Biomedical subjects

T Reinhard

Publications and source records attributed to T Reinhard.

At least 91 records · Page 5Linked to original sources

PubMed1997

[Acute and chronic immune reactions after penetrating keratoplasty with normal immune risk].

BACKGROUND: For diagnostic and therapeutic reasons it is important to differentiate between acute and chronic immune reactions. Up to now in the literature as well as in clinical follow-up such a differentiation has been performed only very insufficiently. We analysed retrospectively frequency and type of immune reactions after penetrating keratoplasties with normal immune risk in order to have a data basis for comparison with the corresponding data from our high risk keratoplasties. PATIENTS AND METHODS: The clinical courses of 646 penetrating keratoplasties with good prognosis performed between 11/1986 and 6/1994 were analysed. The mean patient age was 58 (12-89) years. Only endothelial and stromal immune reactions were recorded. RESULTS: 18% of the grafts suffered from at least one immune reaction during the first 3 postoperative years (Kaplan Meier value). 94% of the grafts without immune reactions remained clear in contrast to 45% of the grafts with immune reactions during this period of time (Kaplan Meier values, Log Rank Test: p < 0.001). 81 immune reactions were observed after 62 keratoplasties. 45 immune reactions (56%) had an acute course (43 endothelial, 2 stromal). 36 (44%) were chronic (31 endothelial, 5 stromal). 93.7% of the grafts without clinical signs of immune reactions, 100.0% of the grafts with only chronic immune reactions and 38.7% of the grafts with only acute immune reactions were clear 3 years postoperatively (Kaplan Meier values). No graft with a combination of acute and chronic immune reactions was clear 3 years postoperatively. 56% of all acute immune reactions occurred during the first postoperative year, 82% during the first 2 and 91% during the first 3 postoperative years. For chronic immune reactions the corresponding values reached 51%, 94% and 100%. CONCLUSIONS: After penetrating normal-risk keratoplasty acute immune reactions occur more often than chronic immune reactions, but the latter are in fact far more frequent than anticipated. If they are diagnosed in time and treated correctly they do not lead to graft failure in the mean run. Both types occur predominantly during the first 3 postoperative years and only rarely thereafter.

Acute Disease↗

PubMed1997

[Local cyclosporin A therapy of nummuli after epidemic keratoconjunctivitis--case report].

BACKGROUND: Steroid therapy for persistent or recurrent nummular adenoviral keratoconjunctivitis (AK) has little benefit because of the frequent recurrences, and mostly "offers" only serious steroid side effects. Since January 1995, we have treated different patients with nummuli after AK with topical Ciclosporin A (CSA) in an attempt to achieve at least the same symptomatic effect as with steroids, however, without side effects. Here, we report about our experiences in a very severe case with longterm treatment. CASE REPORT: The patient was sent to our clinic 4 months after AK with confluent nummuli and Descemet folds, more severe in the right than in the left eye. Best corrected visual acuity was 0.05 in the right and 0.5 in the left eye. Topical CSA 2% 4 times daily was first administered only in the right eye. When after 6 weeks a reduction of nummuli was noted in the right eye, the left eye, which had not improved, was started on the same regime. Therapy was tapered and finally stopped after 12 months in the right and 10 months in the left eye, when only minor changes were left in the corneae. A prompt recurrence of nummuli in both eyes within 4 weeks forced us to resume CSA therapy. At present, both corneae are clear with full vision, and this result is stable with 1 drop of CSA daily. No side effects of CSA therapy have been noted. CONCLUSIONS: The disappearance of nummuli with topical CSA and even more the reappearance of nummuli after cessation of CSA therapy show that topical CSA is about as effective as topical steroids in the symptomatic treatment of non-scarred nummuli after KE without the serious steroid side effects. Topical CSA treatment of nummuli after KE is, therefore, a very recommendable alternative for the potentially dangerous steroid therapy. Generally valid data on risk of recurrences, dosage and general effectiveness could only be learned from prospective studies with large numbers of AK patients, which, however, are not available outside epidemics.

Adenovirus Infections, Human↗

PubMed1997

Development of insulin resistance and elevated blood pressure during therapy with cyclosporine A.

