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Biomedical subjects

J Brodehl

Publications and source records attributed to J Brodehl.

At least 127 records · Page 7Linked to original sources
PubMed1987

Cyclosporine in pediatric kidney transplantation.

The immunosuppressive treatment with cyclosporin A plus low-dose prednisolone in 33 children after kidney transplantation was compared with conventional treatment with azathioprine plus regular prednisolone dosage in 34 children. The results showed the following: Graft survival in the CyA group is significantly better than in the conventional group (97% vs. 68% at one year). Patient survival is the same in both groups (97% vs. 94%). Kidney function six weeks and one year after successful renal transplantation is significantly lower in the CyA group than in the conventional group. The major nephrotoxic effect of CyA seems to be related to the first period after kidney transplantation, since later the decline in renal function is the same in both treatment groups. Other side effects of CyA are not severe and are well manageable. A major benefit of CyA treatment is the growth after transplantation, which is significantly better than in the conventional group. Almost all transplanted children show normal or even catch-up growth rates.

Adolescent↗
PubMed1987

Complete absence of tubular glucose reabsorption: a new type of renal glucosuria (type 0).

Primary renal glucosuria is an inherited defect of tubular glucose reabsorption and usually classified in type A and type B. We now observed a new type in a 15-year-old boy who had a complete absence of tubular glucose reabsorption. His father had a daily glucosuria of 1.1 g/1.73 m2 and his mother of 2.7 g/1.73 m2. Two siblings excreted 0.4 g/1.73 m2 and 0.3 g/1.73 m2 glucose and one sister had no glucosuria. The proband excreted daily 136 to 160 g/1.73 m2 glucose accompanied by normal blood glucose levels between 75-105 mg/dl. The glomerular filtration rate (inulin clearance) was 148-153 ml/min/1.73 m2 and the endogenous glucose clearance was 112-160 ml/min/1.73 m2 when blood glucose levels were 72-82 mg/dl. Thus, glucose clearance was nearly identical to inulin-clearance. After intravenous glucose loading with a blood glucose concentration of 261-342 mg/dl, glucose clearance remained in the same range and tubular glucose reabsorption was virtually absent. There were no disturbances in tubular reabsorption of other substrates. This new type of primary renal glucosuria was not recognized thus far, and we propose to call it type O glucosuria. The family tree revealed consanguinity and most probably the proband is homozygous and both his parents are heterozygous for type O renal glucosuria.

Adolescent↗
PubMed1986

[Liver transplantation in childhood].

From 1977 to 1985 altogether 143 children were referred to our hospital for liver transplantation. These children were aged 6 months to 15 years. According to the results of a defined examination protocol liver transplantation was indicated in 102 of these children. Contraindications were observed in 17 patients. In 14 children liver transplantation was not yet indicated. Parents of 8 children refused transplantation. Only 30 children have been transplanted so far. Out of these, 21 actually survive. The cumulative 5-year survival rate after transplantation is calculated to be 60.5%.

Adolescent↗
PubMed1986

[Primary polyuric kidney failure and acute yellow liver dystrophy following infusion of glucose substitutes in children].

Four children (aged 2 1/2-14 years) were given infusions of fructose, sorbitol and xylitol after sustaining head trauma (n = 3) or after attempted suicide with carbromal (n = 1). After transitory polyuria renal failure of varying severity set in three to five days after onset of the infusion treatment. Serum osmolality fell to 265-274 mosm/kg, haematocrit to 0.25-0.31, and hyponatraemia developed. Serum creatinine rose to maximally 256-930 mumol/l. Liver damage developed in parallel to the renal failure, two children dying with acute yellow liver atrophy. Two children--given symptomatic treatment with balanced equalization of the hyponatraemia, administration of frusemide and adjusted carbohydrate substitution--were discharged after four to eight weeks with normal renal and hepatic functions. Dialysis was not required. The hepatic and renal abnormalities must have been due to the high amounts of fructose, sorbitol and xylitol, to a total of 7.1-23.0 g/kg on the first day, well above recommended levels.

Acute Kidney Injury↗
PubMed1986

Acute renal failure in children: prognostic features after treatment with acute dialysis.

A 12-year review (1972-1983) is presented of 76 children who were dialysed because of acute renal failure. The causes of acute renal failure were mainly the haemolytic-uraemic syndrome (53%), trauma (16%) and operation (13%). Fifty-eight children (76%) survived, 18 children (24%) died. Fifty-two children, the majority suffering from haemolytic-uraemic syndrome, regained complete or partial renal function after a period of dialysis lasting between 1 and 57 days. One to 7.7 years after dialysis, clearance studies with inulin (CIn), p-aminohippuric acid (CPAH) and phosphate (Tp/CIn) for staging renal function were carried out. The results of this investigation show a significant inverse correlation between the glomerular function regained and the duration of intermittent dialysis.

