Kidney preservation in situ and conservative treatment of renal cell carcinoma: application of HTK solution (CUSTODIOL).
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Adolescent↗
Biomedical subjects
M Kallerhoff
Publications and source records attributed to M Kallerhoff.
Prenatal diagnosis of congenital nephrosis of the Finnish type (CNF) in the second trimester.
Congenital nephrosis of the Finnish type is an hereditary, autosomal recessive disease which leads to death in early infancy. This is a case report concerning an affected fetus with legal interruption in the 24th week of gestation on the basis of certain sonographic changes in the fetal kidneys and changes in the protein profile in amniotic fluid, which were consistent with nephrotic damage of the kidneys. Light and electron microscopy showed evidence of CNF, i.e. increase of mesangial matrix and cells in glomeruli, dilated tubular segments, and effaced and plumb foot-processes of the glomerular epithelial cells. Antenatal diagnosis of CNF therefore seems feasible in the second trimester of gestation by means of AFP determinations in maternal serum and amniotic fluid as well as by using sonographic criteria and determination of proteins in amniotic fluid.
Amniotic Fluid↗
Differentiation between renal and postrenal type of hematuria and proteinuria measuring urinary apolipoprotein A1 excretion.
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Apolipoprotein A-I↗
[Follow-up of tissue acidosis, lactic acid production and morphologic changes in testicular tissue in ischemia and the effect of cooling].
More than 90% of the patients with a testicular torsion are loosing their testis by orchiectomy or by following ischemic atrophy. The critical time of irreversible changes of the testis is according to literature 4-6 hours. The aim of our study was to measure the tissue acidification (pH) in the testis at different temperatures and to estimate the cooling effect on pH, lactate accumulation and morphological changes. We have measured in 36 human testis (orchiectomy in patients with metastatic prostate cancer) the tissue acidification (pH), the tissue lactate level and the morphology changes at a temperature of 35, 25, 15 and 5 C. In 12 testis of young dogs we have measured the same parameters. Starting with a normal testis temperature of 35 C the pH is falling to 6.0 within 1 hour of ischemia. By colling to 15 C this time can be prolonged to 6 hours. The tissue lactate level rises from 25 mumol/gdw to nearly 200 mumol/gdw at 35 C. The morphology of semi-thick slices of the testis shows a swelling of the intratubular tissue (spermatogenesis) by loss of the interstitial space. By reducing temperature also a slowdown of the changes can be observed. The critical pH value of the testis for irreversible changes is not known. A ph of less than 6.0 is probably a value, which may result in such changes.
Acid-Base Equilibrium↗
[Course of tissue acidosis, lactic acid production and morphologic changes in testicular tissue during ischemia. Effect of hypothermic measures].
More than 90% of patients with testicular torsion lose their testis, either because orchiectomy is necessary or because ischaemic atrophy develops. The critical time before irreversible changes to the testis have taken place is, according to literature, 4-6 h. The aim of our study was to measure the tissue acidification (pH) in the testis at different temperatures and to estimate the effect of cooling on pH, lactate accumulation and morphological changes. In 36 human testes (obtained by orchiectomy in patients with metastatic prostate cancer) we measured the tissue acidification (pH), the tissue lactate level and the morphological changes at temperatures of 35, 25, 15 and 5 degrees C. We also measured the same parameters in 12 testes taken from young dogs. At the normal testicular temperature of about 35 degrees C the pH falls to 6.0 within 1 h of ischaemia. Cooling to 15 degrees C can extend this time to 6 h. The tissue lactate level rises from 25 mumol/gdw to nearly 200 mumol/gdw at 35 degrees C. The morphology of semithin sections of the testis shows swelling of the intratubular tissue (spermatogenesis) with loss of the interstitial space. Reducing temperature can also slow-down these changes. The critical pH value of the testis beyond which irreversible changes take place is not known; a pH of less than 6.0 is thought to be the probable threshold.
Acid-Base Equilibrium↗
[Imaging and functional parameters in diagnosis of obstructive nephropathy].
