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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Pediatric nephrology 13 (1999), S. 816-823 
    ISSN: 1432-198X
    Keywords: Key words Schönlein-Henoch purpura ; Glomerulonephritis ; Hypertension ; Proteinuria ; Renal failure ; Plasma exchange
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We studied the long-term outcome of 64 children with biopsy-proven Schönlein-Henoch purpura (SHP) nephritis over 1–23 years of follow-up. Overall renal survival 10 years after onset was 73%. Multivariate logistic regression analysis identified initial renal insufficiency (P=0.004), nephrotic syndrome (P=0.037), and the severity of histological alterations, as defined by the proportion of glomerular crescents (P=0.051), as significant independent predictors of progressive renal failure. Four patients followed for more than 19 years showed glomerular damage after transient recovery. Eight children with crescentic nephritis associated with a rapidly progressive course and/or persistent nephrotic syndrome were treated by at least seven sessions of plasma exchange (PE) within 16 weeks of onset of purpura. During treatment serum creatinine levels dropped in each patient from a mean of 2.3 to 1.1 mg/dl, followed by a rebound increase. Repeated courses of PE in 5 patients produced comparable responses. Four patients undergoing PE reached end-stage renal disease at 1.2.–3.7 years after onset, whilst 3 finally were in preterminal renal failure (creatinine 3.2–6.1 mg/dl after 7–13.5 years), and 1 patient reached a normal glomerular filtration rate. Our experience suggests that initial renal insufficiency is the best single predictor of the further clinical course in children with SHP nephritis. Early PE appears to delay the progression in some patients with severe, rapidly progressive forms of the disease.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1203
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract To test whether the differentiation events that lead to the embryonal layers and their derived organs produce divergent X-chromosome activation ratios among the different tissues, the X-chromosome activation ratios in leucocytes and muscle (mesodermal origin), thyroid gland (endodermal origin) and medulla of the suprarenal glands (ectodermal origin) from ten deceased females were surveyed. Analysis of the degree of methylation of the polymorphic alleles recognized by the probes M27β and pSPT-PGK showed that the ratios for the medulla of the suprarenals correlated well with those of all other tissues except for leucocytes; the thyroid gland showed limited correlation with muscle, whereas leucocytes showed correlation only with muscle. The results of this preliminary study suggest that differentiation events result in considerable variation in the activation ratios in different tissues. As a consequence caution should be taken in extrapolating from the activation ratios observed in leucocytes or fibroblasts to tissues of endodermal or ectodermal origin.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1434-0879
    Keywords: Urinary diversion ; Carcinoma induction ; Carcinoma prophylaxis ; Ileal interposition ; Urointestinal anastomosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Eighty Wistar rats were randomized into two groups. In group 1 vesicosigmoidostomy with proximal colostomy was performed, in group 2, vesicosigmoidostomy. The total tumor incidence did not differ significantly (group 1 10/40, 25%; group 2 13/40, 32.5%). The tumor spectrum differed, with more adenocarcinomas in group 2 (11/40, 27.5% vs 4/40, 10%;P=0.047) and urothelial carcinomas only in group 1 (5/40, 2.5%). One hundred and ten other Wistar rats were randomized into three groups. Animals in group A received vesicoileosigmoidostomy, group B, two-step vesicosigmoidostomy with initial separation of urine and the urocolonic anastomosis, group C, vesicosigmoidostomy. Significantly fewer adenocarcinomas were observed in group A (2/40, 5%) than in group B (16/40, 40%,P〈0.002) and group C (9/30, 30%;P〈0.007). These results indicate a similar cancer risk in all continent forms of urinary diversion, at least via colon. Ileal interposition seems to be an effective carcinoma prophylaxis following ureterosigmoidostomy. The proliferative instability at the urointestinal anastomosis is crucial for the pathogenesis and prophylaxis of this form of carcinogenesis, whereas urine seems to play only a minor role.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1433-0563
    Keywords: Schlüsselwörter Xenotransplantation ; Komplement ; Löslicher Komplementrezeptor Typ 1 (sCR1) ; Key words Xenotransplantation ; Complement ; Soluble complement receptor type 1 (sCR1)
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary In this study a modified experimental kidney xenograft model was developed, which reproduced, in a reliable way, the course of hyperacute rejection. In this model guinea-pig kidneys were transplanted to rats using end-to-side anastomoses with recipient aorta and vena cava, respectively, and ureter drainage for diuresis monitoring. The aim of this study was to investigate the protective effects of complement modulation by soluble complement receptor 1 (sCR1) on the xenografts. Twenty-four xenotransplantations were performed and recipients randomized for treatment either by 3 ml saline or 50 mg/kg sCR1 as a 3-ml bolus. It was found that sCR1 was highly efficient in delaying hyperacute rejection from 10.5 ± 2.1 min in the control group to at least 2 h in the therapy group and in prolongation of graft function. The complement activity was significantly reduced in the sCR1-treated rats, even at the time of rejection, as a result of complement modulation in this group of xenograft recipients. Xenografts from saline-treated animals showed necroses, interstitial haemorrhages and platelet aggregates occluding the vessels as soon as 10 min after the reperfusion started. No such changes could be seen even after 120 min in the xenografted kidneys of sCR1-treated rats. Also C3 deposits in the glomeruli and interstitium were markedly reduced.
