[Acquired perforating dermatosis in the patient with chronic kidney disease ­ case report and literature review].

Acquired perforating dermatosis (APD) represents a heterogenous group of skin disorders characterized histopathologically by transepithelial elimination (TEE) of dermal structures. APD is manifested clinically as multi-localized, papulo-nodular skin lesions accompanied by a refractory pruritus. APD typically coexists with long-term disorders, most often diabetic kidney disease (DKD). The paper presents a case of a 56-year-old male patient with chronic kidney disease (CKD) and concomitant acquired reactive perforating collagenosis (ARPC), which is a subtype of APD. Etiological theories of ARPC as well as current diagnostic and treatment principles in dermatosis were described. On the basis of the presented case report and the literature review attention was paid to diagnostic difficulties associated with APD. The assumption was made that APD can be an underdiagnosed disease and thus it is not treated correctly. According to the authors' opinion, this is an important circumstance to popularize the knowledge about APD.

Assessment of cytokine release after in vitro stimulation of whole blood with legionella pneumophila in immunocompromised patients.

This study we examined ex vivo potential of the immune response after stimulation of whole blood with L. pneumophila SG 1, SG 2-14 and L. pneumophila standard strain ATCC 33152 in immunocompromised patients, such as: hemodialysis patients and patients after renal transplantation. The levels of TNF-α and IFN-γ in supernatants were measured with the use of commercial ELISA kits. The synthesis of TNF-α and IFN-γ after stimulation with L. pneumophila were analyzed in two aspects: differentiated stimulatory activity in relation to SG 1, SG 2-14 and ATCC 33152 L. pneumophila and differentiated response of the hemodialysis patients and patients after renal transplantation in relation to the control group. The positive and negative results of anti-L. pneumophila antibodies of two groups of our patients were found for the analysis of the stimulatory activity of L.pneumophila as a primary or secondary response. In patients with immunosuppression the response in the secretion of cytokines (TNF-α and IFN-γ) was reduced after stimulation of L. pneumophila SG 1 but in varying degrees after stimulation of L. pneumophila SG 2-14, which indicates that the risk of the infection is varied.

Interleukin-18 gene polymorphism and risk of CVD in older patients with type 2 diabetes mellitus.

OBJECTIVE: Interleukin-18 (IL-18), a proinflammatory cytokine, plays a key role in the acute and chronic inflammatory processes. It is associated with risk of developing cardiovascular disease (CVD). The aim of this study was to evaluate association between G(-137)C polymorphism (rs187238) in the IL-18 gene and risk of diabetes and CVD in type 2 diabetes patients. METHODS: We examined 1548 T2DM patients and 590 controls. All subjects were genotyped for the G(-137)C promoter region polymorphism by polymerase chain reaction (PCR-SSP). RESULTS: Genotype distribution of the G(-137)C polymorphism showed no significant difference between T2DM patients and controls (p=0.115). An association with CVD was analyzed in two age groups: ⩾65 and <65years. In patients younger than 65years there was a tendency to association of CC genotype with CAD (OR 1.87, 95% CI 1.0-3, p=0.051). In contrast, in subjects aged 65 or older, the C allele and CC genotype showed the significant association with the presence of CVD, with the OR 1.99, p=0.001 and OR 5.31, p=0.006, respectively. The C allele carriers showed the higher prevalence of CVD compared to non-carriers (61% vs. 39%, p<0.0001). CONCLUSION: Older T2DM patients carrying the C allele of IL-18 G(-137)C polymorphism have a significantly increased risk of CVD.

[Clinical analysis of CAPD-treated patients without anemia]. / Analiza kliniczna chorych bez niedokrwistosci leczonych ciagla ambulatoryjna dializa otrzewnowa.

Very few patients with chronic renal failure (CRF) can maintain a hemoglobin concentration > 12 g/dl without rHuEpo treatment. Among 68 patients treated in our Department by CAPD, 12 of them (17.6%) with daily diuresis < 400 ml, for at least 6 months had Hb level over 12 g/dl, Hct > 35% without rHuEpo treatment. In present study we carried out a clinical analysis of 12 patients without anaemia treated CAPD from 12 to 63 months. Mean Hb value was 13.5 +/- 0.97 g/dl (range 12.4-14.9 g/dl). None of 12 patients had acquired cystic kidney disease in ultrasonographic investigation. Nobody of these patients was rHuEpo treated. Mean C-reactive protein as well as ferritin serum concentrations was significantly lower in this group of patients compared to others. Mean endogenous Epo concentration was not significantly different from other CAPD pts. We conclude that spontaneous increase in Hb concentration in CAPD pts was not connected with increase in the serum endogenous Epo concentration. Factors other than Epo probably play a role in regulation of erythropoiesis in these pts.

Cardiac sympathetic hyperactivity in chronic kidney disease--a comparison between haemodialysis and peritoneal dialysis patients.

