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Biomedical subjects

V Teplan

Publications and source records attributed to V Teplan.

At least 37 records · Page 2Linked to original sources
PubMed1998

Evolution of renal replacement therapy in Central and Eastern Europe 7 years after political and economical liberation. Central and Eastern Europe Advisory Board in Chronic Renal Failure.

PURPOSE OF THE STUDY: The conditions of renal replacement therapy (RRT) were very poor in the countries located in Central and Eastern Europe (CEE) when they were members of the so-called 'socialist bloc'. The aim of the present analysis was to document the impact of the socioeconomic changes on dialysis therapy in the CEE countries. DESIGN: This was a special survey with the participation of 12 CEE countries, with data obtained through national registries (with the exception of Russia). RESULTS: During the period 1990-1996 the number of haemodialysis units increased by 56% and the number of centres performing peritoneal dialysis by 296%. The number of patients increased respectively by 78% (haemodialysis) and 306% (peritoneal dialysis). The percentage of patients with diabetic nephropathy and elderly patients rose dramatically during this period. One of the main reasons of such expansion was the rapid development of peritoneal dialysis programmes in the majority of the CEE countries. The introduction of modern haemodialysis machines and a wider choice of different dialysers and concentrates permitted individualization of dialysis procedures. These points and the wider use of erythropoietin had a positive influence on quality of life and treatment outcome. There was also a notable increase in the number of transplant centres, but less so of the number of transplanted patients. CONCLUSION: Renal replacement therapy experienced a major expansion in the CEE countries. Despite the progress achieved, the level of RRT is not yet completely satisfactory in most CEE countries.

Europe↗
PubMed1998

Long-term follow-up of the tubular secretion of creatinine in renal graft recipients.

The differences in glomerular filtration rate (GFR) based on creatinine clearance (Ccr) or obtained by the more exact methods are caused mainly by tubular creatinine secretion. In this study, we monitored creatinine clearance (Ccr), GFR on the basis of polyfructosan renal clearance (C(PF)) and parameters characterizing tubular creatinine secretion (Ccr/C(PF), Ccr - C(PF), Tcr/C(PF) x 100) in 12 individuals with renal grafts (Group A), 12 kidney graft donors for related transplantation (Group B), and in 27 individuals undergoing nephrectomy for a pathological process in one kidney (Group C). In the monitored groups, C(PF) and Ccr values were within the limits consistent with the normal function of a single kidney in a healthy individual. The values characterizing tubular creatinine secretion in Group A did not differ significantly from those obtained in Groups B and C. However, the parameters showed a wide range in all groups. In seven individuals with a renal graft, all the above functional parameters were monitored at three-month intervals for a period of 24 months. Significant differences in the time courses of Ccr and C(PF) due to marked intra-individual fluctuations were found in tubular creatinine secretion. The findings suggest that the rate of tubular creatinine secretion in the renal graft does not differ significantly from that in individuals with a single native (normally functioning) kidney. However, there are large inter-individual differences. The large intra-individual fluctuations in tubular creatinine secretion in the kidney graft result in significant differences in the time courses of Ccr and C(PF) and a possibility of erroneous evaluation of graft function if based exclusively on Ccr.

Adolescent↗
PubMed1998

[Renal excretion of potassium in individuals with stabilized function of a transplanted kidney].

From previous work it is known that in subjects with a transplanted kidney treated with cyclosporin A hyperkalaemia may develop even if the glomerular filtration rate is within the normal range or only slightly reduced. The mechanism of this defect was not elucidated so far. In the present work the authors try to study the question whether and how renal potassium excretion by the transplanted kidney is influenced by the intensity of sodium excretion. Focused on renal excretion of potassium, sodium, chlorides, all osmotically active substances, glomerular filtration rate (polyfructosan clearance) and renal plasma flow (paraaminohippuric acid clearance) the authors examined 12 patients after transplantation of the kidney from a cadaverous donor (group A), 11 subjects after unilateral nephrectomy for the purpose of donorship for transplantation (group B) and 27 subjects after nephrectomy on account of a pathological process in one kidney (group C). The glomerular filtration rate in the investigated groups was greater than 1.0 ml/s/1.73 m2. The mean value of the fractional potassium excretion (FEK) in group A was 15.2 (+/- 6.3)%, in group B 18.4 (+/- 6.6)% and in group C 20.1 (+/- 8.6)%. The value of FEK in group A was significantly lower than in group C (p < 0.01). Groups B and C did not differ significantly in the mean value of FEK. Between values of FEK and FENA a significant direct correlation was found (r = 0.621, p < 0.001) in the group of subjects with a single kidney of their own (B + C). On the other hand, this correlation was not found in subjects with a transplanted kidney (A). The achieved results support the idea that in subjects with a transplanted kidney treated with cyclosporin A there are deviations in tubular potassium transport even when its serum level is not elevated. This deviation is manifested by lower FEK values and also by and inadequate response of the distal tubule to an increased sodium supply by increased tubular potassium secretion. The authors assume that when drugs with a potential potassium retaining effect are administered to subjects with a transplanted kidney it is important to check carefully the serum potassium level even when the glomerular filtration rate is within normal limits or only slightly reduced.

