Lipid abnormalities in chronic renal failure patients undergoing hemodialysis.

Lipid abnormalities are common in patients with renal disease, probably contributing to the high incidence of cardiovascular diseases in this population. In this study we determined the plasma and erythrocyte lipid profile in patients with chronic renal failure (CRF) along 30 months under hemodialysis. In the same patients the influence of cuprophane and polysulfone dialysis membranes on the fatty acid pattern of plasma and erythrocytes, before and after dialysis, was also studied. Fluidity in erythrocyte membranes was also assessed by diphenylhexatriene (DPH) fluorescence polarization measurements. Triglyceride levels were increased in the plasma and in erythrocyte membranes of CRF patients compared to healthy subjects. Plasma polyunsaturared fatty acids decreased whereas palmitic and monounsaturated acids increased in CRF patients. No changes were observed in either the fatty acid profile or DPH fluorescence anisotropy of erythrocyte membranes. The lipid composition abnormalities persisted after 18 months and they became more notorious after 30 months. Neither the plasma nor the erythrocyte membrane lipid pattern changed in CRF patients during the dialysis session, regardless of the dialysis membrane used. We conclude that CRF patients under regular hemodialysis evidence a gradual deterioration in the fatty acid and triglyceride abnormalities, a finding that might be relevant to the risk of cardiovascular disease in this setting.

Lipid abnormalities in chronic renal failure patients undergoing hemodialysis.

Lipid abnormalities are common in patients with renal disease, probably contributing to the high incidence of cardiovascular diseases in this population. In this study we determined the plasma and erythrocyte lipid profile in patients with chronic renal failure (CRF) along 30 months under hemodialysis. In the same patients the influence of cuprophane and polysulfone dialysis membranes on the fatty acid pattern of plasma and erythrocytes, before and after dialysis, was also studied. Fluidity in erythrocyte membranes was also assessed by diphenylhexatriene (DPH) fluorescence polarization measurements. Triglyceride levels were increased in the plasma and in erythrocyte membranes of CRF patients compared to healthy subjects. Plasma polyunsaturared fatty acids decreased whereas palmitic and monounsaturated acids increased in CRF patients. No changes were observed in either the fatty acid profile or DPH fluorescence anisotropy of erythrocyte membranes. The lipid composition abnormalities persisted after 18 months and they became more notorious after 30 months. Neither the plasma nor the erythrocyte membrane lipid pattern changed in CRF patients during the dialysis session, regardless of the dialysis membrane used. We conclude that CRF patients under regular hemodialysis evidence a gradual deterioration in the fatty acid and triglyceride abnormalities, a finding that might be relevant to the risk of cardiovascular disease in this setting.

Effect of methyl-prednisone and cyclosporine on the lipid pattern and polyunsaturated fatty acid biosynthesis in the rat.

The hyperlipidemia posttransplant has been largely attributed to immunosuppressant agents. In the present work we evaluated the effect of oral administration of cyclosporine (5 mg/kg/day) and/or methyl-prednisone (1 mg/kg/day) on lipid composition and polyunsaturated fatty acid biosynthesis in normal adult male rats. The results obtained showed that both agents produced a delay on the growth together with a significant loss of body weight. In liver microsomal fraction from rats treated with methyl-prednisone, a depression in delta 6 and delta 5 desaturation activities, was observed. This effect was corroborated in the fatty acid pattern through the enhancement of linoleic and dihomo-gamma-linolenic acids, and a depression of arachidonic acid. Similar results were noticed in those rats treated with both drugs when compared to the controls. No changes were observed either in the amount of liver microsomal total lipids or in the fatty acid composition of kidney and testis microsomes, as well as in erythrocyte membranes, among the different groups studied. Cyclosporine alone produced a significant depression in plasma triglycerides and showed no modifications in the other lipid parameters studied compared to the controls. Fluorescence anisotropy measured in the different membranes was not modified by the several treatments used. In view of the aforementioned data, it can be stated that methyl-prednisone would be the responsible for many of the lipid disorders that can be observed in posttransplant patients when they are subjected to the combined immunotherapy with cyclosporine.

