9 results on '"Anke Kulschewski"'
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2. MO444MACROPHAGE DENSITIES CORRELATE WITH LONG-TERM FUNCTION IN PAUCI-IMMUNE AND MEMBRANOUS GLOMERULONEPHRITIS AS WELL AS IN HYPERTENSIVE NEPHROPATHY
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Jessica Schmitz, Thorsten Feldkamp, Kevin Schulte, Ulrich Kunzendorf, Jan Hinrich Bräsen, Wilfried Gwinner, Sebastian Dietrich, Jan T. Kielstein, Abedalrazag Khalifa, Anke Kulschewski, Maren Bettina Pfenning, and Carsten Hafer more...
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Transplantation ,Pathology ,medicine.medical_specialty ,Kidney ,medicine.diagnostic_test ,business.industry ,Fibrillary Glomerulonephritis ,Renal function ,Glomerulonephritis ,medicine.disease ,medicine.anatomical_structure ,Nephrology ,Pauci-immune ,Hypertensive Nephropathy ,Biopsy ,Medicine ,Immunohistochemistry ,medicine.symptom ,business - Abstract
Background and Aims Macrophages and monocytes are main players in innate immunity. In renal diseases, their role is poorly understood. Our multicentric cross-sectional study aimed to study the prevalence of macrophages and monocytes in various human native kidney diseases. For this, we used precise pixel-based digital quantification of their densities in renal biopsies and correlated our findings with clinical data. Method We included 324 patients, who underwent a diagnostic renal biopsy. Additional normal kidney samples from 16 tumour nephrectomies were used as controls. According to the diagnosed diseases, we established 17 patient groups. Biopsies were stained for CD68+-macrophages using automated immunohistochemistry (Ventana Ultra) and selected groups were further subtyped for CD14+-monocytes and CD163+-M2-macrophages (67 cases, pauci-immune glomerulonephritis (PIGN), IgA-nephropathy (IgAN) and control samples). Digitized sections (Leica) were analysed using the open-source software QuPath to quantify cell densities (positively stained areas displayed as percentages of ROI) in renal cortex, medulla and extrarenal tissue, respectively. Detailed clinical and laboratory data at timepoint of biopsy were available for all patients. Additional data for follow-up were achievable in 158 cases. Results Renal disease samples presented higher mean macrophage densities compared to control cases (CD68: cortex 1.2 vs. 0.2%, p64 years) showed a higher medullary M2-infiltration (1.81% vs. 4.34%, p Conclusion Macrophages may promote progression of human renal diseases, whereas monocytes do not correlate with eGFR-decline. Especially, in cANCA- vasculitis CD163+- infiltration is associated with renal outcome. Additional studies are needed to investigate, whether macrophages can serve as predictive markers or therapeutical targets in native renal diseases. more...
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- 2021
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Catalog
3. Validity of hospital ICD-10-GM codes to identify anaphylaxis
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Fabian Otto-Sobotka, Andreas Weyland, Sanny Kappen, Jonas Reinold, Antje Timmer, Anke Kulschewski, Joan Fortuny, Dominik de Sordi, Tania Schink, and Lia Gutierrez
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medicine.medical_specialty ,Databases, Factual ,Drug-Related Side Effects and Adverse Reactions ,Epidemiology ,business.industry ,ICD-10 ,Comparative safety ,Anaphylaxis ,Electronic health records ,Validation ,Germany ,Claims data base ,medicine.disease ,Predictive value ,Hospitals ,Confidence interval ,Cross-Sectional Studies ,International Classification of Diseases ,Chart review ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,business ,Sensitivity analyses ,Algorithms ,Adverse drug reaction - Abstract
PURPOSE: Anaphylaxis (ANA) is an important adverse drug reaction. We examined positive predictive values (PPV) and other test characteristics of ICD-10-GM code algorithms for detecting ANA as used in a multinational safety study (PASS). METHODS: We performed a cross-sectional study on routine data from a German academic hospital (2004–2019, age ≥ 18). Chart review was used for case verification. Potential cases were identified from the hospital administration system. The main outcome required at least one of the following: any type of specific in-hospital code (T78.2, T88.6, and T80.5) OR specific outpatient code in combination with a symptom code OR in-hospital non-specific code (T78.4, T88.7, and Y57.9) in combination with two symptom codes. PPV were calculated with 95% confidence interval. Sensitivity analyses modified type of codes, unit of analysis, verification criteria and time period. The most specific algorithm used only primary codes for ANA (numbers added in brackets). RESULTS: Four hundred and sixteen eligible cases were evaluated, and 78 (37) potential ANA cases were identified. PPV were 62.8% (95% CI 51.1–73.5) (main) and 77.4% (58.9–90.4) (most specific). PPV from all modifications ranged from 12.9% to 80.6%. The sensitivity of the main algorithm was 66.2%, specificity 91.5%, and negative predictive value 92.6%. Corresponding figures for the most specific algorithm were 32.4%, 98.0%, and 87.0%. CONCLUSIONS: The PPV of the main algorithm seems of acceptable validity for use in comparative safety research but will underestimate absolute risks by about a third. Restriction to primary discharge codes markedly improves PPV to the expense of reducing sensitivity. more...