Adult↗
PubMed1998

[Hyperlipidemia after kidney transplantation and its control by individualized therapy: evaluation of the first years' trial].

Secondary hyperlipidaemia (HLP) is one of the most serious metabolic complications in patients after transplantations of the kidney. In its development a number of factors may participate, the most important ones being immunosuppressive drugs (cyclosporin A and prednisone) and the patients dietary habits. In a prospective metabolic trial a group of 248 patients after transplantation of the kidney with a long-term stable function of the graft were followed up for 12 months. Group I (128 patients) was systematically followed up in the Institute of Clinical and Experimental Medicine and the patients were treated by individualized dietetic and pharmacological intervention. Group II (120 patients) were out-patients who were treated according to current procedures in other departments than the Institute of Clinical and Experimental Medicine. The cholesterol and LDL-cholesterol increased significantly in both groups starting with the 3rd month of the follow-up. A subsequent decline was observed in group I from the 9th month onward, while in group II both values rose steadily. The triacylglycerol level rose in both groups during the 6th month, there were however great interindividual differences. There was a significant rise of the HDL-cholesterol. The Lp(a) level changed also significantly--its values--after an initial drop during the 3rd month--rose significantly in group II.

Adult↗
PubMed1997

Predicting glomerular function from adjusted serum creatinine in renal transplant patients.

In 22 individuals with a renal graft the correlations between the renal clearance of polyfructosan (CLPF), renal creatinine clearance (CLcr)--established under the same conditions as CLPF--and the value of glomerular function predicted using the equation by Cocroft and Gault (PredCLcr) were followed up, at an interval of 2-3 months, for 8-22 months. A significant linear correlation (r = 0.777, p < 0.001) was found between PredCLcr and CLPF as well as between PredCLcr and CLcr (r = 0.801, p < 0.001). Equally significant correlations, however, were established when relating the serum concentrations of creatinine (Scr) to 1/CLPF (r = 0.784, p < 0.001) and Scr to 1/CLcr (r = 0.744, p < 0.001). The values of the PredCLcr/CLPF and PredCLcr/CLcr ratios during follow-up in one and the same individual may vary significantly. This fluctuation exceeds maximal error of the analytical methods employed in one third of the individuals examined. When considering stabilization or slow changes in graft function on the basis of PredCLcr and CLPF we found significant discrepancies in more than one half of the individuals examined (64%). The findings support the assumption that more accurate methods must be used to assess graft glomerular function on long-term follow-up.

Adult↗
PubMed1997

[Renal excretion of sodium in individuals with stabilized renal graft function].

In subjects with a transplanted kidney frequently tubular functions are impaired even when the glomerular filtration is within the normal range. In the present work the authors are dealing in more detail with the problem of tubular sodium reabsorption in the transplanted kidney. The purpose of the investigation was to assess to what extent these changes can be explained as the consequence of adaptational changes due to reduction of the number of nephrons and whether these changes have to be taken into consideration in the differential diagnosis of acute changes of graft function. The glomerular filtration rate (GF) was assessed on the basis of polyfructosan clearance, fractional sodium and potassium excretion (FENa and FEK) in a group of 12 subjects with a stabilized function of a transplanted kidney (group A), in 11 subjects after nephrectomy in healthy donors for transplantation (group B) and in 27 subjects after nephrectomy indicated for a pathological process in one kidney (group C). The mean values of GFR were as follows: Group A: 1.21 (+/- 0.19)ml/s/1.73 sq.m Group B: 1.19 (+/- 0.17)ml/s/1.73 sq.m Group C: 1.24 (+/- 0.21)ml/s/1.73 sq.m The mean values of GFR in different groups did not differ significantly. The mean values of FENa in different groups were as follows: Group A: 3.02 (+/- 1.59)% Group B: 2.05 (+/- 0.77)% Group C: 2.01 (+/- 1.17)% The mean value of FENa in group A was significantly higher than the mean value in group B (p < 0.01) and in group C (p < 0.01). The assembled findings support the idea that reduced tubular sodium reabsorption in the transplanted kidney (with a stabilized value of GFR) cannot be explained only as a manifestation of adaptation of tubular function as a result of the reduced number of functioning nephrons. The persisting osmotic sodium diuresis in the transplanted kidney must be viewed from the aspect of possibly impaired water preservation and the development of dehydration associated with a drop of GFR and must be differentiated from rejection.

