Rudolf Jagenburg

Blood haemoglobin declines in the elderly: implications for reference intervals fromage 70 to 88

Abstract: The objective was to determine whether Hb declines in healthy elderly men and women and if this influences health‐related reference intervals. A representative population sample, comprising 30% of all 70‐yr‐old subjects in a Swedish city with 420,000 inhabitants (n=1148, participation rate 85%), was followed at 1–5‐yr intervals for 18 yr within a longitudinal population study. Age‐related changes in Hb were calculated after exclusion of non‐healthy probands and by multivariate analyses in the total study group. Mean Hb declined between age 70 and 88 from 149 to 138 g/L in men (annual decline 0.69 g/L, p=0.000), and from 139 to 135 g/L in women (annual decline 0.06 g/L, n.s.). Healthy men declined from 152 to 141 g/L (annual decline 0.53 g/L, p=0.038), for women from 140 to 138 g/L (annual decline 0.05 g/L, n.s.). Age and body mass index correlated, in multivariate analysis, independently to Hb in both men and women, as did variables indicating a non‐healthy state. Epidemiological decision limits for anaemia declined for men from 128 to 116 g/L, for women from 118 to 114 g/L. Anaemia, thus defined, occurred in 3.2 to 9.7% of the subjects, whereas 28.3% of the 88‐yr‐old men had anaemia according to the WHO definition. In conclusion, there is a significant age‐related decline in Hb from age 70 to 88 among healthy men, and a less pronounced decline among women. This justifies the use of lower epidemiological decision limits for anaemia of about 115 g/L for both men and women from age 80–82.

Determination of Glomerular Filtration Rate in Advanced Renal Insufficiency

The glomerular filtration rate (GFR) has been determined in 17 patients with advanced renal insufficiency (GFR less than 15 ml/min) by different clearance techniques using creatinine, inulin and 51Cr-EDTA as filtration markers. With renal inulin clearance as reference method for GFR, endogenous renal creatinine clearance overestimated GFR by an average of 30%. Renal clearance of 51Cr-EDTA and inulin were closely correlated and thus 51Cr-EDTA is a suitable GFR marker even at low filtration rates. However, it was found that the plasma clearance of 51Cr-EDTA overestimated the GFR often by more than 100% in the range 2.6--11.2 ml/min. Renal clearance measured during 24 h was lower than 4 h renal clearance with the patient well hydrated and resting in bed. It is concluded that the precise measurement of low glomerular filtration rates requires the use of renal clearance techniques. Four-hour 51Cr-EDTA renal clearance is a suitable method for measuring and following the development of renal function in advanced renal insufficiency.

Girls prone to urinary infections followed into adulthood. Indices of renal disease.

This study describes blood pressure and renal function, as well as indices of renal disease, in females with and without renal scarring followed from their first urinary tract infection (UTI) in childhood. Of the 111 patients with a median follow-up time of 15 years, 54 had renal scarring (reflux nephropathy) on urography, which was severe in 19 and moderate in 35. The glomerular filtration rate was lower in patients with severe renal scarring and correlated with renal area on urography. However, the filtration rate was decreased below the lower reference limit in only 7 patients, with a lowest value of 70 ml/min per 1.73 m2. The diastolic blood pressure was higher in women with severe scarring. Hypertension of at least 140/90 mmHg was diagnosed in 3 of 54 (5.5%) females with renal scarring, 2 before and 1 at the follow-up examination. The excretion of albumin in urine was low and not correlated to filtration rate. Tubular enzymes in urine were similar in all groups. Thus the renal function was well preserved and the incidence of hypertension low. Within this range of renal function, the level of albumin in urine did not predict the degree of renal scarring.

