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Biomedical subjects

J Kindler

Publications and source records attributed to J Kindler.

At least 37 records · Page 2Linked to original sources
PubMed1989

Elimination of the nonionic contrast medium iopromide in end-stage renal failure by hemodialysis.

The increasing life-expectancy of patients with end-stage renal failure has led to a significant increase of diagnostic and interventional radiologic measures. The contrast media used in these procedures, however, are excreted only very slowly, due to the renal failure. We have therefore studied the elimination of the nonionic x-ray contrast medium iopromide (Ultravist) during dialysis in nine anuric patients with end-stage renal failure. All of the patients received 100 ml iopromide (30 g iodine) for the visualization of their Cimino-Brescia shunt. They were then dialyzed 30 minutes after the injection. The plasma iodine concentration declined from 1.7 to 0.7 mg I/ml plasma during the 3-hour dialysis treatment. The iopromide clearance was a constant 80 ml/min. This is the equivalent of a relative dialysance of 65% of the creatinine clearance. There were no incidences of side effects requiring therapy in this high-risk group of patients. The quality of the image was good in all cases. Iopromide proved itself to be an x-ray contrast medium with a low rate of side effects, which can be effectively eliminated from the body by means of conventional dialysis.

Adult↗
PubMed1988

Long-term treatment of minimal-change nephrotic syndrome with cyclosporin: a control biopsy study.

Seven patients with minimal-change nephrotic syndrome confirmed by renal biopsy were treated with cyclosporin (CsA). Four patients had frequent relapses and three others had primary steroid resistant nephrotic syndrome. Corticosteroids were discontinued as soon as CsA whole blood trough values of 200-500 ng/ml (RIA method) were reached. A full remission, defined as complete disappearance of proteinuria, was achieved in five patients under this treatment. In the two other patients proteinuria was reduced. Two patients experienced an acute episode of dose-dependent nephrotoxicity; however, overall renal function, as determined by the creatinine clearance, was stable. Control biopsies in five patients after a mean treatment period of 10 months showed no significant vascular or interstitial toxicity.

Adolescent↗
PubMed1988

Torasemide for diuretic treatment of advanced chronic renal failure.

In a double-blind randomized clinical trial the efficacy and safety of oral high-dose torasemide (1-isopropyl-3- ([4-(3-methyl-phenylamino)pyridine]-3-sulfonyl)urea, T) therapy was compared with that of furosemide (F) in 10 patients with advanced chronic renal failure. The efficacy on edema, fluid and electrolyte balance including the influence on renin-angiotensin-aldosterone system and cochlear function was evaluated. Patients were randomly allocated to either 500 mg F/d (group 1) or 200 mg T/d (group 2). After 14 days of treatment doses were doubled in each group for further 14 days. With respect to the 2.5 times lower dose of T the clinical effect of both drugs on edema, fluid and sodium excretion was equipotent. Significant differences were noted on calciuresis. Serum calcium levels were reduced with F, while T had no influence on calcium balance. A significant increase in plasma renin activity (PRA) was observed after F, whereas T had no raising effect on PRA. No significant alteration of plasma aldosterone concentration occurred with T or F. No adverse effects were noted in both groups. Serial audiometries showed no significant impairment of cochlear function with both drugs. In conclusion, these results indicate that high-dose T is efficient and safe in the treatment of advanced chronic renal failure. The lack of a calciuric effect with T can be regarded as an advantage in patients with hypocalcemia in chronic renal failure.

Adult↗
PubMed1987

Effect of food intake on plasma levels and antihypertensive response during maintenance therapy with endralazine.