Obstruction of the kidney leads to terminal kidney failure within a few years. Therefore, early recognition of such obstruction is of importance. Non-invasive diagnostic ultrasound examination now allows intrauterine visualization of a suspected obstruction. However, the implications of such a dilated ureteral pelvic system are obscure. Whether there is obstruction or dilatation can only be evaluated postnatally by a nuclear technique. The aim of our study was to measure the recovery of kidney function. We investigated 13 kidneys of 9 newborns or small infants (up to 2 years). The follow-up was continuous for up to 29 days. The parameters were: urine output (24-h clearance), glomerular filtration rate, fractional excretion of sodium and potassium, free water clearance, total protein excretion, albumin and alpha 1 microglobulin excretion. The urine output fell from 0.3 to 0.12 ml/min within 14 days after relief of obstruction. The glomerular filtration rate rose from nearly 30 ml/min to about 50 ml/min within a week. The fractional excretion of sodium and potassium indicated recovery of the proximal tubli. The fractional sodium excretion fell below 1% within 4 days. The free water clearance reflects the concentrating ability of the kidney, and in kidneys from newborns it had only positive values, while in kidneys of children older than 6 months there were also negative values. The protein excretion and the albuminuria showed recovery of the glomerular as well as the tubular system.(ABSTRACT TRUNCATED AT 250 WORDS)
Alpha-Globulins↗
[A retroperitoneal space-occupying lesion following tumor nephrectomy].
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Carcinoma, Renal Cell↗
[Clearance behavior of the kidney in relation to ANF in the autologous dog transplantation model].
ANF is totally filtrated by the kidney and is degradated in the brush border of the tubuli. In an experimental transplant model in dogs excretion of ANF is investigated after a cold ischemia period of 48 h and HTK-protection. The ANF-renin-antagonism was of interest respectively. The experiments demonstrated that the filtration in the glomeruli and the function of the endopeptidases in the brush border is normal after a cold ischemia period of 48 and HTK-protection. There is a linear correlation between the concentration of ANF in the renal vein and the aorta. An antagonism of ANF and renin could not be found. ANF is discussed as an additional ischemia parameter in renal transplantation.
Animals↗
[Localization and extent of tissue damage caused by extracorporeal lithotripsy (ESWL)].
Extracorporeal shock wave lithotripsy (ESWL) causes proteinuria. In our study we investigated the protein fractions and the electrolyte composition of the urine in patients who had been treated with ESWL. The aim was to obtain information on the degree and the localisation of the glomerular, tubular or vascular destruction caused by ESWL in humans. A total of 34 patients with stones had been treated with ESWL. As parameters we used: urine output, creatinine clearance, total protein, albumin, immunoglobulin G, N-acetyl-beta-D-glucosaminidase (beta-NAG), alpha-1-microglobulin, the fractional excretion of Na+ and apolipoprotein-A-1. After ESWL treatment proteinuria and albuminuria are found. Our parameters show no deterioration of the glomerula or the tubulus. The increase in apolipoprotein-A-1, a postglomerular parameter, however, is interpreted as a manifestation of vascular destruction after ESWL; this is normally temporary, leaving no permanent damage.
Acetylglucosaminidase↗
[Extracorporeal shockwave lithotripsy in the treatment of pediatric urolithiasis].
The 2nd generation lithotripter LITHOSTAR plus was used for extracorporeal shock wave lithotripsy of 9 kidney stones, 2 ureteral calculi and 2 bladder stones in 10 children 15 months to 17 years old. Ultrasonic stone localization was used in 2 children, x-ray guided stone localization in 8 children. General anesthesia was necessary in 6 children. A stone free rate of 60% was achieved after 1 treatment. Except for one 14-year old boy no adjuvant procedures like percutaneous nephrostomy or ureteral stents were applied. No major complications were encountered.
Adolescent↗
A new method for conservative renal surgery--experimental and first clinical results.
