[Liver transplantation and peri-operative changes to renal function]. / Transplantace jater a perioperacní zmeny renálních funkcí.

THE AIM OF THE STUDY: Was to analyze in detail perioperative changes of renal function during orthotopic liver transplantation (OLT) and to identify risk factors, that were associated with the need of renal replacement therapy (RRT) during the first week after liver transplantation. METHODS: Prospective study of 50 consecutive patients undergoing OLT was performed. Selected laboratory and clinical parameters were monitored prior to the procedure, after reperfusion, at the end of the procedure, and at 12 hours after the procedure. In the first post-transplant week, necessity to use RRT in the presence of acute kidney injury was monitored and the analysis of risk factors for the need for RRT was performed. Patient survival, graft function, need for dialysis and selected laboratory parameters were assessed at one year post-transplant. RESULTS: During OLT, there was an increase in S(cr) and S(urea), which persisted as late as 12 hours post-transplant. There was a decrease in U(cr) and U(urea) and an increase in S(Na) and S(K). During the procedure any increase in S(cyst) were observed, increase the values were recorded 12 hours after surgery. S(bili) level decreased. There was a rise in the urinary levels of total protein, albumin and beta2-microglobulin. U(prot)/U(cr) increased significantly after reperfusion, with a peak after the procedure. At 12 hours after the procedure, there was a decrease in U(prot)/U(cr), but the values were still many times higher than those seen preoperatively. RRTwas necessary in 14% cases. Risk factors for acute kidney injury requiring RRT included a higher APACHE score, higher BMI, higher preoperative S(cr) and S(urea), hepatorenal syndrome pretransplant, blood loss and intraoperative hemodynamic instability, postoperative complications and dysfunction of the liver graft. One year after OLT, there was no difference in followed laboratory values between patients requiring postoperative RRT and others; no patient was treated with dialysis. CONCLUSION: OLT has a major impact on glomerular and tubular renal functions. Our data suggest that patients surviving acute renal injury treated with RRT in the early postoperative period have a high chance of restoring renal function. A sensitive marker of renal injury during OLT seems to be perioperative proteinuria.

[Thromboelastography in liver transplantation, a comparison with conventional laboratory tests]. / Trombelastograf pri transplantaci jater, porovnání s konvencními koagulacními testy.

BACKGROUND: The aim of our study was to compare the results of conventional tests and thromboelastography during liver transplantation and to determine their importance for blood loss. METHODS AND RESULTS: Thromboelastography and conventional laboratory tests were undertaken in 25 patients at the end of the anhepatic phase. Transfusion requirements correlated significantly only with prothrombin time and reaction time, R. These two tests likewise correlated significantly one with the other. CONCLUSIONS: Lowered plasma levels of coagulation factors of the prothrombin complex influenced the blood losses in our patients. While not replacing conventional tests, thromboelastography can serve as an additional test for monitoring acute changes in hemostasis.

[A negative interference effect of pathologic levels of bilirubin on the determination of serum creatinine]. / Vliv negativní interference patologických hladin bilirubinu na stanovení koncentrace sérového kreatininu.

BACKGROUND: Negative interference of bilirubin with assessment of creatinine concentration is generally known from the biochemical aspect. The objective of the presented work was to find the bilirubin level and creatinine concentration where this phenomenon has actually a clinical impact. METHODS AND RESULTS: In 200 samples selected at random the bilirubin and creatinine levels were examined by the classical Jaffé method and a method where the effect of bilirubin is suppressed. After dividing the group into 8 sub-groups by bilirubin and creatinine concentrations it was revealed that the interference plays a statistically significant role (p < 0.01) already at total bilirubin concentrations above 70 mumol.l-1. In abnormal creatinine levels the interference is manifested only at bilirubin concentrations above 150 mumol.l-1 (p < 0.001). The degree of interference in the whole group is directly proportional to the bilirubin level (r = 0.5497, p < 0.001). CONCLUSIONS: At bilirubin levels above 70 to 150 mumol.l-1 its interference with assessment of the creatinine concentration can be so significant that it must be taken into account when evaluating the patient's renal function.

Decreased urinary kallikrein with hyperglycemia in patients with short-term insulin-dependent diabetes mellitus.

