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Biomedical subjects

H Bucht

Publications and source records attributed to H Bucht.

At least 19 recordsLinked to original sources
PubMed1991

Deterioration of GFR in IgA nephropathy as measured by 51Cr-EDTA clearance.

In 191 patients with mesangial IgA nephropathy, GFR was determined as clearance of 51Cr-EDTA. 86 (45%) of them had subnormal renal function 7.3 +/- 4.6 years after renal biopsy. The change in GFR was followed in 153 patients with repeated determinations of 51Cr-EDTA clearance. 50.3% of the patients had a loss of more than 1.1 ml/min/year, which we regard as pathological. The markers of progressive disease were: male sex, high output of urinary protein, severe histological lesions and presence of hypertension. Even patients lacking these markers had a significantly increased incidence of progressive disease. Of 93 patients, with initially normal GFR, 32% will have a subnormal GFR within five years and 25% will develop end-stage renal failure within 20 years. In 38 patients with six or more determinations of 51Cr-EDTA clearance, the predictive value of the first four determinations was calculated. Of 26 with a decrease of more than 1.1 ml/min/year, 13 (50%) developed subnormal GFR during follow-up, while 11 of 12 (91.7%) with a decrease of less than 1.1 ml/min/year (P less than 0.05) remained normal. This shows that repeated determinations of GFR with an accurate method will predict the final outcome early in the disease. We also confirmed that single or repeated determinations of clearance of creatinine are of little value in separating a normal GFR from a slightly decreased one, but more reliable in detecting a markedly reduced GFR.

Adult↗
PubMed1991

Deterioration rate in hypertensive IgA nephropathy: comparison of a converting enzyme inhibitor and beta-blocking agents.

The effect of beta-blocking agents and enalapril as antihypertensive drugs has been compared in 47 patients with IgA nephropathy. The deterioration rate was calculated from the regression line of 51Cr-EDTA clearance and expressed in ml/min/year. The annual loss in glomerular filtration rate (GFR) was greater in patients treated with different beta-blocking agents (-4.9 +/- 6.8 ml/min/year) compared to patients treated with Enalapril (1.7 +/- 7.4 ml/min/year), in spite of the fact that these patients had a lower initial GFR. Nine patients were initially treated with beta-blocking agents (-9.5 +/- 9.3 ml/min/year) and then with an angiotensin-converting enzyme inhibitor (5.5 +/- 11.2 ml/min/year). Angiotensin-converting enzyme inhibitors should therefore be preferred in the treatment of hypertension in IgA nephropathy.

Adrenergic beta-Antagonists↗
PubMed1990

Development of hypertension in IgA nephropathy as a marker of a poor prognosis.

We have studied 209 patients with IgA nephropathy. 26 were hypertensive at the time of renal biopsy, and 59 patients developed hypertension during follow-up. Survival statistics show that only 45% of the patients will remain normotensive 10 years after renal biopsy. The presence of hypertension at renal biopsy correlated well with the usual parameters of a poor prognosis. The same markers predicted a later development of hypertension in patients who were normotensive at the time of renal biopsy. When hypertension is established, the prognosis is poor. Three years after diagnosis of hypertension, the renal survival was found to be 70% in the 59 patients we have followed. It is also possible that the markers of a poor prognosis actually predict the progression rate rather than the prognosis, because in time, some patients with initially mild manifestations of the disease will progress to end-stage renal failure.

Actuarial Analysis↗
PubMed1989

IGA nephropathy: a retrospective evaluation of prognostic indices in 176 patients.

One hundred and seventy-six patients with mesangial IgA nephropathy have been studied retrospectively. Mean follow up from apparent onset of the disease was 9.3 years and with follow up from the diagnostic renal biopsy of 4.6 years. Our aim was to evaluate the prognostic significance of sex, age and type of symptoms at onset. The degree of proteinuria, presence of hypertension or decreased renal function, histological lesions and IFL pattern at the time of the diagnostic renal biopsy were recorded. 17 of the patients developed End Stage Renal Failure (ESRF) during the study. According to the Logrank test (renal survival) and Cox stepwise proportional hazard model, severity of glomerular mesangial lesions and degree of proteinuria are the most important indicators of a poor prognosis. The significance of all other parameters disappear after correction for histological lesions and degree of proteinuria. Our conclusion is that a semiquantitative light microscopical examination is an excellent prognostic index in IgA nephropathy, as is a simple determination of protein excretion in the urine.

Adult↗
PubMed1989

Stockholm clinical study on progression of chronic renal failure--an interim report.

