Effect of epoetin zeta for correction of renal anemia in hemodialysis patients with thalassemia minor.

Two patients with thalassemia minor and end-stage renal failure on hemodialysis were treated with epoetin zeta (Silapo, Retacrit; STADA, Germany), a medicinal product that was developed and registered as biosimilar to epoetin alfa. Dosing was titrated individually for two patients to achieve a stable hemoglobin (Hb) concentration of 10.5-12.0 g/dL. One patient was treated intravenously with epoetin zeta; the other patient was treated subcutaneously. After 12 weeks of therapy both patients achieved Hb levels within the target range, confirming the effi cacy of epoetin zeta in patients with thalassemia minor.

[Lymphocyte populations and subpopulations in peripheral blood of pregnant women with pre-eclampsia].

AIM: To investigate the changes of lymphocyte populations and subpopulations in peripheral blood of pregnant women suffering preeclampsia. MATERIAL AND METHODS: By means of flowcytometry the following lymphocyte populations and subpopulations were determined in peripheral blood of 37 pregnant women, of whom 12 had preeclampsia and 25 had normal pregnancy pespectively: Total lymphocyte count CD19+ (B-lymphocytes), CD2+ (Total T-lymphocytes), CD3+ (Immunocompetent T-lymphocytes) CD3+CD4+ (T-helpers), CD3+CD8+ (Suppressor-cytoxic T-lymphocytes), CD4+/CD8+ ratio, Lymphocyte subpopulations with predominant killer activity: CD8-CD56+, CD8+CD56+ and activated immunocompetent T-lymphocytes (CD3+HLADR+). RESULTS: In patients with preeclampsia a T-helper increase and relative T-suppressor cytotoxic decrease was found. A significant increase of activated immunocompetent T-lymphocyte was found, compared to the total increase of immunocompetent T cell. No significant difference between cytotoxic cell with MHC unrestrained function (CD8-CD56+) and cell with MHC restrained cytotoxic function (CD8+CD56+) was found. CONCLUSIONS: In pregnant women with preeclampsia the main lymphocyte populations and the immunocompetent T-lymphocytes are increased. The raised level of T-lymphocytes is found as a result of the substantial quantitative changes of T-helper cells an increase of CD4+/CD8+ ratio is prominent, which is a proof of the activated immune potential in pregnant women with preeclampsia with the dominant influence of T-helper subpopulations.

Angiotensin-converting enzyme activity and the ACE Alu polymorphism in autosomal dominant polycystic kidney disease.

BACKGROUND: Previous studies concerning Alu I/D polymorphism in the ACE gene and ADPKD severity have used the Alu genotypes as a representative of the true biological variable, namely ACE activity. However, wide individual and ethnic differences in the proportion of variance in ACE activity explained by the I/D genotype may have confounded these studies. This investigation examines the association between ADPKD severity and ACE in terms of plasma enzyme activity and I/D genotypes in individuals from three different countries. METHODS: Blood samples were collected from 307 ADPKD patients (116 Australian, 124 Bulgarian and 67 Polish) for determination of ACE activity levels and I/D genotypes. Chronic renal failure (CRF) was present in 117 patients and end-stage renal failure (ESRF) in 68 patients. RESULTS: ACE activity was related to the I/D genotype, showing a dosage effect of the D allele (P=0.006). The proportion of variance due to the Alu polymorphism was 14%. No difference in ACE activity and I/D genotype distribution was found between patients with CRF versus normal renal function (P=0.494; P=0.576) or between those with ESRF versus those without ESRF (P=0.872; P=0.825). No effect of the I/D genotype on age at development and progression to renal failure (CRF; ESRF) was detected in the overall group, and in subgroups based on ethnic origin, linkage status and sex. CONCLUSION: ACE is not likely to play a role as a determinant of ADPKD phenotype severity.

Treatment of immune nephropathies with high doses of immunoglobulins.

