Inverted duplication of the distal short arm of chromosome 3 associated with lobar holoprosencephaly and lumbosacral meningomyelocele

A fetus with lobar holoprosencephaly and lumbosacral meningomyelocele associated with duplication of the short arm of chromosome 3 is reported. The anomalies were detected on fetal ultrasound at 20 weeks' gestation and the autopsy findings correlated well with the prenatal findings. The fetal karyotype was 46,XY,der(3)del(3)(p26) dup(3)(p26p21.3). The association of holoprosencephaly with duplication 3p is well known, but to the best of our knowledge this is the first reported association of meningomyelocele with 3p duplication. These findings suggest that a gene or genes with a crucial role in central nervous system development are located on the short arm of chromosome 3.

Practical Approach for Determining Glomerular Filtration Rate by Single-Injection Inulin Clearance

We compared the glomerular filtration rate as measured by a single-injection inulin clearance with that measured by a standard isotope method with 99mTc-labeled diethylenetriaminopentaacetic acid in 21 subjects with glomerular filtration rates greater than 35 mL/min. After a bolus injection of 5 g of inulin, blood samples were taken 20, 45, 90, 120, 145, 180, and 240 min afterwards. Inulin was measured by optimized chemical or enzymatic methods of high analytical sensitivity to determine inulin at low concentrations. We used the one-compartment model and inulin concentrations measured at two sampling times to calculate the glomerular filtration rate from the data of the disappearance curve of inulin. Inulin concentrations at 20 and 240 min after injection of the inulin bolus were suited to estimate glomerular filtration rate by this procedure, resulting in values (y) comparable with those obtained by isotope technique (x). The relationship to the isotope technique was characterized by the equation y = +4.80 mL/min + 0.92x (r = 0.97). The single-injection inulin clearance determination can detect a decrease of glomerular filtration rate at the beginning of kidney damage, given that our study included subjects with glomerular filtration rates greater than 35 mL/min. We conclude that the glomerular filtration rate can be determined by analyzing only two blood samples after a bolus injection of inulin.

Practical approach for determining glomerular filtration rate by single-injection inulin clearance

We compared the glomerular filtration rate as measured by a single-injection inulin clearance with that measured by a standard isotope method with 99mTc-labeled diethylenetriaminopentaacetic acid in 21 subjects with glomerular filtration rates greater than 35 mL/min. After a bolus injection of 5 g of inulin, blood samples were taken 20, 45, 90, 120, 145, 180, and 240 min afterwards. Inulin was measured by optimized chemical or enzymatic methods of high analytical sensitivity to determine inulin at low concentrations. We used the one-compartment model and inulin concentrations measured at two sampling times to calculate the glomerular filtration rate from the data of the disappearance curve of inulin. Inulin concentrations at 20 and 240 min after injection of the inulin bolus were suited to estimate glomerular filtration rate by this procedure, resulting in values (y) comparable with those obtained by isotope technique (x). The relationship to the isotope technique was characterized by the equation y = +4.80 mL/min + 0.92x (r = 0.97). The single-injection inulin clearance determination can detect a decrease of glomerular filtration rate at the beginning of kidney damage, given that our study included subjects with glomerular filtration rates greater than 35 mL/min. We conclude that the glomerular filtration rate can be determined by analyzing only two blood samples after a bolus injection of inulin.

[Prognosis of acute dialysis dependent renal failure]

In a retrospective study of 116 patients with acute renal failure treated by hemodialysis the prognostic value of various clinical data was evaluated by discriminant analysis. With a letality of 73.6% the patient survival was dependent on the frequency of associated organ disorders. The following order was prognostical important: respiratory insufficiency, age, cardio-vascular complications and infection or sepsis. Other problems like gastrointestinal complications, coagulation disorders and hepatic failure were without significant value.

[Basic program for the diagnosis and therapy of inflammatory diseases of the kidney]

The specialist for general medicine and for internal medicine, respectively, in the primary consultation must express the suspicion of the occurrence of a renal disease on the basis of the anamnesis and the findings of the clinical examination and confirm or exclude it by simple diagnostic tests. It is entered into the individual test component in diagnostics. The securing of the diagnosis, the judgement of the renal function as well as differential-therapeutic considerations for the further care are to be performed by the results of the diagnostic steps II (basic diagnostics, in special questionings by step III). About 100,000 patients with renal diseases are country-wide cared for at present, in whom 11% already suffer from a renal insufficiency. It is referred to the most important recommendations for therapy in bacterial and glomerular renal diseases.

