Tacrolimus decreases tubular phosphate wasting in renal allograft recipients.

The aim of the study was to elucidate whether cyclosporine- and tacrolimus-based immunosuppression impairs tubular reabsorption of phosphate after kidney transplantation. Sixty cadaveric allograft recipients were included in the study. Forty patients receiving triple immunosupression with cyclosporine, azathioprine, and prednisone were studied for 1, 6, 12 months (groups A1 and A2, 20 patients) and for 24, 30, and 36 months (groups B1 and B2, 20 patients) after transplantation. Twenty patients who received tacrolimus with steroid withdrawal after 3 months were included in the study (group C). Recipients from groups A2 and B2 were treated additionally with vitamin D and calcium carbonate. Serum iPTH, 25-OHD, 1.25(OH)(2)D concentrations were determined, and TRP (mmol/L) and TmP/GFR (mmol/L) were calculated using Walton-Bijvoet nomogram. Higher values of total calcium serum concentration in group A were detected. Lower inorganic phosphate serum concentrations were detected in groups A and C, in contrast to group B where they remained within normal values. TmP/GFR values were significantly higher in group C in the first and third examination in comparison with patients of group A. Moreover, TRP index values were significantly higher than analogous values of groups A and B. Tacrolimus-treated patients exhibit significantly faster recovery from tubular phosphate reabsorption impairment compared to cyclosporine-treated recipients. No correlation between iPTH, 25-OHD, 1,25(OH)(2)D concentration, and tubular dysfunction parameters was observed. Amelioration of phosphate handling, in spite of hyperparathyroidism intensity, can follow early steroid avoidance.

Is renal function altered in patients with psoriasis vulgaris?--A short review.

Psoriasis is a chronic inflammatory dermatosis with distinct microvascular changes. Although it is generally accepted that the psoriatic process is limited to the skin, it is not excluded that similar vascular lesions might be present in internal organs, such as the kidneys. This review summarizes data on renal function in psoriatic patients who were never treated with the potentially nephrotoxic drugs used for treatment of psoriasis. The limited number of such studies is mainly concentrated on microalbuminuria. Enhanced urinary albumin excretion at the level of microalbuminuria has been found in some psoriatic individuals. All other routine laboratory renal tests were within their normal ranges. As microalbuminuria is regarded as a subclinical marker of glomerular dysfunction, the authors hypothesize that some psoriatic patients may present subclinical glomerular changes. However, kidney histopathology is necessary to confirm this hypothesis.

Excess benign melanocytic naevi in renal transplant recipients.

BACKGROUND: Some studies indicate that malignant melanoma occurs more frequently in renal transplant recipients than in the normal population. The development of excess benign melanocytic naevi is regarded as an indicator of the risk for malignant melanoma. OBJECTIVE: This study was undertaken to evaluate the prevalence of benign melanocytic naevi in adult renal transplant patients. METHOD: All benign melanocytic naevi irrespective of size were counted in 76 patients with renal transplants and were compared to naevus counts in 55 sex- and age-matched healthy controls. RESULTS: The mean total number of benign melanocytic naevi was significantly higher (p < 0.001) in renal transplant patients than in the control group: 93.6 +/- 52.2 and 36.1 +/- 29.9, respectively. The most evident increase occurred on the palms/soles and back/buttocks. A positive, although not significant, correlation between naevus counts and duration of immunosuppression was found. CONCLUSION: Renal transplant recipients have an increased number of benign melanocytic naevi and should be considered as a risk group for malignant melanoma.

[C-reactive protein (CRP) as a marker of of hemodialysis biocompatibility]. / Bialko C-reaktywne (CRP) jako wskaznik biozgodnosci hemodializy.

Haemodialysis leads to monocytes activation and secretion of cytokines, which stimulates hepatic production of CRP. To assess the biocompatibility of haemodialysis the CRP serum levels were measured. CRP serum levels during haemodialysis with the use of cuprophane membranes increased from 4743.3 +/- 3251.6 ng/ml to 5231.8 +/- 3458.4 ng/ml just after haemodialysis and 5865.4 +/- 3684.8 ng/ml 22 hours after haemodialysis (p < 0.001). During haemodialysis using polysulfone membranes CRP from the initial value of 4819.4 +/- 4328.2 ng/ml decreased to 3316.9 +/- 3882.7 ng/ml just after haemodialysis (p < 0.01) and increased to 5086.9 +/- 4193.0 ng/ml 22 hours after haemodialysis (p < 0.05). Re-counted CRP values, according to changes in total blood protein, increased significantly (p < 0.02) 22 hours after haemodialysis with the use of cuprophane membranes. During haemodialysis using polysulfone membranes above mentioned levels were significantly decreased just after haemodialysis (p < 0.001). The cuprophane membranes surface area and reutilization of dialyzers did not affect the changes of CRP serum levels. No correlation was observed between CRP level changes and dialysis neutropenia and complement activation. Our results indicate, that CRP serum level measurement may be feasible to assess the biocompatibility of dialysis membranes.

