Ulrike John - Academia.edu (original) (raw)
Papers by Ulrike John
Birth Defects
Objective: Determine whether amniotic fluid volume (AFV) determination by magnetic resonance imag... more Objective: Determine whether amniotic fluid volume (AFV) determination by magnetic resonance imaging (MRI) can be compared with ultrasound based amniotic fluid index (AFI) and whether diffusion weighted imaging (DWI) of the fetal kidneys can be used as surrogate marker for the assessment of AFV and fetal kidney function. Methods: In the period from August 2013 to September 2014 prospective evaluation of AFV based on TRUFI MRI in 2 spatial planes (AFVMRI) and ultrasound based AFI. Inclusion criteria for the evaluation were: 1) Full image of the fetus (including AF and placenta) in an MR-study in at least two planes (sagittal and coronal), 2) Layer thickness 8 mm, 3) DWI-images of the fetal kidney in two planes (sagittal and transverse to the fetus). ROI analysis of the ADC values in normal kidneys and in pathological fetal kidneys (CAKUT) as well as the correlation of AFVMRI vs. AFI, renal volume and ADC were performed. Results: The correlation between AFI (13.60 ± 2.46 cm) and AFVMRI (579 ± 353 mL) was 0.69 (p=0.03). There was no significant correlation between AFVMRI and kidney volume, between AFVMRI and ADC700 and ADC800. The B700-ADC values of fetuses with CAKUT (n=14) were considerably higher than the values in fetuses with healthy kidneys. Conclusion: Compared to AFI, AFVMRI showed higher accuracy, but was associated with higher time consumption. Thus it cannot be routinely recommended for the purpose of AFV-determination alone. MRI can be used to establish a relationship between kidney diffusion parameters, renal volume, GA and AFV in fetuses with CAKUT.
BMJ open, Jun 12, 2017
It is known that transition, as a shift of care, marks a vulnerable phase in the adolescents'... more It is known that transition, as a shift of care, marks a vulnerable phase in the adolescents' lives with an increased risk for non-adherence and allograft failure. Still, the transition process of adolescents and young adults living with a kidney transplant in Germany is not well defined. The present research aims to assess transition-relevant structures for this group of young people. Special attention is paid to the timing of the process. In an observational study, we visited 21 departments of paediatric nephrology in Germany. Participants were doctors (n=19), nurses (n=14) and psychosocial staff (n=16) who were responsible for transition in the relevant centres. Structural elements were surveyed using a short questionnaire. The experiential viewpoint was collected by interviews which were transcribedverbatim before thematic analysis was performed. This study highlights that professionals working within paediatric nephrology in Germany are well aware of the importance of succe...
Der Urologe. Ausg. A, 2009
Transition to adult care is a generic issue for subspecialties dealing with chronic illness and h... more Transition to adult care is a generic issue for subspecialties dealing with chronic illness and has received little attention to date. The transition from pediatric to adult care for renal transplant recipients is recognized as a high-risk period for poor graft outcome associated with more than 20% graft loss. Non-adherence to immunosuppressive medications is one of the most important factors contributing to graft loss during this period. Transition is, therefore, a concern of both pediatric and adult providers, and medical improvements in this area will require more effective collaboration at this interface. This report explores medical and psychological risk factors and barriers during the transition process. In addition, a specially developed coaching concept for young adults is presented intended to assist adolescents with early childhood end-stage renal disease in the transition from pediatric to adult care.
Kinderärztliche Praxis
128 infants between 1 and 18 months, 80 girls and 48 boys suffering from their first pyelonephrit... more 128 infants between 1 and 18 months, 80 girls and 48 boys suffering from their first pyelonephritis (PN), were investigated and followed up over 2.9 +/- 2.2 years (mean +/- SD). 20 children showed urinary tract obstructions. In 49 of 108 cases (45%) with nonobstructive PN a vesico-uretero-renal reflux (VUR) was found and surgically corrected in 13 cases. In 36 patients (52 renal units) the VUR disappeared in most cases under medical management within 3 years. Recurrences of urinary tract infections (UTI) were found in the same frequency in children with and without reflux (28%), but those with VUR showed significantly more PN. 22 of 108 patients with nonobstructive PN (20%) developed renal scars, 39% of children with reflux (mostly VUR III. or IV. degree), 5% of those without reflux. In more than half of these cases renal scars were found already after the first PN. We conclude that a reduction of the risk of renal damage and an improvement of the prognosis can achieved by the following measures: 1. early detection of obstruction by pre- or postnatal sonographic screening, 2. early and exact diagnosis of PN and antibiotic therapy without delay. PN has to be excluded in all infants with unclear fever. 3. In all infants with PN a voiding cystography should be performed. In children with VUR, long-term chemoprophylaxis is necessary to avoid recurrence of PN.