OBJECTIVES: Essential hypertension and insulin resistance frequently coexist; cyclosporine A (CsA) is known to induce hypertension which has been used as a model for essential hypertension. The present study aimed to evaluate whether elevated blood pressure and insulin resistance coexist during CsA therapy to prove the similarity between essential hypertension and CsA induced hypertension. DESIGN: Normotensive patients who underwent keratoplasty were investigated before and during single therapy with CsA (2-4 mg/kg body weight) in an open A-B Trial. PATIENTS: Eighteen lean, normotensive patients without metabolic disorders with normal renal function and without family history of hypertension or metabolic abnormalities. MAIN METHODS: Insulin sensitivity index was determined by the modified frequent sampling intravenous glucose tolerance test (FSIGT) and blood pressure was determined by indirect ambulatory blood pressure monitoring. RESULTS: Mean insulin sensitivity index (S1) was significantly reduced (p < 0.03) during treatment with CsA (4.4 +/- 2.6 x 10(-4) vs 2.8 +/- 2.0 x 10(-4)/min per microU/ml), whereas mean systolic daytime blood pressure increased from 126.4 +/- 10.8 mmHg to 135.7 +/- 11.8 mmHg (p < 0.02), as well as the corresponding diastolic blood pressure from 76.8 +/- 8.7 mmHg to 82.8 +/- 9.3 mmHg (p < 0.05). CONCLUSIONS: CsA therapy induces elevated blood pressure and insulin resistance as seen in patients with essential hypertension, thus CsA induced hypertension is considered to have pathophysiological similarities to essential hypertension.

Adult↗

PubMed1996

Systemic ciclosporin A in high-risk keratoplasties.

BACKGROUND: It was the purpose of this study to compile the results of all high-risk keratoplasties (kp) performed in our hospital under systemic ciclosporin A (Ci A) cover from 1987 through 1994. METHODS: One hundred and thirty-one keratoplasties were performed. Ci A was administered for an average period of 9.4 months. We aimed at trough levels of 100-150 ng/ml (monoclonal RIA/TDx). The 29 kp in group A were second or third repeat kp and/or the recipient cornea had severe deep vascularization in all quadrants and/or a transplant position at the limbus was inevitable (expected risk: only immune reactions). The 40 kp in group B were threatened by severe ocular surface disorders (without severe limbal stem cell insufficiency) and by immune reactions (atopic keratopathy, keratoconus with severe endogenous eczema or chronic blepharokeratoconjunctivitis). In the 45 kp of group C resurfacing problems from severe limbal stem cell insufficiency and immune reactions were anticipated (severe burns, pseudopemphigoid or Lyell syndrome). Group D comprised 17 kp with various diagnoses (e.g. kp in newborns, rheumatic and Acanthamoeba keratitis). RESULTS: In group A 91% of the grafts were clear 2 years postoperatively, in group B 76%, in group C 38% and in group D 18%. In 32 of 41 failed grafts (78%), resurfacing problems were the only reason for or participated in final graft failure. Immune reactions and other causes of graft failure were of minor importance. CONCLUSIONS: (1) Systemic Ci A cover can efficiently suppress immune reactions. (2) With the suppression of immune reactions, resurfacing disorders become the most important single cause for functional graft failure. (3) For eyes with a considerable loss of limbal stem cells, limbal stem cell transplantation should be combined with systemic Ci A cover in order to improve the long-term prognosis for penetrating keratoplasty.

Adolescent↗

PubMed1996

Central corneolimbal transplantation under systemic ciclosporin A cover for severe limbal stem cell insufficiency.

BACKGROUND: Severe stem cell deficiencies uniformly lead to superficial conjunctivalization of corneal grafts with subsequent functional failure. We sought better long-term results by transplanting central corneolimbal grafts and simultaneously protecting the graft and its stem cells from immunological destruction by means of systemic administration of ciclosporin A. PATIENTS AND METHODS: In an ongoing pilot study, up to April 1995 20 eyes with stem cell dysfunctions of various etiology (e.g. chemical burn, ocular pseudopemphigoid, congenital aniridia) received eccentrically trephined fresh corneal grafts of 7.7-10.0 mm diameter. About one third of the circumference of the grafts contained limbal area. The mean age of the patients was 46.2 years (range 9-84 years). All patients received systemic ciclosporin A for at least 12 months. At present, the mean follow-up period is 9.6 months (mean 1-20.6 months). RESULTS: Fourteen of 20 grafts (70%) have remained clear so far. Reasons for six graft failures were surface disorders in four eyes, immune reactions in one eye and surface disorders in combination with immune reactions in another eye. Ten of 20 grafts (50%) experienced severe surface disorders. In six eyes surface disorders were coincident with endothelial immune reactions, in four eyes they were not. In four of 20 grafts (20%) conjunctivalization was observed in front of the transplanted limbal area; in seven of 20 grafts (35%) conjunctivalization occurred only distant from the transplanted limbal stem cells. CONCLUSIONS: Our method of central corneolimbal transplantation with simultaneous protection of the transplanted stem cell population from immunological destruction by means of systemic ciclosporin A has been successful for 14 eyes with severe stem cell deficiencies up to 20.6 months postoperatively. This new treatment principle promises - for the first time - long-term rehabilitation for a majority of eyes with severe limbal stem cell deficiencies.

