The polymorphism of the ACE gene affects left ventricular hypertrophy and causes disturbances in left ventricular systolic/diastolic function in patients with autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most frequently occurring autosomal diseases inherited in the dominant manner. Due to this, lesions in the cardiovascular system of ADPKD patients have caught the attention of clinical investigators worldwide. The aim of the study was to analyse cardiovascular complications in ADPKD patients with a focus on left ventricular hypertrophy (LVH) and selected components of its systolic/diastolic function based on echocardiography. The study was conducted on 55 patients with ADPKD (24 males, 31 females), subdivided into three groups according to the stage of chronic kidney disease (CKD). The patient group with ADPKD and ESRD (group C) manifested an increased incidence of the D allele as compared to group A and group B (χ(2) = 4.217, P = 0.04). In all ADPKD patients with the DD genotype, left ventricular mass (LVM), posterior wall thickness (PWT), and interventricular septal thickness (IVS) were significantly higher compared to patients possessing the II and ID genotypes (P < 0.02, P < 0.003, and P < 0.009, resp.). The DD genotype exists more frequently in ADPKD patients with ESRD and is associated with a higher occurrence of LVH and disturbances in systolic-diastolic function when compared to ADPKD ESRD patients with the II and ID genotypes.

Arterial hypertension due to perirenal and subcapsular hematoma induced by renal percutaneous biopsy.

In this study we report three patients, in whom arterial hypertension was induced by compression of the kidney parenchyma due to perirenal or subcapsular hematoma following percutaneous blind renal biopsy with use of Vim-Silverman type needle.

Frequency of BCR-ABL gene mutations in Polish patients with chronic myeloid leukemia treated with imatinib: a final report of the MAPTEST study.

INTRODUCTION: The presence of BCR-ABL oncogene mutations in patients with chronic myeloid leukemia (CML) may be responsible for the failure of tyrosine kinase inhibitor treatment. OBJECTIVES: The aim of the study was to evaluate the frequency of BCR-ABL gene mutations in patients with CML (the MAPTEST study) treated with imatinib (IM). PATIENTS AND METHODS: Direct sequencing analysis of BCR-ABL gene was performed in 92 patients treated with IM for more than 3 months. The mean time of IM treatment was 18 months. At the time of the analysis, 75 patients were in the first chronic phase (CP), 4 in the second CP, 5 in the acceleration and 8 in the blastic phase. Fifty-seven patients (62%) were treated with IM at a daily dose of 400 mg and 35 patients with higher doses (600 or 800 mg daily). Inclusion criteria were based on the European Leukemia Net definitions for failure and suboptimal response to IM. RESULTS: Twelve mutations were detected in 11 of 92 patients, including 4 mutations (36.7%) diagnosed during CP, 3 (27.3%) in acceleration, and 4 (36.7%) in blast crisis. In 1 patient with lymphoid blast crisis of CML coexisting F359V and Y253F mutations were detected. In the whole group mutations were detected in 2 of 5 patients (40%) with primary resistance (M351T, F359V + Y253F) and in 9 of 87 patients (10.3%) (E255K, T315I-3x, M351T, E355G, F359V-2x) with acquired resistance to IM. CONCLUSIONS: The study confirmed the usefulness of BCR-ABL gene mutation screening in patients with CML resistant to IM therapy.

[Combined therapy with L-carnitine and erythropoietin of anemia in chronic kidney failure patients undergoing hemodialysis]. / Skojarzone leczenie niedokrwistosci L-karnityna i erytropoetyna u chorych na przewlekla niewydolnosc nerek poddanych hemodializoterapii.

OBJECTIVES: The aim of this study was to analyze the influence of combined therapy with L-carnitine and erythropoietin on selected blood morphology parameters in patients treated with hemodialysis and to assess whether combined therapy could decrease the requirement for exogenous erythropoietin. PATIENTS AND METHODS: The results of anemia treatment were compared in three groups of patients: 27 patients treated with L-carnitine and erythropoietin, 15 patients treated with erythropoietin and 9 patients treated only with L-carnitine. The patients were treated for 6 months. L-carnitine was given orally at a dose of 4 x 250 mg daily. Erythropoietin was administered intravenously after each hemodialysis session and the mean dose of erythropoietin at the beginning of observation was 5642 +/- 2134 units/week. Before treatment serum concentrations of free and total carnitine, parathormone (PTH), aluminium, lead were determined and basic laboratory examinations were performed. The blood morphology was evaluated once a month. RESULTS: Combined therapy resulted in the improvement of blood morphology parameters (hemoglobin [Hb] before treatment 9.9 +/-1.4 g/dl, during treatment 10.7 +/- 1.6 g/dl), compared to treatment with erythropoietin (Hb before treatment 9.5 +/- 1.2 g/dl, during treatment 9.9 +/- 1.4 g/dl) or L-carnitine alone (Hb before treatment 11.3 +/- 1.0 g/dl, during treatment 12.0 +/- 1.1 g/dl). Combined therapy was associated with the reduction of erythropoietin dosage during treatment from 6287 +/- 1987 units/week to 2286 +/- 1684 units/week. The correlation between serum carnitine concentration and erythrocyte osmotic resistance indicates indirectly the beneficial effect of L-carnitine administration on erythrocyte cell membrane stabilization.

