[GBV-C/HGV, a new virus as one possible cause of hepatitis of unknown etiology]. / Nový virus GBV-C/HGV jako jeden z mozných puvodcu etiologicky nevyjasnených hepatitid.

For etiologically obscure (some 4%) viral hepatitis agents are sought and tested to make elucidation of their cause possible. One of the candidates is since 1995 the newly discovered virus GBV-C/HGV. Despite intense research its relationship to viral hepatitis of obscure origin (VHN) has not been elucidated so far. In the submitted paper the authors attempted to contribute to the elucidation of etiological associations of GBV-C/HGV infection and VHN by comparing the dynamics of markers of the infection in a group of 59 patients with VHN, two control groups exposed to a high risk of parenteral operations and a third comparative group. The first control group comprised 64 patients in a long-term haemodialyzation programme (HD), the second group was formed by 82 patients with haematooncological disease (BD). The third comparative group comprised 22 patients coinfected (CI) with virus of hepatitis C (VHC), or possibly hepatitis B (VHB). The patients with VHN were HBsAg, anti HCV and anti HEV negative. In the majority in the first blood sample transaminases were elevated which was one of the main reasons for examination of GBV-C/HGV RNA. Prevalence of GBV-C/HGV infection, proved by the presence of at least one of the two markers of current or past infection (GBV-C/HGV RNA, antiGBV-C/HGV) was in the compared VHN, HD and BD groups as follows: 88.1%, 59.4% and 43.9%. The frequency of GBV-C/HGV positivity was highest in VHN-76.3%. In control groups HD and BD GBV-C/HGV RNA positivity was substantially lower, 18.8% and 25.6% resp. Long-term continuous viraemia was recorded in patients with VHN in 18.6%. In groups HD and BD it was half that value: 9.3% and 9.18%. In patients with VHN surprisingly after 6.5 months a marked rise of negative findings occurred (5.6x) without the expected increase of antibodies. A similar finding was recorded also in the other groups (HD and BD), incl. CI patients. Disappearance of viraemia was observed most frequently in VHN (55.9%). In groups HD and BD GBV-C/HGV RNA disappeared only in 7.8% and 12.1% resp. In treated patients of the CI group viral RNA was present in 45.5% and it disappeared in 36.4%. On the other hand, seroconversion to antibodies was comparable in VHN, HD and BD (11.9%, 9.4%, 8.5%), only in group CI it was higher (18.2%), obviously in conjunction with treatment of concurrent HCV or HBV infection. Disappearance of viraemia without subsequent seroconversion occurs in GBV-C/HGV infection frequently, the highest rate was observed by the authors in patients with VHN. Disappearance of viraemia does not necessarily imply clearance of GBV-C/HGV but may be due to a change of GBV-C(HGV into a state of persistence without positive laboratory markers of the infection. Persistence of the virus could also be the reason of the assumed conditioned pathogenicity of the virus, and the effect of frequent disappearance of both markers could explain some controversial epidemiological observations when in studies only static data without dynamic associations were used.

[Evaluation of the adequacy of hemodialysis from the aspect of urea kinetics models]. / Posuzování adekvátnosti hemodialýzy z hlediska modelování kinetiky mocoviny.

BACKGROUND: One of the widely used indicators of adequacy of haemodialysis (HD) is assessment of the Kt/V of urea (K-dialysis clearance of urea, t-time of haemodialysis, V-distribution volume of urea). Work accomplished in recent years suggests that when the HD is adequate, the value of Kt/V should be 1.5. The objective of the present work was to assess to what extent the so-called adequate value of Kt/V can be influenced by the dietary protein intake and the frequency of HD sessions. METHOD AND RESULTS: In 15 subjects on regular haemodialysis treatment the kinetics of urea in serum and in the dialyzation fluid was investigated. The protein intake and residual renal function was also recorded. The mean age of the examined subjects was 49 years (28-65 years). For HD treatment capillary dialyzers FOCUS 120H and ALPHA 160H, cuprophan and haemophan membranes with an area of 1.2-1.6 sq.m were used. The period of HD was 4-5 hours. The mean Kt/V value was 1.31 (+/- 0.20) at a normal level of protein catabolism (NPCR): 1.48 (+/- 0.17)g/kg/day. The mean value of the predialysis serum concentration of urea was 28.8 (+/-52)mmol/l. A formula was derived which makes it possible to calculate the adequate value of Kt/V which respects the intensity of the protein metabolism (NPCR which in a stabilized state is identical with the dietary protein intake), body weight (BW), intensity of urea excretion due to residual renal function (U) duration of the dialysis cycle (T is the sum of the dialysis and interdialysis time expressed in days) and the required value of the predialysis serum concentration of urea (CPRE). The relationship between these variables can be expressed by the following formula: [formula: see text] The calculated adequate value of Kt/V in the examined group varied within a wide range from 1.15 to 1.91 (mean value 1.47 +/- 0.25). The assembled results support the idea that an adequate value of Kt/V cannot be expressed by a single figure and that this value must be evaluated on an individual basis with regard to all measurable factors which influence protein metabolism.

