Biomedical subjects

V Schwenger

Publications and source records attributed to V Schwenger.

23 records · Page 2Linked to original sources

PubMed2000

The optimal target hemoglobin.

There is still controversy concerning the optimal target hemoglobin during treatment with recombinant human erythropoietin (rHuEPO). Some evidence suggests that hemoglobin concentrations higher than currently recommended lead to improvements in cognitive function, physical performance, and rehabilitation. At least in patients with advanced cardiac disease, however, one controlled trial failed to show a benefit from normalizing predialysis hemoglobin concentrations. In contrast, preliminary observations in three additional studies (albeit with limited statistical power) failed to show adverse cardiovascular effects from normalization of hemoglobin, but definite benefit with respect to quality of life, physical performance, and cardiac geometry. These observations are consistent with the notion that hemoglobin concentrations higher than those recommended by the National Kidney Foundation Dialysis Outcomes Quality Initiative Anemia Work Group are beneficial, at least in patients without advanced cardiac disease.

Anemia, Iron-Deficiency↗

PubMed1999

Antihypertensive therapy in renal patients - benefits and difficulties.

High blood pressure values, diastolic and systolic, are associated with decreased renal function. This is particularly true when the diastolic blood pressure is higher than 90 mm Hg. Several studies showed that lowering of the blood pressure within the range of normotension according to the WHO causes a reduction in the rate of progression to terminal renal failure. These studies have led to recommendations to aim at a target blood pressure of approximately 125/75 mm Hg in the treatment of patients with glomerular diseases and particularly diabetic nephropathy with proteinuria >1 g/day. In contrast to these results, blood pressure values corresponding to the recommendation (</=125/75 mm Hg) of the JNC VI (see text) were achieved in 15% of the patients only. It has also been shown that at any given level of an average 24-hour blood pressure, patients with an insufficient decrease of the blood pressure during nighttime have a higher risk to progress to terminal renal failure. Thus it is very important to lower the nighttime blood pressure and to detect nighttime blood pressure increases using ambulatory blood pressure measurements.

Aged↗

PubMed1999

How can we improve prognosis in diabetic patients with end-stage renal disease?

Diabetes has become the single most important cause of end-stage renal failure, but survival of diabetic patients with renal replacement therapy continues to be poor. The major causes of death are cardiovascular complications. Most cardiovascular complications, particularly coronary atheroma, accumulate before patients enter renal replacement programs. This observation points to the need for improved patient care in pre-end-stage renal failure. In the diabetic patient, dialysis should be started earlier than in the nondiabetic patient, and prophylactic vascular access should be established when the glomerular filtration rate is approximately 20 ml/min. Proposals to improve prognosis of the diabetic patient with renal failure include interdisciplinary care for the patients with renal disease, strict normotension, administration of ACE inhibitors, administration of lipid-lowering agents, near-normalization of anemia using recombinant human erythropoietin, and improvement of diabetic foot care in the patient on renal replacement therapy.

Diabetic Nephropathies↗

PubMed1998

Audit of antihypertensive treatment in patients with renal failure.

BACKGROUND: Recently, intensified antihypertensive treatment has been recommended for patients with proteinuric renal disease, and a target blood pressure of 125/75 mmHg has been proposed. METHODS: In a retrospective crossectional study, all consecutive patients with renal disease and reduced GFR seen in the renal outpatient clinic Heidelberg during a specified time period were analysed. Physicians administered antihypertensive agents according to their clinical judgment aware of recent recommendations, but without structured guidelines. The aims of the study were: (i) to monitor achieved blood pressure (clinic measurement, self measurement, ambulatory BP measurement); (ii) to monitor the number of antihypertensive medications required; and (iii) to analyse the factors which determine achieved blood pressure and the number of antihypertensive agents required. RESULTS: There were 201 non-transplanted patients, median age 60 years (range 20-86), 131 male, 70 female, median S-creatinine 2.33 mg/dl (1.4-10.9). Fifty-two of the patients had diabetes, 41 GN, 18 ADPKD, 17 vasculitis, seven reflux nephropathy, three analgesic nephropathy and 63 other or unknown renal diseases. When the patients had originally been referred to the renal clinic, median clinic BP had been 160 mmHg systolic (104-260) and 95 mmHg diastolic (65-160). Under nephrological care, achieved clinic systolic (140; 90-190) and diastolic BP values (85; 45-130) were significantly (P<0.0001) lower. Achieved BP was slightly (r=0.23, P<0.05) correlated with age, was not significantly different between genders, and was not correlated to proteinuria, serum creatinine, renal disease or BMI. Average self measured BP values were not different from systolic and diastolic clinic BP values. Ambulatory BP values, however, were significantly (P<0.0001) lower, e.g. daytime systolic BP 133 mmHg (107-171), diastolic 82 mmHg (65-97). A night-time decrease of BP > or = 15% was seen in 18/25 patients only. The median number of antihypertensive classes required was 3 (range 1-7) in non-diabetic and 3.5 (1-7) in diabetic patients, respectively. The number of antihypertensive classes was independent of serum creatinine, BMI or proteinuria, but was significantly (P<0.01) higher in males (4; 1-7) than in females (3; 1-6) and correlated to age (r=27, P<0.01). CONCLUSIONS: The study (i) illustrates the difficulty to achieve recommended target BP in patients with renal failure, (ii) shows remarkably little white coat effect on clinic blood pressure, (iii) illustrates the value of ambulatory blood pressure measurement and (iv) documents the importance of multidrug antihypertensive treatment in patients with renal failure.

Adult↗

PubMedDate not supplied

CRP levels in autoimmune disease can be specified by measurement of procalcitonin.

Autoimmune diseases (AID) are prone to infection particularly under immunosuppression. The differentiation of infection from active AID is often difficult. In order to specify the diagnostic value of measurement of procalcitonin (PCT) in AID 81 patients with anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis were analyzed, 27 with rheumatoid arthritis and 25 patients with systemic lupus erythematosus at various stages of the disease. Although PCT levels (95th percentile) were below 0.5 ng/ml in patients with active systemic lupus erythematosus and rheumatoid arthritis, the cutoff for normal values (95th percentile) in patients with active ANCA-positive vasculitis was 0.89. Therefore PCT levels of < 1 ng/ml are recommended as cutoff for invasive infections in patients with ANCA-positive vasculitis. In view of the increased mortality under immunosuppression in patients with AID and additional bacterial infection the measurement of PCT is helpful when an infectious origin is suspected.

Antibodies, Antineutrophil Cytoplasmic↗