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Biomedical subjects

G Offner

Publications and source records attributed to G Offner.

At least 109 records · Page 6Linked to original sources
PubMed1986

Cyclosporin A in pediatric kidney transplantation and its effect on posttransplantation growth.

Results of cyclosporin A (CyA) treatment following kidney transplantation in 28 children were compared with those of conventional immunosuppression with azathioprine (Aza) in 34 children. CyA was given in combination with low-dose prednisolone. Under CyA the 2-year survival rate of patients and grafts was 96%, under Aza the 2-year survival rate of patients was 94% and of grafts 68% (p less than 0.01). Graft function was slightly lower in the CyA than in the Aza group. Growth after kidney transplantation was evaluated in those patients with a first graft and a function of longer than 1 year. Annual growth velocity for bone age was normal or even accelerated in all children treated with CyA and significantly better than in the children treated with Aza. It is concluded that CyA treatment combined with low-dose prednisolone yields excellent results and allows normal growth rates after kidney transplantation.

Adolescent↗
PubMed1986

Urinary protein analysis in the early detection of acute rejection episodes after renal transplantation in children.

The purpose of the present longitudinal investigation was to assess the predictive value of urinary protein analysis in the early detection of rejection crisis after renal transplantation. Forty-one children were studied consecutively over a period of 6 months applying the following methods: creatinine clearance (Ccr); urinary total protein (UTP); and electrophoretic differentiation of urinary proteins according to their molecular size by microgradient-gel electrophoresis (MGGE) with a continuous concentration gradient of 4-40% of polyacrylamide. Protein fractions analyzed were albumin (69,000 d), low molecular weight proteins (LMW-proteins, less than 69,000 d), and high molecular weight proteins (HMW-proteins, greater than 69,000 d). No rejection was observed in 30 children (group A), a total of 18 rejection episodes occurred in 11 children (group B). UTP was significantly lower in group A as compared to group B (107 vs 376 mg/m2/24 h), but no differences in urinary protein pattern were observed between group A and group B prior to rejection. One to two days after rejection UTP increased to 938 mg/m2/24 h, and 3-7 days after rejection LMW-protein fraction increased from 9% to 23% with a corresponding decrease of albumin fraction from 71% to 56% of UTP. No qualitative changes were noted in respect to HMW-protein excretion. It is concluded that changes of UTP and urinary protein pattern occur during rejection episodes but are of no predictive value in detecting rejection before clinical symptoms appear.

Acute Disease↗
PubMed1985

[14 years of kidney transplantation in children. Results with special reference to cyclosporin A treatment].

In Hannover, between 1970 and 1983 a total of 115 kidney transplantations were performed in 97 children aged between 2 and 16 years. On 31st December 1983, 85 children (= 88%) were alive and 77 of them (= 79,4%) had a functioning graft, while 8 (= 8,2%) had to return to dialysis treatment. Of 115 grafts transplanted 39 (= 33,9%) were lost again. Late complications in children with longlasting graft function included hypertension, steroid-cushing, osteo-porosis and growth retardation. Since September 1982 the new immunosuppressive drug cyclosporin A was used in combination with a low dose prednisolone therapy. Results of 28 kidney transplantations with cyclosporin A treatment are compared to 37 kidney transplantations with cyclosporin A treatment are compared to 37 kidney transplantations with conventional immunosuppression with azathioprin plus prednisolone. The two year survival rate of grafts was 96% under cyclosporin A, compared to 68% under conventional immunosuppression. The survival rate of patients after two years did not differ in both groups (96 vs. 94%). The growth rates under cyclosporin A are significantly better than under conventional immunosuppression.

Adolescent↗
PubMed1984

Dosage of Cyclosporin A in children with renal transplants.

Results of Cyclosporin A (CyA) treatment following kidney transplantation in 16 children are reported. CyA was used in combination with low-dose prednisolone. The dosage of CyA was related to body surface area, starting with 500 mg/m2 daily and was reduced weekly by 50 mg/m2 until the maintenance dose of 300 mg/m2 was reached at the end of the fifth week. The dosage was controlled and adjusted by monitoring the CyA blood concentrations. In comparison with adults, children required higher CyA doses related to body weight to maintain the desired trough blood level range (200-750 ng/ml). In 16 children treated with CyA the graft function rate at three months was 100% and at six months 90%, because one patient died of septicemia. 10 patients experienced 20 reversible rejection episodes. Infectious complications and side-effects were similar to those observed in adults. Almost half of the patients exhibited transient nephrotoxicity which reversed after dose reduction. It is concluded that CyA treatment in a body surface area related dosage and in combination with blood level monitoring offers a successful way for kidney transplantation in childhood.

