Biomedical subjects
Publications and source records attributed to J Girndt.
Manifestation and progression of diabetic nephropathy is very much influenced by the high of blood pressure values. There is evidence that not pregnancy per se aggravates the disease but only deterioration of blood pressure control.
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Drugs may induce functional or organic lesions of the kidneys. Organic lesions may consist of glomerulonephritis, interstitial nephritis, and/or toxic tubular necrosis. Clinical symptoms may include temporary deterioration of the renal function, acute but reversible renal failure, or chronic progressive uremia calling for dialysis treatment.
In patients suffering from renal failure pharmacological therapy is performed to influence the causal disease, to mitigate symptoms of the uremic syndrome, or to treat additional illness. Immunosuppressive therapy may be initiated in patients with rapidly progressive glomerulonephritis. Anemia and osteopathia have to be treated in most patients with renal insufficiency. Medication with antibiotics and digitalization shows special aspects in patients with impaired renal function.
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The effect on renal function of a combination of a beta 2 receptors stimulating tokolytic agent (Fenoterol) with a so-called cardioselective beta 1 blocker (Metoprolol) which is able to antagonise the cardiac side effects of beta 2 stimulation, was examined in femaLe rabbits in a 24-hour test. Infusing 31.5 ml/h isotonic solution, 20 micrograms/kg/min Fenoterol and 3.125 micrograms/kg/min Metoprolol, excretion, creatinine clearance, electrolyte elimination, the serum electrolyte levels, Hb, HK and the weight were determined. The combination of Fenoterol and Metoprolol antagonised almost completely the massive water retention occurring under Fenoterol alone. At the latest after 12 hours, normal values were obtained in respect of the creatinine clearance reduced under Fenoterol, the urine excretion rate and, consequently, the Hb concentration and haematocrit reading. The reduction of sodium elimination caused by Fenoterol was completely reversed under the combination, whereas the reduced excretion of potassium was not influenced. Water retention in tocolysis with beta 2 stimulants is one of the most important causes for the information of a pulmonary oedema. The danger of the occurrence of such pulmonary oedemas, especially in risk pregnancies (gestosis), is drastically reduced by antagonising water retention, and hence the combination of Fenoterol and Metoprolol seems to be very favourable from both the cardiac and renal viewpoints. In a group of 17 pregnant women, the drastic improvement of urine excretion under the combination could be confirmed.
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Hypertension in pregnancy is not only of importance to the mother, for whom there is an increased risk of cardiovascular damage, but also for the unborn child because it leads to a reduction of blood flow in the uteroplacental unit and consequently to a disturbance of growth and maturation. Reduction of blood pressure by drugs lowers the incidence of cardiovascular diseases in the mother in the same way as outside pregnancy. There is, however, a well-founded suspicion that the blood flow in the uteroplacental unit may be still further reduced by some antihypertensives, at least in certain situations. Therefore careful consideration must be given to which antihypertensives can be used during pregnancy and which cannot.
Plasma oestradiol and testosterone concentrations were measured in 44 men with angiographically proven coronary heart disease, 66 men without evidence of coronary heart disease serving as control. Another group consisted of 28 men with renal failure. Those with coronary heart disease had a significantly higher oestradiol concentration than the control group. This increased value also was present in patients with renal failure. There was a relationship between the level of oestradiol on one hand and glucose tolerance, ratio of beta to alpha-lipoproteins and blood pressure, on the other, in both the patients with coronary heart disease and the healthy controls. These results indicate the oestradiol may in males be an indicator of a risk constellation of vascular damage. Perhaps, it may be the cause of an abnormal carbohydrate and fat metabolism, which then leads to hypertension and degenerative vascular lesions.
During tocolytic treatment with Beta 2-Sympathomimetic drugs pulmonary edema is occasionally observed. The cause remains uncertain. Within 48 hours after the onset of treatment marked water retention is observed. The weight increases, the hemoglobin decreases the hematocrit decreases, the albumin concentration decreases, the water and sodium excretion decreases. The pathogenesis is discussed and recommendations for the management are proposed. Water retention due to tocolytic treatment in addition to the physiologic water retention of pregnancy or in addition to pre-eclampsia cortisone treatment, renal insufficiency, or treatment with intravenous infusions may lead to a hypervolemia which can no longer be compensated by diuresis and therefore can lead to pulmonary edema. A list of 10 groups of patient with a high risk is described. These require thorough observation following tocolytic treatment.
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Four patients with different forms of glomerulonephritis were treated with the anticoagulant heparin (Liquemin) or phenprocoumon (Marcumar). Following the results in these cases and the experiences of other research groups, which have been published in the last few years, we have tried to lay down a scheme for treatment with anticoagulants in glomerulonephritis. Such a treatment is recommended in peracute or rapid progressing glomerulonephritis, in forms of the disease of which is known that they have a poor prognosis, and in situations in which the risk of simultaneous thromboembolic complications as a result of a nephrotic syndrome represents a further argument for the use of anticoagulants.
Rats with experimental renovascular hypertension were treated with high doses of beta-blocking agents. Pindolol 10 mg/kg per day increased Goldblatt-type hypertension, whereas Propranolol 100 mg/kg per day showed an antihypertensive effect. A linear correlation between the weight of the left-heart ventricle and the systolic blood pressure was found in animals treated with Pindolol as well as in untreated Goldblatt rats. On the contrary, the weights of the left-heart ventricle were significantly higher in those animals treated with Propranolol than in the other groups. The results show that Pindolol in high doses, possibly on account of its sympathomimetic activity, leads to an increase in Goldblatt hypertension, but does not influence the pressure-dependent progression of left-heart hypertrophy. On the other hand, Propranolol, possibly on account of a cardiodepressory effect, leads to a decrease in blood pressure.
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Severe secondary hyperparathyroidism and marked metabolic acidosis occurred in five patients in advanced renal failure due to chronic interstitial nephritis. In all instances there was an immediate and lasting rise in plasma standard bicarbonate concentration after subtotal parathyroidectomy. These observations suggest that the metabolic acidosis in some patients with advanced renal failure is, at least in part, due to hyperparathyroidism and, therefore, responsive to its appropriate treatment.