Zeitschrift fur Urologie und Nephrologie最新文献

The data system nephrology/dialysis (DSND) may improve the documentation and information processes used in chronic hemodialysis. DNSD is efficient if the data input is done carefully. It is possible to display large numbers of laboratory and dialysis data arranged alpha-numerically or graphically. Data over a period of 5 weeks or 14 consecutive examinations are recorded. An advantage is the possibility to print letters, labels and dialysis protocols. For scientific questions the points of class wideness for laboratory results, weight changes or medication are possible. Furthermore, the use of DSND may be valuable for use in a kidney transplantation information system.

1100 patients with pathological findings of the prostate, urothelium and lymph-nodes underwent cytological examination with histological control. Prostatic cytology showed a sensitivity of 81% in detecting cancer. Through reassessment of originally false negative or only suspicious aspirates a specificity rate of 90% was achieved while the rate of unsatisfactory smears were doubled. In urothelial tumors evidence of lavage cytology was significantly higher than exfoliative cytology and depends on grading and staging of the tumor. Tumors with a low grade of malignancy were rarely detected cytologically. Topical chemotherapy seems to change the accuracy of cytological examinations because of the difficulty to separate malignancy associated cell changes from therapy induced cellular features. Transperitoneal aspiration cytology of retroperitoneal lymph-nodes has no evidence.

In 48 patients suffering from giant renal calculi a percutaneous nephrolitholapaxy was done. The use of perioperative antibiotic prophylaxis using aminoglycosides or cephalosporins was effective in reduction of postoperative urinary tract infections.

Among 136 patients with unilateral nephrectomy between 1985 and 1988 at the Marienhospital Gelsenkirchen the renal function was evaluated in the postoperative course. The serum creatinine value did increase from 88.4 +/- 5.3 mumol/l preoperatively to 168.8 +/- 13.3 mumol/l on the 10th postoperative day. The elevation was significantly higher in patients with more than one associated disease (e.g. diabetes, hypertension). The extent of creatinine elevation could predicated safe by both preoperative creatinine value and isotope renal split function analysis. Therefore, functional isotope examination may not be indicated in patients without impairment of renal function.

The most important disturbances of pregnancy excluding the birth canal are complications due to diseases and alterations of the kidney and the urinary tract. The urinary transport disorders are of significant importance; frequency and clinical relevance and follow-up are presented. In the second part an overview to urinary tract disorders due to iatrogenic injuries is given.

In 26 dialysis patients (age 46 +/- 47.8 years, dialysis 20.1 +/- 57 months) calcium carbonate was introduced to phosphate reduction for 3 years. The use of CaCO3 (4.4-9 g/d) for 9 months did reduce the phosphate level from 2.51 to 1.51 mmol/l in 77% of the patients and increase the calcium from 2.23 to 2.47 mmol/l. The long-term use use up to 3 years did'nt reduce the phosphate level effectively (mean value 2.24 mmol/l). In 77% of the patients a progression and in 42% new calcifications could be observed. The percentage of patients with soft tissue calcification within the 3-year CaCO3 therapy was increased from 43% to 67%. Therefore, CaCO3 alone in unsuitable for long-term use as phosphate binder in dialysis patients.

The use of intraoperative ultrasonography in urology was exclusive in open stone surgery to search for residual stones. However, this procedure may applied successfully to renal cancer, if parenchyma-sparing resection or enucleation should performed. Our experience in 6 cases show the helpful use of intraoperative ultrasonography in the judgement of normal parenchyma.

Among 331 recipients of cadaveric renal allografts, transplanted from 1976 to 1986 at the Rostock Transplant Center the graft survival rates have been analyzed. All patients have been treated by conventional immunosuppressive therapy using azathioprine and prednisolone. A relation between graft survival and immunological factors was found: the better the HLA match, the better the transplant results. The necessity of a restrictive transfusion regime was stressed. The higher the number of pretransplant transfusions, the higher is the panel reactivity with following lower graft survival. Cold ischemic time was without influence on graft survival. The introduction of cyclosporin may improve the graft survival rate as known of 10-20%.

By means of observation of 191 own patients suffering from a symptomatic single renal cyst and a literature review, epidemiology, clinical presentation, diagnostic procedures and therapy are presented. The significance of ultrasonography and computerized tomography are emphasized. For single, symptom-free cysts besides regular ultrasonographic examinations no further therapy is necessary. In case of a required therapeutic procedure, an open resection of the cyst should be preferred to percutaneous a required therapeutic procedure, an further therapy is necessary. In case of a required therapeutic procedure, an open resection of the cyst should be preferred percutaneous approach.

The 1-pool-model of sodium kinetics during hemodialysis is based upon the assumption of an immediate compensation of osmotic shifts. This assumption is not supported by measurements of plasma sodium, total protein concentration and colloid osmotic pressure kinetics. When a high dialysate sodium concentration is applied, an inflow of sodium into the plasma space occurs, which results in an osmotic suction and thus a plasma dilution. These conditions can be represented by a 2-pool-model taking into consideration capillary filtration. The results indicate that following the first treatment period the sodium kinetics are sufficiently explained by a 1-pool-model with the total body water as distribution volume. Both the plasma sodium concentration and the eliminated sodium at the end of a hemodialysis treatment can be described to an acceptable level by the 1-pool-model. The input of the measured in-vivo sodium dialysance value (or alternatively the urea clearance) is necessary.