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M Renke

Publications and source records attributed to M Renke.

10 recordsLinked to original sources
PubMed2006

Management of inguinal hernia on peritoneal dialysis: an audit of current Polish practice and call for a standard.

Peritoneal dialysis is becoming more and more common as a method of treating patients at the final stage of renal failure. In the year 2002 the number of patients treated with this method in Poland amounted to 1324. Studies have demonstrated that inguinal and abdominal hernias develop more frequently in chronic renal failure patients. The percentage of patients with hernia diagnosed within the first five years of dialysis is about 10%. Continuation of dialysis with the hernia condition left untreated may result in severe complications which are the third most frequent cause of converting treatment method into hemodialysis in PD patients. Currently in Poland there is no national standard in existence as to the management of hernias, and the only British standard from 1998 does not reflect the present expertise of either surgical treatment or dialysis methods. The aim of the current questionnaire based study investigating Polish peritoneal dialysis centers was to assess the treatment when hernia had been diagnosed in the PD patient. Of 49 dialysis centers in Poland, 39 do have protocols on managing the patient before and after the operation. A considerable diversity has been found as to surgical techniques used and the ways the patients are managed in hospital. Following the need expressed by 33 dialysis centers in Poland for some standard for relevant procedures, the authors formulated principles of modern hernia treatment in PD patients. Accordingly, the main principles include: 1) consulting a surgeon collaborating with the center before qualifying for peritoneal dialysis and when hernia symptoms have manifested; 2) Tension-free methods used in a treatment of choice (recommended by PHS); 3) Application of antibiotic prophylaxis (preferably first generation cephalosporin); 4) Induction of local or epidural anesthesia; 5) Peritoneal dialysis programme does not need to be discontinued but low volume dwells or preferably intermittent APD is recommended immediately after surgery.

Female↗
PubMed2001

Interrelationship between cardiac structure and function and incidence of arrhythmia in peritoneal dialysis patients.

Cardiovascular complications in patients with end-stage renal disease requiring dialytic therapy are frequent and account for approximately 40% of all deaths in these patients. The aim of this study was to analyze the occurrence of cardiac arrhythmia in peritoneal dialysis (PD) patients with respect to the changes in left ventricular structure and function. To determine characteristics of arrhythmia in patients on PD for chronic renal failure, 30 patients (18 male and 12 female; aged 54.1+/-13.8 years) underwent twice (interval of 20+/-4.1 months) ambulatory 24 hour Holter ECG monitoring. At the same time all the patients were analyzed by echocardiography and pulsed Doppler echocardiography to estimate cardiac structure and function. Ventricular arrhythmias were seen in 9 patients (30%) during the first examination and in 13 patients (43.3%) on the second. Ventricular arrhythmias were observed only in patients with left ventricular hypertrophy (LVH). Supraventricular arrhythmias were seen in 12 (40%) and 17 (56.7%) patients. The majority of these patients also had LVH, with 11/12 (91.7%) patients at the first examination and 15/17 (88.2%) at the second respectively. We conclude that the incidence of arrhythmia is primarily dependent on the presence of LVH in PD patients. It appears that peritoneal dialysis does not provoke or aggravate arrhythmia.

Age Factors↗
PubMed1999

The role of Automated Peritoneal Dialysis in peritoneal dialysis programme: one centre experience.

The results of the Automated Peritoneal Dialysis (APD) therapy in adult patients in the Department of Nephrology in Gdańsk during the years 1995-98 are presented. Seventeen patients (8-M, 9-F) aged 25-86 years (mean age 55.3 years), including 7 diabetics, were treated with different forms of APD. The most common indication for APD therapy was patients' loss of ability to perform Continuous Ambulatory Peritoneal Dialysis due to progressive blindness, leg amputation related to diabetic foot complications or cerebrovascular episodes (8 pts). The cumulative therapy period was 231.5 patient-months. During the observation 4 patients died, 1 received kidney transplant and 12 were still treated with APD at the end of the study. No patient was transferred to long-term hemodialysis. The peritonitis rate in the APD group was 1/57.5 patient-months. Most patients reached adequacy targets, the mean Kt/V value was 1.97 (range 1.17 - 2.36). To achieve this, 12-19 litres of dialysate were used per day (mean 14.6 L/d). There were significant differences between CCPD and NPD groups with respect to dialysis adequacy, body weight and dialysis fluid volume. We conclude that APD may be used with success in patients in whom continuation of CAPD or HD therapy is very difficult due to its complications or comorbid conditions.