Acute Kidney Injury↗
PubMed1986

Thromboembolic complications in children with nephrotic syndrome. Risk and incidence.

Coagulation studies were performed in 16 children with steroid responsive minimal change nephrotic syndrome in order to elucidate the incidence of thromboembolic complications. Fibrinogen and alpha 2-macroglobulin concentrations were inversely correlated with serum albumin concentrations, antithrombin III correlated positively (p less than 0.001). Factor VIII:R:AG concentration was elevated. Coagulation disturbances in children are not less severe than in adults with nephrotic syndrome. Combined scintigraphic pulmonary ventilation and perfusion studies were employed in 26 children to detect noninvasively events of pulmonary embolism, respectively their residual changes. The lung scintigraphic investigation demonstrated a pattern consistent with pulmonary embolism in 7 patients (27.9%), residual changes in 10 (38.5%) and normal findings in 9 (34.9%). The incidence of thromboembolic complications in children with severe nephrotic syndrome is as high as reported for adults. Pulmonary symptoms may well be due to pulmonary embolism.

Antithrombin III↗
PubMed1986

Cyclosporin A in pediatric kidney transplantation and its effect on posttransplantation growth.

Results of cyclosporin A (CyA) treatment following kidney transplantation in 28 children were compared with those of conventional immunosuppression with azathioprine (Aza) in 34 children. CyA was given in combination with low-dose prednisolone. Under CyA the 2-year survival rate of patients and grafts was 96%, under Aza the 2-year survival rate of patients was 94% and of grafts 68% (p less than 0.01). Graft function was slightly lower in the CyA than in the Aza group. Growth after kidney transplantation was evaluated in those patients with a first graft and a function of longer than 1 year. Annual growth velocity for bone age was normal or even accelerated in all children treated with CyA and significantly better than in the children treated with Aza. It is concluded that CyA treatment combined with low-dose prednisolone yields excellent results and allows normal growth rates after kidney transplantation.

Adolescent↗
PubMed1986

Urinary protein analysis in the early detection of acute rejection episodes after renal transplantation in children.

The purpose of the present longitudinal investigation was to assess the predictive value of urinary protein analysis in the early detection of rejection crisis after renal transplantation. Forty-one children were studied consecutively over a period of 6 months applying the following methods: creatinine clearance (Ccr); urinary total protein (UTP); and electrophoretic differentiation of urinary proteins according to their molecular size by microgradient-gel electrophoresis (MGGE) with a continuous concentration gradient of 4-40% of polyacrylamide. Protein fractions analyzed were albumin (69,000 d), low molecular weight proteins (LMW-proteins, less than 69,000 d), and high molecular weight proteins (HMW-proteins, greater than 69,000 d). No rejection was observed in 30 children (group A), a total of 18 rejection episodes occurred in 11 children (group B). UTP was significantly lower in group A as compared to group B (107 vs 376 mg/m2/24 h), but no differences in urinary protein pattern were observed between group A and group B prior to rejection. One to two days after rejection UTP increased to 938 mg/m2/24 h, and 3-7 days after rejection LMW-protein fraction increased from 9% to 23% with a corresponding decrease of albumin fraction from 71% to 56% of UTP. No qualitative changes were noted in respect to HMW-protein excretion. It is concluded that changes of UTP and urinary protein pattern occur during rejection episodes but are of no predictive value in detecting rejection before clinical symptoms appear.

Acute Disease↗
PubMed1985

[Drug treatment of chronic glomerulonephritis: pro].

This paper sets out the arguments for drug treatment of chronic glomerulonephritides (GN). Although the pathogenesis and mechanism of progression of chronic GN remained to be clarified, on the basis of controlled studies performed to date, there is a strong case to be made for an aggressive treatment approach to this disease spectrum. For instance, in patients with idiopathic membranous glomerulonephritis a six months treatment with chlorambucil (0.2 mg/KG/day) or prednisone (0.6 mg/KG/day) each given once a day over a period of three months has recently been shown to improve the outcome of the renal functional parameters after three years follow up. In another controlled trial a daily dose of 225 mg dipyridamole and 975 mg aspirin given over 12 months in patients with membrano-proliferative GN type I has been reported to normalize the increased platelet consumption rate and to stabilize the glomerular filtration rate. A third trial has demonstrated that the combined use of cyclophosphamide (100 mg/day) and prednisone (30 mg/day) over several months was superior to the use of prednisone alone (40 mg/day) in improving the long-term prognosis of diffuse-proliferative lupus nephritis (type IV, WHO). In some entities, however, as in IgA-nephritis there is still no evidence for a specific treatment improving the course of the chronic glomerular disease. Other therapeutic problems have to be solved: thus, in patients with minimal change nephropathy with a steroid dependent nephrotic syndrome the benefit of cyclophosphamide (given over three months) or of cyclosporin A is still being investigated. Furthermore, there is some evidence that progression of chronic GN, particularly that of glomerular sclerosing, can be prevented by a low protein diet. The role of eicosanoides and their inhibitors in this context has not yet been fully investigated. The different drug trials and new therapeutic concepts indicate a rapid development of chronic GN treatment. Therefore, a failure to treat actively is difficult to understand.