A sensitive HPLC assay has been used to determine the effect of food on plasma endralazine levels in 8 patients with essential hypertension. Subjects were investigated whilst on maintenance therapy with endralazine combined with a fixed antihypertensive baseline treatment for at least 4 weeks, samples being collected after the usual oral morning dose of endralazine (5 mg and 10 mg), on two occasions at least 7 days apart. Endralazine was administered with the concomitant therapy in randomised order once 90 min before and once immediately after a standard breakfast. Acetylator status did not affect its pharmacokinetics in the postprandial study after a 5 mg dose, the peak endralazine concentration averaged 57.5% lower and the AUC had fallen significantly by 49.9%, whereas after 10 mg the postprandial peak level and the AUC were 82.9% and 64.7%, lower. In the 5 mg study the mean arterial blood pressure was decreased by 30 mm Hg in the fasting subjects and by 21 mm Hg in the postprandial group. For the 10 mg dose the corresponding values were 35 and 24 mm Hg. The blood pressure lowering effect was only weakly correlated with the food--related reduction in the plasma endralazine levels. The results suggest that endralazine has a similar kinetic interaction with food as that found for hydralazine.

Antihypertensive Agents↗
PubMed1985

[Autoradiographic studies of the distribution of 14C-endralazine in the mouse].

In a macroautoradiographic study in pregnant and nonpregnant mice the distribution pattern of 14C-Endralazine (6-Benzoyl-3-hydrazino-5,6,7,8-tetrahydropyrido(4,3-c)-pyridazine- mesilate), a new direct vasodilator drug, was investigated, since earlier studies with minoxidil and hydralazine had shown apparent discrepancies between the relatively short elimination-half-life and the long pharmacological effect of the drugs. After a single oral administration of 5 mg/kg 14C-endralazine the initial high amounts of radioactivity in the gastro-intestinal tract, the kidneys and the liver continuously decreased in the course of the 2nd to the 8th hour after application. 24 h after administration the drug was nearly completely eliminated from these organs except the liver. A remarkably high and persistent affinity of 14C-radioactivity to the blood vessel walls was found even 48 h after application which could explain the long acting pharmacological response to the drug. Only low levels of radioactivity were registrated in the fetus of pregnant mice.

Animals↗
PubMed1983

Does atherosclerosis caused by dialysis limit this treatment?

A retrospective study of 332 dialysis patients (observation period up to 17 years) demonstrated that cardiovascular and cerebrovascular death rates due to atherosclerosis did not increase with length of time on dialysis. Data analysis showed that cardiovascular and cerebrovascular morbidity and mortality during dialysis is primarily caused by high blood pressure existing prior to commencement of dialysis and an unfavourable very low-density lipoprotein/high-density lipoprotein (VLDL/HDL) cholesterol quotient at the beginning of dialysis treatment. The treatment of the patient before acceptance onto dialysis seems therefore to be the determining factor in the prognosis on dialysis.

Adult↗
PubMed1982

Antihypertensive effects of captopril and saralasin in essential and renal hypertension.

The antihypertensive effect of captopril and its mechanism of action were studied in patients with essential and renal hypertension. In mild essential hypertension (n = 12), during monotherapy with captopril (50 to 450 mg, 4 to 12 weeks) blood pressure was normalized in seven, improved in two and remained unchanged in three patients, plasma levels of active and acid-activatable inactive renin significantly increased and angiotensin II decreased, whereas no consistent changes in urinary kallikrein excretion occurred. In severe renal (n = 14) and essential (n = 9) hypertension, blood pressure was normalized in eight (seven with renal hypertension), improved in seven and unchanged in eight patients, when captopril (50 to 450 mg, 3 to 15 months) was added to the antihypertensive medication. In one patient with stenosis in a transplanted renal artery reversible renal failure occurred during captopril therapy possibly because of a steep initial decrease in blood pressure, although a toxic effect of the drug cannot be excluded. In another series of 12 renal and 8 essential hypertensive patients, a significant correlation between the acute effect of captopril (within 90 minutes) an saralasin on blood pressure was demonstrated (r=0.71, p less than 0.001). The change in blood pressure after either drug was significantly related to the initial plasma renin concentration. In conclusion, captopril seems to be an effective antihypertensive agent in essential and renal hypertension. Renal function should be monitored during captopril therapy. Our studies suggest that captopril decreases blood pressure by inhibiting the vasopressor action of the renin-angiotensin system.

Angiotensin II↗
PubMed1982

Dopamine treatment of human cadaver kidney graft recipients: a prospectively randomized trial.

