[Renal involvement in vasculitis]. / Zmiany w nerkach w przebiegu ukladowych zapalen naczyn.

Systemic vasculitides are a heterogenous group of diseases, characterized by inflammation of blood-vessel walk. In the course of different types of vasculitis renal involvement is quite often present. Renal dysfunction may manifest as a component of multi-system disease or as the first clinical expression of vasculitis. Presented paper shows the clinical picture of different form of vasculitis and possibilities of their urinary tract manifestations.

[Cyclophosphamide pulse therapy in patients with primary glomerulonephritis]. / Leczenie pulsami cyklofosfamidu pacjentów z pierwotnymi glomerulopatiami.

UNLABELLED: Cyclophosphamide is a cytostatic drug, widely used in therapy of secondary glomerulonephritis. Because pulse therapy bears less side effects than oral one we aimed to follow the cyclophosphamide effect on the course of patients with primary glomerulonephritis. We observed 20 pts (7 women and 13 men), mean age 33 +/- 10.0 yrs, age range 18-50 yrs with primary glomerulonephritis and proteinuria more than 3.5 g. 12 patients also had erythro-cyturia. In all pts kidney biopsy was performed, but in one woman the biopsy was not diagnostic. Renal biopsy revealed: FSG in 2 pts, membranous glomerulonephritis in 2 pts, in 9 pts mesangial proliferative changes and in 6--mesangiocapillary lesions. In 5 pts renal failure was observed. Cyclophosphamide was administered i.v. in the dose 0.75 g/m2 b.s., no more than 1.0 g per dose, in renal failure 0.5 g/m2. During the first six months patients received cyclophosphamide every month and then every three months. Before cyclophosphamide pulse therapy all patients were pretreated with steroids, 3 pulses of 1.0 g Methylprednisolone and then oral prednisone in the dose 20 mg/m2 body surface. RESULTS: In 3 patients we obtained remission of proteinuria, in 11 patients decrease of proteinuria but 6 patients didn't answer to the introduced treatment. In whole group of examined patients we obtained the statistically significant decrease of proteinuria from 12.2 +/- 10.5 to 5.3 +/- 5.2 g (p < 0.05) after the treatment. The creatinine clearance did not change in the time of the treatment and any special complications during the treatment were observed. We suggest that cyclophosphamide pulse therapy could be an effective treatment in pts with primary glomerulonephritis. Our results showed that the answer of proposed treatment was independent of the type to the changes found in kidney biopsy.

Wegener's granulomatosis with unusual cavernous sinus and sella turcica extension.

Intracerebral extension of Wegener's granulomatosis (WG) is rare. We present a patient with oculomotor and trochlear nerve palsy with histologically proved WG. An MR examination revealed granulomatous tissue in nasal cavity, paranasal sinuses with meningeal infiltration, and uncommon penetration into cavernous sinus and sella turcica. The MR images before and during pharmacological therapy are presented.

Recombinant human erythropoietin stimulates production of interleukin 2 by whole blood cell cultures of hemodialysis patients.

The impairment of function of human T lymphocytes, leading to an inappropriate cytokine production, is partially responsible for defective immunological response in hemodialysis patients (HD). Recent data suggest that recombinant human erythropoietin (rhEPO) may exert immunological effects. The aim of this study was to find out whether rhEPO treatment of the HD patients may have an effect on the interleukin 2 (IL-2) production by their whole blood cell cultures. The study was carried out in 10 HD patients receiving rhEPO for 6 months. Compared with the levels seen before the treatment, the concentration of IL-2 increased in the phytohemagglutinin-stimulated whole blood cell cultures of 7 of 10 patients under study. Addition of rhEPO in vitro to the whole blood cell cultures of the HD patients before implementation of erythropoietin confirmed that rhEPO is able to directly stimulate IL-2 production. Our studies show that the therapy with rhEPO affects IL-2 secretion.

[Neurologic complications in Wegener's granulomatosis]. / Powiklania neurologiczne ziarniniakowatosci Wegenera.

Nervous system involvement is relatively frequent in Wegener's granulomatosis (WG). It may be difficult to differentiate between the primary central nervous system involvement and complications secondary to concomitant arterial hypertension, renal insufficiency and iatrogenic effects of immunosuppressive therapy. The crucial role in the assessment of intracranial pathology may be ascribed to the diagnostic imaging techniques: magnetic resonance imaging (MRI), computed tomography (CT) and cerebral blood flow imaging utilising the single photon emission computed tomography (SPECT). SPECT may prove superior sensitivity to MRI. It may be especially useful in differentiating central nervous system involvement in WG with secondary changes of other origin.

The influence of recombinant human erythropoietin on tumor necrosis factor alpha and interleukin-10 production by whole blood cell cultures in hemodialysis patients.