![Research paper thumbnail of [Kidney transplantation in childhood and adolescence. Management of functional disorders and follow-up care of the kidney transplant recipient]](https://attachments.academia-assets.com/42092753/thumbnails/1.jpg)
](Der Urologe
The causes that lead to terminal renal failure in children and adolescents and subsequently requi... more The causes that lead to terminal renal failure in children and adolescents and subsequently require dialysis are different from those in adults. Moreover, children with a functioning kidney transplant evidence an approximately fourfold higher survival probability than children on dialysis. This contribution describes kidney transplantation in light of the specific features for this age group.
Ultraschall in der Medizin - European Journal of Ultrasound, 2009
Pediatric nephrology (Berlin, Germany), Jan 19, 2015
Growth restriction and retarded bone age are common findings in children with chronic kidney dise... more Growth restriction and retarded bone age are common findings in children with chronic kidney disease (CKD). We compared the automated BoneXpert™ method with the manual assessment of an X-ray of the non-dominant hand. In this retrospective multicenter study, 359 patients with CKD stages 2-5, aged 2-14.5 (girls) or 2.5-17 years (boys) were included. Bone age was determined manually by three experts (according to Greulich and Pyle). Automated determination of bone age was performed using the image analysis software BoneXpert™. There was a strong correlation between the automatic and the manual method (r = 0.983, p < 0.001). The automatic method tended to generate higher bone age values (0.64 ± 0.73 years) in the younger patients (4-5 years) and to underestimate retardation or acceleration of bone age. The so-called "bone health index" (BHI) was reduced in comparison to the reference population. Bone health index standard deviation score (BHI-SDS) was not related to the sta...
Zusammenfassung Hintergrund. Durch prä- und postnatales sonographisches Screening werden bei an... more Zusammenfassung Hintergrund. Durch prä- und postnatales sonographisches Screening werden bei annähernd jedem 100. Kind Nieren- oder Harnwegsfehlbildungen erkannt. Meist besteht das Bild einer ureteropelvinen Stenose oder eines Megaureters. Diagnostik. Besonders in diesen Fällen ist für die Therapieentscheidung die Differenzierung zwischen einer korrekturbedürftigen Obstruktion und einer Harnwegsdilatation ohne Auswirkung auf die Nierenfunktion essenziell. Beurteilungskriterien für die Einschätzung der Harntransportstörung sind die
European journal of pediatrics, 2001
Multicystic dysplastic kidney (MCDK) is one of the most common congenital renal anomalies. Arteri... more Multicystic dysplastic kidney (MCDK) is one of the most common congenital renal anomalies. Arterial hypertension is a potential complication of MCDK. Blood pressure (BP) has so far been measured only casually and the frequency of hypertension has been estimated to be between 0%-8%. Ambulatory blood pressure monitoring (ABPM) provides more precise information on BP than the casual BP measurement. The aim of this study was to investigate the BP profile in children with MCDK using ABPM. A group of 25 children (16 girls), with a mean age of 7.8 years (range 3.8-17.7 years) were investigated. ABPM was performed using the oscillometric SpaceLabs 90207 device. Hypertension was defined as mean systolic and/or diastolic BP during the day and/or in the night exceeding 95th percentile for ABPM. Five (20%) children showed hypertension, two of them had combined daytime and night-time hypertension and three had isolated nocturnal hypertension, although daytime BP was between the 90th-95th percent...
