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Biomedical subjects

H Kopsa

Publications and source records attributed to H Kopsa.

At least 73 records · Page 4Linked to original sources
PubMed1979

[An evaluation of candida serology following renal transplantation and its connexion with other postoperative complications (author's transl)].

53 renal transplant recipients aged 13 to 58 years were followed up regularly clinically, microbiologically and serologically over observation periods ranging from 6 to 82 months following transplantation with a view to diagnosing mycetic complications. The only (facultative) pathogenic species found was Candida albicans. This species was isolated in every single patient, but far-reaching differences were observed with regard to the degree of form of infection in the individual person. Mainly, cases showed only a transient growth of Candida to a greater or lesser extent on the mucous membranes of the orointestinal tract, but in few cases serious systemic forms like fungaemia and urinary tract infections were manifest. Comparing the mycological and clinical findings it was apparent that the degree of mycetic infection and attendant complications was closely correlated to the incidence and severity of several--at least primarily--non-mycetic complications postoperatively, such as disorders of transplant function, rejection reactions, diabetes and bacterial infections. A causal connexion, thus, probably exists between postoperative mycetic and non-mycetic complications and the presumable underlying pathological mechanism is discussed.

Adolescent↗
PubMed1979

"Triple infections" (fungal, bacterial and viral) in immunosuppressed renal transplant recipients.

In a period of 5 years, 8 out of 77 renal transplant patients showed simultaneous fungal, bacterial and viral infections. Candida albicans was found in all cases. The most severe bacterial complications were infections with Klebsiella, Pseudomonas and Staphylococcus aureus. Cytomegalovirus, persistent HBsAg positive hepatitis, herpes zoster, and herpes simplex infections were also found. Seven patients died of bacterial superinfection and miliary tuberculosis. The data presented show that "triple infections" are associated with high mortality and that miliary tuberculosis occurred frequently in immunosuppressed renal transplant recipients.

Adolescent↗
PubMed1979

Reversible acute tubular necrosis following severe acute renal rejection.

The clinical observation of 6 out of 250 renal transplant patients showed that acute renal rejection may lead to reversible acute tubular necrosis (ATN) necessitating intermittent haemodialysis treatment. Despite missing early response to high-dose (methyl-) prednisolone therapy (during a mean period of 4.7 days) all 6 patients developed spontaneous diuresis 14.5 days on average after onset of rejection while on maintenance immunosuppressive therapy. From the clinical course the conclusion was drawn that in severe cases of renal rejection with arteriographic and histological findings consistent with acute tubular necrosis, prolonged therapy with high doses of (methyl-) prednisolone is not desirable, since after reversal of immunological rejection the onset of spontaneous diuresis will be determined mainly by the duration of the healing and recovery phase of acute tubular necrosis.

Acute Kidney Injury↗
PubMed1979

[Cholestasis after renal transplantation and immune-suppressive therapy (author's transl)].

A 39 year old female patient developed jaundice 16 months after having received a renal transplant. Intrahepatic cholestasis was diagnosed on the basis of serum enzyme concentration patterns and of histology of a liver biopsy specimen; it was thought to be due to immune-suppressive therapy. Azathioprine was stopped and the hepatic situation normalized within 5 months. HBs-infection was present at the same time, so it is being discussed, if this condition may have influenced the development of intrahepatic cholestasis as well. It has to concluded from this case report, that liver function of patients with renal transplants receiving azathioprine has to be controlled regularly. Stopping azathioprine may induce normalization of even severely damaged liver function without influencing the function of the renal transplant.

Adult↗
PubMed1979

[Report on renal transplant patients. Ocular changes due to renal disease and immunosuppressive therapy (author's transl)].

51 patients with renal transplants were examined ophthalmologically 31,1 (1--77) months after the transplantation. 80,4 p. c. showed ocular complications: cataract formation in 43,1 p. c. of the patients examined and increased intraocular pressure values between 22 and 30 mm Hg in 3 patients are to be attributed to the systemic immunosuppressive therapy. Further ocular changes were recurrent subconjunctival haemorrhages due to increased vascular rigidity, calcium phosphate deposits in the conjunctiva due to persistant secondary hyperparathyroidism and fundus changes (pigmentary irregularities in the foveal regions, narrow arterial vessels). Although marked arterial hypertension was observed in 21 patients after the transplantation, no signs of hypertensive retinopathy could be found. Despite the high incidence of ocular complications after renal transplantation the risks of immunosuppressive therapy must be considered as tolerable: cataract formation and increased intraocular pressure do not impair the positive effect of renal transplantation on ocular functions. Regular ophthalmological control examinations of renal transplant patients are advisable.

Adolescent↗
PubMed1979

Use of thermography in kidney transplantation: two year follow up study in 75 cases.

During a period of 24 months 75 renal transplant recipients were examined by thermography according to Tricoire. Thermography is a non-invasive, quickly available and reproducible method. Because of the 92% incidence of exact diagnosis this investigation is a helpful additional test in kidney transplantation for evaluation of graft function as well as for diagnosis of pathological intrarenal or perirenal disorders. Thermography is especially recommended for patients if postoperative haemodialysis is necessary. In these cases information can easily be achieved whether postoperative oligo-anuria is caused by acute tubular necrosis or by primary vascular insufficiency of the transplant.

Abscess↗
PubMed1979

Cadaveric renal graft acceptance without azathioprine.

