Prognostic Value of Proinflammatory Markers in Patients After Kidney Transplantation in Relation to the Presence of Diabetes.

BACKGROUND: Patients who are receiving immunosuppressive treatment after kidney transplantation are at greater risk of developing new-onset diabetes after transplantation (NODAT). New biochemical markers that may contribute to a better assessment of the prognosis of renal failure for patients diagnosed with diabetes mellitus (DM) are needed. The aim of this study was to assess selected proinflammatory markers in patients after kidney transplantation depending on the prevalence of DM and to evaluate the predictive value of these cytokines. METHODS: A total of 82 patients were divided into 3 groups after kidney transplantation and were included in the analysis: group I, no DM; group II, DM diagnosed before transplantation; and group III, NODAT. Selected marker levels (platelet-derived growth factor, transforming growth factor ß1, tumor necrosis factor receptor II [TNF-RII], and high-sensitivity interleukin-6 [IL-6 HS]) were assessed by using enzyme-linked immunosorbent assays. For summary endpoint, a return to dialysis treatment and/or death of the patient was adopted. RESULTS: Patients with NODAT were characterized by higher levels of IL-6 HS and body mass index. There were no statistically significant differences in the levels of other assessed markers among the 3 analyzed groups. The summary endpoint was observed in 16 cases (19.5%). Patients with summary endpoint during the observation time at baseline had higher levels of TNF-RII (7180 vs 4632 pg/mL; P = .0002) and IL-6 HS (4.58 vs 2.72 pg/mL; P = .033). CONCLUSIONS: Levels of inflammatory markers in patients after kidney transplantation did not differ between groups with and without DM. In the study population, DM was not a significant risk factor for graft loss or death. Patients who experienced these complications at baseline were characterized by higher values of TNF-RII and IL-6 HS.

Effects of Immunosuppressive Drugs on Serum Fatty Acids of Phospholipids Fraction in Renal Transplant Recipients.

BACKGROUND: Immunosuppressive medications often cause posttransplant hyperlipidemia. The effects of cyclosporine (CsA) and tacrolimus (Tac) on lipid profile is well-known; however, there are very few studies related to the effect of these immunosuppressants on fatty acids (FA) of phosholipids fraction (PL) in renal transplant recipients (RTR). We sought to analyze the FA profile in PL fraction of RTR treated with Tac or CsA. METHODS: The study included 65 renal transplant patients on CsA (n = 24, group I) or Tac (n = 41, group II), and 14 healthy controls. Individual serum FA concentrations were measured by gas chromatography. Chemstation software was used to analyze the data. RESULTS: No differences between studied groups and controls were noted for monounsaturated FA, polyunsaturated n-3 FA (PUFA n-3), PUFA n-6, or the ratio of PUFA n-6 to PUFA n-3. The following mean values of FA were significantly higher in the CsA-RTR and Tac-RTR as compared with controls: total FA (P < .01 in both cases), saturated FA (SFA; P < .02 in both cases), C12 (P < .003 in both cases), C18 (P < .003 in both cases), and C18:2 (P < .01 for CsA RTR; P < .02 for Tac RTR). No differences between the measurements in patients on CsA and in patients on Tac were noticed. Significant correlation between SFA and eGFR was observed only in the CsA RTR group (P < .05). A negative relationship between PUFA n-6 and the estimated glomerular filtration rate was seen, but the correlation was not significant. CONCLUSIONS: Immunosuppressive drugs may affect FA metabolism, but the FA profile does not depend on the type of immunosuppressive drug administered.

Influence of prostacyclin infusion on haemodialysis efficiency and blood cells.

