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Biomedical subjects

W Tschöpe

Publications and source records attributed to W Tschöpe.

At least 19 recordsLinked to original sources
PubMed1993

Survival and predictors of death in dialysed diabetic patients.

The objective of this study was to examine diabetic patients at the time of admission to maintenance haemodialysis and to follow them for 36 months in order to define predictors of cardiovascular and non-cardiovascular death. This prospective study comprised all consecutive diabetic patients admitted to 28 German dialysis centres between January 1985 and October 1987; 196 patients were examined, 67 Type 1 (insulin-dependent) diabetic (43 male, 24 female; median age 49 years, range 22-73) and 129 Type 2 (non-insulin-dependent) diabetic patients (54 male, 75 female; 64 years, range 37-82). Outcome measures were death, i.e. myocardial infarction, sudden death, cardiac death of other causes, stroke and non-cardiovascular death. Actuarial survival 36 months after the beginning of dialysis was similar in Type 1 (40%) and Type 2 diabetic patients (43%) despite the age difference. Causes of death were myocardial infarction (18%), sudden death (18%), other cardiac causes (18%); stroke (6%); septicaemia (17%) mostly originating from diabetic foot problems; and interruption of therapy. Survival rates and the proportion dying from cardiac causes were similar in patients with diabetic nephropathy or with other primary chronic renal disease and coincidental diabetes. On dialysis, de novo amaurosis or de novo amputation was not observed in any patient. The strongest predictor of myocardial infarction or sudden death was serum lipids on admission. Duration of hypertension, blood pressure at the time of admission to dialysis, left ventricular hypertrophy or end-diastolic diameter by echocardiography, Sokolow index and average predialysis blood pressure, smoking, interdialytic weight gain and type of dialysis were not predictive of cardiovascular death or death by all causes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Serum lipids predict cardiac death in diabetic patients on maintenance hemodialysis. Results of a prospective study. The German Study Group Diabetes and Uremia.

The objective of this study was to measure cholesterol concentrations in diabetic patients at the beginning of maintenance hemodialysis treatment and to define their role as predictors of subsequent cardiac death on maintenance hemodialysis. The design of this study consisted of a prospective study of all consecutive diabetic patients newly admitted to 28 German dialysis centers between January 1985 and October 1987. The patients were examined on admission and subsequently followed for 45 months on dialysis. This study included 196 patients, 67 type I (43 male, 24 female, median age 49 years, range 22-73) and 129 type II (54 male, 75 female, aged 64 years, range 37-82). Lipids (total cholesterol, triglycerides low-density lipoprotein (LDL) cholesterol high-density lipoprotein (HDL) cholesterol apolipoprotein B and A and anthropometric indices (body mass index, triceps skinfold thickness) were measured. The outcome was death, i.e., cardiovascular (myocardial infarction, sudden death, other cardiac causes, stroke) and noncardiovascular death during a 45-month follow-up. At the start of treatment, total cholesterol, triglycerides LDL cholesterol, LDL/HDL ratio and apolipoprotein B were significantly higher in diabetics than in healthy controls or patients with standard primary renal disease starting dialysis. Only minor differences were found between males and females and type I and type II diabetics. Fourty-three percent of type I and 50% of type II diabetics died, 61% from cardiovascular causes, mostly myocardial infarction (in 40% reinfarction) and sudden death. On admission, diabetics subsequently dying from myocardial infarction had significantly higher median cholesterol than survivors, i.e., 259 versus 222 mg/dl, and higher LDL cholesterol, LDL/HDL ratio and apolipoprotein B.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Does the care of diabetic patients with renal failure in the predialysis phase need improvement?].

The cardiovascular risk profile was assessed in all 208 diabetics accepted for dialysis in 28 German dialysis centres from 1985-1987 (104 men, 104 women, mean age 60 [22-82] years). 71 patients had type 1 and 128 type 2 diabetes, and 9 maturity onset diabetes of the young. Of 169 patients, 164 (97%) had hypertension (median systolic blood pressure at start of dialysis 200 [120-280] mm Hg). Only 74 patients (44%) were on continuing anti-hypertensive medication. Median serum cholesterol was 225 (66-424) mg/dl, LDL-cholesterol 158 (43-335) mg/dl and HDL-cholesterol 32 (10-67) mg/dl. In patients with a history of myocardial infarction (n = 26) the median cholesterol concentration was 269 (126-424) mg/dl, while in those with no history of myocardial infarction (n = 132) it was 221 (66-280) mg/dl (P less than 0.05). Only 5% of the patients had received lipid lowering therapy. Out of 175 patients, 65 (37%) had a history of smoking, and 25 (14%) were still smokers at the start of dialysis. There was a strong association between smoking history and amputations. Only 98 of 208 patients (47%) had had a specialist ophthalmological examination in the 12 months preceding the start of dialysis. Proliferative retinopathy was present in 33 out of 53 (62%) type 1 and 15 out of 98 (15%) type 2 diabetics. Out of 22 patients with unilateral or bilateral blindness, 2 (10%) had received no photocoagulation. - This investigation reveals a need for better medical care of diabetics with pre-end-stage renal failure.

Adult↗
PubMed1990

Diabetic nephropathy--are there differences between type I and type II?

