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Biomedical subjects

M Molzahn

Publications and source records attributed to M Molzahn.

At least 37 records · Page 2Linked to original sources
PubMed1986

Acute interstitial nephritis and non-oliguric renal failure after cefaclor treatment.

A case of acute interstitial nephritis (AIN) developing after cefaclor treatment is reported. Diagnosis was proofed by kidney biopsy and lymphocyte transformation test. The clinical course of the patient with non-oliguric renal failure was favourable. Four weeks after discontinuation of cefaclor treatment the renal function was completely restored and remained stable over the ten-month follow-up period. It is concluded that cefaclor can cause hyperallergic AIN and acute renal failure.

Acute Kidney Injury↗
PubMed1986

The influence of long-term infusion of the calcium antagonist diltiazem on postischemic acute renal failure in conscious dogs.

The influence of long-term infusion of the calcium-entry blocker diltiazem on postischemic acute renal failure was investigated in conscious dogs monitored by implanted instruments. In 18 uninephrectomized beagle dogs on a salt-rich diet, an electromagnetic flow probe and an inflatable plastic cuff were placed around the renal artery. Acute renal failure was induced by inflating the cuff for 180 min in the conscious animal. Group A (n = 5, control) received an intraaortic injection of 0.9% NaCl (5 ml/day) from the 3rd day before until the 7th day after ischemia and group B (n = 6, posttreatment) an intra-aortic injection of diltiazem (5 micrograms X min-1 X kg-1) beginning at the end of ischemia until the 7th day. Group C (n = 7, pre- and posttreatment) received diltiazem from the 3rd day before until the 7th day after ischemia. In group A, renal blood flow dropped from 149 +/- 16 (preischemic) to 129 +/- 29 ml X min-1 on the 1st day after ischemia. In contrast, renal blood flow increased on the 1st postischemic day in both treatment groups by 29 +/- 15% (group B, P 0.05) and 14 +/- 13% (group C). In the following days, there was no significant difference in renal blood flow between groups A, B and C. In group B, the reduction of the glomerular filtration rate was similar to that in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1986

The analgesic problem in the Federal Republic of Germany: analgesic consumption, frequency of analgesic nephropathy and regional differences.

The recent withdrawal of phenacetin from the pharmaceutical market in the FRG has stimulated the discussion of the extent of analgesic abuse and analgesic nephropathy (AN). Data from wholesale statistics, given here, revealed in the FRG population a high yearly per-capita consumption of analgesics (18.2 g), mostly used in mixed compounds. According to standardized data, the FRG ranks first among the north European countries. We suggest that the prevalence data given from the EDTA-registry (4.6% of the endstage renal population) underestimates the real extent of AN. AN in the FRG shows a north-to-south decline and is most prevalent in northern areas and West Berlin. It is assumed that the analgesic dilemma in the FRG is identical to the dilemma in Switzerland and Belgium.

Adolescent↗
PubMed1985

[Characteristics of terminal analgesics-induced nephropathy].

The diagnosis of analgesic-associated nephropathy (AAN) may be missed because of the patients denial or regular analgesic intake. We therefore performed a cross-sectional study of the 144 patients of our hemodialysis center to investigate differences between the 48 patients with AAN (33%) and patients with other kidney diseases who served as controls. The aim was to find other attributes of analgesic users relating to social history, habits and morbidity. Dialysis patients with AAN were significantly older (60 +/- 10 versus 52 +/- 15 years) and more frequently women (65% versus 37%) compared with controls; they often had a family history of analgesic abuse. Comparison with an age-matched control group of hemodialysis patients with other kidney diseases showed that AAN patients smoked, used hypnotics and laxatives, and required prescriptions significantly more frequently; they were less frequently willing to undergo renal transplantation. With regard to accompanying diseases, they suffered significantly more often than the age-matched controls from anemia, renal osteodystrophy, peptic ulcer disease, diverticulosis, hemorrhoids, atrial fibrillation, coronary heart disease, hyperlipidemia, carpal tunnel syndrome, and urinary tract infections. The characteristic pattern of habits, social history and accompanying diseases may facilitate the diagnosis of AAN even in cases where analgesic consumption is denied.

Age Factors↗
PubMed1985

Haemodialysis in 'hepatorenal syndrome': report on two cases.

We report two patients with hepatorenal syndrome who recovered from oliguria and renal failure after temporary treatment with haemodialysis. Hepatorenal syndrome developed under diuretic treatment in both patients. Volume expansion, dopamine, and prostaglandin I2 did not improve renal function. In the one patient with alcoholic cirrhosis, renal biopsy showed only minimal alterations of glomeruli, tubuli, and arterial vessels. In the other case, the deterioration and improvement in renal function parallelled changes in acute alcohol-toxic hepatic function. We conclude that haemodialysis should be considered for treatment of hepatorenal syndrome in selected patients where reversal of liver failure can be expected.