Dialysis efficiency, platelet and leukocyte counts, as well as malonyldialdehyde (MDA) level and lactate dehydrogenase (LDH) activity in serum were assessed in 10 patients (8 males, 2 females, aged 28-58 years) treated with repeated haemodialysis due to terminal renal failure. Patients were examined twice: during a 4-hour haemodialysis in the presence of heparin as the anticoagulant, and a week later in the course of another haemodialysis combined with infusion of heparin and prostacyclin. Statistically significant lower level of urea at the end of dialysis and significantly higher urea clearance were found during haemodialysis with prostacyclin-heparin infusion in comparison with infusion of heparin alone. As compared with the initial values obtained prior to dialysis, neutropenia and thrombocytopenia were observed during haemodialysis with heparin alone but the counts remained generally unaltered when both prostacyclin and heparin were administered. During and after haemodialysis with heparin and prostacyclin both MDA level and LDH activity were lower than in case of haemodialysis with heparin alone.

Effect of heparin and prostacyclin-heparin infusion on blood coagulation in haemodialysed patients.

In 10 patients (8 men and 2 women) aged 28 to 58 years (mean 44.4 years) treated by repeated haemodialysis due to end-stage renal failure, the bleeding time, whole-blood coagulation time, one-stage prothrombin time, thrombin time of plasma, activated partial thromboplastin time (APTT), fibrinogen level and euglobulin lysis time have been determined (1) during a 4-hour haemodialysis using heparin as an antithrombotic agent, and (2) one week later in the course of another haemodialysis using prostacyclin-heparin. The values for any of the above parameters with both anticoagulant treatment types did not differ. Plasma fibrinogen level after haemodialysis was significantly lower after administration of heparin alone as compared with the group treated by prostacyclin-heparin infusion. During haemodialysis performed with prostacyclin-heparin infusion, activation of the blood fibrinolytic system was manifested by a significant shortening of euglobulin lysis time, observed after 1.5 hours and after the end of haemodialysis. The above phenomenon did not occur when haemodialysis was performed with heparin alone.

[Evaluation of the effectiveness of hemodialysis using only heparin or prostacyclin with heparin]. / Ocena efektywnosci hemodializy prowadzonej z uzyciem samej heparyny i prostacykliny z heparyna.

In ten patients treated by maintenance hemodialysis due to end-stage renal failure evaluation of dialysis efficiency was performed during the treatment with heparin alone as well as in the course of prostacyclin -heparin infusion. Statistically significant lower level of urea at the end of dialysis and significantly higher urea clearance were found during hemodialysis with prostacyclin -heparin infusion in comparison with infusion of heparin alone.

[Urological complications in patient after kidney transplantation. Correction of ureter stenosis with consequent proper renal graft function]. / Pacjentka po przeszczepieniu nerki z powiklaniem urologicznym. Skuteczna korekta zwezonego moczowodu z nastepowa dobra funkcja przeszczepu.

Urological complications constitute significant problem following renal transplantation. Incidence ranges from 4 to 14% in graft recipients. The most important aspects concerning these complications are early diagnosis and prompt treatment, any delay in diagnosis and management may lead to deterioration of renal graft function or graft loss. The following case report discusses management of hydronephrosis in renal graft caused by ureter stenosis due to scarring and fibrosis of its distal end after remote kidney transplantation. The patient was a 33-year-old woman with previous history of end stage renal failure in the course of chronic glomerulonephritis. A triple drug immunosuppressive regimen consisting of Azathioprine (AZT), Cyclosporine A and Encorton (AZT + CsA + Encorton) was administered during a period of three years after kidney transplantation. At this time AZT administration was discontinued due to chronic viral hepatitis type B. Episodes of expansion sensation (discomfort) and graft pain were reported by the patient which after 3 days were followed by a period of oliguria and then anuria. The patient was admitted to the Department of Nephrology CMUJ, where ultrasound imaging revealed graft hydronephrosis. In the presence of such clinical and biochemical indications due to acute graft failure, one hemodialysis session, was performed. The patient was transferred to the Urological Department CMUJ where ureter exploration was attempted, but was unsuccessful. Subsequently percutaneous nephrostomy was performed which lead to immediate diuresis. Next, distal ureter stenosis (located by the urinary bladder) was surgically removed and reimplantation of the ureter was carried out. Due to early diagnosis and surgical reconstruction of the transplanted ureter, renal graft function returned to normal requiring only one hemo-dialysis session.

