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Obwohl der Mensch metabolisch zur Ernährung von einer großen Vielzahl von Pflanzen in der Lage ist, beschränkt er sich auf wenige domestizierte Anbaupflanzen. Die Rolle der Sekundärstoffe für die Auswahl dieser Pflanzen wird an Nüssen, Leguminosen und weiteren Pflanzen untersucht. Eine grundsätzliche Vermeidung von Pflanzen mit toxischen Inhaltsstoffen ist nicht erkennbar. Eine akute Toxizität von Leguminosen, Palmfarnen und anderen wird durch detoxifizierende Massnahmen vor dem Verzehr reduziert oder eliminiert. Die einseitige pflanzliche Kost offenbart dagegen gesundheitliche Risiken durch eine Langzeitexposition gegenüber toxischen Sekundärstoffen.

Die Ernährung durch wenige domestizierte Nahrungspflanzen stellt die Zufuhr biologisch wichtiger pflanzlicher Sekundärstoffe nicht sicher. Mangelerkrankungen wie Skorbut oder Pellagra können auftreten. Mit einer gemüsereichen Kost wie rund um das Mittelmeer werden Sekundärstoffe automatisch aufgenommen. Produkte wie Knoblauch und Olivenöl emanzipieren sich aus diesem Ernährungskontext und werden separat zur Stärkung der Gesundheit eingesetzt. Eine noch weitergehende Unabhängigkeit von Speisen haben Gewürze und Arzneipflanzen. Letztere werden ohne Ernährungsbezug zur Prophylaxe und Therapie von Krankheiten eingesetzt. Gewürze und Arzneipflanzen stammen häufiger als Nahrungspflanzen aus Wildbeständen oder stehen mit diesen im genetischen Austausch. Ihre vielfach regional beschränkte Nutzung erklärt einen Trend zur Substitution wirkverwandter Pflanzen in anderen Regionen.

Die sogenannten Sekundärstoffe der Pflanzen haben spezifische Funktionen für den pflanzlichen Organismus und seine ökologische Position, z.B. zur Abwehr von Herbivoren oder zur Attraktion bestäubender Insekten. Herbivoren einschliesslich des Menschen haben infolge von Koevolution mit den Pflanzen Transportproteine, Enzyme und weitere Instrumente erworben, um einerseits geeignete Sekundärstoffe zu resorbieren, zu metabolisieren oder für eigene Zwecke zu instrumentalisieren und andererseits toxische Sekundärstoffe zu meiden, nach Resorption auszuscheiden oder zu detoxifizieren.

Glomerulonephritiden sind eine wichtige Ursache fur terminale Niereninsuffizienz und Dialysepflichtigkeit. Sie werden nach klinischem Verlauf, Histologie und Pathogenese zu Entitaten klassifiziert, fur die jeweils unterschiedliche Therapiekonzepte gelten. Da bei den meisten GN eine autoimmunologische Pathogenese vorliegt, sprechen sie auf Immunsuppressiva an – allerdings bei vielfach noch unbefriedigendem Erfolg und dem Preis hoher Toxizitat. Wahrend aus der europaischen Tradition der Phytotherapie keine Therapien fur diese Erkrankungen hervorgegangen sind, gibt es interessante Phytotherapeutika innerhalb der chinesischen Medizin. Beginnend mit diesem Beitrag zu Astragalus membranaceus werden in den folgenden Beitragen die wichtigsten Phytotherapeutika fur diese Erkrankungen vorgestellt und kritisch bewertet.