BACKGROUND: The effect of renal replacement therapy on cardiac sympathetic function in patients with chronic kidney disease has not yet been completely elucidated. The aim of this study was to evaluate the impact of renal replacement therapy on the activity of cardiac sympathetic nervous system. MATERIAL AND METHODS: Thirty-four patients with chronic kidney disease were studied: 14 patients (6 men, mean age 48 ± 11 years) were receiving peritoneal dialysis (PD) and 20 patients (20 men, mean age 52 ± 10 years) were receiving haemodialysis (HD). Patients with diabetes and heart failure were excluded from the study. All patients underwent resting gated myocardial perfusion and ¹²³I-mIBG myocardial scintigraphy from which early and late heart to mediastinum ratios (HRM) and myocardial washout rate (WR) values were calculated. RESULTS: PD and HD patients did not differ with respect to left ventricular ejection fraction (52 ± 9% vs. 57 ± 7%) and summed rest score (3.8 ± 2.4 vs. 3.5 ± 0.3). Similarly, early (1.89 ± 0.23 vs. 1.87 ± 0.27) and late (1.76 ± 0.47 vs. 1.74 ± 0.25) HMR, and washout rate (35.5 ± 15.8% vs. 31.3 ± 9.4%) were not significantly different between the two groups of patients. CONCLUSIONS: These results suggest that the applied method of renal replacement therapy has no significant influence on global activity of cardiac sympathetic nervous system.

Aortic stiffness and valvular calcifications in patients with end-stage renal disease.

OBJECTIVES: To evaluate the presence and extent of cardiac calcifications and aortic stiffness in patients with end-stage renal disease (ESRD). PATIENTS AND METHODS: The study group consisted of 60 patients with ESRD with a mean age of 51.7 years, treated with peritoneal dialysis. In all patients transthoracic echocardiogram was performed to assess the following parameters: left ventricular end-systolic diameter, left ventricular end-diastolic diameter (LVEDd), interventricular septum end-diastolic diameter (IVSDd), posterior wall end-diastolic diameter (PWDd), ejection fraction (EF), fractional shortening (FS), aortic maximal and minimal diameter, aortic valve area, mitral valve area (MVA), left ventricular ejection time (LVET), maximal aortic velocity. Aortic stiffness index (AS) was calculated. Aortic and mitral valve calcifications were assessed. RESULTS: Patients with ESRD had a larger left ventricle (LVEDd 5.4 cm vs. 4.76 cm) and its wall was thicker (IVSDd 1.36 cm vs. 1.02 cm; PWDd 1.31 cm vs. 0.94 cm). Patients had poorer left ventricle contractility (EF 56.1 vs. 61.6%; FS 28.5 vs. 33.2%). Atherosclerotic plaques, calcified plaques and valvular calcifications were more frequently detected in patients with ESRD. Patients with ESRD had significantly higher values of the AS index: (5.34 vs. 3.24). Among ESRD subjects with the stiffer aorta, atherosclerotic plaques including calcificones and the aortic valve damage were more frequently detected. CONCLUSIONS: Patients with ESRD are characterized by increased aortic stiffness. Atherosclerotic plaques in the aorta as well as cardiac and large vessels calcifications are more common among patients with ESRD. In patients with ESRD there is a correlation between an increase in aortic stiffness and damage of aortic valvular leaflets as well as calcifications of atherosclerotic plaques in the aorta. The degree of aortic stiffness is not related to impairment of mitral valvular leaflets and extravalvular calcifications. A relationship between aortic stiffness and aortic or aortic valve calcifications suggest a different pathogenesis of aorta calcification as compared to that underlying calcifications of other localizations.

[Analysis of some risk factors of coronary artery calcification in peritoneal dialysis patients]. / Badanie niektórych czynników ryzyka kalcyfikacji naczyn wiencowych u pacjentów leczonych dializa otrzewnowa.

Cardiovascular disease (CVD) is a major cause of death in peritoneal dialysed patients (PD-pts). Coronary artery calcification (CAC) is likely to affect the development of CVD. Purpose of our study was to evaluate coronary artery calcification and risk factors of this calcification in PD-pts. We studied 62 patients (38 F, 24 M) undergoing peritoneal dialysis (PD). Coronary calcification was examined by ECG-gated multidetector CT (Light Speed Ultra) using Agatson (AG) and volumetric (V) methods. Patients were divided into 3 groups depending on mean value of estimated CAC: group A-no calcification, group B-CAC maximal value 400 mm3, group C-CAC value more than 400 mm3. As risk factors of CAC were evaluated: patients age, sex, dialysis duration, serum concentration of Ca, P, homocysteine CRP and fibrinogen, as well as, CaxP product, intact PTH; presence of diabetes or hypertension. Coronary artery calcification was detected in 68% of patients. In the whole observed population positive correlation between CAC determined by AG and V methods and CRP (r = 0.36, p < 0.05) as well as patients age (r = 0.5, p < 0.01) was observed. There was also positive correlation between CAC and fibrinogen concentration (AG CAC r = 0.58, p < 0.05; V CAC r = 0.72, p < 0.05). When compared group C with the groups A and B cardiovascular complications were in this group more frequent than in the last two: 4 patients from group C died because of cardiovascular complications.