So far two methods for prolonging the tolerance of renal ischemia are available: 1) surface cooling with crushed ice and 2) perfusion cooling with an extracellular-like solution. Both methods use only the principle of reducing metabolism through cooling. While rewarming during surgery the ischemic protection is lost, or the kidney must be cooled once again. Therefore, a new preservation solution should reduce energy consumption due to its composition in addition to cooling. For open heart surgery, the HTK solution by Bretschneider is already used clinically. In 71 dog kidney experiments, the ischemic time kidneys could tolerate was prolonged by this solution from 15 to 120 min at 35 degrees C and from 45 to 360 min at 25 degrees C. After 2 h of ischemia at 30 degrees C glomerular filtration rate was about 20 ml/min.100gww within 3 h of reperfusion. After six postoperative days the filtration rate was 40 ml/min.100 gww. No ischemic damage could be recognized by histological investigations. The clinical effectiveness of this method was shown in 7 clinical applications. Ischemic duration lasted up to 113 min, and blood creatinine was between 0.8 and 2.4 mg% at the 6th postoperative day. Use of this preservation technique thus leads to improved kidney function immediately following operation. Longer ischemia can be tolerated by a kidney thus protected, and using this technique excellent visibility can be achieved during intrarenal surgery, simplifying, for example, tumor extirpation.
Animals↗
Glucose content and efficiency of glycolysis in protected ischemic kidneys of different species.
In ischemic canine kidneys protected by Bretschneider's HTK solution the glycolytic lactate production is limited by a low renal substrate content. However, for anaerobic energy supply ischemic organs depend on glycolysis. To evaluate the role of glycolysis in renal protection, the relationship between lactate production and anaerobic energy supply was examined in protected kidneys of dogs, sheep, and swine. Additionally, in canine kidneys an attempt was made to improve anaerobic energy provision by adding glucose to the protective solution. The results were as follows: (1) According to increasing lactate production from swine to dog to sheep, intraischemic ATP decay was delayed least in swine and most in sheep. (2) Glucose addition (10 mM) to the HTK solution roughly doubled the time for ATP to fall to 1 mumol/g dry wt (tATP) in dogs. (3) The greater the lactate production in all three species, the lower the decrease in SAN (ATP + ADP + AMP) from 5 to 120 min of ischemia. (4) A glucose additive in the protective solution led to a significant (p less than .005) increase of SAN in dogs at 120 min of ischemia. A sufficient substrate supply seems to be an essential component of a reliable renal protection.
Adenine Nucleotides↗
["Imperative indication" for organ-preserving kidney tumor surgery].
Imperative indications for organ-sparing surgery of renal tumors are given mainly in existing or imminent restriction of renal function. Organ-sparing excision of renal tumors under in-situ protection with HTK-solution compared with operations without protection have the following advantages: 1. reduced blood loss, 2. longer ischemia, 3. better tissue differentiation with benefit for radicality, 4. shorter hospital stay.
Cardioplegic Solutions↗
Urinary LDH-release for evaluation of postischemic renal function.
Following renal ischemia under protection, the perfusion of the tubular system increases concomitant to the rise of GFR. The transport into urine of enzymes entering the tubular lumen due to ischemic injury is dependent on tubular flow. Thus, we examined if in the early postischemic phase urinary enzyme determinations can contribute to the evaluation of the ischemic injury despite the interference of a changing tubular washout. Canine kidneys were perfused with different protective solutions and subsequently rendered ischemic. From the beginning of reperfusion the endogenous creatinine clearance, the urine minute volume and the urinary LDH-concentration were determined. The urinary LDH-concentration allowed only a rough assessment of renal ischemic damage. The adjustment of the urinary LDH amounts to the GFR resulted in a better graduation according to the ischemic stress. With such a standardized LDH parameter the urinary LDH release was somewhat lower on the average when L-aspartate was added to the HTK solution in place of chloride. In conclusion, during the early postischemic recovery after renal protection the examination of the urinary enzyme release may be a useful diagnostic means for the assessment of the extent of the ischemic injury if an appropriate frame of reference is applied.
Animals↗
Intraischemic metabolic effects of different disaccharides on protected canine kidneys.
The addition of the disaccharides maltose (10, 20, 30 mM) and sucrose (30, 60 mM) to Bretschneider's organ protective HTK solution was evaluated to improve renal protection by an enhanced glycolytic energy supply. Canine kidneys were perfused for 8 min with either HTK solution or HTK solution containing additional disaccharides. After nephrectomy the kidneys were incubated at 25 degrees C and metabolic parameters were determined at regular intervals. Maltose and sucrose are slowly cleaved during renal ischemia but maltose distinctly faster than sucrose. Maltose increases intraischemic ATP supply. However, 30 mM maltose was no better than 10 mM. 60 mM sucrose was about as effective for glycolysis as 10 mM maltose. However, possibly due to fructose release there was an accelerated decrease of adenine nucleotides with sucrose. Although fructose enters glycolysis it seems to have negative side-effects. Hence, probably neither sucrose nor fructose are appropriate for renal substrate supply during ischemia.
