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Biomedical subjects

G Offner

Publications and source records attributed to G Offner.

At least 55 records · Page 3Linked to original sources
PubMed1996

Predictors of the response to growth hormone in short prepubertal children post-renal transplant. German Study Group for Growth Hormone Treatment in Children Post Renal Transplantation Study Group Members.

The growth response to recombinant human growth hormone (rhGH) in post-renal transplantation children is variable. We sought to determine predictive factors of this variable effect of rhGH by analysis of a homogeneous group of 16 prepubertal children with a median age of 12.4 years (range 7.7-18.0 years). rhGH was given at 30 i.u./m2/week for at least one year. All children remained prepubertal during the study period. Height velocity increased from 2.5 +/- 0.4cm/year to 7.4 +/- 0.5cm/year after one year of treatment (p < 0.001). The growth response to rhGH (height velocity after one year of rhGH) was not significantly correlated with the dose of prednisolone administered (range 2.3-9.1mg/m2/day), graft function as estimated by creatinine clearances (range 19-88ml/min/1.73m2), the degree of stunting at baseline, baseline height velocity, or chronological age. However, a relatively tight inverse correlation was found between the growth response to rhGH and the degree of bone age delay (r = 0.73, p < 0.005). Hence, the degree of bone age delay appears to be a helpful clinical predictor of response to rhGH in short prepubertal children post-renal transplantation.

Adolescent↗
PubMed1996

[Living related kidney transplantation in children younger than 5 years of age--intraperitoneal or extraperitoneal surgical procedure?].

The extraperitoneal approach and positioning of the vascular anastomoses, invariably to the distal aorta and inferior caval vein has been shown to represent a technically feasible, safe, and successful procedure for transplanting adult renal grafts to children under 5 years of age weighing less than 10 kg. Since it offers additional advantages compared to the transperitoneal approach we recommend the extraperitoneal approach in the pediatric living-related renal transplantation setting as the standard procedure.

Adult↗
PubMed1995

Improved absorption of cyclosporin A from a new microemulsion formulation: implications for dosage and monitoring.

Recently, a new oral microemulsion formulation of cyclosporin A (CsA)--Neoral (Sandoz, Basle, Switzerland)--with a higher bioavailability has become available. Ten stable paediatric renal transplant recipients with excessive variations in CsA trough levels with the original Sandimmun (Sandoz, Basle, Switzerland) preparation were switched to Neoral on a 1:1 basis. Pharmacokinetic studies revealed impaired absorption of Sandimmun in six patients. Compared with equal doses of Sandimmun, the 8-h area under the concentration-time curve increased from 1,422 to 2,657 ng x h/ml and the peak concentration rose from 319 to 824 ng/ml (P < 0.01). In six patients with Sandimmun malabsorption, conversion on a 1:1 basis led to a reduction in creatinine clearance which was reversible after dose reduction by 9%-25%. With trough levels at the lower end of the present target range, creatinine clearance stabilised around pre-conversion values.

Adolescent↗
PubMed1995

Steroid resistant nephrotic syndrome associated with spondyloepiphyseal dysplasia, transient ischemic attacks and lymphopenia.

Focal segmental glomerulosclerosis, nephrotic syndrome and chronic renal failure were associated with spondyloepiphyseal dysplasia, growth failure, lymphopenia and transient ischemic attacks leading to severe neurological symptoms in three children. Two boys and one girl developed the full syndrome at the age of 5, 6 and 10 years. Positron emission tomography revealed perfusion defects of both cerebral and cerebellar arteries. A variant of the disease was found in two other children who had a nephrotic syndrome and terminal renal failure with only mild spondyloepiphyseal dysplasia, impaired growth and a normal cerebral function. It is concluded that there may be a close association between focal segmental glomerulosclerosis and spondyloepiphyseal dysplasias.

Brain↗
PubMed1994

Nifedipine aggravates cyclosporine A-induced gingival hyperplasia.

Gingival hyperplasia is a common side-effect of immunosuppression with cyclosporine A. Nifedipine is often used to control hypertension in kidney graft recipients. Analysis of gingival status in 106 children transplanted at our centre, and treated either with azathioprine, cyclosporine A or both, revealed significantly higher degrees of gingival overgrowth in those children receiving a combination of cyclosporine A and nifedipine compared with those children treated with cyclosporine A or nifedipine alone. Seven children undergoing gingivectomy at our centre over the past few years had received this combination. After a change in the antihypertensive regimen, avoiding long-term nifedipine medication, and improved dental care with chlorhexidine gel, we noted a reduction in the degree of gingival hyperplasia. In the majority of patients, nifedipine could be replaced by a single drug, usually hydralazine. We therefore recommend avoiding calcium channel blockers in the long-term management of hypertension in patients receiving cyclosporine.