The incidence and severity of interactions of herbal products with calcineurin inhibitor (CNI) metabolism in renal transplant recipients have not been systematically investigated. These patients have a high rate of herbal product consumption, including products interfering with CNI metabolism. The study aimed at identifying an impact of herbs and foods on CNI metabolism in a cohort of renal transplant recipients by conducting dietary interviews (1) in patients with very low and high CNI maintenance dose requirements and (2) by retrospective analysis of unexplained marked deviations from CNI baseline trough levels. Of 73 renal transplant recipients, 59 were treated with a CNI-based immunosuppressive regimen. Seven patients with an exceptionally high or low CNI dose were interviewed. Five of these seven patients had not consumed any plant product with known influence on CNI metabolism. In one patient chicory-coffee and bitter chocolate had been suspected as contributing to high CNI dose requirement, but the dose could not be lowered after discontinuation of these foods. Participating nephrologists reported three as yet unexplained temporary deviations from baseline CNI trough levels, of which two could be linked to newly started consumption of high volumes of herbal teas and the other to St. John's wort. Consumption of herbal products within the study cohort had no detectable impact on maintenance doses of CNI. However, herbal products, and specifically teas when consumed by the liter, could be linked to temporary strong deviations from CNI trough levels. The study demonstrates that as yet unnoticed herbal interactions with CNI can be detected by detailed dietary analysis, but that the overall impact on maintenance doses of CNI appears to be low.

Cranberry juice (Vaccinium macrocarpon) is a widely used and recommended North-American folk remedy for prophylaxis of urinary tract infections (UTI). Clinical trials have documented its efficacy in women with recurrent UTI, but so far not in other groups of patients. The composition of effective cranberry products and its dosage in UTI prophylaxis have not been defined. Intriguing experimental research has identified an anti-adhesive mechanism of cranberry juice that prevents docking of bacteria on host tissues. This efficacy mechanism can be traced in patients' urine following oral intake of cranberry products and appears to be due to proanthocyanidins with an A-type linkage of flavanols. The application of this anti-adhesion mechanism of cranberry-proanthocyandins is currently also investigated in other common diseases of bacterial pathogenesis, for example Helicobacter pylori-associated gastritis and dental caries/periodontal disease. The use of cranberry products appears to be safe and provide additional benefits by anti-oxidant and cholesterol-lowering activity.

Cranberry (Vaccinium macrocarpon) is a North-American folk remedy for treating and preventing infection. Research has identified an anti-adhesive mechanism of cranberry-proanthocyanidins that inhibit docking of bacteria on tissues in vitro. The efficacy of cranberry juice and extracts as a prophylactic agent against recurrent urinary infections is well documented in women. The anti-adhesion effect of cranberry-proanthocyandins can also be applied for treatment of other common diseases of bacterial pathogenesis, e.g. Helicobacter pylori-associated gastritis and dental caries/parodontal disease. Cranberries have an exceptionally high anti-oxidative capacity.

Cranberry (Vaccinium macrocarpon) is a North-American folk remedy for treating and preventing infection. Research has identified an anti-adhesive mechanism of cranberry-proanthocyanidins that inhibit docking of bacteria on tissues "in vitro". This efficacy mechanism can be traced in the patient's urine following oral intake of cranberry juice. The efficacy of cranberry juice and extracts as a prophylactic agent against recurrent urinary infections is well documented in women. The anti-adhesion effect of cranberry-proanthocyandins can also be applied for treatment of other common diseases of bacterial pathogenesis, e.g. Helicobacter pylori-associated gastritis and dental caries/periodontal disease.

A soluble form of the complement receptor CD21 (sCD21) is shed from the lymphocyte surface. The amount of sCD21 in serum may modulate immunity as sCD21 levels are correlated with several clinical conditions. We report here the serum levels of sCD21 in juvenile arthritis (JA), systemic lupus erythematosus (SLE) and Sjogren's syndrome (SS). Using enzyme-linked immunosorbent assay, we determined sCD21 levels in SLE, SS and JA patients. Mann-Whitney test for nonparametric two-tail P value was performed to obtain statistical significance. Cytometrical analysis of synovial fluid leucocytes of JA patients was done on a FACSsort. While sCD21 levels in SLE and SS are reduced to levels previously found in rheumatoid arthritis (RA), JA sCD21 levels were normal. sCD21 levels did not correlate with clinical parameters and immunophenotype of synovial cells. CD4 T cells in the synovium were almost all of the CD45RO memory type and 13 of 40 patients displayed synovial expansion of gammadeltaT cells. CD21 shedding in JA differs from RA/SS/SLE. JA sCD21 levels in synovial fluid are always lower compared to blood levels of the same patients. Analysis of JA synovial T cells indicates a T-cell driven response.