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- 2021
4. Inhibition of the Renin-Angiotensin System and the Prevention of Stroke
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Anke Kulschewski, Andreas Dendorfer, and Joachim Schrader
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medicine.medical_specialty ,Angiotensin-Converting Enzyme Inhibitors ,Blood Pressure ,Models, Biological ,law.invention ,Renin-Angiotensin System ,Meta-Analysis as Topic ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Animals ,Humans ,Pharmacology (medical) ,cardiovascular diseases ,Cognitive decline ,Risk factor ,Stroke ,business.industry ,General Medicine ,medicine.disease ,Angiotensin II ,Clinical trial ,Losartan ,Endocrinology ,Hypertension ,ACE inhibitor ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Angiotensin II Type 1 Receptor Blockers ,medicine.drug - Abstract
BP is the most important determinant of the risk of stroke. A small reduction in BP results in a substantial reduction of both ischemic and hemorrhagic stroke. Any of the commonly used antihypertensive drugs lower the incidence of stroke, with larger reductions in BP resulting in larger reductions in risk. Experimental evidence has linked the renin-angiotensin system (RAS) to the development and progression of cerebrovascular disease. Inhibition of the RAS has beneficial cerebrovascular effects and may reduce the risk of stroke in a manner possibly independent from the alterations of BP. Some clinical trials even suggest that ACE inhibitors and angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) exert cerebroprotective effects beyond BP lowering, but the evidence is controversial. Studies on specific protective actions of antihypertensive drugs are generally hampered by the fact that any treatment-related difference in BP may play a dominant role in the prevention of stroke. There are also indications that the protective potency of ARBs might be superior to that of ACE inhibitors, due to their differential activation of angiotensin II type 2 receptors, but the clinical relevance of this mechanism is unclear. Some studies in primary prevention of stroke, acute stroke, and secondary prevention show advantages for ARBs beyond controlling BP alone. In primary prevention, the LIFE randomized trial showed a significant difference in stroke rate in favor of losartan compared with atenolol despite similar reductions in BP. In acute stroke, the role of hypertension and its treatment remains controversial. ACCESS, however, suggested that an ARB is safe in hypertensive acute stroke patients and may offer advantages independent from BP control. In secondary stroke prevention, there are very few antihypertensive trials. These trials show that BP lowering is at least as successful as in primary prevention, but the absolute stroke risk is much higher. An ACE inhibitor was effective compared with placebo in the PROGRESS trial. The MOSES study showed that eprosartan prevented vascular events more effectively than nitrendipine, despite similar BP-lowering effects. Hypertension is not only the most important risk factor for stroke, but is also closely correlated with cognitive decline and dementia. Therefore, prevention of cognitive decline or even improvement of slightly diminished brain function should be an important goal for antihypertensive treatment in the future. Some clinical data suggest advantages for ACE inhibitors, ARBs, and calcium channel antagonists. Currently, however, the existing data are not sufficient for clinical recommendations. Therefore, ongoing trials will further define the exact role of inhibitors of the RAS and are urgently needed in secondary prevention, in acute stroke, and in the prevention of cognitive decline. more...