Transplantation, 2009
: Many transplant centers practice late steroid withdrawal after pediatric renal transplantation,... more : Many transplant centers practice late steroid withdrawal after pediatric renal transplantation, but evidence-based data on the overall risk-to-benefit ratio in this patient population are lacking. : We therefore conducted the first prospective, randomized, open-label multicenter study to validate this strategy: 42 low-immunologic risk pediatric kidney allograft recipients, aged 10.3+/-4.3 years, on cyclosporine microemulsion, mycophenolate mofetil, and corticosteroids were randomly assigned, more than or equal to 1-year posttransplant, to continue steroids or to withdraw over 3 months. This report contains the 1-year results. : In response to steroid withdrawal, patients experienced a significant catch-up growth with a mean standardized height gain of 0.3+/-0.1 standard deviation score (SDS) per year (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05 vs. control), whereas mean height SDS in the control group did not change (0.0+/-0.1 SDS). Standardized body mass index declined significantly by 0.68+/-0.23 SDS after steroid withdrawal, but rose significantly by 0.26+/-0.34 SDS in the control group. Patients off steroids had less frequent arterial hypertension (50% vs. 87.5% (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) and significantly lower serum cholesterol (by 21%) and triglyceride values (by 36%) than control patients. Patient and graft survival were 100%. The incidence of acute rejection episodes in the steroid-withdrawal group was 1 of 23 (4%) compared with 1 of 19 (5%) in controls. Transplant function remained stable in both groups. : Late steroid withdrawal in low-immunologic risk European pediatric kidney transplant recipients on cyclosporine microemulsion and mycophenolate mofetil is not associated with an increased rate of acute rejection episodes, enables catch-up growth and ameliorates cardiovascular risk factors.
Urology, 2012
We report a male newborn presenting with sonographically normal kidneys, oligohydramnios during l... more We report a male newborn presenting with sonographically normal kidneys, oligohydramnios during late pregnancy, and persisting anuric renal failure. Despite intensive treatment, the patient suffered from severe hypotension and died at the age of 4 weeks. At autopsy, kidneys were found to be normal; on histology, deranged renal structures, in particular proximal tubuli and vessels, were noted, leading to the diagnosis of renal tubular dysgenesis (RTD). The diagnosis was confirmed by 2 heterozygous nonsense mutations of the ACE gene. Because the recurrence rate of RTD is 25% for the autosomal recessive trait, knowledge and genetic diagnosis of the disease is important for the parents.
Der Urologe, 2010
Zusammenfassung Harnwegsinfektionen (HWI) sind die am häufigsten auftretenden Infektionen (beson... more Zusammenfassung Harnwegsinfektionen (HWI) sind die am häufigsten auftretenden Infektionen (besonders in der Frühphase nach Transplantation) und können langfristig die Transplantatfunktion beeinträchtigen. Jeder HWI bei Nierentransplantierten ist mit den entsprechenden Konsequenzen für Diagnose und Therapie als „kompliziert“ anzusehen. Der zunehmende Anteil multiresistenter Keime ist eines der zentralen Probleme bei der Behandlung. Dies bedeutet für den klinischen Alltag u. U. Isolationsmaßnahmen konsequent umzusetzen und
Transplantation Proceedings, 2005
In pediatric renal transplant recipients, most patients receive maintenance treatment with cyclos... more In pediatric renal transplant recipients, most patients receive maintenance treatment with cyclosporine (CsA) and mycophenolate mofetil (MMF). Until now, the 2-hour postdose CsA target level for combined maintenance treatment with MMF has not been defined. This prospective pilot study evaluated the pharmacokinetics of CsA under the influence of MMF to determine a reliable single CsA concentration time that correlates with the area under the curve (AUC(0-6h)) estimates for adolescents who were additionally treated with MMF during the late posttransplant period. The study included 13 adolescents (mean posttransplantation time, 3.5 +/- 2.55 years) with stable renal transplant function (S-Crea 121 +/- 40 micromol/L). CsA pharmacokinetic absorption profiles over a 6-hour dose interval (n = 26) were evaluated for the optimal single peak concentration using the CsA concentrations predose (C0) and at 1, 2, 3, 4, and 6 hours postdose (C1-6). Whereas C2 (mean 743.2 +/- 221.8 ng/mL) was the single point with the closest correlation to AUC(0-6h) (r2 = 0.86; P &amp;lt; .001), C0 (mean 120.5 +/- 35.2 ng/mL) showed the weakest correlation (r2 = 0.61, P = .002). C2 appears to be an accurate predictor of CsA exposure in adolescent kidney transplant recipients under maintenance immunosuppression in combination with MMF. Average values achieved with current dosing practices cluster around the target C2 ranges recommended for adults. The data provide a foundation for initiation of prospective clinical trials to assess the long-term risk for chronic allograft dysfunction among pediatric stable renal transplant patients in combination protocols.