Development of a C1q-adsorbent for the selective removal of circulating immune complexes

In body fluids circulating immune complexes possess a substantial pathogenic effect on a variety of diseases. Thus it seems to be reasonable to influence the pathogenic mechanism of such diseases by removing the circulating immune complexes out of the body fluids. The selective adsorbent for binding immune complexes were developed as possible alternative of plasmapheresis for specific removal of immune complexes out of the blood plasma. The principle is based on the biospecific binding of immune complexes to C1q that is immobilized by a covalent binding to different solid phases. Thus: so bound immune complexes can be separated by detaching the solid phases. The adsorbent may be regenerated by non-denaturated media and can be used manyfold. This adsorbent has a high biocompatibility and offers the possibility for clinical use.

[The development of nephrology and dialysis in the past 40 years]

In the past 40 years the nephrology has been established in the GDR as a subspeciality of internal medicine and pediatrics. In the districts more than 60 nephrological centres were opened and modern diagnostical and therapeutical methods were introduced. More than 2000 patients were treated regularly by artificial kidney. Further detoxification methods including therapeutical plasmapheresis were introduced in the practice in the last years. The number of dialysis increase from 300,000 in 1989 to 500,000 in 1991.

[Changes in anti-oxidative homeostasis in hemodialysis patients]

Changes of the antioxidative homoeostasis in hemodialysis patients were registered by determination of the antioxidative capacity (AC). This capacity has been increased before dialysis and decreased by 50% during dialysis. After 30 minutes of dialysis the AC was much more decreased than creatinine and urea. The cause of this AC reduction is not only a loss of antioxidants into the dialysate, but possibly also an oxygen radical formation by C5a-activated granulocytes, sequestered in pulmonary capillaries during transient leucopenia.

[The syndrome of retrograde venous arterialization following arteriovenous vascular anastomoses for hemodialysis]

In 9 patients with arterio-venous side-to-end anastomosis on the forearm as vascular access for chronic hemodialysis an uniform symptom complex was observed: retrograde flow of the ectatic vein into the periphery, swelling and pain in this area, partly with trophic skin disorders on the hand. After occlusion of the arterio-venous anastomosis these symptoms could reversed completely with exception of venous dilation.

[The low molecular weight proteins ribonuclease, beta 2 microglobulin and lysozyme in the serum and urine of patients with chronic kidney diseases]

The diagnostical relevance of the low-molecular proteins ribonuclease, beta 2-microglobulin and lysozyme in serum and urine to detect a reduced glomerular filtration rate was examined in 52 patients with chronic renal diseases. The radioisotope clearance using 99mTc-DTPA was the base reference; the reference values of the low-molecular proteins were estimated in a control group. Ribonuclease was increased above the upper borderline value, if the glomerular filtration rate was lower than 1.24 ml s-1. Creatinine, beta 2-microglobulin and lysozyme remain yet in part in the normal range. The estimation of the ribonuclease in serum is suitable to detect an impaired glomerular filtration rate if the creatinine value is still not increased. Thereby, the diagnostics in renal diseases may be improved in the creatinine-blind area.

[Subclavian Scribner shunt for hemodialysis]

In two dialysis patients with absolute indication to a temporary Scribner shunt and lacking typical access possibilities (limb, leg) an effective vascular access has been created between the Arteria and Vena acromio-clavicularis. Because of the short trunk of the A. acromio-clavicularis a lengthening by a vein transplant was necessary.

[Indications for the Scribner shunt in hemodialysis]

The indication to a Scribner shunt as vascular access for hemodialysis has been reduced significantly by the use of central-venous catheters and creation of subcutaneous access methods. In 13 patients suffering from septic complications of the central-venous vascular access catheters a Scribner shunt was created for continuation of hemodialysis. After removal of infected catheters and specific antibiotic therapy the sepsis could be controlled in 12 patients within 4-18 days.

