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Biomedical subjects

F Scheler

Publications and source records attributed to F Scheler.

At least 55 records · Page 3Linked to original sources
PubMed1988

[Angiotensin-converting enzyme inhibition: side effects and risks].

Adverse effects of converting enzyme inhibitors are either substance-specific (neutropenia, proteinuria, skin rashes, taste disturbances) or due to the converting enzyme inhibition (hypotension, functional renal insufficiency, hyperkalemia, cough, angioedema). They are rare nowadays because of better knowledge of the pharmacokinetics and -dynamics of the converting enzyme inhibitors, resulting in lower dosage, and because of identifying patients at high risk. The dosage must be adjusted according to renal function, in order to prevent accumulation and toxicity. In addition to patients with renal insufficiency, patients at high risk are those with a stimulated renin-angiotensin-aldosterone system, i.e. patients with renovascular hypertension or heart failure. Patients with collagen vascular disease, for example, systemic lupus erythematosus or scleroderma, should not be considered for long-term therapy with converting enzyme inhibitors because of the increased risk of neutropenia. Life-threatening angioedema may develop, mainly during the first few hours after drug administration.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1988

[Is the plasma ANP level an index of volume expansion in dialysis patients?].

Fluid overload is a frequent complication in anuric patients undergoing hemodialysis (HD) or hemofiltration (HF). Elevated ANP plasma concentrations are associated with overhydration or congestive heart failure (CHF). After intensive ultrafiltration in 18 HD patients with high ANP levels at the end of HD, ANP values normalized (28 +/- 4 fmol/ml) in 11 patients (group A), suggesting previous volume overload, whereas ANP remained elevated (126 +/- 31 fmol/ml) in seven patients (group B). Left ventricular ejection fraction by radionuclide ventriculography (LVEF) was significantly (p less than 0.01) lower in group B (41 +/- 7%) as compared to normal values in group A (67 +/- 8%). M-mode echocardiography demonstrated left atrial enlargement (53 +/- 3 mm) and pathologic enddiastolic left ventricular diameters (58 +/- 4 mm) in group B, compared to normal dimensions of left atrial (43 +/- 1 mm) and left ventricular enddiastolic diameters (47 +/- 4 mm) in group A. Persisting high ANP concentrations after intensive ultrafiltration in HD patients indicate CHF and require further diagnostic evaluation.

Atrial Natriuretic Factor↗
PubMed1987

Selective removal of low density lipoproteins (LDL) by precipitation at low pH: first clinical application of the HELP system.

The first clinical application of a new extracorporeal procedure (HELP) for the selective elimination of low-density lipoproteins by heparin precipitation at acid pH is described. Plasma, obtained by filtration of whole blood through a 0.2 mu filter, is continuously mixed with an equal volume of an acetate buffer (pH 4.85) containing heparin. After removal of the precipitated heparin complex by filtration, excess heparin is adsorbed to a specially developed filter and the clear plasma filtrate is subject to bicarbonate dialysis/ultrafiltration to restore physiologic pH and remove excess fluid. The calculated efficiency for the elimination of low-density lipoproteins from plasma by HELP is 100% and is therefore comparable to conventional plasmapheresis. The HELP system shows a high degree of specificity with over 80% of total protein being returned to the patient. Over 130 treatment procedures have now been performed. Patient compliance and acceptance have been excellent and no major complications have been observed.

Adult↗
PubMed1987

[Clinical aspects of renal ischemia and acute renal failure].

The rapid breakdown of renal excretory function termed "acute renal failure" (ARF) is accompanied by an increase in nitrogenous substances in the blood, usually eliminated with the urine (azotemia). Important causes of renal injury are renal ischaemia and the application of nephrotoxic drugs. The period of increasing symptoms (initiation) may be reversed by early therapeutic interventions, while the advanced stage with persistent oligo-/anuria (maintenance) requires haemodialysis treatment. The phase of repair (recovery) is initiated by the polyuric stage of ARF. Even in uncomplicated cases, one should expect only partial restoration of renal concentration ability.

Acute Kidney Injury↗
PubMed1986

Isolation and structural analysis of the circulating human cardiodilatin (alpha ANP).