After azathioprine withdrawal serum creatinine concentrations at the end of an observation period of up to 26 months were not significantly different from the previous values in five out of seven patients with good transplant function. Patients with chronic rejection showed a constant rate of loss of transplant function, assessed by a straight line relationship between the logarithm of serum creatinine and time. After stopping azathioprine, however, there was no break in the slope of the curve in five out of six patients. Azathioprine withdrawal may be compatible with good long-term graft acceptance. Azathioprine seems to be of little value in the management of chronic renal rejection.

Azathioprine↗
PubMed1979

[Hemolysis after combined azathioprine and allopurinol therapy].

In a 37 year old renal transplant woman haemolytic anaemia was observed in the course of a combined azathioprine-allopurinol therapy. Azathioprine is converted to 6-mercaptopurine, which then catalyzed by xanthine oxidase is oxidized to 6-thiouric acid. When allopurinol and azathioprine are administered simultaneously, high 6-mercaptopurine concentrations in plasma may be expected because of inhibition of xanthine oxidase activity by allopurinol. We assume that elevated plasma 6-mercaptopurine concentration could possibly be responsible for haemolytic anaemia in this renal transplant patient.

Adult↗
PubMed1979

Recovery of kidney function following prolonged acute renal failure.

Twenty-two patients with prolonged acute renal failure (ARF), successfully treated by haemodialysis, were analysed. The clinical course was oliguric in 16 and non-oliguric in 6 cases. Twenty-seven haemodialyses on average (15-54) during a mean duration of 66.9 (30-172) days were needed for recovery of kidney function. Overall, maximum improvement of renal function was achieved within 116.4 (51-259) days, in oligo-anuric cases within 80.1 (51-208) days, in non-oliguric cases within 160.3 (90-259) days. In the latter group pre-existing renal damage was probably the cause of the more extended duration of acute renal failure.

Acute Kidney Injury↗
PubMed1978

[Long-term ophthalmologic follow-up after kidney transplantation].

16 renal transplant recipients underwent ophthalmological examination 11.4, 19.4 and 61.3 months after renal transplantation. The most common side effects of immunosuppressive therapy were steroid-induced cataract formation, steroid glaucoma, and recurrent subconjunctival haemorrhages. Posterior sub-capsular cataracts may develop as early as 2 months after surgery, reach their highest incidence within 2 years and may be reversible under low dosage steroid therapy. 75.5% of 57 ophthalmologically examined patients showed ocular complications or changes, but visual function was not severely disturbed. Despite hypertension in 23 cases, no hypertensive retinopathy was observed. In the light of these findings we assume that kidney transplantation has a positive influence on ocular functions, and especially on fundus changes dating from the time of regular dialysis treatment.

Adolescent↗
PubMed1978

[Intractable renal and enteral loss of potassium in a case of Turner's syndrome (author's transl)].

A case of Turner's syndrome is presented; many congenital defects were detected. Predominant clinical findings were cheilognatoschisis, respiratory distress, caused by congenital bronchiektasis and chronic hypokalemia with paroxysmal attacks of paralysis and tetania. Hypokalemia was mainly due to gastrointestinal losses as a consequence of permanent vomiting in the presence of stomach atonia and hiatus insufficiency or because of "third space losses", while a subileus persisted chronically. Furthermore also a renal loss of serum potassium was evident in the patient's predialytic time. Basic renal diseases were pyelonephritis, renal damage from phenacetine abuse, or probably even a nephropathy due to potassium depletion. Uraemia was controlled by dialysis treatment and by a dialysate consisting of 7 and 6 mmol/l potassium respectively. The result of this intense therapy was physical rehabilitation and the patient finally could resume her professional work again.

Adult↗
PubMed1978

[Parathyroid hormone and 25-hydroxycholecalciferol concentrations in the serum of patients with kidney transplantations and their radiological correlation].

In 40 renal transplant patients the serum concentration of parathyroid hormone, 25-hydroxycholecalciferol, calcium and inorganic phosphate were estimated. The results of these biochemical studies were compared to X-ray soft tissue and bone pathologic findings. The serum immunoreactive parathyroid hormone (iPTH) was normal in 37 patients and increased in 3 cases. 19 (47.5%) renal transplant recipients showed decreased serum 25-hydroxycholecalciferol levels. In 23 out of 40 patients (57.5%) serum phosphate was lower than 3.0 mg/100 ml. X-ray soft tissue changes were observed in 28 (70%) and bone changes in 18 (45%) patients; both frequencies were higher when compared to occurrence during regular dialysis treatment. Features of hyperparathyroid osteopathy were frequently observed in renal transplant recipients. Femoral head necroses were predominant in men, whereas osteomalacia with Looser's zones were found mainly in women. The pathogenesis of X-ray bone changes in patients with renal transplants seems to be multifactorial and related to the duration of secondary hyperparathyroidism before renal transplantation as well as to phosphate depletion and 25-hydroxycholecalciferol deficiency.

Adult↗
PubMed1978

[Osteopathy and serum parathormone and 25-hydroxycholecalciferol levels in patients on long-term haemodialysis (author's transl)].

Skeletal radiological changes were analyzed in 22 patients treated by chronic haemodialysis. Furthermore, the serum parathormone and 25-hydroxycholecalciferol concentrations were determined. X-ray evidence of renal osteopathy was found in 13 patients (59%). Extraskeletal calcification, subperiostal erosions and cystoids were the predominant lesions. Serum iPTH concentrations were increased in 21 out of 22 haemodialyzed patients. The serum 25-hydroxycholecalciferol concentration was normal. The results of this study seem to indicate that other factors apart from secondary hyperparathyroidism have a share in the development of renal osteopathy in patients on chronic haemodialysis.

Adult↗