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E Ritz

Publications and source records attributed to E Ritz.

At least 73 records · Page 4Linked to original sources
PubMed2001

Serum cystatin C concentration as a marker of renal dysfunction in the elderly.

Serum cystatin C is a novel marker of renal function claimed to be superior to plasma creatinine. We assessed both parameters in young normotensive subjects (n = 12; 6 men; mean age, 25 +/- 2 years) and elderly normotensive and hypertensive subjects (n = 41; 19 men; mean age, 67 +/- 6 years). Glomerular filtration rate (GFR) was measured in all individuals using the inulin clearance (C(in)) technique. Compared with young subjects, mean GFR was modestly but significantly (P: < 0.001) less in elderly subjects (young, 119 +/- 11 mL/min/1.73 m(2) versus elderly, 104 +/- 12 mL/min/1.73 m(2)). Mean plasma creatinine concentration was identical in both groups (young, 0.93 +/- 0.11 mg/dL versus elderly, 0.93 +/- 0.10 mg/dL; P: < 0.90). Mean serum cystatin C concentration was significantly (P: < 0.001) greater in elderly subjects (0.84 +/- 0.10 mg/L) compared with young subjects (0.69 +/- 0.08 mg/L). In all but one elderly subject, plasma creatinine concentration was within the 95% confidence interval of plasma creatinine concentration in young subjects. Eleven of 41 elderly subjects (27%) had GFRs less than the lower 95% confidence interval, respectively, and 12 of 41 elderly subjects (29%) had a serum cystatin C concentration greater than the upper 95% confidence interval in young subjects. The correlation between serum cystatin C concentration and C(in) (r = -0.65; P: < 0.001) was considerably better than between plasma creatinine concentration and C(in) (r = -0.30; P: < 0.02). Serum cystatin C concentration is a better marker of renal dysfunction (ie, reduced GFR) than plasma creatinine concentration, at least in elderly subjects with plasma creatinine concentrations within the normal range.

Adult↗
PubMed2001

The epidemiology of end-stage renal disease in the Baltic countries: an evolving picture.

INTRODUCTION: The epidemiology of end-stage renal disease (ESRD) and renal replacement therapy (RRT) is under continuous evolution all over the world. Of particular interest is the development of RRT in the countries of the former Soviet bloc which underwent great political and socio-economical changes in the last decade. We report here the epidemiological analysis of ESRD and RRT in the three Baltic countries: Lithuania, Estonia, Latvia. Subjects and methods. This epidemiological report is based on data from centre questionnaires which were collected from 1996 onwards, with a response rate of 98-99%. RESULTS: The prevalence/incidence of RRT patients in 1999 were 213/99.5 p.m.p. in Lithuania, 186/45.5 p.m.p. in Estonia and 172/55.8 p.m.p. in Latvia. Haemodialysis (HD) was the most common RRT modality in Lithuania (60% of prevalent patients), but not in Estonia (29%), while in Latvia it was nearly as common as renal transplantation (45 and 46%, respectively). Home HD was not performed. The proportion treated by peritoneal dialysis (PD) was very low in Lithuania (4% of RRT patients), while the percentage was higher in Latvia (9%) and Estonia (20.4%). The percentage of patients on RRT treated by renal transplantation was high throughout, representing the main modality of treatment in Estonia (50.5% of RRT prevalent patients, 94 p.m.p.) and in Latvia (46%, 79 p.m.p.) and being high in Lithuania (36%, 77 p.m.p.). The main renal diseases leading to ESRD were glomerulonephritis, pyelonephritis and diabetes. CONCLUSION: The epidemiology of RRT in the Baltic countries is undergoing rapid changes. Transplantation has reached an impressive level. A high percentage of RRT patients live with a functioning graft.

Estonia↗
PubMed2001

Sympathetic overactivity and arterial hypertension in renal failure.

In the past, it had been presumed that hypertension in chronic renal disease can be explained by the dual effects of sodium retention and inappropriate activity of the renin-angiotensin system. Recent experimental and clinical data provide strong evidence that the increase in blood pressure is to a large part due to sympathetic overactivity which is triggered by afferent signals emanating from the kidney and resetting sympathetic tone by stimulation of hypothalamic centres. The sequelae of sympathetic overactivity extend beyond their effects on blood pressure and include accelerated progression of renal failure and presumably increased cardiac arrhythmia.

Adrenergic beta-Antagonists↗
PubMed2001

Renal disease in type 2 diabetes.

