The Nephrotoxicity of Drugs Used in Causal Oncological Therapies.

In recent years, a dynamic development of oncology has been observed, resulting from the increasingly frequent occurrence of neoplasms and therefore, increasing population of patients. The most effective form of therapy for cancer patients is complex multidisciplinary specialized disease management, including nephro-oncology care. Different forms of renal function impairment are frequently diagnosed in cancer patients. They are caused by different co-morbidities existing before starting the oncologic treatment as well as the direct undesirable effects of this therapy which may cause temporary or irreversible damage of the urinary system-especially kidneys. According to different therapeutic programs, in such cases the degree of renal damage is often crucial for the possibility of further anti-cancer treatment. Medical personnel responsible for delivering care to oncology patients should be properly educated on current methods of prevention and treatment of renal complications resulting from anti-cancer therapy. The development of oncologic medicines design, including especially immuno-oncological agents, obliges us to learn new patomechanisms determining potential adverse effects, including renal complications. This publication is focused on the most important undesirable nephrotoxic effects of the frequently used anti-cancer drugs.

Cystinuria poorly responding to treatment - the risk of chronic kidney disease.

Cystinuria is the genetic condition for the increased excretion of cystine in the urine. Patients mainly suffer from afflictions related to the presence and passage of kidney stones. The currently available treatment methods include conservative treatment based on increased fluid intake, appropriate diet, medications and urological procedures. The causal treatment has not yet been invented. A CASE REPORT: A patient case was described whose first symptomatic kidney stones appeared after the second year of life. Urinary cystine excretion was significantly increased - 25,431 µmol/1g creatinine (norm: 167-333 µmol/1g creatinine), which was also shown, but lower, in both parents of the patient. Despite the early initiation of therapy including low sodium diet, abundant hydration, alkalization, captopril and compliance with stringent restrictions, the level of urinary cystine excretion was still not within the normal range. There have been many modifications to the therapy and dose increases of drugs, but without visible results. The patient underwent several urological procedures, including: ESWL (Extracorporeal shock wave lithotripsy), URSL (Ureteroscopic lithotripsy), PCNL (Percutaneous nephrolithotomy) and open surgery to remove cystine deposits that were still produced in the kidneys. In addition, for many years the disease was complicated by recurrent urinary tract infections, underweight and lesions like epithelial metaplasia in the bladder. Renal parameters were repeatedly examined. Elevated results such as: serum creatinine 0.9 mg/dl, cystatin C concentration 1.10 mg/l, albumin-creatinine index 0.197, creatinine clearance 50.7 ml/min /1.73 m2 and eGFR 73 ml/min/1.73 m2 allowed for the diagnosis of chronic kidney disease before the age of 18. After many years of conservative treatment, only the introduction of thiopronine, still little known in Poland, reduced the level of cystine excreted in the urine. The inclusion of the drug reduced the tendency to produce kidney stones, which allowed to inhibit the progression of renal failure. CONCLUSIONS: Despite many years of research and modern drugs, cystinuria is still a disease with which patients are associated for the rest of their lives. The ongoing research, along with attempts to understand the genetic and epigenetic mechanisms responsible for the emergence of mutations in the main genes causing the disease and the course of the disease, gives hope for finding a method of causal treatment for cystinuria.

Early complications of translumbar cannulation of the inferior vena cava as a quick, last-chance method of gaining access for hemodialysis. Ten years of experience in one clinical center.

INTRODUCTION: The gold standard of vascular access for chronic hemodialysis patients is the arteriovenous fistula (AVF). If an AVF cannot be created, the hemodialysis catheter can be inserted into the internal jugular, femoral or subclavian vein. After exhausting the abovementioned standard accesses, translumbar access to the inferior vena cava (IVC) is considered a quick, last-chance and rescue method. AIM: Retrospective analysis of early complications (EC) of translumbar IVC catheterization using one type of catheter by one medical team. MATERIAL AND METHODS: From January 2010 to October 2019, a total of 34 translumbar IVC catheters were implanted in 27 patients. RESULTS: A major EC was found in 1 (2.9%) procedure. Minor EC occurred in 23.5 attempts. None of these complications required an intervention. CONCLUSIONS: In patients with exhausted possibilities of obtaining standard vascular access for HD, translumbar IVC cannulation proved to be a safe and effective method.