A new method was applied to isolate a polypeptide hormone from human blood. The polypeptides from 1,000 1 of hemofiltrate with a molecular weight lower than 20 kDaltons were adsorbed to 2.5 kg alginic acid, then eluted, precipitated, and desalted on a G-25 Sephadex column, thus obtaining a crude lyophilised plasma polypeptide extract. These polypeptides were further submitted to ion-exchange chromatography. Thereafter, two steps of HPLC were carried out to purify a distinct polypeptide which was the circulating form of cardiodilatin (CDD) in this case. The amino acid analysis, C-terminal enzymatic cleavage by carboxypeptidase A, and sequence analysis showed that the only form of circulating cardiodilatin is the 28 amino acid residue containing molecule, cardiodilatin-99-126 cleaved from the C-terminus of cardiodilatin-126 and identical with alpha-ANP (alpha atrial natriuretic polypeptide). Other bioactive molecular forms of the polypeptide hormones of the cardiodilatin family were not detected in the hemofiltrate. The isolation procedure was followed up by a bioassay using in vitro vascular smooth muscle relaxation.

Amino Acid Sequence↗
PubMed1986

[Results of a 5-year study with captopril in patients with severe therapy-resistant hypertension].

The angiotensin converting enzyme (ACE) inhibitor captopril proved to be an effective antihypertensive drug during a 5-year follow-up study of patients with severe hypertension who had been resistant to a triple-drug regimen. Of the 42 patients, 41 had to be treated additionally with diuretics. Because of hypokalemia, potassium supplements were necessary in 26 patients, despite the use of "potassium-saving" diuretics in 12 patients. Blood pressure was controlled sufficiently in 3/4 of the patients during the 5 years. Patients with a large elevation in plasma renin activity showed the best response to the treatment. Six patients died during the 5 years. Therapy had to be stopped in 11 patients because of complications. The following complications and adverse effects were observed: cerebral ischemia (n = 10), vertigo and orthostasis (10), exanthema (9), hypogeusia (7), circulatory failure (7), myocardial infarction (6), and scintigraphically demonstrable decrease of renal perfusion (5). One patient with bilateral renal artery stenosis suffered from acute renal failure, which was reversible after withdrawal of captopril. Significant changes of red and white blood cell counts, transaminases, lipids, urine protein excretion, and heart rate were not observed.

Adult↗
PubMed1986

Fibrinolytic activity in renal venous blood in man.

In 50 patients without renal insufficiency, fibrinolytic activity, as reflected by euglobulin lysis time, was determined in blood obtained from the renal veins, the renal artery and a peripheral vein. Fibrinolytic activity was found to be significantly higher in the renal veins than in the renal artery and the peripheral vein. Other coagulation and fibrinolysis parameters did not show such differences. In addition, a patient with acute oligoanuric renal failure was investigated. This patient demonstrated reduced overall fibrinolytic activity, but there were no differences between the activity in the blood of the renal veins and that of the renal artery or peripheral vein. It seems, therefore, that the kidneys release plasminogen activators into the systemic circulation. This may be decreased in renal failure, probably contributing to the well-known diminished fibrinolysis in some kidney diseases.

Acute Kidney Injury↗
PubMed1986

[Rhabdomyolysis as a complication of chronic alcoholism. Observations in 19 cases].

In 19 chronic alcoholics with rhabdomyolysis the clinical picture demonstrated markedly different degrees of severity of myolysis. Muscle pain, muscle swellings and brown-coloured urine were rare. But symptoms of delirium, at times with cerebral seizures, were frequent at the onset. Renal failure of different degrees was common; five patients had to be dialysed. Two patients died in irreversible shock. Respiratory insufficiency and hypercalcaemia were other complications. Early recognition of the disease is important, because early treatment can prevent acute "myoglobinuric" renal failure.

Adult↗
PubMed1986

Comparison of unfractionated heparin and low molecular weight heparin during long-term use in chronic haemodialysis and haemofiltration patients.

