[The influence of short-term magnesium carbonate treatment on calcium-phosphorus balance in dialysis patients]. / Wplyw krótkoterminowego leczenia weglanem magnezu na gospodarke wapniowo-fosforanowa u chorych przewlekle hemodializowanych.

INTRODUCTION: The phosphate-binders presently used in the treatment of calcium-phosphorus disorders in dialysis patients remain a crucial element of cardio-vascular protection. The aim of the study was to assess short-time magnesium carbonate treatment efficacy in hemodialysis patients with hyperphosphatemia. MATERIAL AND METHODS: The study involved 64 participants (32 male and 32 female) aged 29-84 years, with end-stage renal disease, hyperphosphatemia (> 1.78 mmol/l), dialysis 3 times a week, mean session time 4 hours 15 minutes. All the patients were divided into three groups: I--30 patients treated with magnesium carbonate 3 x 1 g; group II--10 patients treated with sevelamer hydrochloride 0.8 g--3 x 2 tabl (3 x 1.6 g); group III--24 patients treated with calcium carbonate 3 x 2 g. Participants were categorized randomly to groups I and II and to group III only patients with decreased serum calcium concentration (< 2.1 mmol/1) were assigned. The doses stayed constant within 12 weeks of therapy. RESULTS: In group treated with magnesium carbonate after 3 months of the treatment the decrease of plasma parathormon (iPTH) from 526.1 +/- 463.3 to 443.2 +/- 223.1 (pg/ml), calcium (Ca) from 2.4 +/- 0.2 to 2.3 +/- 0.1 (mmol/1); the highest reduction of phosphate (P) 2.1 +/- 0.5 to 1.6 +/- 0.4 (mmol/1) and calcium phosphate product (Cax P) from 4.6 +/- 2.3 to 3.5 +/- 1.1 (mmol2/ l2) were observed. In group II, iPTH slightly increased from initial 425.26 +/- 192.5 to 445.6 +/- 222.3 (pg/ml); serum calcium decreased from 2.23 +/- 0.17 to 2.0 +/- 0.2 (mmol/l); phosphates dropped from 2.35 +/- 0.43 to 2.0 +/- 0.3 (mmol/l) and Ca x P index from 5.1 +/- 1.2 to 4.1 +/- 0.7 (mmol2/l2). In group treated with calcium carbonate iPTH decreased from 308.2 +/- 196.6 to 301.9 +/- 188.5 (pg/ml). Calcium, phosphate and Ca x P dropped during the treatment from 2.06 +/- 0.23 to 2.05 +/- 0.2 (mmol/l), 2.17 +/- 0.36 to 1.86 +/- 0.45 (mmol/l) and from 4.7 +/- 0.8 to 3.7 +/- 0.9 (mmol2/l2), respectively. Calcium-phosphorus disorders were normalized to actual guidelines only in participants treated with magnesium carbonate. CONCLUSIONS: Magnesium carbonate seems to be the effective treatment of calcium-phosphorus disorders in hemodialysis patients. However its administration, similarly to other non-calcium phosphate-binders, is limited and dedicated to patients with normal serum calcium concentration.

[Prognostic values of serum concentration and urinary excretion of interleukin-1 receptor antagonist and tumor necrosis factor receptors type I and II in patients with IGA nephropathy]. / Wartosc prognostyczna pomiarów stezen w surowicy i wydalania z moczem antagonisty receptora interleukiny-1 i rozpuszczalnych receptorów TNF typu I i II u chorych z nefropatia IgA.