Continuous renal replacement therapy as a treatment of selected acute intoxications.

The methods of extracorporeal elimination remain a particularly useful therapy of selected, most severe intoxications caused by drugs and other chemical substances. The hemodialysis (HD) is the most commonly used therapy, which results from the widest availability of this method. However, due to the gradual spread of modern continuous dialysis techniques, continuous veno-venous hemodialysis (CVVHD) in particular creates a new opportunity of treatment of severe intoxications - especially in patients with cardiovascular complications. The review of literature dealing with the experience in using continuous methods of treatment of selected severe intoxications is presented in the article. Taking into account a lack of analyses assessing the efficacy of different toxicological methods used in large populations of patients, the experiences are mainly based on individual case reports. The presented data indicate that CVVHD may be treated as the preferred method of treatment of severe intoxications in hemodynamically unstable patients. Moreover, CVVHD may be useful as a continuation of therapy following the initial HD treatment.

Application of the Molecular Adsorbent Recirculating System in Type 1 Hepatorenal Syndrome in the Course of Alcohol-Related Acute on Chronic Liver Failure.

BACKGROUND This study aimed to evaluate the Molecular Adsorbent Recirculating System (MARS) effectiveness in patients with alcohol-related acute-on-chronic liver failure (AoCLF) complicated with type 1 hepatorenal syndrome (HRS). So far, MARS efficacy and safety has been demonstrated in various acute liver failure scenarios. MATERIAL AND METHODS Data from 41 MARS procedures (10 patients with type 1 HRS, in the course of alcohol-related AoCLF were considered for this study. Biochemical tests of blood serum were performed before and after each procedure. The condition of patients was determined before and after the treatment with the use of the model for end-stage liver disease - sodium (MELD-Na) and the stage of encephalopathy severity based on the West Haven criteria. RESULTS During the observation period (20.5±13.9 days), 5 patients died, and the remaining 5 surviving patients were discharged from the hospital. In the group of 10, the 14-day survival, starting from the first MARS treatment, was 90%. The MARS procedure was associated with a 19% reduction in bilirubin (27.5±6.1 versus 22.3±4.0 mg/dL, P<0.001), 37% reduction in ammonia (44.1±22.5 versus 27.6±20.9 P<0.001), 27% reduction in creatinine (1.5±1.0 versus 1.1±0.6 mg/dL, P<0.001) and 14% reduction urea (83.8±36.1 versus 72.1±33.3, P<0.001) in blood serum samples, with stable hemodynamic parameters. In the group of patients discharged from the clinic (n=5), the MARS treatments resulted in an improvement in hepatic encephalopathy (West Haven; P=0.043), as well as a reduction in the MELD-Na score (P=0.015). CONCLUSIONS MARS is a hemodynamically safe method for supporting the function of the liver and the kidneys. Application of the MARS reduces the symptoms of encephalopathy in patients with alcohol-related type 1 HRS.

Inflammatory Markers During Continuous High Cutoff Hemodialysis in Patients with Septic Shock and Acute Kidney Injury.