[Effect of recombinant human erythropoietin (rHu-EPO) on anemia and selected biochemical parameters in patients in the pre-dialysis period]. / Wplyw rekombinowanej ludzkiej erytropoetyny (rHu-EPO) na niedokrwistosc i wybrane parametry biochemiczne u chorych w okresie przeddializacyjnym.

The effect of recombinant human erythropoietin (rHu-EPO) on anaemia and some biochemical parameters was investigated in 7 predialysis patients. A statistically significant increase in erythrocyte, haematocrit and haemoglobin levels was observed after 3 weeks of treatment and such changes were constant during the 6 month maintenance therapy. The mean urea and creatinine levels were comparable during the tested period in 4 of the studied patients. The other 3 patients did not completed the planed period and started the dialytic therapy because of progression of renal insufficiency. The latter group had more advanced renal failure and higher blood pressure prior to rHu-EPO treatment as compared with the patients who completed the study.

[Lipid abnormalities in kidney diseases--significance of radical hypolipemic therapy (LDL-apheresis)]. / Zaburzenia gospodarki lipidowej w chorobach nerek--znaczenie radykalnej terapii hipolipemicznej (LDL-aferezy).

In several renal diseases such as nephrotic syndrome or terminal renal insufficiency changes in lipids metabolism may lead to increase of cholesterol level or changes in its fractions proportions. There are many clinical and experimental observations demonstrating direct toxic effect of lipids on endothelium leading to impairment of endothelial function what can increase damage of glomeruli. It is associated with passive filtration of lipoprotein to mesangium and active fagocytosis by mesangial cells and infiltrating macrophages, which release cytokines and growth factors increasing mesangial proliferation. There are first publications suggesting possibility of application LDL-apheresis-radical cholesterol removing procedure in renal disease. Periodical cholesterol lowering in the blood reduces proteinuria in patients with resistant for pharmacotherapy nephrotic syndrome, especially with focal glomerulonephritis.

[Results of the treatment of acute renal failure in 3 selected dialysis units in southern Poland 1981-1990]. / Wyniki leczenia ostrej niewydolnosci nerek w 3 wybranych osrodkach dializ Polski poludniowej w latach 1981-1990.

The results of the treatment of patients with acute renal failure (ARF) in dialysis units of Kraków, Nowy Sacz and Tarnów were estimated on the basis of prepared questionnaire. The increased number of patients treated because of ARF was demonstrated in the successive years of the study. The mortality rate in the tested group of patients remained about 27%. It depended on the cause of ARF and equalled to 26.7% in medical, 36.7% in surgical, 8% in obstetrical and 6.7 in urological patients, respectively.

Ethylene glycol acute poisoning treatment results in Kraków in the years 1990-1994.

An analysis of ethylene glycol acute intoxication treatment results was performed in a group of 36 patients hospitalized within a five year period. Mean serum and urine glycol concentrations in the analyzed population ranged from 0-851 mg/dl (mean = 130 mg/dl) and from 12.4 to 930.0 mg/dl (mean 333 mg/dl), respectively. At the time of admission to the clinic 15 of 36 patients were deeply unconscious and mean acid-base balance values were as follows: pH 6.99, pCO2 16.7 mmHg, pO2 140.1 mmHg, HCO3 6.36 mmol/l, BE -29.6 mmol/l. Because of respiratory failure 21/36 patients (58.3%) required controlled ventilation and 24/36 (66.7%) underwent dialysis. Sixteen patients (44.4%) developed acute renal failure. Mean hospitalization period was 16 days (1-53). Eighteen patients (50%) died. The direct death mechanism in 15 patients (83.3%) was asystolia and in the remaining individuals other circulatory disturbances. The main reasons of high mortality rate were multiple organ damages secondary to severe metabolic acidosis.

[Factors influencing prevalence and clinical course of cytomegalovirus (CMV) infection in kidney transplant patients]. / Czynniki wplywajace na wystepowanie i przebieg kliniczny zakazenia wirusem cytomegalii (CMV) u chorych po przeszczepieniu nerki.