Antithrombotic activity, necessary doses and effects on coagulation and lipid variables of the low molecular weight heparin derivative Fragmin were compared to unfractionated (UF) heparin in long-term multicentre trials. Results of more than 10,000 dialyses are reported. On the basis of preliminary studies, UF heparin and Fragmin doses were used that lead to anti-Xa activities of more than 0.5 U/ml. With this dose, sufficient antithrombotic activity was achieved with both heparins. Bleeding complications were not noticed. Partial thromboplastin time (PTT) and thrombin time were only marginally increased by Fragmin (5-8 s) in contrast to UF heparin (PTT 90-120 s, thrombin time 230-260 s). Surprisingly, the elevated levels of factor VIII strongly decreased during the 6-month treatment period with Fragmin and increased again during the following 6-month treatment period with UF heparin. Creatinine, urea, haemoglobin and transaminases did not change in both heparin groups: this excluded reduced dialysis efficiency or occult blood loss. Additionally, 15 patients with acute renal failure and high bleeding risk were dialysed with low doses of Fragmin (anti-FXa: 0.2-0.3 U/ml). No severe bleeding occurred. A continuous ambulant peritoneal dialysis patient with deep vein thrombosis was treated effectively with intraperitoneal application of Fragmin for 6 months without any problems.

Acute Kidney Injury↗
PubMed1986

Detection of fluid overload by plasma concentration of human atrial natriuretic peptide (h-ANP) in patients with renal failure.

There are no reliable parameters for the detection of fluid overload in anuric patients. In 70 patients on regular haemodialysis (HD) or haemofiltration (HF) treatment, plasma ANP IR concentrations were determined by radioimmunoassay and compared to 43 controls with normal renal function. ANP IR levels were markedly elevated immediately before HD or HF (m 82 fmol/ml) compared to ANP IR plasma concentrations after HD or HF (m 42 fmol/ml) and to ANP IR levels of healthy controls (m 19 fmol/ml). ANP IR was detected in haemofiltrates and found to be eliminated by HF. During isovolemic HF, ANP IR levels remained constant suggesting that ANP synthesis is much higher than elimination by HF and that the decrease in circulating volume at the end of HF or HD is the main stimulus for a lower secretion rate of ANP. Elevated ANP IR levels at the end of HD/HF were found to be associated with fluid overload even without clinical or radiographic symptoms. Consistent weight reduction was followed by a decrease of ANP IR levels.

Adolescent↗
PubMed1986

[Significance of antithrombin III in kidney diseases].

This article deals with the clinical importance of antithrombin III (AT III) in renal disease. Patients with nephrotic syndrome demonstrates a high risk of thromboembolism. A renal AT III loss is an important pathogenetic factor in these events. Patients with serumalbumin below 2.0 g/dl are mostly endangered. In patients with acute oligoanuric renal failure low AT III-levels due to consumption were often found that lead to diminished protection against intravascular coagulation processes and can therefore contribute to progression of illness. An AT III-substitution may be of some benefit in these patients. Additionally AT III was given in patients with dialysis-dependent renal failure and low levels of AT III leading to a reduced incidence of thrombosis of the extracorporeal system. Unnecessary high doses were also avoided and a minimal heparinization could be performed more efficiently in bleeding risk patients. Furthermore, AT III-levels during renal transplantation and during organ rejection are reported.

Acute Kidney Injury↗
PubMed1985

Gas chromatography of amino acids in urine and haemofiltrate.

Capillary gas chromatography of amino acid derivatives obtained from biological material shows a large number of previously unknown constituents. The profiles of amino acids obtained from urine of healthy individuals and haemofiltrate of uraemic patients indicate that haemofiltration removes some amino acids to a considerably higher extent from uraemic patients than the kidney does from healthy persons. For instance, if haemofiltration is required three times a week, an approximately ten-fold amount of the essential amino acid methionine and a forty-fold amount of the essential amino acid leucine is lost compared to their excretion in urine by a healthy individual over the same period.

Amino Acids↗
PubMed1985

[Hypersensitivity phenomena in dialysis patients. Incidence of eosinophilia, raised IgE and ethyleneoxide-induced antibodies].

The hypersensitivity parameters eosinophil count, serum IgE and IgE-type antibodies to ethylene oxide-albumin conjugates (ETO-antibodies), were determined in 182 dialysis patients. Eosinophilia was seen in 21.7% of patients, IgE elevation in 21.4% and ETO-antibodies in 12.4%. A pathological change in at least one of the measured parameters was present in 33.1%. The appearance of ETO-antibodies was frequently associated with severe clinical symptoms, especially asthma and anaphylactic shock. Sensitisation is apparently common in dialysis patients. Since ETO-antibodies are often associated with severe clinical symptoms, their presence should be sought in those dialysis patients showing incompatibility reactions or asthma.

Adult↗