[Blood pressures values during evaluation of 24-h ambulatory blood pressure monitoring and left ventricular hypertrophy in patients with chronic renal failure treated with hemodialysis (HD)]. / Wysokosc cisnienia tetniczego oceniana metoda 24-godzinnego monitorowania a przerost lewej komory serca u chorych na przewlekla niewydolnosc nerek (p.n.n.) leczonych hemodializami (HD).

Left ventricular hypertrophy (LVH) is common and important predictor of risk of death in end-stage renal failure. In the present study we have analysed the relationship between 24-h ambulatory blood pressure (BP) profile and LVH. The effect of parathyroid hormone (PTH) on was also assessed. From a cohort of 85 patients with crf we selected for analysis 59 stable patients. Ambulatory BP 24-h monitoring, echocardiography (ECHO), body mass index (BMI), serum creatinine, hemoglobin, total protein, albumin, electrolytes and PTH concentrations were assessed in all patients. Concentric LVH was detected by ECHO in 46 patients, in 13 patients excentric LVH was observed. Mean 24-h ambulatory sBP, dBP, mean 24-h ambulatory day sBP, dBP as well as night sBP and dBP were significantly higher than in a control group 60 healthy subjects. It was a correlation between mean 24-h ambulatory sBP and left ventricular mas (LVM) r = 0.606 (p < 0.0001), between mean dBP and (LVM) r = 0.498 (p < 0.001), between mean day sBP and (LVM) r = 0.591 (p < 0.0001), between mean day dBP and (LVM) r = 0.479 (p < 0.001), between mean night dBP and (LVM) r = 0.548 (p < 0.0001), between left ventricular mass index (LVMI) and mean sBP r = 0.428 (p < 0.05), between LVMI and mean day sBP r = 0.442 (p < 0.05). The loss in physiological night-time BP was observed in all patients. It was also correlations between PTH and (LVM) r = 0.704 (p < 0.001), and between BMI and LVMI r = -0.451 (p < 0.05). LVH is common in crf patients. These results confirmed that strong correlations between BP values and LVH and between serum PTH concentrations and LVH indicate that both hypertension and hyperparathyroidism play an important role in the LVH development.

[Cardiac troponin I (cTnl) serum concentration in patients with chronic renal failure treated by hemodialysis]. / Stezenie sercowej izoformy troponiny I (cTnl) w surowicy chorych z przewlekla niewydolnoscia nerek leczonych hemodializami.

UNLABELLED: Elevated serum concentration of cardiac troponin I (cTnl) is a highly sensitive and specific marker of myocardial damage. Patients with chronic renal failure (crf) treated by hemodialysis often have increased serum cTnl level without evidence of acute myocardial ischemia. In chronic HD patients, elevated serum concentration of endothelin-1 (ET-1) and angiotensin II have been reported which may be associated with ischemic heart disease. The aim of the present study was to investigate possible association between cTnl serum level, ET-I, angiotensin II, other cardiac markers and the structural changes of myocardium assessed by echocardiographic (ECHO) method. Fifty nine patients with crf treated by HD were studied. ECHO and ECG examinations were performed in all patients and serum levels of cTnl, endothelin-1 (ET-1), angiotensin II were evaluated. In all patients left ventricular mass (LVM) was increased, and in 78% of patients was found concentric hypertrophy of the heart while in 22% excentric hypertrophy was found. In 54 patients there was no ECG changes and ST segment depression in V4-V6 leads, less than 1 mm was found in 5 patients. Arterial hypertension was found in 44 patients (75%), systolic and diastolic pressure was significantly higher (p<0.05) than in a control group. Increased serum level of cTnl was found in 12.0% of HD patients, increased serum level of endothelin-1 and angiotensin II were found in all patients. LVM in HD patients with elevated cTnl levels was significantly higher than in patients with normal cTnl concentration. There was a positive correlation between LVM and cTnl levels, and between angiotensin II serum concentration and cTnl levels and between ET-1 serum level and RWT. IN CONCLUSION: our findings suggest that elevated cTnl serum level reflect left ventricular hypertrophy and/or myocardial ischemia in HD patients, and indicate that ET-1 and angiotensin II might be associated with these conditions.

[Dermatosis bullosa in patient with chronic renal failure under hemodialysis treatment--case report]. / Porfiria skórna pózna u chorej na przewlekla niewydolnosc nerek leczonej zabiegami hemodializ--opis przypadku.

A case of 45-year-old patient with chronic renal failure treated by hemodialysis associated with skin changes typical for porphyria cutanea tarda is reported. The diagnosis was based on clinical manifestations and on histopathologic examination of the skin segment. The skin was low sensitive for UVA rays, serum levels of aluminium and lead were significantly elevated. We did not find porphyrins in the urine (24-hour collection 100 ml) as well as in the dialysis fluid.