UNLABELLED: The present study presents the results from the application of high doses of gamma-globulin in the treatment of immune (idiopathic and satellite) glomerulopathies. MATERIALS AND METHODS: Twenty patients were treated. Of these 12 were with primary chronic glomerulonephritis, 7--with lupus nephritis and 1--with renal amyloidosis. All diagnoses were verified through a renal puncture biopsy. The following therapeutic scheme was used--85 mg/kg/body weight of gamma-globulin was applied intravenously three times a day every other day till reaching a total course dose of 250 mg/kg/body weight. All patients presented with nephrotic syndrome following conventional treatment with corticosteroids, anticoagulants and anti-aggregants. The blood cell count, the serum creatinine, creatinine clearance, 24 h diuresis and level of proteinuria were monitored. RESULTS AND DISCUSSION: 14 of the patients showed a complete clinical and laboratory remission. Four of them got an incomplete remission with a proteinuria of 2 g/24 h. No positive effect from the treatment was observed in 2 of the patients. All patients with lupus nephritis were influenced positively to a certain extent by the treatment applied. No serious side effects leading to therapy interruption were observed. CONCLUSIONS: 1. The treatment with high doses of immunoglobulin is a good alternative to the pulse immunosuppressive treatment of patients with idiopathic and lupus nephritides, manifested with a nephrotic syndrome and unaffected by a previous conventional immunosuppressive and anticoagulant therapy. 2. The results from the treatment with high doses of immunoglobulin are more pronounced in patients with lupus nephritides, which in turn raises the possibility for an earlier reduction of corticosteroid therapy and avoidance of its side effects. 3. Immunoglobulin therapy is an alternative in the management of nephrotic symptoms in cases with chronic renal failure where an immunosuppressive treatment is irrelevant.

Assessment of serum osteocalcine level in pre-dialysis patients with chronic renal failure.

UNLABELLED: The application of serum osteocalcine as a marker of osseous synthesis in patients with renal osteodystrophy is still disputable because of its predominantly renal excretion. The aim of the present study was to investigate the level of serum osteocalcine in pre-dialysis patients with chronic renal failure (CRF). MATERIAL AND METHODS: 47 patients aged 22-60 years (26 males and 22 females) with chronic renal failure were studied. 23 of them were stage I CRF patients (creatinine up to 353.6 mumol/l) and 24 were stage II and III CRF patients (creatinine up to 800 mumol/l). 35 healthy subjects (15 males and 20 females) were used as controls. Serum osteocalcine was measured by a radioimmunologic assay (ELSA-OSTEO-CIS, France). Serum creatinine, calcium, phosphorus and alkaline phosphatase were detected on a biochemical analyzer "Optima" (Kone Instruments, Finland) using the standard techniques recommended by IFCC. RESULTS: Serum osteocalcine was significantly elevated in patients with stage I CRF (45.61 +/- 7.75 ng/ml), compared to the control group (14.61 +/- 1.02, p < 0.001; u = 3.96). A significant increase was also found in patients with stage II and III CRF (120.48 +/- 15.96 ng/ml, p < 0.001; u = 4.22). No significant difference in osteocalcine level was found between male and female patients (83.77 +/- 15.09 vs. 94.52 +/- 16.88). 32 (68%) patients of the entire sample had osteocalcine above the reference values. These included 11 out of 23 patients with stage I CRF (47%) and 21 out of 24 patients with stage II and III CRF (87%). A moderately positive correlation was established between osteocalcine level and the duration of CRF (0.57), as well as between serum creatinine (0.39) and phosphorus (0.34). A moderately negative correlation was discovered between creatinine clearance (-0.42) and total serum calcium (-0.37). CONCLUSIONS: Serum osteocalcine could be used as a marker for bone synthesis in pre-dialysis patients with CRF. Our results indicate that more than 50% of the patients show evidence for renal osteodystrophy.

Screening the 3' region of the polycystic kidney disease 1 (PKD1) gene in 41 Bulgarian and Australian kindreds reveals a prevalence of protein truncating mutations.