[Changes in selected parameters of bone turnover resulting from use of different calcium concentrations in dialysate of patients treated with CAPD]. / Zmiennosc wybranych parametrów przemiany kostnej przy zastosowaniu dwóch róznych stezen wapnia w plynie dializacyjnym u pacjentów dializowanych otrzewnowo.

Renal osteodystrophy is a common complication occurring in patients with end stage disease. Using dialysis solutions with different concentrations of calcium undoubtedly has an influence on calcium-phosphorus homeostasis and bone turnover. The aim of the study was to examine the influence of dialysate with calcium concentrations of Ca 1.75 mmol/l and Ca 1.25 mmol/l on selected parameters of bone turnover. The study was performed on 12 clinically stable patients treated with CAPD. After 24 weeks of the treatment with Ca 1.75 mmol/l solution the initial investigation was performed. The next step was to switch to dialysate with the Ca level of 1.25 mmol/V. After 2, 12, and 24 weeks of the treatment with solutions of low calcium level the concentrations of PTH, osteocalcin, total calcium, and ionized calcium, phosphorus were calculated. We have observed that the level of PTH and osteocalcin was increased significantly at the time of treatment with Ca 1.25 mmol/l solution. We have also observed a decrease in concentration of total and ionized calcium. We did not observe any change of phosphorus concentrations in the serum of treated patients.

Asymptomatic bacteriuria in patients on continuous ambulatory peritoneal dialysis.

UNLABELLED: Chronic inflammatory state and chronic infections appear to be one of the most important risk factors of morbidity and mortality in patients (pts) on dialysis. The aim of our study was to determine the frequency of urinary tract infections (UTI) in clinically asymptomatic patients on CAPD. The study included 43 (22F, 21M) clinically stable asymptomatic CAPD patients with diuresis ranged from 300 to 2500 ml per 24 h. Clean catch urine specimen, was cultured and identified by standard technique. Urine from 31 patients had no significant organism growth, from 12 patients grew over 100,000 colonies per ml; 8 patients had been infected with E. coli, 2 pts with Proteus mirabilis, one with Enterococcus gallinarum, one with Klebsiella oxytocea. 7/12 infected pts were diabetic, 67% infected and 13% not infected pts had pyuria. CONCLUSIONS: Immune system disturbance and renal failure can predispose to common asymptomatic UTI in CAPD pts. E. coli is the most common bacterial strain found in infected dialysis pts. Diabetes mellitus is and additional predisposing factor for UTI in patients on CAPD. Pyuria is a valuable parameter of UTI in CAPD patients.

Genetic polymorphisms of renin-angiotensin system and progression of interstitial nephritis.

Genes of the renin-angiotensin system (RAS) are involved in the progression of renal failure. Among them, the angiotensin-converting enzyme (ACE), angiotensinogen (AGT) and angiotensin II type 1 receptor (AT1R) genes are of particular interest. We examined polymorphisms of these three genes for association with the development of interstitial nephritis and progression to end-stage renal failure. The allele frequency and genotype distribution were compared in 90 patients with interstitial nephritis and 200 healthy controls. DNA samples were genotyped by polymerase chain reaction (PCR). We did not find statistically significant differences between groups in the insertion/deletion polymorphism of the ACE gene. An involvement of M235T polymorphism of the AGT gene in renal disease was observed in our study. The frequency of the T allele was higher in patients than in controls (32% vs. 24%). In the A1166C AT1R polymorphism the homozygous CC genotype was also more frequent in interstitial nephritis patients (7% vs. 3.5%). In patients carrying the C allele, an average time to ESRD was significantly shorter than in subjects with the AA genotype. Our study shows the association of the AGT and AT1R gene polymorphisms with the development and progression of interstitial nephritis. The C allele of the A1166C polymorphism appears to be a risk factor for faster disease progression.

Comparison between some anthropometric measurements in adequately treated peritoneal dialysis and hemodialysis patients.

Some anthropometric measurements are usually used to estimate the nutritional status of dialysis patients. The aim of our study was the comparison of some anthropometric measurements in patients adequately (from the clinical point of view) treated with peritoneal dialysis (PD) and hemodialysis (HD). The study was performed on 40 chronic dialysis (both: PD and HD), non-diabetic patients, without any inflammatory process. The patients were divided into two groups, 20 patients in each: I peritoneal dialysis patients (PD-pts), II--hemodialysis patients (HD-pts). In each patient body mass index (BMI), total body water (TBW), lean body mass (LBM), fat body mass (FBM), upper limb musculature (ULM), mid arm circumference in tension and in rest MAC-t and MAC-r), triceps skinfold thickness (TSF) and dialysis index (Kt/V) were determined. The obtained values were analyzed statistically and compared between the groups. In peritoneal dialysis the patients' higher values of BMI, FBM, MAC and TSF (p < 0.01), as well as higher LBM and ULM (p < 0.05) than those in hemodialysis patients were observed. TBW was not statistically different in the PD and HD patients (p > 0.05). Mean Kt/V values observed were as follows: 2.16 +/- 0.48 in PD patients vs 1.05 +/- 0.35 in the HD patients; (p < 0.01). We conclude that adequately treated, from the clinical point of view the PD patients had better anthropometric indicators of nutritional status than the adequately treated HD patients.