The aim of the study was to evaluate the role of urinary kallikrein in the regulation of renal hemodynamics and sodium handling in insulin-dependent diabetes mellitus (IDDM), and to test the effect of acutely induced hyperglycemia. Urinary kallikrein excretion was evaluated (1) under basal conditions and after stimulation with i.v. furosemide (0.5 mg x kg(-1)), (2) during glycemic clamp-induced eu- and hyperglycemia (5 and 12 mmol/L) and, (3) during time-controlled euglycemia in 21 short-term IDDM patients without microalbuminuria and in 18 weight-, age- and gender-matched healthy controls. Sodium excretion and renal hemodynamics using the clearances of inulin and para-amino-hippuric acid were measured during examinations in both groups. The baseline urinary kallikrein excretion during clamp-induced euglycemia was comparable in diabetic and control subjects (10.89+/-5.98 versus 10.38+/-3.73 mUE x min(-1)), whereas it was decreased in the baseline for furosemide (5.77+/-3.22 versus 10.9+/-3.7 mUE x min(-1); p < 0.01) and even after furosemide administration (12.0+/-1.6 versus 21.3+/-2.0 mUE x min(-1); p < 0.01) while the patients were hyperglycemic. During intravenous dextrose-induced hyperglycemia, the urinary kallikrein excretion significantly declined in diabetic patients (10.89+/-5.98 versus 5.45+/-0.88 mUE x min(-1); p < 0.01), whereas it did not change in controls (10.38+/-3.73 versus 12.55+/-5.47 mUE x min(-1)). A decrease in the fractional excretion of sodium and an attenuated rise in natriuresis after furosemide administration have been found in diabetic compared to control subjects. There were no significant relationships between kallikrein excretion and (1) renal hemodynamics, which was comparable in both groups, or (2) plasma renin activity, plasma and urine aldosterone and cortisol. We conclude that short-term IDDM without renal hemodynamic alterations is associated with decreased basal and furosemide-stimulated kallikrein excretion, which is directly related to the blood glucose level. The decreased activity of the renal kallikrein-kinin system might be involved in the increased tendency to sodium retention in diabetic patients.

[Pulsed doses of calcitriol in the treatment of secondary hyperparathyroidism in patients on hemodialysis]. / Nárazové dávky kalcitriolu pri lécení sekundární hyperparatyreózy u hemodialyzovaných nemocných.

Administration of pulse doses of calcitriol is a better way of conservative treatment of secondary hyperparathyroidism (2HPT), making use of the direct suppression of parathormone (PTH) secretion. In a group of 29 haemodialyzed patients the authors evaluated during a six-month follow-up the effect of intravenous Calcijex in 12 and of oral Rocaltrol in 8 subjects. In responders of the calcijex group the PTH level declined by 67.6%, the mean baseline PTH value being 787.8 pg/ml, as compared with non-responders where the decline of PTH at the end of the investigation was 7.5%, the baseline PTH being 1296.4 pg/ml. The difference was significant (p < 0.05). In patients treated with Rocaltrol the therapeutic effect was apparent also in subjects with a lower baseline PTH. An associated phenomenon of treatment are as a rule parallel changes of kALP and ACP levels with those of PTH. It was however revealed that the drop of serum activities can occur also without a concurrent drop of PTH which indicates a dissociation between the level of bone metabolism and PTH secretion. The therapeutic effect can be influenced not only by the stage of 2HPT but also by the route of administration and quantity of calcitriol doses, as ensues from a long-term follow up of one patient. Moreover, the morphological substrate of the hyperplastic tissue of the parathyroid gland and their receptors for 1,25(OH)2D3 must be taken into account. Successfully performed parathyroidectomy, a still justified therapeutic step, is associated as a rule with rapid restoration of PTH levels. TO CONCLUDE: Pulse doses of calcitriol seem to be at present the effective treatment of diagnosed 2HPT, conventional oral calcitriol doses are useful in 2HPT prophylaxis. 2. The i.v. form should be the last resort of conservative treatment before parathyroidectomy. 3. Calcitriol treatment should attempt to maintain slightly raised PTH levels. 4. The limiting indicators of treatment are hypercalcaemia, hyperphosphataemia and the development of extraosseous calcifications. 5. In order to adhere to these criteria it is necessary to use dietary provisions, the dialyzation technique and check biochemical indicators of bone metabolism and possibly change doses of pharmaceutical preparations.

[Renal hemodynamics and its regulation in recently diagnosed type 1 diabetes mellitus (insulin-dependent diabetes mellitus). The effect of hyperglycemia]. / Renální hemodynamika a její regulace u nove zjistených diabetiku 1. typu (inzulin-dependentní diabetes mellitus). Vliv akutní hyperglykémie.

BACKGROUND: The changes in renal haemodynamics are considered to be one of the pathophysiological mechanisms of the development of diabetic nephropathy. The aim of the study was to evaluate the renal haemodynamics and its regulation in insulin-dependent diabetes mellitus (IDDM) during glycemic clamp-induced eu- and hyperglycaemia (5 and 12 mmol/l), and to test the hormonal vasoactive systems after stimulation with furosemide. METHODS AND RESULTS: Renal haemodynamics using the clearances of inulin and paraaminophippuric acid during eu-hyperglycaemic clamp and furosemide test were performed in 21 short-term IDDM patients without microalbuminuria (DM) and in 18 weight-, age- and sex-matched healthy controls (K). The glomerular filtration rate and effective renal plasma flow were comparable in IDDM and C and were not affected by hyperglycaemia. Compared to C diabetics had lowered fractional excretion of sodium (1.41 +/- 0.68 vs 2.23 +/- 0.67%; p < 0.01), which did not change during hyperglycaemia, and lowered furosemide stimulated natriuresis (1242 +/- 339 vs 1606 +/- 340 mumol/min; p < 0.01). Hyperglycaemia resulted in comparable fall in fractional excretion of potassium in both groups (p < 0.001). Decreased basal (5.77 +/- 3.22 vs 10.9 +/- 3.7 mEU/min; p < 0.05) and furosemide-stimulated (12.0 +/- 1.6 vs 21.3 +/- 2.0 mEU/min; p < 0.01) urinary kallikrein has been found in diabetic compared to control subjects. During clamp-induced euglycaemia, kallikrein excretion was comparable in diabetic and control subjects (10.89 +/- 5.98 vs 10.38 +/- 3.73 mEU/min) and significantly declined during intravenous dextrose-induced hyperglycaemia in diabetics (p < 0.01), while it did not change in controls. There were no differences and no changes in plasma renin activity, plasma and urine aldosterone and cortisol in IDDM and C. CONCLUSIONS: The short-term IDDM without renal haemodynamic alterations is associated with the tendency to sodium retention and decreased basal and furosemide-stimulated kallikrein excretion, which is directly related to the blood glucose level. Acutely-induced hyperglycaemia decreases fractional excretion of potassium, which cannot be explained by the changes of evaluated hormonal systems.