Acute rejection and delayed graft function--risk factors of graft loss.

Acute graft rejection and delayed function are considered to be the major risk factors of short-term as well as long-term graft survival. We studied the impact of these factors on graft outcome among 109 renal transplant recipients. All recipients were treated with triple drug protocol. The recipients were divided into two groups: I group included 57 patients with delayed graft function (DGF), II group included 52 patients with immediate graft function (IGF). We studied graft survival, incidence of acute rejection, serum creatinine levels and the cause of graft loss for patients in both groups. Acute rejection episodes occurred in 49% of patients from DGF group and 45% of patients from IGF group. Graft survival in IGF group was better than in DGF group. Actuarial graft survival at 1, 2, 3 and 4 years in examined groups was 84%, 82%, 72%, 65% vs. 92%, 86%, 84%, 84%, respectively. One-year graft survival in patients with acute rejection from DGF group and IGF group was significantly lower than in patients who remained rejection free (69%, 74% vs. 94%, 96%). We concluded that delayed graft function decreases long-term graft survival, while immediate graft function has an excellent impact on graft outcome. Acute graft rejection is the strongest risk factor of graft loss.

[Urinary tract infections in the first three months following kidney transplantation]. / Zakazenia ukladu moczowego w pierwszych trzech miesiacach po przeszczepieniu nerki.

Eighty kidney transplants were examined. During the first three months following transplantation, urinary tract infections occurred in 68 patients (85%). Fifty patients (74%) have had a few episodes of infections in the form of either suprainfection or recurrence whereas in the remaining patients there was only one episode of urinary infection. No difference in infection incidence was noted in both men and women. Ninety percent of urinary infections occurred within the first 4 weeks following transplantation. The most frequent cause of the urinary tract infections were gram-negative bacilli of Enterobacteriaceae family. In case of multiple infections there was a high percentage of gram-positive cocci.

[Influence of cuprophane membrane surface dialyzers on beta2-microglobulin serum concentration in patients during hemodialysis]. / Wplyw powierzchni blny kuprofanowej dializatora na stezenie beta 2-mikroglobuliny w surowicy krwi chorych w czasie hemodializy.

In 14 patients beta 2-microglobulin serum concentration before and after haemodialysis using cuprophane capillary dialyzers with 0.7; 1.2 and 1.5 m2 surface was measured. beta 2-microglobulin concentration did not change during the haemodialysis procedure using 0.7 m2 dialyzers and was 31.15 +/- 7.58 mg/l before the dialysis and 31.10 +/- 13.59 mg/l after the procedure. Using 1.2 m2 dialyzers beta 2-microglobulin serum level increased (not significantly) from 29.40 +/- 7.53 mg/l before dialysis up to 36.29 +/- 11.70 mg/l after dialysis. When employed 1.5 m2 dialyzers the increase of beta 2-microglobulin serum concentration was higher and statistically significant (p < 0.02). The values of beta 2-microglobulin serum level before and after the haemodialysis were 29.89 +/- 2.44 mg/l and 38.04 +/- 5.89 mg/l respectively. There was a significant increase of number of patients with higher beta 2-microglobulin serum level (p < 0.01) according to the increase of dialyzers surface. beta 2-microglobulin concentration after the haemodialysis procedure using 0.7 m2 dialyzers was lower than calculation of protein changes could show. However using 1.2 and 1.5 m2 dialyzers beta 2-microglobulin serum level was markedly higher (statistically significant (p < 0.05) when employed 1.5 m2 dialyzers), than expected using the some above calculation. The increase of beta 2-microglobulin showed positive, but statistically not significant correlation with the index of haemodialysis intensitivity. The above mentioned data indicate that the increase of beta 2-microglobulin after haemodialysis is not related to biocompatibility of cuprophane membrane, but is dependent on intensivity of haemodialysis, which associated with the surface of the membrane.

Antilymphocyte globulin with a small dose of cyclosporine A and prednisone as the induction of immunosuppression in renal allograft recipients.