    Notes: Zusammenfassung In der vorliegenden Arbeit wurde ein modifiziertes tierexperimentelles Modell der Nierenxenotransplantation entwickelt, im Rahmen dessen der Verlauf einer hyperakuten Abstoßungsreaktion hochgradig reproduzierbar ist. In diesem Modell wurden Meerschweinchennieren als Spenderorgane auf Wistarratten als Empfängertiere verpflanzt, wobei End-zu-Seit-Gefäßanastomosen mit Spenderaorta, bzw. V. cava und Harnleiterdrainage mittels Schienung zur Diureseüberwachung zum Einsatz kamen. Ziel der vorliegenden Untersuchung war es die protektive Wirkung der Komplementmodulation mit Hilfe des löslichen Komplementrezeptors Typ 1 (sCR1) auf die Nierenxenotransplantate zu analysieren. Insgesamt wurden 24 Xenotransplantationen vorgenommen und randomisiert mit 3 ml 0,9 % NaCl (Kontrollgruppe), bzw. 50 mg/kg sCR1 als 3-ml-Bolus (Behandlungsgruppe) therapiert. Der lösliche Komplementrezeptor Typ 1 (sCR1) war wirksam in bezug auf die Verlängerung der Transplantatüberlebenszeit (von 10,5 ± 2,1 min in der Kontrollgruppe auf mindestens 2 h in der Behandlungsgruppe) und seine Funktion. Serologisch konnte eine deutliche Reduktion der Komplementaktivität in der sCR1-Gruppe festgestellt werden, die auf eine modulatorische Wirkung des sCR1 zurückzuführen ist. Bereits 10 min nach Reperfusionsbeginn zeigten sich histologisch in der Kontrollgruppe massenhaft Thrombozytenaggregate, Fibrinablagerungen in den Kapillaren und interstitielle Infiltrate. Die mit sCR1 behandelten Nierentransplantate wiesen dagegen nach 120 min eine deutlich reduzierte intravasale Thrombenbildung und geringere interstitielle Infiltration auf. Die immunhistologische Studie ließ eine gleichermaßen verminderte Ablagerung von C3 in den Glomeruli und im Interstitium in der Therapiegruppe erkennen.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Thrombotisch-thrombozytopenische Purpura ; Hämolytisch-urämisches Syndrom ; Systemischer Lupus erythematodes ; Plasmapherese ; Key words Thrombotic thrombocytopenic purpura ; Hemolytic uremic syndrome ; Systemic lupus erythematosus ; Lupus-like-syndrome ; Plasma exchange
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A 139/12 year old boy presented with the clinical and laboratory signs of a systemic lupus erythematosus (SLE)-like illness. Three months later he developed acute renal failure associated with hemolytic anemia and thrombocytopenia while being treated with prednisone and a non-steroidal antiphlogistic agent. Kidney biopsy revealed endotheliotropic microangiopathy. A thrombocytopenic purpura/hemolytic uremic syndrome was diagnosed according to clinical and histological findings. Plasma exchange, hemodialysis and immunosuppressive therapy with prednisone and cyclophosphamide resulted in a normalization of the hematologic findings, and the kidney function improved. The cyclophosphamide therapy was continued over 21/2 years. Three years after the acute episode the boy is free of symptoms with glomerular filtration rate of 71 ml/min/1.73 qm. Discussion. The association of SLE with thrombotic thrombocytopenic purpura is rare, has predominantly been described in adults and has a high mortality rate. Our case demonstrates the success of an early aggressive therapy including plasma exchange, hemodialysis, prednisolone and cyclophosphamide.
    Notes: Zusammenfassung Ein 139/12 Jahre alter Knabe entwickelte 3 Monate nach Beginn einer Lupus-ähnlichen Systemerkrankung unter Prednisontherapie ein akutes Nierenversagen mit hämolytischer Anämie und Thrombozytopenie. Die Nierenbiopsie zeigte eine thrombotische Mikroangiopathie. Unter Behandlung mit Plasmaaustausch, immunsuppressiver Therapie und Hämodialyse normalisierten sich die hämatologischen Befunde, und die Nierenfunktion besserte sich. Die Cyclophosphamidtherapie wurde über 21/2 Jahre fortgesetzt. Drei Jahre nach dem akuten Nierenversagen ist der Junge unter antihypertensiver Behandlung symptomfrei und hat eine normale glomeruläre Filtrationsrate. Diskussion. Die Assoziation eines systemischen Lupus erythematodes mit einer thrombotisch-thrombozytopenischen Purpura ist in der Literatur bisher nur selten und fast nur bei Erwachsenen beschrieben worden; sie hat eine hohe Mortalität. Der dargestellte Fall demonstriert den Erfolg einer frühzeitigen aggressiven Therapie.
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