Interleukin-1 receptor antagonist (IL-1ra) and tumor necrosis factor soluble receptors (sTNFR) type I and II reducing the activity of IL-1 and TNFalpha may inhibit inflammatory reactions. The aim of the study was to assess whether serum and urine IL-1ra and sTNFR measurements may be useful as the early predicting factors in patients with IgA nephropathy. Twenty seven patients (16 males, 11 females), mean age 41.6 +/- 22.3 years with biopsy-proven IgA nephropathy and nephrotic-range proteinuria were included in this study. Serum concentrations (sIL-1ra, ssTNFR I and II) and urinary excretions (uIL-1ra, usTNFR I and II) of IL-1ra, sTNFR I and II had been measured before the treatment was instituted. After 12 months of therapy with steroids and cyclophosphamide, the patients were divided into two subgroups i.e. R - responders, and NR - nonresponders according to the treatment results. The control groups comprised 8 healthy people. IL-1ra serum concentration and urinary excretion were lower in the patients than in the controls (202 vs 330 ng/ml and 970 vs 1607 ng/mg creatinine respectively; p < 0.05 both). Serum concentrations and urinary excretion rates of sTNFR 1 (5.1 vs 1.7 ng/ml and 4.1 vs 1.1 ng/mg creatinine respectively) and sTNFR II (14.4 vs. 5.0 ng/ml and 8.3 vs. 4.4 ng/mg creatinine respectively) were higher (p < 0.05 each) in the patients than in the controls. The subdivision of patients and their classification according to achieved treatment results showed no statistically significant differences between initial interstitium volume neither concentration of serum total protein, serum creatinine or proteinuria and glomerular filtration rate in R and NR subgroups. Initial IL-1ra serum concentration, its urinary excretion and sTNFR type I and II urinary excretion rates were significantly higher in R than NR (sIL-1ra - 297 vs 167 ng/ml, p < 0.05; uIL-1ra 1360 vs 87 ng/mg Cr, p < 0.01; and ssTNFR I 5.2 vs 2.2 ng/mg Cr, p < 0.05; ssTNF RII14 vs 6 ng/mg Cr, p < 0.05). However, serum concentration and urinary excretion of sTNF R type I and II were significantly higher in R and NR subgroups than in controls (p < 0.05 both), sIL-1ra and uIL-1ra were significantly lower in R and NR than in healthy subjects. The results of evaluations of serum concentration and urinary excretion of IL-1ra showed similar values to control group results only in responders. No statistically significant differences between sIL-1ra or/and uIL-1ra in both R and control groups were found. Increased serum concentration and urinary excretion of IL-1ra correlates with better prognosis for remission of proteinuria and lower risk of deterioration of kidney function. Those assessments may be helpful as a part of initial screening in patients with IgA nephritis and heavy proteinuria. In contrast the evaluation of both serum and urinary TNF RI and II seems to have no predictive value.

[Serum concentration and urinary excretion of soluble receptors for tumor necrosis factor in patients with primary glomerulonephritis]. / Stezenie w surowicy oraz wydalanie z moczem rozpuszczalnych receptorów dla czynnika martwicy nowotworów u chorych z pierwotnymi glomerulopatiami.

In sera and urine of healthy and diseased patients two soluble types of TNF receptors--p55--sTNF RI and p75--sTNF RII have been detected. They can protect cells against excessive cytotoxic activity of TNF-alpha in vitro and in vivo. The aim of the study was to investigate the prognostic significance and role of sTNF R in various types of glomerular diseases. We studied 49 patients with primary glomerular diseases (5 minimal change--MC; 4 focal glomerulosclerosis--FSGN; 4 membranous nephropathy--MN; 12 mesangial proliferative GN--MSPGN; 18 IgA nephropathy--IgAN; and 6 membranoproliferative GN--MPGN) and 10 healthy persons. Renal biopsies were evaluated by light and immunofluorescence microscopy. STNF RI and sTNF RII concentrations were measured by ELISA (BIOSOURCE international kits). The treatment of patients consisted of 3 to 5 i.v. methylprednisolone pulses (1.0 g per single dose, average total 1.0 g/20 kg given alternate days) followed by oral prednisone 20 to 25 mg/day and six monthly i.v. cyclophosphamide 0.6 g/1 m2/month. The studied groups showed a significantly higher concentration of sTNF RI and sTNF RII in their sera and urine when compared with the control. In patient groups serum Cr showed significant correlations with volume of interstitial tissue in renal biopsy, correlation of serum Cr with serum sTNF RI, serum sTNF RI with serum sTNF RII and with urinary sTNF RI, serum sTNF RII with urinary sTNF RI and with urinary sTNF RII. The ratio of serum sTNF RI to serum sTNF RII in patients was unchanged compared to the controls but ratio of urinary sTNF RI to sTNF RII was higher in all patient groups except patients with MC. In patients with renal sufficiency (Cr < 1.3 mg/dl) and reduction of proteinuria > 50% after 1 year of therapy urinary secretion of sTNF RII was higher before treatment than in patients with protein reduction < 50%. In patients with renal insufficiency and reduction of proteinuria > 50% urinary excretion of sTNF RI was lower than in patients with lower reduction of proteinuria (< 50%) after 1 year of therapy. Our results suggest that serum sTNF R could be useful as indicator of clinical activity of the disease and urinary excretion of soluble receptors as a predictor of effectiveness of immunosuppressive therapy.

