[Thromboembolic risk factors in kidney transplantation: hemorheologic examination in secondary polycythemia]. / Thromboembolische Risikofaktoren bei Nierentransplantierten--hämorheologische Untersuchungen bei sekundärer Polyglobulie.

Cardiovascular risk factors will increase the lethality of kidney patients being under dialysis treatment and after transplantation. This risk is additionally increased after transplantation by secondary polycythemia. The paper investigates the rheological properties of the blood of 20 patients affected by secondary polycythemia after kidney transplantation, 10 patients without polycythemia after kidney transplantation and 19 test persons. Plasma viscosity, erythrocyte aggregation and whole blood viscosity were determined. As a result, an increase of erythrocyte aggregation without their deformability being changed could be found in patients affected by polycythemia after kidney transplantation. The reduced thrombocyte aggregation identified in these patients can be explained by the influence of therapy.

[Oxygen exchange processes between the dialyzing fluid and the blood during hemodialysis and resultant practical consequences]. / Sauerstoffaustauschvorgänge zwischen Spüllösung und Blut während der Hämodialyse und abgeleitete praktische Konsequenzen.

The polarographic measuring technique was used to examine the processes of oxygen exchange between dialysing fluid and blood during haemodialysis in 21 patients of the chronic haemodialysis programme. During haemodialysis there is a tendency for the arterial oxygen partial pressure to fall; on the statistical average this is slight, in individual cases it is a marked tendency. With the apparatus KNA 302 (without degassing facilities) the blood is slightly oxygenated. This is less with the apparatus KN 401 (not very effective degassing facilities). With complete degassing of the dialysis solution a loss of oxygen through the membrane would be expected. This loss could be avoided by complete degassing of the dialysis solution and subsequent oxygenation. Various ways of realizing extrapulmonary oxygenation during haemodialysis in order to counteract the described tendency to hypoxaemia are pointed out. They should be particularly important when pulmonary means are exhausted (acute dialysis, shock lung).

[Behavior of important serum lipid fractions in chronic hemodialysis patients and following kidney transplantation]. / Zum Verhalten wichtiger Serumlipidfraktionen bei chronisch hämodialysierten Patienten und nach Nierentransplantation.

In patients in the chronic programme of haemodialysis and 51 patients with transplanted kidney selected lipid-chemical parameters were investigated and compared. 1. Disturbances of the lipid metabolism more frequently occurred in patients with transplanted kidney than in chronically haemodialyzed patients. 2. Triglycerides, total cholesterol and LDL cholesterol were more frequently increased in patients with transplanted kidney than in chronically haemodialysed patients. 3. The HDL cholesterol of patients with transplanted kidney was only somewhat higher in comparison to patients in the chronic haemodialysis programme. 4. Sex-specific differences of the HDL cholesterol level were neither in chronically haemodialysed patients nor in patients with transplanted kidney. 5. Klimov-index and LDL/HDL cholesterol quotient referred to a permanently high risk of cardiovascular complications even after transplantation of a kidney.

[Effect of ultraviolet irradiation on renal osteopathy in patients in the chronic hemodialysis program]. / Einfluss der ultravioletten Bestrahlung auf die renale Osteopathie bei Patienten im chronischen Hämodialyseprogramm.

