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  • 1
    Electronic Resource
    Electronic Resource
    Assessment of maximal tubular phosphate reabsorption: comparison of direct measurement with the nomogram of Bijvoet (1988)
    Springer
    Pediatric nephrology 2 (1988), S. 183-189 
    Details
    ISSN: 1432-198X
    Keywords: Phosphate ; Tubular reabsorption ; Theoretical phosphate threshold
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract It is well established that plasma phosphate (Pp) is largely determined by the renal phosphate threshold, which is best described by the maximal rate of tubular phosphate reabsorption divided by the glomerular filtration rate (Tmp/GFR). For its clinical assessment either direct phosphate loading with simultaneous measurement of GFR is performed, or the nomogram described by Walton and Bijvoet is used. In order to test the validity of the two methods, we compared in 20 infants and 31 children the fasting values of phosphate reabsorption [endogenous phosphate reabsorption/inulin clearance (Tp/Cin) and Tp] with those obtained after phosphate loading [maximal phosphate reabsorption (Tmp) and Tmp/Cin], and both with those derived from the nomogram. In addition the fasting Tp/Cin of 50 infants and 143 children could be compared with the nomogram. The results demonstrate that the directly measured Tp/Cin was the same as the directly measured Tmp/Cin and that the measured Tmp/Cin was correctly estimated by the nomogram. However, the comparison of fasting Tp/Cin with nomogram-derived values showed a systematic error, by which the latter values were higher than those measured. The discrepancy was due to the splay of the phosphate titration curve, which was found by Bijvoet when the ratio of phosphate clearance (Cp) corrected for GFR (Cp/GFR) fell below 0.2. The incorporation of this splay in the nomogram could not be confirmed by data measured in our children. It is concluded that fasting Tp is already “maximal” and that, therefore, no phosphate loading is necessary to estimate Tmp. Furthermore, there is no evidence of a major splay, which makes the nomogram incompatible below a Cp/GFR ratio of 0.2. For clinical assessment we recommend use of the formula Tmp/GFR=Pp−(Up×Pcrea/Ucrea) where Pp, Up, Pcrea and Ucrea refer to the plasma and urinary concentration of phosphate and creatinine respectively. This formula can be applied easily without the need to collect timed urinary specimens and is independent of the phosphate load.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00862587
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  • 2
    Electronic Resource
    Electronic Resource
    Practical aspects in the use of cyclosporin in paediatric nephrology (1991)
    Springer
    Pediatric nephrology 5 (1991), S. 630-638 
    Details
    ISSN: 1432-198X
    Keywords: Cyclosporin A ; Absorption ; Distribution ; Metabolism ; Monitoring ; Clinical application
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Many factors must be considered for the effective and safe use of cyclosporin A (CsA) in paediatric nephrology. Detailed knowledge of the variable bioavailability, tissue distribution, and metabolism, as well as causes which lead to their alteration are necessary. Factors which affect the activity of the mixed function oxidase system cytochrome P-450 must be considered, i. e. liver dysfunction and many drugs. Precise knowledge of the CsA determination method and the spectrum of metabolites is essential. In children with renal transplants, a body surface area-related dose will better meet the dose requirements than a body weight related-dose. For drug level monitoring whole blood rather than plasma should be used, and the parent drug level should be the main determinant; elevated metabolite levels may be important in suspected nephrotoxicity or liver dysfunction. Pharmacokinetic profiles are necessary to discover absorption problems or increased CsA clearance rates which necessitate shorter dosing intervals. In children with steroid-dependent minimal change nephrotic syndrome, remission without steroids is maintained as long as CsA is given. The appropriate starting dosage is 150 mg/m2 per day; trough level monitoring is mandatory to prevent nephrotoxicity and to confirm adequate immunosuppressive drug levels which should be 80–160 ng/ml (parent drug level). Although the benefit of CsA has been reported in some cases of lupus erythematosus, its use should be restricted to severe cases only until its efficacy and safety has been confirmed in controlled trials.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00856658
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  • 3
    Electronic Resource
    Electronic Resource
    Renal transplantation in 22 children with nephropathic cystinosis (1991)
    Springer
    Pediatric nephrology 5 (1991), S. 708-714 
    Details
    ISSN: 1432-198X