Acute Kidney Injury↗
PubMed1985

Low cyclosporin A blood levels and acute graft rejection in a renal transplant recipient during rifampin treatment.

Cyclosporin A trough blood levels were unusually low during rifampin treatment in a kidney transplant patient. Simultaneously, acute graft rejection occurred. Pharmacokinetic investigation revealed a rapid turnover of cyclosporin A leading to low blood levels. Cessation of rifampin therapy reversed these changes. Rifampin substantially reduces the bioavailability of cyclosporin A and should not be used in transplant recipients on cyclosporin A.

Adult↗
PubMed1985

Value of human chorionic gonadotropin measurements in blood as a pregnancy test in women on maintenance hemodialysis.

Human chorionic gonadotropin (hCG beta) values were determined in the blood of 19 women and 4 men on maintenance hemodialysis. Blood samples were taken 3 times at an interval of 1 week. Measurements were done by an hCG beta RIA kit (Serono). The median hCG beta values were 9 mIU/ml (range 0-116) in 7 menstruating women, 6 (0-25) in 11 postmenopausal women and 0 (0-7) in 4 men. There was no statistically significant difference between the 3 groups. The median hCG beta values in all 3 groups were below the upper normal limit. However, the individual measurements varied considerably with elevation in 32% of 52 measured values (10-fold elevation in 2 cases). We conclude that in the blood of non-pregnant women on chronic hemodialysis, elevated hCG beta values can be found, erroneously indicating an intact pregnancy of 3-5 weeks duration or a nonintact pregnancy (e.g. impending abortion, extrauterine gravidity).

Chorionic Gonadotropin↗
PubMed1985

Patients' expectations from renal grafting and transplantation outcome.

Prevailing reports on psychological prediction of renal graft integration are rare, mostly based on case studies. Focusing on patients' expectations from the transplantation process before grafting, we investigate the influence of psychological data and statements on the final transplantation results. In the whole group (n = 83) the attitude toward transplantation was very optimistic. Comparing the features of patients with successful graft outcome (n = 23) and graft failure or patient's death (n = 10) the latter group shows: lower scale values of optimistic attitude toward transplantation outcome, higher level of fear concerning surgical treatment, less willingness to agree preoperatively to second transplantation in case of first graft failure. Psychological data indicate a greater tendency toward more submissive, rigid, and depressive behavior. It is assumed that the patient's attitude and expectation on grafting is a part of the conditions influencing the final transplantation result. Further studies should prove this concept.

Adult↗
PubMed1985

Beneficial effects of long-term prostaglandin E2 infusion on the course of postischemic acute renal failure. Long-term studies in chronically instrumented conscious dogs.

The effect of a continuous intra-aortal infusion of prostaglandin E2 (PGE2) (0.03 microgram . min-1 . kg-1) on the course of postischemic renal failure (180 min cessation of blood flow by inflation of a pneumatic cuff) has been investigated in 11 conscious sodium-replete dogs. The glomerular filtration rate (51Cr-EDTA: endogenous creatinine clearance) was less decreased in the PGE2 group (group B, n = 6) than in the control group (group A, n = 5; 13 ml . min-1 vs. 22 ml . min-1; p less than 0.05). Renal blood flow (electromagnetic flow probe) was markedly lower in the control group (82 ml . min-1) than in the PGE2 group (130 ml . min-1; p less than 0.05), even exceeding baseline levels in the latter group. Accordingly, the excessive rise in renal vascular resistance in the control group (+277%) was abolished in the PGE2 group (-20%) (p less than 0.05). Nitrogen retention was also markedly improved. Plasma renin activity, which was markedly raised initially (25.8 ng angiotensin I . ml-1 . h-1) was not significantly further increased during the subsequent 7 days. Urinary excretion of PGE2 was diminished in the control group and elevated following PGE2 infusion. It is suggested that the beneficial effects of PGE2 are mediated by preservation of renal perfusion. Additional effects of prostanoids on the ultrafiltration coefficient (KF) and cytoprotection by reduction of intracellular calcium accumulation must also be taken into consideration.

Acute Kidney Injury↗
PubMed1985

Does captopril reduce renal function in renovascular disease by postglomerular vasodilatation?

In hypertensive patients with bilateral renal artery stenosis (RAS) or RAS of a solitary kidney, reversible decrease of glomerular filtration rate (GFR) or acute renal failure has been observed following captopril administration. Decrease of GFR has been ascribed to preferential efferent vasodilatation. To test this hypothesis, acute changes of mean arterial pressure (MAP), renal plasma flow (RPF), GFR, plasma renin activity (PRA) and PGE2-excretion after 50 mg captopril orally were measured in post-transplant hypertensives with and without transplant renal artery stenosis (TRAS) during treatment with diuretics. The fall in MAP was similar in both groups; RPF did not change significantly; GFR decreased from 58 +/- 14 (s.d.) to 49 +/- 14 ml/min (TRAS, n = 8) and from 60 +/- 15 to 50 +/- 16 ml/min (without TRAS, n = 8). There was no evidence of postglomerular dilatation in patients with TRAS, and filtration fraction decreased only in patients without TRAS. Increase of PRA after captopril was not significantly different between the two groups. PGE2-excretion did not change significantly. In one patient with severe TRAS, long term angiotensin converting enzyme (ACE) inhibition and acute normalization of MAP with sodium nitroprusside both induced a comparable decrease of GFR. The results demonstrate that acute postglomerular vasodilatation does not necessarily occur after ACE inhibition in patients with TRAS and a high-renin state.

