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Biomedical subjects

W Grotz

Publications and source records attributed to W Grotz.

At least 19 recordsLinked to original sources
PubMed2000

Dihydropyridine calcium antagonists and renal function in hypertensive kidney transplant recipients.

OBJECTIVE: To investigate whether calcium antagonists are nephroprotective in hypertensive cyclosporine-treated renal allograft recipients. METHODS: We studied 50 hypertensive and 17 normotensive renal transplants (eight females, nine males; 14-54 years, mean age 38.8 +/- 3.5 years). Hypertensive patients were randomized to be treated with (+Ca; 11 females, 13 males; 20-65 years, mean age 43.1 +/- 3 years) or without (-Ca; 15 females, 11 males; 25-60 years, mean age 41.3 +/- 2.5 years) a calcium antagonist (nitrendipine or nifedipine). Additional antihypertensives were given stepwise according to a standardized protocol: beta1-adrenoceptor blocker, diuretic alpha1-adrenoceptor blocker or vasodilator. Data were analysed at 0, 1, 2 and 3 years on an intention-to-treat basis. RESULTS: Hypertensive patients had a higher body mass index at 0/3 years (23.7 +/- 0.6/25.1 +/- 0.6 kg/m2) than normotensive patients (22.2 +/- 0.6/22.1 +/- 0.7 kg/m2). During the study, blood pressure in normotensive transplants was always slightly, but not significantly, lower than that of transplants with treated hypertension. There was no difference between the groups (+Ca) and (-Ca). Cr51-ethylenediaminetetracetic acid (EDTA) clearance (0/2 years) was 58 +/- 4/57 +/- 6 ml/min in normotensives, 52 +/- 4/47 +/- 4 ml/min in hypertensives (+Ca) and 47 +/- 4/49 +/- 6 ml/min in hypertensives (-Ca). Proteinuria (0/3 years) was 0.16 +/- 0.04/0.15 +/- 0.02 g/24 h in normotensive, 0.26 +/- 0.08/0.23 +/- 0.05 g/24 h in hypertensives (+Ca) and 0.26 +/- 0.07/0.22 +/- 0.05 g/24 h in hypertensives (-Ca). CONCLUSIONS: Post-transplant hypertension is associated with higher body mass index and poor renal function. No difference in the course of Cr51-EDTA clearance, serum creatinine, proteinuria or blood pressure was observed between groups treated with or without calcium antagonists. Calcium antagonists and conventional antihypertensive treatment have the same nephroprotective effect in hypertensive renal transplants, when treatment is started 3 months after transplantation.

Adult↗
PubMed1999

Compliance of German pediatric patients with oral antibiotic therapy: results of a nationwide survey.

BACKGROUND: Noncompliance with a prescribed therapy is a common problem in ambulatory pediatrics. OBJECTIVE: To establish a nationwide status quo of compliance of German ambulatory pediatric patients with oral antibiotics prescribed for various bacterial infections. PATIENTS AND METHODS: In this study, organized and financed by the German Society for Pediatric Infectious Diseases, 42 pediatricians in private practice who were selected to represent the 3 main regions of Germany and residence in large cities or small towns, respectively, enrolled consecutive patients who had bacterial infections that required therapy with oral antibiotics. Choice of agent and duration of treatment were left to the study physicians. Compliance was measured by a standardized telephone interview on the penultimate day and a urine bioassay for antibacterial activity on the last day of the planned treatment period. Parents did not know the true purpose of the study. RESULTS: Five hundred eight-four patients were fully evaluable. The most frequent diagnoses included tonsillopharyngitis (n = 231), otitis media (n = 170) and lower respiratory tract infections (n = 114). Most frequently prescribed antibiotics included amoxicillin (n = 102), potassium penicillin V (n = 81) and clarithromycin (n = 67). Overall compliance (positive urine test) on the last day of therapy was 69.5% (406 of 584 patients). Compliance was not significantly influenced by the region of residence or the underlying bacterial infection. It was significantly associated with the antibiotic used (macrolides, 89.0%; penicillins, 62.2%; cephalosporins, 66.4%; P = 0.0001 for macrolides vs. the others). Best compliance was found with clarithromycin (94.0%) and erythromycin estolate (89.8%). Compliance was also significantly better in patients > or =6 years old (77.7%; P = 0.016); with a treatment duration of < or =7 days (77.6%; P = 0.014); when the drug package contained a dose-taking reminder (79.7%; P = 0.003); and when the pediatrician's behavior toward the patient was assessed by the parents as "very sympathetic" or "sympathetic" (72.6%; P = 0.017). Subjecting all variables to logistic regression analysis, we found 3 variables to be significant predictors of treatment compliance: choice of antibiotic (P = 0.0001); patient age (P = 0.0008); and residence in town or city (P = 0.03). CONCLUSIONS: A noncompliance rate of >30% is unsatisfactory. Whereas some variables significantly associated with compliance cannot be influenced (patient age; place of residence in town or city), others are amenable to modifications. These include the physician-patient interaction and the choice of antibiotic. Agents should be preferred that are well-accepted by patients, that enable short-term therapy with few daily doses and with a package that contains a dose-taking reminder.