Adolescent↗

PubMed1996

[Local cyclosporin A therapy in Thygeson superficial punctate keratitis--a pilot study].

PURPOSE: It was the purpose of this prospective study to evaluate the effect of topical Ciclosporin 2% on epithelial and subepithelial opacities in Thygeson's superficial punctate keratitis. PATIENTS AND METHODS: We administered Ciclosporin A 2% eye drops to 31 eyes of 17 patients with Thygeson's superficial punctate keratitis. The initial dose was 3 drops daily during the first month. It was reduced according to the following scheme: 2 drops in the second month, 1 drop in the third month, 1 drop every second day in the fourth to sixth months. Thereafter therapy was stopped. RESULTS: The opacities were suppressed completely in 21/31 eyes mostly after 4 weeks of therapy and incompletely in 8/31 eyes. Of the 21 eyes with complete suppression, 6/21 showed recurrent opacities when therapy was stopped after six months. 7/21 eyes had no recurrences after cessation of therapy. Follow-up of 8 eyes is currently less than 6 months and these eyes still receive Ciclosporin A 2% eye drops. All patients complained of a slight burning caused by the drops. CONCLUSIONS: In the majority of patients with Thygeson's superficial punctate keratitis topical Ciclosporin A 2% suppresses epithelial and subepithelial opacities as long as this non-steroid therapy is administered at a low dose. In a considerable percentage therapy seems to be curative.

Adolescent↗

PubMed1996

Cyclosporin-A and its metabolites in the anterior chamber after topical and systemic application as determined with high-performance liquid chromatography-electrospray mass spectrometry.

Penetration of cyclosporin A (CSA) into the anterior chamber through the intact cornea after topical application is difficult due to its hydrophobic structure. Following systemic application the anterior-chamber levels of CSA are reported to be higher. CSA metabolites are more hydrophilic than CSA. Only high-performance liquid chromatography-electrospray mass spectrometry allows exact quantification of the CSA level and the identification of all CSA metabolites. We studied the anterior-chamber levels of CSA and different CSA metabolites after topical and systemic application. CSA and CSA-metabolite anterior-chamber levels were measured in 49 patients after topical application of CSA 2% eye drops preceding routine cataract surgery with 2 different application schemes and in 7 patients receiving systemic CSA after high-risk penetrating keratoplasty. After topical application the average CSA level measured in the anterior chamber was 81 ng/ml. The CSA-metabolite levels were much higher, reaching an average of 378 ng/ml. After systemic therapy the anterior-chamber levels of CSA and of the metabolites were much more balanced at 256 and 317 ng/ml, respectively. CSA penetrates into the anterior chamber after topical eye-drop application, but these levels are much lower than those measured after systemic CSA therapy. After topical application the CSA metabolites might play an important role; they are found in the anterior chamber in much higher concentrations than is CSA, and the metabolite pattern differs from that seen after systemic therapy. The relevance of these findings to the immunosuppressive activity of the CSA metabolites, however, remains unclear.

Administration, Topical↗

PubMed1995

Cyclosporin A in perforating keratoplasty.

Systemically administered cyclosporin A offers three advantages for the management of high risk keratoplasties. First, its immunomodulating action reduces the risk of immune complications. Second, it can be used in cases where no topical steroids can be applied. Third, it may exert an extra beneficial effect on underlying disadvantageous immune disorders like endogenous eczema. We present some of the currently available core data on 12/1986 through 2/1993.

Cyclosporine↗

PubMed1994

[Iris black diaphragm intraocular lenses in traumatic Aniridia].