Effect of methyl-prednisone and cyclosporine on the lipid pattern and polyunsaturated fatty acid biosynthesis in the rat

The hyperlipidemia posttransplant has been largely attributed to immunosuppressant agents. In the present work we evaluated the effect of oral administration of cyclosporine (5 mg/kg/day) and/or methyl1-prednisone (1 mg/kg/day) on lipid composition and polyunsaturated fatty acid biosynthesis in normal adult male rats. The results obtained showed that both agents produced a delay on the growth together with a significant loss of body weight. In liver microssomal fraction from rats treated with methyl1-prednisone, a depression in delta 6 and delta 5 desaturation activited, was observed. This effect was corroborated in the fatty acid pattern through the enhancement of linoleic and dihomo-gamma-linolenic acids, and a depression of arachidonic acid. Similar results were noticed in those rats treated with both drugs when compared to the controls. No changes were observed either in the amount of liver microsomal total lipids or in the fatty acid composition of kidney and testis microsomes, as well as in erythrocyte membranes, among the different groups studied. Cyclosporine alone produced a significant depression in plasma triglycerides and showed no modifications in the other lipid parameters studied compared to the controls. Fluorescence anisotropy measured in the different membranes was not modified by the several treatments used. In view of the aforementioned data, in can be stated that methyl-prednisone would be the responsible for many of the lipid disorders that can be observed in posttransplant patients when they are subjected to the combined immunotherapy with cyclosporine. (AU)

Effect of methyl-prednisone and cyclosporine on the lipid pattern and polyunsaturated fatty acid biosynthesis in the rat

The hyperlipidemia posttransplant has been largely attributed to immunosuppressant agents. In the present work we evaluated the effect of oral administration of cyclosporine (5 mg/kg/day) and/or methyl1-prednisone (1 mg/kg/day) on lipid composition and polyunsaturated fatty acid biosynthesis in normal adult male rats. The results obtained showed that both agents produced a delay on the growth together with a significant loss of body weight. In liver microssomal fraction from rats treated with methyl1-prednisone, a depression in delta 6 and delta 5 desaturation activited, was observed. This effect was corroborated in the fatty acid pattern through the enhancement of linoleic and dihomo-gamma-linolenic acids, and a depression of arachidonic acid. Similar results were noticed in those rats treated with both drugs when compared to the controls. No changes were observed either in the amount of liver microsomal total lipids or in the fatty acid composition of kidney and testis microsomes, as well as in erythrocyte membranes, among the different groups studied. Cyclosporine alone produced a significant depression in plasma triglycerides and showed no modifications in the other lipid parameters studied compared to the controls. Fluorescence anisotropy measured in the different membranes was not modified by the several treatments used. In view of the aforementioned data, in can be stated that methyl-prednisone would be the responsible for many of the lipid disorders that can be observed in posttransplant patients when they are subjected to the combined immunotherapy with cyclosporine.

Effect of methyl-prednisone and cyclosporine on the lipid pattern and polyunsaturated fatty acid biosynthesis in the rat.

The hyperlipidemia posttransplant has been largely attributed to immunosuppressant agents. In the present work we evaluated the effect of oral administration of cyclosporine (5 mg/kg/day) and/or methyl-prednisone (1 mg/kg/day) on lipid composition and polyunsaturated fatty acid biosynthesis in normal adult male rats. The results obtained showed that both agents produced a delay on the growth together with a significant loss of body weight. In liver microsomal fraction from rats treated with methyl-prednisone, a depression in delta 6 and delta 5 desaturation activities, was observed. This effect was corroborated in the fatty acid pattern through the enhancement of linoleic and dihomo-gamma-linolenic acids, and a depression of arachidonic acid. Similar results were noticed in those rats treated with both drugs when compared to the controls. No changes were observed either in the amount of liver microsomal total lipids or in the fatty acid composition of kidney and testis microsomes, as well as in erythrocyte membranes, among the different groups studied. Cyclosporine alone produced a significant depression in plasma triglycerides and showed no modifications in the other lipid parameters studied compared to the controls. Fluorescence anisotropy measured in the different membranes was not modified by the several treatments used. In view of the aforementioned data, it can be stated that methyl-prednisone would be the responsible for many of the lipid disorders that can be observed in posttransplant patients when they are subjected to the combined immunotherapy with cyclosporine.