Under influence of the ultraviolet radiation the formerly lowered 25-hydroxycholecalciferol (25-OH-CC) level increases in persons with healthy kidneys. Such investigations were not yet carried out in patients undergoing dialysis. Since the insufficiency of active vitamin-D-metabolites plays an essential role in the development of the renal osteopathy, since 1978 in 13 patients undergoing dialysis a regular ultraviolet radiation has been performed, in order to stimulate the cutaneous vitamin-D-production. The time of observation was 31.7 +/- 14.3 months. Deionized water served for the production of dialysate. The calcium content was about 3.5 +/- 3.8 mval/l. The patients had very rarely bone and joint complaints. Severe clinical complications of renal osteopathy developed only in one female patient in the 3rd year of dialysis with a fracture of the neck of the femur as well as in a 2nd patient after transplantation of a kidney with permanently progressing demineralization and spondylitis. Controls of the courses showed only in 18.2% a progressing loss of the peripheral mineral content of the bones. The alkaline phosphatase was not increased, the alkaline bone phosphatase appeared with low and not provable activities. A suppression of the secondary hyperparathyroidism could not be proved. Parathormone was increased with 2.30 +/- 1.90 micrograms/l. The 25-OH-CC-levels were normal or slightly increased with 39.1 +/- 12.4 micrograms/l, whereas they were essentially lower in a comparative group without ultraviolet radiation. Therefore in connection with the very low rate of complications of the renal osteopathy with normalized 25-OH-CC-levels new therapeutic possibilities were the result in patients undergoing dialysis after ultraviolet radiation. The increasing importance consists also in the fact that 90% of the human vitamin-D-need are supplied via skin and it was proved by animal experiments that also after bilateral nephrectomy the formation of the active vitamin-D-metabolite 1,25-dihydroxycholecalciferol is possible by photosynthesis.

[The problem of sodium metabolism in chronic kidney failure]. / Zum Problem des Natriumhaushaltes bei chronischer Niereninsuffizienz.

The endogenous 24-hour-clearance and the sodium excretion during 24 hours in the urine were investigated on 12 healthy persons with chronic nephropathies, 5 patients with condition after acute renal failure and 75 patients with condition after transplantation of a kidney. A correlation between the quantity of urine and the excretion of sodium in 24 hours could be proved in patients with a retention to 884.0 mumol/l creatinine in the serum. Only with further restriction of the renal function a reduction of the sodium excretion during 24 hours below 150 mmol becomes significant. In 16 of 25 patients in the early phase of the again occurring renal function after transplantation the sodium excretion more rapidly improved than the creatinine clearance. In 20 patients with chronic crises of rejection in 15 cases the creatinine clearance and the sodium excretion simultaneously decreased. In one patient the rejection began with a reduction of the sodium excretion.

[Cytomegalovirus infections following kidney transplantation - clinical and serological studies of the early and late phases]. / Zytomegalievirus-Infektionen nach Nierentransplantation -- klinische und serologische Untersuchungen in der Früh- und Spätphase.

In 71 patients after kidney transplantation the cytomegalovirus-antibody state was recognized with the help of the indirect fluorescence antibody test in a period of 24 months. The first estimations were performed in 33 patients in the early phase up to the 3rd month and in 38 patients in the late phase up to the 100th months after transplantation. Of 13 patients who had been controlled already before operation only 3 patients were seronegative. After this twice a seroconversion with clinically manifest cytomegalovirus infection appeared, in one case an irreversible failure of the graft developed. In the late phase 4 patients remained seronegative. Of these patients also in one case the chronic rejection caused the entering into the dialysis programme. -- A positive cytomegalovirus-antibody state was found in the early phase in 30 of 33 patients and in the late phase in 34 of 38 patients. An active cytomegalovirus infection was present in the early phase in 11 of 30 and in the late phase in 11 of 34 patients. In the early phase the clinical symptoms fever, leukopenia and hepatitis were more frequent and more expressed than in the late phase. In 7 of the 11 patients in the early phase and in 8 of 11 patients with active cytomegalovirus infection in the late phase rejections occurred which in 2 of the 7 patients in the early phase and in 5 of the 8 patients in the late phase led to the loss of the graft. In inactive cytomegalovirus infection an irreversible course thrice appeared in 11 patients with rejections. Three typical instances are demonstrated: 1. The course of an active cytomegalovirus infection in the early phase with rejection and irreversible failure of the graft. 2. The reactivation of a latent cytomegalovirus infection by uncontrollable rejection processes. 3. The course of an active cytomegalovirus infection without clinical complications and with transition into an inactive stage in minimal immunosuppression. The treatment is performed with immunosuppression of a possibly low dosage, the avoidance of increases of prednisolone in cytomegalovirus-associated rejections, the intravenous application of human-gamma-globulin as well as the prevention or intensive treatment of superinfections. In these cases the close relations between rejection processes, immunosuppressive therapy, superinfections and cytomegalovirus infections should find the necessary consideration.