In the paper the authors tried to identify factors influencing prevalence and clinical course of cytomegalovirus (CMV) infection in kidney transplant patients. The study was performed in the group of 100 patients after cadaveric kidney transplant followed up in the Chair and Department of Nephrology, Collegium Medicum, Jagiellonian University in Krakow. CMV infection was demonstrated to occur more frequently and significantly earlier in the patients administered prednisone, cyclosporin A and mycophenolate mofetil, compared to the group treated with standard triple-drug-therapy (prednisone, cyclosporin A, azathioprine) or double-drug-therapy (prednisone, cyclosporin A). Higher serum levels of cyclosporin A did not increase prevalence of the infection but urged its onset. Risk for CMV infection was however higher in the group of patients treated for acute rejection episodes, especially with antilymphocyte preparations. No differences were shown in the immunological matching within HLA-A, -B and -DR antigens between the patients without features of CMV Infection and those treated for its active form. The infection occurred significantly more frequently in the recipients with HLA-A1 antigen than in those with HLA-A9 and -DR7. In patients with delayed transplanted kidney functioning, time of the infection onset and a number of its episodes were similar to the remaining population, however severity of the clinical course positively correlated with the duration of acute tubular necrosis (ATN). CMV infection occurred slightly more frequently in patients requiring transfusions compared to those not administered blood preparations. Among patients with AB blood type, active CMV infection occurred statistically less frequently, whereas in those with other blood types percentage of patients with/without CMV infection were comparable.

[Pregnancy in patients with end-stage renal failure on maintenance dialysis: case reports]. / Ciaza u pacjentek przewlekle dializowanych z powodu terminalnej niewydolnosci nerek--opisy przypadków.

Pregnancy in women with end-stage renal failure on maintenance dialysis is rare, and the chance of successful delivery is relatively low. In this paper we present two cases of women who conceived just prior to initiation of renal replacement therapy and the pregnancy was terminated successfully already on chronic dialysis treatment. The special attention was paid on the necessity of multi-disciplinary collaboration and the need for changes in regular dialysis schedule as the conditions crucial for successful delivery. In summary, the review of current literature dealing with mentioned problem was done.

[Results of kidney transplantation in Krakow in 1992-2000]. / Wyniki przeszczepiania nerek w Krakowie w latach 1992-2000.

The aim of the study was an analysis of renal transplantation results in the Krakow Transplant Center during 1992-2000. The analysis concerned 94 cadaveric transplant recipients. The study group included 31 females aged 23 to 61 years (mean 40.4 years) and 63 males aged 16 to 60 years (mean 41.8 years). The time of pre-transplant renal replacement therapy ranged from 4 to 120 months (mean 32 months). The mean time of total ischaemia was 22 hours 20 minutes. The majority of the recipients had three identical antigens out of six typed. Most of the recipients were treated with three immunosuppressive drugs including: Cyclosporine A, Azathioprine and steroids. Immediately after kidney transplantation 25.6% of the patients had urine output and did not require dialysis. Acute renal failure (ARF) of the graft was observed in 73.2% recipients. The average number of hemodialysis sessions in patients presenting ARF was 10. Acute rejection was diagnosed in 41.5% of the patients. The most frequent complications were: CMV (cytomegalovirus) infection, UTI (urinary tract infection) and policytemia. In the study group 1-year survival rate of the patients was 97.8% and 1-year graft survival was 93.61%. The 5-year survival rates both in the patients and the grafts were very satisfactory (96.96% and 87.7% respectively).

Activity of some lysosomal enzymes in peripheral blood lymphocytes of patients with lung cancer. A cytochemical study.

In 33 patients with lung cancer (6 women and 27 men, aged at average 61.2 years) the activity and intracellular localization of acid phosphatase, beta-glucuronidase and N-acetyl-beta-glucosaminidase in peripheral blood lymphocytes were determined by means of semiquantitative cytochemical methods. In comparison to the control group of healthy subjects, the patients with lung cancer showed increased counts of acid phosphatase-positive lymphocytes with granular-diffuse cytochemical reaction, increased counts of beta-glucuronidase-positive lymphocytes with solely granular type of reaction and increased numbers of N-acetyl-beta-glucosaminidase-positive cells showing the granular, granular-diffuse and diffuse type of reaction. The total count of beta-glucuronidase-positive and N-acetyl-beta-glucosaminidase-positive lymphocytes was significantly elevated in these patients. The authors discuss the significance of their observations for evaluating lymphocyte response in patients with lung cancer.