Adolescent↗
PubMed1994

Continuous arteriovenous haemofiltration in critically ill children.

We report 24 children with acute renal failure treated with continuous arteriovenous haemofiltration (CAVH) between 1987 and 1991. The median age was 2.9 years (range 3 days to 9 years). The main causes of the acute renal failure were: open heart surgery (n = 11) and liver failure of different origins before and after liver transplantation (n = 10). The indication for CAVH was oliguria or fluid overload in all children. The femoral vessels were used as vascular access in most instances. Different filters were used, depending on the size of the patient and an average ultrafiltration of 130 +/- 89 ml/h was achieved, which resulted in a fluid clearance of 4.0 +/- 2.6 ml/min per 1.73 m2. In 18 patients uraemia was adequately controlled. Nine children survived after recovery of their renal function; 15 (62.5%) died as a consequence of multiorgan failure. We conclude that CAVH is an effective method to support critically ill children with acute renal failure.

Acute Kidney Injury↗
PubMed1994

Exercise capacity and blood pressure response in children and adolescents after renal transplantation.

Physical working capacity and cardiovascular response to graded exercise on a bicycle ergometer were investigated in 70 children and adolescents (33F, 37M) after renal transplantation. Results of static and dynamic lung function tests were within the normal range in all patients. Systolic blood pressure, heart rate, pulmonary ventilation and oxygen uptake increased with workload and returned to pre-exercise levels after 5 m of rest. During exercise, blood pressure values were within the normal range in almost all patients. The increase in heart rate and respiratory frequency was blunted in patients receiving beta blocking agents. Maximum workloads (Wmax) were 2.00 +/- 0.48 W/kg in females and 2.38 +/- 0.54 W/kg in males, which are 78 +/- 18% and 84 +/- 18% of the normal values predicted for age. Maximum oxygen consumption (VO2max) was 23.2 +/- 5.8 ml/min/kg in females and 28.3 +/- 5.8 ml/min/kg in males. Half of the patients had height below the third percentile. For this reason exercise capacity in relation to height is probably a more relevant parameter than age. Using actual height, Wmax was 102 +/- 20% and 102 +/- 29%, and VO2max 74 +/- 14% and 80 +/- 18% of predicted values, respectively. We conclude that the adaption of the cardiovascular and respiratory system to graded exercise was influenced by beta blocking agents. Wmax and VO2max were significantly reduced for age in pediatric patients after renal transplantation. Wmax was normal, but VO2max was still reduced if corrected for height.

Adolescent↗
PubMed1993

Pre-emptive renal transplantation in children and adolescents.

Forty-three out of 204 children received their first renal transplant without prior dialysis. In order to evaluate the outcome of pre-emptive transplantation, two groups were compared retrospectively. The groups consisted of 28 children who received their transplants either without prior dialysis (ND) or after a varying period of dialysis (D). They were matched by age, year of transplantation, immunosuppressive regimen, donor source, and original disease. The percentage of living related donors was 50% in each group. Patient survival was identical in both groups; one patient died in each group due to infection in the early post-transplantation period. The 5-year graft survival rates were 89% in the ND group versus 72% in the D group. The functional parameters graft function, anemia, hyperparathyroidism, hypertension, and the growth rates tended to be slightly better in the ND group than in the D group. The differences, however, were not significant. We conclude that pre-emptive transplantation is a safe procedure that shortens the period of uremia and is, therefore, recommended for children with end-stage renal failure.

Adolescent↗
PubMed1993

Twenty-four hour blood pressure monitoring in healthy children.

