Synergy between tumour necrosis factor alpha and interleukin-1 in the induction of polymorphonuclear leukocyte migration during inflammation.

Endotoxin is a potent inflammatory stimulus and induces polymorphonuclear leukocyte (PMNL) infiltration into tissues. Macrophage (M phi) derived IL-1 has been proposed as a mediator of this response. TNF alpha is also produced by M phi s in response to endotoxin and both IL-1 and TNF enhance PMNL adhesion to vascular endothelium in vitro. We investigated the activity of recombinant human IL-1 alpha, IL-1 beta, and TNF alpha in inducing PMNL infiltration into the skin of rabbits using a quantitative 51Cr labelled blood leukocyte assay. IL-1 alpha and IL-1 beta induced progressive PMNL accumulation, the 50% maximal response being induced by approximately equal to 20 units. In comparison, TNF alpha even at 100,000 U, induced only mild PMNL accumulations, although IL-1 alpha and TNF alpha were similarly active in inducing PMNL adherence to human umbilical vein endothelium. The human TNF alpha preparation was pyrogenic and induced acute, transient neutropenia in rabbits upon i.v. infusion, IL-1 alpha, IL-1 beta and TNF alpha are often secreted simultaneously by M phi s, therefore we investigated their action in combination. The combination of IL-1 alpha with IL-1 beta was nearly additive in inducing PMNL accumulation, i.e., 87% of predicted result based on the sum of the responses to individual components. The combination of TNF alpha with either IL-1, each in submaximal doses, resulted in 65-125% greater than the additive response. No such effect was observed when these monokines were injected in combination with PMNL chemotactic stimuli. These results indicate a complex interaction between inflammatory monokines in the regulation of PMNL accumulation in vivo.

Imaging of the peritoneal cavity in CAPD.

The aim of our study was the use of the optimal imaging of the peritoneal cavity (PC) for continuous ambulatory peritoneal dialysis (CAPD)-related problems. Ultrasonography (USG), direct abdominal radiography (DAR), peritoneoscintigraphy (PSG), and standard peritoneo-computed tomography (PCT) with reconstruction (R-PCT) were performed in 25 patients on CAPD from three to 44 months. Studies were done at the beginning of CAPD (1-3 months) as well as in the noncomplicated and complicated course of CAPD. Group 1 comprised 17 patients in whom 77 PC images were taken in the non-complicated course of CAPD. Group II comprised 15 patients in whom 65 images were taken during or after complications. For USG and DAR we used standard equipment, PSG was done with sulfur colloid labeled with technetium 99m (Tc 99m), PCT, and R-PCT were done with Omnipaque and Somatom HiQ Siemens unit. In PCT, two- and three dimensional reconstruction were done by our own computer program. USG was recommended for imaging of tunnel infections, exit-site infection (ESI), and adhesion. PSG was useful in almost all observed complications of CAPD except thickening of the peritoneal membrane (PM). Standard PCT with R-PCT was more useful than PCT because of a more legible image of the peritoneal cavity, which gives the possibility of monitoring fluid distribution and measuring of intraperitoneal fluid volume.

The value of peritoneoscintigraphy in the investigation of ultrafiltration loss during peritoneal dialysis.

Peritoneoscintigraphy (PSG) was performed in 18 patients with ultrafiltration (UF) loss during peritoneal dialysis (PD). In 9 patients PSG was abnormal after peritonitis (PT), and transfer to hemodialysis (HD) was necessary. In three cases peritoneal catheter malfunction was suspected, and PSG provided information about the catheter's position and function. In two cases loss of UF was connected with extraperitoneal leakage of the dialysis solution (which was confirmed by PSG). In cases of UF loss and normal control, the peritoneal equilibration test (PET) was used, and its result was abnormal for glucose D/D0 (too high). PSG was useful for diagnosing the reasons for UF loss during PD.

[Changes in some metabolic pathways in women ingesting progestagens as contraceptives]. / Zmiany w niektórych metabolizmach ustrojowych kobiet stosujacych preparaty gestagenowe dla celów antykoncepcyjnych

PIP: Literature concerning the changes caused in lipids and protein metabolism in women using gestagen preparations for contraceptive purposes is surveyed. The level of metabolic changes was found to be related to the estrogen content of the preparation. Lipid metabolism changes are in the form of increases in the total lipids in the serum, insignificant increases in the beta-lipoproteins, and increases in the total cholesterol concentrations. The preparations Femigen-Polfa and Anacyclin were not found to increase the total cholesterol concentrations in the pre beta and beta lipoprotein fractions. There is a possible effect on the triglyceride concentrations. Gestagens are assumed to cause changes in the blood serum protein fractions characterized by an increase in the alpha-1, alpha-2, and beta globulins. Concentrational and transportational changes are caused by decrease of the erythrocytes and resin test values and increase in the thyroid hormone binding globulins with a collateral normal concentration of free thyroxine and normal index of free thyroxine. These changes are observed only with the use of estrogen preparations.^ieng

[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.

[Urinary tract infections in the elderly]. / Zakazenia ukladu moczowego w wieku podeszlym.

This review refers to the special aspects of diagnosis and therapy of urinary tract infections in the elderly.

[Report from the 1st korean-Polish seminar: "Theoretical, technical and clinical aspects of renal replacement therapy (5/18-21/2000)]. / Sprawozdanie z I Koreansko-Polskiego Seminarium: "theoretical, technical and clinical aspects of renal replacement therapy (18-21.05.2000)".

