Coexistence of granulomatosis with polyangiitis (GPA) and Crohn's disease or multiorgan manifestation of the same disease?

Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis of unknown aetiology, often related to the antineutrophil cytoplasmic antibody (ANCA). GPA was previously named Wegener's granulomatosis (WG). The disease frequently has multisystemic presentation, targeting mainly the respiratory tract and kidneys, but gastrointestinal involvement is uncommon. Crohn's disease (CD) is an inflammatory bowel disease (IBD) with many extraintestinal manifestations. Clinically, symptoms of WG and CD can mimic each other. In this paper a case of GPA manifested initially by severe multiorgan damage including colitis, regarded to be coexistent CD, is presented. The case illustrates the difficulties in establishing the diagnosis when symptoms of the diseases mimic each other.

[Pseudo-Bartter syndrome--2 cases]. / Rzekomy zespól Barttera--opis 2 przypadków.

Bartter syndrome represents the group of renal disturbances characterized by hypokaliemia and metabolic alkalosis. Some diseases could display hypokalemic metabolic alkalosis without primary tubular dysfunction. These disorders are called pseudo-Bartter syndrome. In this paper we present 2 cases of pseudo-Bartter syndrome related among to other things to overuse of diuretic drugs.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in Poland: further evidence for the changing epidemiology of MRSA.

This study reports the isolation of CA-MRSA strain which was found to colonize the nasal mucosa of a patient undergoing haemodialysis treatment. The MRSA was subjected to molecular analysis by Pulsed Field Gel Electrophoresis (PFGE), multiplex PCR assay for staphylococcal cassette chromosome mec (SCCmec) typing, and PCR detection of the pvl gene encoding for Panton-Valentine leukocidin. The analyzed MRSA harbored the SCCmec type IV and the pvl gene-two unique genetic markers of CA-MRSA. The PFGE pattern of the strain corresponded to the common European CA-MRSA (MLST Type ST80). Moreover, the strain was only resistant to beta-lactam agents and tetracycline. This study adds further evidence for the changing epidemiology of MRSA and indicates the ability of CA-MRSA to affect persons with established risk factors in addition to previously healthy individuals.

Characterisation of Staphylococcus aureus nasal and skin carriage among patients undergoing haemodialysis treatment.

The aim of the study was to investigate the rate of Staphylococcus aureus nasal and skin carriage in patients undergoing haemodialysis. The cultured staphylococcal isolates were subsequently characterized by molecular methods. The study group comprised 43 haemodialysed patients from whom nasal and skin swabs from the vascular access sites were collected. The identification of staphylococcal isolates and antibiotic susceptibility testing were performed on the basis of conventional diagnostic procedures. The staphylococci were further characterized using Pulsed-Field Gel Electrophoresis (PFGE). S. aureus was cultured from 12 (27.9%) patients. Only one (8.3%) patient was colonized with the microorganism both in the anterior nares and the vascular access site representing a single strain, as evidenced by PFGE analysis. Antibiotic susceptibility testing identified one (7.6%) methicillin-resistant S. aureus (MRSA) strain. PFGE typing identified several S. aureus genotypes with the lack of one specific strain responsible for colonization. However, it should be noted that among two (A and D) PFGE patterns genetically indistinguishable and closely related isolates (two isolates for each pattern) were identified. The obtained results revealed a relatively low rate of S. aureus carriage accompanied by low methicillin resistance rate and a significant genetic diversity of cultured isolates with the lack of one predominant strain responsible for colonization.

[Severe, life-threatening renal anemia treatment in patients who do not accept heterologous blood transfusion for religious reasons--case report]. / Leczenie niedokrwistosci nerkopochodnej zagrazajacej zyciu u pacjentów odmawiajacych transfuzji krwi z przyczyn religijnych--opis przypadków.

The management of severe anemia in patients who do not accept heterologous blood transfusion for religious reasons presents many different challenges both at the level of treatment strategy and ethics. Recently, new interventional treatment strategies have become available, including human and bovine hemoglobin substitutes and high-dose recombinant human erythropoietin. We present the successful management of two Jehovah's Witnesses patients with severe, life-threatening anemia caused by chronic renal failure and exacerbated by sepsis.

Cerebral oligemic hypoxia and MK-801 treatment: effect on alternation behavior in mice.

It is known that glutamatergic system is one of neurotransmitter systems affected by a transiently reduced oxygen supply. The aim of the present study was to examine the effects of MK-801, a noncompetitive NMDA receptor antagonist, on spontaneous alternation in mice exposed to cerebral oligemic hypoxia. Spontaneous alternation behavior and locomotor activity were evaluated using the Y-maze task. Transient cerebral oligemia was induced by bilateral clamping of carotid arteries (BCCA) for 30 min under pentobarbital anesthesia. MK-801 was injected 48 h after BCCA or sham surgery, 30 min before the test session. Treatment with MK-801 (0.1 mg/kg ip) impaired spontaneous alternation both in sham-operated and BCCA mice. MK-801 (0.1 mg/kg ip) significantly enhanced the locomotion of mice. The effects of MK-801 were not exacerbated by BCCA. These results show that cerebral oligemic hypoxia induced by BCCA does not change alternation behavior of mice treated with MK-801.