[Preventive administration of antithymocyte globulin in combined immunosuppressive therapy with cyclosporin A, azathioprine and prednisone in kidney transplantation]. / Profylaktické podávání antithymocytárního globulinu v kombinované imunosupresívní lécbe s cyklosporinem A, azathioprinem a prednisonem u transplantací ledvin.

Forty-five patients after transplantation of the kidney from a dead donor were treated by a triple combination of cyclosporin A, azathioprine and prednisone. In patients where during the first two days after transplantation the function of the graft was not restored, cyclosporin A was reduced and treatment supplemented by a combination of four by prophylactic administration of ATG for a period of 7 days. A total of 18 patients had a complete prophylactic dose of ATG. The results in this group were compared with a historical comparable group of 27 subjects treated only with the triple combination of drugs without reduction of cyclosporin A. In patients treated with ATG the mean initial function of the graft was reduced only insignificantly and the one-year survival of the graft was only insignificantly better than in the control group. During the first two months after transplantation there were significantly more leucopenic episodes in patients treated with ATG, however, no direct relationship with the latter was proved. The number of infectious complications in these patients was lower than in the control group.

[A nutritionally defined liquid diet for hemodialyzed patients]. / Nutricne definovaná tekutá výziva pro hemodialyzované nemocné.

BACKGROUND: For patients having regular haemodialysis there are no suitable complete preparations for general use in case intensive treatment is needed. Nutrilac renal is a new preparation of a nutritionally defined liquid diet corresponding as to its composition to the needs of haemodialyzed patients. The purpose of the present work was to assess whether this preparation when administered as a supplement will have a favourable effect on the nutritional parameters of haemodialyzed patients. METHODS AND RESULTS: Nutrilac renal was administered to haemodialyzed patients for a period of three weeks as a supplement meeting 20% of the energy requirements. The protein intake rose from 0.87 to 0.95 g/kg body weight (p < 0.05), the energy intake from 109 to 126 kJ/kg body weight (p < 0.05). As to nutritional parameters, the serum albumin values improved (from 25.0 to 29.4 g/l, p < 0.05) and Whitehead's quotient from 1.8 to 1.5, p < 0.05). The favourable effect on the amino acid spectrum was manifested by a significant rise of essential amino acids and those with branched side chains (p < 0.01). The preparation did not lead to a rise of potassium, ura and vitamin A levels. CONCLUSIONS: The newly developed preparation Nutrilac renal exerts a favourable effect on nutritional parameters. Changes in the aminogram characterized by an increase of essential amino acids, in particular threonine, valine, leucine and isoleucine indicate the high biological value of the protein component of the preparation for patients with chronic renal failure.

[Therapy in kidney transplant rejection using murine monoclonal IgG2a A1CD3 (Cedetrin)]. / Lécba rejekce transplantované ledviny mysím monoklonálním IgG2a A1CD3 (Cedetrin).