Adenosine Triphosphate↗
Contribution of amino acids in protective solutions to postischemic functional recovery of canine kidneys.
Amino acids are known to increase glomerular filtration rate (GFR). There is also an early resumption of filtration following 2-h renal ischemic stress under protection by histidine-buffered histidine-tryptophan-ketoglutarate solution (HTK), possibly due in part to an amino acid effect. Hence, we have examined the possibility of further enhancing the postischemic GFR by adding 32 (ASP I; 4 mM Mg2+) or 36 (ASP II; 6 mM Mg2+) mM L-aspartate (asp) or 32 mM DL-aspartate (ASP III) to the HTK solution in place of chloride. After infusion of 500 ml 5% glucose, canine kidneys were protected by an 8-min perfusion with HTK (n = 5), ASP I (n = 4), ASP II (n = 5) or ASP III-solution (n = 3). The subsequent ischemia lasted for 2 h at 27-31 degrees C. During reperfusion, both GFR and filtration fraction (FF) were higher in kidneys protected by L-aspartate-containing solutions. ASP III showed no improvement against HTK. An additional preischemic intra-aortal application of HTK or ASP I solution just above the exit of the renal arteries prior to the intrinsic protective perfusion further raised the postischemic GFR. The present results suggest that L-aspartate but also histidine may have favorable amino acid effects in renal protective solutions in addition to known positive effects of histidine.
Animals↗
Postischaemic interrelations between energy metabolism and functional recovery of protected canine kidneys.
Following renal ischaemia under effective protection glomerular filtration starts at a time when renal high-energy phosphates are resynthesized. The present investigation was carried out to examine the interdependence of the two processes. Therefore, canine kidneys were protected with sodium poor and nominally Ca2+ free buffered solutions. After different times of ischaemia and reperfusion the glomerular filtration rates (GFR) were determined and afterwards tissue specimens were excised for the determination of high-energy phosphates. Both the GFR and the renal energy content were higher with shorter ischaemia periods or longer reperfusion. As a rule there was a correlation between GFR and ATP, both probably mainly signifying the degree of preservation of proximal nephron sites, as the interrelation between the GFR and the renal SAN (ATP + ADP + AMP) content also signifies. However, with the addition of aspartate to the protective solution it could be demonstrated that the GFR also can rise without a concomitant increase of ATP. Under certain conditions an increase of GFR can even be associated with a lowering of the renal ATP content.
Adenosine Monophosphate↗
Metabolic, energetic and structural changes in protected and unprotected kidneys at temperatures of 1 degree C and 25 degrees C.
In 110 canine kidneys, we examined the time course of energy rich phosphates, lactate, intrarenal ph and renal morphology with Euro-Collins- or with HTK-protection of Bretschneider and compared these findings with unprotected kidneys during complete ischemia at 1 degree C and at 25 degrees C. Both kidney protective solutions prolonged energy-rich phosphate-decline by a factor of 3-4 compared with that of unprotected kidneys. The lactate increase was greater in Euro-Collins-protected kidneys than in HTK-protected and in unprotected kidneys, leading to pH values of 6.5 in Euro-Collins and to 6.4 in unprotected kidneys after 24 hours, in contrast to a pH-value of 7.3 with HTK-protection. This may be the reason for structural deterioration seen in unprotected and in Euro-Collins-protected kidneys after 12, and 48 h of ischemia at 1 degree C, whereas in HTK-protected kidneys a sufficient preservation of structure can be seen. In one human kidney, protected with Euro-Collins-solution, we were able to show that at 1 degree C intrarenal pH and lactate accumulation is similar to the levels in canine kidneys. In Euro-Collins preserved kidneys lactate accumulation at 25 degrees C is even greater than at 1 degree C, leading to inhibition of energy metabolism and to structural deterioration, whereas HTK-solution, because of its high buffer concentration, is able to maintain ischemic metabolism leading to sufficient protection of intrarenal pH and of adenine nucleotides as well as structural protection at 1 degree C and at 25 degrees C.
Animals↗