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Biomedical subjects

R Schmicker

Publications and source records attributed to R Schmicker.

At least 19 recordsLinked to original sources
PubMed1995

Nutritional treatment of hemodialysis and peritoneal dialysis patients.

The success of hemodialysis and peritoneal dialysis therapy is essentially dependent on adequate nutrition. Malnutrition represents one of the main factors in morbidity and mortality of dialysis patients. The main causes of malnutrition are insufficient energy intake, insufficient protein supply, loss of amino acids by dialysis, the uremic state of metabolism, catabolic stress of underlying diseases, and endocrinological disorders. For successful long-term chronic dialysis therapy, it is very important that patients be in an anabolic nutritional state when entering the dialysis program. In this paper, the nutritional needs of dialysis and peritoneal dialysis patients (fluid restriction, protein intake, energy supply, electrolyte balance, vitamin intake) are discussed to prevent the catabolic state.

Dietary Proteins↗
PubMed1989

What can be safely said about predialysis treatment?

The modern principles of protein restriction and concomitant treatment in the predialysis period were explained. Our own data of a prospective study show the superiority of a keto acid-substituted diet with regard to the progression of chronic renal failure. The advantage of a keto acid administration was underlined.

Amino Acids, Essential↗
PubMed1989

[The value of conservative treatment measures in treatment of chronic renal failure].

In a review article the value of conservative therapeutic measures in the therapeutic strategy of chronic renal insufficiency is illustrated. In a number of experimental and clinical studies it was shown that by a conservative therapy (diet, treatment of original disease, antihypertensive therapy etc.) the progression of chronic renal insufficiency is delayed. Assumption of therapeutic success is the elimination of catabolism in the strong protein restriction during predialysis period. Main causes of catabolic metabolism are false indication, insufficient energy intake, shortage of essential amino acids and lack of patient compliance.

Combined Modality Therapy↗
PubMed1988

Role of keto acids in the prophylaxis and treatment of renal osteopathy.

KA administration given in addition to a low-protein diet leads to a reduction of PTH secretion followed by diminishing of osteofibrosis. Osteomalacia will also be reduced by a better control of the calcium-phosphate metabolism, an increase of 1,25-(OH)2-D levels, and a lower burden of aluminum. Therapeutic levels of 25-OH-D and calcitonin (caused by simultaneous administration of vitamin D) are probably necessary to achieve this effect. KA are not only the optimum form of substitution in the nutritional treatment of chronic renal failure, but they seem to be very effective in the treatment of renal osteodystrophy.

Amino Acids, Essential↗
PubMed1987

Conservative long-term treatment of chronic renal failure with keto acid and amino acid supplementation.

In a group of 119 patients with advanced chronic renal failure (serum creatinine level 733 +/- 186 mumol/l) the effect of a low-protein diet supplemented with essential amino acids (EAA) or their keto analogues (KA) on uremic metabolism and rehabilitation status was investigated. The protein intake amounted to 0.4 g/kg B.W./day, the phosphorus intake 0.4-0.6 g/day and the energy supply 120-150 kJ/kg B. W./day. In 51 patients there was a substitution with EAA and in 68 patients with their KA. The mean duration of dietary treatment in this study was 19 months (6-64 months). During this time, the serum creatinine increased from 733 +/- 186 to 1,220 +/- 256 mumol/l, whereas the urea nitrogen values remained relatively constant at between 26 and 30 mmol/l. There were no signs of protein malnutrition (nitrogen balance, serum transferrin and serum protein were normal). The hemoglobin concentration remained at greater than 5 mmol/l with creatinine levels of 1,220 +/- 256 mumol/l. During the substitution with KA, there was a significantly greater decrease in serum phosphate (p less than 0.05) and parathyroid hormone (PTH) (p less than 0.01) as compared with the uremics given EAA. In addition, we found a significant increase in testosterone (p less than 0.01) in patients supplemented with KA. Despite advanced chronic renal failure there was a good degree of rehabilitation (full-time work: 21%; part-time work: 66.4%). It can be concluded that a low-protein diet supplemented with EAA or KA can improve the uremic metabolism, rehabilitation status and safely postpone the start of maintenance dialysis.

Adolescent↗
PubMed1987

Influence of keto acid (KA) treatment on renal osteodystrophy.

A marked improvement of renal osteodystrophy was achieved after a combined treatment with keto acids and vitamin D in patients with chronic renal failure. Results were checked by histological investigations. The biochemical background of the successful treatment was analysed. A regression of hyperparathyroidism and improvement in vitamin D status are the cause of this phenomenon.