The expression of CD14, CD18, and major histocompatibility complex II on unprimed monocytes from healthy donors after incubation with IgG from patients with antineutrophil cytoplasmic autoantibody (ANCA)-positive active Wegener's granulomatosis (n = 6) and microscopic polyangiitis (n = 6) in comparison with IgG from healthy controls (n = 6) was studied. Monocytes were incubated with IgG (100 microg/ml) at 37 degrees C, and expression of antigens was measured by fluorescence-activated cell sorter after 18 h. Cytoplasmic ANCA (C-ANCA) IgG and perinuclear ANCA (P-ANCA) IgG in comparison with control IgG increased the expression of CD14 (49.2% [SD: 37, P:0. 001], and 55.8% [SD: 41, P:0.05]) and CD18 (11.4% [SD: 18, P:0. 01] and 8% [SD: 26, P:0.05]) but did not change the major histocompatibility complex II expression. Upregulation of CD14 started after 6 h and reached a peak after 10 to 14 h of incubation and was not inhibited by polymyxin B. F(ab)(2) fragments of C- and P-ANCA IgG also increased expression of CD14 and CD18 as compared with control IgG F(ab)(2), but for CD14 less than with complete IgG. ANCA IgG depleted of antiproteinase 3 and antimyeloperoxidase antibodies by immunoadsorption failed to upregulate CD14. Monoclonal murine antibodies against proteinase 3 and myeloperoxidase yielded a strong upregulation of CD14 when compared with an isotype control or human control IgG. The data show that CD14 and CD18 are upregulated on monocytes by C- and P-ANCA IgG in vitro, as well as by monoclonal antibodies against proteinase 3 and myeloperoxidase and that this effect is not dependent on Fc gamma receptor crosslinking. Upregulation of CD14 and CD18 on monocytes by ANCA suggests a pathogenetic role of ANCA monocyte interactions in systemic vasculitis.

Whether autoimmune or rheumatic disease may be precipitated after vaccination is controversially discussed among experts. Here we describe 4 cases of new onset or relapsing antineutrophil cytoplasmic antibodies associated vasculitis occurring in timely association with influenza vaccination. In the literature different subtypes of vasculitis have been repeatedly reported after influenza vaccination. Several trials in patients with preexisting auto-immune disease failed to indicate an increased risk for disease recurrence after influenza vaccination but these investigations might be underpowered to detect this very rare but relevant side effect. Although our report does not prove a causal association between vaccination and vasculitis, it seems possible that in rare cases vaccination might induce vasculitic disease.

Two familial clusters of systemic vasculitis are described. In one family, microscopic polyangiitis and rapidly progressive glomerulonephritis occurred in HLA-identical siblings; in the second family, 3 second- and fourth-degree related members were affected by Wegener's granulomatosis. Published clusters of systemic vasculitides and Goodpasture's syndrome are reviewed, and, together with the observed families, the evidence for genetic susceptibility and a causative role of environmental factors for these diseases with special emphasis on the HLA system is discussed.

Fehl- und Mangelernahrung sind ein Risikofaktor fur Lebensqualitat und Lebenserwartung von Dialysepatienten. Die Ernahrungsempfehlungen fur Dialysepatienten betreffen daher nicht nur die reduzierte Zufuhr von Kalium, Phosphat und Flussigkeit, sondern auch die ausreichende Aufnahme von Kalorien und Eiweis.