Fifty-seven patients with chronic renal failure (CRF) of diverse etiology entered a prospective, randomized study to evaluate the effect of a low protein diet on the progression rate of CRF. All patients were followed for a control period of 12 or 24 months before randomization into two groups, one permitted unrestricted protein intake and the other prescribed a diet containing 0.4 g/kg body wt/day of protein and 0.1 g/kg body wt/day of essential amino acids, (LPD + EAA). During both the control and study periods, patients were clinically evaluated and had serum biochemistry and 24-hour clearance of creatinine, urea and protein excretion checked monthly. The 51Cr-EDTA clearance (plasma slope and urinary clearance) was determined every third month. The progression of renal failure was evaluated from the regressions of the reciprocal of serum creatinine (SCr-1), creatinine clearance and urinary 51Cr-EDTA clearance against time. Having defined criteria for progression, only patients in whom renal failure had progressed over 12 or 24 months were randomized. In 28 patients, data were available, permitting a comparison of the progression of renal failure (estimated from regression of SCr-1 and of creatinine clearance against time) during the retrospective and prospective periods. There was a significant correlation between the change in progression rate and the change in mean arterial pressure, a relationship which was also present in patients with mild hypertension or those with blood pressure within the "normal" range. The urinary protein excretion also correlated with the change in mean arterial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Reduction of blood pressure retards the progression of chronic renal failure in man.

The effect of blood pressure reduction on the progression rate of chronic renal failure (CRF) was studied in 28 patients with CRF of diverse aetiology entering a prospective study (observation time 7-24 months, mean 16 months). Endogenous creatinine clearance was 12-66 ml/min (mean 30 +/- 3 ml/min). We aimed to keep the blood pressure below 160/90 mmHg. Dietary protein was not restricted. The progression rate of CRF was assessed from the regression coefficients of the regressions of creatinine clearance and the inverse of s-creatinine, respectively, on time. Progression rate and the means of all recordings of mean arterial blood pressure (MAP) and urinary protein excretion, respectively, in each patient during the prospective phase were compared with retrospective data from the proceeding period (observation time 4-25 months, mean 19 months). The patients received various combinations of antihypertensive drugs including diuretics, beta-blockers and vasodilatory drugs. In 19 patients MAP decreased from 109 +/- 2 to 102 +/- 2 mmHg (group I), whereas MAP increased from 105 +/- 2 to 108 +/- 2 mmHg in nine patients (group II). In group I proteinuria was significantly lower (P less than 0.05) and the progression of CRF was approximately 50% slower (P less than 0.01) in the prospective phase than in the retrospective phase; no changes were observed in group II. Calculated for all patients, significant correlations were observed between the change in MAP and the change in progression rate and protein excretion, respectively. These results indicate that lowering of blood pressure results in decreased proteinuria and retardation of the progression of CRF irrespective of the aetiology.

Adult↗
PubMed1988

What is the role of controls in an outpatient department on progression of renal disease?

Evidence that protein restriction retards the progression of chronic renal failure in man is mostly derived from anecdotic data and retrospective studies with inappropriate controls and inferior methodology for evaluating renal function. Data from a prospective randomized study in Stockholm demonstrate that more frequent clinical follow-ups without changing the dietary intake of protein significantly retards the progression of renal failure and that the degree of retardation is correlated to improvement in blood pressure control.

Blood Pressure↗
PubMed1987

Cytotoxic drug treatment of reactive amyloidosis in rheumatoid arthritis with special reference to renal insufficiency.

Twenty-two patients with amyloidosis secondary to rheumatoid arthritis were randomised and followed prospectively in order to determine whether treatment with cytotoxic drugs could postpone the development of end-stage renal failure. The diagnosis of amyloidosis was based on albuminuria, amyloid-positive rectal and/or abdominal fat aspiration and/or renal biopsies. Renal function was followed by repeated 51Cr-EDTA measurements of the glomerular filtration rate (GFR). Urinary albumin and serum-creatinine were found unreliable as predictors of renal function. GFR declined more rapidly in the patient group receiving only symptomatic drugs and no cytotoxic drugs (NT-group). After an initial decline, the GFR in the cytotoxic drug treatment group (T-group), mean treatment quotient 79%, levelled off and remained constant for a considerable time. The mean observation time was 45.7 months in the NT-group and 53.5 months in the T-group. Seven out of eleven patients in the NT-group developed end-stage renal disease, compared to two out of eleven patients in the T-group. The cumulative proportion of survivors in the NT-group at 36 and 60 months was 71% and 27% respectively. The corresponding figures in the T-group were 89% and 89%. The difference in favour of the cytotoxic drug-treated group was significant (p less than 0.04).

Adult↗
PubMed1986

Progression of chronic renal failure in man is retarded with more frequent clinical follow-ups and better blood pressure control.