[The kidney and diuretics]. / Niere und Diuretika.

In an experiment carried out on 5 awake dogs with different size of the kidney could be shown that the diuretic effect of the xanthines is only slight and depends on the number of nephrons got. The application of thiazides, which possess a long-term effect, is indicated only up to a value of the creatinine clearance of about 25 ml/min/1.73 m2. At the beginning retention of the substances contained in the urine furosemide can still be used in high doses. In 18 patients with values of serum creatinine between 2-20 mg/100 ml also with a dosage up to 500 mg furosemide within 24 hours the Na+-concentration in the urine did not exceed a value of 90 mval/l. These findings are explained in the sense of the proof of a limit of the possibilities of a conservative treatment of the chronic renal insufficiency with furosemide.

[Differential diagnosis and therapy of nephrogenic hemorrhagic diathesis]. / Differentialdiagnose und Therapie der nephrogenene hämorrhagischen Diathesen.

For the development of nephrogenic haemorrhagic diatheses in the first place a decreased function of the thrombocytes and a thrombocytopenia are responsible. An inhibition in the intrinsic system may be referred to a lesion of the thrombocytic factor 3. Up to now defects in the extrinsic system do not allow a systematic classification. The best causal therapy are an effective haemodialysis and a renal transplantation. The detection of defects in the coagulation system is of importance for the dosed heparinisation and the control of the treatment with cytostatics for the immune suppression. Among 33 patients undergoing dialysis only 3 patients the Quick-value was reduced to 50% in 9 patients the thrombocyte values were below 150,000 mm3 and in 2 patients below 100,000 mm3. Among 28 carriers with renal graft only in 1 case the Quick-value was reduced to about 50%. In 12 patients the thrombocyte values were decreased below 150,000 mm3 and in 4 patients below 100,000 mm3. A correlation between the two global tests was not to be proved.

[Pregnancy and delivery after renal transplantation (author's transl)]. / Schwangerschaft und Geburt nach Nierentransplantation.

A case report is given on a 21-years-old woman who became pregnant 18 months after renal transplantation. In spite of relatively unfavourable conditions (match 0,25; hypertension) renal function showed a good adaptation throughout the gestation. In the 38. week of pregnancy the woman was successfully delivered of a 2440 g healthy female child by vacuum extraction. There were no effects of the immunsuppressive drugs on the newborn. It is the third case of a successful delivery after renal transplantation in the GDR.

[Progressive multifocal leukoencephalopathy as a complication of immunosuppression in kidney transplantation]. / Die progressive multifokale Leukenzephalopathie als Komplikation der Immunsuppression der Nierentransplantierten.

The progressive multifocal leukencephalopathy is mostly observed as paraneoplastic complication of malignant lymphoproliferative systemic diseases. It may develop also under the influence of a long-term immunosuppressive therapy, as it is necessary in the rejection treatment of recipients or organ transplantations. It is reported on a 44-year-old man in whom a progressive multifocal leukencephalopathy with exitus letalis developed 6 months after a kidney transplantation and following immunosuppressive therapy. In the oligodendroglia of the marginal region of leukodystrophic foci in the centrum semiovale of the right cerebral hemisphere by means of electron microscopy paracrystalline situated virions of the type Papova were proved in most cases.

[Goodpasture's syndrome and nephrocalcinosis]. / Goodpasture-Syndrom und Nephrokalzinose.

In comparison with literary data is reported on 3 young men with a Goodpasture syndrome. Immunohistologically in all cases a glomerulonephritis of the type of basal membrane antibodies was proved, in one patient also still 14 months after having reached the terminal stage of the renal insufficeincy. In every case the disease led to the dialytic treatment without the necessity of nephrectomies for commanding haemmorrhages of the lungs. The longest survival time was 3 years. -- In 1 patient within metastatic calcifications a pronounced nephrocalcinosis developed. Massive depositions of calcium were found in the basal membranes of the glomeruli and tubuli. It is discussed on the genesis of nephrocalcinosis, in which case a secondary hyperparathyrodism, an elevation of the calcium-phosphate-product, an alkalotic metabolic position as well as the dystrophic renal parenchyma of the rapidly progressing glomerulonephritis of Goodpasture's syndrome are taken into consideration.

