Stefan Büttner
Goethe University Frankfurt
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Publication
Featured researches published by Stefan Büttner.
The Journal of Pathology | 2014
Stefan Porubsky; Giuseppina Federico; Johannes Müthing; Richard Jennemann; Norbert Gretz; Stefan Büttner; Nicholas Obermüller; Oliver Jung; Ingeborg A. Hauser; Elisabeth Gröne; Helmut Geiger; Hermann Josef Gröne; Christoph Betz
The pathogenesis and therapy of Shigatoxin 2 (Stx2)‐mediated kidney failure remain controversial. Our aim was to test whether, during an infection with Stx2‐producing E. coli (STEC), Stx2 exerts direct effects on renal tubular epithelium and thereby possibly contributes to acute renal failure. Mice represent a suitable model because they, like humans, express the Stx2‐receptor Gb3 in the tubular epithelium but, in contrast to humans, not in glomerular endothelia, and are thus free of glomerular thrombotic microangiopathy (TMA). In wild‐type mice, Stx2 caused acute tubular dysfunction with consequent electrolyte disturbance, which was most likely the cause of death. Tubule‐specific depletion of Gb3 protected the mice from acute renal failure. In vitro, Stx2 induced secretion of proinflammatory cytokines and apoptosis in human tubular epithelial cells, thus implicating a direct effect of Stx2 on the tubular epithelium. To correlate these results to human disease, kidney biopsies and outcome were analysed in patients with Stx2‐associated kidney failure (n = 11, aged 22–44 years). The majority of kidney biopsies showed different stages of an ongoing TMA; however, no glomerular complement activation could be demonstrated. All biopsies, including those without TMA, showed severe acute tubular damage. Due to these findings, patients were treated with supportive therapy without complement‐inhibiting antibodies (eculizumab) or immunoadsorption. Despite the severity of the initial disease [creatinine 6.34 (1.31–17.60) mg/dl, lactate dehydrogenase 1944 (753–2792) U/l, platelets 33 (19–124)/nl and haemoglobin 6.2 (5.2–7.8) g/dl; median (range)], all patients were discharged after 33 (range 19–43) days with no neurological symptoms and no dialysis requirement [creatinine 1.39 (range 0.84–2.86) mg/dl]. The creatinine decreased further to 0.90 (range 0.66–1.27) mg/dl after 24 months. Based on these data, one may surmise that acute tubular damage represents a separate pathophysiological mechanism, importantly contributing to Stx2‐mediated acute kidney failure. Specifically in young adults, an excellent outcome can be achieved by supportive therapy only.
Journal of Cardiology | 2013
Henrik Fox; Stefan Büttner; Katrin Hemmann; Aida Asbe-Vollkopf; Mirko Doss; Andres Beiras-Fernandez; Anton Moritz; Andreas M. Zeiher; Ernst H. Scheuermann; Helmut Geiger; Stephan Fichtlscherer; Ingeborg A. Hauser; Ralf Lehmann
BACKGROUND Cardiovascular disease is the most frequent cause of mortality for kidney transplant recipients. Open heart surgery has particularly high mortality and morbidity. As an alternative to traditional aortic valve replacement (AVR) for patients with high-grade aortic stenosis, transcatheter aortic valve implantation (TAVI) was developed as an innovative therapy for patients considered at high surgical risk. METHODS We considered all kidney transplant recipients as high-risk patients, which are candidates for TAVI. In 2010 and 2011, eight kidney transplant recipients with severe aortic stenosis underwent TAVI (6 transfemoral; 2 transapical; group I). The outcome of these patients was compared retrospectively to 18 kidney transplant recipients with aortic stenosis, who underwent conventional AVR (group II). RESULTS Both groups had similar baseline characteristics, including estimated perioperative risk (EuroSCORE group I vs. group II: 9.5±5.9 vs. 10.4±10.5; p=0.829). All TAVI procedures were performed successfully with excellent functional results. In the TAVI group (group I), all patients were alive at the 12-month follow-up with one cardiovascular event (stroke). In contrast, the surgical group experienced a 30-day-mortality of 11.1% (n=2) and a 1-year-mortality of 16.7% (n=3). CONCLUSIONS Based on our centers experience, TAVI appears to be an effective and safe alternative to conventional surgery for AVR in patients with prior renal transplantation. Renal transplantation is not currently identified as a risk factor in our traditional scoring system, and may need to be considered independently when weighing alternatives for AVR.
