Charcoal: from antiquity to artificial kidney.

According to Herodotus, the use of charcoal was introduced in ancient Egypt; however only in 1773 Carl Willhelm Scheele utilized it for adsorbing gases. Finally, Hippocrates Yatzidis in 1963 demonstrated its binding capacity for toxic substances of endogenous or exogenous origin and used it for hemoperfusion systems.

[History of nephrology and extracorporeal drug removal at the L. Pasteur Hospital in Kosice]. / História nefrológie a mimotelovej eliminacnej liecby vo Fakultnej nemocnici L. Pasteura v Kosiciach.

The authors describe the development of clinical nephrology from 1948 to 2002 at the Medical Faculty of the P. J. Safarík University and L. Pasteur Faculty Hospital from the aspect of therapeutic and preventive care, teaching and research activities. The dialysis centre which was established in 1966 at the Medical Clinic of the Faculty Hospital in Kosice continued in the activities as the Nephrological laboratory which was founded in 1954. This laboratory still operates under the conditions of the Nephrological Clinic. In 1964 at the Medical Clinic the first percutaneous renal biopsy was implemented. In 1966 the first peritoneal dialysis was implemented and the first haemodialysis in a patient with chronic renal failure, later gradually all so far known therapeutic methods were introduced which replace renal function and are used in acute and chronic renal failure and in acute intoxication. On March 18, 1977 in the authors' department the first haemoperfusion over active charcoal was made successfully in a patient intoxicated with parquat. It was the first haemoperfusion in the former Czechoslovak Republic. From 1991 at the Clinic a Sub-chair of nephrology and dialysis was established attached to the Institute for Postgraduate Training, later SPAM. Within the framework of the latter several nephrological courses were organized as well as courses in extracorporeal elimination treatment and in acute toxicology. The department acted also as a training place for future nephrologists before the specialization examination in nephrology. Since 1981 successfully several research grants concerned with the use of haemoperfusion over active charcoal and other sorbents in acute intoxications were completed as well as grants focused on metabolic vitamin disorders in chronic renal failure. On October 24 1997 in our department within the framework of the P. J. Safarík University Medical Faculty and L. Pasteur Faculty Hospital the Nephrological Clinic was established, the first one in the Slovak Republic. This stimulated further qualitative development of nephrology not only in Kosice but in the whole of Slovakia.

Development and perspectives of bioartificial liver support.

Bioartificial liver support systems containing adsorbent devices, xenogeneic whole liver perfusion, and hybrid bioartificial liver are anticipated to be effective for the treatment of severe hepatic failure. At present, whole liver perfusion and the hybrid bioartificial liver are two mainstreams in the field of the bioartificial liver, but it is still unclear whether either of them has significant beneficial effects in hepatic failure patients. We developed a new system of xenogeneic direct hemoperfusion consisting of a leukocyte adsorbent, an immunoglobulin adsorbent, and a substitute unit for hepatic function, that is, whole liver or bioreactor. Using this system, the perfusion efficiency rate and oxygen supply of the substitute unit for hepatic function were significantly increased. A further improvement of our system by incorporating a leukocytapheresis device to return the leukocyte-rich portion of the perfused blood back to the patient's body directly was undergone. Moreover, our system can be applied not only as a bioartificial liver, but also as a bioartificial kidney. To solve the problem of xenogeneic protein influx into the human body associated with extracorporeal bioartificial liver support, it is important to develop transgenic cattle in which human protein genes are transduced. Influx of porcine endogenous retrovirus into the human body has been a controversial subject. In relation to this issue, the cross-hemoperfusion method is promising in that the patient's circuit and the bioartificial liver circuit are separated by a semipermeable membrane, which can prevent any kind of virus from flowing into the patient's circuit.

Hemoperfusion in the treatment of uremia.

The usefulness of hemoperfusion in ESRD therapy has not yet been proven in long-term studies. This negative assessment of results is not meant to impugn the efforts of the many investigators in this field. Their research has led to the development of sorbent cartridges, which have played a major life-saving role in acute poison therapy. Moreover, many futuristic artificial organs, such as the wearable artificial kidney and the prosthetic liver, will be lineal descendants of early sorbent research and their development will be facilitated further by current and future studies. Surely, for all those who are not prematurely discouraged by the negative results to date, hemoperfusion remains a challenging avenue for clinical innovation.