[Multifocal fungal infections in patients after renal transplantation undergoing immunosuppression]. / Wieloogniskowe zarazenia grzybami u poddawanych immunosupresji osób po przeszczepach narek.

The aim of the study was to estimate the prevalence of fungi in monofocal and multifocal infections in renal transplant recipients and the characteristics of 60 species and intraspecies features of fungal strains isolated from the organ ontocenoses: oral cavity, rectum and genital organs in 32 patients undergoing permanent immunosuppression after renal transplantation. Fungal strains were recovered in 66 out of 96 samples (68.2% off all renal transplant recipients). There were in ontocenoses: oral cavity (65.6%), rectum (37.5%) and genital organs (25.0%). Monofocals mycosis were found only in 21.9% of the patients. Multifocal infections occurred in 68.2% and contained ontocenoses of oral cavity and rectum (34.4%) the most frequently. Trifocal infection occurred in 12.5% of all examined renal transplant recipients. Fungal strains identified using API 20 C and API 20 C AUX (bioMérieux). The activity of 19 hydrolases was investigated using API ZYM. From among 41 strains of fungi the following were found: Candida albicans (31 strains), Candida glabrata (5), Candida guilliermondii (2), Candida krusei (2) and Saccharomyces cerevisiae (1). The enzymograms were described for all strains and the highest activity was noted in case of: leucine arylamidase, acid phosphatase, esterase, naphtol-AS-BI-phosphohydrolase. The presence high mean of activity of this enzymes means high pathogenicity of C. albicans strains.

[Serum levels and urinary excretion of soluble receptors for tumor necrosis factor (sTNF R) in patients with primary glomerulonephritis]. / Stezenie w surowicy krwi oraz wydalanie z moczem rozpuszczalnych receptorów dla czynnika martwicy nowotworów (sTNF R) u chorych z pierwotnymi glomerulopatiami.

Tumor necrosis factor alpha (TNF-alpha) is a pro-inflammatory cytokine and has multiple physiological function. Its binding to specific receptors produced the reactions of TNF. In sera and urine of healthy persons and diseased patients two soluble types of TNF receptors--p55--sTNF I and p 75--sTNF RII have been detected. They can protect cells against excessive cytotoxic activity TNF-alpha in vitro and in vivo. The aim of the work was to investigate the prognostic significance and role of sTNF R in various types of glomerular diseases. We studied 49 patients with primary glomerular diseases (5 minimal change--MC; 4 focal glomerulosclerosis--FS; 4 membranous nephropathy--MN; 12--mesangial proliferative GN--MesPGN; 18 IgA nephropathy--IgAN; and 6 membranoproliferative GR--MPGN) and 10 healthy persons. Renal biopsies were evaluated by light and immunofluorescence microscopy. sTNF RI and sTNF RII concentrations were measured by ELISA (BIOSOURCE International kits). The treatment of patients consisted of 3 to 5 i.v. methylprednisolone pulses (1.0 g per single dose, average total 1.0 g/20 kg given alternate days) followed by oral prednisone 20 to 25 mg/day and six monthly i.v. cyclophosphamide 0.6 g/l m2/month. The study groups showed a significantly higher concentration of sTNF RI and sTNF RII in their sera and urine compared with the control. In patient groups serum Cr showed significant correlations with interstitial volume in renal biopsy, correlation serum Cr with serum sTNF RI, serum sTNF RI with serum sTNF RII and with urinary sTNF RI, serum sTNF RII with urinary sTNF RI and with urinary sTNF RII. The ratio of serum sTNF RI to serum sTNF RII in patients was unchanged compared to the controls but ratio urinary sTNF RI to sTNF RII was higher in all patient groups except patients with MC. In patients with renal sufficiency (Cr < 1.3 mg%) and reduction of proteinuria > 50% after 1 year treatment urinary secretion of sTNF RII was higher before treatment than in patients with protein reduction < 50%. In patients with renal insufficiency and reduction of proteinuria > 50% urinary excretion of sTNF RI was lower than in patients with lower reduction of proteinuria (< 50%) after 1 year treatment. These results suggest that serum sTNF R could be useful as indicator of clinical disease activity but urinary excretion permits prediction of reduction in proteinuria.