Screening for disease-causing mutations in the unique region of the polycystic kidney disease 1 (PKD1) gene was performed in 41 unrelated individuals with autosomal dominant polycystic kidney disease. Exons 34-41 and 43-46 were assayed using PCR amplification and SSCP analysis followed by direct sequencing of amplicons presenting variant SSCP patterns. We have identified seven disease-causing mutations of which five are novel [c.10634-10656del; c.11587delG; IVS37-10C>A; c.11669-11674del; c.13069-13070ins39] and two have been reported previously [Q4010X; Q4041X]. Defects in this part of the gene thus account for 17% of our group of patients. Five of the seven sequence alterations detected are protein-truncating which is in agreement with mutation screening data for this part of the gene by other groups. The two other mutations are in-frame deletions or insertions which could destroy important functional properties of polycystin 1. These findings suggest that the first step toward cyst formation in PKD1 patients is the loss of one functional copy of polycystin 1, which indirectly supports the "two-hit" model of cystogenesis where a second somatic mutation inactivating the normal allele is necessary to occur for development of the disease condition.

Screening for mutations in the peripheral myelin genes PMP22, MPZ and Cx32 (GJB1) in russian charcot-marie-tooth neuropathy patients; irina V. Mersiyanova, sookhrat M. Ismailov, alexandr V. Polyakov, elena L. Dadali, valeriy P. Fedotov, eva nelis, ann Lofgren, vincent timmerman, christine van broeckhoven, and oleg V. Evgrafov (Article was originally published in human mutation 15:340-347, 2000)

The authors wish to correct a mistake which occurred in the reporting of one of the mutations. The mutation in Cx32 Met34Lys is wrongly described as 100A>G. The correct description of the mutation should be 101T>A (Met34Lys).

Location of mutations within the PKD2 gene influences clinical outcome.

BACKGROUND: Since the cloning of the gene for autosomal dominant polycystic kidney disease type 2 (PKD2), approximately 40 different mutations of that gene have been reported to be associated with the disease. The relationship between the PKD2 genotype and phenotype, however, remains unclear. METHODS: Detailed clinical information was collected for PKD2 families in which the underlying mutation had been identified. Logistic regression analysis was employed to assess the influence of age and sex on hypertension, hematuria, renal calculi, and urinary tract infections, and a clinical phenotype score was computed. Patients were then grouped according to the relative location of their mutation within the cDNA sequence, and differences in the mean phenotypic score between groups were tested for statistical significance by means of a multiple pairwise t-test. RESULTS: While phenotypic scores for each mutational group revealed a considerable degree of intragroup variability, the variability in phenotypic scores was significantly higher between mutational groups than within groups. A group-wise comparison of the mean phenotypic scores confirmed the observation of significant nonlinear variation in disease severity, with high- and low-scoring mutational groups interspersed along the gene sequence. CONCLUSION: The identification of groups of mutations in the PKD2 gene, which differ significantly with respect to clinical outcome, is to our knowledge the first description of a genotype/phenotype correlation in autosomal dominant polycystic kidney disease. It also provides evidence against complete loss of function of the mutant PKD2 gene product.

Influence of age, sex and body weight on renal osteodystrophy in predialysis patients with chronic renal failure.

UNLABELLED: The aim of the present investigation was to examine the influence of age, sex and body weight on osseous changes in pre-dialysis patients with chronic renal failure (CRF). 87 patients (44 males and 43 females) aged 18-60 years with CRF were studied. The levels of serum creatinine, total and ionized calcium, phosphorus, alkaline phosphatase, intact parathormone and serum osteocalcine were followed up. Body weight is presented as BMI. 47 of the patients were subjected to double X-ray absorptiometry of lumbar vertebra (Lunar) and 40 patients were examined by computed tomography osteometry. RESULTS: No reliable differences in the levels of biochemical parameters in male and female patients with the same degree of CRF were established. A tendency towards an increase in the level of intact parathormone and serum osteocalcine in women with both initial and advanced CRF was recorded. The BMI in patients with advanced CRF was lower as compared to those with initial CRF. Different stages of osseous changes were observed in 29 males (74.35%) and in 25 females (60.97%). A tendency for a higher frequency and severity of osseous changes in men aged up to 40 years was observed. After this age males and females were equally affected. A high positive correlation (r = 0.50) between BMI and the percentage of the normal Bone Mineral Density/Bone Mineral Content in females with CRF stage II and III was noticed. CONCLUSIONS: No significant difference in the frequency and severity of osseous changes in male and female uremic patients was observed. Bone changes were more frequent and pronounced in males up to 40 years of age, while this tendency reversed after the menopause. The higher body weight was beneficial for the osseous changes only in females with advanced CRF, while in all other patients no correlation with densitometric parameters was noticed.