Determination of the acid-base status in blood of patients on chronic haemodialysis and of bicarbonate in dialysate: comparison of three techniques and their mathematically derived values

The study deals with the comparison of acid-base parameters in blood of patients on chronic haemodialysis and of bicarbonate dialysate determined by Gas-Check AVL 945, equilibration technique (ET), and a titrimetric method. The results show that an acceptable agreement exists between AVL and ET with respect to measurements of pH, pCO2, HCO3-, and base excess. However, the values obtained for total buffer base related to the actual haemoglobin concentration are significantly lower (P less than 0.001) when determined by AVL. A titrimetric method is proposed for routine measurement of HCO3- in bicarbonate dialysate. Values obtained using this method are 3-4 mmol/l higher than those determined by AVL and ET. However, when the values for pK1' and for the solubility coefficient used in the Henderson-Hasselbalch equation are replaced by those for saline-bicarbonate solutions, results obtained using the titrimetric determined values agree well with those obtained by AVL and ET.

Diagnostic value of low-molecular mass proteins in serum for the detection of reduced glomerular filtration rate

The diagnostic value of the low-molecular mass proteins ribonuclease, beta 2-microglobulin, and lysozyme in serum for the detection of reduced glomerular filtration rates was evaluated. The values of these proteins and of serum creatinine investigated in 52 patients suffering from chronic renal diseases were plotted against 99m-Tc-diethylenetriaminopentaacetate clearance as an indicator of glomerular filtration rate. Log-transformed data showed a good fit of linearity. Considering the 95% confidence limits of the regression equations, ribonuclease increased above the normal range when the glomerular filtration rate was lower than 1.24 ml/s whereas the other analytes partly remained within their normal limits. Out of those 18 patients with glomerular filtration rates lower than 1.24 ml/s, all patients showed elevated ribonuclease levels. beta 2-Microglobulin, creatinine, and lysozyme were increased in 17, 14, and 12 cases, respectively. Ribonuclease and beta 2-microglobulin showed similar results when other diagnostic criteria (specificity, efficiency and predictive values) were taken into account. We recommend ribonuclease determination in serum for the detection of reduced glomerular filtration rate in the normal range of creatinine. The test is diagnostically powerful, cheap and easy to perform.

Erythrocyte sodium transport in normotensive and hypertensive patients on chronic hemodialysis, acute effect of treatment

Patients on chronic hemodialysis were divided into two groups: normotensive patients (group I) and renal hypertensive patients treated with antihypertensives (group II). The sodium and potassium contents in red blood cells ([Na+]i, [K+]i), ouabain-resistant net sodium uptake (ORNa+ uptake, phi Na), the relative ORNa+ uptake (k), the mean cell hemoglobin concentration (MCHC), and acid-base status were examined just before and after dialysis. The results indicate that in treated renal hypertensive patients k is stimulated and causes lower red blood cell sodium content. The reason for this increase remains obscure: the pattern of alterations of the sodium transport components during dialysis is similar in all patients: [Na+]i and phi Na increase significantly during dialysis, and the increases in [Na+]i are closely related to increases in pH and bicarbonate.

[Results of a multicenter study of the early detection of glomerulonephritis. 1]

In the framework of a multicentric retrospective study between selected clinics of the Republic Austria and the GDR anamnestic, clinical and paraclinical data were investigated in their valency for the early recognition of glomerulonephritis. Data of 583 patients were evaluated. Hereby it was shown that independent of the size of excretion and the reproducibility the findings "proteinuria" are of particular significance for the early recognition. The serological investigations usually performed within the diagnostic of glomerulonephritis proved as insignificant for the early recognition. Since the establishing of an exact diagnosis is up to now possible only with the help of invasive methods, a call on research is made to develop reliable, non-invasive diagnostic methods.

[Rational kidney diagnosis with special reference to noninvasive and invasive procedures]

The permanently growing demands on clinic and laboratory constrain to considerations concerning a rational diagnostics. The spectrum of clinical interrogations which needs a clarification by laboratory diagnostics increases continuously. For the nephrologic diagnostics is again oriented to a step programme, which is adapted to the centrally published references to the development of a comprehensive system of the renal dispensary. It takes into consideration the possibilities of the diagnostics of the specialist for general medicine up to the subspecialist in a county hospital. As to the invasive diagnostics, particularly the renal biopsy, one must be reversed. This is indicated then, when from the result consequences would arise concerning the therapy to be performed or the choice calling etc.