PURPOSE: In this study we wanted to gain experiences with a new black diaphragm IOL concerning surgical postoperative difficulties in traumatic aniridia. PATIENTS: Since June 1991 we have implanted the IOL prototype and the modifications into 13 eyes with traumatic aniridia. The IOL was transsclerally sutured in 11 eyes without capsular support and it was positioned in front of capsular remnants in two eyes. In eight eyes penetrating keratoplasty was necessary. The mean follow-up period was 17 (1-34) months. RESULTS: The seventh IOL modification can be implanted safely now. Persistent intraocular inflammation (Tyndall +) has been observed in all eyes postoperatively but it seems to disappear slowly. Its effect upon the corneal endothelium and the development of cystoid macula edema is still under investigation. Secondary glaucoma has been the greatest postoperative problem: It could be controlled medically in five eyes, surgically in two eyes, but remained uncontrolled in one eye. Implantation of the IOL improved visual acuity in 11/13 eyes. CONCLUSION: Rehabilitation of eyes with traumatic aniridia by implanting the new black diaphragm IOL still presents some unsolved problems, especially uncontrolled secondary glaucoma and prolonged intraocular inflammation. In spite of many encouraging aspects we advise to be rather cautious and self-restrictive in this group of patients.

Adolescent↗

PubMed1994

[Lamellar horseshoe sclerokeratoplasty and thermoplasty in keratoconus with peripheral ectasia of the cornea].

PURPOSE: Peripheral ectasia of the cornea is a rare, but rather complicated form of keratoconus, which in its severest form cannot be corrected by glasses or contact lenses. Penetrating corneal grafts must be positioned directly at the limbus. Such transplants mostly fail because of a high risk of immune reactions which can only be circumvented by systemic Ciclosporin A. To avoid the potential risks of such a systemic immunomodulation we performed instead of a penetrating keratoplasty a special lamellar procedure which restored the normal configuration of the cornea. PATIENT: The 35-year-old man presented with best corrected visual acuity of 0.1 in both eyes. Contact lenses were not tolerated any longer. RESULT: After lamellar dissection, thermoplasty and lamellar horse-shoe sclerokeratoplasty the patient now wears well-fitting contact lenses and has a visual acuity of 0.8 with his right and 0.5 with his left eye after a follow-up period of 25 and 14 months respectively. There were no postoperative complications. CONCLUSION: Lamellar horse-shoe sclerokeratoplasty preceded by lamellar corneal dissection and thermoplasty is a technically difficult, but efficient surgical measure to restore the normal corneal curvature in patients with advanced peripheral ectasia of the cornea.

Corneal Transplantation↗

PubMed1994

Black diaphragm intraocular lens in congenital aniridia.

Beginning in June 1991, we implanted a newly designed, black diaphragm intraocular lens (IOL) into 13 eyes with congenital aniridia after cataract surgery. To the best of our knowledge, this is the first group of patients to receive a black diaphragm IOL. With the first prototype we experienced various difficulties, which prompted four design modifications. The latest IOL with a diaphragm diameter of 10 mm can be guided safely into the ciliary sulcus. IOL implantation improved visual acuity in 9 of 13 eyes; 4 of these exhibited considerably less nystagmus than was observed preoperatively. During the mean follow-up-period of 7.9 months (range, 1-27 months), a slight, persistent intraocular "inflammation" [Tyndall (+)] was observed in all eyes. Glaucoma occurred postoperatively in 4 eyes and was controlled medically in 2 eyes but remained uncontrolled in 2 other eyes that had the condition preoperatively. This pilot study indicates that most patients with congenital aniridia and cataract benefit considerably from the implantation of this newly designed, black diaphragm IOL. However, preexisting glaucoma may herald severe postoperative glaucoma-related problems and should be considered a contraindication until more information has been gained about the long-term tolerance of this IOL.

Adolescent↗

PubMed1994

Black-diaphragm intraocular lens for correction of aniridia.

In cooperation with Morcher GmbH, we developed a black-diaphragm aphakia intraocular lens (IOL) designed to correct congenital and traumatic aniridia. Since June 1991, we have implanted this IOL into five eyes with congenital aniridia combined with cataract, and into eight eyes with traumatic aniridia combined with cataract or aphakia. Positioning the IOL was rather difficult, especially in the traumatic cases with inadequate capsular support, and in combination with penetrating keratoplasty. After up to 15 months' follow up, functional results are encouraging. However, slight persistent intraocular inflammation was observed in all of the eyes, more obviously in the traumatic cases. The effect of the IOL on the corneal endothelium is still being investigated. Cystoid macular edema was observed in one eye, but probably preexisted in this eye, following several earlier surgical procedures. Glaucoma was observed preoperatively in five eyes; postoperatively, in six. After surgery, it was controlled medically in 4 eyes, surgically in 1, and remained uncontrolled in 1.