Transplantation Journal, 2004
Despite their numerous systemic side effects, glucocorticoids (steroids) still form a cornerstone... more Despite their numerous systemic side effects, glucocorticoids (steroids) still form a cornerstone in immunosuppressive regimens in pediatric renal transplant recipients. The addition of mycophenolate mofetil (MMF) to a cyclosporine A (CsA)-based immunosuppressive regimen after renal transplantation may allow steroid withdrawal and amelioration or avoidance of steroid-specific side effects. In a retrospective case-control study, covering a mean follow-up period of 46 +/- 2.3 months and 40 patients aged 11.4 +/- 4.9 years, we analyzed the safety and efficacy of steroid withdrawal in pediatric renal transplant recipients receiving CsA micoroemulsion, MMF, and low-dose prednisone treatment. : Steroid withdrawal in all 20 pediatric renal transplant recipients receiving CsA and MMF was successful and not associated with an acute rejection episode; graft function remained stable. At baseline, the degree of growth retardation was comparable between the groups (mean height standard deviation scores [SDSs] -1.60 +/- 0.30 [withdrawal group] and -1.32 +/- 0.39 [case-control group]). After steroid withdrawal, prepubertal patients exhibited a significant catch-up growth with a mean height gain of 1.47 +/- 0.32 SDS, whereas height SDS did not improve in patients receiving steroids. Growth was also improved in pubertal patients who stopped taking steroids. Standardized body mass index in patients who stopped taking steroids decreased significantly by 49% from 0.87 +/- 0.31 SDS to 0.45 +/- 0.30 SDS. After steroid withdrawal, mean arterial blood pressure SDS decreased significantly by 45%. Moreover, the need for antihypertensive medication declined significantly in patients who stopped taking steroids. The white blood cell counts and hemoglobin levels were comparable between the groups. : This study suggests that steroids can be safely and successfully withdrawn in selected pediatric renal transplant recipients receiving immunosuppressive maintenance therapy consisting of CsA and MMF.
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2004
Birth Defects
Objective: Determine whether amniotic fluid volume (AFV) determination by magnetic resonance imag... more Objective: Determine whether amniotic fluid volume (AFV) determination by magnetic resonance imaging (MRI) can be compared with ultrasound based amniotic fluid index (AFI) and whether diffusion weighted imaging (DWI) of the fetal kidneys can be used as surrogate marker for the assessment of AFV and fetal kidney function. Methods: In the period from August 2013 to September 2014 prospective evaluation of AFV based on TRUFI MRI in 2 spatial planes (AFVMRI) and ultrasound based AFI. Inclusion criteria for the evaluation were: 1) Full image of the fetus (including AF and placenta) in an MR-study in at least two planes (sagittal and coronal), 2) Layer thickness 8 mm, 3) DWI-images of the fetal kidney in two planes (sagittal and transverse to the fetus). ROI analysis of the ADC values in normal kidneys and in pathological fetal kidneys (CAKUT) as well as the correlation of AFVMRI vs. AFI, renal volume and ADC were performed. Results: The correlation between AFI (13.60 ± 2.46 cm) and AFVMRI (579 ± 353 mL) was 0.69 (p=0.03). There was no significant correlation between AFVMRI and kidney volume, between AFVMRI and ADC700 and ADC800. The B700-ADC values of fetuses with CAKUT (n=14) were considerably higher than the values in fetuses with healthy kidneys. Conclusion: Compared to AFI, AFVMRI showed higher accuracy, but was associated with higher time consumption. Thus it cannot be routinely recommended for the purpose of AFV-determination alone. MRI can be used to establish a relationship between kidney diffusion parameters, renal volume, GA and AFV in fetuses with CAKUT.
