Pharmacokinetics of tocainide in patients with severe renal failure.

The plasma levels of tocainide have been followed after oral administration of 600 mg p.o. to 20 patients with renal failure due to various causes, and to 8 healthy controls. The peak plasma concentrations in the patients with pyelonephritis (3.80 micrograms/ml) and interstitial nephritis (3.74 micrograms/ml) but not in those with glomerulonephritis (3.17 micrograms/ml) differed from that in healthy volunteers (3.24 micrograms/ml). The renal clearance of tocainide was well correlated with the endogenous creatinine clearance and was dependent on urine pH. No difference in renal clearance was observed between the patients groups. It is suggested that the changes in plasma levels are a consequence of decreased renal clearance. Creatinine clearance was shown to be a poor estimator of tocainide clearance, which suggests that extrarenal clearance plays an important role in the handling of the drug in the body. The findings are used to suggest a safe dosage regimen.

Systolic time intervals before and after haemodialysis.

We investigated changes of haemodynamics during haemodialysis in 107 patients by noninvasive measurement of systolic time intervals. Heart rate and preejection period index increased and systolic and diastolic blood pressure, left ventricular ejection time and isovolumic contraction time decreased. We found, that if the pre-dialysis ejection fraction (EF) was more than 55 per cent, post-dialysis EF decreased by about 10 per cent. However if pre-dialysis EF was less than 55 per cent, post-dialysis EF increased by five per cent. Regarding cardio-thoracic-ratio, Sokolow-Lyon-Index (SLI) and repolarisation disorders we found the most remarkable decrease in EF in patients with normal sized hearts with enlarged SLI and repolarisation disorders.

Experiences with Redy-dialysis on a camper.

In April 1976 a dialysis camper with Redy-dialysis equipment was put into service by the Institute of Nephrology of the 4th Department for Internal Medicine of the City Hospital Nürnberg. In the following six years of service the bus was rented 40 times by 20 different home dialysis patients and was driven more than 100 000 km in Europe on 700 days. Two hundred and eighty haemodialyses with the Redy-system showed that this kind of dialysis during the holidays can be carried out without running a greater risk than with home dialysis itself. A home dialysis patient describes his own experiences with the 'Redy-bus'.

[Immunosuppressive therapy following kidney transplantation]. / Immunosuppressive Therapie nach Nierentransplantation.

Immunosuppressive therapy is necessary after transplanting allogenous organs. Various methods of non-specific immunosuppression are discussed. It is usually achieved by combined administration of glucocorticosteroids, azathioprine and antilymphocyte globulin. Improvement may result from using cyclosporine A. Other methods such as total radiation of the lymph nodes, drainage of the thoracic duct or plasmapheresis are restricted in their application because of additional high risk and the additional effort. Complications after a kidney transplantation are often complications of the immunosuppressive therapy. Low dosage of the substances used and limitation of the dosage in the therapy of acute rejection seem to be advisable.

Subtypes of acute postinfectious glomerulonephritis. Synopsis of clinical and pathological features.

42 kidney biopsies from adults and children suffering from acute postinfectious glomerulonephritis were examined by light microscopy, immunofluorescence and electron microscopy. The biopsies were obtained within 9 weeks of the onset of the first clinical symptoms. The results show not only a range of variation in the histological picture (particularly in the accumulation of leukocytes in the capillary lumens, and in the degree of cell proliferation) but also different immunofluorescent patterns which we have called the "starry sky", "garland" and "mesangial" patterns. These patterns correspond to characteristic differences in the electron microscopic picture. The "starry sky" pattern (IgG, IgM and/or IgA, combined with C3) occurs mainly in the first weeks of the disease and is associated with an endocapillary-mesangial glomerulonephritis. This may turn into a "mesangial" pattern (mostly C3 alone) which is associated mainly with mesangial proliferation. Four types of immune deposits can be observed electron microscopically in all three patterns (subendothelial, subepithelial, mesangial and intramembranous), but their different quantitative distribution determines the characteristic picture. Subepithelial deposits (so called "humps") often considered characteristic of poststreptococcal glomerulonephritis play a dominant role in the "garland" pattern. The cases with a "garland" pattern often show strikingly high levels of proteinuria (greater than 5 g/24 hr). It is believed that in patients with postinfectious glomerulonephritis deposition of immune complexes of various composition is responsible for producing the described subtypes depending on their different distribution in the glomeruli. It seems possible that these subtypes have different clinical significance, something which could be confirmed by performing follow-up studies.

[Water-, electrolyte- and acid-base equilibrium in the aged]. / Wasser-, Elektrolyt- und Säure-Basen-Haushalt im Alter.

The functional capacity of the kidney decreases with advancing age. We not only find a reduced glomerular filtration rate but also disturbances in the functioning of the tubules which influence the capacity to dilute and concentrate the urine and the renal electrolyte excretion. In addition, the plasma-renin activity shows decreased response to stimulation; the aldosterone and vasopressin secretions are also decreased in old age. Disturbances of the water-, electrolyte and acid-base equilibrium often cause secondary renal failure. On the other hand, as the renal capacity is limited, renal disorders occurring in old age may lead to quicker decompensation.

[Embolization of renal artery -- an alternative in nephrectomy in the treatment of patients with dialysis and malignant hypertension (author's transl)]. / Nierenarterienembolisation -- Eine Alternative zur Nephrektomie in der Therapie der malignen Hypertonie bei Dialysepatienten.

Embolization of renal arteries (coil embolization by Gianturco) was performed in four patients with malignant renal hypertension as an alternative to bilateral nephrectomy. Three patients with successful renal transplantation developed intractable hypertension without arterial stenosis of the transplant. One patient treated with hemodialysis showed malignant hypertension refractory to volume depletion and antihypertensive therapy. In all cases hypertension could be improved and thus medical therapy be reduced.

[Percutaneous transluminal catheter dilatation of kidney artery stenoses in patients with renovascular hypertension]. / Perkutane transluminale Katheterdilatation von Nierenarterien-Stenosen bei Patienten mit renovaskulärer Hypertonie.

14 patients with severe hypertension showed unilateral (7) or bilateral (6) stenoses of renal artery due to arteriosclerosis (12) or fibromuscular hyperplasia (7); one stenosis appeared after renal transplantation. Successful application of percutaneous transluminal angioplasty of renal artery was performed in 14 stenoses. 4 of 10 patients showed normal values of blood-pressure, in 4 patients blood-pressure was improved, in 2 patients hypertension remained unchanged. The patients were observed 1 to 23 months after dilatation; antihypertensive drugs were necessary in all cases, but could be reduced. The effectiveness of the procedure was demonstrated by renal arteriogram and determination of pre- and poststenotic blood-pressure values.

[Home dialysis (author's transl)]. / Heimdialyse.

100 patients requiring dialysis were trained between 1970 and 1975. Up to 31. 12. 1975, 56 patients were on home dialysis, 10 on the self-care program and 6 were freshly trained. Training usually lasts 8 weeks. The training course is briefly presented and the supervision of home dialysis patients after discharge from training is described. The possibility of vacation plays an important role in social rehabilitation. Since the spring of 1976, the hospital has operated a camping dialysis bus, the use of which is reported.