Impaired immunological response in hemodialysis (HD) patients, which leads to inappropriate cytokine production, is partially caused by the hyperstimulation of both T lymphocytes and monocytes/macrophages. Recent data suggest that human recombinant erythropoietin (rhEPO) may have an immunological action. The goal of our study was to estimate the influence of rhEPO treatment on the production of the inflammatory cytokine tumor necrosis factor alpha (TNFalpha) and antiinflammatory cytokin interleukin-10 (IL-10) in 10 HD patients receiving rhEPO for 6 months. The levels of cytokines were measured in the in vitro cultures of whole blood. The level of IL-10 increased in all treated patients during the therapy, and it was accompanied by a transitory decrease of TNFalpha. The results of our studies suggest that rhEPO may reduce the inflammatory process by decreasing production of TNFalpha and increasing production of IL-10.

[Platinum-based chemotherapy in renal transplant recipients with malignancies: a case report and review of literature]. / Chemioterapia zawierajaca zwiazki platyny we wtórnych nowotworach u biorców przeszczepów nerek -- opis przypadku i przegland pismennictwa.

Authors present a case of renal transplant recipient treated with a carboplatin-based chemotherapy for testicular embryonal carcinoma. The patient experienced severe treatment-related toxicity and died due to bone marrow aplasia 3 months after the diagnosis of cancer. The safety of platinum-based chemotherapy in renal transplant recipients is discussed with reference to the literature data.

[The levels of adenine nucleotides and hypoxanthine in blood of patients on long-term hemodialysis using dialysis fluid containing acetate or bicarbonate]. / Stezenie nukleotydów adeninowych i hipoksantyny we krwi chorych przewlekle hemodializowanych przy uzyciu plynu dializacyjnego zawierajacego octany albo wodoroweglany.

Intraerythrocyte adenine nucleotides concentration reflects energy balance of red cells and plays pivotal role in their function. In hemodialysed patients both ATP and ADP concentration in red cells was higher than in controls, p < 0.001 and p < 0.005 respectively. But AMP and hypoxanthine did not differ from control. No change of ATP, ADP and AMP was observed after hemodialysis, but hypoxanthine fall significantly, p < 0.001. The pattern of nucleotides concentration and its changes during hemodialysis was the same regardless of the mode of the therapy; e.g. acetate or bicarbonate.

[Significant negative correlation between fasting plasma insulin and ambulatory blood pressure in patients on chronic hemodialysis]. / Znamienna ujemna korelacja miedzy stezeniem insuliny na czczo i ambulatoryjnym cisnieniem tetniczym u chorych przewlekle dializowanych.

Positive correlation between blood pressure and insulin is well established in patients with essential hypertension. The aim of the present study was to examine the relationship between fasting plasma insulin level and ambulatory blood pressure (ABPM) in patients with chronic renal failure. The study group consisted of 20 patients (11 females, 9 males, mean age 39 +/- 12 years) on chronic haemodialysis (mean 2.5 years). Fasting plasma insulin (FPI) was measured by radioimmunoassay. The patients were investigated before and after haemodialysis. FPI significantly increased after haemodialysis from 18.4 +/- 12.0 to 40.1 +/- 31.9 mIU/l (p < 0.01), while creatinine concentration decreased from 1158 +/- 130 to 910 +/- 159 mumol/l (p < 0.001). Night-time systolic blood pressure (SBP) was significantly lower during the day of haemodialysis (141.9 +/- 19.6 mmHg vs. 136 +/- 27.7 mmHg, p < 0.05). 24-hour and daytime SBP was nonsignificantly lower after haemodialysis. 24-hour diastolic blood pressure (DBP) was significantly lower during the day of haemodialysis (92.9 +/- 12.5 mmHg vs. 87.3 +/- 14.3 mmHg, p < 0.05), as well as daytime (94.9 +/- 12.1 mmHg vs. 88.8 +/- 14.6 p < 0.05) and night-time DBP (88.9 +/- 16.0 mmHg vs. 83.8 +/- 17.4 mmHg p < 0.05). FPI was found to be significantly negatively correlated with 24-hour, daytime and night-time SBP on the day of haemodialysis (r = -0.63, p < 0.005; r = 0.64, (p < 0.005 and r = -0.54, p < 0.05, respectively). The significant negative correlation between FPI and 24-hour SBP suggests that insulin could reveal its hypotensive effect after the haemodialysis.

Erythrocyte nucleotides and blood hypoxanthine in patients with uremia evaluated immediately and 24 hours after hemodialysis.

Using high-performance liquid chromatography, concentrations of erythrocyte adenine nucleotides and hypoxanthine were evaluated in patients undergoing regular acetate hemodialysis before dialysis, immediately following dialysis, and 24 hr after. It was shown that adenosine triphosphate concentration was maintained consistently high, not only just after hemodialysis but also 24 hr later. There was also no difference in concentration of mono- and diphosphates of adenosine. Hypoxanthine concentration decreased twofold after hemodialysis. However, it was still markedly higher than normal values. The level of hypoxanthine was maintained at the postdialysis level, 24 hr later. This suggests that hypoxanthine production could be stimulated during acetate dialysis.