[Studies and results of the use of nuclear medicine methods in kidney function tests]

It is sought for alternative methods for the endogenous creatinine clearance as parameters for the GFR. For this purpose served investigations with Tc-99m-Sn-DTPA. It was found a good reproducibility for the slope clearance with 3 blood takings between 60 and 120 minutes. When combined with the camera function scintigraphy a side-separated quantitative statement of the clearance equivalent is possible. The inulin clearance serves as reference method. The investigations at the gamma-camera with Tc-99m-Sn-DTPA also allow the determination of the perfusion which is particularly of interest in patients with hypertension. According to the comparison at the gamma camera a diagnostic schema is recommended.

[A comparison of cinoxacin and nalidixic acid in the treatment of chronic urinary tract infections]

A total of 60 patients with chronic urinary tract infections were included in this comparative study. 29 patients received cinoxacin and 31 nalidixic acid for a period of ten days. There were five therapy failures in the cinoxacin group and nine in the nalidixic acid group. Drug-related side-effects were reported by 11 patients in the cinoxacin group and by 13 patients in the nalidixic acid group. Gastrointestinal and central nervous disturbances were the adverse reactions which occurred most frequently. In all cases side-effects disappeared quickly after therapy was discontinued.

[Treatment trials with hemofiltration/hemodialysis in pernicious catatonia]

Two juvenile patients affected for the first time with pernicious catatonia were treated repeatedly with combined hemofiltration and hemodialysis. During the first two or three sessions, the distinct psychopathological improvement only persisted during the session itself and in a lesser degree during the following hours. It was only after further treatments that the therapy effect lasted longer and passed over into a continuous remission tendency. The findings might support a toxin hypothesis (in a broad sense) with respect to the genesis of catatonia and encourage a continuation of the studies.

[Comparative studies of the efficiency of MLW-1.3 and 1.8-hollow fiber dialyzers]

Clinically contradictory results in the use of hollow-fibre dialysers with surfaces of 1.3 and 1.8 m2 prompted us to compare their efficiency under standard conditions. It was found that the efficiency does not increase proportionally to the enlargement of the dialyser surface. the reason for this is to be seen in: the supply of rinsing solution in the dialyser, blood flow, insufficient degassing, coating of the membrane with denatured protein and, last but not least, the body mass of the patient himself. For optimum dialysis an individually suited dialysis time can be calculated from these data for each patient.

On the pyridoxal-5'-phosphate stimulation of aspartate aminotransferase and alanine aminotransferase in serum and erythrocytes of patients undergoing chronic haemodialysis and with kidney transplants

Aspartate aminotransferase (AST) determinations in erythrocytes of patients undergoing chronic haemodialysis and with kidney transplants showed that patients receiving vitamin B6 had a smaller relative stimulation rate of AST by pyridoxal-5'-phosphate (P-5-P). In contrast to these results in erythrocytes, the apoAST and apo-alanine aminotransferase (ALT) activities in serum were increased in patients as compared with those of healthy persons. The corresponding relative stimulation rates of AST and ALT by P-5-P addition to the reaction mixture were not changed in the haemodialysis patients, but in renal transplant recipients the relative stimulation rate of AST was significantly smaller and that of ALT was greater.

[Homologous umbilical vein and vena saphena transplants as possible means of vascular access in chronic hemodialysis]

For a patient in the chronic programme of haemodialysis an uncomplicated accession to the vessels is the prerequisite for an optimum medical and social rehabilitation. Each form of a subcutaneous arteriovenous fistula is to be preferred to an epicutaneous shunt prosthesis. The percutaneous puncture of large vessels is necessary for the rapid connection to the dialyses in acute situations. In long-term treatments often all autologous accessions to the vessels are used up. Homologous substitution material for vessels is increasingly used also in patients ongoing dialysis. Apart from the methods for gaining homologous material is reported on first experiences in the application of homologous grafts of the umbilical vein and of a homologous vena saphena graft in patients undergoing dialysis.