Blood pressure and heart rate were measured every 20 min during the day and every 30 min during the night in 105 children (51 girls and 54 boys, aged 6-10 years) with a portable automated blood pressure monitor using an oscillometric principle of measurement. The monitor was well accepted by most of the children and the rate of invalid measurements was only 13%. Mean systolic and diastolic blood pressure was 114 +/- 7/72 +/- 5 by day and 99 +/- 7/56 +/- 6 by night. The corresponding heart rates were 93 +/- 8 and 72 +/- 9 beats/min. No significant differences were found between boys and girls. At night, systolic blood pressure dropped by 13% +/- 4%, the diastolic value by 22% +/- 7% and heart rate fell by 22% +/- 6%. Mean systolic and diastolic blood pressure measurements correlated positively with the subject's height, whereas no correlation was found with age.

Age Factors↗
PubMed1993

Growth and pubertal development in nephropathic cystinosis.

In a retrospective investigation growth and pubertal development were evaluated in 30 patients with nephropathic cystinosis. Growth was investigated during the stage of chronic renal insufficiency as well as after successful kidney transplantation and growth rates were related to kidney function. Pubertal development was evaluated in 17 patients between 12 and 25 years of age. Prepubertal growth rates were stable in a range between -2 and -3 height velocity SDS as long as glomerular filtration rate was above 20ml/min per 1.73m2. A decrease in glomerular filtration rate below this threshold was followed by further decrease in height velocity. After kidney transplantation a significant catch-up growth was seen if immunosuppression was performed with cyclosporine A and low dose prednisolone. This did not occur if conventional therapy with azathioprine and high-dose prednisolone was used. Onset of puberty was delayed in all patients. Gonadotropin and oestradiol levels in female patients showed normal fluctuations according to ovulatory cycles. In male patients after puberty there was an increase in gonadotropin levels above the normal range for adult men while testosterone levels remained in the low normal range. These results indicate that adult men with nephropathic cystinosis may develop hypergonadotropic hypogonadism.

Adolescent↗
PubMed1992

Post-renal transplant erythrocytosis in a child.

We report the case of a 7-year-old boy who developed severe erythrocytosis 4 months after successful kidney transplantation, with a well-functioning graft. When the haematocrit rose above 60%, phlebotomy had to be performed once to twice a week in order to keep the haematocrit below 50%. A 3-month course of theophylline therapy did not influence the erythrocytosis significantly. There were 5 further patients with erythrocytosis out of 186 children who had undergone kidney transplantation at our centre.

Bloodletting↗
PubMed1992

Psychosocial adaptation of children and adolescents with chronic renal failure.

In a multicentre study comprising five paediatric nephrology centres in Western Germany, psychosocial and educational parameters were assessed (during 1987) in 479 children and adolescents with chronic renal failure (CRF) in order to gain insight into their psychosocial adaptation to the disease. At the time of assessment, 31% of patients were on conservative treatment, 14% on haemodialysis, 9% on continuous ambulatory peritoneal dialysis and 46% had a functioning transplant. The mean age at assessment was 13.6 years. Additional disabilities were noted in 29% of patients. School attendance of the 233 children of school age was in general satisfactory; 22% of patients attended schools for disabled or handicapped children. Vocational training was frequently inadequate, especially for dialysed patients, and only 14 of 53 adolescents over 16 years had graduated. Of 49 adult patients, only 21 were in some form of employment. A lack of age-appropriate independence was observed in a large proportion (86%) of patients over 17 years, who continued to live with their parents or other persons taking care of them, whilst only 14% were living alone or with a partner. We conclude that, despite improved survival, psychosocial adaptation continues to be impaired in paediatric patients with CRF, especially in adolescents and those on dialysis.

Adaptation, Psychological↗
PubMed1992

Paediatric aspects of renal transplantation: experience of a single centre.

From 1970 to 1991 a total of 244 renal transplantations were performed in 203 children at the Medical School in Hannover. The mean patient age was 10.4 years with a range between 11 months and 16.9 years. Fifty-nine children received a living donor graft from one parent and 144 received cadaveric grafts. Forty-two children were transplanted without prior dialysis treatment. After 20 years the overall survival rates were 86% for the patients and 39% for the first grafts. Grafts from donors below 5 years of age had a less favourable survival (44% after 5 years). Pre-emptive transplantation yielded comparable results with the benefit of a shorter period of uraemia. Hypertension developed in 80% of transplanted patients. Only children with living related donor grafts had significantly less hypertensive problems independent of the immunosuppressive regimen. Post-transplantational growth improved under cyclosporin. Children with nephropathic cystinosis also showed catch up growth after transplantation under cyclosporin. The long-term outcome and rehabilitation of grown-up recipients were encouraging.

Adolescent↗