Errors involved in the application of an imperfect peritoneal volume marker.

Peritoneal volume markers have been used in numerous studies on fluid transport in peritoneal dialysis. The basic assumption used was that the macromolecular marker was stable and that the free fraction of a label (usually radiolabel) was negligibly small. In this study are presented theoretical investigations on the errors involved in application of an imperfect volume marker containing free fraction of a label. These investigations were used in assessing the errors in calculation of peritoneal volume time course, V, and fluid absorption rate (estimated by volume marker clearance, kE) using data from 20 clinical dwell studies with 1.36% Dianeal dialysis solution and radioiodinated human serum albumin as a volume marker. It has been shown that with an in vitro measured 125I free fraction of 2.72%, the error of kE estimation was 11%. However, the maximal error in estimation of V was only 0.2%. In conclusion, the performed analysis implies that calculation of the peritoneal volume time course during the dwell (with correction for the volume marker elimination) is very reliable, and the existence of a free fraction of a volume marker label results in a negligibly small error. However, even small free fraction of the label results in a significant overestimation of the fluid absorption rate.

[Doppler sonography assessment of renal arteries against the cardiovascular risk factors in young men--preliminary report]. / Ultrasonograficzna dopplerowska ocena tetnic nerkowych a czynniki ryzyka chorób sercowo-naczyniowych u mlodych mezczyzn--doniesienie wstepne.

The purpose of this study was to find out a relationship between cardiovascular risk factors (CVRF) and abnormal results of Duplex Doppler sonography (DD), suggesting renal artery stenosis (RAS). The group of 30 potentially healthy men (age: 35.5 +/- 7.9) randomly selected from population of 200 young men, underwent DD of renal arteries. Abnormal results of DD study, suggesting RAS were found in 19 of 30 men (63%). In this group, occurrence of 3 or more CVRF was significantly higher (15/19) than in the group with normal results of DD (5/11; p < 0.05). The significantly higher (77%; p < 0.05) occurrence of the abnormal DD and the significantly longer (p < 0.001) duration of habitual tobacco smoking were also found out in the group with RR > or = 130/85 mm Hg, in comparison to the group with RR < 130/85 mm Hg. Emphasizing preliminary character of this study and the need of confirmation on larger population, it seems reasonable to consider the assessment of renal arteries with DD in the population of men with cardiovascular risk factors.

[Captopril angioscintigraphic test in the screening for renovascular hypertension in the light of long-term own observation (1098-2001)]. / Angioscyntygraficzny test kaptoprylowy w diagnostyce przesiewowej nadcisnienia tetniczego naczyniowo-nerkowego w swietle wieloletniej obserwacji wlasnej (1986-2001).

In 430 patients (pts) with hypertension (209F + 221M, mean age 46 +/- 13 yrs) screening value of the captopril angioscintigraphic test (CAT) was evaluated in years 1986-2001 in the diagnosis of renovascular hypertension (RVHT). Captopril renin test (CRT) and CAT were performed simultaneously in all 430 pts. Classical renal angiography was performed in 95 pts suspected for RVHT on the basis of clinical anamnesis and positive result at least one of captopril tests. Results were as follows. The critical renal artery stenosis (RAS) was found in 47 pts. At least one positive captopril test was found in 42 from 47 pts with critical RAS in angiography. CRT was found to be more sensitive and CAT more specific for hemodynamically significant RAS. The absence of false positive results of CAT as well as considerable percentage of false positive results of CRT stress the importance of isotopic test as the screening test for the diagnosis of RVT. Simplicity of the test, availability as well as immediately obtained result allow to propose CAT as a routine ambulatory screening test for RVHT.

[Biochemical risk factor for atherosclerosis in young men. Preliminary report]. / Biochemiczne czynniki ryzyka miazdzycy u mlodych mezczyzn. Doniesienie wstepne.

