Baclofenintoxikation bei chronischer Hämodialyse und Nierentransplantation

Fourteen days after renal transplantation, at first gave with good transplant function, a 36-year-old woman developed neurogenic dysfunction of bladder emptying. This was treated with baclofen, 5 mg three times daily by mouth. Between the 7th and 10th treatment day she progressively developed an organic psychotic syndrome and increasing respiratory paralysis after the onset of renal failure, associated with rejection of the transplanted kidney which required dialysis. Plasma concentration of baclofen was 565 ng/ml (therapeutic range 80-400 ng/ml). After discontinuing the drug and renewed haemodialysis the baclofen level rapidly fell and the symptoms receded. In a second case, a 57-year-old …

Reduced secretion of proinflammatory cytokines of monosodium urate crystal‐stimulated monocytes in chronic renal failure: an explanation for infrequent gout episodes in chronic renal failure patients?

In gouty arthritis, monosodium urate (MSU) crystals interact with monocytes and neutrophils to produce inflammatory reactions associated with acute synovitis. In patients with end-stage renal disease (ESRD), gouty arthritis is a rare condition despite often severe hyperuricaemia. We wondered whether differences in the secretion of proinflammatory cytokines by MSU crystal-stimulated monocytes might be one explanation for the low incidence of gouty arthritis in patients with ESRD compared with healthy controls.Thirteen patients with ESRD on intermittent haemodialysis treatment, six patients with chronic renal failure not yet on dialysis, and 15 age- and sex-matched healthy controls were exami…

Tubulointerstitielle-Nephritis-Uveitis-Syndrom (TINU-Syndrom)

Abstract For 10 weeks a 25-year-old man had been suffering from tiredness, fatigue, nausea and a 16 kg weight loss. Erythrocyte sedimentation rate (83/133 mm), serum C-reactive protein (5.5 mg/dl) and creatinine (5.05 mg/dl) were all elevated. He also had proteinuria (1120 mg daily), sterile leukocytosis and a creatinine clearance of 10 ml/min. Renal biopsy showed interstitial nephritis and bone marrow biopsy revealed non-caseous epithelioid-cell granulomas. 14 days after admission he developed acute iritis in the right eye. Other causes having been excluded, the diagnosis of tubulo-intestinal nephritis with uveitis (TINU syndrome) was made. The clinical symptoms and laboratory findings imp…

Die lokale Fibrinolyse bei Nierenarterienverschlüssen

The indications and technique of local fibrinolysis therapy of acute renal artery occlusions are discussed in relation to four patients. Because of the short period for which ischaemia is tolerated by the kidney, the result of treatment depends largely on the time interval between occlusion and the beginning of treatment. Partial perfusion of the renal artery was obtained in three patients. Since the "ischaemia time" of the kidneys had been exceeded, it was not possible to obtain complete restitution of renal function in any of these patients.

Acanthocytes in urinary sediment--a pathognomonic marker?

The lady with a history of blood transfusion who developed palpable purpura and microhaematuria

Prospektive Beobachtungsstudie zur operativen Therapie des renalen Hyperparathyreoidismus

In einer prospektiven Beobachtungsstudie bei Patienten mit renalem Hyperparathyreoidismus wurden nach Eingriffen an den Nebenschilddrusen der Verlauf und die Abhangigkeit der Symptomatik von praoperativ ermittelten Laborparametern analysiert. Zwischen dem 1. 8. 1987 und dem 31. 12. 1995 wurden 79 Patienten operiert. Bei 72 Patienten erfolgten erstmalige Eingriffe an den Nebenschilddrusen. Bevorzugtes Operationsverfahren war die totale Parathyreoidektomie mit autologer Epithelkorperchenreplantation (n = 67). Informationen zum postoperativen Verlauf liegen von allen Patienten vor. Bei 74 der 79 Patienten erfolgten regelmasige Nachuntersuchungen (1–9, Median = 4) mit einer Nachbeobachtungszeit…