Adolescent↗
PubMed1996

[Relation between creatinine clearance and glomerular filtration in long-term monitoring of individuals with kidney transplants].

The authors examined in 22 subjects with a transplanted kidney after 2- to 3-month intervals for a period of 8-22 months the renal creatinine clearance (Ccr) and glomerular filtration rate (GFR) based on polyfructosan clearance (CPF). The mean value of the Ccr was 72.9 (+/- 23.3) ml/min/1.73 m/ and CPF 52.0 (+/- 19.5) ml/min/1.73 m2. The mean value of the Ccr/CPF ratio was 1.45 (+/- 0.33) and the tubular creatinine secretion (Tcr) 4.8 (+/- 5.5) mumol/min/100 ml CPF. Between values of Ccr and CPF a significant correlation was found (r = 0.752, p < 0.001). The value of the Ccr/CPF ratio in the same individual varied markedly in the course of the follow up period. The differences between the maximal and minimal values of the ratio in the same subject were in 36% of the patients greater than could be explained by errors of the applied analytical methods. From comparison of values of creatinine clearance and polyfructosan clearance at the onset and at the end of the investigation period ensues than in one half of the investigated cases a discrepancy was found between changes of the investigated clearance values. The assembled findings are consistent with the ideal that tubular creatinine secretion in the transplanted kidney may vary considerably in the course of time. Due to significant changes of tubular creatinine secretion in the same subject discrepancies develop between changes of creatinine clearance and the GFR. When evaluating the long-term stabilization or small changes of GFR of the transplanted kidney only on the basis of creatinine clearance erroneous conclusions may be reached.

Adult↗
PubMed1995

[A nutritionally defined liquid diet for hemodialyzed patients].

BACKGROUND: For patients having regular haemodialysis there are no suitable complete preparations for general use in case intensive treatment is needed. Nutrilac renal is a new preparation of a nutritionally defined liquid diet corresponding as to its composition to the needs of haemodialyzed patients. The purpose of the present work was to assess whether this preparation when administered as a supplement will have a favourable effect on the nutritional parameters of haemodialyzed patients. METHODS AND RESULTS: Nutrilac renal was administered to haemodialyzed patients for a period of three weeks as a supplement meeting 20% of the energy requirements. The protein intake rose from 0.87 to 0.95 g/kg body weight (p < 0.05), the energy intake from 109 to 126 kJ/kg body weight (p < 0.05). As to nutritional parameters, the serum albumin values improved (from 25.0 to 29.4 g/l, p < 0.05) and Whitehead's quotient from 1.8 to 1.5, p < 0.05). The favourable effect on the amino acid spectrum was manifested by a significant rise of essential amino acids and those with branched side chains (p < 0.01). The preparation did not lead to a rise of potassium, ura and vitamin A levels. CONCLUSIONS: The newly developed preparation Nutrilac renal exerts a favourable effect on nutritional parameters. Changes in the aminogram characterized by an increase of essential amino acids, in particular threonine, valine, leucine and isoleucine indicate the high biological value of the protein component of the preparation for patients with chronic renal failure.

Amino Acids↗
PubMed1994

[Individualized supplemented low-protein diet in patients with chronic kidney failure].

The possibility of developing protein-energy malnutrition poses a serious risk associated with long-term administration of a restrictive low-protein diet. We conducted a randomized prospective study designed to evaluate 36 patients with chronic renal failure in initial malnutrition (BMI 22%, albumin 35 milligrams, WQ 2.02). In 20 of these patients (Group I), low-protein diet was supplemented with ketoanalogs of essential amino acids along with a low-phosphate drink from casein-free protein. The diet of another 16 patients (Group II) was supplemented with a mixture of essential and non-essential amino acids of egg white. Three-month follow-up revealed a statistically significant improvement in selected metabolic parameters (Surea, albumin, WQ, valine HDL-CH cholesterol, SP and SCa), particularly in Group I (p < 0.01). In group II, the improvement was either not marked (p < 0.05) or no improvement was seen. Results of the study indicate that patients found to suffer from initial malnutrition require early dietary supplementation including ketoanalogs of essential amino acids and a special protein providing an adequate amount of energy.

Adult↗
PubMed1994

[Renal clearance of hippurate in persons with chronic renal insufficiency].