Effects of insulin and lipid emulsion on renal haemodynamics and renal sodium handling in IDDM patients.

To evaluate the role of insulin and hypertriglyceridaemia in the regulation of renal haemodynamics and sodium handling in insulin-dependent diabetes mellitus (IDDM), 11 IDDM patients without microalbuminuria and 13 weight-, age-, protein intake- and sex-matched healthy control subjects were studied. Clearances of inulin (Cin), para-amino-hippuric acid (CPAH), sodium (CNa), and lithium (CLi) were measured in four 60-min clearance periods (periods I, II, III and IV) during isoinsulinaemia with lipid emulsion infusion (study 1), a hyperinsulinaemic isoglycaemic clamp with Intralipid infusion (study 2), and during time-controlled isoinsulinaemia (study 3). We found that Cin, CPAH and filtration fraction were comparable in IDDM and control subjects, whereas CNa was decreased in diabetic subjects (2.01 +/- 1.11 vs 3.03 +/- 1.32 ml/min; p < 0.05) due to elevations of proximal tubular fractional and absolute reabsorptions of sodium (p < 0.05). Insulin infusion did not affect Cin, increased CPAH (p < 0.05) and, consequently, lowered the filtration fraction (p < 0.01) in both groups. While acute hyperinsulinaemia resulted in increases in distal tubular fractional and absolute reabsorptions of sodium (p < 0.01) contributing to a fall in CNa (p < 0.01) in control subjects, in diabetic subjects the sodium-retaining effect of insulin was not significant. The lipid emulsion did not alter any of the estimated parameters. We conclude that IDDM without microalbuminuria is associated with a tendency to sodium retention which is not aggravated by insulin when compared to control subjects. Acutely induced hypertriglyceridaemia does not alter renal haemodynamics or renal sodium handling.

[Membrane transport of cations in erythrocytes during treatment of essential hypertension with angiotensin-converting enzyme inhibitors]. / Membránový transport kationtu v erytrocytech pri lécbe esenciální hypertenze inhibitorem angiotensin konvertujícího enzymu.

The authors investigated in ten patients with essential hypertension changes in the membrane transport of sodium in red blood cells and the intracellular calcium content of thrombocytes during the control period during treatment of hypertension with central sympatholytics and after three-week treatment with an inhibitor of the angiotensin converting enzyme (ACE), enalapril. The effect of enalapril in hypertonic patients was manifested by a rise of the renin plasma activity and the potassium concentration and a reduction of the sodium plasma concentration which corresponds to the inhibition of angiotensin II. The intracellular calcium and sodium content was unaltered. In 8 of 10 patients after enalapril treatment increased values of Vmax for Na(+)-K+ cotransport occurred, incl. 6 patients where at the same time a rise of Vmax Na(+)-Li+ countertransport was recorded.

Factors influencing the activity of cellular alkaline phosphatase during growth and sporulation of Bacillus cereus.

Alkaline phosphatase (EC 3.1.3.1) is synthesized in media with a low phosphate concentration (0.37 mM of total and 19 microM of inorganic phosphate, respectively) already during the exponential phase of growth of Bacillus cereus. The enzyme is repressed by higher phosphate concentrations (3.7 mM) during the whole growth period; during sporogenesis the enzyme activity in cells slightly increases even under these conditions. During growth the enzyme is not secreted into the medium, a minor amount being released after cessation of growth. The enzyme activity can be increased by adding Zn2+ ions (10 microM). When during growth without phosphate the pH of the medium decreases below 5.0, the enzyme activity temporarily decreases and growth is slowed down, followed by a subsequent increase of the enzyme activity. In this case the onset of sporulation is also delayed.

Transformation of Streptomyces granaticolor with natural and recombinant plasmid vectors.

Protoplasts of Streptomyces granaticolor were found to be transformable by the broad-host-range plasmid pIJ350 but no transformants were detected when the narrow-host-range plasmid pIJ2 or the shuttle vector pPM66 (pIJ350--pBR322) isolated from E. coli cells were used. The onset of blue colour granaticin production by S. granaticolor cells was used as a marker to prepare protoplasts with a high transformation capacity. The presence of a restriction system is discussed.