The investigation of Staphylococcus aureus and coagulase-negative staphylococci nasal carriage among patients undergoing haemodialysis.

The frequency of nasal staphylococcal colonization among haemodialysed patients was investigated. The swabs were collected in 1998 and 2004 from 28 and 43 patients, respectively. Staphylococcus aureus colonization rates were 57.1% and 27.9% in 1998 and 2004, respectively. Twenty-six coagulase-negative staphylococci (CNS) isolates were cultured: S. epidermidis (21), S. lugdunensis (2), single S. haemolyticus, S. warneri, and S. capitits isolates. One S. aureus and 10 CNS isolates were methicillin resistant. The methicillin-resistant S. aureus (MRSA) was resistant to beta-lactams, tetracycline, and harbored the pvl gene encoding the Panton-Valentine leukocidin. The decrease in S. aureus colonization at 6-year interval was observed. The presence of the pvl gene and a favorable antibiotic susceptibility pattern of the MRSA suggest that the isolate was a member of community-acquired MRSA (CA-MRSA). Concluding, screening of haemodialysed patients for staphylococcal colonization accompanied by characterization of cultured isolates is important to understand its epidemiology and to develop infection prevention measures and treatment strategies.

Association of the human bradykinin B2 receptor gene with chronic renal failure.

INTRODUCTION: The kallikrein-kinin system plays an important role in blood pressure homeostasis and renal sodium regulation, and some studies have reported that the kinins have a protective effect against hypertension and the development of renal disease. The B2-bradykinin receptor (B2R) mediates the majority of physiological actions of bradykinin. We investigated the effect of the C181-->T polymorphism in exon 2 of the B2R gene in patients with end-stage renal disease (ESRD). METHODS: This study involved 790 patients with ESRD and 510 healthy controls. All participants were genotyped for the B2R C181-->T polymorphism by PCR followed by digestion of a PCR product with TaqI restriction endonuclease. DNA fragments were separated by agarose gel electrophoresis. Genotype and allele frequencies were compared between the groups. All calculations were performed using SPSS 5.0 for Windows. RESULTS: B2R genotype distribution in patients and controls was in accordance with Hardy-Weinberg equilibrium. The frequency of the T allele was higher in ESRD patients than in controls. The significant difference was observed in the age at onset of renal disease; for patients with the T allele the mean age at onset was 36.8 years, compared with 52.4 years for those carrying only the C allele (p<0.001). The frequencies of the T allele and carrier genotypes were not associated with gender, presence of hypertension, or underlying kidney disease. CONCLUSION: Our results suggest that the B2R polymorphism has a potential role in the earlier development of chronic renal failure in susceptible individuals. We did not confirm the previously published reports that the B2R gene polymorphism has a protective role in the development of ESRD.

Association of the VEGF gene polymorphism with diabetic retinopathy in type 2 diabetes patients.

BACKGROUND: Diabetic microvascular complications are the major causes of morbidity and early mortality in diabetes. Vascular endothelial growth factor (VEGF) is a potent multifunctional cytokine which plays a key role in the pathogenesis of diabetic microvascular complications. We examined the possible association of the VEGF gene polymorphisms with diabetic nephropathy and retinopathy in type 2 diabetes patients. METHODS: Genotyping of the VEGF gene insertion/deletion (I/D) and +405 polymorphisms was done by the polymerase chain reaction (PCR) and restriction fragment length polymorphism methods. A total of 426 patients with type 2 diabetes and 493 healthy subjects were genotyped. The frequency of VEGF alleles and genotype distribution were compared in diabetic and control groups. RESULTS: The distribution of the VEGF DD genotype was significantly different in patients with diabetic retinopathy compared with healthy controls, entire diabetic group and patients with no complications (44 vs. 23, 30 and 21%, respectively; P < 0.01). Such differences were not observed in the diabetic nephropathy group. The odds ratio for the D allele was 2.27 (95% CI 1.59-3.25). The multivariate logistic regression analysis revealed that the D allele of the VEGF gene I/D polymorphism was an independent risk factor of retinopathy (P < 0.001). The VEGF +405 genotype was not associated with diabetic complications in type 2 diabetes patients. CONCLUSION: Our study suggests that the I/D polymorphism in the promoter region of the VEGF gene is associated with retinopathy but not nephropathy in type 2 diabetes patients. The multivariate logistic regression analysis showed that the D allele of the VEGF polymorphism is an independent risk factor of diabetic retinopathy after controlling for other clinical variables.