Low protein diet and ketosteril in predialysis patients with renal failure.

UNLABELLED: After a short review of the contemporary understanding of amino acid supplementation to low protein diets in patients with uremia we present the results of administration of ketosteril in 20 low-protein-diet patients on such a diet. MATERIAL AND METHODS: Twenty patients (10 men and 10 women) with stable II and III stage chronic renal failure were assigned to a low protein diet (protein up to 40 g/day). Ketosteril (6 tablets a day) were added to the diet. Some of the basic markers of protein metabolism and nitrogen balance were followed. RESULTS: No evidence of deteriorated protein synthesis was found in the therapy thus administered. Serum urea and creatinine values did not change and even tended to decrease. Glomerular filtration was found to increase insignificantly more markedly in the patients with renal failure in the early stages. CONCLUSIONS: A low protein diet with increased content of essential amino acids and their keto-analogues does not deteriorate the nitrogen balance of patients with chronic renal failure. By adding essential amino acids and keto-analogues a normal protein metabolism is maintained in spite of the reduce intake of protein substances with the diet. Supplementation of the diet of chronic renal failure patients with essential amino acids and keto-analogues allows a considerable reduction of the protein intake to be achieved which brings about reduction of glomerular hyperfiltration which actually retards the progression of renal failure and improves its short-term prognosis.

Cyclosporin A in the treatment of patients with nephrotic syndrome.

OBJECTIVE: To present our experience in the treatment of conventional therapy refractory nephrotic syndrome with cyclosporin A. MATERIAL AND METHODS: The study sample included 22 patients (12 men, 10 women, aged 40.43 +/- 5.93 years). Twenty one patients were diagnosed histologically: 11 were with different histologic variants of chronic gtlomerulonephritis, 7 with lupus nephritis and 3 with renal amyloidosis. Sandimmun Neoral-Sandoz was given orally in a dose of 2-5 mg/kg/24 hours; mean duration of the course of treatment 41.4 +/- 12.4 days. In the course of treatment we followed quantitatively 24-hour proteinuria, diuresis, hematologic parameters, serum creatinine, transaminases, the fat profile, and creatinine clearance. RESULTS: The patients were allocated into 3 groups according to their response to treatment--in 5 patients (22.73%) it achieved complete clinical and laboratory remission, in 8 (36.36%)--partial remission and in 9 (40.91%) it failed. The 24-hour diuresis in the patients with complete and partial remission increased significantly during the third week of treatment (from 1212.5 +/- 114.7 to 2700 +/- 394.61, p < 0.05, t = 3.62). Proteinuria was reduced from 3.47 +/- 0.54 to 1.86 +/- 0.36 g/d (p < 0.05, t = 2.48) at the end of treatment. No substantial change in the antihypertensive therapy was necessary in any of the patients. There was no decline of the renal and liver functions. Neither allergic reactions nor serious side effects that may have caused discontinuation of treatment were observed. Complete or partial clinical and laboratory remission was achieved in 59.09% (13 patients) (confidence interval = 39.2%-78.9%, odds ratio = 0.95). Cyclosporin A therapy is an appropriate alternative in the treatment of refractory nephrotic syndrome in some of the immunologic glomerulopathies. The types of glomerulopathy that are best affected are minimal-change glomerulonephritis, some of the mesangioproliferative glomerulonephritis cases and some forms of lupus nephritis. No effect whatsoever was found in cases with renal amyloidosis.

Epoetin-beta (Recormon-Roche) in the treatment of renal anemia in patients with chronic renal failure.