    Keywords: Nephropathic cystinosis ; Renal transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In 1989, 22 children (11 boys, 11 girls aged 8–23 years) with nephropathic cystinosis, who had received a total of 28 renal allografts over the previous 14 years, were reviewed. Nineteen were alive, of whom 17 had functioning grafts 5 months to 13 years after transplantation. The mean serum creatinine level in these 17 was 135 μmol/l. Patient and graft survival did not differ from non-cystinotic children. Persistent hypothyroidism was found in 3 patients, transient diabetes mellitus in 1, severely disturbed vision in 1 and brain atrophy in 11. Arterial hypertension was present in 16 patients. Growth retardation was universal, although in 4 patients on cyclosporin A post-transplant catch-up growth occurred. Five patients over 15 years completed puberty. Readjustment in terms of school performance was good but was less good for psychosocial development. None of the patients had ever been treated with cystine-depleting agents; the data will therefore provide a historical control group with which to compare the results from a group treated with these agents.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00857880
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  • 4
    Electronic Resource
    Electronic Resource
    Improved absorption of cyclosporin A from a new microemulsion formulation: implications for dosage and monitoring (1995)
    Springer
    Pediatric nephrology 9 (1995), S. 196-198 
    Details
    ISSN: 1432-198X
    Keywords: Cyclosporin A ; Pharmacokinetics ; Renal transplant ; Side-effects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Recently, a new oral microemulsion formulation of cyclosporin A (CsA) — Neoral (Sandoz, Basle, Switzerland) — with a higher bioavailability has become available. Ten stable paediatric renal transplant recipients with excessive variations in CsA trough levels with the original Sandimmun (Sandoz, Basle, Switzerland) preparation were switched to Neoral on a 1∶1 basis. Pharmacokinetic studies revealed impaired absorption of Sandimmun, in six patients. Compared with equal doses of Sandimmun, the 8-h area under the concentration-time curve increased from 1,422 to 2,657 ng×h/ml and the peak concentration rose from 319 to 824 ng/ml (P〈0.01). In six patients with Sandimmun malabsorption, conversion on a 1∶1 basis led to a reduction in creatinine clearance which was reversible after dose reduction by 9%–25%. With trough levels at the lower end of the present target range, creatinine clearance stabilised around pre-conversion values.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00860745
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  • 5
    Electronic Resource
    Electronic Resource
    Acute rejection episodes after renal transplantation in children under cyclosporin A treatment (1987)
    Springer
    Pediatric nephrology 1 (1987), S. 253-259 
    Details
    ISSN: 1432-198X
    Keywords: Renal transplantation ; Children ; Rejection episodes ; Cyclosporin ; Azathioprine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Thirty-two pediatric renal transplant patients receiving cyclosporin and 34 receiving azathioprine treatment (historical controls) were investigated for the occurrence of rejection episodes; their clinical symptoms and findings, time of onset, influence of donorship, relation to cyclosporin blood levels and graft function outcome were also studied. In the cyclosporin group, four grafts were lost in the 2nd year, while in the azathioprine group five grafts were lost within the first 5 weeks after transplantation due to acute irreversible rejection. Clinical signs of rejection episodes under cyclosporin were mild and usually presented a silent increase of serum creatinine. First rejection episodes occurred later in patients treated with cyclosporin than in azathioprine-treated patients (50% probability after 7 weeks as opposed to 2 weeks). The percentage of patients receiving cyclosporin who had experienced no rejection episodes was 18,8% as opposed to 11,8% of patients receiving azathioprine. The lowest incidence of rejection episodes was observed in patients with living related grafts receiving cyclosporin treatment, 75% of whom were free of rejection episodes after 2 years. Cyclosporin blood levels below 400 ng/ml were observed in 74% of rejection episodes. Biopsies were often used to differentiate between cyclosporin nephrotoxicity and rejection when the cyclosporin levels were above 400 ng/ml. Both treatment groups exhibited a parallel decline in graft function, which correlated with the number of rejection episodes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00849219
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  • 6
    Electronic Resource
    Electronic Resource
    Renal handling of uric acid under cyclosporin A treatment (1988)
    Springer
    Pediatric nephrology 2 (1988), S. 18-21 
    Details
    ISSN: 1432-198X