In 17 patients with chronic renal failure (creatinine clearance 12-66 ml/min) who entered a prospective study, clinical and laboratory check-ups were made once a month. This was much more frequent than during the preceding 2-year period. The progression rate of renal failure evaluated from the change with time in the reciprocal of serum creatinine and creatinine clearance, respectively, was significantly slower after entering the study than before, without any dietary intervention having been instituted. The retardation of progression was associated with improved blood pressure control. We conclude from this study that the frequency and presumably the quality of the clinical check-ups, especially with regard to control of hypertension, may favorably influence the progression of chronic renal failure, independently of the protein intake. This may have important implications for the design of randomized studies, aimed at assessing whether a lowering of protein intake may retard progression.

Adult↗
PubMed1985

Are beta-haemolytic streptococci involved in the pathogenesis of mesangial IgA-nephropathy?

In retrospect we have found that 38 of 187 patients who fulfilled the criteria of mesangial IgA-nephropathy had possible acute glomerulonephritis at the onset of their disease. We have therefore studied anti-streptococcal antibodies (ASO and ADNAseB) prospectively. Forty-three per cent of the patients had ADNAseB greater than 800 units. Thirty-one per cent of the patients studied more than once had a fourfold or greater change in their ADNAseB titre. Thirty-three per cent of the patients had different groups of beta-haemolytic streptococci isolated from their throats. This indicates a possible role of beta-haemolytic streptococci in the pathogenesis of some cases of mesangial IgA-nephropathy.

Adult↗
PubMed1984

Nitrogen balance studies in patients with uremia during treatment with protein-reduced diet and supplementation with essential amino acids or keto acids.

Nitrogen balance was studied in 4 patients with uremia during treatment with a protein-reduced diet (20 g) supplemented with either essential amino acids and histidine or a mixture of keto analogues of five of the essential amino acids and essential amino acids. 3 patients completed the study. Nitrogen balance was negative on the diet only and was improved with both forms of supplementation. However, supplementation with the keto acids did not offer any advantage over the conventional essential amino acid supplementation. 1 patient developed serious hypercalcemia during treatment with the keto acid supplementation.

Adult↗
PubMed1983

Three-day treatment of acute lower urinary tract infections in women. A double-blind study with amoxycillin and co-trimazine.

The aim of this study was to determine if a three-day treatment of lower urinary tract infection (UTI) is effective. 215 women with symptoms of lower UTI, seen in general practice, were randomly allocated to a double-blind study and given either amoxycillin 1000 mg twice a day for three days or trimethoprim 90 mg/sulphadiazine 410 mg (co-trimazine) 2 tablets initially, then one tablet twice daily for three days. 157 women (73%) had significant bacteriuria. Therapeutic efficacy was evaluated in 146 patients. One week after treatment had started, 88% of the women in the amoxycillin group and 100% in the co-trimazine group were cured (p less than 0.01). After a follow-up period of four weeks, the cumulative relapse frequencies were 19% and 9% respectively. Adverse reactions were mild in most cases. Two patients, both on co-trimazine, had to discontinue treatment because of nausea and vomiting. Vulvovaginal irritation was more often reported by women treated with amoxycillin (n = 8) than by those treated with co-trimazine (n = 1) (p less than 0.05). It is concluded that a three-day course of amoxycillin or co-trimazine in lower UTI is safe, causes few adverse reactions, is simple to administer and comfortable for the patient. Co-trimazine seems to be more effective than amoxycillin.

Adolescent↗
PubMed1983

Effect of a three-day course of nalidixic acid in the frequency-dysuria syndrome with significant bacteriuria in women.

The effect of a 3-day course of nalidixic acid was studied in 82 women, presenting with the dysuria-frequency syndrome and significant bacteriuria, mostly Escherichia coli sensitive to nalidixic acid. 62/76 patients (82%) that could be evaluated about 1 week after initiation of therapy were subjectively cured. Negative urinary cultures were found in 64/76 patients (84%). Two patients (2.4%) developed resistance to nalidixic acid. Bacteriological cure rate was 76% of 71 patients that could be controlled 1 month after the initiation of therapy. Nalidixic acid in the used granulate preparation initiated only mild side-effects.

Adolescent↗
PubMed1983

Protein-reduced diet in diabetic renal failure.

The effect of treatment with a protein-reduced diet (20-30 g/day) and essential amino acids was studied in 21 patients with diabetes mellitus and renal failure. The mean treatment time was 5.0 (0.5-14) months. Most patients experienced considerable amelioration of their uremic symptoms and the mean serum value was reduced by 50% of the initial value during treatment. Residual renal function continued to decrease during treatment. Vigorous treatment of fluid retention and hypertension was a prerequisite for a successful course and may also have decreased the rate of progression towards dialysis. Compliance with the diet was not different from that found in non-diabetic uremic patients. Satisfactory control of blood glucose levels was obtained with no or only minor adjustments of the insulin dosage. It is concluded that dietary therapy should be considered in diabetic patients with renal failure for treatment of uremic symptoms.

Adult↗