UNLABELLED: In the study a clinical assessment is made of the results of treatment of patients with renal anemia by epoetin-beta. MATERIAL AND METHODS: Thirty two patients (22 women, 10 men) with chronic renal failure and anemia, ranging from 18 to 77 years of age (mean age 46.29 +/- 5.84), were recruited for the study. All patients underwent treatment with epoetin-beta (Recormon, Boehringer-La Roche). The criterion for inclusion in the study was presence of severe anemia (HGB < 90 g/l). Extrarenal causes for the anemia were excluded in all patients. The main treatment objective was to increase hemoglobin to 100-120 g/l. All patients received concomitant iron supplementation at constant control of the iron status. The predialysis patients were administered iron perorally (200 mg/day) while the patients on chronic hemodialysis were given iron parenterally (intravenously) (Venofer, 100 mg/day). RESULTS: Anemia was significantly corrected. Hemoglobin level rose significantly from 77.15 +/- 2.32 g/l before treatment to 110.71 +/- 6.25 g/l at the end of month three. It remained less than 100 g/l for the time of study only in one patient. Neo-Recormon had a considerable positive effect on the overall condition of patients. No significant changes were found in the rate of progression of renal failure nor were there any marked side effects and intolerability to the drug observed. CONCLUSIONS: Anemia was significantly corrected in the renal anemia patients treated with epoetin beta. In predialysis patients iron supplementation can be effectively administered orally. If given in high doses (more than 4000 IU/kg), epoetin-beta can cause rapid increase of the hematologic parameters, especially in the initial phase of treatment; this affects adversely arterial pressure which necessitates changes in the antihypertensive therapy. Erythropoietin therapy reduces and even eliminates the need of transfusion in patients with chronic renal anemia.

Frequency and clinical characteristics of mycoplasma urinary tract infections in the early post-transplantation period in renal allograft patients.

Using a highly sensitive and specific polymerase chain reaction (PCR) protocol, we studied 36 renal allograft recipients and 30 healthy controls. Midstream urine samples were analyzed using routine microbiological methods and the Mycoplasma IST (BioMerieux, France). Mycoplasma infections of the upper urinary tract were found in 9 patients. In three of them E.coli and Proteus were also present. We discuss the clinical characteristics of mycoplasma infections in the early post-transplantation period and its possible implications for graft rejection.

Our experience in the combined pathogenetic treatment of chronic glomerulonephritis.

UNLABELLED: The most common combined pathogenetic treatment regimens for the treatment of chronic glomerulonephritis are the object of the present study. It is not quite uncommon in everyday clinical practice for the physician to encounter patients with similar pathohistologic patterns who respond differently to a standard therapeutic schedule. METHODS: Having in mind the complexity of the problem we analyzed our ten-year experience with the combined pathogenetic treatment of 150 patients, aged 17 to 52, with histologically proven chronic glomerulonephritis. The diagnosis was made on the basis of light microscopy, immunofluorescent and, where available, electron microscopy studies of kidney biopsies using clinical and laboratory criteria. In most cases the combined pathogenetic treatment included standard dosage regimens consisting of corticosteroids--Prednisolone in a dose of 1.0-1.5 mg/kg, cytotoxic agents--Cyclophosphamide 1.0-1.5 mg/kg, anticoagulants--heparin (Calciparin) given for one month and antiplatelet drugs--Dipyridamole 300 mg/day. When the preceding regimen was unsuccessful the patients were given pulse therapy with Methylprednisolone 10-15 mg/kg on three successive days or Cyclophosphamide 10 mg/kg in a single dose. Those who failed to respond to the standard pathogenetic and pulse therapy were treated with Cyclosporin (Sandimmun-Sandoz) in a daily dose of 2-5 mg/kg. Complete remission occurred in forty-two patients (63.6%) with mesangial proliferative glomerulonephritis and 18 patients (60%) with membranous glomerulonephritis. The remaining patients were non-responders. RESULTS: The highest percentage of patients with complete remission was observed among those with minimal-change glomerulonephritis--20 patients (95.2%) and the lowest--among those with mesangiocapillary glomerulonephritis--5 patients (27.7%), focal segmental glomerular sclerosis and hyalinosis and sclerosing glomerulonephritis--11.1% and 16.7%, respectively. CONCLUSIONS: The authors think that at present the combined pathogenetic treatment of chronic glomerulonephritis has no alternative and can slow the progression of the renal injury as well as influence favorably the short- and long-term prognosis of the patient with glomerulonephritis.

A case of primary Sjögren's syndrome in combination with chronic mesangiocapillary glomerulonephritis and interstitial nephritis.