[Chronic pyelonephritis from a clinical viewpoint]

The chronic pyelonephritis is an unspecific, bacterial, focal, interstitial nephritis with faculative participation of the pyelon. It is differentiated between an obstructive (secondary) and non-obstructive (primary) form. It is referred to the importance of risk factors and risk groups deriving themselves from this. Without doubt, the chronic pyelonephritis is the most frequent renal disease which is confirmed by new statistics of morbidity. The diagnostics still renders difficulties. In a course poor in symptoms it is not thought of the existence of the disease. For the rational dignostics in practice a step plan is recommended. In every case diagnostics should precede therapy. A therapeutic nihilism is to be avoided. A schematic treatment used without criticism and without taking into consideration individual peculiarities, secondary diseases, pregnancy and so on is to be abandoned. Short-term therapy and long-term prevention must be tuned one to another and possibly rationally combined. A plan for the long-term control in the renal dispensary is proposed.

Lecithin: cholesterol acyltransferase activity, HDL-cholesterol and apolipoprotein A in serum of patients undergoing chronic haemodialysis

In comparison with a control group, significantly lower lecithin:cholesterol acyltransferase activities and HDL-cholesterol values were found in the serum of patients undergoing chronic haemodialysis, while apolipoprotein A concentration remained unchanged. Reduced activity of lecithin:cholesterol acyltransferase is an indication of the abnormal cholesterol metabolism in haemodialysed patients and could be, in addition to other factors, an explanation for the high incidence of cardiovascular diseases in this patient group.

Creatine kinase isoenzyme BB in serum of patients undergoing chronic hemodialysis and with kidney transplant

The activity of creatine kinase isoenzyme BB (CK-BB) was determined in serum of healthy adults and in patients undergoing maintenance hemodialysis and with kidney transplant. In the healthy adults examined, an activity of 0.56 +/- 0.16 U/l (mean +/- SD) was found. The arithmetic mean of CK-BB activity in patients with renal insufficiency under hemodialysis was 1.42 +/- 0.87 U/l and differed from that of the healthy group. The CK-BB activity in patients with kidney transplant was not different from that of the control group. The occurrence of CK-BB in serum is discussed from diagnostic and methodological point of view.

[Effect of chemotherapy on kidney function in pyelonephritis due to calculi with kidney insufficiency]

In patients with stone pyelonephritis the behaviour of the renal function under the influence of chemotherapy was examined at the stage of the compensated retention. 24 cures carried out on clinical conditions on 10 patients with an average age of 52 years (14--71) were evaluated. By means of chemotherapy in connection with the treatment of anaemia and the compensation of acidosis the renal function could favourably be influenced and the terminal stage of the renal insufficiency could be shifted. The author adopts a definite attitude to the long-term prophylaxis.

[Studies of disinfection of hemodialysis instruments]

Fever reactions in dialysis patients may partly be traced back to the transmission of pyrogens from the rinsing solution compartment into the sanguiferous system. The pyrogen concentration increases with the germ contents of the rinsing solution, which, therefore, should be kept as low as possible by suitable desinfection measures. For the artificial kidney Gambro AK 3 a hot water desinfection of 90 minutes at 90 degrees C or a formalin desinfection of 30 minutes, respectively, for the artificial kidney Leuven IIIC the formalin or peracetic acid desinfection of 30 minutes each proved to be sufficient.

[Laboratory diagnosis in kidney- and bladder diseases]

The laboratory diagnostic spectre in diseases of the kidneys and the urinary bladder is demonstrated in form of a 3-step-programme. The concentration of suitable investigation methods in complexes allows a rational and economical diagnostics for patient and physician. A standardisation of the diagnostics in out-patient department and clinic essentially contributes to the reduction of excessive work in overcharged laboratories as well as to the shortening of the patient's stay in the hospital.

[Functional and urinary analysis diagnosis of pyelonephritis]

For the practicing physician pyelonephritis is a frequently observed clinical picture which still has its diagnostic problems. With the help of a step programme a reasonable diagnostics is striven for which gives the possibility of an early recognition in the general surgery and a far-reaching clarification of the clinical picture in the out-patient department.