In attempt to avoid a detrimental synergism between CsA and renal ischemia in the immediate postoperative period, ALG (425 lymphocytotoxic units/kg) with small doses of CsA (6-8 mg/kg) and P were applied as the initial immunosuppressive therapy in 14 recipients of cadaveric kidneys. ALG was administered for 5 to 14 days and 2 days before withdrawing ALG, Aza (2 mg/kg) was introduced. Results of this protocol were compared with those of 19 pts treated with CsA (12 mg/kg) and P. All the pts were followed for at least 12 months. The duration of posttransplant anuria was significantly reduced in the ALG/CsA/P group (p < 0.02). The sCr concentration after 12 months of observation was significantly lower (p < 0.05), no alterations in urinalysis were detected, the number of hypertensive pts was decreased. The acute rejection rates were equivalent in both groups, however 3 of 4 rejections in ALG/CsA/P group were resistant to steroids and occurred in pts with shortened period of ALG administration. The one year patient and graft survival in the ALG/CsA/P and control groups were respectively: 78.5%, 71.4% and 89.4%, 78.9%. Severe infectious complications in the group treated with ALG/CsA/P occurred in pts who were subsequently treated with OKT3.

[Effect of re-utilization of cuprophan capillary dialysers with different liquids on their biocompatibility and effectiveness of elimination]. / Wplyw reutylizacji róznymi plynami na biozgodnosc kuprofanowych dializatorów kapilarnych i efektywnosc eliminacji.

In 22 patients cuprophane capillary dialyzers reutilized in turn with four sets of liquids were used four times (Andante type in 13 and TAF-12 in 9 patients). The degree of biocompatibility and efficiency of elimination of small molecules was evaluated. During four-time reuse of dialyzers reutilized with sodium hypochlorite and with formaldehyde a reduction of intra-dialysis leukopenia, granulocytopenia and thrombocytopenia was not stated in blood of the patients. Activation of the complement system measured with the quantity of decrease of C3c fraction of the complement in the patients blood after 20 minutes of dialysis reduced essentially only at the fourth reuse of dialyzers (p < 0.01). Creatinine clearance measured always one hour after starting of the dialysis, did not change in succeeding reuse of dialyzers. Reutilization of dialyzers with hydrogen peroxide solution and formaldehyde caused essential reduction of ++intra-dialysis leukopenia and neutropenia (p < 0.001). There was lack of changes in ++intra-dialysis thrombocytopenia. Activation of the complement system was reduced essentially only after the fourth reuse of dialyzers (p < 0.001), but was also essentially lower (p < 0.05) than with dialyzers reutilized with sodium hypochlorite and with formaldehyde. Creatinine clearance practically did not change and at the fourth reuse of dialyzers it decreased on the average by 1.8%. Reutilization with acetic acid already at the second reuse of dialyzers essential (p < 0.001) and deepened decrease of intradialytic leukopenia and neutropenia and the activation of the complement system in course of succeeding reuses. Intradialytic thrombocytopenia was subjected to vestigal, not essential decrease. Creatinine clearance lowered a little but not essentially. At the fourth reuse of dialyzers it was lower on the average by 3.6% than the initial one. Reutilization with Dialina (stabilized blend of peracetic, acetic acid and hydrogen peroxide solution) caused essential (p < 0.001) and, in course of further reuses, deepening of lowering of intradialytic leukopenia and neutropenia as well as the activation of the complement system already at the second reuse. At the same time at the second and fourth reuse of dialyzers reutilized with Dialina the activation of the complement system was essentially lower than reutilized with the other liquids (p < 0.02). At the fourth reuse intradialytic thrombocytopenia also lowered essentially (p < 0.01). Creatinine clearance lowered a little more than with other liquids and at the second reuse of dialyzers was lower on the average by 5.6%, and at the fourth reuse--by 6.7% in relation to the new dialyzers.(ABSTRACT TRUNCATED AT 400 WORDS)

[Beta 2-microglobulin--its role in renal failure and hemodialysis therapy]. / Beta-2-mikroglobulina--rola w niewydolnosci nerek oraz dializoterapii.

A review of existing knowledge of beta 2M-microglobulin and their origin, physicochemical structure, metabolism and clinical significance with particular allowance of renal insufficiency patients in chronic hemodialysis was conducted. The probably important participation of beta 2-microglobulin in the development of later complications, especially dialysis-related amyloidosis, occurring in hemodialysis patients was discussed.

