[Metabolic effects of intermittent hemofiltration in patients with acute renal failure]. / Metabolicheskii éffekt intermittiruiushchei gemofil'tratsii u bol'nykh s ostroi pochechnoi nedostatochnost'iu.

AIM: Investigation of postaggressive reaction of metabolism on intermitten hemofiltration (IHF) in patients with acute renal failure (ARF). The speed of generation of urea, creatinine and oligopeptides was estimated in the course of (IHF) and in interval between the procedures. Hormonal stress was evaluated by concentration of hydrocortisone in plasma and and filtrate. MATERIALS AND METHODS: The trial covered 36 patients with oliguric ARF (21 males and 15 females) for whom IHF was the main method of replacement renal therapy. The kinetic modelling accounted for distinctive distribution of markers in body fluids. Statistical processing was made according to Student-Fisher T-criterion. RESULTS: IHF runs with intensive proteinolysis with acceleration of oligopeptides generation by 810%, degradation of large quantities of creatine triphosphate and 770%-accelerated production of creatinine, with protein catabolism and 440%-accelerated production of urea. Hydrocortisone blood levels rise about two-fold despite intensive elimination of the hormone with filtrate. Between speeds of IHF, generation of creatinine and secretion a direct correlation was found. This indicates the importance of the perfusion rate for induction of the stress and catabolism. Background hydrocortisone Irvrl has significant effects only on urea accumulation rates in IHF-free intervals. However, in the course of IHF, generation of urea and oligopeptides is to a great extent independent of hydrocortisone secretion. CONCLUSION: Application of IHF in ARF patients results in rather strong stress with enhanced proteinolysis and protein catabolism. To compensate protein loss associated with only urea generation, additional administration of minimum 60 g of plasma or amino acids is required.

[Plasma contents of cytokines (TNF-alpha, IL-1 beta, IL-6) and their clearance during continuous hemofiltration in patients with sepsis and multiple organ failure]. / Soderzhanie v plazme tsitokinov (TNF-alfa, IL-1beta, IL-6) i ikh klirens pri postoiannoi gemofil'tratsii u bol'nykh s sepsisom i poliorgannoi nedostatochnost'iu).

The total-systems inflammatory response was assessed in patients with sepsis and multiple organ failure by measuring plasma cytokines TNF-alpha, IL-1 beta, and IL-6 and their clearance and total elimination in the course of permanent hemofiltration (PHF). Sepsis and multiple organ failure were found to involve a stable circulation of numerous cytokines, their levels reaching the peaks in some cases. No correlation between the content of individual cytokines in the plasma were detected. Appreciable amounts of TNF-alpha and IL-1 beta were eliminated during PHF, their clearance being approximately 15 ml/min, whereas elimination of IL-6 was negligible. Hence, PHF affects the mediator component in the pathogenesis of sepsis and the multiple organ failure syndrome.

[Plasma myoglobin and continuous hemofiltration in patients with rhabdomyolysis and acute kidney failure]. / Mioglobin plazmy i postoiannaia gemofil'tratsiia u bol'nykh s rabdomiolizom i ostroi pochechnoi nedostatochnost'iu.

Plasma and filtrate levels of myoglobin, specific antibodies and immune complexes were measured by radioimmunoassay or enzyme immunoassay in patients with rhabdomyolysis and acute renal failure on continuous hemofiltration (CHF). 14 of them had crush syndrome, 7 had other forms of rhabdomyolysis. 11 patients died (52%) because of the underlying disease or its complications. Rhabdomyolysis was associated with marked and long-lasting myoglobinemia. Early amputation and restoration of diuresis combined with CHF resulted in a fall in myoglobin content. CHF provided elimination of large amounts of myoglobin with filtrate. In rhabdomyolysis in all cases there appeared specific antibodies and circulating immune complexes.

[Urea and creatinine kinetics during the continuous hemofiltration of patients with acute kidney failure]. / Kinetika mocheviny i kreatinina pri postoiannoi gemofil'tratsii u bol'nykh s ostroi pochechnoi nedostatochnst'iu.

