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A significant decrease of the glutamic oxalacetic transaminase activity of erythrocytes (EGOT) was found in patients on regular dialysis treatment. When pyridoxal-5-phosphate, the active metabolite of vitamin B6, was added to the samples, EGOT activity increased in dialysis patients and in normals, but the activity obtained after stimulation was not as high in haemodialyzed patients as in volunteers. In normals and in patients under pyridoxine treatment the EGOT activity was significantly higher when compared to the corresponding groups without vitamin B6 administration, the EGOT activity depending on duration of pyridoxine treatment.

Alpha-1-Antitrypsin und Fibrinogenspiegel wurden bei zehn nichtdialysierten Patienten mit chronischer Niereninsuffizienz, 18 Dialysepatienten und 70 Nierentransplantierten untersucht. Die hochsten α1-Antitrypsin- und Fibrinogenwerte boten Dialysepatienten mit 314 ± 98 bzw. 485 ± 127 mg/dl. Bei nierentransplantierten Patienten bestand eine signifikante positive Korrelation zwischen α1-Antitrypsin und Fibrinogenkonzentrationen (p < 0,001).

Bei 11 chronischen Dialysepatienten wurden die Plasmakonzentrationen von Kupfer, Eisen und deren Tragerproteine (Coeruloplasmin und Transferrin) und der Einflus der Dialysebehandlung auf diese Parameter untersucht. Kupfer und Eisen wurden photometrisch, Coeruloplasmin und Transferrin nach der Radialimmunodiffusionsmethode bestimmt. Der mittlere Kupfer- und Coeruloplasminspiegel lagen im oberen Bereiche der Norm, moglicherweise als Ausdruck einer chronischen Kupferuberladung durch die Verwendung kupferhaltiger Dialysatoren. Niedriges Transferrin im Plasma, vermindertes ungesattigtes Eisenbindungsvermogen und erhohte prozentuelle Eisensattigung waren mit einer Transfusionshamosiderose und einer katabolen Stoffwechsellage in Einklang zu bringen. Trotz einer ausgepragten Kupferabgabe von der Membran an das Patientenblut in der ersten Dialysestunde kam es zu keiner Anderung des Kupferspiegels im Plasma gegen Ende der Dialyse. Coeruloplasmin, Transferrin und Eisen zeigten einen Konzentrationsabfall im Plasma wahrend der Dialysen. Es wird angenommen, das niedermolekulare Untereinheiten von Coeruloplasmin und Transferrin dialysabel sind.

Sodium dodecyl sulphate (SDS) electrophoresis of urinary proteins was used routinely for monitoring more than 80 kidney transplant recipients as out-patients during one year. Special attention was paid to the question of whether this method can help the clinician to differentiate between a graft rejection reaction and Cyclosporin A-induced nephrotoxic damage. Two cases are presented showing the time course of proteinuric patterns together with serum creatinine, total urinary protein and, in one case, the blood level of Cyclosporin A. Changes of proteinuric patterns signalled the start of rejection and/or nephrotoxicity. A homogeneous collective of 33 kidney recipients (first transplantation) with chronic glomerulonephritis as a basic disease was specially selected. In this collective, the distribution of proteinuric patterns among patients and its dependence on immunosuppressive therapy was investigated. During the observation period of 7 months, two proteinuric patterns, "tubular" and "mixed weak", were found exclusively in Cyclosporin A-treated patients. We ascribe this finding to nephrotoxic effect of Cyclosporin A. We found the SDS electrophoresis of urinary proteins to be a useful, non-invasive method for monitoring Cyclosporin A-treated kidney transplant patients.

Die Beobachtung haufiger dermatologischer Komplikationen auf Basis der immunsuppressiven Therapie nach Nierentransplantationen veranlaste uns, unser eigenes Krankengut mit funktionierenden Transplantaten hinsichtlich Art und Haufigkeit einer Hautmanifestation naher zu analysieren.

Secondary oxalosis in chronic hemodialyzed patients is caused by impaired renal excretion and inadequate removal of oxalic acid during hemodialysis. Ascorbic acid is a precursor of oxalic acid. We report a parathyroidectomized patient with chronic renal failure, on hemodialysis, who received over a period of several months a total dose of 91.0 g ascorbic acid i.v. The plasma oxalic acid level in this patient was 14-fold higher than in healthy persons. Increased oxalic acid synthesis from its precursor ascorbic acid may be responsible for hyperoxalemia, high content of oxalic acid in myocardium, aorta and lung, and calcium oxalate deposition in soft tissues. Application of high doses of ascorbic acid should be avoided in hemodialysed patients with chronic renal failure.

The successful outcome of a pregnancy complicated by reversible renal failure secondary to total ureteral obstruction caused by a pregnant uterus and treated temporarily with nephrostomy is reported. The cyclosporine A (CsA) and prednisone treated female recipient of a cadaveric renal allograft gave birth to a male child, which at 2080 grams was small for gestational age (35 weeks of pregnancy). The child presented neither signs of congenital anomalies or chromosome aberrations nor nephrotoxicity, hepatotoxicity or anemia. Simultaneous measurement of trough CsA blood levels (CsA RIA, Sandoz) displayed reduced values in the child's blood (mother 864 ng/ml-4 hours after oral CsA intake; son 312 ng/ml). Beside postrenal failure the patient's pregnancy was complicated by 7 rejection episodes treated with high doses of methylprednisone (total dose 5 g) with reversible damage of the transplant function, two episodes of a urinary tract infection and increasing anemia necessitating blood transfusions. The HIV negative patient had developed a Kaposi's sarcoma 6 weeks after grafting. The progression of infiltrating skin lesions during pregnancy was not seen.

