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Biomedical subjects

H Løkkegaard

Publications and source records attributed to H Løkkegaard.

At least 37 records · Page 2Linked to original sources
PubMed1992

Intravenous versus subcutaneous administration of recombinant human erythropoietin in patients on haemodialysis and CAPD.

The most effective route of administration of rHuEpo is still a matter of discussion. Prospectively we studied subcutaneous (s.c.) versus intravenous (i.v.) administration in three comparable groups of patients; HD-s.c. (n = 9), HD-i.v. (n = 11), and CAPD-s.c. (n = 9). All the groups initially received 50 units/kg three times weekly. During the first 8 weeks dose adjustments were made only if target haemoglobin exceeded 11.3 g/dl (7 mM). Target haemoglobin was reached after 84 (42-98) days in the i.v. group and 42 (14-77) and 42 (28-56) respectively in the HD-s.c. and CAPD groups. The difference was statistically significant (P less than 0.05). Even the cumulative doses to reach target haemoglobin were significantly less in the two s.c. groups. To maintain haemoglobin at about 11.3 g/dl, weekly doses were as follows: HD-i.v. 125 U/kg (86-168), HD-s.c. 63 U/kg (20-85), and CAPD 72 U/kg (31-100). The total observation time after the target haemoglobin level was reached, was median 130 (114-264) days. The difference between the i.v. group and the two s.c. groups was statistically significant, (P less than 0.05) whereas there was no difference between the s.c. groups. We conclude that s.c. administration of rHuEpo is more effective in induction as well as in maintenance therapy and that s.c. administration is equally efficient in HD and CAPD patients.

Adolescent↗
PubMed1991

Is initial (24 hours) lavage necessary in treatment of CAPD peritonitis?

A randomized trial was conducted to examine the influence of initial lavage on treatment of CAPD peritonitis. Patients with hypotension and shock were excluded from the trial. Thirty-six CAPD patients with acute peritonitis were randomized to treatment with intraperitoneal antibiotics including either initial 24 hours lavage before resumption of routine CAPD schedule (prior standard approach) or continued prolonged exchanges as in routine CAPD schedule. Median time to solved infection (normalization of white cell count in dialysis effluent) was identical (3 days) in the two groups. Treatment success rate was found to be 72% in the group with initial lavage and 89% in the group with prolonged exchanges. The difference in treatment success (17%) in favour of continued CAPD schedule was not found significant (95% confidence limits--1% to 35%). The results suggest lavage to be of no clinical benefit in treatment of CAPD peritonitis in patients without profound hypotension and shock.

Acute Disease↗
PubMed1990

Glomerular structure and function in diabetic nephropathy. Early to advanced stages.

Kidney biopsies from 14 insulin-dependent diabetes mellitus patients with persistent albuminuria were studied by light and electron microscopy. In terms of kidney function, the patients spanned stages from early to advanced nephropathy. The clinical parameters were (ranges, with medians in parentheses) urinary albumin excretion (UAE) 158-5494 micrograms/min (1153 micrograms/min), glomerular filtration rate (GFR) 30-128 ml.min-1 x 1.73 m-2 (90 ml.min-1 x 1.73 m-2) and mean arterial blood pressure (BP) 87-122 mmHg (109 mmHg). The severity of clinical nephropathy (UAE, GFR, and BP together) correlated with an index of the structural lesions (basement membrane [BM] thickness, mesangial expansion, and glomerular occlusion together; r = 0.62, 2P less than 0.05). GFR compared with remnant surface of glomerular capillaries (filtration surface; FS) gave values of r = 0.72 and 2P = 0.004, and UAE compared with the percentage of the peripheral BM surface carrying fluffy loose intrinsic fine structure gave r = 0.62 and 2P = 0.02. BP per se did not correlate with structural parameters. The area of FS per open glomerulus did not decrease with increasing mesangial volume fraction, which indicates compensatory changes of the capillaries in early and advanced stages of glomerulopathy. In 7 patients with less than 10% occluded glomeruli, correlations between glomerular volume and the parameters of diabetic glomerulopathy (i.e., BM thickness and volume fractions of mesangium and mesangial matrix) failed to reach statistical significance. The actual glomerular volume, however, is a product of the individual's original glomerular volume, probably the early diabetic hypertrophy and modifying changes consequent to the development of glomerulopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Paramedian versus midline incision for the insertion of permanent peritoneal dialysis catheters. A randomized clinical trial.