[Prevalence of multifocal fungal infections in patients undergoing permanent immunosuppresion after renal transplantation]. / Prewalencja wieloogniskowych zarazen grzybami u chorych z przeszczepami nerek poddawanych stalej immunosupresji.

Prevalence of multifocal fungal infections in patients undergoing permanent immunosuppresion after renal transplantation. The aim of the study was to estimate the prevalence of fungi in monofocal and multifocal infections in renal transplant recipients. 32 renal transplant recipients were examined for presence of fungi in genital organs, oral cavity and rectum. Fungal strains were recovered in 66 out of 96 samples (68.2% off all renal transplant recipients) in oral cavity (65.6%), rectum (37.5%) and genital organs (25.0%) Monofocal mycosis was found only in 21.9% of the patients. Multifocal infections occurred in 68.2% and contained ontocenoses of oral cavity and rectum (34.4%) the most frequently. Trifocal infection (genital organs - oral cavity - rectum) occurred in 12.5% of all examined renal transplant recipients. The following fungi were found: Candida albicans (31 strains), C. glabrata (5), C. guilliermondii (2), C. krusei (2), Saccharomyces cerevisiae (1).

[Characteristics of phenotypic specific and intraspecific features of fungal strains isolated from the organ ontocenoses in patients after renal transplantation]. / Charakterystyka cech fenotypowych gatunkowych i wewnatrzgatunkowych szczepów grzybów wyodrebnionych z wybranych ontocenoz narzadowych osób po przeszczepach nerek.

Characteristics of phenotypic specific and intraspecific features of fungal strains isolated from the organ ontocenoses in patients after renal transplantation. The aim of present study was to describe 60 specific and intraspecific features of fungal strains isolated from the organ ontocenoses: oral cavity, rectum and genital organs in 32 patients undergoing permanent immunosupression after renal transplantation. Fungal strains identified using API 20 C and API 20 C AUX (bioMérieux). The activity of 19 hydrolases was investigated using API ZYM. Among 41 strains of fungi the following were found: Candida albicans (31 strains), C. glabrata (5), C. guilliermondii (2), C. krusei (2) and Saccharomyces cerevisiae (1). The number of fungal strains isolated from the oral cavity was the highest (21), less numerous from rectum (12) and the least from the genital organs (8). The enzymograms were described for all strains and the highest activity was noted in case of: e6 - leucine arylamidase, e11 - phosphatase acid, e3 - esterase (C4), e12 - naphtol-AS-BI-phosphohydrolase. The activity of these enzymes is connected with higher pathogenicity of C. albicans strains.

[Serum level and urinary excretion of RANTES in patients with primary glomerulonephritis]. / Stezenie w surowicy oraz wydalanie z moczem RANTES u chorych z pierwotnymi glomerulopatiami.