Blood Purification | 2014
Stefan Büttner; Benjamin Koch; Olga Dolnik; Markus Eickmann; Tilo Freiwald; Sarah Rudolf; Jürgen Engel; Stephan Becker; Claudio Ronco; Helmut Geiger
Therapeutic options for Ebola virus disease (EVD) are currently limited to (1) best supportive care, and (2) evolving virus-specific therapies, resulting from decades of analyzing one of the worlds deadliest diseases. Supportive care ranges from oral or intravenous rehydration therapy and anti-emetics in developing countries to much more extensive life-support interventions in resource-rich countries. Current EVD-specific therapies attempt to either interfere with the earliest steps of viral replication or to elicit a strong immune response against the virus. An entirely new approach is the extracorporeal elimination of viruses and viral glycoproteins by lectin affinity plasmapheresis. Herein, we report for the first time the successful and safe use of lectin affinity plasmapheresis in a patient with severe Ebola virus disease.
Transplant International | 2016
Rudolf Richter; Caner Süsal; Stefanie Köhler; Sara Qidan; Alicia Schödel; Lisa Holschuh; Martin Brzoska; Aida Asbe-Vollkopf; Stefan Büttner; Christoph Betz; Eva Herrmann; Stefan Gauer; Erhard Seifried; Helmut Geiger; Christian Seidl; Ingeborg A. Hauser
Clinical relevance of ELISA‐ and single‐antigen bead assay (SAB)‐detected pretransplant HLA antibodies (SAB‐HLA‐Ab) for kidney graft survival was evaluated retrospectively in 197 patients transplanted between 2002 and 2009 at the University Clinic Frankfurt. Having adjusted for retransplantation and delayed graft function, a significantly increased risk for death‐censored graft loss was found in patients with pretransplant SAB‐HLA‐Ab [HR: 4.46; 95% confidence interval (CI): 1.47–13.48; P = 0.008]. The risk for increased graft loss was also significant in patients with pretransplant SAB‐HLA‐Ab but without SAB‐detected donor‐specific Ab (SAB‐DSA) (HR: 4.91; 95% CI of 1.43–16.991; P = 0.012). ELISA was not sufficient to identify pretransplant immunized patients with an increased risk for graft loss. In immunized patients, graft loss was predominantly present in patients who received transplants with a mismatch on the HLA‐DR locus. In conclusion, even if our study is limited due to small sample size, the results show an increased risk for long‐term graft loss in patients with pretransplant SAB‐HLA, even in the absence of DSA. SAB‐HLA‐Ab‐positive patients, being negative in ELISA or CDC assay, might profit from a well‐HLA‐DR‐matched graft and intensified immunosuppression.
The Annals of Thoracic Surgery | 2016
Stefan Büttner; Helge Weiler; Carolin Zöller; Benjamin Koch; Andreas Zierer; Andreas M. Zeiher; Helmut Geiger; Mariuca Vasa-Nicotera; Ingeborg A. Hauser; Stephan Fichtlscherer
Management of dialysis patients with valvular heart disease waitlisted for kidney transplantation is challenging. Development of severe aortic valve stenosis can lead to the exclusion from the transplant program or even death while on the waiting list. In dialysis patients, surgical aortic valve replacement is associated with a high perioperative risk with increased morbidity and mortality. In contrast, transcatheter aortic valve implantation emerges as a viable option for dialysis patients. Herein, we present the long-term follow-up of successful kidney transplantation after TAVI in a diabetic patient receiving long-term hemodialysis.