Adolescent↗

PubMed1993

[5-fluorouracil injection treatment after fistulating glaucoma operations].

BACKGROUND: Since 1984 subconjunctival 5-Fluorouracil injections have been applied with success after filtering surgery. It was the purpose of this retrospective study to find out whether the results justify this treatment in view of all side effects. MATERIALS AND METHODS: Between 2/1991 and 1/1993 twenty-nine eyes of 11 female and 16 male patients with high-risk glaucoma (unsuccessful previous filtering surgery and a high risk of scarring) were treated with subconjunctival injections of 5-Fluorouracil after filtering surgery in the University Eye Hospital Düsseldorf. The mean age of the patients was 58 (11-84) years and the mean follow-up period was 16 (4-24) months. The mean amount of injected 5-Fluorouracil was 43 (5-85) mg. Glaucoma was regarded as controlled when intraocular pressure levels were reduced by more than 20% of the preoperative level and stayed consistently below 21 mm Hg. RESULTS: 26 (89.6%) of the eyes had controlled intraocular pressure during the follow-up period. Two eyes were controlled only after additional cyclocrycoagulation, and 1 glaucoma has remained uncontrolled. Postoperatively we observed fistulas of the conjunctiva in 24% of the eyes and 69% of the eyes had corneal epithelial breakdown problems. It is unlikely that subconjunctival injections of 5-Fluorouracil work only by inhibiting scarring of the filtration bleb. Long-lasting e-vacuo-symptoms in single cases with no functioning bleb at all as well as scarred blebs in 9 of 26 eyes with controlled glaucoma must be interpreted as a probable sign of 5-Fluorouracil toxicity on the ciliary epithelium. CONCLUSIONS: Subconjunctival injections of 5-Fluorouracil after filtering surgery are helpful to control high-risk glaucoma, but there are several disadvantages of this treatment as fistulas of the conjunctiva, corneal surface problems, discomfort for the patient, difficult follow-up and a potential toxicity on the ciliary epithelium that may be pronounced in some cases. Therefore, subconjunctival injections of 5-Fluorouracil after filtering surgery are a useful means for eyes with a high risk of scarring. However, 5-Fluorouracil should not be applied for primary normal glaucoma surgery.

Adolescent↗

PubMed1993

[Corneal puncture in recurrent corneal erosion].

On the long term, conventional therapy of recurrent erosion (posttraumatic, dystrophic, idiopathic) by patching, bandage lenses and debridement often does not avoid recurrences. Between February 1990 and June 1992 we performed anterior stromal punctures in 47 eyes of 45 patients with recurrent erosion which had not responded to conventional therapy. Our current results during an average follow-up period of 12 months are: 1. Anterior stromal puncture is a safe procedure if exerted under the operation microscope. In our patients perforations did not occur. 2. Neither early postoperative complications, e.g. corneal ulcers, nor long-term postoperative complications, e.g. vision limiting severe stromal scars, could be observed. 3. About 81% of our patients experienced no further recurrence. Another 11% benefitted from significant reduction of recurrences. Therapeutic response was equally good in patients with dystrophic as well as in patients with posttraumatic recurrent erosion. Therefore anterior stromal puncture, if exerted properly, represents a safe and effective therapy in patients with recurrent erosion. For a final judgement much larger groups of patients must be treated in controlled studies and a much longer follow-up period is necessary.

Adult↗

PubMed1992

[Perforating keratoplasty in endogenous eczema. An indication for systemic cyclosporin A--a retrospective study of 18 patients].

Endogenous eczema represents a considerable risk for perforating keratoplasty because of the associated chronic surface disorders and complex immunological disturbances. Between December 1986 through October 1991 we performed 24 perforating keratoplasties in 20 eyes of 18 patients with endogenous eczema suffering from keratokonus, atopic keratokonjunctivitis and bullous keratopathy after intracapsular cataract extraction. During the follow-up period of 16 (3-48) months 6 transplants failed mostly due to surface problems as well as immune reactions and bacterial transplant infections. Systemically administered ciclosporin A was found to eliminate many of the previously unsolved problems. In summary, 18 out of 20 eyes achieved an improved visual acuity with clear transplants.