UNLABELLED: The authors present an extremely rare case of combination of primary Sjögren's syndrome and chronic glomerulonephritis, which was subsequently found to be mesangiocapillary on pathohistologic examination. METHODS: This case of mesangiocapillary glomerulonephritis in combination with interstitial nephritis is characterized in terms of the clinical, laboratory, immunologic and instrumental methods for diagnosis. Percutaneous kidney biopsy was performed and the characteristic findings on light microscopy were recorded. RESULTS: The therapeutic regimen consisting of pulse therapy with Immunovenin-intact and cyclophosphamide resulted in long-term clinical and laboratory remisson of the glomerulopathy and positively influenced the remaining syndromes. CONCLUSION: Pulse therapy with these drugs is an alternative to conventional pathogenetic therapy; it can also be the therapeutic modality of choice in cases similar to the one described here having in mind the long-term therapeutic remission.

PCR studies on the presence of Chlamydia trachomatis in the upper urinary tract of patients with obstructive pyelonephritis.

Chlamydia trachomatis infections are among the most common sexually transmitted diseases in the world and it is only logical to hypothesize that it alone or in association with mycoplasmas can participate in the initiation and persistence of upper urinary tract infections. Having in mind the inconclusive evidence regarding the role of C. trachomatis in upper urinary tract infections we decided to study the presence of C. trachomatis in the upper urinary tract of patients with obstructive pyelonephritis using the polymerase chain reaction. We studied 20 patients (12 female and 8 male, aged 20-60 years) with symptoms and signs of acute pyelonephritis in accordance with Kunin's criteria (1997). Samples were taken during surgery of the upper urinary tract by aspirating urine from the renal pelvis or the ureter above the level of the obstruction and analyzed for the presence of bacterial pathogens using routine microbiological techniques and employing the "AMPLICOR CT/NG" test (Roche Diagnostic Systems, Branchburg, NJ, USA) for the presence of C. trachomatis. Chlamydia trachomatis was found in the aspirated urine of 5 patients (25%). In 3 of the patients the microbiological tests of the aspirated urine did not establish any other microbial agent. In the other two Escherichia coli and Proteus mirabilis were cultured. The analysis of the clinical and laboratory findings in the patients with Chlamydia trachomatis infection alone and those with an associated bacterial pathogen failed to reach statistical significance. Following the operation all of the patients received treatment with Ofloxacin 200 mg bid for 7 days with a favorable clinical and laboratory outcome. In our opinion, the AMPLICOR CT/NG test is a sensitive and specific method for diagnosing low-number Chlamydia trachomatis infections of the upper urinary tract in patients with obstructive pyelonephritis. Chlamydia trachomatis should be considered as a possible etiologic agent in acute pyelonephritis and the therapeutic regimen in such patients should be targeted at its possible underlying presence.

On the disturbances in carbohydrate metabolism in pre-dialysis patients with chronic renal failure.

UNLABELLED: We describe some of the aspects of impaired carbohydrate metabolism in predialysis uremic patients. METHODS: A total of seventy-five nondiabetic patients with chronic renal failure (CRF) were enrolled in the present study. The level of glycosylated hemoglobin was measured in 51 patients using kits from Merck and an oral glucose challenge test was performed in 20 according to a standard protocol. The levels of immunoreactive insulin and growth hormone (GH) were measured in all predialysis patients using original kits and an automatic minigamma counter (Abbott, USA). The results were compared with those from 30 healthy controls. RESULTS: In patients with first degree CRF the level of glycosylated hemoglobin was 5.9 +/- 05%. In patients with second and third degree CRF there was a trend towards higher glycosylated hemoglobin levels--6.3 +/- 0.6% (P > 0.05; u = 1.1) as compared with the controls--5.5 +/- 0.4%. The analysis of the results from the oral glucose challenge test revealed impaired glucose tolerance in 12 predialysis patients with CRF with blood glucose levels of 9.1 +/- 1.6 mmol/l at the second hour following the ingestion of glucose. Nine of those had second or third degree CRF. The baseline levels of plasma immunoreactive insulin showed a tendency towards increase in the patients with uremia as compared with the controls (7.2 +/- 1.1 IU/ml versus 6.4 +/- 0.7 IU/ml) whereas no significant difference was found at the 1st, 2nd or 3rd hour following the ingestion of glucose as compared with the healthy controls. Five of our patients had significantly elevated basal insulin levels. With regard to GH levels, we found similar baseline values in our study patients and the controls. At the 1st hour following the glucose challenge the GH values showed a tendency towards increase in the uremic patients--6.1 +/- 1.1 ng/ml. In 4 of our study patients we found significantly elevated GH levels at the 1st hour following the ingestion of glucose (6.6 +/- 0.7 ng/ml). CONCLUSIONS: 1. No significant disturbances in carbohydrate metabolism were found in patients with mild (initial) CRF. 2. In patients with moderate and advanced CRF we found changes consistent with impaired carbohydrate metabolism and a tendency towards an increase in the basal immunoreactive insulin levels. 3. Growth hormone levels showed a different pattern of change in predialysis patients and those changes cannot be explained by the changes in carbohydrate metabolism.