Proteinuria plays a central role in the progression of glomerular disease, and there is growing evidence suggesting that it may determine tubular cell activation with release of proinflammatory chemokines and fibrogenic factors, leading to interstitial inflammatory reaction. Chemokines are proteins that contribute to the migration of leukocytes to sites of tissue injury. C-C chemokine receptor 5 is receptor for the C-C chemokine RANTES, which is expressed in inflammatory kidney diseases. To better understand the role of RANTES in various types of human glomerular diseases, we studied 53 patients with primary glomerular diseases (5 minimal change--MC; 4 focal glomerulosclerosis--FS; 4 membranous nephropathy--MN; 12--mesangial proliferative GN--MesPGN; 18 IgA nephropathy--IgAN; 6 membranoproliferative GN-MPGN, and 4 extracapillary GN-ExGN) and 10 healthy person. Renal biopsies were evaluated by light and immunofluorescence microscopy. RANTES concentrations in serum and urine were measured by ELISA (BIOSOURCE international kits). The treatment of patients consisted of 3 to 5 i.v. methylprednisolone pulses (1.0 g per single dose, average total 1.0 g/20 kg given alternate days) followed by oral prednisone 20 to 25 mg/day and six monthly i.v. cyclophosphamide 0.6 g/l m2/month. The study groups (except FS) showed a significantly higher concentration of RANTES in their sera compared with the control. The increase of urinary excretion for RANTES was 2-fold in patients with MN, and 8-fold in patients with ExGN but in patients with FS a significant decrease in urinary RANTES excretion was found. There was no significant differences in the urinary excretion of RANTES in other groups compared to a control group. In patient groups serum Cr showed significant correlations with interstitial volume in renal biopsy. No significant correlation was found between serum concentration of RANTES and their urinary excretion and other parameters considered (serum creatinine, urinary protein, serum protein concentration, and interstitial volume in renal biopsy). In patients with renal insufficiency (Cr > 1.3 mg%) and reduction of proteinuria > 50% after 1 year of treatment, the serum concentration and urinary secretion of RANTES was higher before treatment than in patients with protein reduction < 50%, and in patients with renal sufficiency. These results showed that patients with glomerular diseases who showed renal insufficiency and reduction of urinary protein after 1 year of immunosuppressive treatment revealed high levels of serum and urinary excretion of RANTES. It was thus suggested that the measurement of serum and urinary excretion of RANTES is useful in evaluating the degree of renal injury in patients with glomerular diseases after immunosuppressive treatment.

[Serum level and urinary excretion of soluble Fas (sFas) in patients with primary glomerulopathies]. / Stezenie w surowicy oraz wydalanie z moczem rozpuszczalnych Fas (sFas) u chorych z pierwotnymi glomerulopatiami.

Fas ligand (Fas-L) is a lethal cytokine that promotes apoptosis, as well as the immune and inflammatory responses through cross-linking of the Fas receptor. Soluble Fas (sFas) blocks apoptosis by inhibition of binding between Fas and Fas-L or soluble Fas-L. The aim of the work was to investigate the prognostic significance and role of the serum levels and urinary excretion of sFas in various types of adult chronic primary glomerular diseases. We studied 53 patients with primary glomerular diseases (5 minimal change--MC; 4 focal glomerulosclerosis--FS; 4 membranous nephropathy--MN; 12--mesangial proliferative GN--MesPGN; 18 IgA nephropathy--IgAN; 6 membranoproliferative GN--MPGN, and 4 extracapillaris GN--ExGN) and 10 healthy persons. Renal biopsies were evaluated by light and fluorescence microscopy. Concentrations of sFas were measured by ELISA (BIOSOURCE international kits). The treatment of patients consisted of 3 to 5 i.v. methylprednisolone pulses (1.0 g per single dose, average total 1.0 g/20 kg given alternate days) followed by oral prednisone 20 to 25 mg/day and six monthly i.v. cyclophosphamide 0.6 g/l m2/month. The serum levels and urinary excretion of sFas in the patients with MC, and MN were similar to controls. However, the serum levels and urinary excretion of sFas were insignificantly elevated in patients with MesPGN, MPGN, FS, and ExGN, but significantly elevated in patients with IgAN as compared with control and patient groups. In patient groups serum Cr showed significant correlations with interstitial volume in renal biopsy, and urinary excretion of sFas, but serum levels of sFas with interstitial volume. Serum levels and urinary secretion of sFas in patients with renal insufficiency (Cr > 1.3 mg%) and reduction of proteinuria < 50% after 1-year treatment was higher before treatment than in another patient groups. These results suggest that increased serum and urinary excretion of sFas in proliferative glomerulonephritis PGN (particularly in IgAN) may inhibit apoptosis in glomeruli and may be one of the progressing factors in PGN.