Fallt die Entscheidung zur HD, so macht speziell die Anlage eines Gefaszugangs aufgrund von arteriellen Verkalkungen Probleme. Rechtzeitige Planung und Anlage eines Shunts sind in dieser Situation besonders wichtig. Eine desolate Gefassituation kann ein Argument zur Entscheidung fur die PD sein, die insgesamt aber auch bei Diabetikern unterreprasentiert ist.

Akutes Nierenversagen bei Intensivpatienten fuhrt zur drastischen Prognoseverschlechterung, die Mortalitat steigt auf bis zu 50% an. Trotz umfassender Therapie – die Nierenersatzverfahren eingeschlossen – erholt sich die Nierenfunktion in bis zu 45% nicht mehr vollstandig. Es bleiben 20% der Patienten chronisch dialysepflichtig. Die Prognose des akuten Nierenversagens war vor Jahrzehnten gunstiger, offenbar weil sich die betroffene Patientengruppe anders zusammensetzte. Heute haben die Patienten ein hoheres Alter und zahlreiche Begleiterkrankungen. Patienten mit septisch bedingten Multi-Organ-Dysfunktionssyndrom (MODS) benotigen in bis zu 70% eine Nierenersatztherapie (McCullough 1997). Jungere Patienten mit akutem Nierenversagen ohne chronische Begleiterkrankungen haben dagegen nach wie vor eine gunstigere renale Prognose.

Das Akronym RIFLE steht fur Risk (Risiko) – Injury (Schadigung) – Failure (Nierenversagen) – Loss (Verlust der Nierenfunktion) und ESRD („end-stage renal disease”, terminales Nierenversagen). In 2007 wurde der Begriff akutes Nierenversagen (ANV = „acute renal failure”, ARF) durch den Begriff akute Nierenschadigung („acute kidney injury”, AKI) ersetzt (AKIN = Acute Kidney Injury Network, http://www.akinet.org).

Bei der Erstdialyse muss die volle Leistungsfahigkeit des Verfahrens noch nicht ausgeschopft werden. Im Gegenteil: es ist wichtig, dass sie fur den Patienten schonend durchgefuhrt wird.

Die pharmakokinetischen Eigenschaften von Medikamenten konnen bei terminaler Niereninsuffizienz verandert sein. Die Ausscheidung von Medikamenten kann renal oder extrarenal erfolgen. Ist der Anteil der extrarenalen Ausscheidung an der Gesamtausscheidung gros, muss die Nierenfunktion bei der Dosierung nicht berucksichtigt werden. Standardbeispiel ist hier das Chloramphenicol. Ein Medikament mit fast ausschlieslicher renaler Ausscheidung dagegen ist z. B. Penicillin.

Die Entgiftung des Bluts geschieht uber den Primarhar, der durch Filtration in den Nierenkorperchen (Glomeruli) entsteht. Die Filtration erfolgt aufgrund hydrostatischer Druckdifferenzen von 70–100 mmHg an der glomerularen Basalmembran, glomerulare. Die Basalmembran wirkt als Siebmembran und schrankt die Passage auf Molekule bestimmter Grose (

Die wichtigsten Indikationen zur Nierenersatztherapie sind das akute Nierenversagen (ANV) und die terminale chronische Niereninsuffizienz (ESRD). Oft ist die Unterscheidung, ob ein akutes oder chronisches Nierenversagen vorliegt, nicht einfach – gerade bei Erstvorstellung eines Patienten, dessen Anamnese noch unbekannt ist. In dieser Situation steht oft rasches Handeln im Vordergrund und der Nephrologe benotigt bewahrte klinische Parameter fur die Indikationsstellung einer Nierenersatztherapie.

Der hohe extrakorporale Blutfluss der Hamodialyseverfahren bedarf eines speziellen Gefaszugangs, der entweder arteriell gespeist wird oder auf die zentralen Venen zugreift. Das Blutflussangebot peripherer Venen erlaubt keine effiziente Dialyse. Groskalibrige zentrale Venen konnen passager oder permanent als Gefaszugang genutzt werden, indem ein Katheter mit ausreichendem Lumen und Stabilitat eingefuhrt wird.