In 8 subjects with chronic renal failure treated conservatively the renal hippurate clearance (CHip), polyfructosan (CPF) and creatinine (Ccr) clearance was assessed. The mean values of the investigated variables were as follows: CHip = 1.06 +/- 0.79 ml/s, CPF = 0.15 +/- 0.08 ml/s, Ccr = 0.27 +/- 0.17 ml/s. The ratios between the investigated clearance values were: CHip/CPF = 6.9 +/- 4.2 and CHip/Ccr = 4.2 +/- 1.4. The ratio of CHip/CPF was in some instances as high as 10 or more. Between values of CHip/CPF and the plasma hippurate concentration (PHip) a significant negative (non-linear correlation was found (p < 0.01). When the PHip values were very high, the value of the CHip/CPF ratio was close to 1. The recorded findings confirm that in subjects with chronic renal failure in the residual nephrons hippurate is synthetized and its urinary excretion in relation to glomerular filtration is increased. The findings suggest also that in these patients the tubular transport for hippurate is saturated. It will be necessary to take into account the possible saturation of tubular transport for hippurate when interpreting changes of drug excretion (i.e. those excreted by the same mechanism as hippurate) in subjects with chronic renal failure.

Adult↗
PubMed1994

[Renal excretion of amino acids in patients on a regular dialysis program].

In 10 patients with chronic renal failure and a polyfructosan S clearance (CPFS): 1.91-12.70 ml/min (mean 5.68 ml/min) with a preserved residual diuresis (more than 1000 ml/24 hours) renal excretion of 22 amino acids by residual nephrons was investigated before and 12 hours after haemodialysis. It was revealed that 12 hours after haemodialysis a significant drop of the filtered amount of all investigated amino acids occurred. Renal clearance of Ser, Pro, Glu, Gly, Ala, Tyr, Met, Leu and Cit after haemodialysis declined significantly (p < 0.05-0.001). Haemodialysis was not associated with significant changes of fractionated excretions (FE) of amino acids with the exception of Gly (p < 0.01) and Trp (p < 0.05) where an increase of FE was recorded. Hitherto assembled results are consistent with the idea that a reduction of the tubular resorption of amino acids in the residual nephrons in subjects with chronic renal failure cannot be explained by a change of their filtered amount (as "overflow" aminoaciduria) nor as the consequence of retention of some dialyzable substances which could inhibit tubular transport of amino acids. The reduced tubular transport of some of the investigated amino acids (Cys, Lys, Cit, Met, Asn+Gln, Orn, Ile) was significantly related with the drop of tubular sodium transport.

Adult↗
PubMed1992

[Evaluation of glomerular filtration in patients after renal transplantation and treatment with cyclosporin A].

According to some findings (Ross et al. 1987) the creatinine plasma concentration (Pcr) is an inaccurate indicator of glomerular filtration (GFR) in patients with a transplanted kidney, treated with cyclosporin A (CyA), who are in a stabilized state of renal function. In the submitted work the authors investigated whether the inaccuracy of the assessed GFR based on Pcr or creatinine clearance (Ccr) is greater than in patients with various chronic renal diseases who at the time of examination did not take any drugs. The investigation was made in 30 patients with a transplanted kidney treated with CyA as well as azathioprine and prednisone. The authors examined also 51 patients with various chronic renal diseases, mostly chronic glomerulonephritis or tubulo-interstitial nephritis. The GFR value was assessed on the basis of polyfructosan clearance (CPF). In subjects with a transplanted kidney a significant linear relationship was found between Ccr and CPF (r = 0.829, p < 0.001). A similar relationship was found in patients with chronic renal disease (r = 0.935, p < 0.001). The regression lines characterize this relationship in both groups and do not differ significantly. Between values of Pcr and CPF a significant relationship of a hyperbolic character was found in both groups (r = 0.693, p < 0.001 and r = 0.741, p < 0.001 resp.). The hyperbolic relations found in the examined groups did not differ significantly. The findings confirm that a normal or only slightly elevated Pcr value can be associated with a markedly reduced GFR, in some instances to as much as one third of the normal values.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Relation between creatinine clearance and glomerular filtration in various stages of chronic renal disease].