Interleukin-6 gene polymorphism and faster progression to end-stage renal failure in chronic glomerulonephritis.

Interleukin-6 (IL-6) is a multifunctional cytokine produced by different cell types, including monocytes, lymphocytes, endothelial and mesangial cells. Deregulated production of IL-6 was found to be involved in mesangial proliferative glomerulonephritis. We investigated whether the single nucleotide polymorphism (SNP) in the promoter region of the IL-6 gene is associated with a development of chronic glomerulonephritis (CGN). The study group consisted of 541 patients with CGN. Of those 338 already progressed to ESRD. The control group involved 253 healthy individuals. All subjects were genotyped for the -634 C/G polymorphism of the IL-6 gene by polymerase chain reaction (PCR). PCR product was digested with BsrBI restriction endonuclease and analyzed on 3% agarose. The allele and genotype frequencies were similar between CGN patients in a pre-dialysis stage and control subjects. Significantly increased frequency of the G allele was observed in the ESRD patients (13% vs. 6% in pre-dialysis stage, P < 0.01). After dividing ESRD patients according to time from reported disease onset to ESRD, those with time < or =5 years showed even higher G allele frequency (21% vs. 13% in entire ESRD group). Interestingly, most of the GG homozygotes were in this faster progressing group. Both subgroups were comparable for sex, age, BMI, total cholesterol and serum creatinine. The multivariate logistic regression analysis revealed that the IL-6 genotype with the G allele was an independent risk factor of progression to ESRD (P < 0.001). Our results indicate that the IL-6 -634 G/C polymorphism may be a possible risk factor for faster progression of chronic glomerulonephritis to ESRD. It is also possible that this polymorphism is in linkage disequilibrium with another functional polymorphism in the II-6 gene or its vicinity.

[Hemolytic uremic syndrome]. / Zespól hemolityczno-mocznicowy.

Hemolityc anemia, thrombocytopenia and acute renal failure are characteristic features of hemolytic uremic syndrome (HUS). The disease occurs mainly in infants and little children, sometimes it occurs in adult people. Most often it occurs in the course of diarrhorea cause by E. coli O 157:H7. Many other agents can induce HUS. The case of 54 year old female with HUS which developed in the course of diarhoea was reported. The course of HUS was complicated by multiorgan--brain, heart, pancreas and liver injure. Hemodialysis and plasmapheresis were used in the treatment. The treatment made the health recovery possible in our case.

[Comparison of some nutritional parameters in hemodialysis patients over and below 65 years of age]. / Ocena porównawcza wybranych parametrów stanu odzywienia u chorych powyzej oraz ponizej 65 roku iycia, przewlekle hemodializowanych.

UNLABELLED: There is a close relationship between inflammation, malnutrition and atherosclerosis in chronic hemodialysis (HD) patients (pts). This process is closely related to poor clinical outcomes including morbidity and mortality, especially in elderly patients. The aim of this study conducted in HD pts over 65 years old (group A) and in younger pts (group B) was the assessment of some parameters of: nutritional status, inflammation, atherosclerosis and anthropometry. In group A (40 pts), mean age 72,2 +/- 4,7, the time on HD treatment was 37,1 +/- 33,0 months and in group B (83 pts), mean age 48,3 +/- 9,7 years, time on HD treatment was 97,4 +/- 90,1 months. We have measured the serum concentrations (conc.) of some parameters: hemoglobin (Hb), C-reactive protein total (CRP), albumin (alb), cholesterol (t-chol), calcium (Ca), phoshorus (P), intact parathormone (iPTH). The adequacy of HD was measured by Kt/V. We have estimated: body mass index (BMI), interdialytic weight gain (IWG), normalized protein catabolic rate (nPCR) and weekly EPO consumption. Some anthropometric parameters which were studied included: triceps skin fold (TSF), waist circumference (WC), mid-arm muscle circumference (MC). The physical activity was expressed by hand grip test (GT) on the hand without the vascular access. The mean values of Kt/V were similar in both groups (1,2 +/- 0,1 vs 1,2 +/- 0,2). Likewise there were no significant differences in mean levels of CRP (9,7 +/- 9,1 vs 14,1 +/- 12,2 mg/l) and Hb (6,7 +/- 0,7 vs 7,0 +/- 0,9 mmol/l), but weekly EPO consumption was higher in group A (48,1 +/- 35,8 vs 38,6 +/- 29,3 U/kg, p<0,01). We have observed, that in group A the mean serum levels of albumin and t-chol were significantly lower (33,2 +/- 3,1 vs 37,5 +/- 3,9 g/l, p <0,05 and respectively 3,9 +/- 0,7 vs 4,3 +/- 0,9 mmol/l, p<0,05).) and IWG as well (2,1 +/- 1,2 vs 3,3 +/- 1,6 kg; p<0,01). The mean values BMI and nPCR were significantly lower in group A (24,4 +/- 3,2 vs 27,3 +/- 2,5 kg/m2, p<0,01 and respectively: 0,9 +/- 0,1 vs 1,1 +/- 0,2 g/kg/day, p<0,01). Likewise mean values of IWG and MAP were significantly lower in elderly patients (2,1 +/- 1,2 vs 3,3 +/- 1,6 kg; p<0,01 and respectively 91,5 +/- 19 vs 95,5 +/- 13 mm Hg; p<0,01). Mean serum Ca and P conc. were significantly lower in group A (2,1 +/- 0,1 vs 2,3 +/- 0,2 mmol/l, p<0,01 and respectively 1,4 +/- 0,3 vs 1,8 +/- 0,5 mmol/l, p<0,01). Likewise mean iPTH conc. was significantly lower in elderly patients (379,2 +/- 362,3 vs 571,6 +/- 510,9 pg/ml). The mean values of strength of grip were lower in group A (20,5 +/- 11,4 vs 34,7 +/- 13,6 kg, p<0,01). In both groups there were no significant differences between the mean values of TSF (11,2 +/- 3,8 vs 13,4 +/- 6,8 mm), but mean values of WC and as well MC as well were lower in group A (91,0 +/- 8,1 vs 98 +/- 12,4 cm; p<0,05 and respectively 25,5 +/- 3,1 vs 28,9 +/- 3,8 cm; p<0,05). There was a significant negative correlation (cor.) between the age of patient and intradialytic body weight gain (r = -0,4607, p<0,001) and significant positive cor. between: albumin and nPCR (r = 0,433, p<0,01) and albumin and Hb (r = 0,391, p<0,01). There was a significant negative cor. between strength of grip and time of HD treatment (r = -0,350, p<0,05). IN CONCLUSION: The studied elderly hemodialysis patients are more malnourished than younger ones.