Anticuerpos contra el virus de la hepatitis C - anti HCV. Prevalencia e influencia sobre la morbimortalidad en los pacientes sometidos a trasplante renal, en los dos ultimos anos del programa de trasplante renal de la ciudad de la Plata / Hepatitis C viruses antibodies - anti HCV. Prevalence and their influence on the morbi-mortality in transplantation patients, in the last two years of the kidney transplantation program of the La Plata city

Se estudiaron 34 pacientes con trasplante renal (TxR), 18 varones y 16 mujeres, con el objetivo de conocer la prevalencia de Anti HCV, en este tipo de pacientes y su influencia sobre la morbimortalidad temprana. La media de segmiento fue 8.44 DS 6.7 meses y la de edad 38.32 años DS 13.97. Todos recibieron el mismo esquema inmuno-supresor y los episodios de rechazo se trataron con pulsos de metilprednisolona. Resultaron Anti HCV r (por EIA II) de Abbott e Inmunoblotting de Péptidos Sintéticos LIA TEK Organon Teknika); 7 (20.6 por ciento) pacientes y (NR) 27 (79.4 por ciento). Recibieron injerto de donante cadavérico 4 (57.1 por ciento), Anti HCV R y 10 (37.0 por ciento) Anti HCV NR; de donante vivo relacionado 3 (42.9 por ciento) Anti HCV R y 17 (63.0 por ciento) Anti HCV NR. Tenían antecedentes de haber pedacido hepatitis 6 (85.7 por ciento) de lso 7 Anti HCV R: 2 hepatitis crónicas y 4 agudas (2 HBV y 2 no B (NABV) y 6 (22.2 por ciento) de los 27 Anti HCV NR. El tiempo medio de tratamiento hemodialítico antes del trasplante en el grupo Anti HCV r fue 63.0 DS 27.0 meses y resultó significativamente superior (P<0.05) al del grupo Anti HCV (NR) (27.3 DS 20.7). Episodios de rechazos, hepatopatías post-trasplante y sobrevida del injerto y del paciente no fueron significativamente diferentes entre los pacientes Anti HCV R y los NR.

Anticuerpos contra el virus de la hepatitis C - anti HCV. Prevalencia e influencia sobre la morbimortalidad en los pacientes sometidos a trasplante renal, en los dos ultimos anos del programa de trasplante renal de la ciudad de la Plata / Hepatitis C viruses antibodies - anti HCV. Prevalence and their influence on the morbi-mortality in transplantation patients, in the last two years of the kidney transplantation program of the La Plata city

Se estudiaron 34 pacientes con trasplante renal (TxR), 18 varones y 16 mujeres, con el objetivo de conocer la prevalencia de Anti HCV, en este tipo de pacientes y su influencia sobre la morbimortalidad temprana. La media de segmiento fue 8.44 DS 6.7 meses y la de edad 38.32 años DS 13.97. Todos recibieron el mismo esquema inmuno-supresor y los episodios de rechazo se trataron con pulsos de metilprednisolona. Resultaron Anti HCV r (por EIA II) de Abbott e Inmunoblotting de Péptidos Sintéticos LIA TEK Organon Teknika); 7 (20.6 por ciento) pacientes y (NR) 27 (79.4 por ciento). Recibieron injerto de donante cadavérico 4 (57.1 por ciento), Anti HCV R y 10 (37.0 por ciento) Anti HCV NR; de donante vivo relacionado 3 (42.9 por ciento) Anti HCV R y 17 (63.0 por ciento) Anti HCV NR. Tenían antecedentes de haber pedacido hepatitis 6 (85.7 por ciento) de lso 7 Anti HCV R: 2 hepatitis crónicas y 4 agudas (2 HBV y 2 no B (NABV) y 6 (22.2 por ciento) de los 27 Anti HCV NR. El tiempo medio de tratamiento hemodialítico antes del trasplante en el grupo Anti HCV r fue 63.0 DS 27.0 meses y resultó significativamente superior (P<0.05) al del grupo Anti HCV (NR) (27.3 DS 20.7). Episodios de rechazos, hepatopatías post-trasplante y sobrevida del injerto y del paciente no fueron significativamente diferentes entre los pacientes Anti HCV R y los NR. (AU)