Adult↗
PubMed1998

[The effect of nasal and skin colonization on the development of exit site and peritoneal catheter tunnel infections in patients on peritoneal dialysis].

ESI remain a major problem in patients undergoing peritoneal dialysis and are frequently the reason for catheter removal. The treatment is often costly and not effective and the need for routine prophylactics has to be clarified. In this study 38 peritoneal dialysis patients (15 F & 23 M, age: 18-73) were analysed prospectively for ESI and TI in respect to skin (exit site and inguinal area) and nostrils colonisation. There were 14 diabetics and 24 non-diabetics. All had standard double-cuff Tenckhoff catheter and none presented with ESI prior to the study. No treatment was applied on the basis of positive culture only. In 27 patients swab were repeated after 6-11 months. Eight episodes of ESI and three TI were recorded. Following pathogens were cultured: S.aureus in 4 Klebsiella pneumoniae in 2, Corynebacterium sp. in 1, negative in 1 and with TI S.aureus in 3. Positive nasal cultures (S.aureus, Klebs.pn.) were observed in 5 patients subsequently developing ESI (p < 0.01) and in 2 with TI. In 2 cases exit site was also colonized by pathogens responsible for ESI (p = NS). Inguinal area was colonized by various pathogens in 7 patients, but only one of these developed ESI (p = NS) and no one TI. There was no difference between diabetic and non-diabetics neither in the frequency of ESI, TI nor in nasal carriage of pathogens. In the majority of patients nostrils and inguinal area were colonized by S.epidermidis. When the second culture was analyzed it appeared that significantly more patients had exit site colonized by S.epidermidis (2 and 11 patients in 2 consecutive cultures respectively (p < 0.01). In conclusion, it appears that nasal carriers of pathogens like S.aureus and Klebsiella pneumoniae are more prone to ESI. Inguinal area and exit site colonization does not seem to precede ESI or TI. We would suggest that nasal carriage status should be routinely identified in all patients entering peritoneal dialysis programme and the carriers properly treated.

Adult↗
PubMed1998

[Lipoprotein metabolism disturbances in patients with kidney diseases].

Lipoprotein(a) was discovered over 30 years age and it is an independent risk factor for atherosclerosis, coronary artery disease and peripheral vascular diseases. Among patients with end stage renal failure lipoprotein(a) levels are higher than in general population and being independent of the type of treatment. Cardiovascular diseases are the most important cause of mortality in ESRD patients. Moreover we have interesting information about possibility of influence of Lp(a) serum levels.

Cardiovascular Diseases↗
PubMed1986

Long-term prognosis for endocapillary glomerulonephritis of poststreptococcal type in children and adults.

The long-term clinical course of sporadic, acute endocapillary glomerulonephritis of poststreptococcal type is reported. In all cases, the diagnosis was established by renal biopsies and in most cases by clinical tests. The study is based on retrospective/prospective data from 36 children and 101 adults in the Federal Republic of Germany, Luxemburg, and Austria. In 72 patients (21 children, 51 adults) the disease course was clinically followed over periods of 2-13 years (clinical features: blood pressure, serum creatinine, proteinuria, hematuria). In this group, the number of clinical recoveries (i.e., all features within strictly defined normal ranges) increased with increasing length of observation. Children showed more rapid clinical recovery. 29% of the children and 41% of the adults showed no clinical recovery. Out of all 137 patients, 3 progressed to chronic renal failure, and 4 other patients died. Cases with an initial nephrotic syndrome had a significantly poorer long-term prognosis (p less than 0.005). Initial elevation of serum creatinine concentration due to acute renal failure did not influence the long-term prognosis. Our results indicate that the acute endocapillary glomerulonephritis of poststreptococcal type has a slow tendency towards clinical recovery under good hygienic conditions and if unaccompanied by nephrotic syndrome in the initial phase.

Adult↗