Heart and renal failure in renovascular hypertension caused by giant cell arteritis--case report.

We report a case of a male teenager with severe heart and acute renal failure as the dominant clinical manifestations of renovascular hypertension (RVH) caused by atypical giant cell arteritis (GCA). Unrecognized RVH and treatment of the consequent heart failure by angiotensin-converting enzyme inhibitors (ACEI) probably contributed to progression of renovascular disease to bilateral renal artery occlusion. Recurrent "flash" pulmonary edemas could not be prevented until surgical revascularization of the only functioning right kidney was achieved by an aortorenal bypass. Prompt post-operative normalization of heart function and arterial hypertension occurred despite the histopathological finding of the resected renal artery compatible with GCA and 4-year duration of significant renovascular disease. At the last check-up, the patient was asymptomatic, with normal arterial pressure on the prescribed treatment: carvedilol, hydrochlorothiazide, prednisolone 20 mg daily and aspirin. Subsequent follow-up is necessary to observe the evolution of GCA as an exceptionally rare cause of RVH.

Relationship between IL-1beta and TNFalpha production by PBMC and clinical features of hemodialysis patients.

The relationship between production of IL-1beta and TNFalpha by peripheral blood mononuclear cells (PBMC) of hemodialysis (HD) patients and clinical disorders characteristic for HD patients was examined. The study included 28 HD patients divided in the 4 groups: group 1--6 patients with malnutrition; group 2--6 patients with secondary hyperparathyroidism; group 3--6 patients with eosinophilia; group 4--10 stable HD patients without clinical complication. The control group consisted of 9 healthy volunteers. All patients were dialyzed with cuprophane membrane more than one years. Blood samples were taken immediately before the beginning of hemodialysis and PBMC were isolated by centrifugation on the density gradient. Concentrations of IL-1beta and TNFalpha were measured in the supernatants of the cultures by ELISA tests. The results showed marked individual differences in cytokine production both in healthy controls and in HD patients. Spontaneous and LPS stimulated production of IL-1beta by PBMC of HD patients was significantly higher compared to PBMC of healthy controls. There were no significant differences between group of patients with different clinical complications in cytokine production. However, a positive correlation was found between IL-1beta concentration and body mass index for patients with malnutrition and between concentration of IL-1alpha and parathyroid hormone (PTH) for patients with secondary hyperparathyroidism. The results suggest that PBMC of HD patients are chronically stimulated to produce IL-1beta, which may contribute to the development of particular chronic complications.