Amino Acids↗
PubMed1985

Tubular function disturbances in chronic glomerulonephritis and their significance for identifying tubulointerstitial lesions.

The tubular and tubulointerstitial renal functions of 237 patients with chronic glomerulonephritis and functional compensation corresponding to their plasma creatinine levels were investigated and the results were compared with the light microscopic findings obtained by examination of kidney interstices obtained by biopsy. Pronounced structural interstitial lesions (TiC) were found in 30% of the cases. Investigation of the predictive values of tubular function data in respect of the presence or exclusion of TiC showed that, although individual parameters of the renal function permit the exclusion of TiC disturbances with a high degree of certainty, the diagnostic value can be enhanced by considering pairs of such parameters. Five parameter combinations were found to have the highest predictive value regarding the diagnosis of TiC. These were disturbed concentration capacity accompanied by reduced ammonia excretion or total acid excretion, reduced water diuresis accompanied by disturbed ammonia excretion or total acid elimination; and, finally, the total acid excretion and maximum dilution capacity. The highest predictive values for the exclusion of TiC are shown by inconspicuous concentration capacity accompanied by normal ammonia excretion, total acid excretion, water diuresis, free water clearance or urine dilution capacity.

Adolescent↗
PubMed1985

Influence of phosphate restriction, keto-acids and vitamin D on the progression of chronic renal failure.

Progression of renal failure was investigated in a prospective follow-up study of 60 patients with mild and 100 patients with advanced renal failure. Phosphate restriction in mild and protein restriction in advanced renal failure can delay the progression rate of patients with chronic renal insufficiency. Simultaneous administration of Vitamin D does not effect the progression. Administration of keto-acids to the low protein diet has a strong delaying effect on the progression rate.

Dietary Proteins↗
PubMed1984

[Controlling renal osteopathy with keto acids].

Starting from the results of former investigations the influence of the long-term treatment with the KA of the essential amino acids on the renal osteopathy is investigated. For this purpose we compared 27 patients with renal insufficiency (serum creatinine 981 +/- 354 mumol/l), who besides vitamin D had been treated with KA for at least 12 months, to a group of 50 patients (serum creatinine 778 +/- 273 mumol/l), who had received vitamin D over 19 +/- 9 months, and to a control group of 27 patients (serum creatinine 928 +/- mumol/l) without an adequate conservative therapy. While the control group showed the typical constellation in advanced renal insufficiency with hypocalcaemia, hyperphosphataemia, clearly increased PTH levels, clearly increased CT values and normal 25-OH-D concentrations, during the diettherapy and the vitamin D substitution a significant increase of the serum levels of calcium, 25-OH-D and CT as well as a significant decrease of the PTH and the anorganic phosphate in the serum developed. Under the combination therapy with KA and vitamin D despite the reduction of the phosphate binders another significant decrease of the PTH and the anorganic phosphate was observed. The mineral content of the bones was within the normal in the two therapy groups. The percentage of the normal histological findings of the bones was with 40.7% highest despite the advanced renal insufficiency in the simultaneous substitution with KA. While in the vitamin D group during the control biopsy after 12 months in 20.5% of the cases an improvement of the histological findings developed, this effect occurred under additional KA-therapy in 51.9% of the cases. The results allow the conclusion that by means of the long-term treatment with KA a favourable influence on the renal osteopathy develops.

Adult↗
PubMed1984

[Correspondence of functional and structural findings in tubulo-interstitial disorders in chronic glomerulonephritis].

In 237 patients with chronic glomerulonephritis and according to the serum creatinine level of functional compensation tubular and tubulointerstitial renal functions, respectively, were investigated and compared with the light-microscopic findings of the renal interstice. A distinct structural tubulointerstitial lesion (tiK) was found in 30%. The diagnostic predictivity for the recognition and the exclusion of the tiK was tested for single or paired data of the renal function. As a result it is possible with a suitable combination of parameters in on an average more than 80% of the cases to establish or to exclude function-diagnostically a tubulointerstitial structural lesion even in still inconspicuous creatinine values. From the clinical point of view thus the information value of functional diagnostic investigations of the renal water treatment is confirmed (concentration power, dilution ability, water diuresis), in which case the differentiated test of the renal acidification may supplement the informations about the tiK-situation.

Adolescent↗