Journal of Intensive Care Medicine | 2018
Stefan Büttner; Andrea Stadler; Christoph Mayer; Sammy Patyna; Christoph Betz; Christian Senft; Helmut Geiger; Oliver Jung; Fabian Finkelmeier
Purpose: Acute kidney injury (AKI) is a severe complication in medical and surgical intensive care units accounting for a high morbidity and mortality. Incidence, risk factors, and prognostic impact of this deleterious condition are well established in this setting. Data concerning the neurocritically ill patients is scarce. Therefore, aim of this study was to determine the incidence of AKI and elucidate risk factors in this special population. Methods: Patients admitted to a specialized neurocritical care unit between 2005 and 2011 with a length of stay above 48 hours were analyzed retrospectively for incidence, cause, and outcome of AKI (AKI Network-stage ≥2). Results: The study population comprised 681 neurocritically ill patients from a mixed neurosurgical and neurological intensive care unit. The prevalence of chronic kidney disease (CKD) was 8.4% (57/681). Overall incidence of AKI was 11.6% with 36 (45.6%) patients developing dialysis-requiring AKI. Sepsis was the main cause of AKI in nearly 50% of patients. Acute kidney injury and renal replacement therapy are independent predictors of worse outcome (hazard ratio [HR]: 3.704; 95% confidence interval [CI]: 1.867-7.350; P < .001; and HR: 2.848; CI: 1.301-6.325; P = .009). Chronic kidney disease was the strongest independent risk factor (odds ratio: 12.473; CI: 5.944-26.172; P < .001), whereas surgical intervention or contrast agents were not associated with AKI. Conclusions: Acute kidney injury in neurocritical care has a high incidence and is a crucial risk factor for mortality independently of the underlying neurocritical condition. Sepsis is the main cause of AKI in this setting. Therefore, careful prevention of infectious complications and considering CKD in treatment decisions may lower the incidence of AKI and hereby improve outcome in neurocritical care.
Journal of Clinical Medicine | 2017
Stefan Büttner; Jürgen Bachmann; Helmut Geiger; Nicholas Obermüller
Hyponatremia is the most common and by far underestimated electrolyte disorder in clinical practice. Especially in elderly patients, treatment of symptomatic hyponatremia is challenging. Herein we describe the case of an octogenarian with recurrent symptomatic hyponatremia due to idiopathic syndrome of inappropriate antidiuretic hormone release (SIADH). Fluid restriction was insufficient to prevent repeated episodes of hyponatremia complicated by falls and coma. After introduction of a low-dose therapy with tolvaptan, serum sodium levels as well as the clinical condition were stable under vaptan therapy, without any relapse for more than six years now. This case demonstrates that long-term tolvaptan treatment for hyponatremia caused by SIADH is safe and well tolerated, even in the elderly.
Blood Purification | 2017
Stefan Büttner; Sammy Patyna; Benjamin Koch; Fabian Finkelmeier; Helmut Geiger; Christoph Sarrazin; Harald Farnik
course, he developed hepatorenal syndrome and subsequent dialysis dependency. Consequently, the patient was treated for more than a month in the intensive care unit to stabilize the cirrhosis and acute kidney injury. During this time, an evaluation as to whether the patient could be listed for a liver transplantation or not was rejected by the Liver Board. Since no transplant option existed, we continued therapy with available treatment options including steroid therapy with 40 mg per day, however, with no significant improvement. Plasma bilirubin concentrations showed a significant increase of up to 24.5 mg/dL; ammonia levels were 130 μg/dL. In addition, transaminases (GOT 259 U/L, GPT 59 U/L) as well as μGT (352 U/L) were markedly elevated and markers for spontaneous coagulation at this time were also poor. He also exhibited highly elevated markers of inflammation (leukocytes 43,000/μL, C-reactive protein 3.46 mg/dL, and interleukin-6 42 pg/mL). Continuous renal replacement therapy (CRRT) was started in the CVVHD mode (Multifiltrate, Fresenius Medical Care). During this phase, the patient received a low-dose norepinephrine infusion (<0.025 μg/kg/min). As a “last resort” therapy, a hemoadsorpDear