Atherosclerotic damage of cardiovascular system, including kidneys, is an increasing problem not only in the modern cardiology but also in nephrology and dialysotherapy. The purpose of our study was to evaluate the frequency of particular biochemical risk factors for atherosclerosis (RFfA) in young men being over-pressed with psychological stress because of decisive character of their professional job. There were 68 men in mean age 33.3 +/- 7.4 years, being employed in the state administration for mean 10.9 +/- 7.5 years. On the basis of the results of environmental questionnaire the studied group was divided into two subgroups: subgroup A "passive" (30 persons) which was physically passive (employed in the administration) and subgroup B "active" (38 persons) whose professional job was connected with physical activity. The following biochemical RFfA in the blood were examined: cholesterol and its fractions, triglycerides, urea acid, glucose, fibrinogen, C-reactive protein, homocysteine and antibodies against Chlamydia pneumoniae. The results were as follows: total cholesterol above 200 mg/dl in 63%, LDL cholesterol above 130 mg/dl in 60% and HDL cholesterol below 50 mg/dl in 31% of men. Among "new" RFfA we found "cardiological" (above 0.2 mg/dl) levels of CRP almost in 25% of the whole group. There were no statistically significant differences with respect to the studied RFfA between "active" and "passive" group. On the basis of these preliminary results we presume, that potentially healthy men over-pressed with psychological stress because of decisive character of their professional job, are characterized--independently on the proclaimed physical activity--by high frequency of risk factors for premature atherosclerosis.

[Does the treatment of peritonitis affect residual renal function in CAPD?]. / Czy leczenie dializacyjnego zapalenia otrzewnej uposledza resztkowa czynnosc nerek w ciaglej ambulatoryjnej dializie otrzewnowej?

The aim of the study was a retrospective analysis of potentially negative influence of aminoglycosides on RRF in patients with peritonitis in course of CAPD program. From the group of 47 patients of our center who were treated because of peritonitis in years 1991-2000 we finally selected 11 persons with preserved RRF in whom 16 incidents of peritonitis were revealed. The mean value of RRF in this group was 1.55 (+/- 2.0) ml/min before the treatment and 1.44 (+/- 2.2) ml/mi after the treatment of peritonitis. There was no statistical difference between these values (p = 0.32). It was also revealed that in 5 cases (31%) RRF decreased after the peritonitis treatment while in 7 cases (44%) no change of RRF value was observed and in 4 cases (25%) RRF value was increased after the treatment of peritonitis. The efficacy of treatment with the standard protocol in observed group was 93.75%. On the base of performed analysis no negative influence of peritonitis therapy with aminoglycosides and I-st generation cephalosporines was observed. It was stated that aminoglycosides may still be used in peritonitis therapy under the condition that precise monitoring of RRF will be introduced.

[Bone mineral density in patients with irreversible renal failure treated with peritoneal dialysis]. / Gestosc mineralna kosci u chorych z nieodwracalna niewydolnoscia nerek leczonych dializa otrzewnowa.

Frequency of osteoporosis in patients on dialysis varies in different studies depending of method and measured region of bone mineral density (BMD). The aim of the study was to evaluate the frequency of disturbances of BMD in patients on peritoneal dialysis (PD). We studied 100 patients: 56 on PD and 44 on HD. (49F, 51 M.age mean 54 +/- 29) on dialysis for 6 to 104 months. BMD was measured using dual energy X-ray densitometry (DEXA) in L1-L4 segment of the vertebral column, femoral neck and forearm. The results of the BMD were presented as T-score in the standard deviation of the mean peak bone mass according to WHO criteria. Depending on the region of interest (ROI), osteoporosis was diagnosed in 20% to 70% of women and in 4% to 35% of men. In females the lowest values of BMD were found in forearm (T-score = -3.16 SD), in males it was femoral neck (T-score = -2.87 SD). In these ROI's the lowest values of BMD in both genders were found in patients with the level of iPTH higher than 300 pg/ml. We did not find any significant difference in BMD between patients on PD and HD. Values of bone mineral density were not related to the duration of dialysotherapy and cause of irreversible renal failure. On the results of our study it has been concluded that, enhancement of disturbances of BMD in patients on PD is related to the region of interest, gender of the patient and functional status of parathyroid glands.