A randomized trial was conducted to examine the influence of the site of catheter insertion on the mechanical complications associated with the use of peritoneal dialysis catheters (pericatheter leakage/herniation and tip migration). 37 patients requiring a dialysis catheter for future CAPD were randomized to insertion by either a midline (prior standard approach) or a lateral incision (new approach). Thirteen catheters (6 midline, 7 lateral) failed for mechanical reasons--mainly irreversible tip migration. The one year estimated catheter survival without mechanical failure was found to be similar in the two groups: midline (59%) and lateral (51%), (0.4 less than p less than 0.5).

Catheterization↗
PubMed1990

Risk factors in continuous ambulatory peritoneal dialysis. A seven year follow up.

The purpose of the present study is to assess the mortality rate and the magnitude of technical problems forcing a patient off CAPD and to clarify the effect to which age, sex, diabetes, or cardiac disease influence mortality rate and technique survival. For this purpose, we used estimated survival probabilities by Kaplan-Meier methods. The study of all patients in our department dialysed on CAPD until July 1986 revealed a two-year survival of 63% for 121 patients. Mortality was significantly higher in patients with diabetes or prior cardiac disease. Non-diabetic patients over 60 had the same mortality rate as younger non-diabetic patients. The overall rate of transfer to other forms of dialysis was 35% after two years with little variation between subgroups, suggesting that parameters such as age, sex, diabetes and cardiac disease need not influence the choice of CAPD if based on technical considerations.

Cause of Death↗
PubMed1989

[Peritonitis in continuous ambulatory peritoneal dialysis. Experiences after 7 years].

A retrospective study of CAPD-related peritonitis revealed a frequency of 1.7 episodes per treatment year among 121 patients during a period of 7 years. Life-table methodology estimated a 44% probability of still remaining peritonitis-free after six months on CAPD, with no differences between subgroup populations according to sex, age (younger/older than 60 years) and primary disease (diabetic/non-diabetic). A marked improvement in probability of remaining peritonitis-free was evident in the last calendar period (1983-86). The predominant etiological microorganisms in peritonitis episodes were staphylococci. In 25% of the episodes, no microorganism could be isolated. One patient died from peritonitis; lethality 0.7% per year. Ten patients (8%) were transferred from CAPD because of either repeated episodes of peritonitis or a single complicated episode.

Denmark↗
PubMed1988

A strong correlation between glomerular filtration rate and filtration surface in diabetic nephropathy.

Quantitative structural studies were performed in kidney biopsy specimens from 24 long-term Type 1 (insulin-dependent) diabetic patients with persistent albuminuria due to diabetic glomerulopathy. Ten patients were receiving antihypertensive treatment, and among the remaining patients the mean blood pressure was 142/91 mm Hg (SD = 11/9). The urinary albumin excretion rate showed a range from 100 to 5494 micrograms/min (geometric mean 688 micrograms/min.) Glomerular filtration rate also showed a wide range, from supranormal to markedly decreased values (128 to 28 ml.min-1. (1.73 m2)-1, mean 75). The filtration surface (interface between capillary and urinary space) per total number of nephrons (open + occluded) was estimated by combined light-and electron microscopy. The percentage occluded glomeruli as well as structural quantities in the open glomeruli were taken into account in this estimate. A highly significant correlation was seen between glomerular filtration rate and filtration surface per nephron (r = 0.77, p less than 10(-4). The percentage occluded glomeruli contributed significantly to the variation in glomerular filtration rate (for this relationship tested separately r = -0.78, p less than 10(-5). The volume of open glomeruli was even larger than that seen in early diabetic glomerular hypertrophy and tended to increase with the percentage of glomerular closure, indicating that a compensatory hypertrophy might have taken place. In the open glomeruli the filtration surface constituted a smaller percent of total capillary surface (the remaining part facing the mesangial regions) than in early diabetic patients and control subjects. Our study has demonstrated that reduced glomerular filtration surface is closely associated with reduced glomerular filtration rate in Type 1 diabetic patients with diabetic nephropathy.