Wenn eine chronisch progrediente, sicher zur terminalen Niereninsuffizienz fuhrende Nierenerkrankung vorliegt, sollte sehr fruh nach passenden potenziellen Lebendspendern fur eine praemptive Nierenlebendspende gesucht werden. So ist ausreichend Zeit fur die Evaluation sowohl von Spender als auch Empfanger vorhanden. Ab einer GFR

Studien haben gezeigt, dass 50–60% (bis 85%) der Hamodialysepatienten und ca. 30% der Peritonealdialysepatienten hypertensiv sind. Dieser Prozentsatz liegt deutlich unter den 80%, die zu Beginn der Hamodialysebehandlung hypertensiv sind, was wahrscheinlich auf die Korrektur der Hypervolamie durch die Dialysebehandlung zuruckgeht.

Gegenuber nicht-diabetischen Patienten haben Diabetiker eine ungunstigere Prognose an der Dialyse, mit einer besonders hohen Sterbequote innerhalb der ersten Monate der Dialysetherapie. Kardiovaskulare Ereignisse sind die fuhrenden Todesursachen.

Fur eine Dialyseeinrichtung bedeutet das: Alle Tatigkeiten – von der Patientenversorgung uber die Abrechnung bis hin zur Personalfuhrung – werden systematisch und regelmasig einer praxisinternen Uberprufung unterzogen, um organisatorische Schwachstellen zu identifizieren. So wird ein kontinuierlicher Verbesserungsprozess eingeleitet, dessen Ziel es ist, die wirtschaftliche Situation des „Unternehmens Dialysepraxis“ zu starken und eine hochwertige Patientenversorgung sicherzustellen.

Exogenous growth hormone (GH) and insulin-like growth factor (IGF)-I induce an increase of renal hemodynamics in normal subjects, but the precise mechanism mediating this phenomenon has not been explored in humans. We investigated whether the renal response to exogenous GH requires the presence of vasodilating prostaglandins (PG). In 10 healthy normotensive women with normal renal function, the effect of recombinant human (rh)GH on glomerular filtration rate (GFR) was examined using an intraindividual cross-over design. The subjects were studied under conditions of normal hydration and controlled sodium and protein intake without and with coadministration of indomethacin, 150 mg/d. rhGH, 4.5 IU twice per day, was administered by subcutaneous self-injection for 3 days. GFR was measured as inulin clearance (Cin) in the morning hours in the fasting state in supine position before and after 3 days of rhGH treatment. Baseline GFR was 115.7 +/- 10.1 (SD) mL/min/1.73 m2. Three days of treatment with rhGH caused a 50% increase in serum IGF-I values and GFR increased by 10% to 127.9 +/- 11.7 mL/min/1.73 m2 (P0.03). The study was repeated under coadministration of indomethacin, which was started 2 days before application of rhGH. Despite a similar increase in serum IGF-I values, the increase in GFR was completely blocked by indomethacin. Urinary PGE2 excretion was not stimulated by rhGH, but decreased by 50% during indomethacin treatment, as expected. These findings suggest that the increase of GFR during GH treatment in humans is mediated by or requires the presence of vasodilating prostanoids.