BMJ open, Jun 12, 2017
It is known that transition, as a shift of care, marks a vulnerable phase in the adolescents'... more It is known that transition, as a shift of care, marks a vulnerable phase in the adolescents' lives with an increased risk for non-adherence and allograft failure. Still, the transition process of adolescents and young adults living with a kidney transplant in Germany is not well defined. The present research aims to assess transition-relevant structures for this group of young people. Special attention is paid to the timing of the process. In an observational study, we visited 21 departments of paediatric nephrology in Germany. Participants were doctors (n=19), nurses (n=14) and psychosocial staff (n=16) who were responsible for transition in the relevant centres. Structural elements were surveyed using a short questionnaire. The experiential viewpoint was collected by interviews which were transcribedverbatim before thematic analysis was performed. This study highlights that professionals working within paediatric nephrology in Germany are well aware of the importance of succe...
Der Urologe. Ausg. A, 2009
Transition to adult care is a generic issue for subspecialties dealing with chronic illness and h... more Transition to adult care is a generic issue for subspecialties dealing with chronic illness and has received little attention to date. The transition from pediatric to adult care for renal transplant recipients is recognized as a high-risk period for poor graft outcome associated with more than 20% graft loss. Non-adherence to immunosuppressive medications is one of the most important factors contributing to graft loss during this period. Transition is, therefore, a concern of both pediatric and adult providers, and medical improvements in this area will require more effective collaboration at this interface. This report explores medical and psychological risk factors and barriers during the transition process. In addition, a specially developed coaching concept for young adults is presented intended to assist adolescents with early childhood end-stage renal disease in the transition from pediatric to adult care.
Kinderärztliche Praxis
128 infants between 1 and 18 months, 80 girls and 48 boys suffering from their first pyelonephrit... more 128 infants between 1 and 18 months, 80 girls and 48 boys suffering from their first pyelonephritis (PN), were investigated and followed up over 2.9 +/- 2.2 years (mean +/- SD). 20 children showed urinary tract obstructions. In 49 of 108 cases (45%) with nonobstructive PN a vesico-uretero-renal reflux (VUR) was found and surgically corrected in 13 cases. In 36 patients (52 renal units) the VUR disappeared in most cases under medical management within 3 years. Recurrences of urinary tract infections (UTI) were found in the same frequency in children with and without reflux (28%), but those with VUR showed significantly more PN. 22 of 108 patients with nonobstructive PN (20%) developed renal scars, 39% of children with reflux (mostly VUR III. or IV. degree), 5% of those without reflux. In more than half of these cases renal scars were found already after the first PN. We conclude that a reduction of the risk of renal damage and an improvement of the prognosis can achieved by the following measures: 1. early detection of obstruction by pre- or postnatal sonographic screening, 2. early and exact diagnosis of PN and antibiotic therapy without delay. PN has to be excluded in all infants with unclear fever. 3. In all infants with PN a voiding cystography should be performed. In children with VUR, long-term chemoprophylaxis is necessary to avoid recurrence of PN.
Der Urologe
The causes that lead to terminal renal failure in children and adolescents and subsequently requi... more The causes that lead to terminal renal failure in children and adolescents and subsequently require dialysis are different from those in adults. Moreover, children with a functioning kidney transplant evidence an approximately fourfold higher survival probability than children on dialysis. This contribution describes kidney transplantation in light of the specific features for this age group.
Ultraschall in der Medizin - European Journal of Ultrasound, 2009
Pediatric nephrology (Berlin, Germany), Jan 19, 2015
Growth restriction and retarded bone age are common findings in children with chronic kidney dise... more Growth restriction and retarded bone age are common findings in children with chronic kidney disease (CKD). We compared the automated BoneXpert™ method with the manual assessment of an X-ray of the non-dominant hand. In this retrospective multicenter study, 359 patients with CKD stages 2-5, aged 2-14.5 (girls) or 2.5-17 years (boys) were included. Bone age was determined manually by three experts (according to Greulich and Pyle). Automated determination of bone age was performed using the image analysis software BoneXpert™. There was a strong correlation between the automatic and the manual method (r = 0.983, p < 0.001). The automatic method tended to generate higher bone age values (0.64 ± 0.73 years) in the younger patients (4-5 years) and to underestimate retardation or acceleration of bone age. The so-called "bone health index" (BHI) was reduced in comparison to the reference population. Bone health index standard deviation score (BHI-SDS) was not related to the sta...