[Survival of patients with diabetic nephropathy on continuous ambulatory peritoneal dialysis. Own experiences]. / Przezywalnosc chorych z nefropatia cukrzycowa leczonych za pomoca ciaglej ambulatoryjnej dializy otrzewnowej. Doswiadczenia wlasne.

We analyzed 5 years survival on CAPD diabetics with respect to the type of diabetes (D). There were 24 pts with type 1 D, 13 pts with type 2 D and 29 non diabetic CAPD pts (for comparison of long-term survival). In the D groups we analyzed adequacy of dialysis, nutritional status (albumin level), frequency of peritonitis (PN) as well as character and progression of cardiovascular complications. Patients with type 2 D were older (58.46 +/- 8.54 yrs), had lower initial level of albumin's in serum (3.3 +/- 1.0 g/dl), more cardiovascular complications at the start of CAPD. Survival of 1st 3rd, and 5th year of CAPD was achieved respectively in 89%, 70.8% and 58.3% of type 1 D; in 100%, 69% i 38.5% of type 2 D; and in 96.5%, 72.4% i 65.5% of the control group of non diabetics. Despite similar adequacy of CAPD (Kt/V 2.14 +/- 0.62 vs 2.08 +/- 0.36; weekly CrCI 64.15 +/- 16.1 vs 62.08 +/- 12.72 ml/min/1.73 sq.m) and low ratio of PN (1:30.6 vs 1:32.7 ptsmnths) cardiovascular complications progressed in both groups of D, especially in type 2, being responsible for death of 3/24 pts with type 1 D and 8/13 pts with type 2 up to 5th year of observation. Because of progressive character of cardiovascular complications and high ratio of death especially in diabetes type 2 despite adequate dialysis, we recommend early referral of predialysis diabetics to nephrologist as well as earlier start of CAPD with simultaneous application for kidney or kidney and pancreas transplantation.

[Evaluation of glomerular filtration rate in plasma cell dyscrasias--which test for ambulatory practice?]. / Ocena filtracji klebuszkowej w dyskrazjach komórek plazmatycznych--jaki test w praktyce ambulatoryjnej?

To select the best mathematical formula for ambulatory monitoring of glomerular filtration rate (GFR) in patients with plasma cell dyscrasias (PCD's) we evaluated GFR in 32 pts (22 M + 10 F; mean age 66.1 +/- 9.6) with newly recognized PCD's with the following routine GFR tests: creatinine concentration in serum (Crs); 24 hr's standard creatinine clearance (Crcl) as a reference test; calculation of GFR from Baracskay (BGFR) and Cockcroft-Gault (C-GGFR) formulas. There were: 16 pts without monoclonal proteinuria MP(-) and 16 pts with monoclonal proteinuria MP(+) (0.44-40.3; mean 9.54 g/day). The abnormal values for Crs were defined as > 1.5 mg/dl; for Crcl as < 80.0 ml/min. Only 41% (13/32) of pts had abnormal values of Crs and 84% (27/32) had abnormal values of Crcl. In the group of pts without monoclonal proteinuria MP(-) statistical significance between 24-hr's creatinine clearance and GFR calculated by Cockcroft-Gault as well as Baracskay formulas was not stated. In the group of pts with monoclonal proteinuria MP(+) statistical significance was not stated only between 24-hr's creatinine clearance and GFR calculated by Cockcroft-Gault formula. That was no statistical significance in GFR evaluated with this methods between patients with kappa and lambda monoclonal proteinuria. We concluded, that for ambulatory monitoring of pts with PCD's MP(+) only Cockcroft-Gault formula is recommended. On the other hand pts MP(-) might be monitored using Barasckay as well as Cockcroft-Gault formulas. Because Csr over estimated values of Crcl in both groups of pts, the other serum marker of GFR should be investigated.

[Diagnostic and therapeutic problem of infected arteriovenous fistula for hemodialysis-case report]. / Problemy diagnostyki i leczenia zakazonej przetoki tetniczo-zylnej do hemodializy--opis przypadku.