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- 2007
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5. The ACCESS Study
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Hans-Christoph Diener, Anke Kulschewski, Stephan Lüders, Peter Dominiak, Joachim Schrader, Karl M. Einhäupl, Walter Zidek, Jürgen Berger, and Johannes Treib
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Male ,medicine.medical_specialty ,Tetrazoles ,Blood Pressure ,Drug Administration Schedule ,Receptor, Angiotensin, Type 1 ,Time ,Angiotensin Receptor Antagonists ,Double-Blind Method ,Internal medicine ,Odds Ratio ,medicine ,Humans ,Prospective Studies ,Survivors ,Risk factor ,Prospective cohort study ,Stroke ,Antihypertensive Agents ,Aged ,Advanced and Specialized Nursing ,business.industry ,Biphenyl Compounds ,Odds ratio ,medicine.disease ,Survival Analysis ,Angiotensin II ,Surgery ,Biphenyl compound ,Candesartan ,Treatment Outcome ,Blood pressure ,Acute Disease ,Benzimidazoles ,Female ,Neurology (clinical) ,Safety ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background and Purpose— The Acute Candesartan Cilexetil Therapy in Stroke Survivors (ACCESS) study was designed to assess the safety of modest blood pressure reduction by candesartan cilexetil in the early treatment of stroke. The study was also designed to provide an estimate of the number of cases required to perform a larger phase III efficacy study. Methods— Five hundred patients were recruited in a prospective, double-blind, placebo-controlled, randomized, multicenter phase II study. Results— This safety trial was stopped prematurely when 342 patients (339 valid) had been randomized because of an imbalance in end points. Demographic data, cardiovascular risk factors, and blood pressure on admission, on study onset, and within the whole study period were not significantly different between the 2 groups. However, the cumulative 12-month mortality and the number of vascular events differed significantly in favor of the candesartan cilexetil group (odds ratio, 0.475; 95% CI, 0.252 to 0.895). There were no significant differences in concomitant medication and in number or type of side effects. Conclusions— Although the mechanisms by which angiotensin type 1 (AT 1 ) receptor blockade affects cardiovascular morbidity and mortality are still unresolved, the present study shows that early neurohumoral inhibition has similar beneficial effects in cerebral and in myocardial ischemia. The fact that no cardiovascular or cerebrovascular event occurred as a result of hypotension is of significant clinical importance. When there is need for or no contraindication against early antihypertensive therapy, candesartan cilexetil is a safe therapeutic option according to the ACCESS results. more...
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- 2003
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6. Morbidity and Mortality After Stroke, Eprosartan Compared with Nitrendipine for Secondary Prevention: principal results of a prospective randomized controlled study (MOSES)
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Jürgen Berger, Joachim Schrader, Walter Zidek, Hans-Christoph Diener, Peter Dominiak, Kerstin Plate, Stephan Lüders, Frank Hammersen, and Anke Kulschewski
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Male ,medicine.medical_specialty ,Randomization ,Magnetic Resonance Spectroscopy ,Time Factors ,Sodium Chloride Symporter Inhibitors ,Blood Pressure ,Thiophenes ,law.invention ,Body Mass Index ,Randomized controlled trial ,Nitrendipine ,law ,Recurrence ,Risk Factors ,Internal medicine ,medicine ,Humans ,Single-Blind Method ,Prospective Studies ,Prospective cohort study ,Stroke ,Antihypertensive Agents ,Aged ,Advanced and Specialized Nursing ,business.industry ,Imidazoles ,Eprosartan ,Middle Aged ,medicine.disease ,Angiotensin II ,Surgery ,Blood pressure ,Treatment Outcome ,Acrylates ,Cardiovascular Diseases ,Hypertension ,Cardiology ,Calcium ,Female ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Angiotensin II Type 1 Receptor Blockers ,medicine.drug - Abstract
Background and Purpose— In hypertensive stroke patients, for the same level of blood pressure control, eprosartan will be more effective than nitrendipine in reducing cerebrovascular and cardiovascular morbidity and mortality. Methods— A total of 1405 well-defined, high-risk hypertensives with cerebral event during the last 24 months (proven by cerebral computed tomography scan or nuclear magnetic resonance) were randomized to eprosartan or nitrendipine (mean follow-up 2.5 years). Primary end point was the composite of total mortality and all cardiovascular and cerebrovascular events, including all recurrent events. Results— Randomization was successful without significant differences in the baseline characteristics. Blood pressure was reduced to a comparable extent without any significant differences between the 2 groups during the whole study period (150.7/84 mm Hg and 152.0/87.2 mm Hg with eprosartan and nitrendipine therapy to 137.5/80.8 mm Hg and 136.0/80.2 mm Hg, respectively, confirmed by ambulatory blood pressure monitoring). Moreover, already after 3 months, normotensive mean values were achieved, and 75.5% reached values P =0.014). Cardiovascular events were: 77 eprosartan and 101 nitrendipine (IDR, 0.75; 95% CI, 0.55 to 1.02; P =0.06); cerebrovascular events: 102 eprosartan and134 nitrendipine (IDR, 0.75; 95% CI, 0.58 to 0.97; P =0.03). Conclusions— The Morbidity and Mortality After Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention (MOSES) study was the first to compare an angiotensin II type 1 receptor antagonist with a calcium antagonist in secondary stroke prevention. In these high-risk hypertensive stroke patients, an early normotensive and comparable blood pressure was achieved. The combined primary end point was significantly lower in the eprosartan group. more...