Adult↗
PubMed1988

Postoperative radionuclide monitoring of renal allografts on triple therapy.

Renal allograft dysfunction arising from rejection or cyclosporin A nephrotoxicity in patients on high-dose cyclosporin A administration can currently only be distinguished reliably by allograft biopsy excluding rejection. The renographic course up to 35 days after transplantation or to discharge was followed in 30 patients treated with low-dose azathioprine, prednisone, and cyclosporin A (triple therapy). Routine renographic monitoring combined with intravenous angiography in critical periods proved a valuable aid in the differentiation between post-operative complications such as acute rejection and surgical complications.

Azathioprine↗
PubMed1988

Early arteriolopathy following "high-dose" cyclosporine in kidney transplantation.

Thirty-seven consecutive kidney graft biopsies from 37 patients immunosuppressed with "high-dose" cyclosporine (CsA) were mixed with 37 random biopsies obtained from 37 patients given azathioprine and prednisone (Aza/P) and reexamined by light microscopy, without knowledge of the therapy, for occurrence of early arteriolopathy. All biopsies were taken within 35 days after transplantation. Arteriolopathy was demonstrated in 12 biopsies from 37 patients given CsA but in none of those from 37 patients on Aza/P. The specific alteration found in those 12 biopsies was glycogen storage in the muscular layer of the arterioles. The average donor was significantly older in those grafts in which arteriolopathy was shown than in those without arteriolopathy but also given CsA (p less than 0.001). All kidneys from donors more than 53 yr old had arteriolopathy. The occurrence of arteriolopathy was independent of the average CsA level from transplantation to biopsy, but the CsA level had never been below 380 ng/ml in those patients with arteriolopathy. The clinical course in grafts with arteriolopathy was characterized by poorer graft function as judged from the renograms, delayed onset of function and a high proportion of "never-functioning" grafts (50%). We concluded that patients receiving a cadaver graft from a donor older than 50 yr should not be treated with "high-dose" CsA. If the arteriolopathy is demonstrated in kidney graft biopsies within the first 5 weeks after transplantation in patients treated with CsA, one should consider a change or modification of the treatment strategy.

Age Factors↗
PubMed1987

Renography and biopsy-verified acute rejection in renal allotransplanted patients receiving cyclosporin A.

Acute impairment of renal function caused by cyclosporin A can be hard to differentiate from acute rejection. Therefore, kidney function after cadaveric allograft transplantation was repeatedly determined by renography in 42 patients receiving either high dose cyclosporin A (32 patients) or azathioprine and prednisone (10 patients) until a graft biopsy showed either acute rejection or no rejection within the first 5 postoperative weeks. The graft function as judged from the renograms was significantly poorer when cyclosporin A was used than when azathioprine and prednisone were the immunosuppressants. In the azathioprine and prednisone group a biopsy showing acute rejection was always preceded by a deterioration in the renogram. In cyclosporin A treated patients a graft biopsy following an early deterioration in the renogram showed acute rejection in only 56% of the biopsies. It was not possible to identify a time course or a function level of the renogram that could predict rejection in these patients. It is concluded that graft biopsies should be used liberally to diagnose rejection during cyclosporin A treatment if surgical complications after transplantation have been ruled out. Radionuclide studies may offer an invaluable aid in determining a nonnephrotoxic initial dose of the drug.