[28-year-old woman with Goodpasture's syndrome and nonspecific colitis]. / Zespól Goodpasture'a wspólistniejacy z nieswoistym zapaleniem jelit u 28-letniej kobiety.

Goodpasture's syndrome usually becomes manifest with progressive glomerulonephritis and pulmonary hemorrhage. The diagnostic hallmark is the demonstration of anti-basement membrane anti-alpha3 type IV collagen antibodies (anti-GMB antibodies) in patient sera. Herein is reported the case of 28-year-old woman with Goodpasture's syndrome who developed the acute symptoms of nonspecific colitis which required surgical intervention. Immunosuppression along with plasmapheresis was successful in the treatment of life-threatening pulmonary hemorrhage, but not for the improvement of renal function.

Competitive NMDA receptor antagonists and agonists: effects on spontaneous alternation in mice exposed to cerebral oligemia.

The purpose of the present study was to investigate the effects of competitive NMDA receptor antagonists,D,L-(E)-2-amino-4-methyl-5-phosphono-3-pentenoic acid (CGP 37849) and its ethyl ester (CGP 39551), or agonist, N-methyl-D-aspartate (NMDA) on spontaneous alternation in mice exposed to cerebral oligemia. Alternation behavior was evaluated in an Y-maze. Transient cerebral oligemic hypoxia was induced by bilateral clamping of carotid arteries (BCCA) for 30 min under pentobarbital anesthesia. In BCCA mice, CGP 37849 (5 mg/kg, ip) impaired spontaneous alternation when given 48 h or 7 days after surgery. CGP 39551 (5 mg/kg, ip) had no effect.NMDA (50 mg/kg, sc) improved performance of the task in BCCA mice when tested 48 h after surgery. These results suggest that cerebral oligemic hypoxia induced by BCCA leads to functional disturbances in the central nervous system, such as spontaneous alternation impairment and increased susceptibility to NMDA receptor-related drugs. Adverse potential of cerebral oligemia may limit a therapeutic use of NMDA receptor antagonists.

[Acute cardiac failure secondary to brachiocephalic arteriovenous fistula in patient on chronic haemodialysis]. / Ostra niewydolnosc lewokomorowa po wytworzeniu wysokoprzeplywowego zespolenia tetniczo-zylnego u chorego przewlekle hemodializowanego.

Vascular access for hemodialysis is crucial for appropriate course of the treatment as well as for good prognosis for patients with chronic renal insufficiency. In this paper we present the case of chronically hemodialysed patient who developed high-output cardiac failure after several days before creation of the upper arm brachio-cephalic arteriovenous fistula. Ultrasonographic imaging of the fistula showed an over-functioning anastomosis with flow reaching 41/min. The surgical correction of the anastomosis length to 4 mm and reduction of the cephalic vein diameter to 5 mm, significantly improved general status of the patient, simultaneously maintaining an accurate function of the fistula, with the maximal flow up to 850 ml/min.