The increase in GFR after an amino acid (AA) load, the so-called renal functional reserve, is impaired in the aged rat. Whether the renal functional reserve predicts the progression of renal disease in humans is controversial, but it is possible that age-related alterations of renal hemodynamics are relevant for the evolution of renal disease in the elderly. We compared renal hemodynamics before and after an AA infusion in 15 healthy normotensive subjects of young age (seven women, eight men; median age, 26 yr; range, 23 to 32) and in 10 subjects of old age (six women, four men; median age, 70 yr; range, 61 to 82) on normal dietary protein intake. Baseline GFR and effective RPF were measured after 12 h of fasting by the inulin (Cin) and para-aminohippurate (Cpah) steady-state infusion techniques. The renal functional reserve was examined after an overnight AA infusion (7% solution; 83 mL/h). Median basal Cin and Cpah were significantly lower (P < 0.01) in the elderly (102 and 339 mL/min per 1.73 m2) than in the young subjects (122 and 647 mL/min per 1.73 m2), but virtually all GFR values of the elderly were still within the normal range. Median Cin upon infusion of AA was 118 mL/min per 1.73 m2 (range, 98 to 137) in the elderly and 146 (range, 120 to 171) in the young, respectively. Corresponding values of Cpah were 349 mL/min per 1.73 m2 in the elderly versus 689 mL/min per 1.73 m2 in the young. Cin increased significantly (P < 0.01) after the AA load in both young and elderly subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Pancytopenia with severe thrombocytopenia occurred in a patient treated with low-density lipoprotein (LDL)-apheresis by polyacrylate adsorption from whole blood, after treatment frequency had been increased from once to twice a week. Cell counts recovered with discontinuation of LDL-apheresis, but thrombocytopenia recurred after resumption of twice-weekly treatments. Thrombocyte counts remained stable following the replacement of polyacrylate adsorption from whole blood by double-filtration plasmapheresis. The complications' close coincidence with twice-weekly polyacrylate adsorption from whole blood suggests a causal relationship, although by a still unknown mechanism. Monitoring of thrombocytes should be advised in patients treated with LDL-apheresis by polyacrylate adsorption from whole blood.

Glomerular hyperfiltration is thought to play an important role in the genesis of diabetic nephropathy. While hyperfiltration is well documented in early type I diabetes, the evidence for hyperfiltration in type II diabetes is conflicting. We investigated 16 nonproteinuric patients with recently diagnosed type II diabetes. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured as inulin clearance (CIN) and p-aminohippuric acid clearance (CPAH) using a constant infusion technique. Lean body mass was measured by densitometry (weighing under water). Renal hemodynamics were also measured in 31 healthy volunteers and six obese nondiabetic individuals. Median GFR in diabetics (133 mL/min/1.73 m2; range, 95 to 165) was significantly (P0.01) higher than in obese nondiabetic controls (median, 118; range, 95 to 139). Elevated GFR (ie,95th percentile of nonobese healthy controls) was found in 44% of patients. When GFR was factored for lean body mass, it was elevated in 50%. GFR did not correlate with fasting glucose, hemoglobin A1C (HbA1C), insulin-like growth factors, IGF-1 and IGF-2, or somatomedin-binding protein (SMBP). The findings document that hyperfiltration is common in recent-onset type II diabetics.

The epidemiology, clinical symptomatology, diagnosis and management of acute and chronic lead intoxication are reviewed. While acute lead intoxication has become rare, the elevated environmental lead burden is thought to play a causal role in hypertension. Lead may also be linked with neuropsychological disorders of children and possibly even chronic renal failure. The epidemiological and experimental evidence for this hypothesis is critically discussed.

The problem of diagnosing vasculitic neuropathy is discussed based on case reports of two patients with Wegener's granulomatosis. One patient developed de novo 6(th) nerve palsy as an isolated relapse manifestation and the second patient a sequence of multiple cranial nerve palsies. Brain imaging with CT and MRI and the laboratory provided no clues suggesting active vasculitis. However, in both patients the neuropathies fully recovered in response to standard induction protocols of vasculitis. In the absence of organ-specific proof of vasculitis, these treatment decisions were guided by the overall clinical presentations. Cranial neuropathy may be the first obvious vasculitic manifestation preceding other organ disease, and since single reliable tests for its diagnosis are lacking, a multidisciplinary approach is advocated here to detect vasculitic manifestations in other organs.