Plasma oxalic acid concentrations were measured in 13 chronic haemodialysis patients. The mean plasma oxalic acid concentration was 128.0 +/- 48.6 mumol/l, being approximately 8 times higher than the plasma concentration of 14 volunteers (mean = 16.8 +/- 5.2 mumol/l). Ultrafiltrates obtained in vivo from these patients showed a mean oxalic acid concentration of 138.2 +/- 56.5 mumol/l. Since in vivo ultrafiltrates are free of erythrocytes and plasma enzymes, an in vitro synthesis of oxalic acid from precursors by erythrocytes and plasma enzymes can be excluded. As the oxalic acid concentration of plasma corresponded to that of in vivo ultrafiltrates, it is concluded that any in vitro formation of oxalic acid in haemodialysis patients must be negligibly small, and is irrelevant for the measurement of plasma oxalic acid levels in patients receiving regular haemodialysis.

Zusammenfassung: aj-Antitrypsin im Serum wurde bei 30 gesunden Probanden, 18 Dialysepatienten und 11 Nierentransplan tierten mit einer Beobachtungszeit bis zu 24 Monate nach Nierentransplantation mittels radialer Immundiffusion untersucht. Die aj-Antitrypsin-Konzentration im Serum war bei Dialysepatienten mit 2570 ± 570 mg/1 nicht signifikant hoher im Vergleich zu 2280 ± 450 mg/1 der Kontrollgruppe. Nach einer erfolgreichen Nierentransplantation stieg die -Antitrypsin-Konzentration im Serum ab dein ersten postoperativen Tag signifikant an, um wiederum ab dem 10. postoperativen Tag abzufallen. Langzeitkontrollen nach 3, 6,12,18 bzw. 24 Monaten nach Nierentransplantation bei guter Funktion des Transplantates ergaben im Bereich der Norm liegende Werte. Eine akute Abstosungsreaktion des Transplantates war mit einem signifikanten Anstieg des aj -Antitrypsins verbunden. Die Bestimmung des c^ -Antitrypsins im Serum bereichert die Diagnostik der akuten Abstosungsreaktion nach Nierentransplantation.

In nine patients with nephrotic syndrome the behaviour of plasma fibronectin was studied. Of nine patients seven showed elevated plasma fibronectin levels while the plasma fibrinogen level was increased in eight of the nine investigated patients. A positive correlation was found between plasma fibronectin levels and fibrinogen (P less than 0.01), cholesterol (P less than 0.01) and proteinuria (P less than 0.05). The results indicate that elevated plasma fibronectin levels could be an additional factor responsible for hypercoagulability in nephrotic syndrome.

Long-term administration of cimetidine, a histamine2 receptor antagonist, has been reported to normalize elevated parathyroid hormone (PTH) concentrations in patients with secondary [1] and primary hyperparathyroidism [2] and even to improve the clinical symptoms. We have compared the effect of cimetidine and pirenzepine on PTH and calcitonin (CT) plasma levels in a short-term trial on patients with secondary hyperparathyroidism. After cimetidine a significant effect on PTH was seen within 30 min lasting 30 min and after pirenzepine, within 60 min and lasting 60 min. The effect on CT was only significant after cimetidine.

Nephrotoxicity is the main side effect of cyclosporine therapy. In this study 2 groups consisting of 6 kidney transplant recipients were investigated. The oral cyclosporine daily dose was in the first group 13 mg/kg, in the second 11 mg/kg, respectively. In both groups, the daily dose was divided on the first day of investigation in 2 equal portions given at an interval of 12 hours. On the second day, the same dose was divided in 3 equal portions given at an interval of 8 hours. After cyclosporine administration twice a day very high blood cyclosporine peak concentrations (two to three times higher than the therapeutic range) were measured. These potential nephrotoxic cyclosporine concentrations could be prevented by cyclosporine application in 3 equal portions. A reduction of the daily dose in the early period after kidney transplantation to a starting daily dose of 12 mg/kg or even 10 mg/kg can be recommended.

In 5 cases with minimal change nephritis Cyclosporine A has been added to the conventional steroid therapy, when relapse of nephrotic syndrome occurred while reducing the daily prednisolone dose. The intended cyclosporine trough level ranged from 250 ng/ml to 450 ng/ml whole blood, estimated by the RIA method. Proteinuria disappeared in 4 out of the 5 cases, in the other one urinary protein excretion was strikingly reduced. In the 4 cases with complete remission of proteinuria prednisolone was tapered. These patients have cyclosporine A as the sole immunosuppressive drug since 56 weeks and do not show proteinuria. Side effects of cyclosporine therapy have been slight deterioration of kidney function in 2 out of the 5 cases and the occurrence of hypertension in 4 patients.