Zusammenfassung Hintergrund. Durch prä- und postnatales sonographisches Screening werden bei an... more Zusammenfassung Hintergrund. Durch prä- und postnatales sonographisches Screening werden bei annähernd jedem 100. Kind Nieren- oder Harnwegsfehlbildungen erkannt. Meist besteht das Bild einer ureteropelvinen Stenose oder eines Megaureters. Diagnostik. Besonders in diesen Fällen ist für die Therapieentscheidung die Differenzierung zwischen einer korrekturbedürftigen Obstruktion und einer Harnwegsdilatation ohne Auswirkung auf die Nierenfunktion essenziell. Beurteilungskriterien für die Einschätzung der Harntransportstörung sind die
European journal of pediatrics, 2001
Multicystic dysplastic kidney (MCDK) is one of the most common congenital renal anomalies. Arteri... more Multicystic dysplastic kidney (MCDK) is one of the most common congenital renal anomalies. Arterial hypertension is a potential complication of MCDK. Blood pressure (BP) has so far been measured only casually and the frequency of hypertension has been estimated to be between 0%-8%. Ambulatory blood pressure monitoring (ABPM) provides more precise information on BP than the casual BP measurement. The aim of this study was to investigate the BP profile in children with MCDK using ABPM. A group of 25 children (16 girls), with a mean age of 7.8 years (range 3.8-17.7 years) were investigated. ABPM was performed using the oscillometric SpaceLabs 90207 device. Hypertension was defined as mean systolic and/or diastolic BP during the day and/or in the night exceeding 95th percentile for ABPM. Five (20%) children showed hypertension, two of them had combined daytime and night-time hypertension and three had isolated nocturnal hypertension, although daytime BP was between the 90th-95th percent...
Transplantation, 2009
: Many transplant centers practice late steroid withdrawal after pediatric renal transplantation,... more : Many transplant centers practice late steroid withdrawal after pediatric renal transplantation, but evidence-based data on the overall risk-to-benefit ratio in this patient population are lacking. : We therefore conducted the first prospective, randomized, open-label multicenter study to validate this strategy: 42 low-immunologic risk pediatric kidney allograft recipients, aged 10.3+/-4.3 years, on cyclosporine microemulsion, mycophenolate mofetil, and corticosteroids were randomly assigned, more than or equal to 1-year posttransplant, to continue steroids or to withdraw over 3 months. This report contains the 1-year results. : In response to steroid withdrawal, patients experienced a significant catch-up growth with a mean standardized height gain of 0.3+/-0.1 standard deviation score (SDS) per year (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05 vs. control), whereas mean height SDS in the control group did not change (0.0+/-0.1 SDS). Standardized body mass index declined significantly by 0.68+/-0.23 SDS after steroid withdrawal, but rose significantly by 0.26+/-0.34 SDS in the control group. Patients off steroids had less frequent arterial hypertension (50% vs. 87.5% (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) and significantly lower serum cholesterol (by 21%) and triglyceride values (by 36%) than control patients. Patient and graft survival were 100%. The incidence of acute rejection episodes in the steroid-withdrawal group was 1 of 23 (4%) compared with 1 of 19 (5%) in controls. Transplant function remained stable in both groups. : Late steroid withdrawal in low-immunologic risk European pediatric kidney transplant recipients on cyclosporine microemulsion and mycophenolate mofetil is not associated with an increased rate of acute rejection episodes, enables catch-up growth and ameliorates cardiovascular risk factors.
Urology, 2012
We report a male newborn presenting with sonographically normal kidneys, oligohydramnios during l... more We report a male newborn presenting with sonographically normal kidneys, oligohydramnios during late pregnancy, and persisting anuric renal failure. Despite intensive treatment, the patient suffered from severe hypotension and died at the age of 4 weeks. At autopsy, kidneys were found to be normal; on histology, deranged renal structures, in particular proximal tubuli and vessels, were noted, leading to the diagnosis of renal tubular dysgenesis (RTD). The diagnosis was confirmed by 2 heterozygous nonsense mutations of the ACE gene. Because the recurrence rate of RTD is 25% for the autosomal recessive trait, knowledge and genetic diagnosis of the disease is important for the parents.