It has commonly been assumed that the renal risk in type II diabetes is markedly lower than in type I diabetes since only approximately 5% of the former but 40% of the latter experience renal failure. Based on our observations in the diabetes outpatient department of the University of Heidelberg, we conclude that the cumulative risk of developing proteinuria for the nonproteinuric type II diabetic and the cumulative risk of developing renal failure for the proteinuric type II diabetic are comparable with the respective risks of the type I diabetic. This observation is noteworthy since there is no uncontroversial evidence of hyperfiltration in early type II diabetes. Type II diabetes may be an interesting model for testing the hyperfiltration theory.

Diabetes Mellitus, Type 1↗
PubMed1988

[New aspects of calcium metabolism in kidney calculus disease].

Recurrent calcium stone disease appears to be related to a high dietary intake of animal protein. The following mechanisms have been discussed to explain the relationship between dietary protein and calciuria: increased glomerular filtration rate (GFR), increased rate of sulphate excretion, acidosis-induced increase in ionised serum calcium ("filtered load") and decrease in tubular reabsorption, and mobilisation of bone mineral. Protein also diminishes urinary citrate. However, it has not been established in controlled trials whether a reduced dietary intake of protein diminishes the recurrence rate of renal stones. Determination of the normal range of urinary calcium is dependent on numerous variables: size; GFR; age; excretion of Na, Mg and Pi; dietary intake of Ca and protein; season. Ideally, all these variables should be evaluated. In many patients with recurrent stone formation hypercalciuria will be found. There is a consensus of opinion that intestinal Ca absorption is increased, but elevated frequency of a renal Ca leak has not been established. For patient management discrimination between absorptive and resorptive hypercalciuria is important; a simple test that can be performed as an outpatient procedure is proposed in order to make this distinction.

Calcium↗
PubMed1985

Sulfur-containing amino acids are a major determinant of urinary calcium.

Epidemiological evidence suggests a relation between dietary protein intake and nephrolithiasis. In addition, generation of acid equivalents from dietary protein increases urinary calcium excretion. To further evaluate the usefulness of epidemiological or clinical tools to study the relation between dietary protein and urinary calcium, the correlation between urinary urea and sulfate excretion on the one hand and calcium excretion on the other hand was examined in 42 healthy individuals. Only a modest correlation was found between urea and calcium excretion (r = 0.33); in contrast, the correlation between sulfate and calcium excretion was marked (r = 0.73) and highly significant (p less than 0.01). It remained significant when the influences of urea, sodium, hydroxyproline, and oxalate excretion were taken into account using partial regression analysis. In 9 healthy male probands, addition of 6 g L-methionine (40 mmol) to their usual diet caused an increase of urinary sulfate (+ 3,795 mg/24 h) and urinary calcium (+ 86.4 mg/24 h). The variable methionine/cysteine-cystine content of dietary proteins may explain why urinary calcium is correlated better with urinary sulfate than urinary urea.

Adult↗
PubMed1984

Decreased plasma phosphate under hormonal contraceptives.

Plasma phosphate (Pi) and several indices of Ca-Pi metabolism were measured in 129 randomly selected healthy female individuals of the general population, of whom 59 were on hormonal contraceptives and 70 were not. Fasting plasma Pi was significant (p less than 0.01) lower in those taking hormonal contraceptives (0.96 +/- 0.17 mmol/l) than in those not taking them (1.06 +/- 0.16). Those on hormonal contraceptives had identical age, body weight and UVcr. Systolic and diastolic blood pressure was higher in those on hormonal contraceptives, and there was an inverse relationship between blood pressure and plasma Pi. Between those on hormonal contraceptives and those not on them, no significant difference of urinary cAMP (non-hormone 4.69 +/- 1.48 nmol/l GF; hormone 4.43 +/- 1.18) or iPTH could be shown. The present study documents that hormonal contraceptives with estrogen (less than or equal to microgram/dl) decrease plasma Pi and urinary Ca in premenopausal nonosteoporotic women.

Adult↗
PubMed1983

[Acute kidney failure in secondary renal oxalosis. Additional indications for a causal connection to xylitol infusions].

A 35 years old female developed a slowly progressive acute renal failure after surgical drainage of a pancreatic abscess. Due to the uncharacteristic course a renal biopsy was performed which revealed a severe obstructive renal oxalosis with concomitant interstitial nephritis. Primary oxalosis was excluded by determination of glyceric and glycolic acid in the urine. Since other preconditions for increased oxalate formation were not present it was considered as an adverse reaction to the parenteral application of xylitol. During 4 weeks of total parenteral nutrition the patient received this sugar alcohol in a dose of 3.0 g/kg/day (total dose 4480 g). In recognition of preceding autopsy studies and recent experimental investigations on the metabolic pathways from xylitol to oxalate the chances and conditions of renal deposition of calcium oxalate after administration of xylitol are discussed.

Acute Kidney Injury↗
PubMed1983

Different effects of oral glycine and methionine on urinary lithogenic substances.

Nine male healthy volunteers were examined during a control period, during an oral glycine load (45 g/day, 600 mmol) and oral methionine (6 g/day, 40 mmol). Glycine caused a significant increase of urinary oxalate above baseline (from 644 to 797 mumol/day) without change in calciuria (4.74 vs 4.84 mmol/day). In contrast methionine caused no change of oxaluria, but a significant increase in calciuria (from 4.74 to 6.9 mmol/day). Alterations of lithogenic ions in urine after protein ingestion are mediated by different amino acids. The particular lithogenic risk of animal protein may be related to its high methionine/cystine and glycine content.

Adult↗