The relationship between creatinine clearance (Ccr) and inulin (C(in)) was investigated in 20 healthy subjects (group A) and 54 subjects with chronic renal disease (C(in): 10-80 ml/min/1.73 m2) treated conservatively (group B) and in 10 subjects with regular dialyzation treatment and a preserved residual diuresis (more than 1000 ml/24 h) (group C). In subjects from group B the Ccr/C(in) values were significantly higher than in healthy subjects (p < 0.01). In subjects of group C the values of Ccr/C(in) before dialysis did not differ significantly from values recorded in healthy subjects. Twelve hours after dialysis a marked increase of C(in)/Ccr occurred (p < 0.001). The findings are consistent with the idea that the increase of tubular creatinine secretion in patients with chronic renal disease is associated with a rise of its plasma concentration. In terminal stages in chronic renal failure there is, however, again a drop of tubular creatinine secretion which is reversible and rises after dialysis. These changes in tubular creatinine secretion could be explained by the fact that in chronic renal failure substances cumulate in the organism which inhibit tubular creatinine secretion. Due to haemodialysis the concentration of these inhibitors of creatinine secretion declines and after dialysis this process increases again temporarily. The findings suggest that the residual Ccr value assessed before dialysis is closer to the real value of glomerular filtration than values assessed during dialysis.

Adult↗
PubMed1992

Cyclosporine A treatment and evaluation of glomerular filtration rate in patients with a transplanted kidney.

According to some findings [Ross et al. 1987], the plasma concentration of creatinine (Pcr) is an inaccurate reflection of the glomerular filtration rate (GFR) in renal graft recipients with stabilized renal function, treated with cyclosporine A (CyA). In this study, we sought to determine whether the inaccuracy of GFR assessment on the basis of Pcr or creatinine clearance (Ccr) in these individuals is greater than in patients suffering from various chronic renal diseases untreated by any drugs during the examination. The study was performed in 30 renal graft recipients, treated with CyA in combination with azathioprine and prednisone. Further, 51 patients suffering from a chronic renal disease, mostly chronic glomerulonephritis or tubulointerstitial nephritis, were investigated. GFR was evaluated on the basis of polyfructosan clearance (CPF). A significant linear relation between Ccr and CPF (r = 0.829, p less than 0.001) was demonstrated in individuals with a transplanted kidney graft treated with CyA. A relationship of the same character was observed in the group of patients suffering from chronic renal diseases (r = 0.935, p less than 0.001). There is no statistically significant difference between the regression lines characterizing these relationships in both groups. A significant correlation of hyperbolic character between Pcr and CPF was found in both groups investigated (r = 0.693, p less than 0.001, and r = 0.741, p less than 0.001, respectively). The hyperbolic relationship noted in the studied groups did not differ significantly. These findings confirm a normal, or a mildly raised Pcr can be associated with a marked decrease in GFR, in some cases to a value as low as a third of the normal one.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[The critical value of residual kidney function in patients with chronic kidney failure from the viewpoint of the concentration of urea and potassium in the plasma].

Residual kidney function was examined in 10 patients with chronic renal insufficiency under balance conditions and in 30 outpatients on the basis of urea clearance (Curea) and potassium clearance (CK). Protein intake was 35-40 g/day (0.5 g/kg/day) and potassium intake was 30-40 mmol/day. Under these conditions the critical values of residual kidney function were as follows: 1) plasma urea concentration (Purea) did not exceed 30 mmol/l if Curea did not drop below 3.8 ml/min; 2) plasma potassium concentration (PK) did not exceed 5 mmol/l if CK did not decrease below 4.1 ml/min. Clinical examination of Curea and CK provides additional information to the examination of creatinine clearance (Ccr) or its plasma concentration (Pcr). Our results suggest that the critical value of residual kidney function cannot be defined only on the basis of examination of Ccr or Pcr. Examination of Curea and CK can help in the interpretation of very high Purea and hyperkalemia in patients with chronic renal insufficiency.

Ambulatory Care↗
PubMed1991

[The effect of hemodialysis on potassium excretion by residual nephrons].

In 19 patients with chronic renal failure and still preserved residual diuresis the inulin clearance (Cin) and renal potassium excretion were assessed before and 12 hours after haemodialysis (HD), combined with conventional ultrafiltration. The mean value of Cin after HD declined significantly (p less than 0.001). As a result of HD a significant decline of the plasma potassium concentration occurred (p less than 0.005) and of the urinary excretion (p less than 0.01). The mean value of the fractional potassium excretion (FEK) did not change significantly as a result of HD. The reduced urinary K excretion after HD correlated significantly (p less than 0.05) with the decline of Cin. The findings suggest that the decline of the urinary potassium excretion after HD is above all due to a decline of the glomerular filtration rate. The tubular potassium secretion does not change significantly under these conditions. These findings support indirectly the idea that the increased tubular potassium secretion in residual nephrons in patients with chronic renal failure is not conditioned by retention of low-molecular dialysable substances.

Female↗