High cut-off (HCO) continuous veno-venous hemodialysis (CVVHD) is one of the renal replacement therapies which nonselectively removes inflammatory mediators. This study seeks to examine the association between the inflammatory background and the need for catecholamine treatment in hemodynamically instable patients having septic shock and acute kidney injury during HCO-CVVHD. There were 38 patients (F/M; 16/22, mean age 63 ± 16 years) included in the study. The initial content of the cytokines IL-4, IL-12, IL-17, and TNFα, C-reactive protein, and the score of the Sequential Organ Failure Assessment (SOFA) were assessed. The receiver operating characteristic (ROC) plot showed that a combination consisting of IL-17 × SOFA ≤22.3 was a reliable predictive factor of the need for catecholamine treatment during HCO-CVVHD, with 82% sensitivity and 90% specificity, with the area under curve (AUC) of 0.843; p < 0.001. On the other side, SOFA ≤14.0 predicted catecholamine treatment or its discontinuation when started, with both specificity and sensitivity 83% (AUC = 0.899; p < 0.001). In conclusion, the immune system activation, assessed from the initial level of IL-17, and the clinical SOFA evaluation are of practical help in predicting the need for catecholamine treatment or the probability of a reduction thereof in patients on veno-venous hemodialysis due to septic shock.

Infective endocarditis in chronic hemodialysis patients is it still a growing clinical challenge?

Patients requiring chronic dialysis are at increased risk for a severe complication such as Infective Endocarditis (IE). Infections, immediately after cardiovascular diseases, are the second leading cause of deaths in this group of patients. In the Polish population, the incidence of IE in hemodialysis patients is unknown. AIM: The aim of the study was to present epidemiology, clinical and echocardiographic characteristics and microbiological profile of infective endocarditis with the evaluation of the suitability of the modified Duke criteria for the diagnosis of IE in hemodialysis patients. MATERIALS AND METHODS: The aim of the study was to present epidemiology, clinical and echocardiographic characteristics and microbiological profile of infective endocarditis with the evaluation of the suitability of the modified Duke criteria for the diagnosis of IE in hemodialysis patients. RESULTS: Ten cases of IE in HD patients were diagnosed. The incidence of IE was 1.55/10,000 dialysis sessions/year. The incidence rate for IE in the dialysis population was 2,000/100,000 patients/year, while the incidence rate for IE in all hospitalized individuals was 5/100,000 patients/year. Hemodialyzed patients had significantly higher odds of having IE compared to other hospitalized individuals (odds ratio [OR] = 69; 95%; CI: 35.92-132.06,p<0.0001). Mitral valve involvement was the most frequent. The most common IE etiology was Staphylococcus species. Based on the modified Duke criteria, the "definite IE" was recognized in one case whereas remaining 9 cases were classified as the "possible IE". CONCLUSIONS: In hemodialyzed patients the risk of IE is approximately 69 times higher than in the general hospitalized population. Right heart valve involvement occurs seldom despite the presence of vascular catheters. The modified Duke criteria have a limited applicability in the diagnosis of infective endocarditis.

[Sepsis - still valid economic and epidemiological problem]. / Sepsa ­ wciaz aktualny problem epidemiologiczny i ekonomiczny.

The recognition of sepsis is connected with potentially bad prognosis, high mortality rate and high costs of the therapy. A new definition of sepsis was introduced in 2016. The main role of dysfunction of organs in the course of infection, the potential threat for life and necessity to perform quick diagnosis result from this definition. The review of worldwide literature on sepsis epidemiology and therapy costs was done in the current article. It was observed that the data concerning incidence of sepsis in Polish hospitals are incomplete, related to single observations, and in most cases they come from retrospective analyses. Therefore, the nation-wide registry comprising the data of the sepsis cases should be established.

[The role of high cut off membranes in renal replacement therapy of acute kidney injury in the course of sepsis - the current state of knowledge]. / Rola blon o wysokim punkcie odciecia w leczeniu nerkozastepczym ostrego uszkodzenia nerek w przebiegu sepsy ­ aktualny stan wiedzy.