[Hepatitis C viruses antibodies. Prevalence and their influence on morbidity-mortality in renal transplant recipients, in the last two years of the kidney transplantation program in La Plata city]. / Anticuerpos contra el Virus de la Hepatitis C--anti HCV. Prevalencia e influencia sobre la morbimortalidad en los pacientes sometidos a trasplante renal, en los dos ultimos años del programa de trasplante renal de la ciudad de La Plata.

UNLABELLED: A small series of 34 renal transplanted patients (RTx) were studied, 18 males and 16 females in order to know the prevalence of Anti HCV in this type of patients and their influence on early morbi-mortality. The follow-up mean was 8.44 months SD 6.7, and Age 38.32 SD 13.97. All patients were under the same immunosuppressive scheme, and rejection episodes were treated with methilprednisolone pulses. The results were: 7 (20.6%) Anti HCV seroreactives (R) (EIA II Abbott and Immunoblotting of synthetic Peptides LIA TEK Organon Teknika); and 27 (79.4%) non-serorectives (NR), 14 patients received grafts from cadaveric donor; 4 (57.1%) Anti HCV (R), and 10 (37.0%) Anti HCV (NR). 20 patients have received grafts from lived-related donors: 3 (42.9%) Anti HCV (R), and 17 (63.0%) Anti HCV (NR). 6 (85.7%) of the 7 patients Anti HCV (R) had hepatitis history: 2 chronic hepatitis, 4 acute hepatitis (2HBV) and 2 no A no B (NANBV) and 6 (22.2%) of the 27 Anti HCV (NR). The mean time of hemodialysis treatment before transplantation in the Anti HCV (R) group was of 63.0 months SD27.0, and it was significantly superior (P < 0.05) to the Anti HCV (NR) group with 27.3 months SD 20.7. There were no significant differences between the Anti HCV (R) and (NR) patients with regard to rejection episodes, post-transplant hepatopathies, and survival of graft and patient. CONCLUSIONS: 1) Anti HCV prevalence is of 20.6%. 2) Time of hemodialysis prior to transplantation and an hepatitis history during hemodialysis came out to be significantly higher in Anti HCV (R) RTx. 3) Morbi-mortality is no modified by the presence of Anti HCV during a mean follow-up period of 8.44 months.

[Histopathological and functional study of the kidney in non-insulin dependent diabetes mellitus]. / Estudio histopatológico y funcional del riñón en la diabetes no insulino dependiente.