    Keywords: Cyclosporin A ; Uric acid ; Renal transplantation ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The renal handling of uric acid during cyclosporin A (CyA) treatment was investigated by clearance studies using 24-h urine collections in 28 paediatric renal transplant recipients (CyA group), and the results were compared with those of 19 renal transplanted children treated with azathioprine and prednisolone (AZA group), 35 children with chronic renal failure (CRF) and 10 children with normal renal function (N group). Serum uric acid levels were significantly higher in the CyA group (567±156 μmol/l) compared with the AZA group (378±98), the CRF group (415±119) and the N group (290±68). Mean uric acid clearances in each group measured 3.9±2.8 ml/min per 1.73 m2 (CyA), 5.6±3.4 (AZA), 4.0±2.2 (CRF) and 8.4±3.7 (N). Calculation of the net tubular uric acid reabsorption per millilitre glomerular filtration rate revealed a significantly increased value of 0.53±0.15 μmol/ml in the CyA group (P〈0.01) compared with 0.34±0.08, 0.29±0.15 and 0.27±0.07 μmol/l for the AZA, CRF and N groups respectively. We therefore conclude that CyA treatment is associated with an increased net tubular reabsorption of uric acid, which may lead to hyperuricaemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00870373
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  • 7
    Electronic Resource
    Electronic Resource
    Association of spondylo-epiphyseal dysplasia with nephrotic syndrome (1990)
    Springer
    Pediatric nephrology 4 (1990), S. 117-121 
    Details
    ISSN: 1432-198X
    Keywords: Focal sclerosis ; Nephrosis ; Renal failure ; Spondylo-epiphyseal dysplasia ; Growth failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The association of a spondylo-epiphyseal dysplasia and growth failure with the nephrotic syndrome was found in three boys. Renal biopsy performed on two revealed focal and segmental glomerulosclerosis. The nephrotic syndrome occurred at the age of 3–7 years, leading to end-stage renal failure in all patients. Growth failure persisted after successful renal transplantation. This association may represent a distinct disease entity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00858821
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  • 8
    Electronic Resource
    Electronic Resource
    One year's experience with recombinant erythropoietin in children undergoing continuous ambulatory or cycling peritoneal dialysis (1990)
    Springer
    Pediatric nephrology 4 (1990), S. 498-500 
    Details
    ISSN: 1432-198X
    Keywords: Recombinant human erythropoietin ; Continuous ambulatory peritoneal dialysis ; Continuous cycling peritoneal dialysis ; Renal anaemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Fourteen patients (aged 5.9–22.1 years) undergoing continuous ambulatory or cycling peritoneal dialysis were treated with recombinant human erythropoietin (rhEPO), which was given intravenously once a week at a dosage of 300 units/kg. The mean haematocrit level increased from 18.5% to 27.5% and the reticulocyte count from 19‰ to 62‰ within 1 month. After an average time of 3.1 months rhEPO dosage could be adjusted to 100 units/kg per week to keep the haematocrit level at 30%. Only 1 patient had an exacerbation of hypertension, which required a dosage reduction; other side-effects were not noted.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00869830
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  • 9
    Electronic Resource
    Electronic Resource
    Pharmacokinetics of cyclosporine in pediatric long-term liver transplant recipients converted from Sandimmun to Neoral (1997)
    Springer
    Transplant international 10 (1997), S. 419-425 
    Details
    ISSN: 1432-2277
    Keywords: Key words Cyclosporin ; conversion ; liver transplantation ; Conversion ; cyclosporin ; liver transplantation ; Liver transplantation ; conversion ; cyclosporin ; Pediatric liver transplantation ; pharmacokinetics ; Pharmacokinetics ; pediatric liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Absorption of cyclosporin from the microemulsion formulation Neoral is less variable than from Sandimmun. Because of a lack of data in pediatric liver transplant recipients, the pharmacokinetic profiles with Sandimmun and Neoral were compared in a conversion study. Thirty-eight children with stable graft function were converted 2–12.3 years post-transplant at a 1:1 ratio. The trough-level (Cmin) with Neoral was 123 ± 39 ng/ml versus 134 ± 29 ng/ml with Sandimmun (P = NS), the area under the time-concentration curve (AUC) was 3325 ± 1125 ng*h/ml versus 2423 ± 846 ng*h/ml (P 〈 0.001), the peak concentration (Cmax) was 650 ± 280 ng/ml versus 337 ± 142 ng/ml (P 〈 0.001), and the median time to Cmax was 2 h (range 0.5–3 h) versus 4 h (range 1–8 h; P 〈 0.05). The weak correlation between Cmin and AUC with Sandimmun (r = 0.5; P = NS) was improved by using Neoral (r = 0.7; P 〈 0.001). The best predictor of AUC was the 2-h concentration (C2 h) of Neoral (r = 0.9; P 〈 0.001). Increased absorption and a more predictable pharmacokinetic profile with Neoral permit safer therapeutic monitoring in children. The exclusive measurement of Neoral-C2 h allows one to estimate drug exposure with high precision ( 〉 90 %).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050080
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