Sepsis as a systemic inflammatory reaction to infection is an important interdisciplinary clinical problem. Over the past 20 years, the number of patients who have contracted sepsis has doubled. The occurrence of acute kidney injury in the course of sepsis increases mortality twice, while chronic kidney disease develops in 50% of the patients who survived sepsis. The pathophysiology of acute kidney injury (AKI) development in the course of sepsis is not fully understood. Some researchers, to emphasize the distinctiveness of AKI in the course of sepsis, describe the changes that occur in the kidneys in its course as sepsis induced-AKI. In the last decade, the theory regarding the possibility of modulation of inflammatory pathways through extracorporeal blood purification methods (HCO - using high cut off membranes) from pro-inflammatory cytokines and attempts to restore homeostasis in this way has gained great recognition. The basis for the implementation of this type of treatment was the "maximum concentration" hypothesis, which assumes that, avoiding the onset of the early peak of circulating proinflammatory molecules is possible to prevent and modulate the clinical effects of an excessively expressed inflammatory reaction in the course of sepsis. This study is an attempt to analyze and summarize the current state of knowledge on the effectiveness of using HCO membranes in patients with sepsis who have developed AKI. For this purpose, the resources of MEDLAIN/Pubmed bases from 1965 to April 2018 have been analyzed, taking into account only the full versions of articles in English, using a combination of the following words: super high-flux, high cut-off, dialysis, renal replacement therapy, filtration, diafiltration, hemodialysis, hemofiltration, hemodiafiltration, sepsis, cytokine, inflammatory mediators, inflammation.

Removal of Procalcitonin and Selected Cytokines during Continuous Veno-Venous Hemodialysis Using High Cutoff Hemofilters in Patients with Sepsis and Acute Kidney Injury.

INTRODUCTION: The purpose of this study was to evaluate the impact of continuous veno-venous hemodialysis (CVVHD) using high cutoff (HCO) hemofilters on the removal of procalcitonin (PCT), and other inflammatory markers in the treatment of patients during septic shock with acute kidney injury (AKI). MATERIALS AND METHODS: Thirty-six patients with septic shock and AKI were included in the study. Before and after the 24-h HCO-CVVHD, PCT, native C-reactive protein (CRP) and cytokines (interleukin-1ß, interleukin-6, interleukin-12, interleukin-17, tumor necrosis factor-α) in serum and effluent were assessed. RESULTS: After the HCO-CVVHD serum concentrations of PCT, CRP and selected cytokines were significantly lower. The decrease in PCT was bigger than in CRP (p = 0.007). The change in PCT concentration was significantly influenced by PCT and IL-17 clearances (R2 = 0.525; p < 0.001). CONCLUSION: In contrast to the native CRP, monitoring of PCT during HCO-CVVHD is less useful because it reflects the clearance of this marker and anti-inflammatory effectiveness of the method.

Dynamic tissue perfusion assessment reflects associations between antihypertensive treatment and renal cortical perfusion in patients with chronic kidney disease and hypertension.

PURPOSE: Renal cortical perfusion measured in noninvasive, dynamic ultrasonic method is connected with the hemodynamic cardiac properties and renal function. Antihypertensive drugs affect the functioning of the heart and kidneys. The aim of the study was to evaluate the effect of a chronic use of antihypertensive drugs on ultrasound parameters of renal cortical perfusion. METHODS: The study included 56 consecutive patients (49 M + 7 F, age 54.0 ± 13.3) with stable chronic kidney disease and hypertension. Color Doppler dynamic tissue perfusion measurement was used to assess renal cortical perfusion. RESULTS: Patients were treated with a mean of 2.7 ± 1.4 antihypertensive drugs, of which diuretics accounted for 25%, angiotensin-converting enzyme inhibitors (ACE-I) together with angiotensin receptor blockers (ARB) 24%, beta-blockers (BB) 23%, calcium channel blockers 16%, alpha-1 blockers (α1B) 9% and centrally acting drugs 3%. All investigated groups of drugs correlated significantly with parameters of renal perfusion. In multivariable regression analyses adjusted to age, diuretics were connected with the decrease (r = - 0.473) and ACE-I + ARB (r = 0.390) with the improvement of proximal and whole renal cortex perfusion (R2 = 0.28; p < 0.001), whereas BB (r = - 0.372) and α1B (r = - 0.280) independently correlated with worsened perfusion of renal distal cortex (R2 = 0.21, p < 0.01). CONCLUSIONS: The type of antihypertensive therapy had a significant influence on the ultrasound parameters of renal cortical perfusion. Noninvasive, ultrasonic dynamic tissue perfusion measurement method appears to be an adequate tool to assess the impact of drugs on renal cortical perfusion.