[Concentration of adenine nucleotides in blood of predialysis patients with chronic renal failure]. / Stezenie nukleotydów adeninowych we krwi chorych z przewlekla niewydolnoscia nerek leczonych zachowawczo.

Intraerythrocyte and blood level ATP concentration is increased in CRF. But little is known on the blood concentration of ADP and AMP in CRF. HPLC was applied to evaluate the ATP, ADP, AMP concentration in blood of 25 CRF patients, with serum creatinine from 2.4 mg/dl to 14.4 mg/dl treated conservatively. Controls were healthy people, with normal renal function. In CRF ATP was higher (p < 0.001) and ADP, AMP and hypoxanthine were lower (p < 0.001) then in controls. Also ATP correlated (r = 0.78; p < 0.001) with serum phosphate and (r = 0.40; p < 0.05) with serum creatinine in CRF patients. Adenine nucleotides turnover is increased in CRF and this process is related to severity of the disease.

[Bacterial endocarditis in patients treated with maintenance hemodialysis]. / Bakteryjne zapalenie wsierdzia u pacjentów leczonych przewlekla hemodializa.

UNLABELLED: Bacterial endocarditis (BE) is one of the most severe complications of hemodialysis (HD). The aim of the study was to analyse frequency and severity of BE in patients treated with HD in our dialysis unit. During the period 1969-1993276 patients were treated with HD in Gdansk. In 23 cases (9F, 14M) HD treatment was complicated with BE. Patients were divided into two groups on basis of diagnostic criteria: I-13 patients (5F,8M) with BE diagnosed by means of clinical picture and positive blood culture.; II-10 (4F, 10M) with diagnosis additionally confirmed by echocardiography. In patients from group I BE was observed more often during the first 2 years of HD. In group II during 3-5 years of dialysis therapy, gram negative microorganisms were the most frequent etiological factors. The mean period of antibiotic therapy was 35 days. In all patients from group II changes in the bicuspid valve, in 60% of them additionally in aortic valve and in one patient also in the tricuspid valve were observed. In five patients changes in the parietal endocardium were also present. Development of organic valvular changes was observed in nine patients. Seven of 22 patients died during the acute phase of BE and two others from complications connected with BE. The longest survival of patients after BE was over 10 years. CONCLUSIONS: 1. The threat of BE in patients treated with HD decreased between 1987 and 1993 in comparison with the initial period of our HD station operations.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of treatment with erythropoietin (r-EPO) on hemodynamics of the cardiovascular system in patients with chronic renal failure (c.r.f.)]. / Wplyw leczenia erytropoetyna (r-EPO) nahemodynamike ukladu krazenia u pacjentów z przewlekla niewydolnoscia nerek (p.n.n.).

Patients with chronic renal failure (c.r.f.) are at high risks of death from cardiovascular diseases. It was found that successful treatment of anemia could positively influence not only patients well being but also caused some unfavourable hemodynamic changes. The aim of the study was the estimation of some morphological and functional parameters of left ventricle (lv) in dialyzed and predialyzed patients treated with r-Epo. Two groups of patients with c.r.f. were studied. The I group of 10 dialyzed patients (6 W, 4 M, mean age 34 +/- 11, weight 55 +/- 9 kg), and the II group of 9 pre-dialyzed patients (6 W, 3 M, mean age 50.6 +/- 10, weight 63 +/- 14 kg). r-Epo (Eprex Cilag AG) was administered during 6 months s.c. The I group was given initial dose 3 x 2000 u per week (mean dose 24-46 u/kg b.w./per week, the II was on 3 x 2000 u per week (mean dose 24-46 u/kg b.w./per week) subcutaneously. The doses were adjusted by Hb level in order to keep it within limits (10-12 g/dl). Hematological parameters were monitored once a week by Technicon H1. Morphology and function of the lv were evaluated using echocardiographic measurements performed by Irex IIIA system. According to prescriptions of ASE the following parameters have been assessed: lv dimension, thickness of posterior wall in diastole and systole and thickness of interventricular septum in diastole.(ABSTRACT TRUNCATED AT 250 WORDS)

Importance of iron status monitoring during erythropoietin treatment in uremic predialysis patients.

Since recombinant human erythropoietin (r-Hu EPO) has been introduced to the treatment of anemia in uremic patients the issue of optimal therapy appeared. For proper erythropoiesis not only erythropoietin but also iron, folic acid and B12 vitamin are needed. Iron deficiency is one of the most common factors causing resistance to r-Hu EPO in uremic patients, so its recognition and eventual supplementation is required for optimal hemopoietic response. The aim of presented study, besides monitoring hematological changes, was to measure iron status parameters such as iron, transferrin, ferritin and percentage of hypochromic erythrocytes and estimation of their usefulness in monitoring iron deficiency during r-Hu EPO treatment.