Administration, Oral↗
PubMed1998

Occurrence and management of hepatitis B virus reactivation following kidney transplantation.

A 28-year-old woman was kidney transplanted. She had an inapparent hepatitis B virus (HBV) infection 2 years previously. At the time of transplantation she was hepatitis B surface antigen (HBsAg) negative, anti-HBs, anti-HBc, anti-HBe and anti-HCV antibody positive and her transaminase activities were within the normal range. The donor of the kidney allograft was HBV negative. Twelve weeks after transplantation a life-threatening liver failure occurred with a rapid rise of alanine aminotransferase (ALT) to 1427 U/l and a decrease of the prothrombin time to 25% of normal value. Anti-HBs had become negative, anti-HBc and anti-HBe titers had decreased. HBsAg became positive, associated with a HBV DNA of 3 x 10(8) genome equivalents/ml. Azathioprine and prednisone were withdrawn and foscarnet therapy was started. This therapy led to a decrease of ALT activity associated with an elimination of HBsAg and HBV DNA. Eight months after transplantation liver function tests were within the normal range. Graft rejection did not occur despite low or intermittent cessation of immunosuppressive therapy.

Adult↗
PubMed1997

Determinants of intrarenal Doppler indices in stable renal allografts.

Color Doppler sonography has been introduced for graft monitoring after renal transplantation. Little is known, however, about independent factors that have an impact on intrarenal Doppler indices as indicators for transplant dysfunction. Therefore, in this study, potential determinants of the resistive index (RI) and of the pulsatility index (PI) in 110 patients with stable renal allografts were studied. The mean RI and PI were 0.70 +/- 0.07 (range, 0.53 to 0.88) and 1.36 +/- 0.21 (range, 0.91 to 1.98), respectively. In multivariate regression analysis, RI and PI correlated significantly with age and arterial pulse pressure of the recipient. There was no correlation with donor age, heart rate, mean arterial blood pressure, and cyclosporine trough levels. Furthermore, parameters of kidney function, such as serum creatinine concentration, creatinine clearance rate, 51Cr-ethylenediaminetetraacetate clearance rate, and proteinuria, showed no significant correlation with the Doppler indices. The data indicate that intrarenal Doppler indices of the grafts are hemodynamic indices, primarily depending on the recipient-related vascular compliance rather than on the function of the graft. Therefore, only intraindividual comparison of the Doppler indices may be useful to detect potential changes of graft resistance during long-term follow-up.

Adolescent↗
PubMed1996

Pharmacokinetic profile of cyclosporine A after conversion to Sandimmun Optoral: influence on ambulatory blood pressure in renal transplant patients.

The aim of the present study was to investigate whether the pharmacokinetic profile of cyclosporin A under Sandimmun Optoral compared to Sandimmun has an effect on blood pressure in patients with stable renal allograft function. Twenty-eight patients were randomized into two groups. Two pharmacokinetic profiles (I, II; time interval 7 days) were obtained in each group. One group (n = 18) was switched from Sandimmun to an equal dose (1:1) of Sandimmun Optoral after the first kinetic and the other (n = 10) received Sandimmun for both kinetics. Eight blood samples were taken during each kinetic and cyclosporine values were measured. Ambulatory blood pressure measurement was performed during each kinetic. There were no differences in the pharmacokinetic parameters between kinetics I and II in the control group but significant differences in the switched group with increased Cmax (+64%), AUC (+44%), C0 (+17%) and decreased Tmax (-39%) in kinetic II compared to kinetic I. Correlation of C0 with AUC was stronger for Sandimmun Optoral (r = 0.792) than for Sandimmun (r = 0.718). Correlation of C0 with Cmax was similar for Sandimmun Optoral (r = 0.53) and Sandimmun (r = 0.56). Mean 12 h blood pressure of kinetic II tended to be lower than that of kinetic I in the control group, but the opposite was true for the switched group. When blood pressure levels around Tmax +/- 1 h were analyzed only, RR (syst/diast) in mmHg was 135 +/- 3.7/89 +/- 2.2 (kinetic I) and 130 +/- 2.8/85 +/- 2.8 (kinetic II) for control as compared to 134 +/- 2.4/85 +/- 2.9 and 137 +/- 3.1/86 +/- 2.8 for the switched group, respectively. Sandimmun Optoral shows an improved pharmacokinetic profile. However, higher blood concentrations of cyclosporine under Sandimmun Optoral tend to increase slightly systemic blood pressure as compared to that under Sandimmun.

Adult↗
PubMed1996

Renal tubular damage: an extraintestinal manifestation of chronic inflammatory bowel disease.