Azathioprine↗
PubMed1987

Influence of normal central venous pressure on onset of function in renal allografts.

The central venous pressure was kept above 5 cmH2O during the perioperative and early postoperative period as guidance for fluid replacement in 31 patients receiving a renal graft (group B). In 30 other transplant recipients the central venous pressure was not measured (group A). The two groups were otherwise comparable. Onset of graft function within the first 3 postoperative days was significantly more frequent in group B than in group A (62% vs. 30%), despite absence of difference in the measurable warm and cold ischemic periods. Fluid replacement guided by the central venous pressure thus is concluded to reduce the number of kidneys with delayed function in the immediate postoperative period.

Body Weight↗
PubMed1986

90-minute 99mTc-MDP scintigraphy and 131I-hippuran renography in recently allotransplanted kidneys: evaluation of renal ischemia.

Renal ischemic damage in 31 transplanted kidneys was evaluated by renal scintigraphy with 99mTc-methylene diphosphonate and 131I-hippuran renography. The renal uptake of phosphate was monitored for 100 s at 10-min intervals during 90 min following injection. The average uptake of radioactivity in the graft on the 60-, 70-, 80-, and 90-min scintigram was calculated. Grafts with an average uptake of 99mTc-MDP of 150% or below had a significantly more frequent onset of function within the first 3 days following operation than grafts with an average uptake above 150%. Renography was shown to be an equally good method for predicting the onset of function. The success rate (correct prediction of onset of function) was almost equal for the two methods, but in 11 patients the results of the two methods diverged. An obvious degree of overlap limits the usefulness of both methods in any one particular patient. It is concluded that renal scans with 99mTc-MDP and 131I-hippuran renography are complementary in the assessment of ischemic damage following transplantation.

Graft Survival↗
PubMed1985

Renal function in 153 manic-depressive patients treated with lithium for more than five years.

Renal function was examined in 153 manic-depressive patients treated with lithium for more than 5 years, mean 10 years. No significant change was detectable in plasma creatinine. Glomerular filtration rate (GFR) decreased slightly, but significantly, and not until after 17 years of treatment did the regression line reach the lower confidence limit in the reference material. GFR was generally only moderately decreased. Renal concentrating capacity was significantly reduced during the whole investigation period and did not change with time. GFR was independent of the dosage pattern. The diuresis did not differ markedly in patients given one or three daily doses. In a two-dose group predominantly treated with slow-release tablets, the diuresis was somewhat higher in 75% of the patients but much higher for the rest of the group. Since the prophylactic effect of lithium was the same in the one-dose group (mean dosage 21 mmol/day) as in the two-dose and three-dose groups (mean dosage 27-28 mmol/day), our data indicate that generally employed lithium doses may be reduced somewhat without loss of prophylactic efficacy.

Adult↗
PubMed1984

Effect of cimetidine on upper gastrointestinal bleeding after renal transplantation: a prospective study.

In 97 consecutive patients undergoing renal transplantation the incidence of upper gastrointestinal bleeding was registered over 180 days after allocation to treatment with either cimetidine or placebo. Bleeding episodes occurred in 12 patients, 11 of whom were receiving placebo and only one cimetidine (p less than 0.01). All bleeding episodes occurred during the first month after allotransplantation. Treatment with cimetidine did not lead to an increased incidence of rejection of the allograft. It is concluded that cimetidine is effective and safe in protecting against upper gastrointestinal bleeding after renal transplantation.

Cimetidine↗
PubMed1984

Evaluation of kidney grafts with 99mTc-methylene diphosphonate within 36 hours after transplantation: a marker of ischemic damage.