Der Urologe, 2010
Zusammenfassung Harnwegsinfektionen (HWI) sind die am häufigsten auftretenden Infektionen (beson... more Zusammenfassung Harnwegsinfektionen (HWI) sind die am häufigsten auftretenden Infektionen (besonders in der Frühphase nach Transplantation) und können langfristig die Transplantatfunktion beeinträchtigen. Jeder HWI bei Nierentransplantierten ist mit den entsprechenden Konsequenzen für Diagnose und Therapie als „kompliziert“ anzusehen. Der zunehmende Anteil multiresistenter Keime ist eines der zentralen Probleme bei der Behandlung. Dies bedeutet für den klinischen Alltag u. U. Isolationsmaßnahmen konsequent umzusetzen und
Transplantation Proceedings, 2005
In pediatric renal transplant recipients, most patients receive maintenance treatment with cyclos... more In pediatric renal transplant recipients, most patients receive maintenance treatment with cyclosporine (CsA) and mycophenolate mofetil (MMF). Until now, the 2-hour postdose CsA target level for combined maintenance treatment with MMF has not been defined. This prospective pilot study evaluated the pharmacokinetics of CsA under the influence of MMF to determine a reliable single CsA concentration time that correlates with the area under the curve (AUC(0-6h)) estimates for adolescents who were additionally treated with MMF during the late posttransplant period. The study included 13 adolescents (mean posttransplantation time, 3.5 +/- 2.55 years) with stable renal transplant function (S-Crea 121 +/- 40 micromol/L). CsA pharmacokinetic absorption profiles over a 6-hour dose interval (n = 26) were evaluated for the optimal single peak concentration using the CsA concentrations predose (C0) and at 1, 2, 3, 4, and 6 hours postdose (C1-6). Whereas C2 (mean 743.2 +/- 221.8 ng/mL) was the single point with the closest correlation to AUC(0-6h) (r2 = 0.86; P &amp;lt; .001), C0 (mean 120.5 +/- 35.2 ng/mL) showed the weakest correlation (r2 = 0.61, P = .002). C2 appears to be an accurate predictor of CsA exposure in adolescent kidney transplant recipients under maintenance immunosuppression in combination with MMF. Average values achieved with current dosing practices cluster around the target C2 ranges recommended for adults. The data provide a foundation for initiation of prospective clinical trials to assess the long-term risk for chronic allograft dysfunction among pediatric stable renal transplant patients in combination protocols.
Transplantation Journal, 2004
Despite their numerous systemic side effects, glucocorticoids (steroids) still form a cornerstone... more Despite their numerous systemic side effects, glucocorticoids (steroids) still form a cornerstone in immunosuppressive regimens in pediatric renal transplant recipients. The addition of mycophenolate mofetil (MMF) to a cyclosporine A (CsA)-based immunosuppressive regimen after renal transplantation may allow steroid withdrawal and amelioration or avoidance of steroid-specific side effects. In a retrospective case-control study, covering a mean follow-up period of 46 +/- 2.3 months and 40 patients aged 11.4 +/- 4.9 years, we analyzed the safety and efficacy of steroid withdrawal in pediatric renal transplant recipients receiving CsA micoroemulsion, MMF, and low-dose prednisone treatment. : Steroid withdrawal in all 20 pediatric renal transplant recipients receiving CsA and MMF was successful and not associated with an acute rejection episode; graft function remained stable. At baseline, the degree of growth retardation was comparable between the groups (mean height standard deviation scores [SDSs] -1.60 +/- 0.30 [withdrawal group] and -1.32 +/- 0.39 [case-control group]). After steroid withdrawal, prepubertal patients exhibited a significant catch-up growth with a mean height gain of 1.47 +/- 0.32 SDS, whereas height SDS did not improve in patients receiving steroids. Growth was also improved in pubertal patients who stopped taking steroids. Standardized body mass index in patients who stopped taking steroids decreased significantly by 49% from 0.87 +/- 0.31 SDS to 0.45 +/- 0.30 SDS. After steroid withdrawal, mean arterial blood pressure SDS decreased significantly by 45%. Moreover, the need for antihypertensive medication declined significantly in patients who stopped taking steroids. The white blood cell counts and hemoglobin levels were comparable between the groups. : This study suggests that steroids can be safely and successfully withdrawn in selected pediatric renal transplant recipients receiving immunosuppressive maintenance therapy consisting of CsA and MMF.
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2004