Left ventricular end-diastole hemodynamics is strongly associated with spontaneous cardiac baroreflex in humans.

BACKGROUND: In animals, hemodynamic conditions during left ventricular (LV) end-diastole are crucial for the excitation of autonomic afferents distributed throughout cardiac chambers and large thoracic vessels. The objective of the study was to select the echocardiographic indices of LV diastolic function that are the most potent predictors of the heart's spontaneous baroreflex in humans. METHODS: In 47 untreated hypertensive patients (26 with normal and 21 with increased left atrium diameter) and 24 healthy controls, baroreflex sensitivity (BRS) was assessed in the low (αLF; 0.04-0.15 Hz) and high frequency (αHF; 0.15-0.4 Hz) components in the supine and during tilting. The [Formula: see text] normalized to LV end-diastolic diameter (the [Formula: see text] index) is a marker of the septum late diastolic distension rate ([Formula: see text] denotes peak late diastolic velocity at the septal mitral annulus) under the corresponding transmitral pressure gradient that determines the peak velocity of blood flow (A) into the LV chamber. RESULTS: The [Formula: see text] markedly stronger than [Formula: see text] ratio correlated with the BRS. In the best-fit models of multivariable linear regression, the [Formula: see text] index was the independent predictor of the αLF BRS at tilting (ß = -0.3; p = 0.01). Independent of clinical and echocardiographic parameters, the [Formula: see text] index predicted also both the αHF BRS in the supine position (ß = -0.23; p = 0.01) and the αHF BRS reinforcement due to increased preload (ß = -0.28; p = 0.001). CONCLUSIONS: The [Formula: see text] index is a reliable marker of diastolic dysfunction that evokes significant heart's baroreflex impairment and is markedly stronger than [Formula: see text] ratio associated with these systemic consequences of altered LV diastole hemodynamics.

Ultrasonic evaluation of renal cortex arterial area enables differentiation between hypertensive and glomerulonephritis-related chronic kidney disease.

PURPOSE: Identifying the primary etiology of cardio-renal syndrome in a timely manner remains an ongoing challenge in nephrology. We hypothesized that hypertensive kidney damage can be distinguished from chronic glomerulonephritis at an early stage of chronic kidney disease (CKD) using ultrasound (US) Doppler sonography. METHODS: Fifty-six males (age 54 ± 15, BMI 28.3 ± 3.5 kg/m2) with hypertension and stable CKD at stages 2-4 [38 with essential hypertension (HT-CKD); 18 with glomerulonephritis (GN-CKD)] were studied. Blood tests, UACR, echocardiography, ABPM, carotid IMT, and an ultrasound dynamic tissue perfusion measurement (DTPM) of the renal cortex were performed. RESULTS: HT-CKD patients had reduced proximal renal cortex perfusion as well as reduced total and proximal renal cortex arterial area. Proximal renal cortex arterial area ≤0.149 cm2 identified hypertension-related CKD with a sensitivity of 71% and a specificity of 78% (AUC 0.753, p < 0.001). CONCLUSIONS: Evidence of diminished arterial vascularity or perfusion of renal proximal cortex, both derived from US Doppler, could be helpful in differentiating hypertensive nephropathy from glomerulonephritis-related CKD.

Effectiveness of High Cut-Off Hemofilters in the Removal of Selected Cytokines in Patients During Septic Shock Accompanied by Acute Kidney Injury-Preliminary Study.

