[What is certain in the therapy of glomerulonephritis?].
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Biomedical subjects
Publications and source records attributed to D Seybold.
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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.
Indications, selection of donor and recipient, medical and surgical management and complications, problems of organ procurement. Renal transplantation has become routine therapy. Organs are predominantly obtained from cadavers, transplantations from living donors are rarely indicated. Advances in preservation methods have improved organ quality and prolonged storage time. Selection of the most suitable recipient is based on histocompatibility matching. Blood transfusions before transplantation seem to improve the results. Recognition of a rejection crisis is primarily based on clinical symptoms. Persistent rejection calls for prompt explantation and the patient has to return to dialysis. Infections, serum-hepatitis and gastro-intestinal bleeding are the most common complications. Late complicatons are diabetes mellitus, cirrhosis of the liver, osteopathy, recurring glomerulonephritis, and, rarely, malignomas. Transplantation frequency in the Federal Republic of Germany could be increased by more awareness of physicians and a better knowledge of the general public about the need for cadaver donors.
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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'.