Captopril↗
PubMed1985

Morbidity of patients with analgesic-associated nephropathy and end-stage renal failure.

In our haemodialysis centre patients (n = 144), we compared 48 aspects of morbidity in patients with analgesic-associated nephropathy (AAN) and patients with other kidney diseases to determine the presence of characteristic diagnostic features of AAN in addition to a history of habitual analgesic intake. The comparison between 48 AAN patients and the control patients revealed statistically significant differences (p less than 0.05) with regard to myocardial infarction (25% vs 7%), angina pectoris (63% vs 32%), atrial fibrillation (21% vs 4%), arteriosclerosis obliterans of the lower extremity (52% vs 33%), anaemia (mean haemoglobin, 8.38 vs 9.16 g/dl), renal osteodystrophy (67% vs 41%), carpal tunnel syndrome (23% vs 7%), peptic ulcers and erosive gastritis (54% vs 23%), colonic diverticula (15% vs 4%), and haemorrhoids (67% vs 28%). AAN patients therefore have significantly higher morbidity with a characteristic pattern than do patients with other renal diseases.

Analgesics↗
PubMed1984

[Carpal tunnel syndrome, a late complication in chronic hemodialysis].

145 patients on haemodialysis for 1 month to 16 years were examined for carpal tunnel syndrome. Typical signs and symptoms of the syndrome, mostly in both hands but more pronounced on one side, were seen in 21 patients (15%). In these cases carpal tunnel syndrome was frequently (19%) accompanied by Raynaud's phenomenon of the digits supplied by the median nerve. There was a significant correlation between the incidence of carpal tunnel syndrome and the duration of dialysis. The association of carpal tunnel syndrome with analgesic nephropathy was significantly higher than with other kidney diseases. Immediate relief of pain was achieved after carpal tunnel release in eight patients (11 hands). Sensory and motor function was gradually, but often only partially, restored. Unoperated carpal tunnel syndrome progressed to loss of sensory and motor function within 1 to 4 years after onset of symptoms. Carpal tunnel syndrome should be considered an important late complication of chronic haemodialysis.

Adult↗
PubMed1984

[Trial for digitalis withdrawal in hemodialysis patients].

The indication for digitalis treatment was investigated in a controlled and prospective study lasting 12 months in 110 patients on long-term haemodialysis. In ten patients, digitalis was needed because of tachyarrhythmia due to atrial fibrillation and in five because of recurrent pulmonary edema. In 57 patients receiving digitoxin, therapy was discontinued for 4 to 6 weeks, whereas 13 patients not yet treated with digitalis, received digitoxin for 4 weeks. Without digitoxin, trial fibrillation occurred in 4 patients, while no patient experienced atrial fibrillation with digitoxin (P = 0.002). In 13 patients, radiological findings (heart enlargement, pulmonary congestion) were better with digitoxin than without. Thus digitoxin appeared to be clearly indicated in 29% of the haemodialysed patients. Additionally, digitalis was indicated in 31 patients because of heart enlargement, pulmonary congestion and (or) previous pulmonary edema. Initially, 76% of the patients were receiving digitoxin, whereas, after the investigation, the rate was only 57% (P less than 0.001). The prospective frequency of clinically apparent digitoxin intoxication was low (3%) and so were the overall toxic plasma digitoxin levels (5%). Digitalis should be given deliberately but not restrictively to haemodialysis patients, since atrial fibrillation (13%) and heart failure (50%) are frequent and often concealed.

Adult↗
PubMed1984

Prostaglandin E2 promotes hypotension on low-sodium hemodialysis.

The influence of low-sodium dialysate (126 mmol/l) on plasma levels of prostaglandin E2 (PGE2) and PGF2 alpha, plasma renin activity (PRA) and arterial blood pressure was investigated in 16 patients on maintenance hemodialysis. PGE2 rose more than tenfold and there was a significant increase in PGF2 alpha and PRA. Mean arterial pressure dropped by 30 mm Hg causing discomfort in several patients. By contrast, conventional hemodialysis against 140 mmol/l of sodium was followed by less pronounced changes in plasma prostaglandins, and reduction of blood pressure was moderate (13 mm Hg). It is suggested that vasodilating prostaglandins may contribute to dialysis hypotension. Their origin may not be confined to the kidneys but rather extend to the lungs and circulating blood cells. The in vitro generation of prostaglandins was demonstrated when donor blood was circulated in an extracorporeal dialysis system.

Dinoprost↗