Continuous hemofiltration (CHF) procedures (a total of 33 with overall duration 2495 hours and replacement of 2221 kg of fluid) were conducted in 23 patients (12 males and 11 females) aged 30.5 +/- 2.5 years suffering from severe acute renal failure (ARF). CHF efficacy was judged by the kinetics of urea and creatinine. With parenteral feeding the patients received protein and amino acids 1.2-1.5 g/day/kg b.m. The death of 13 patients resulted from sepsis, hemorrhage, shock, adrenal insufficiency. The filtration speed 15.6 +/- 0.6 (7-34) ml/min allowed replacement of 21.7 +/- 1.3 (8-49) kg or 0.49 +/- 0.03 of body fluid a day. The highest rate of hemofiltration was used on day 1, this reducing plasma urea from 35.7 +/- 2.5 (7.5-55.0) to 27.5 +/- 2.0 mmol/l (p < 0.05) and creatinine from 742 +/- 77 (182-1800 to 539 +/- 44 mumol/l (p < 0.05). Subsequently urea and creatinine were maintained in the plasma at the levels 26.8 +/- 1.0 mmol/l and 539 +/- 73 mumol/l, respectively. Urea eliminated with the filtrate amounted to 591 +/- 53, creatinine 13.5 +/- 4.0 mmol or 0.49 +/- 0.02 and 0.65 +/- 0.07 of the overall pools, respectively. In anuria urea generation reached 525 +/- 35 (108-1071) mmol/day, that of creatinine 9.6 +/- 1.4 (1.2-14.0) mmol/day, being on the average less than filtrate elimination of these substances. It is believed that CHF contributes to balanced treatment of severe ARF in spite of parenteral introduction of large quantities of protein and amino acids.

[The level of neopterin in the plasma of patients with acute kidney failure during treatment with continuous arteriovenous hemofiltration]. / Uroven' neopterina v plazme bol'nykh s ostroi pochechnoi nedostatochnost'iu pri ee lechenii postoiannoi arteriovenoznoi gemofil'tratsiei.

Neopterin is a biochemical marker of cellular mediated immune reactions and may be used in elucidating the cause of acute renal failure. 9 patients (6 males, 3 females) aged 23 to 56 years suffering from a severe form of the disease were examined. A continuous arteriovenous hemofiltration was used as a treatment with exchanging 29.2 +/- 2.0 (14-65) kg of fluid during 24 hours. The patients' diet included protein and amino acids of 1.2-1.5 g/kg of body weight, 35-45 Kcal/kg of body weight per 24 hours with meal and parenteral infusions. 4 patients died. Contents of neopterin in the plasma of the healthy equaled to 6.8 +/- 03 (3.4-11.3) nmol/l (radioimmunoassay; Henning; Berlin, GmbH). In patients with acute renal failure plasma neopterin contents were increased, i.e. 130.0 +/- +/- 9.6 (48.2-200.2) nmol/l and in two thirds of the cases and correlated with creatinine levels (r = + 0.60 +/- 0.17; p less than 0.05; n = 23), thus showing a simultaneous influence of anuria and continuous arteriovenous hemofiltration on a neopterin pool amount at the same time, in patients with tropical malaria and hemotransfusion shocks (2 cases), the neopterin contents were extremely high and did not correlate with the creatinine level. During continuous hemofiltration at a rate of 21.6 +/- 1.3 (15.9-36.9) ml/min neopterine clearance was 17.2 +/- 2.1 (6.7-36.2) ml/min. Neopterin hyperproduction after blood transfusion suggests an immune conflict as a possible cause of acute renal failure.

[Middle-molecule oligopeptide kinetics during intermittent hemofiltration in patients with acute kidney failure]. / Kinetika oligopeptidov srednei molekuliarnoi massy pri intermittiruiushchei gemofil'tratsii u bol'nykh s ostroi pochechnoi nedostatochnost'iu.

Acute renal failure was treated by intermittent hemofiltration in 19 patients (8 males and 11 females), 13 of which survived and 6 died. All of them underwent examinations for kinetics and clearance of middle-mass oligopeptides (MMOP) performed by gel filtration (sephadex G-15) and densitometry in UV light (280 nm) using C phi-24 device. Plasma levels of oligopeptides in acute renal failure were found increased 20-fold. They consisted mainly of MMOP (1000-3000 D) entering the 13th eluate fraction. There appeared a correlation between oligopeptides and creatinine plasma levels. Under hemofiltration lasting for 6.45 hours and replacing approximately total body fluid, nearly all the baseline extracellular oligopeptide pool was removed. The average rate of the filtration reached 127 ml/min, clearance of oligopeptides being 57.9 ml/min or more than 22 1 of fluid per one procedure. Intermittent hemofiltration went in enhanced (8-fold) MMOP generation responsible for residual high levels of them in plasma after the procedure.