BACKGROUND In recent years there have been attempts to treat sepsis using various methods of extracorporeal blood purification in order to eliminate selected mediators of inflammation. MATERIAL AND METHODS This retrospective study assessed 28 patients (17 males, 11 females, age 60.3 ± 14.5 years) in septic shock, treated with continuous venovenous hemodialysis (CVVHD). Oligoanuric patients with acute kidney injury were qualified for 24-hour CVVHD using high cut-off (HCO) hemofilter. Before the start of dialysis and after 24 hours of treatment, the concentration levels of selected cytokines (IFN-α, IFN-γ, TNF-α, IL-1ß, IL-2, IL-6, IL-10, IL-12) in serum were assessed. After 12 hours and 24 hours of treatment, the concentration of the same cytokines in the dialysis fluid was assessed. The aim of our study was to evaluate the effectiveness of HCO-CVVHD in the removal of selected cytokines. RESULTS After 24-hour HCO-CVVHD treatment, IL-10 and IL-12 levels in serum were significantly lower. Concentrations of INF-α, IL-1ß and IL-2 in dialysis fluid significantly increased during HCO-CVVHD, which corresponded with the parallel rise of related clearances. Clearance of IL-6 was approximately four times higher than IL-10. The rise of IL-6 during HCO-CVVHD significantly correlated with mortality due to sepsis. CONCLUSIONS Continuous venovenous hemodialysis using high cut-off hemofilter proved to be effective in the removal of IFN-α, IL-1ß, IL-2 and IL-6, IL-10 and IL-12 from serum in patients during septic shock. The rise of IL-6 during HCO-CVVHD seems to be a marker of bad prognosis in septic shock patients.

Cystatin C as a predictor factor in patients with renal cell carcinoma treated by everolimus.

BACKGROUND: We evaluated the influence of serum cystatin C (CysC) with respect to other glomerular filtration rate (GFR) markers on the treatment effect of everolimus in a phase II study in patients with metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS: Outcomes were from the study's primary analysis. GFR was calculated according to CKD-EPI-sCr equation, CKD-EPI-CysC equation and CKD-EPI-sCr-CysC equation, Modification of Diet in Renal Disease (MDRD) equation and Cockcroft-Gault (CG) equation, serum levels of creatinine (sCr) and CysC before the treatment. RESULTS: We observed in 56 patients analysed patients high correlation (R Spearman from ±0.69 to ±1.00; P < 0.0001) between CysC level and GFR markers: sCr, CKD-EPI-sCr, CKD-EPI-CysC, CKD-EPI-sCr-CysC, MDRD, GFR (CG) before everolimus therapy. We observed that the adverse independent predictors for everolimus therapy were increased CysC level [HR: 2.85 (95 % CI 1.34-6.05), P = 0.0065], histologic grade G1/2 [HR: 3.38 (95 % CI 1.59-7.20), P = 0.0016] and increased LDH level [HR: 5.59 (95 % CI 2.52-12.40), P < 0.0001]. Worse OS was seen in multivariate analysis in patients with increased cystatin C level before treatment [HR: 2.60 (1.03-2.60), P = 0.0428], increased corrected calcium level [HR: 2.78 (95 % CI 1.03-7.54), P = 0.0441] and increased LDH level before treatment [HR: 2.34 (95 % CI 1.11-4.97), P = 0.0262]. CONCLUSION: Increased serum CysC level in contrast to other studied GFR markers had predictive significance in patients with mRCC.

D-Galactosamine Intoxication in Experimental Animals: Is it Only an Experimental Model of Acute Liver Failure?