The histopathological characteristics of the kidney using light microscopy and immunofluorescence studies in samples obtained by renal percutaneous biopsy in 19 women and 7 men with non-insulin dependent diabetes mellitus (NIDDM) (mean of age: 55.07 +/- 9.04 yr and mean of "known" diabetes duration: 7.50 +/- 6.87 yr) were studied. The relationship with age, blood pressure, diabetic retinopathy and other complementary diagnostic methods such as serum creatinine (Cr), creatinine clearance (CrC), renal plasma flow (RPF), proteinuria and filtration fraction (FF) were also determined. Light microscopy studies detected 92.3% of patients with renal lesions of different degrees of severity. The presence and severity of glomerulopathy and arteriolopathy were related to diabetes duration (r: 0.764) and they were related to each other (rs: 0.773). In 2 patients, lesions were not observed and in 11 out of 14 patients with less than 5 yr of diabetes duration, mild lesions were detected. However, the histological changes became worse after that period. The glomerulopathy was also statistically correlated with Cr, CrC, RPF, proteinuria and FF. By immunofluorescence, fibrinogen, IgA and C3 were the most frequent and intense precipitates observed. They increased with diabetes duration and were located predominantly in the wall and the periphery of the glomerules and in renal tubules, suggesting that they originated by trapping. There were no precipitates in the mesenchyma, they were scarce in the interstice, Bowman's capsule and arterioles. Statistical correlation between diabetic histopathological renal changes and retinopathy was found. These results confirm that lesions in the kidney and retina in non-insulin dependent diabetic patients generally appear and evolve in a similar manner. Hypertension was diagnosed in 80.76% of patients, without statistical correlation between blood pressure and renal lesions. This suggests that at the onset, in non-insulin dependent diabetic patients hypertension and nephro-pathy are caused by different and independent pathogenic mechanisms. However, at an end stage, it seems that both situations can influence each other in a way that their evolution becomes more severe. Nephropathy in non-insulin dependent diabetes mellitus displayed scarce clinical signs and poor laboratory evidence except when the renal lesions become too severe. The lack of correlation between renal lesions and patients' age and blood pressure suggests the participation of diabetes at the onset of kidney structural impairment.

Estudio histopatológico y funcional del riñón en la diabetes no insulino dependiente. / [Histopathological and functional study of the kidney in non-insulin dependent diabetes mellitus]

The histopathological characteristics of the kidney using light microscopy and immunofluorescence studies in samples obtained by renal percutaneous biopsy in 19 women and 7 men with non-insulin dependent diabetes mellitus (NIDDM) (mean of age: 55.07 +/- 9.04 yr and mean of [quot ]known[quot ] diabetes duration: 7.50 +/- 6.87 yr) were studied. The relationship with age, blood pressure, diabetic retinopathy and other complementary diagnostic methods such as serum creatinine (Cr), creatinine clearance (CrC), renal plasma flow (RPF), proteinuria and filtration fraction (FF) were also determined. Light microscopy studies detected 92.3

of patients with renal lesions of different degrees of severity. The presence and severity of glomerulopathy and arteriolopathy were related to diabetes duration (r: 0.764) and they were related to each other (rs: 0.773). In 2 patients, lesions were not observed and in 11 out of 14 patients with less than 5 yr of diabetes duration, mild lesions were detected. However, the histological changes became worse after that period. The glomerulopathy was also statistically correlated with Cr, CrC, RPF, proteinuria and FF. By immunofluorescence, fibrinogen, IgA and C3 were the most frequent and intense precipitates observed. They increased with diabetes duration and were located predominantly in the wall and the periphery of the glomerules and in renal tubules, suggesting that they originated by trapping. There were no precipitates in the mesenchyma, they were scarce in the interstice, Bowmans capsule and arterioles. Statistical correlation between diabetic histopathological renal changes and retinopathy was found. These results confirm that lesions in the kidney and retina in non-insulin dependent diabetic patients generally appear and evolve in a similar manner. Hypertension was diagnosed in 80.76

of patients, without statistical correlation between blood pressure and renal lesions. This suggests that at the onset, in non-insulin dependent diabetic patients hypertension and nephro-pathy are caused by different and independent pathogenic mechanisms. However, at an end stage, it seems that both situations can influence each other in a way that their evolution becomes more severe. Nephropathy in non-insulin dependent diabetes mellitus displayed scarce clinical signs and poor laboratory evidence except when the renal lesions become too severe. The lack of correlation between renal lesions and patients age and blood pressure suggests the participation of diabetes at the onset of kidney structural impairment.