Effect of hemodialysis on plasma and erythrocyte phenylalanine levels in end-stage kidney patients.

Effect of hemodialysis on phenylalanine distribution between the intracellular water of erythrocytes and the plasma obtained from patients with end-stage kidney was studied by fluorimetric measurements of phenylalanine concentration according to the method of Mc Caman and Robins. The measurements were performed twice: before and after 4 h of hemodialysis. It was found that the nondialyzed patients with end-stage kidney had higher than normal phenylalanine concentrations both in plasma and in the intracellular water of erythrocytes. Hemodialysis brought about a decrease in plasma phenylalanine level without influencing the erythrocyte concentration of the studied amino acid and without altering the function of the erythrocyte cell membrane, as far as the phenylalanine transport was concerned.

Two cases of unusual rupture of aortic aneurysm.

Two cases of unusual rupture of aortic aneurysm with extravasation in the bronchus and duodenum are described. The clinical evolution of such aneurysm ruptures is associated with considerable diagnostic difficulties due to the absence of pathognomonic typical features and the short survival time after onset of pain symptoms.

[Use of urea kinetic modeling in patients on maintenance hemodialysis]. / Zastosowanie modelowania kinetycznego mocznika u chorych leczonych powtarzanymi hemodializami.

The effect of urea kinetic modeling (u.k.m.) application on dialysis efficiency and metabolic status was evaluated in 50 maintenance dialyzed patients. U.k.m. sessions were performed once a month based on the self-developed computer program to control dialysis. The dialysis index (Kt/V), the time averaged concentration (TAC), protein catabolic rate (pcr) and dialysis effectiveness (Ct/Co) were evaluated and the results obtained at the beginning and after 2, 4, and 8 months of the study were compared. Kt/V had risen significantly in the modeled patients from 1.04 to 1.24 and was accompanied by 12% Ct/Co increase of urea removal after 8 months. The tendency of the moderate (non significant) decrease of TAC from 54.57 to 52.48 mg% BUN was observed during the study. According to the NCDS criteria the percentage of adequately dialyzed patients increased from 42% at the beginning to 64% after 80 months; underdialyzed patients decreased from 16% to 6% and malnourished also from 16% to 6%, respectively, after u.k.m. application. Dialysis effectiveness for creatinine and uric acid described by Ct/Co for the above after 4 and 8 months was significantly increased when compared with the results obtained at the beginning of the study. These results indicate that u.k.m. application allowed to take control over uremic toxemia and improved dialysis adequacy in patients on maintenance dialysis. Protein catabolic rate in studied patients increased from 1.18 to 1.24 g/kg/per day during the study and it was accompanied by a total blood protein and serum albumin increase. This could indicate improvement of the nutritional status of dialyzed subjects.

[Recombinant human erythropoietin stimulates synthesis of fetal hemoglobin in patients with renal anemia treated by repeated hemodialysis]. / Rekombinant ludzkiej erytropoetyny pobudza synteze hemoglobiny plodowej u chorych z niedokrwistoscia nerkowo-pochodna leczonych powtarzanymi hemodializami.

Effect of intravenously administered recombinant human erythropoietin (rHu EPO) on haemoglobin (Hb) level, haematocrit (Ht), reticulocyte count and foetal haemoglobin (HbF) concentration was assessed in 10 patients with anaemia, treated by repeated haemodialysis due to end-stage kidney. As compared to the initial values, erythropoietin treatment brought about a significant increase in all the parameters examined. During the subsequent therapy with lower, supporting doses of erythropoietin, the elevated HbF values fell back to normal, whereas the higher level of total Hb and Ht were maintained.