On the case of 48 old patient with chronic renal failure, treated with repeated hemodialyses, we described diagnostic and therapeutic problems of infected arterio-venous fistula of severe clinical course and rare epidemiology (Staphylococcus warneri). Special attention was paid to the difficulties in the confirmation of bacterial etiology of this infection as well as practical usefulness of ultrasonography in the monitoring of clinical course and therapy of infected arteriovenous fistula.

[Bilateral nephrectomy as a life saving procedure in a young woman with recurrent bacteremic shock]. / Obustronna nefrektomia jako zabieg ratujacy zycie u mlodej kobiety z nawracajacym wstrzasem bakteriemicznym.

On the basis of the recurrent bacteremic shock in young woman with bilateral reflux nephropathy and recurrent urinary tract infections (UTI) from early childhood we present diagnostic and therapeutic problems of complicated UTI. Negative results of localization diagnosis of UTI and clinical suspicious on renal microabscesses as a cause of recurrence bacteremic shock were the reason of bilateral nephrectomy--as a life saving procedure--and initiation of CAPD programme.

[Evaluation of cyclosporin A efficacy in the treatment of steroid-resistant nephrotic syndrome in the course of membranoproliferative glomerulonephritis--case report]. / Ocena skutecznosci cyklosporyny A w leczeniu steroidoopornego zespolu nerczycowego w przebiegu bloniastoproliferacyjnego klebuszkowego zapalenia nerek--opis przypadku.

On the case of 35 old patient with steroid-resistant nephrotic syndrome in the course of membranoproliferative glomerulonephritis complicated with renal failure, we paid the attention to the therapeutic efficacy of CsA in this case with remission of nephrotic syndrome and significant improvement of renal function, which enabled us to withdraw the patient from the hemodialysis programme.

[Coping style with stress against chosen biochemical risk factors of atherosclerosis in potentially health men]. / Styl radzenia sobie ze stresem a wybrane biochemiczne czynniki ryzyka rozwoju miazdzycy u potencjalnie zdrowych mezczyzn.

The aim of the study was to assess the relationship between some psychological variables and biochemical and inflammatory risk factors for atherosclerosis in healthy men. Studied group, 70 potentially healthy men randomly selected from the group of 200 potentially healthy men previously screened for atherosclerosis risk factors, workers of state administration in mean age of 33.3 +/- 7.4 years, with mean duration of job employment 10.9 +/- 7.5 years, was divided into two groups of 35 persons each, according to physical activity: "active" and "passive". For psychological examination we used Coping Inventory for Stressful Situations Questionnaire (CISS) and State and Trait Anxiety Inventory (STAI). "Passive" group had better results in scales: I--task oriented coping; II--emotion oriented coping; III--avoidance oriented coping; IV--distraction. "Active" group had better results in scales: IIIB--social diversion, LS--anxiety as a state; LC--anxiety as a trait. These differences were not statistically significant. Among biochemical atherosclerosis risk factors mean levels of LDL, triglycerides (TRIG) and C-reactive protein (CRP) were higher in "passive" group. HDL was higher in "active" group. There were no statistical significant differences between both groups, too. Statistical analysis showed positive correlation of LC with scale II in both groups (r > 0.6, p < 0.002). In "passive" group significant negative correlation was found between: TRIG and III (r = -0.562; p = 0.025); TRIG and IIIB (r = -0.497; p = 0.036). LS correlated positively with LC (r = 0.476; p = 0.046) and scale IIIA correlated positively with scale IIIB (r = 0.550; p = 0.018). In "active" group positive correlation was found between: CRP and LC (r = 0.476; p = 0.021) and negative correlation between CRP and scale I (r = -0.437; p = 0.037); LS correlated positively with IIIA (r = 0.443; p = 0.039) but LC correlated negatively with scale I (r = -0.424; p = 0.049). We conclude, that men using in stressful situations task oriented coping style are less prone for atherosclerosis. This hypothesis needs to be confirmed on the larger population of potentially healthy men.

[Geriatric nephrology: new branch of study about internal diseases?]. / Nefrologia geriatryczna: nowa galaz nauki o chorobach wewnetrznych?

This review refers to the main geriatric health problems, especially dysfunction of the autonomic sympathetic system and urine incontinence in the elderly, pathophysiology of aging kidney, as well as distinct clinical course of many kidney diseases in the advanced age.