Estudio histopatologico y funcional del riñon en la diabetes no insulino dependiente / Histopathological and functional study of the kidney in non-insulin dependent diabetes mellitus

Se describen los hallazgos histopatológicos estudiados por microscopía ópticas (MO) e inmunofluorescencia (IF) de muestras obtenidas por biopsia renal percutánea en 19 mujeres y 7 hombres cpn diabetes mellitus no insulino dependiente (DMNID) (media de la edad de 55,07 ñ 9,04 años y de la antigúedad "conocida" de la DMNID de 7,50 ñ 6,87 años). Se intentó correlacionarlos con la edad, la retinopatía diabética, la tensión arterial, la creatininemia (CR), el clearance de creatinina (CCr), el flujo plasmático renal (FPR), la proteinuria y la fracción de filtración (FF). La MO detectó una nefropatía diabética en el 92,3 por ciento de los sujetos cuya gravedad estuvo ligada a la antigüedad de la DMNID. En 2 no se observaron y en 11 de 14 sujetos con menos de 5 años de evolución las alteraciones fueron leves, pero la severidad aumentó a partir de ese período. La glomerulopatía se relacionó con la arteriopatía, la Cr, el CCr, el FPR, la proteinuria y la retinopatía. Los preciptados más comunes por IF fueron de fibrinógeno, IgA y C3, localizados en la pared y la periferia glomerular y en los túbulos renales. No hubo acúmulos en el mesangio, fueron escasos en el intersticio, la cápsula de Bowman y las arteriolas, aumentaron con la duración de la DMNID, predominó el tipo granular y parecieron formados por atrapamiento. El 81 por ciento eran hipertensos (la tensión sistólica se relacionó a la edad y la diastólica con el CCr). La retinopatía se correlacionó con la duración de la DMNID, la CR, CCr y tuvo una evolución similar a la de la glomerulopatía. El 57,7 por ciento tuvieron proteinuria y no se detectó hiperfiltrado en estadíos tempranos. La nefropatía de inicio en la DMNID produce escasas manifestaciones clínicas y una pobre repercusión bioquímica apesar de las lesiones anatómicas. La falta de correlación de las lesiones con edad de los pacientes y con la hipertensión arterial destaca la participación de la diabetes en el origen de los trastornos estructurales del riñon

Estudio histopatologico y funcional del riñon en la diabetes no insulino dependiente / Histopathological and functional study of the kidney in non-insulin dependent diabetes mellitus

Se describen los hallazgos histopatológicos estudiados por microscopía ópticas (MO) e inmunofluorescencia (IF) de muestras obtenidas por biopsia renal percutánea en 19 mujeres y 7 hombres cpn diabetes mellitus no insulino dependiente (DMNID) (media de la edad de 55,07 ñ 9,04 años y de la antigúedad "conocida" de la DMNID de 7,50 ñ 6,87 años). Se intentó correlacionarlos con la edad, la retinopatía diabética, la tensión arterial, la creatininemia (CR), el clearance de creatinina (CCr), el flujo plasmático renal (FPR), la proteinuria y la fracción de filtración (FF). La MO detectó una nefropatía diabética en el 92,3 por ciento de los sujetos cuya gravedad estuvo ligada a la antig³edad de la DMNID. En 2 no se observaron y en 11 de 14 sujetos con menos de 5 años de evolución las alteraciones fueron leves, pero la severidad aumentó a partir de ese período. La glomerulopatía se relacionó con la arteriopatía, la Cr, el CCr, el FPR, la proteinuria y la retinopatía. Los preciptados más comunes por IF fueron de fibrinógeno, IgA y C3, localizados en la pared y la periferia glomerular y en los túbulos renales. No hubo acúmulos en el mesangio, fueron escasos en el intersticio, la cápsula de Bowman y las arteriolas, aumentaron con la duración de la DMNID, predominó el tipo granular y parecieron formados por atrapamiento. El 81 por ciento eran hipertensos (la tensión sistólica se relacionó a la edad y la diastólica con el CCr). La retinopatía se correlacionó con la duración de la DMNID, la CR, CCr y tuvo una evolución similar a la de la glomerulopatía. El 57,7 por ciento tuvieron proteinuria y no se detectó hiperfiltrado en estadíos tempranos. La nefropatía de inicio en la DMNID produce escasas manifestaciones clínicas y una pobre repercusión bioquímica apesar de las lesiones anatómicas. La falta de correlación de las lesiones con edad de los pacientes y con la hipertensión arterial destaca la participación de la diabetes en el origen de los trastornos estructurales del riñon (AU)