disorders].

That the kidneys are vulnerable to damage by drugs is due to functional and morphological factors. Because of the high blood flow to the kidney and the high filtration fractions of the glomerular capillaries, large amounts of solutes are delivered to the tubular system. Luminal concentrations are further increased by tubular transport processes, thus exposing the tubular epithelium to high concentrations. In the medullary interstitium solute concentrations may reach high values by the counter-current multiplier system. Active enzyme systems in the kidney are capable of activating drugs into reactive toxins ("metabolic activation"). Nephrotoxic reactions due to drugs may affect each segment of the nephron, the medullary interstitium and the renal vasculature, resulting in different nephrotoxic syndromes. The drug-induced nephropathies of greatest clinical importance are reviewed and the most common nephrotoxic agents are mentioned. The underlying mechanisms of drug nephrotoxicity include a direct toxic, dose-related cellular injury or an immunologically mediated nephrotoxic drug reaction.

Aminoglycosides↗