Chlorambucil↗
PubMed1985

Proteinuria, hematuria, and leukocyturia in children with mixed urinary and intestinal schistosomiasis.

Quantitative parasitological assessment and quantitative analysis of proteinuria, hematuria, and leukocyturia were carried out in 182 Sudanese schoolboys with mixed urinary and intestinal schistosomiasis. Pathological proteinuria was found in 73% of patients (median = 380, 95% confidence limits = 200 to 500 mg/liter). The median protein/creatinine ratio was 0.54. SDS polyacrylamide gel electrophoresis showed an excretion of albumin, transferrin, and IgG consistent with a postrenal pattern of proteinuria. Pathological erythrocyturia occurred in 84% of patients (median = 255, 95% CL = 95 to 629 cells/microliter) and leukocyturia in 77% of patients (median = 148, 95% CL = 93 to 246 cells/microliter). Phase contrast microscopy revealed intact erythrocytes, suggestive of postrenal hemorrhage. Proteinuria, erythrocyturia, and leukocyturia correlated significantly with the ova excretion in the urine, but not with egg excretion in the stool. Oxamniquine reduced ova excretion in the stool but did not influence pathological urine findings. In patients treated effectively with Praziquantel or Metrifonate, pathological PU, EU, and LU decreased markedly 1 month post treatment. PU in severely proteinuric patients reached physiological values 5 months post therapy. We suggest that the proteinuria, erythrocyturia, and leukocyturia in mixed schistosomiasis were of postrenal origin.

Adolescent↗
PubMed1985

[14 years of kidney transplantation in children. Results with special reference to cyclosporin A treatment].

In Hannover, between 1970 and 1983 a total of 115 kidney transplantations were performed in 97 children aged between 2 and 16 years. On 31st December 1983, 85 children (= 88%) were alive and 77 of them (= 79,4%) had a functioning graft, while 8 (= 8,2%) had to return to dialysis treatment. Of 115 grafts transplanted 39 (= 33,9%) were lost again. Late complications in children with longlasting graft function included hypertension, steroid-cushing, osteo-porosis and growth retardation. Since September 1982 the new immunosuppressive drug cyclosporin A was used in combination with a low dose prednisolone therapy. Results of 28 kidney transplantations with cyclosporin A treatment are compared to 37 kidney transplantations with cyclosporin A treatment are compared to 37 kidney transplantations with conventional immunosuppression with azathioprin plus prednisolone. The two year survival rate of grafts was 96% under cyclosporin A, compared to 68% under conventional immunosuppression. The survival rate of patients after two years did not differ in both groups (96 vs. 94%). The growth rates under cyclosporin A are significantly better than under conventional immunosuppression.

Adolescent↗
PubMed1985

Morbidity in urinary schistosomiasis: relation between sonographical lesions and pathological urine findings.

213 patients with urinary schistosomiasis were investigated under field conditions in the Peoples Republic of Congo by quantitative parasitological examination, urine analysis and abdominal ultrasonography. The study group consisted mainly of children. Disease related pathological ultrasonographical findings were dependent on the intensity of infection. Sixty patients had bladder wall thickening and 55 patients had vesical polyps. Those with multiple vesical polyps were the only patients with urinary retention and they had a significantly higher proteinuria than those with a singular polyp. Obstructive uropathy of different degrees was encountered in 50 cases. Of these, 21 patients had moderate to severe urinary tract obstruction and in all cases except one also presented concomitant vesical abnormalities. Nine patients revealed bilateral obstructive uropathy. Lesions of the lower urinary tract were a predisposing factor in the development of urinary tract obstruction. Morbidity of study patients was considered to be substantial. A proteinuria of more than one gramme per litre in spontaneously voided midday urine indicated a high probability for the presence of urinary tract obstruction and was considered an urgent indication for antischistosomal treatment.

Adolescent↗