BACKGROUND: Short-term administration of Galactosamine to experimental animals causes liver damage and acute liver failure (ALF), as well as acute renal failure in some cases. The aim of our study was to describe kidney disorders that developed in the course of galactosamine-induced liver failure. MATERIAL AND METHODS: Sprague-Dawley rats were randomly divided into 2 groups: a study group administered galactosamine intraperitoneally and a control group administered saline. RESULTS: All the animals in the study group developed liver damage and failure within 48 h, with significant increase of alanine (p<0.001), aspartate aminotransferases (p<0.0001), bilirubin (p<0.004), and ammonia (p<0.005) and decrease of albumin (p<0.001) concentrations. Acute renal failure was observed in all test animals, with a significant increase in creatinine (p<0.001) and urea (p<0.001) concentrations and a decrease in creatinine clearance (p<0.0012). Moreover, osmotic clearance (p<0.001), daily natriuresis (p<0.003), and fractional sodium excretion (p<0.016) decreased significantly in this group of animals. The ratio of urine osmolality to serum osmolality did not change. Histopathology of the liver revealed massive necrosis of hepatocytes, whereas renal histopathology showed no changes. CONCLUSIONS: Acute renal failure that developed in the course of galactosamine-induced ALF was of a functional nature, with the kidneys retaining the ability to concentrate urine and retain sodium, and there were no renal changes in the histopathological examination. It seems that the experimental model of ALF induced by galactosamine can be viewed as a model of hepatorenal syndrome that occurs in the course of acute damage and liver failure.

Renal perfusion index reflects cardiac systolic function in chronic cardio-renal syndrome.

BACKGROUND: Cardiac dysfunction can modify renal perfusion, which is crucial to maintain sufficient kidney tissue oxygenation. Renal cortex perfusion assessed by dynamic ultrasound method is related both to renal function and cardiac hemodynamics. The aim of the study was to test the hypothesis that Renal Perfusion Index (RPI) can more closely reflect cardiac hemodynamics and differentiate etiology of chronic cardio-renal syndrome. MATERIAL AND METHODS: Twenty-four patients with hypertension and chronic kidney disease (CKD) at 2-4 stage (12 with hypertensive nephropathy and 12 with CKD prior to hypertension) were enrolled in the study. Blood tests, 24-h ABPM, echocardiography, and ultrasonography with estimation of Total renal Cortical Perfusion intensity and Renal Perfusion Index (RPI) were performed. RESULTS: In the group of all patients, RPI correlated with left ventricular stoke volume (LVSV), and cardiac index, but not with markers of renal function. In multiple stepwise regression analysis CKD-EPI(Cys-Cr) (b=-0.360), LVSV (b=0.924) and MAP (b=0.376) together independently influenced RPI (R2=0.74; p<0.0001). RPI<0.567 allowed for the identification of patients with chronic cardio-renal syndrome with sensitivity of 41.7% and specificity of 83.3%. CONCLUSIONS: Renal perfusion index relates more strongly to cardiac output than to renal function, and could be helpful in recognizing chronic cardio-renal syndrome. Applicability of RPI in diagnosing early abnormalities in the cardio-renal axis requires further investigation.

Effect of nitric oxide pathway regulation on water/sodium balance and renal function in a rodent model of acute liver and renal failure.

BACKGROUND: The pathomechanism of acute hepatorenal syndrome (HRS), a particular form of acute renal failure that occurs in the course of acute liver injury, is still poorly understood. The aim of our study was to estimate the influence of the activation and inhibition of the nitric oxide pathway on the water/sodium balance and development of acute renal failure in the course of HRS. MATERIAL AND METHODS: We used male Sprague-Dawley rats in the acute galactosamine (Ga1N) model of HRS. The nitric oxide synthase (NOS) inhibitors L-NAME and L-arginine were administered intraperitoneally before and after liver damage. RESULTS: HRS developed in all tested groups. L-NAME increased osmotic clearance and urine volume more effectively before liver injury. Furthermore, administration of L-NAME increased creatinine clearance both before and after Ga1N injection. A double dose of L-NAME did not yield further improvement before Ga1N injection, but improved creatinine clearance after Ga1N intoxication. Injection of L-arginine increased sodium excretion and urine volume, but only after liver injury. Moreover, L-arginine injected after Ga1N caused significant improvement of the creatinine clearance in a dose-dependent manner. CONCLUSIONS: Our study shows that inhibition of the nitric oxide pathway improves parameters of water and sodium balance and prevents development of acute renal failure in the course of acute liver injury and liver failure. Activation of the nitric oxide system also has a favorable influence on water/sodium balance and renal failure, but only after liver injury.