Adult↗

PubMed1992

[Surgical correction of astigmatism after perforating keratoplasty].

Microsurgical control of astigmatism after perforating keratoplasty has widely remained an unsolved problem in spite of many sophisticated suggestions and inventions. The frequent irregularity in the recipient cornea and poor predictability with respect to wound healing are the major obstacles. If spectacles or contact lenses cannot provide useful vision, postoperative surgical correction is needed. Ablative or thermal laser techniques have not been sufficiently tried for such cases to be justified, and one may hesitate anyway to apply destructive methods in transplants. We therefore still use T-incisions and wedge resections, which are said to be rather imprecise. Only 3 out of more than 700 keratoplasties performed in our clinic from 1987 through July 1991 required such procedures. Two more cases were referred by surgeons outside the hospital. All five surgical corrections resulted in a good longterm effect with considerable improvement of vision. Thus, as long as alternative methods for surgical correction of postkeratoplasty astigmatism have not proved to be superior, we should continue to practice these "old" methods, which, indeed, are not bad if properly applied.

Adolescent↗

PubMed1992

Six years' experience with systemic cyclosporin A prophylaxis in high-risk perforating keratoplasty patients. A retrospective study.

Starting with single cases in 1985, we have routinely applied systemic cyclosporin A since 1987 in high-risk keratoplasty patients for a period of up to 37 months postoperatively. In all, 69 eyes undergoing 74 perforating keratoplasties have thus far been treated. A considerable percentage of them initially suffered from chemical burns or from endogenous eczema associated with chronic atopic inflammation. All patients were followed closely and their courses were reevaluated retrospectively. Our current conclusions are that (1) immune reactions are efficiently inhibited with constantly effective blood levels of cyclosporin A, which has enormously increased the rate of keratoplasty successful in these patients; (2) if drug blood levels fall too low due to noncompliance of the patient or to metabolic disturbances, immune reactions may occur, especially during the early postoperative months; (3) serious chronic surface problems, which are especially associated with chemical burns, atopic inflammation, and other chronic kerato-conjunctival diseases, are partly ameliorated but not completely eliminated (surface disorders are presently ranked as the number one cause of transplant failure, whereas immune reactions can be effectively suppressed by cyclosporin A); and (4) close medical follow-up has revealed no serious systemic complication of cyclosporin A prophylaxis over periods of up to 37 months. The present study was not conducted in a prospective, double-blind, controlled fashion.

Adolescent↗

PubMed1991

[Kidney function of patients with healthy kidneys during cyclosporin treatment].

Long-term administration of ciclosporin has been complicated by side-effects, the predominant being nephrotoxicity. We performed renal function studies on 20 patients treated with ciclosporin (group 1) and on 12 patients serving as controls (group 2). Only patients with serum creatinine less than 1.3 mg/dl entered the study. The renal function studies consisted of: Inulin clearance, PAH clearance, sodium sulphate loading, sodium bicarbonate loading. Plasma renin activity (PRA), inactive renin (IR) and aldosterone (ALDO) were measured basally and after stimulation with 40 mg furosemide i.v. Serum creatinine was not significantly impaired under ciclosporin with 1.1 +/- 0.1 mg/dl vs 0.9 +/- 0.1 mg/dl in the control group (ns). Glomerular filtration rates as measured by creatinine and inulin clearance were significantly impaired in group 1 as compared to group 2. Inulin clearance was impaired by ciclosporin with 93.5 +/- 4.4 ml/min/1.73 m2 as compared to 121 +/- 6.6 ml/min/1.73 m2 (p less than 0.05) in patients of group 2. The PAH clearance in ciclosporin treated patients was impaired, with 379 +/- 22.1 ml/min/1.73 m2 in group 1 as compared to 605 +/- 39 ml/min/1.73 m2 (p less than 0.001) in group 2. Mean arterial pressure and renovascular resistance were significantly increased in ciclosporin treated patients. We demonstrated, by means of sodium sulphate and bicarbonate loading, incomplete distal tubular acidosis in 3 patients from group 1 but in none of group 2. There was no difference in basal plasma renin activity (PRA), but during volume contraction induced by furosemide there was only blunted response by PRA in patients receiving ciclosporin with 2.7 +/- 0.3 ng/ml/h as compared to 7.7 +/- 0.5 ng/ml/h in controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