[Bone mineral density in dialysis patients: the optimal region of interest depending on parathormone levels]. / Gestosc mineralna kosci u chorych dializowanych: wybór optymalnego miejsca pomiaru w zaleznosci od poziomu parathormonu.

Frequency of osteoporosis in patients on dialysis with respect to the optimal Region of Interest (ROI) has not been established. Frequency of this complication varies in different studies, especially because of no agreement according to the optimal ROI. We studied 71 patients: 32 on CAPD and 39 on HD (31F, 40m. age mean 56 +/- 29) on dialysis for 3 to 81 months. BMD was measured using dual energy X-ray densitometry (DXA) in L1-L4 segment of the vertebral column, femoral neck and forearm. The results of the BMD were presented as T-score in the standard deviation of the mean peak bone mass according to WHO criteria. Males and females were evaluated separately. Depending on the ROI, osteoporosis was diagnosed in 20 to 68% of women and in 2 to 40% of men. In females the most sensitive region of interest appeared to be forearm, in males it was proximal part of the femur. In these ROI's the lowest values of bone mineral density in both genders were found in patients with the level of iPTH higher than 200 pg/ml. We did not find any significant difference in BMD between patients on CAPD and HD. Values of bone mineral density were not related to the duration of dialysis therapy. On the results of our study it has been concluded, that optimal region of interest for BMD evaluation in dialysed patients depends on gender of the patient and functional status of parathyroid glands but is not related to either the method or duration of dialysis therapy.

[Acute kidney failure in the course of rhabdomyolysis with hemodialysis in personal material from 1995-1999]. / Ostra niewydolnosc nerek w przebiegu rabdomiolizy wymagajaca leczenia dializacyjnego w materiale wlasnym w latach 1995-1999.

Eleven cases (5 F + 6 M; mean age 48.0 years) of acute noninflammatory renal failure (ANRF) in the course of rhabdomyolysis (RBM) were treated with hemodialysis in years 1995-1999. The causes of RBM were the following: ischemia of lower limbs after vascular operations (4 cases), exhausting exercise with rapid body cooling (3 cases), multiorgan failure after traffic accident, acute myositis (1 case), status epilepticus (1 case), rapid clinical course of viral infection (1 case). It was necessary to perform from 1 to 13 hemodialyses in every patient. In nine cases, complete normalization of renal function during 5 to 30 days of therapy was achieved. Two patients died due to multiorgan complications after vascular operations despite effective dialysis therapy. The following correlation were found: positive between initial values of creatine phosphokinase (CPK) activity and creatinine and uric acid concentrations in the blood and negative correlation between CPK and serum calcium concentrations. The higher initial values of CPK activity were observed the more hemodialysis procedures were necessary and the longer time was needed to normalize renal function. On the base of initial, limited up to now, own results it seems that hemodialysis in ANRF in the course of RBM should be started immediately in cases with high activity of CPK in the blood (above 10,000 U/L).

[Evaluation of nephrologic "risk" in a newly diagnosed case of plasma cell dyscrasias from personal material (1994-2000)]. / Ocena "ryzyka" nerkowego w swiezo wykrytych przypadkach dyskrazji komórek plazmatycznych w materiale wlasnym (lata 1994-2000).

UNLABELLED: Among 149 patients with recently recognized plasma cell dyscrasia (PCD) in years 1994-2000 72 persons with serologically and nephrologically documented diagnostic profile were selected. In this group of pts we assessed dependence between degree of reduced glomerular filtration rate (GFR), evaluated by serum creatinine concentration and calculated with Barasckay's formula and hypercalcemia, hyperuricemia as well as type of monoclonal protein in urine. RESULTS: We revealed statistically significant higher values of calcium (p = 0.005), uric acid (p = 0.000001) concentrations and higher occurrence of Bence-Jones proteinuria (mainly kappa) in 22 patients with serum creatinine > 1.5 mg/dl in comparison with 50 patients with serum creatinine < or = 1.5 mg/dl. Among 72 patients, GFR > 90 ml/min, calculated with Barasckay's formula, was stated only in 9 patients (12.5%). There was no difference in nephrotoxity between kappa and lambda light chains with reference to serum creatinine concentration and GFR. The group of 12 patients with light chain dyscrasia (LCD) had higher degree of nephrotoxicity in comparison with other forms of PCD. On the basis of our study we concluded that patients with clinical suspicion of PCD, especially those with LCD are referred to a special Protein Laboratory too late, it means at the time of significant nephrological risk in the form of low glomerular filtration rate, hypercalcemia and hyperuricemia.