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- 2005
7. Response to Letter by Larsen et al
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Stephan Lüders, Kerstin Plate, Walter Zidek, Anke Kulschewski, Hans-Christoph Diener, Jürgen Berger, Joachim Schrader, Peter Dominiak, and Frank Hammersen
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Advanced and Specialized Nursing ,Nitrendipine ,business.industry ,Section (typography) ,Calculus ,Medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Response: It is correct that the stated protective effect of Eprosartan over Nitrendipine concerns the composite primary end points. As pointed out in the statistical section of the article, we summed up the number of primary end points and … more...
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- 2006
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8. Neue Trends in der Hypertoniebehandlung
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Joachim Schrader and Anke Kulschewski
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Emergency Medicine ,Family Practice - Published
- 2005
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9. Microalbuminuria and tubular proteinuria as risk predictors of cardiovascular morbidity and mortality in essential hypertension: Final results of a prospective long-term study (MARPLE Study)
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Joachim Schrader, Badrudin Rangoonwala, Christel Züchner, P. Dominiak, Günter Schrandt, Jürgen Berger, Anke Kulschewski, Walter Zidek, Marion Schnieders, Ulla Venneklaas, Stephan Lüders, and Frank Hammersen more...
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Ramipril ,Male ,medicine.medical_specialty ,Ambulatory blood pressure ,Physiology ,Angiotensin-Converting Enzyme Inhibitors ,Blood Pressure ,urologic and male genital diseases ,Essential hypertension ,Internal medicine ,Internal Medicine ,medicine ,Albuminuria ,Humans ,Prospective Studies ,Antihypertensive Agents ,Aged ,Proteinuria ,business.industry ,Middle Aged ,medicine.disease ,female genital diseases and pregnancy complications ,Surgery ,Stroke ,Blood pressure ,Tubular proteinuria ,Cardiovascular Diseases ,ACE inhibitor ,Hypertension ,Cardiology ,Microalbuminuria ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,medicine.drug - Abstract
To evaluate the impact of microalbuminuria (MAU) or tubular proteinuria (TPU) on cardiovascular and cerebrovascular events and all-cause mortality, and to assess whether a normalization of MAU and/or TPU induced by angiotensin-converting enzyme-inhibitor-based antihypertensive treatment with ramipril improves cerebrovascular prognosis in essential hypertensive patients without diabetes mellitus.A prospective, controlled, multicenter study was performed involving 3529 hypertensive participants (average follow-up 42.5 months). Ramipril was the basic antihypertensive medication. Proteinuria analysis (albumin, alpha 1-microglobulin, SDS electrophoresis) was performed by quantitative measurement every year. Ambulatory blood pressure monitoring was performed once yearly. The main outcome determined was cardiovascular and cerebrovascular events and all-cause mortality.In patients with TPU and/or MAU, the risk for endpoints increased significantly compared with normal (TPU, 30.0%; MAU, 54.7%; MAU + TPU, 64.0%; macroproteinuria, 74.4%). A change of protein excretion either from pathologic to normal or from normal to pathologic showed a clear trend to correlate with cerebrovascular endpoints (P = 0.056 and P = 0.055). Normal protein excretion at baseline and during follow-up indicated a significantly better prognosis than pathologic proteinuria at baseline and during follow-up. (P0.0001). TPU normalized in 31.9%, MAU in 30.6%, MAU + TPU in 29.3%, and macroproteinuria in 10.2% of patients. A total of 445 (25.4%) patients with normal protein excretion developed pathologic proteinuria during follow-up.In non-diabetic hypertensive patients, MAU as well as TPU increases the incidence of cardiovascular events. Normalization of MAU, TPU or macroproteinuria during angiotensin-converting enzyme-inhibitor-based treatment correlates with a reduction of cardiovascular events. Beyond blood pressure control, normalization of MAU and TPU should be considered as a further therapeutic goal. There is a need for further studies to optimize treatment if proteinuria is unresponsive to angiotensin-converting enzyme inhibitors. more...
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