In order to evaluate renal ischemic damage in transplanted kidneys, renal scintigraphy with 99mTc-methylene diphosphonate was performed in 30 kidney grafts within 36 h after transplantation. The renal uptake was monitored for 100s at 10-min intervals during 90 min following injection. Seventeen patients had an average uptake of radioactivity in the kidney on the 60-, 70-, 80-, and 90-min scintigrams expressed as a percentage of the activity present on the 10-min scintigram of 150% or less (low) and 13 patients had an average uptake of radioactivity of above 150% (high). There was no relationship between the average uptake of radioactivity and warm and cold ischemia times (or the combined value: corrected ischemia), maximal function, reversible rejection, and ureteral obstruction. A significant correlation was found between the average uptake of radioactivity in the kidney and onset of function. Seventy-six per cent of the grafts with a low average uptake of radioactivity had an onset of function on or before day 10 after operation (early) whereas only 15% of the kidneys with a high average uptake of radioactivity had an early onset of function. Twelve per cent of the patients with a low average uptake of radioactivity in the kidneys had their grafts removed for various reasons within 2 months after transplantation, whereas 54% with a high average uptake of radioactivity had their grafts removed. It is concluded that 99mTc-methylene diphosphonate scintigraphy may be useful in the prognostic assessment of graft onset of function and of graft survival.

Adolescent↗
PubMed1984

The impact of HLA-DR compatibility on cadaver kidney graft survival in a prospective study with special emphasis on the quality of typing.

The survival data of 151 consecutive cadaver kidneys transplanted by the two transplantation centres of Copenhagen from September 1, 1980 to September 30, 1982 with an observation period of at least 3 months have been analyzed. The HLA-DR types could not be established in 4 out of 130 donors. In most of the analyses only the well-defined antigens DR1, 2, 3, 4, 5, 7, and w8 were included. Inclusions of the DRw6, w9, and w10 antigens in the matching did not change the results. The one-year graft survival (GS) was 72.1% for 97 HLA-DR compatible kidneys as compared to 41.4% for 49 incompatible kidneys (p = .0007); this difference remained highly significant when stratified for the recipient status of pretransfusion, risk, and age. Non-transfused recipients had a fairly good GS but had received significantly better matched kidneys than the remaining recipients. The transfusion "effect" became barely significant (p = .054) when stratified for DR. There was no significant influence of donor or recipient DRw6-type as defined in this study. The GS was not significantly influenced by HLA-A, B matching, recipient antibody status, B cell cross-matches, transplant, or donor centre. Special efforts were made to assign the HLA-DR phenotypes of the recipients and donors as accurately as possible. In 39 cases, there was a discrepancy between the result of the acute DR-typing of the donor and the final result based on subsequent typings. The acute DR match had no influence on GS in these recipients whereas the final match had a significant influence in the same group, which in a way comprise a randomized trial. In the total material, the acute DR match still showed an influence on GS, but the significance decreased by a factor 20. This illustrates how the quality of DR typing may influence the results of the analyses. The overall GS (62.5%) was significantly (p = .05) better in this series than that (48.2%) in our preceding series, but it is uncertain whether this is due to better matching alone.

Cadaver↗
PubMed1984

Quantitative studies of glomerular ultrastructure in human and experimental diabetes.

A brief review is given of glomerular structural changes in diabetes mellitus and in rats with induced diabetes. The stereological methods for obtaining quantitative structural data are mentioned, and references are given to the underlying theories as well as to more detailed descriptions of the practical performance. In short-term diabetes a glomerular hypertrophy is found with increase in the surface area of the capillaries, in parallel with an increase in glomerular filtration. In long-term diabetes mellitus the picture is dominated by accumulations of basement membrane: thickening of the peripheral basement membrane and expansion of the mesangial regions which hold large amounts of basement membrane material. Rats with a moderate diabetes show the early hypertrophy as well as long-term basement membrane thickening. Severely diabetic rats develop basement membrane thickening but do not show the early hypertrophy, which is therefore not a necessary condition for basement membrane thickening to occur.

Adult↗