[Enhanced neuroticism in relation to cardiovascular risk factors in men]. / Wzmozona neurotycznosc a czynniki ryzyka chorób sercowo-naczyniowych u mezczyzn.

Chronic stress is well known as a cardiovascular risk factor in men. There are few reports referred to the relationship between cardiovascular risk factors and level of neuroticism in the psychological examination. We analysed 77 healthy men in mean age of 33.3 +/- 7.4 years being at risk of chronic professional stress. Level of neuroticism was examined by Geras scale and expressed as: low (1-4 sten)--group 1, mean (5-6 sten)--group 2 and high (7-10 sten)--group 3 level of neuroticism. The common biochemical, clinical and environmental cardiovascular risk factors were examined. In the whole group of 77 probands we identified 24 (31%) (group 2) and 10 (13%) (group 3) persons with mean and high level of neuroticism. In the group 2 we find the highest cholesterol (222.7 +/- 39.4 mg/dl), LDL cholesterol (147 +/- 35.1 mg/dl, triglicerydes (144.9 +/- 93.8 mg/dl) and apolipoprotein B (1.11 +/- 0.31 g/l) levels statistically higher than in the other group of neuroticism. In group 3 we find the highest glucose (96.5 +/- 7.4 mg/dl) and fibrinogen (353.8 +/- 39.2 mg/dl) levels. The worst results of the environmental inquiry were obtained in the group 2 (obesity (BMI > 30 kg/m2) in 25%, hypertension in 12.5%, nicotinism in 54%, low physical activity in 79% and positive to cardiovascular disease family history in 91%). Because we found correlation mostly in the group of mean level of neuroticism these results must be confirmed in the larger group of probands using other psychological tests.

[Long-term evaluation results for adequacy of continuous ambulatory peritoneal dialysis in patients with diabetes]. / Wyniki odleglej oceny adekwatnosci ciaglej ambulatoryjnej dializy otrzewnowej u chorych na cukrzyce.

The aim of the study was to analyze CAPD adequacy using own scoring including three groups of parameters: "Adequest" parameters, clinical and biochemical indices. The studied population comprised 17 patients treated with CAPD: 12 DN patients, in this number 6 female and 6 male, aged 44 +/- 10.9 years, treated with CAPD for 47 +/- 10.5 months, observed for 38.5 +/- 12.8 months were included in group 1 (studied group). 105 studies were performed in this group. Group 2 (control) consisted of 5 non-diabetic patients, including 2 female and 3 male, aged 51 +/- 13.6 years, treated with CAPD for 51 +/- 20.2 months, observed for 42.6 +/- 15.2 months. 47 studies were performed in group 2. On the base of own scoring group 1 was divided into two subgroups: 1A including 8 persons dialyzed adequately and 1NA consisting of 4 persons dialyzed inadequately. All patients from group 2 were dialyzed adequately. No significant differences concerning "Adequest" scoring as well as clinical and biochemical scorings were found between subgroup 1NA and group 2. The three kinds of scoring were significantly lower in subgroup 1NA in comparison to other groups of patients. The high level of consistence expressed as percent coefficients between particular scorings was stated in groups dialyzed adequately. This consistence was lower in group 1NA. The results of Spearman correlation test regarding three kinds of scoring were not as clear as consistence assessment using percent coefficients. The results of the study let to conclude that DN patients can reach similar level of CAPD adequacy to non-diabetics. High level of consistence between three kinds of scoring confirms the usefulness of own method of adequacy assessment. However the analysis of CAPD adequacy should not be based on single group of parameters.