Minimalheparinisierung bei Dialysepatienten mit erhöhter Blutungsgefährdung

Abstract In 78 patients (47 men, 31 women; mean age 53 [22-78] years) 174 dialyses were undertaken within one week of a bleeding episode or a diagnostic or therapeutic procedure which may cause bleeding. Minimal anticoagulation with low molecular weight heparin (LMWH) was the aim, using a biocompatible dialyser. During the dialysis coagulation was controlled by global tests (Quick value/international normalized ratio [INR], partial thromboplastin time, thrombin time, antifactor Xa activity), by molecular markers of clotting activity (thrombin-antithrombin III complex [TAT], D-dimers), as well as measurement of elastase (elastase-alpha 1-protein inhibitor complex). The LMWH dosage averaged 9…

Dialyseassoziierte Amyloidosteopathie - Radiologische Aspekte

Amongst the complications of dialysis, amyloid osteopathy is getting increasingly significant. It is due to deposition of beta 2-microglobulin. To determine the incidence and time of development of this complication, the skeletal radiographs of 185 patients undergoing dialysis, some for up to ten years, were analysed retrospectively. In about 10% of patients, the presence of beta 2-microglobulin osteopathy may be expected. The radiological features, sites of predilection and differential diagnosis of amyloid osteopathy and of other skeletal changes due to dialysis are discussed.

Assoziation einer arteriellen Verschlußkrankheit mit Ciclosporin-Therapie nach Nierentransplantation

Renal transplantation followed by immunosuppression with cyclosporine (whole-blood levels 200-300 micrograms/l) and methylprednisolone (4 mg daily) was performed in a 54-year-old man with chronic glomerulonephritis. Three years later rapidly progressive arterial obstructive disease (peripheral type) developed. Parenteral treatment with prostaglandins, calcium antagonists and nitrates, as well as a lumbar sympathectomy, was unsuccessful so that, in rapid succession, several amputations on upper and lower limbs became necessary. The disease progression was arrested only when azathioprine replaced cyclosporine. Raynaud's phenomenon, present at the time, also disappeared and analgesics were no …

Psychological Conflicts Between Relatives During the Long-Term Course After Successful Living Organ Donation

The German transplantation law prefers living organ donation between close relatives and spouses, which is assumed to guarantee unequivocal altruistic motivation. Since 2001, 68 recipient-donor-pairs, who aspired to have a renal or liver transplantation, underwent a systematic psychosomatic evaluation. Meanwhile, 43 transplantations were performed including 34 renal and 9 liver cases. Seventeen recipient-donor-pairs were readministered evaluations by the department of psychosomatic medicine after 1 to 6 years after transplantation for long-term follow-up. In 10 cases of medically successful transplantation, we identified severe conflicts between donor, recipient, and next-of-kin. Major conf…

Operatives Management bei Funktionsstörungen von Dialysefisteln

Aufgrund der oberflachlichen Lage der Shuntgefase verzichten wir bei Shuntinsuffizienz bzw.-verschlus auf eine aufwendige apparative Diagnostik zur morphologischen Beurteilung. Es erfolgen praoperativ lediglich eine subtile klinische Untersuchung mit Inspektion, Erheben des Pulsstatus, Abtasten der Shuntvene und des arteriellen Gefases mit und ohne venosen Stau sowie eine Auskultation des Shunts. Anschliesend fuhren wir die Revision des Shunts in Lokalanasthesie durch, wobei die Anastomose in der Regel revidiert und neu angelegt wird. Bei uns wurden von Januar 1990 bis Mai 1996 bei 371 Patienten insgesamt 539 Shuntoperationen durchgefuhrt, wobei 263 Eingriffe Revisionen waren. Die Revisione…

Human renal tubular epithelial cells as target cells for antibodies to proteinase 3 (c-ANCA)

HCV-associated cryoglobulinaemia presenting with vasculitis, hepatitis, and glomerulonephritis—a therapeutic dilemma

treated by diet. One year prior to presentation the patient suffered a transitory ischaemic brain attack concomitant with the onset of arterial hypertension, which was subsequently treated with calcium antagonists and beta blockers. Purpura-like skin lesions were noted which were reported to have occurred intermittently over a period of 5 years on both legs and occasionally on the arms. Proteinuria and haematuria were noted during periods with skin lesions.

Fibromuscular dysplasia in a transplanted kidney