Adolescent↗
PubMed1983

Acute rejection episodes after renal transplantation in children.

46 renal transplants performed in children at the Medizinische Hochschule Hannover between 1975 and 1980 are evaluated for the occurrence of acute rejection episodes. 33 patients received cadaveric donor grafts (CAD) and 13 living donor grafts (LD). Immunosuppression was carried out with prednisone and azathioprine. 14 patients were treated additionally with antilymphocyte globulin (ALG). A total of 68 acute rejection episodes occurred, 38% of them within the first week of transplantation, and the latest 3 years after transplantation. The most important signs of acute rejection were a rise in serum creatinine concentration, a decrease in urine output and fever. Patients with living donor grafts and full-house matched kidneys had fewer reversible and irreversible rejection episodes than did patients with grafts from cadaveric donors and with grafts with 1-4 mismatches. The value of ALG treatment is doubtful: only 1 out of 14 patients who received ALG treatment experienced no rejection episodes compared to 12 out of 33 patients who did not have ALG treatment. 2.4 rejection episodes/patient occurred in patients who had cadaver grafts and had received ALG compared to 1.17 episodes/patient in similar patients who had not received ALG. Irreversible rejection episodes occurred in 4 out of 9 ALG-treated and in 3 out of 23 non-ALG-treated recipients of cadaver grafts.

Acute Disease↗
PubMed1982

Psychosocial and intellectual development in 12 patients with infantile nephropathic cystinosis.

The psychosocial and intellectual development of 12 children with infantile nephropathic cystinosis was investigated longitudinally by use of biographical data, long-term behavioral observations and psychological assessment. Of the 12 patients, eleven suffered terminal renal failure and 7 of these were followed up after renal transplantation. In spite of the severe illness and the resulting unusual life conditions the patients showed normal intellectual capacity and most of them average school performance. The patients were socially adapted, their behavior was predominantly cooperative, shy and reserved, but depressive at times. After transplantation the children became more active and outgoing. However, growing discrepancies between their physical development and their emotional and social age may lead to adaptational problems at adolescence which may require psychological counselling.

Adolescent↗
PubMed1980

[Plasma parathyroid hormone after kidney transplantation. A sensitive parameter for the estimation of graft function (author's transl)].

Patients after kidney transplantation were investigated for parameters for kidney function and calcium metabolism including a definitively characterized parathyroid hormone (PTH) radioimmunoassay, of which quality criteria have been documented. In 72 transplanted patients 3 months to 7 years after operation a close correlation between graft function and plasma PTH concentrations was found. Patients with clearly elevated PTH revealed definitively decreased graft function. Three patients with normal GFR and clearly elevated PTH showed - at least transiently - all criteria of an autonomous hyperparathyroidism including hypercalcaemia and hypophosphataemia. Borderline PTH elevations associated with normal GFR can be explained by corticosteroid treatment. In 100 patients, which were investigated before and during the first 10 days after transplantation, again a close correlation was documented between the development of PTH concentrations and the function of the transplanted kidney. PTH concentrations are not only a very sensitive parameter of graft function; in various situations plasma PTH concentrations additionally allow an estimate of graft prognosis. This is particularly true in primary graft failure and in early rejection episodes.

Adolescent↗
PubMed1980

[The child's skeleton following renal transplant. A correlation of the radiographic findings to the amount of parathormone (author's transl)].

The skeletal X-rays (magnification radiography of hand, pelvis, knee and shoulder joint) of 20 children before and after successful kidney transplantation were compared with the parathormone concentrations measured in the interval closest to the roentgenological examination. In 19 children, renal osteodystrophy existed before kidney transplantation, which was diagnosed based on the following radiographic findings of varying frequency: rarefaction and fuzziness of the spongiosa, fraying of metaphysical ends, widening of the growth plates, subperiosteal resorption and acroosteolysis. The parathormone concentrations were definitely increased before kidney transplantation. After kidney transplantation the abnormal radiographic findings receded corresponding to normalisation of the parathormone concentrations. Nevertheless, in 14 out of 19 children a rarefaction of the spongiosa remained, the cause of which is presumed to be steroid therapy.

Adolescent↗
PubMed1979

Evidence for cerebral involvement in nephropathic cystinosis.