OBJECTIVE: To investigate whether treatment of inflammatory bowel disease (IBD) with 5-aminosalicylate or sulphasalazine in IBD may induce renal tubular damage. DESIGN AND METHODS: The urinary enzymes beta-N-acetyl-D-glucosaminidase ( beta-NAG), dipeptidylpeptidase 4 (DPP4) and alanine aminopeptidase (AAP) were measured as markers of renal tubular damage in 104 consecutive patients with Crohn's disease and in 43 consecutive patients with ulcerative colitis (all with normal serum creatinine values). Control values were gained from 65 healthy persons. RESULTS: The normal values (mean +/- SD) for the urinary enzymes investigated (U/g creatinine in the urine) were: DPP4 4.5 +/- 2.2, beta-NAG 1.6 +/- 1.4, AAP 11.4 +/- 6.5. In 28% of the patients with ulcerative colitis elevated beta-NAG levels of more than the mean + 2 x SD were measured. This pathological enzymuria was nearly exclusively found in patients with active disease (CAI > 6): DPP4 15.6 +/- 25.3, beta-NAG 8.3 +/- 10.1, AAP 24.7 +/- 50.1 (all three enzymes were significantly elevated). The highest values were measured in patients with active ulcerative colitis before start of therapy. Nineteen per cent of the patients with Crohn's disease had elevated beta-NAG levels of more than the mean + 2 x SD. There was no significant difference in enzymuria between patients with active (CDAI > 150) and patients with inactive Crohn's disease (CDAI < or = 150). DPP4 and AAP were normal in both groups. A correlation between the enzymuria and the cumulative doses of 5-aminosalicylic acid, sulphasalazine or prednisolone could not be found. The courses of enzymuria in three patients who presented with the first severe manifestation of IBD are described. They were treated with either corticosteroids and 5-aminosalicylic acid or corticosteroids and sulphasalazine. Before onset of therapy, very high urine enzyme values were measured. They almost normalized in the course of successful medical therapy despite increasing cumulative doses of 5-aminosalicylic acid or sulphasalazine. CONCLUSIONS: Renal tubular damage can frequently be observed in IBD. Our results suggest that this is an extraintestinal manifestation of the disease and not a toxic side-effect of anti-inflammatory therapy using 5-aminosalicylic acid or sulphasalazine.

Adolescent↗
PubMed1995

Clinical course of patients with antineutrophil cytoplasm antibody positive vasculitis after kidney transplantation.

Four patients with antineutrophil cytoplasm antibody (ANCA)-positive vasculitis were followed over a period from 27 to 54 months after successful kidney transplantation under immunosuppressive treatment with ciclosporine. ANCA titer prior to transplantation was markedly elevated and decreased in 1 of 4 patients under therapy with ciclosporine. Despite adequate ciclosporine blood trough levels, a relapse occurred in 2 patients 18 and 24 months after transplantation but therapy with cyclophosphamide induced remission and no patient lost his graft due to relapse of vasculitis. This observation demonstrates that kidney transplantation may be offered to ANCA-positive patients with end-stage renal disease due to vasculitis. However, patients under ciclosporine therapy are still at risk for the development of relapsing disease and cyclophosphamide has to be added to or substituted in part for standard immunosuppressive therapy in order to reverse clinical symptoms and prevent rapid deterioration of kidney function.

Adolescent↗
PubMed1994

[Unilateral diffuse pulmonary involvement in vasculitis with anti-neutrophil cytoplasmic antibodies and anti-glomerular basement membrane antibodies].

A previously healthy 51-year-old man, hospitalized because of fatigue and joint complaints, was found to have left-sided diffuse pulmonary infiltration and a rapid rise in creatinine concentration. Anti-neutrophil cytoplasmic antibodies (cANCA) and anti-glomerular basement antibodies (anti-GBM) were found in serum. Renal biopsy revealed extracapillary glomerulonephritis with diffuse half-moon formations. Immunohistology showed a diffuse granular pattern for immunoglobulin G, M and complement C3, without linear deposits. Immunosuppressive treatment combined with plasmapheresis brought about rapid clinical improvement and normalization of the lung involvement and renal function, as well as a fall in the cANCA titre. During a follow-up period of 5 years there has been no recurrence of symptoms, although the anti-GBM titre remained strongly positive and the cANCA titre twice rose to abnormal levels.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1994

Radiographic course of pulmonary manifestations in Wegener's granulomatosis under immunosuppressive therapy.

Eleven patients with generalized Wegener's granulomatosis were studied. Pulmonary involvement occurred 1 month earlier than a rapid rise of serum creatinine value. Under immunosuppressive therapy, nodules and infiltrations abated slower in patients with bronchopulmonary superinfection (mean, 30 days) compared with patients without superinfection (mean, 18 days). In the short run, radiographic course was a better indicator for therapeutic success than the course of cytoplasmatic antineutrophil cytoplasm antibody titer. If the pulmonary findings did not begin to clear within 1 week after treatment had been started, either superinfection or insufficient immunosuppression was present. In this situation, a more aggressive therapy in combination with antibiotics is suggested.

Adult↗
PubMed1993

C-ANCA and p-ANCA positive vasculitis with crescentic glomerulonephritis: the same clinical feature but different immunological pathways?

Patients with cytoplasmatic (c)-ANCA positive vasculitis and crescentic glomerulonephritis (n = 25) had similar clinical presentation, age, sex distribution, organ involvement, therapy requirements, and outcome as patients with perinuclear (p)-ANCA positive vasculitis and crescentic glomerulonephritis (n = 7). Therefore, we conclude that these two entities are very closely related or even the same disease.

Adult↗