A case of Chlamydia trachomatis infection in a renal allograft patient.

We describe a renal allograft patient with a Chlamydia trachomatis infection. A 43 year-old man was diagnosed with end-stage renal disease in 1985 which necessitated the transplantation of a cadaver kidney in 1986. The kidney was rejected two years later. A second transplantation was performed in 1991. At the beginning of 1998 symptoms and signs of chronic renal failure and dysuria set in. Routine microbiological studies were negative. Cell culture on McCoy cell line was positive for an active infection with C. trachomatis--initially 3+, then 2+, 1+ and negative following treatment. The patient was positive on the AMPLICOR CT/NG test (Roche Diagnostic Systems, Branchburg, USA) twice with OD values OVER--above 2 at 450 nm wavelength measured on an ELISA reader. The patient received treatment with azithromycin and doxycycline for 10 days following which the serum creatinine levels fell and the creatinine clearance values improved. Dynamic microbiological follow-up showed disappearance of C. trachomatis as evidenced by the negative PCR test. We conclude that the deterioration of renal function in our patient is complex but the infection with C. trachomatis is part of the complex of the underlying chronic renal failure and immunosuppressive treatment.

Dynamic follow-up of the intact parathormone levels in hemodialysis patients treated with Rocaltrol and calcium.

UNLABELLED: The object of the present study was to follow prospectively the serum levels of intact parathormone (PTH) of hemodialysis patients and the subsequent changes following the oral administration of 1.25(OH)D3 and calcium. METHODS: We studied 30 chronic renal failure hemodialysis patients--16 men and 14 women, aged 20-70 years. Twenty-one of them were on hemodialysis with duration of up to 5 years (Group 1) and nine--up to 10 years (Group 2). All patients received oral supplementation therapy with 1.0 elemental calcium and Rocaltrol (Roche) 0.25 microgram/day. We measured the serum calcium, ionized calcium, serum phosphorus, alkaline phosphatase and the intact serum PTH levels in intervals of 12 months. RESULTS: Patients with duration of dialysis of up to 5 years had a significantly lower baseline PTH level of 392.5 +/- 94.7 pg/ml versus 896.4 +/- 160.7 pg/ml for those from the second group (P < 0.01). The intact PTH levels showed a tendency towards decrease--at the end of the study they were as follows: 372.02 +/- 76.9 for group 1 versus a significant increase for those from group 2--serum PTH levels of 1793.65 +/- 290.3 (P < 0.02). The differences in alkaline phosphatase and serum phosphorus levels at the end of the study period failed to reach statistical significance. Serum calcium levels were increased in both groups following the initiation of treatment but the difference was statistically significant only for group 2. A significant positive correlation was observed between the duration of hemodialysis treatment and the intact serum PTH levels. CONCLUSIONS: 1. Long-term low-dose conventional calcitriol therapy in combination with calcium supplementation could slow the progression of secondary hyperparathyroidism in some hemodialysis patients. 2. Low-dose therapy with active vitamin D-metabolites is effective only in hemodialysis patients with baseline serum PTH levels below 500 pg/ml and without pronounced hyperphosphatemia.