PubMed Health⌕ Search

Biomedical subjects

H K Stummvoll

Publications and source records attributed to H K Stummvoll.

At least 91 records · Page 5Linked to original sources
PubMed1979

Handling of phosphate by the transplanted kidney.

Maximal tubular phosphate reabsorption capacity corrected for changes in glomerular filtration rate (TmP/GFR) was taken as a measure of renal phosphate handling in patients with good and stable functioning kidney allografts. TmP/GFR values were within the normal range in only one-fifth of the patients. Eighty per cent had an abnormally low renal phosphate threshold concentration. Persistent hyperparathyroidism was the causative factor of this diminished tubular reabsorption in less than half of these patients, the majority of them showing an iPTH independent phosphate leak. Although glucocorticoids, azathioprine and tubular damage of the graft in the perioperative phase may contribute to this iPTH independent phosphate wasting, no single causative factor could be identified. Cases with hypophosphataemia should be treated in order to avoid symptoms of phosphate depletion. Active Vitamin D metabolites would be the therapy of choice by suppressing the parathyroid glands ("chemical PTX") and by directly enhancing tubular phosphate reabsorption. In persistent hyperpathyroidism with hypercalcaemia, surgical parathyroidectomy must be considered. Therapy with phosphate salts is only symptomatic and should be used only as an adjunct.

Azathioprine↗
PubMed1978

[Spontaneous rupture of renal allografts (author's transl)].

Spontaneous rupture of an allografted kidney is not such a rare complication of kidney transplantation. In our series 5.2% of the transplanted kidneys ruptured spontaneously. The condition is an acute emergency characterized by the triad, acute abdomen, swelling in the region of the transplant and haemorrhagic shock. The aetiology of transplant rupture seems to be multifactorial, but the superimposition of an acute rejection episode on ischaemic tubular damage with acute renal failure was found to be the most important combination of events leading to transplant rupture in our patients. Exceptionally precise immunological monitoring in the early phases following transplantation and early aggressive therapy of an acute rejection crisis associated with acute renal failure should prevent allograft rupture.

Abdomen, Acute↗
PubMed1978

[Serum concentrations of thyroid hormones in severe non-thyroidal illnesses (author's transl)].

Pathologically low serum total triiodothyronine (T3) concentrations are a characteristic finding in patients with severe non-thyroidal illnesses. No adequate explanation has yet been offered for this phenomenon. We have, therefore, investigated the serum concentrations of total thyroxine (T4), total T3 and total 3,3',5'-triiodothyronine (reverse T3)--the metabolically-inactive metabolite of thyroxine--and of TSH in 13 patients with acute myocardial infarction, in 12 patients with compensated liver cirrhosis, in 9 patients with decompensated liver cirrhosis and in 15 patients with chronic renal failure on chronic intermittent haemodialysis by radioimmunoassay. The values obtained were compared to corresponding values of a normal control group (n - 23). According to our results the decrease in serum T3 combined with normal T4 concentrations in severe non-thyroidal illnesses seems to be a consequence of an alteration in thyroxine degradation. Two different possibilities of alteration can be considered: 1. inhibition of the overall deiodinationof T4, leading to low total T3 serum concentrations with concomitant normal to low reverse T3 serum concentrations (chronic uraemia), 2. a shift in the monodeiodination of T4 towards enhanced reverse T3 production, leading also to low total T3 concentrations, but with a concomitant increase in reverse T3 serum concentrations (myocardial infarction, liver cirrhosis). The results obtained in our patients with liver cirrhosis show, moreover, that this alteration of T4 metabolism depends on the severity of the illness.

Humans↗
PubMed1978

Heme synthesis in anemia of the uremic state.

Anemia is a constant complication of uremia. As it has been suggested that uremic toxins (middle molecules) play an important role in the mechanism of anemia, we studied the activities of three heme-synthesizing enzymes: delta-aminolevulinic acid dehydratase, porphobilinogen deaminase and ferrochelatase. In 26 patients on regular dialysis therapy, all three enzymes had significantly lower values than in normal control subjects. From our results, it can be assumed that the decreased heme biosynthesis in chronic uremic patients might be caused by a lack of erythropoietin or by uremic toxins inhibiting erythropoietin and/or heme-synthesizing enzymes.

Anemia↗
PubMed1977

[Pindolol as an antihypertensive agent].