Cranial computerized tomography (CCT) of 3 children with nephropathic cystinosis and chronic renal failure (CRF) revealed a hydrocephalus internus and externus. In two boys the findings consisted of bilateral dilatation of the ventricular system and of the subarachnoid space; in one boy the alterations were mainly unilateral. The children had repeated convolsions which could not be explained by deterioration of renal function. Their neurological condition was otherwise normal. In six non-cystinotic patients with chronic renal failure, CCT showed normal anatomical structures. The possibility is discussed that the hitherto unknown pathogenetic mechanism of cystinosis leads to diffuse cerebral atrophy, resulting in internal and external hydrocephalus.

Atrophy↗
PubMed1979

[Psychosocial intellectual development of children with infantile cystinosis and cerebral atrophy (author's transl)].

The psychosocial and intellectual development of 4 boys with nephropathic cystinosis and brain atrophy documented by cranial computerized tomography was investigated by use of biographical data and psychological tests (HAWIK, Deutscher Rechtschreibtest). Inspite of the brain atrophy the patients showed low-normal intellectual capacities and mainly average school performance. There were no psychosocial abnormalities correlated to the primary metabolic disease. However, renal dwarfism led to mascotism requiring psychotherapy.

Atrophy↗
PubMed1977

[Causes and risks in a interruption of systemic immunosuppressive therapy following kidney transplantation].

The immunosuppressive therapy of 22 transplant recipients was temporarily suspended 25 times resulting in rejection reactions in 7 cases with the eventual loss of five transplants. One patient succumbed to fungal infection following the loss of kidney function. No connection between the risk of rejection and the previous number of rejection treatments or the histocompatibility could be established. Acute rejection reactions mostly occurred immediately after the interruption of therapy. There was no increased risk associated with a longer break in treatment. Interruption of therapy during the first period of immunosuppressive treatment, that is approximately 3 months after transplantation, was associated with the lowest risk of rejection. As a result of our experience in 25 cases it appears that the temporary suspension of immunosuppressive therapy is associated with little risk and avoids a drug intoxication as well as reduces the mortality due to infection.

Azathioprine↗
PubMed1977

[Myoclonic encephalopathy in childhood (author's transl)].

Two new cases of infantile myoclonic encephalopathy are reported and a survey of literature is given. The disease is characterized by generalised myoclonic jerks in all striated muscles, by cerebellar ataxia and by fast, jerking, mostly conjugated irregular eye movements (opsoclonus). The disease develops mostly during late infancy and early childhood. The pathogenesis is unknown, probably it is caused by immunological reactions to various agents. Treatment with ACTH or corticosteroids leads to rapid remission of the initial neurological symptoms, but it is suggested that therapy does not prevent frequent sequelae of psychomotor retardation and speech distubances. Remarkably, there is the high coincidence of infantile myoclonic encephalopathy and neuroblastoma. Therefore it is necessary to keep in mind the possibility of a causative neuroblastoma in all children with myoclonic encephalopathy and to control repeatly radiological findings and urin-excretion of catecholamines as well as their metabolic products.

Adrenal Cortex Hormones↗
PubMed1975

[Acute renal failure after intracranial injury in three children: analysis of possible causes (author's transl)].

In three children (aged 6-8 years)acute renal failure developed three to five days after head injury. After emergency treatment and measures to prevent cerebral oedema, two of the children were given simultaneously dextran, cefalotin, gentaminic and beta-aescin. The dosage of these drugs was much higher than the usual upper limbs, beta-aescin in doses as high as 10 to 20 fold above recommended maximum. There was no proven connection between the drugs and their dosage and renal failure, because many factors were involved. However, in intensive treatment for children an exact control of drug dosage essential because toxic side effects of different drugs can be potentiated. All three children were haemodialysed, renal function recovered and all were discharged without organic sequelae.

Acute Kidney Injury↗
PubMed1975

Posterior subcapsular cataracts: posttransplantation in children.

Posterior subcapsular cataracts (PSC) were noted in 41 of 69 (60%) recipients of renal allografts. The PSC were noted during the first posttransplant year (Group 1) in 21 (30%) recipients and after the first posttransplant (Group 2) year in 20 (30%) recipients. The dosage of prednisone during the first posttransplant year corrected for patient weight showed a significant correlation with the development of PSC during the first posttransplant year. The severity of the PSC were correlated with time of onset and prednisone dosage. Four recipients in Group 1 required cataract extraction to obtain sufficient vision to facilitate school work.

Adolescent↗