The prevalence of type 2 diabetes is rising in all Westernized societies. Presumably as a consequence of diminishing cardiovascular mortality, end-stage renal failure (ESRF) in patients with diabetes (mostly type 2) as a co-morbid condition has risen dramatically in the past decade. This constellation has become the single most common cause of ESRF in most countries. Such an epidemiological trend is particularly regrettable, since in uraemic diabetic patients, medical rehabilitation and survival are remarkably poor. Recent studies indicate that an interplay between genetic predisposition and factors, some of them susceptible to intervention, such as hyperglycaemia, blood pressure, smoking, age, gender and ethnicity, predispose to the development and progression of nephropathy. It has also become clear that trace albuminuria ('microalbuminuria') provides unique opportunities to recognize incipient renal involvement early on, although it is less specific in type 2 as compared with type 1 diabetes. Factors that promote progression include hypertension, proteinuria, smoking, glycaemic control and, less certainly, dietary protein intake and hyperlipidaemia. Cumulating evidence indicates that early intervention delays progression of nephropathy. The most important strategies to combat the medical catastrophe of increasing numbers of diabetic patients with ESRF include: (i) prevention of diabetes (mainly type 2); (ii) glycaemic control to prevent onset of renal involvement; and (iii) meticulous antihypertensive treatment to avoid progression of nephropathy.

Diabetes Mellitus, Type 2↗
PubMed2001

Advances in nephrology: successes and lessons learnt from diabetes mellitus.

The introduction of recombinant erythropoietin (Epo, epoetin) has resulted in a shift in focus from the treatment to the prevention of anaemia. This shift in treatment goals has provided nephrologists with the challenge of implementing preventative strategies in clinical practice. While this area of nephrology is still developing, a lot can be learned from the methods applied by clinicians involved in the prevention of other diseases, particularly non-insulin-dependent (type 2) diabetes mellitus. The prevention of type 2 diabetes has become a major aim of healthcare providers globally due to the epidemic proportions of the disease. In order to reverse this worrying trend, diabetologists have had to develop effective management strategies based upon their current knowledge. Nephrologists must now adopt a similar approach if the increasing threat from diabetic nephropathy is to be reversed. This should include strict normotension, the prescribing of angiotensin-converting enzyme (ACE) inhibitors, administration of lipid-lowering agents, and the near-normalization of anaemia with epoetin. However, the implementation of treatment strategies alone is unlikely to be sufficient. Indeed, an effective programme of education is required to ensure that patients understand the seriousness of their condition and remain compliant with treatment. Similarly, educating the general public may help to reduce the burden of type 2 diabetes and the subsequent problems associated with the disease, including renal disease.

Anemia↗
PubMed2001

Chronic kidney disease: why is current management uncoordinated and suboptimal?

Morbidity and mortality associated with chronic kidney disease (CKD) is higher than that of the normal population, and the incidence of end-stage renal disease (ESRD) continues to increase. Several factors contribute to the uncoordinated and suboptimal management of CKD, including the attitude and behaviour of nephrologists, referring physicians and patients, and economic constraints on healthcare systems. Late referral of at-risk patients to specialist care is an area of particular concern, as this denies nephrologists adequate opportunity to prevent progression of CKD and associated complications such as anaemia. Due to the ageing population and advances in technology, the costs of treating CKD and ESRD continue to escalate and represent another barrier to the delivery of optimal care. Optimizing the care provided to CKD patients requires a coordinated approach to the management of the condition. Closer collaboration and improved communication across specialities is important for the timely referral of patients and for efficient utilization of available resources. A multidisciplinary approach may facilitate patient identification and improve the management of CKD.

Anemia↗
PubMed2001

Effects of all-trans retinoic acid on renin-angiotensin system in rats with experimental nephritis.

We previously demonstrated that all-trans retinoic acid (RA) preserves glomerular structure and function in anti-Thy1.1 nephritis (Wagner J, Dechow C, Morath C, Lehrke I, Amann K, Floege J, and Ritz E. J Am Soc Nephrol 11: 1479-1489, 2000). Because the renin-angiotensin system (RAS) contributes to renal damage, we 1) studied retinoid-specific effects on its components and 2) compared the effects of all-trans-RA with those of the AT(1)-receptor blocker candesartan. Rats were pretreated for 3 days before injection of the OX-7 antibody and continued with treatment with either vehicle or daily injections of 10 mg/kg all-trans-RA only (study 1) or 10 mg/kg body wt all-trans-RA, 1 mg/kg candesartan, or both (study 2) for an additional 7 days. The blood pressure increase observed in anti-Thy1.1 nephritic rats was equally normalized by all-trans-RA and candesartan (P < 0.05). In nephritic rats, mRNAs of angiotensinogen and angiotensin-converting enzyme (ACE) in the kidney were unchanged, but renin mRNA was lower (P < 0.01). Renal and glomerular AT(1)-receptor gene and protein expression levels were higher in anti-Thy1.1 nephritic rats (P < 0.05). In the renal cortex of nephritic rats, pretreatment with all-trans-RA significantly reduced mRNAs of all the examined RAS components, but in the glomeruli it increased ACE gene and protein expression (P < 0.01). In nephritic rats, candesartan reduced the number of glomerular cells and mitoses (P < 0.05) less efficiently than all-trans-RA (P < 0.01). Both substances reduced cellular proliferation (proliferating cell nuclear antigen) significantly (P < 0.05). No additive effects were noted when both compounds were combined. In conclusion, all-trans-RA influences the renal RAS in anti-Thy1.1 nephritis by decreasing ANG II synthesis and receptor expression. The beneficial effect of retinoids may be explained, at least in part, by reduction of RAS activity.

Angiotensin II↗