[New viewpoints on the therapy and prevention of renal osteopathy]. / Neue Gesichtspunkte zur Therapie und Prophylaxe der renalen Osteopathie.

Dihydrotachysterol which was developed already 50 years ago is above all used in the substitution therapy of hypoparathyroidism. Its parathyreomimetic effectivity has led to an enlargement of the spectrum of indication during the last years; it allows the prophylactic use of dihydrotachysterol in chronic nephropathy in order to prevent by this means the risk of reactive hyperparathyroidism as well as its sequelae. On the basis of own experimental results the pathophysiologic prerequisites of this new form of treatment are discussed.

[Therapy of uremic pericarditis]. / Zur Therapie der Pericarditis uraemica.

An uraemic pericarditis can appear as complication of a haemodialysis in different stages. At the beginning an uraemic pericarditis is still to be referred to the uncompensated retention or to adaptation processes in the cellular mineral metabolism. An uraemic pericarditis in the later course of the dialysis nearly regularly is connected with an underdialysis syndrome which can be evoked by fistula or shunt complications or by infections of different genesis (sepsis, hepatitis, virus infections). - It is reported on own experiences in the dialytic treatment of uraemic pericarditis. In the period from 1970 to 1976 among 83 patients who were in chronic dialytic treatment an uraemic pericarditis was observed in 21 cases. In 3 patients developed haemorrhagic effusions with tamponade. The longest survival time of a patient with uraemic pericarditis and acute cardiac arrest in the early stage of the dialytic treatment is up to now 5 1/2 years after transplantation of a kidney of a corpse. - The possibilities of an operative exonneration of the heart from pericarditic changes are discussed.

[Early symptoms of hyperparathyroidism in nephropathies]. / Zur Frühsymptomatik des Hyperparathyreoidismus bei Nephropathien.

The development of an autonomous (tertiary) hyperparathyroidism in patients with renal diseases must clinically be taken into consideration, when by therapeutic measures the causes of a compensatory overfunction of the parathyroid glands were excluded, but the symptoms of a hyperparathyroidism continue or even increase. This is of special importance in the control of patients with renal grafts. The increase of the serum calcium on more than the normal value in simultaneously increased serum phosphate level and increased activity of the alkaline bone phosphatase in connection with demineralisation of the skeleton, osteoclastic changes of the bones and estraossary calcifications may be regarded as early symptoms of a hyperparathyroidism. It is to be discussed the hypothesis, whether in every autonomous hyperparathyroidism a regulative reaction precedes. In patients with renal diseases in a limited number a prevention of the regulative overfunction of the parathyroid glands is possible by an early compensation of a calcium deficit (acquired vitamin D resistance), a hyperphosphataemia and a renal acidosis.

[Significance of the determination of serum and urinary creatinine for the clinical use, dispensatory care and screening of patients with kidney diseases]. / Die Aussagekraft der Kreatininbestimmung im serum und im Harn für die Klinik, Dispensairebetreuung und Screeninguntersuchungen von Nierenkranken

In the early recognition, control of course and therapy of patients with chronic renal diseases the proof of disturbances of the renal functions has a particular value. Here the determination of creatinine in the serum and in the urine increasingly gains significance, since an automatisation stood the test. The creatinine values may be used as orientation values for the clearance method in the dispensary or in the screening as well as in the sense of reference values for other substances normally contained in the urine. In patients with chronic renal diseases a shift of the daily variation of the renal function according to the development of a nycturia is to be observed still before the formation of an isosthenuria. In female test persons the excretion of creatinine is on an average lower than in male ones. This may be based on the differently developed muscle masses. When creatinine is used as reference value for other substances the dependence on age and sex must be taken into consideration in the case that the substance concerned does not reveal the same age- and sex-specific course of behaviour.