BACKGROUND: One of the substances used in recent years to suppress immune reactions after organ and tissue transplantations is mouse IgG2a globulin which acts selectively on CD3 lymphocytes; it is known under the name of Orthoclone (Ortho Co.) An analogous preparation was developed in the Institute of Molecular Genetics, Academy of Sciences, Czech Republic, although the idiotype is different. The authors submit a report on the experience with treatment of rejection of transplanted kidneys. METHODS RESULTS: Monoclonal mouse globulin IgG2a (Cedetrin) was administered to 20 patients after renal transplantation on account of a rejection episode or progressing rejection; the mean interval after transplantation was 16.1 (range 0.25-96) months; the rejection episode or progressing rejection responded little in the majority of patients to 6-alpha-methyl prednisolone (Urbason, Hoechst, Solu-Medrol, Upjohn). For prophylactic immunosuppression the following combinations were used: cyclosporin + azathioprine + prednisone (17x) or azathioprine + prednisone (3x). Cedetrin was administered by the i.v. route in two to 11 doses a 3 mg substance. Of 20 patients in 6 Cedetrin administration had to be discontinued (allergy, infection, leucopenia, hyperhydration). In 14 the tolerance was satisfactory, the type and frequency of side-effects was similar as after Orthoclone; the antibody formation was less frequent. The specificity of Cedetrin as regards its action on T lymphocytes was confirmed. The effect was good to very good in 6 of 8 patients where the rejection filtrate was histologically active. In 9 patients treated during the first year after renal transplantation the cumulative survival of the graft at the end of the 12th, 24th and 36th month following transplantation was 89%, 67% and 56% resp. Because the therapeutic effect depended on histologically proved rejection activity, the authors consider biopsy of the graft before Cedetrin treatment essential. CONCLUSIONS: The therapeutic administration of monoclonal mouse globulin IgG2a A1CD3 (Cedetrin), developed in the Institute of Molecular Genetics, Academy of Sciences, Czech Republic, produced by Exbio Co., CR) has a favourable effect on rejection episodes or progressing rejection of transplanted kidneys. Treatment is indicated in confirmed histologically active rejection.

[Kinetics of phosphorus in individuals on regular dialysis therapy]. / Kinetika fosforu u jedincu v pravidelném dialyzacním lécení.

In eight subjects with hyperphosphataemia included in regular dialyzation treatment repeatedly phosphorus kinetics (iP) were assessed based on changes in serum concentrations and the amount of iP removed from the organism during every dialysis (D). The serum concentration of iP before dialysis (HD) was on average 3.06 (+/- 0.81) mmol/l and D was on average 55.6 (+/- 10.0) mmol. The value of D calculated per body weight (D/BW) was on average 0.76 (+/- 0.15) mmol/kg. As the differences of predialysis serum concentrations of iP after consecutive HD sessions did not exceed the range of error of analytical assessment of iP, the D values were considered identical with the iP value retained during the interdialysis interval (R). Between values of D/BW and R/BW resp. and the difference of iP serum concentrations at the beginning and end of the interdialyzation interval a significant direct correlation was found (r = 0.715, p < 0.001). From an analysis of this correlation ensues that if the predialysis serum concentration is not to exceed the upper range of the normal value (1.7 mmol/l), the retention of iP in the interdialysis interval must not significantly exceed the value of 0.57 mmol/kg. At the end of the interdialysis interval iP was distributed in the organism in such a way that the extracellular space contained on average 0.38 (+/- 10) from the total retained amount and the remaining portion penetrated into deeper body compartments.(ABSTRACT TRUNCATED AT 250 WORDS)

[Renal excretion of amino acids in patients on a regular dialysis program]. / Renální vylucování aminokyselin u nemocných v pravidelném dialyzacním programu.

In 10 patients with chronic renal failure and a polyfructosan S clearance (CPFS): 1.91-12.70 ml/min (mean 5.68 ml/min) with a preserved residual diuresis (more than 1000 ml/24 hours) renal excretion of 22 amino acids by residual nephrons was investigated before and 12 hours after haemodialysis. It was revealed that 12 hours after haemodialysis a significant drop of the filtered amount of all investigated amino acids occurred. Renal clearance of Ser, Pro, Glu, Gly, Ala, Tyr, Met, Leu and Cit after haemodialysis declined significantly (p < 0.05-0.001). Haemodialysis was not associated with significant changes of fractionated excretions (FE) of amino acids with the exception of Gly (p < 0.01) and Trp (p < 0.05) where an increase of FE was recorded. Hitherto assembled results are consistent with the idea that a reduction of the tubular resorption of amino acids in the residual nephrons in subjects with chronic renal failure cannot be explained by a change of their filtered amount (as "overflow" aminoaciduria) nor as the consequence of retention of some dialyzable substances which could inhibit tubular transport of amino acids. The reduced tubular transport of some of the investigated amino acids (Cys, Lys, Cit, Met, Asn+Gln, Orn, Ile) was significantly related with the drop of tubular sodium transport.