Asymmetric dimethylarginine and endothelial progenitor cells after renal transplantation: the effect of exercise training.

Level of asymmetric dimethylarginine (ADMA) is elevated and endothelial progenitor cells (EPC) and stem cells (SC) are decreased in patients undergoing renal transplantation (Tx) and may contribute to cardiovascular complications. We tested the hypothesis that ADMA, EPC and SC can be influenced with regular physical exercise early after Tx. Blood samples of ADMA, EPC, SC, adipocytokines and metabolic parameters were randomly obtained from 50 transplant patients before and 6 months after exercise program (Group I). Fifty age, sex, HLA typing, duration of dialysis and immunosupression regimen-matched non exercising transplant were examined as controls (Group II). After 6 months, in Group I ADMA decreased (3.50+/-0.45 vs 2.11+/-0.35 micromol/l, P<0.01) and was lower comparing to Group II (P<0.01), SC and EPC also decreased (2816+/-600 vs 2071+/-480 cells/ml resp. 194+/-87 to 125+/-67 cells/ml, P<0.02). Next changes in Group I: adiponectin (P<0.01), leptin (P<0.01), resistin (P<0.02). Visfatin, blood lipids, HbA1c, insulin and blood pressure were also influenced by training program (P<0.05).

Transfusion-related acute lung injury: report of two cases.

Transfusion-related acute lung injury (TRALI) is a severe life-threatening complication of blood transfusion, characterized by acute lung injury developing within 2-6 h of transfusion. However, TRALI is difficult to diagnose, and the initial report or suspicion of TRALI depends on close collaboration between clinical departments and transfusion centres. A total of 17 adverse post-transfusion reactions were reported to the Blood Centre of the University Hospital Ostrava as suspected TRALI between 2005 and 2010. We report two cases of serious TRALI with different pathogenetic mechanisms.

[Bone mineral density in patients with chronic renal failure at the start of haemodialysis therapy]. / Kostní minerální denzita u nemocných s chronickým selháním ledvin pri zahájení hemodialyzacní lécby.

AIM: To determine bone mineral density (BMD) in nephrology patients at the start of haemodialysis therapy and its dependence on some laboratory and clinical characteristics of the study set. METHODS: There were 73 newly haemodialyzed patients accepted in the 3 months period from the beginning of the chronic haemodialysis program. Each patient underwent measurements BMD with DXA method in the area of lumbar spine and the left hip. Ca, P and parathormone values were measured once per month during 3 months before BMD determination. 25-OH vitamin D, estradiol and blood pH were determined only once before the densitometry examination. RESULTS: BMD in the osteoporosis zone was measured most often in the area of femoral neck in the whole group (prevalence 35 %) and also in the single groups of patients (men, women, non-diabetics, diabetics). In women, BMD findings corresponding to osteoporosis values in the total hip were significantly more often (p < 0.01). In the area of femoral neck and lumbar spine the percentage of women and men in single groups (osteoporosis, osteopenia and normal values) was without any statistical differentiation. Diabetics and non-diabetics did not distinguish in the number of findings osteoporosis and osteopenia in any followed areas of skeleton. As the significant factors predicating BMD there were found: calcium level and sex for the area of the total hip, calcium level, blood pH and height for the femoral neck, and sex for the lumbar spine only. The certain degree of vitamin D deficiency was measured in nearly all patients (mean 11.5 ± 7.4 µg/l), and hypocalcaemia was demonstrated in one fifth of patients. CONCLUSION: Bone mineral density values and some laboratory parameters affecting bone metabolism are often abnormal in the patients entering the chronic haemodialysis program and must be taken into consideration.

[An effect of continuous and intermittent renal replacement therapy on antibiotic treatment in critically ill patients with sepsis - a practice-based perspective of vancomycin and gentamycin therapies]. / Vliv kontinuální a intermitentní náhrady renálních funkcí na antibiotickou lécbu u kriticky nemocných v sepsi - praktický pohled na lécbu vankomycinem a gentamicinem.

Sepsis and septic shock are common cause of hospitalisation in intensive care unit. Acute kidney injury is an accompanying manifestation of sepsis/septic shock leading to worsening of morbidity and also mortality and requiring use of intermittent or continual renal replacement therapy. Life saving effect is attributed to early and effective antibiotic therapy. Therapeutic drug monitoring and do-sage adjustment is important for successful treatment. Despite therapeutic drug monitoring of both antibiotic agents vankomycin and gentamicin the treatment still rises many questions about the convenient use in septic patients due to their nephrotoxicity.

[Vaccination against hepatitis B in patients with chronic renal failure--twenty years follow-up]. / Ockování proti virové hepatitide B u pacientu s chronickým selháním ledvin--dvacetileté zkusenosti.

AIM: The efficacy of vaccination against hepatitis B was evaluated in patients with chronic renal failure from 4 dialysis units in 1988-2010. PATIENTS AND METHODS: Hepatitis B vaccination was started in 1 271 patients with chronic renal failure (606 female, 665 male). Patients received intramuscularly 3 doses of plasma-derived or since 1990, recombinant vaccine at the interval 0, 1 and 2 months for dialysis patients and 0, 1 and 6 months for pre-dialysis patients. Each vaccine contained 40 microg of hepatitis B surface antigen (HBsAg) in 1 002 patients, however only 20 microg HBsAg in 269 patients till 2000. Blood samples were obtained at the beginning of vaccination, 1-2 month after immunization and biannual thereafter. Serum samples were tested using ELISA methods for HBsAg and antibodies against hepatitis B surface and core antigens (anti-HBs, anti-HBc). The patients without protective anti-HBs level and the patients with waning of anti-HBs antibodies were revaccinated. RESULTS: Anti-HBs antibodies after the third vaccine were investigated in 786 patients. Protective anti-HBs levels (> or = 10 IU/l) were proved in 49%, 65% and 74% patients after the third, fourth and fifth vaccine. The waning of protective anti-HBs antibodies was detected in 47% and 68% of patients during 3 and 5 years after vaccination. The new infections with HBsAg positive status were proved in 28 patients, in 27 of them in period 1988-1994. Anti-HBc seroconversion was observed in 10 patients. CONCLUSION: Vaccination considerably reduced hepatitis B incidence in the patients with chronic renal failure during nineties. However still approximately one quarter of patients did not produce protective anti-HBs level after immunization with recombinant vaccine and new form of vaccination against hepatitis B may be considered also in the Czech Republic.

[Arteriovenous shunt--a prerequisite for long-term hemodialysis therapy]. / Arteriovenózní shunt--nezbytná podmínka dlouhodobého hemodialyzacního lécení.

The authors give an account of the experience of their department with the establishment of arteriovenous fistulae during the preparation of patients for a dialyzation transplantation programme. In the course of 13 years a total of 685 a-v shunts were made. The results in 60 patients are evaluated in detail. These patients were treated in 1989 in the chronic dialyzation programme of the Ostrava dialyzation unit, focused on long-term patency of the fistulae. The cumulative patency of shunts up to one year is 83.3%, the long-term patency is 73.3%.