Editor, Acute-on-chronic liver failure, including decompensated alcoholic steatohepatitis (ASH), represents a distinct type of hepatic decompensation, accompanied by systemic inflammation, extrahepatic organ failure, and susceptibility to infection that can occur in patients with cirrhosis. Short-term mortality from decompensated alcohol-related liver disease is high with up to 10–20% at 1 month [1, 2] . In most cases, corticosteroids are the only available treatment option; however, the proof for their efficacy is missing. Likewise, despite the availability of various techniques for liver organ support (i.e., MARS, SPAD), application is cumbersome and data on their clinical efficiency remain sparse [3] . We report the case of a 36-year-old male patient with a clinical history of chronic viral hepatitis C and longtime chronic alcohol abuse up to the point of admission to hospital and subsequently to ICU with decompensated ethanol toxic liver cirrhosis. At this point, the patient was hypotonic, tachycardic, and oliguric with upper gastrointestinal bleeding, with a MELD score of 40, and progressive hepatic encephalopathy. Initial attempts were made to stabilize the patient using albumin infusion and multiple paracenteses. However, in further Received: December 9, 2016 Accepted: December 12, 2016 Published online: February 25, 2017
International Journal of Molecular Sciences | 2018
Robert Brunkhorst; Waltraud Pfeilschifter; Sammy Patyna; Stefan Büttner; Timon Eckes; Sandra Trautmann; Dominique Thomas; Josef Pfeilschifter; Alexander Koch
Dysregulation of blood sphingolipids is an emerging topic in clinical science. The objective of this study was to determine preanalytical biases that typically occur in clinical and translational studies and that influence measured blood sphingolipid levels. Therefore, we collected blood samples from four healthy male volunteers to investigate the effect of storage conditions (time, temperature, long-term storage, freeze–thaw cycles), blood drawing (venous or arterial sampling, prolonged venous compression), and sample preparation (centrifugation, freezing) on sphingolipid levels measured by LC-MS/MS. Our data show that sphingosine 1-phosphate (S1P) and sphinganine 1-phosphate (SA1P) were upregulated in whole blood samples in a time- and temperature-dependent manner. Increased centrifugation at higher speeds led to lower amounts of S1P and SA1P. All other preanalytical biases did not significantly alter the amounts of S1P and SA1P. Further, in almost all settings, we did not detect differences in (dihydro)ceramide levels. In summary, besides time-, temperature-, and centrifugation-dependent changes in S1P and SA1P levels, sphingolipids in blood remained stable under practically relevant preanalytical conditions.
Blood Purification | 2018
Benjamin Koch; Patricia Schult-Dietrich; Stefan Büttner; Bijan Dilmaghani; Dario Lohmann; Patrick C. Baer; Ursula Dietrich; Helmut Geiger
Background/Aims: Middle East respiratory syndrome coronavirus (MERS-CoV) and Marburg virus (MARV) are among the World Health Organization’s top 8 emerging pathogens. Both zoonoses share nonspecific early symptoms, a high lethality rate, and a reduced number of specific treatment options. Therefore, we evaluated extracorporeal virus and glycoprotein (GP) elimination by lectin affinity plasmapheresis (LAP). Methods: For both MERS-CoV (pseudovirus) as well as MARV (GPs), 4 LAP devices (Mini Hemopurifiers, Aethlon Medical, San Diego, CA, USA) and 4 negative controls were tested. Samples were collected every 30 min and analyzed for reduction in virus infectivity by a flow cytometry-based infectivity assay (MERS-CoV) and in soluble GP content (MARV) by an immunoassay. Results: The experiments show a time-dependent clearance of MERS-CoV of up to 80% within 3 h (pseudovirus). Up to 70% of MARV-soluble GPs were eliminated at the same time. Substantial saturation of the binding resins was detected within the first treatment hour. Conclusion: MERS-CoV (pseudovirus) and MARV soluble GPs are eliminated by LAP in vitro. Considering the high lethality and missing established treatment options, LAP should be evaluated in vivo. Especially early initiation, continuous therapy, and timed cartridge exchanges could be of importance.