In a prospectively randomized trial, 50 human cadaver kidney graft recipients were tested for the effect of dopamine infusion on kidney function after transplantation. The kidneys were taken from beating-heart donors under optimal conditions. The dopamine infusion did not affect the dialysis frequency in the 1st week after transplantation, in the dopamine group only slightly better creatinine clearances could be detected. However, the diuresis increased significantly when dopamine was given and this resulted in the fact that in the dopamine group 47.4% of the patients were dialyzed although the diuresis amounted to more than 11/day as compared to 15.7% of such patients in the nondopamine group. These findings correspond to experimental data, which showed that the dopamine infusion of the recipient mainly ameliorated renal function in those cases where kidneys were taken after hypotensive injury of the donor.

Cadaver↗
PubMed1982

Empiric antibiotic treatment of infections in myelosuppressed cancer patients. Preliminary results.

A prospective, randomized study was performed to compare the efficacy and safety of mezlocillin plus sisomicin (Regimen A) and cefamandole plus tobramycin (Regimen B). Sixty-one episodes of documented infections were treated in 49 adult myelosuppressed cancer patients. About two-thirds of the patients treated with either regimen responded to this antibacterial therapy. The patients failing to respond to the initial therapy were treated with additional antibiotics, either with the empiric Regimen C (cefotaxime plus amikacin plus azlocillin) or with antibiotics selected on the basis of bacteriological results (Regimen D). With these schedules, the over-all response rate was increased to about 90%. The data suggest that febrile granulocytopenic cancer patients may profit from this empiric and sequential antibiotic treatment.

Adult↗
PubMed1981

[Plasma exchange in rapidly progressive glomerulonephritis (author's transl)].

The combination of plasma exchange and immunosuppression appears to result in considerable improvement of therapeutic measures in rapidly progressive glomerulonephritis. In contrast to the unfavourable prognosis prior to the introduction of plasma exchange, 8 out of 13 patients (idiopathic rapidly progressive glomerulonephritis, n = 4; Goodpasture syndrome, n = 2; Wegener's granulomatosis, n = 4; lupoid nephritis, n = 3) showed recompensation of terminal renal insufficiency. Treatment of 4 patients who were already anuric led to reversal of renal function in only one case. There was a clear correlation between demonstration of circulating immune complexes and the response to treatment: in 6 out of 7 patients with circulating immune complexes recompensation of severe renal insufficiency was achieved.

Adolescent↗
PubMed1981

[Choice of donor and the results of renal grafting (author's transl)].

For the calculation of the donor influence on the results of renal grafting, all non-renal causes of transplant failure must be excluded. The following criteria for the selection of a suitable kidney donor were found: the urine production of the donor in the last hour before nephrectomy should amount to at least 200 ml and the age difference between donor and recipient should be not more than 20 years. Proteinuria, a high serum creatinine level, vascular anomalies and a long operation time for vascular anastomosis were unfavourable. The preservation time, the warm ischemia time and the sex of the donor have little effect. If no rejection crises occurred within the first 3 weeks after transplantation, the transplant survival rate increased from 45% to 71%.

Adult↗
PubMed1981

[Management of treatment-resistant hypertension: comparison of the antihypertensive effect of endralazine and minoxidil (author's transl)].

In 16 fo 20 patients with treatment-resistant hypertension endralazine, combined with beta-receptor blockers and diuretics, significantly lowered mean arterial blood pressure from 198/112 mmHg to 148/88 mmHg. The initial dose of endralazine was 2.5 mg three times daily. After this the dosage was increased, at the three to six-day intervals according to antihypertensive action and side effects, to a maximum of 50 mg daily in steps of 5.0--7.5 mg per dose. - In a second series of eleven additional patients with treatment-resistant renal hypertension the blood-pressure lowering effect of hydralazine and minoxidil was compared in an open cross-over trial. The result was in favour of hydralazine. Sodium and water retention was slightly less marked with endralazine. Sleep disorders, increased frequency of feeling cold, moderately severe flushing with red checks and feeling hot occurred but rarely with endralazine and regressed during the period of observation.

Adolescent↗