[Obesity and progression of chronic renal insufficiency: a Czech long term prospective double-blind randomised multicentre study]. / Obezita a progrese chronické renální insuficience: ceská dlouhodobá prospektivní randomizovaná dvojite slepá multicentrická studie.

Obesity represents one of serious risk factors in chronic renal failure patients (CRF). In three years prospective double-blind randomised multicentre study we monitored 66 patients with advanced chronic renal insufficiency, GFR 24.4-37.3 ml/min (0.41 to 0.62 ml/s) and BMI > or = 30 kg/m2 on long term low-protein diet (0.6 P/kg BW/day) and ACEI + ARB. Thirty four randomly selected patients (group I) were treated with keto amino acids, 32 patients in control group (group II) with placebo. During the study period significant decrease of BMI, proteinuria and slowing in progression of renal failure (C(in)) were found. Significant changes were also noted in parameters of albumin and transferrin (p < 0.02), leucin and WQ (p < 0.01 - p < 0.02), glycaemia and HbA1c (p < 0.02), triglycerides (p < 0.01), leptin and ObRe (p < 0.01) and selected parameters of endothelial dysfunction (ET1, p < 0.02, TGFbeta1, p < 0.02). Significantly also decreased PTH value (p < 0.01). Successful treatment of obesity can significantly improve long term prognosis in CRF patients.

[Fibrillary glomerulonephritis]. / Fibrilární glomerulonefritida.

Fibrillary glomerulonephritis (FGN) is a rare cause of nephrotic syndrome. In three patients (65-year-old male; 57- and 38-year-old females) FGN was diagnosed by percutaneous renal biopsy. Clinically, the disease manifested itself with long term proteinuria and nephrotic syndrome without any associated systemic disorder. Histologically, glomeruli showed deposition of PAS+, fuchsinophilic and Orange G+ material in the mesangium and basal membranes. Strong granular immunofluorescence IgG, C3 and weak kappa and lambda light chains mesangial and peripheral deposition were observed in two patients. Electronmicroscopically, deposition of fibrillary material into mesangium and basal membranes was found. Randomly distributed nonbranching fibrils were 18-28 nm thick. After 10 to 13 months of follow-up, the therapy with corticosteroids and immunosuppressives was without effect, and the disease progressed into chronic renal failure in two patients; the third patient did well.

[Cystatin C in estimates of glomerular filtration in patients with renal disease--initial experience]. / Cystatin C v odhadu glomerulární filtrace u pacientu s nemocemi ledvin, první zkusenosti.

Cystatin is reported in the literature with increasing frequency as a new reliable parameter for estimates of glomerular filtration. The authors examined cystatin C by the PET method of DAKO Co. in 151 patients from the nephrological out-patient clinic. 91 patients had normal renal functions, 60 suffered from renal insufficiency of different severity. Between cystatin C and glomerular filtration assessed by creatinine clearance was a close correlation, R = -0.787 according to Pearson. The authors evaluated separately a group of 36 patients with glomerulonephritis, 34 diabetic patients with diabetic nephropathy, 38 patients with tubulointerstitial nephritis and 43 subjects with other kidney diseases. The groups did not differ significantly when compared with the whole group nor mutually (p = n.s.). The authors of the study confirmed that a good correlation of cystatin with creatinine filtration is not influenced by the type of basic nephrological disease. The effect of administration of insulin, antihypertensive drugs, cyclosporin A and glucocorticoids was not proved in the investigated group. The published method is accurate, not demanding from the technical aspect. The examined subject is not restricted by conditions ensuring the accuracy of assessment and seems thus useful and perspective for nephrological patients.

[Levels of selenium and glutathione peroxidase in dialyzed patients]. / Hladina selenu a glutathionperoxidázy u dialyzovaných pacientu.

The authors examined in 37 patients dialyzed in a dialysis centre in Brno-Bohunice, a region with selenium deficiency in the population the serum selenium and glutathione peroxidase level before and after 4-hour standard haemodialysis across a polysulphone membrane. In 78% patients selenium deficiency was found. The mean value in the whole group was 33.4 micrograms Se/l. The reference range for the Brno population is 41.3-80.7 micrograms/l. After dialysis a rise of the serum selenium level by 15.4 micrograms/l occurred due to haemoconcentration during ultrafiltration and also due to redistribution of fluids and selenium during dialysis. In anuric patients selenium does not cumulate in serum, although it is excreted in healthy subjects mainly in the urine. Due to the closer bond with selenoproteins it is not significantly separated by dialysis. Glutathione peroxidase assessed in whole blood was in 76% patients before dialysis within the reference range and did not change significantly as a result of dialysis. Selenium deficiency participates significantly in the inadequate activity of antioxidant systems in the organism and in dialyzed patients it potentiates the development of chronic complications.