26 hypertensive patients groupded according to the severity-index and the WHO-index were treated with pindolol (monotherapy, 15 mg daily). The response of blood pressure depression was statistically significant, although not always sufficient when judged by clinical parameters. Plasma renin activity responded variably to the treatment in different patients and different groups. In 18 patients a statistically significant increase of serum potassium could be observed. No major side effects of therapy were encountered.

Adult↗
PubMed1977

[Extracorporeal uric clearance for the demonstration of in vivo bound uric acid].

Although numerous in vitro experiments demonstrated a variable degree of urate bound to human serum albumin and other macromolecules of human plasma, only few data are available on in vivo bound urate. Extracorporal clearances of uric acid, urea nitrogen, creatinine and phosphorus were performed at the beginning, the midtime and the end of 10 hours of hemodialysis. A continuous decrease of uric acid clearance was observed in ratio with the capacity of the artificial kidney used. In contrast to uric acid the clearances of urea nitrogen, creatinine and phosphorus remained constant during the time of dialysis. From the fall of uric acid clearance, the authors conclude a partial binding of uric acid in human plasma.

Adult↗
PubMed1977

[Idiopathic pulmonary hemosiderosis and Goodpasture's syndrome -- radiological findings (author's transl)].

Description of roentgenographic changes in idiopathic pulmonary hemosiderosis and Goodpasture's syndrome. Diagnostic criteria for differentiation from alveolar edema are shown. Separation of disseminated alveolar infections without clinical information is not possible. The close relation to idiopathic pulmonary hemosiderosis and Goodpasture's syndrome is emphasized.

Acute Disease↗
PubMed1976

[Renal thrombohemolytic microangiopathy (author's transl)].

The clinical findings in three patients with renal thrombohemolytic microangiopathy are presented. The triad of microangiopathic hemolytic anemia, disseminated intravascular coagulation and microangiopathic changes of the kidney leading to renal insufficiency is the characteristic feature of this disease. Beside the usual classification based on etiological factors (distinguishing between primary and symptomatic forms) a topographical classification (distinguishing between generalized forms and localized forms occuring in isolated organs) is suggested. The pathogenesis and therapy of this disorder are discussed.

Adolescent↗
PubMed1976

[Neuropathology of renal transplantation (author's transl)].

The neuropathological features are presented of an autopsy series of 43 renal transplant recipients. Inflammatory CNS lesions were found in 18 cases and were attributable to secondary CNS involvement in bacterial or fungal septicaemia (8 cases) or in localized extraneural infections (5 cases). Mixed bacterial-fungal infection and bacterial-fungal-viral triple infection were seen in one case each. Isolated toxoplasmic granulomas were observed in two cases. No tissue changes typical of CNS viral infections, including cytomegaly, were found except for small glial nodules in the brain stem in 7 cases. Massive intracerebral haemorrhages were seen in 2 cases after haemodialysis; subdural haematoma occurred once. Non-specific changes including brain oedema and diffuse glial poliodystrophy were found in many cases; vascular lesions and purpura occurred only seldom. A meningocerebellar malignant lymphoma, probably of metastatic origin was found in one case. Clinico-pathological correlation was poor in 5 cases; this is considered to be due to immunosuppressive therapy, which may mask either clinical expression of severe CNS lesions or morphological expression of viral encephalitis.

Adult↗
PubMed1976

[Renal transplantation in children (author's transl)].

During the past 2 years 7 children received kidneys from cadaveric donors. 2 transplants had to be removed because of irreversible chronic rejection and 1 recipient died on the 4th day after surgery. The remaining 4 recipients are doing well. In the evaluation of the results special emphasis is placed on the normalization of growth and puberty. The difficulties of psychosocial rehabilitation are stressed.

Adolescent↗
PubMed1976

Corticosteroids and proliferation of smooth muscle cells in arteries of renal transplants.

In the arteries of 17 rejected renal grafts 'activated' smooth muscle cells (ASMC) were discerned from a 'resting' type. Proliferation and fibre production by ASMC resulted in a marked thickening of intima. Each of four normal Wistar rats received 20 mg prednisolone i.v./day for one week and the development of hypertension was therapeutically prevented. Changes similar to those in the graft arteries were found in the rat aortas. We assume that SMC were stimulated by several mechanisms in rejection but also by extremely high dosed corticoids.

Adrenal Cortex Hormones↗