Renal Hemodynamics and Limitations of Creatinine Clearance in Determining Filtration Rate in Glomerular Disease

A series of 160 Inulin/PAH clearances in 126 subjects was performed with the main emphasis on glomerular disorders. In 90 observations (67 subjects) simultaneous creatinine clearances were available. Earlier findings of the occurrence of high and supernormal CPAH in some cases of glomerulonephritis have been supported and extended to systemic lupus erythematosus. Low filtration fractions in various types and stages of glomerulonephritis and systemic lupus erythematosus even at rather advanced renal impairment were observed and contrasted against the findings in cryptogenetic (essential) hypertension. High CCr/CIn ratios have been observed not only in cases of advanced renal insufficiency but also in glomerular disorders in subjects with a mild or moderate reduction in Cm and a maintained or high CPAH at serum creatinine levels from 0.7 to 1.5 mg per 100 ml. Here, CCr/CIn ratios may be as high as 2.0 to close to 4. In some glomerular disorders, notably S.L.E., membranous glomerulonephritis, and transplant ...

Arterial concentrations of free fatty acids and free amino acids in healthy human individuals at rest and at different work loads.

The influence of physical work on the arterial plasma levels of free amino acids and free fatty acids was studied in 13 healthy individuals in a postabsorptive state.During work the total amino nitrogen level increased. Among the individual amino acid-alanine increased markedly.After a slight fall in the plasma free fatty acid level during the first minutes of exercise, the free fatty acids increased to the pre-exercise level after about 15 minutes of exercise.The percentage of stearic acid in the free fatty acid fraction decreased markedly during work.The significance of these findings for muscle metabolism during work is discussed.

Serum cobalamins in the elderly: A longitudinal study of a representative population sample from age 70 to 81

Abstract: In a representative population sample (n = 973) born 1901–1902 and examined at the ages of 70, 75, 79, and 81, the change in serum cobalamins with increasing age was studied by trend analysis using values obtained in single individuals at all four examinations. In subsamples without definable disorders, the mean annual decline was: among men 3.4 pmol/l (p < 0.05), among women 3.2 pmol/l (n.s.). The decline was possibly more pronounced among individuals with low and intermediate concentrations. The health‐related lower reference limits (the 2.5 percentile values of subsamples without definable disorders) did not differ significantly between sexes and age groups, but low concentrations or ongoing cobalamin medication became more common with advancing age. The results indicate a slight fall in serum cobalamins between age 70 and 81 but do not call for age‐related lower reference limits.

Decline of blood haemoglobin in the aged: a longitudinal study of an urban Swedish Population from age 70 to 81

Summary Blood haemoglobin (Hb) and telated components were determined in a representative sample (n=973, 449 men and 524 women) of a 70‐yar‐old population. reinvestigated at age 75. 79 and 81. At age 81. 145 men and 259 wonem remained in the study. Longitudinal analysis demonstrated a significant decline in Hb concentration with advancing age, in the total study groups as well as in subsamples remaining after exclusions due to disease. The mean annual decline from age 70 to 81 in a subsample without definable disorders was in men 0.063 g/g/dl. in women 0.035 g/dl. There was a similar decline among subjects with high, intermediate or low Hb concentrations during the study. Only part of the observed intrainadividual variations could be explainedbny factors other than age.

Long-term dietary treatment of tyrosinosis†

A boy with early signs of tyrosinosis has been treated with a diet low in tyrosine and phenylalanine for 31/2 years. The clinical and biochemical effects of this treatment, which was started when the child was 22 months old, are described.

Separation of p-Acetamidophenol Metabolites by Gel Filtration on Sephadex G 10

Jagenburg, R., Nagy, A. & Rodjer, S. Separation of p-Acetamidophenol Metabolites by Gel Filtration on Sephadex G 10. Scand. J. clin. Lab. Invest. 22, 11-16, 1968. By gel filtration on Sephadex G 10, five metabolites of p-acetamidophenol (acetaminophen) could be separated and quantitatively determined in urine. The quantitatively most important metabolites were p-acetamidophenol-glucuronide and p-acetamidophenol-sulphate. Minor quantities of S-(1-acetamido-4-hydroxyphenyl)-cysteine and free p-acetamidophenol were also found. Data are presented indicating that the fifth metabolite was 1-acetamido-4-hydroxyphenylmercapturic acid, which was also excreted in small amounts.

Protein Hydrolysis in the Stomachs of Premature and Full‐term Infants

The proteins of human milk are subject to a very slight hydrolysis in the stomach of babies, both premature and full‐term. Cows milk proteins are hydrolysed to a much higher degree, and this is independent of the maturity of the infant.