Treatment of chronic renal allograft failure by addition of mycophenolate mofetil: single-center experience in 40 patients.
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Chronic Disease↗
Biomedical subjects
R Brunkhorst
Publications and source records attributed to R Brunkhorst.
[Determination of endotoxin in inflammatory rheumatic diseases--the effect of nonsteroidal anti-inflammatory agents on intestinal permeability].
We measured the amount of plasma endotoxin in 95 patients with inflammatory rheumatic diseases (42 with ankylosing spondylitis; 12 with possible ankylosing spondylitis; 41 with rheumatoid arthritis) and in 16 patients with Crohn's disease with a quantitative Limulus assay. Significantly increased mean values were found in inflammatory rheumatic diseases and in Crohn's disease. Between 31% and 50% of the patients had endotoxin values higher than 10 pg/ml--none of the controls had such values. Patients on regular treatment with NSAIDS had higher amounts of endotoxin again. From our results we discuss an intestinal involvement in inflammatory rheumatic diseases. An inflammation of the gut with an increased permeability seems to be responsible for the raised plasma endotoxin levels compared to healthy controls. NSAIDs probably contribute to the increased permeability of the gut.
Adult↗
Calcium kinetic studies in patients on CAPD: improvement of secondary hyperparathyroidism without concomitant improvement of calcium turnover.
OBJECTIVE: An association between the development of low turnover osteopathy and the form of dialysis treatment, that is, continuous ambulatory peritoneal dialysis (CAPD), has been described. To examine the effect of a year-long CAPD treatment on calcium (Ca) turnover, 12 patients were studied prior to and one year after initiation of CAPD treatment with a dialysate calcium of 1.75 mmol/L. DESIGN: A prospective analysis. SETTING: Academic teaching hospital dialysis unit. PATIENTS: Twelve patients with an average age of 54.8 years (range: 23-76 years) at commencement of dialysis and after 13 months of CAPD treatment. MEASUREMENTS: Calcium kinetic studies were performed using two calcium isotopes: 45Ca as an oral tracer and 47Ca as an intravenous tracer. Measurements of plasma and whole body activities were performed over a four-week period. From these measurements, kinetic parameters describing calcium turnover in different compartments were studied. These measurements were repeated after a mean time of 13.4 months. Patients were not treated with vitamin D, but received aluminum- and calcium-containing phosphate binders, in order to keep inorganic phosphate below 2.0 mmol/L and calcium within the normal range. RESULTS: After one year on CAPD, serum levels of calcium increased from 2.2 mmol/L to 2.35 mmol/L. Inorganic phosphate also increased from 1.4 mmol/L to 1.9 mmol/L, despite increased use of oral phosphate binders. Serum levels of intact parathyroid hormone (IPTH) decreased from 51.2 pmol/L to 28.3 pmol/L. Alkaline phosphatase did not change, nor did serum levels of vitamin D. Despite improvement of serum IPTH levels and better control of serum calcium, the kinetic parameters describing calcium turnover in the different calcium pools did not improve. In addition, the calcium retention of bone remained below normal range and did not rise. Perhaps more importantly, the relationship between Ca efflux and Ca retention did not change. While Ca retention remained low, plasma Ca efflux was normal. This imbalance was seen at the beginning of CAPD and did not change under CAPD. CONCLUSION: These data demonstrate that, after one year of CAPD treatment without vitamin D treatment, calcium turnover did not improve, despite a significant fall in serum IPTH levels. Studies on a larger number of patients are warranted to verify these results.
Adult↗
Chronic induction of C-reactive protein by hemodialysis, but not by peritoneal dialysis therapy.
OBJECTIVE: Evaluation of the inflammatory activity in patients on chronic peritoneal dialysis (PD) and patients on chronic hemodialysis (HD) in comparison to patients with chronic renal insufficiency without dialysis treatment and healthy volunteers. DESIGN: Open, nonrandomized prospective study. SETTING: Nephrology Department, including HD and PD therapy in a university hospital. PATIENTS: Twenty-four patients on chronic PD,21 patients on chronic HD therapy using a cuprophan dialyzer,16 patients with chronic renal insufficiency without dialysis treatment, and 33 healthy volunteers; 8 additional patients before and after initiation of chronic HD therapy. All patients and controls were without infection or immunosuppressive therapy. MAIN OUTCOME MEASURES: As a marker of the inflammatory activity in the different patient groups, C-reactive protein (CRP) was measured serially using a sensitive, enzyme-linked, immunosorbent assay in order to detect values below the detection limit of standard assays. RESULTS: Patient groups had CRP levels higher than the normal controls (p < 0.01). Patients on HD had CRP levels significantly higher than PD patients (p < 0.01) whose levels were comparable to patients without dialysis therapy. Accordingly, longitudinal measurements before and after initiation of chronic HD showed a significant increase in CRP levels after the beginning of HD treatment (p < 0.04). CONCLUSIONS: The results suggest that induction of the inflammatory activity is lower during PD compared to HD, since stimulation by the dialyzer membrane, dialysate buffer, or bacterial fragments in the dialysate is avoided. This observation might indicate a possible lower risk of long-term complications in patients with PD.
Acute-Phase Reaction↗