[Favorable course of pregnancy in a patient two years after kidney transplantation]. / Pomyslny przebieg ciazy u pacjentki w dwa lata po przeszczepieniu nerki.

A 30-year old female underwent kidney transplantation after unsuccessful 3-year dialysis for renal cortex necrosis. Immunosuppression was achieved with cyclosporin followed by azathioprine with prednisone. The patient conceived after 22 months with kidney transplantation. Mild decrease in arterial blood pressure and marked increased in glomerular filtration rate were seen during the first three months of pregnancy. Arterial blood pressure increased but insignificantly at the end of pregnancy. That time, gradual decrease in creatinine clearance was observed. An increase in serum bilirubin and alkaline phosphatase was noted. Pregnancy was terminated by cesarean section on the 38th week. Newborn was female, full-termed, viable, with body weight of 3,300 g. All examined parameters were normalized after delivery. Described case indicates that transplanted kidney functioning during pregnancy is similar to that in healthy women.

[Repeated use of hemodialysis equipment in the same patient]. / Wielokrotne uzycie dializatorów do hemodializy u tego samego chorego.

The authors submit the development of research on multiple use of dialyzers and the present state of the capillary dialysers reuse procedure. At present automated reuse machines are used that utilise ++de-ionized rinsing water or reverse ultrafiltration with or without 0.5% solution of sodium hypochlorite, or 3% solution of hydrogen peroxide. Generally, the sterilisation employs 1-2% formaldehyde and Renalin (stabilised solution of peracetic and acetic acids and hydrogen peroxide); more seldom--5% solution of acetic acid and glutaraldehyde. The pre-rinsing procedure of dialysers could also be performed with these solutions, except formaldehyde. The authors present advantages and disadvantages of every rinsing and sterilising solutions, which are used at present. The protein coat on the dialyzer is removed effectively only with sodium hypochlorite. On the other hand, formaldehyde and Renalin are the most effective sterilising solutions. However, formaldehyde could provide the development of anti-N-like antibodies, and allergic-toxic reactions in some patients. Another problem is a negative effect of formaldehyde on the staff. Renalin's drawbacks are its photosensitivity, a corrosive character and high cost. Multiple use of reprocessed dialyzers in the same patient decreases the cost of haemodialysis by even 70%, not effecting the survival rate. Also it is of considerable medical advantage, i.e. decreases the rate of first use syndrome and improves biocompatibility at subsequent uses of the dialyzers. The decrease of elimination effectiveness is, generally, scarcely noticed, statistically irrelevant and of no essential clinical significance.

[Interaction between blood and dialysis membrane]. / Interakcja krew--blona dializacyjna.

During contact between blood and dialysis membrane after the first 20-30 minutes of haemodialysis there occur the complement activation, ++intra-dialysis thrombocytopenia and leucopenia, especially neutropenia following their degranulation, which results in liberation of a number of proteases and inflammatory reaction mediators and an increased production of active oxygen compounds and peroxide radicals. This is followed by the appearance of thrombocyte-leucocyte aggregates and a decrease of ++intra-dialysis lung diffusion capacity. The clinical consequences of the blood-dialysis membrane interaction exhibit an increased permeability of pulmonic capillaries, pulmonic hypertension and hypoxemia, which might bring about vasogenic respiratory distress syndrome. The remote consequence is dialytic amyloidosis that follows increased generation and accumulation of beta 2-microglobulin. All of the above disturbances occur with cuprophan membranes more significantly that with other dialysis membranes. The blood--dialysis membrane interaction also incorporates the anaphylactic reactions, in some cases occurring when the new dialyzers are used, due to hypersensitivity to ethylene oxide used in sterilisation and the changes due to tissular accumulation of plastieizers rinsed out of the biomaterials during haemodialysis.

[Human recombinant erythropoietin in the treatment of anemia in patients on long-term hemodialysis]. / Ludzka rekombinowana erytropoetyna w leczeniu niedokrwistosci u chorych dlugotrwale hemodializowanych.

Recombinant human erythropoietin (EPO) was administered i.v. to anaemic patients (pts) on hemodialysis in doses from 40 to 120/IU/kg 3 times a week. 20 out of 21 pts showed an increase in hemoglobin (Hb) level above 11 g/dl after 8-12 weeks. Maintenance doses to keep Hb value about 10 g/dl varied from 2 X 40 IU/kg to 3 X 40 IU/kg per week (subcutaneous). EPO improved the well-being and physical condition in all of pts. Six pts developed rise in blood pressure and most an increase in predialysis serum potassium and urea levels during first 16 weeks of treatment.