This was the first Korean-Polish seminar on renal replacement therapies which provided a survey of current research being carried out in both countries, delivered by leading experts in this field. The topics included malnutrition in uremia, biocompatibility, risk factors and complications in renal replacement therapy, diabetic nephropathy, new solutions for peritoneal dialysis, and peritoneal transport. The organizers strove to select the topics which are currently of interest to researchers from both countries with the purpose to compare results and stimulate discussion concerning possible collaboration in the future.

[Significance of clinical anamnesis in the preliminary diagnosis of renovascular hypertension]. / Rola wywiadu klinicznego we wstepnej diagnostyce nadcisnienia naczyniowo-nerkowego.

Differences in the occurrence of renovascular hypertension (RVH) in the population of patients with arterial hypertension related to different preselection criteria induced us to analyse practical usefulness of clinical anamnesis for RVH. In 130 patients with arterial hypertension (72 women, 58 men, average age 48 years) and clinical suspicion on RVH, the initial renal angioscintigraphy (with 99m Tc-DTPA) was abnormal, demonstrating impairment of glomerular filtration rate. In the whole group captopril angioscintigraphy test (CAT) as well as captopril renin test (CRT) were simultaneously performed according to own protocol. In 24 cases highly suspected for RVH on the ground of clinical anamnesis the critical stenosis of renal artery (> 75% of the lumen) was found in the arteriography. The most significant signs of RVH in clinical anamnesis were the following: the diastolic blood pressure > 120 mm Hg (92% cases), resistance to 3 hypertensive drugs (92%), sudden onset and rapidly progressive course of hypertension (88%) and advanced hypertension retinopathy (79%). On the ground of these results, detailed clinical anamnesis is recommended as a cheap and easy preselection test for RVH in the hypertensive population.

[Assessment of active renin instead of plasma renin activity in the renin captopril test]. / Oznaczanie aktywnej reniny w miejsce aktywnosci reninowej osocza w reninowym tescie kaptoprylowym.

In the study usefulness of active renin (AR) measurement instead of plasma renin activity (PRA) in the diagnosis of reno-vascular hypertension(RVH) was evaluated. 42 patients with arterial hypertension (17F, 25M; mean age 45 + 12 years) and suspicion on RVH on the ground of the abnormal result of the preliminary renal angioscintigraphy were qualified to the study. Angioscintigraphic (SCT) and simultaneously renin captopril test (RCT) followed by renal arteriography or Doppler ultrasonography of renal arteries were performed in every case Haemodynamic significant stenosis of renal artery was revealed in 5 cases. The results of the examination in this group were as follows: in 3 patients positive RCT with PRA, in 4 patients positive RCT with R and in 2 patients positive SCT were found. The false positive results of RCT using PRA were obtained in 5 patients and only in 2 patients if using AR. There were no false positive results of SCT. The introduction of AR instead of PRA in RCT resulted in simplification and shortening of the diagnostic procedure. Furthermore, this modification increased detection of hemodynamically significant stenosis of renal artery from 2 cases revealed with SCT and 3 cases with PRAin RCT to 4 cases with AR. The successful preliminary results let us to introduce this modification of RCT to routine out-patients screening for RVH.

[Continuous ambulatory peritoneal dialysis as a renal replacement therapy in blind diabetics with type 1 diabetes]. / Ciagla ambulatoryjna dializa otrzewnowa jako metoda leczenia nerkozastepczego u ociemnialych chorych na cukrzyce typu 1.

UNLABELLED: Controversy around the place of CAPD in renal replacement therapy of blind Diabetics (BD) with type 1 Diabetes induced us to start CADP programme also in this group of patients. In yrs 95-98 we treated with CAPD 5 BD send to our Centre in IV/V phase of diabetic nephropathy (acc. to Mogensen). Duration of D up to 20 yrs, complete blindness in the last 2-10 yrs. Criteria of qualification for CAPD: standard medical +motivation of patient and family helper for self dialysis, unaided everyday life as well as blindness not before maturity. CAPD equipment: twin bag system with special modifications for BD. Own training programme of 2 weeks for patient/family helper modified for BD (without visual aids). We achieved full clinical and biochemical compensation of uremia; KT/Vurea > 1.9, weekly creatinine clearance > 60 1/1.73 sqm, UF > 400 ml. Peritonitis occurred in 2 of 5 patients with ratio 1:28 ptsmnths. IN CONCLUSION: for BD with type 1 Diabetes, leading unaided everyday life, the blindness doesn't seem to be limitation for CAPD, if patients are motivated for self dialysis and the training programme has been specially modified for them.

[The value of urine sediment cytomorphology in the ambulatory differential diagnosis of hematuria]. / Wartosc badania cytomorfologicznego osadu moczu w ambulatoryjnej diagnostyce róznicowej krwiomoczu.

In order to improve early diagnosis of urotheliale neoplasms (UN) in nephrology outpatient clinic, 274 patients (221 male and 53 female, mean age 54 yrs), with recurrent hematuria (> 5 E/hpf) were investigated in years 1994-1998. The following examinations of fresh urine sediment were performed: in 114pts (group 1) erythrocytes of urine sediment examined with phase-contrast microscopy (PCM); in 129pts (group II) urine sediment examined with classical oncological cytology; in the III-rd group of 31pts (29M and 2F, aged 61-72), both methods were used because of high suspicion on UN on the ground of initial result of PCM, precisely clinical anamnesis as well as predominance of men in advanced age. Results were as follows. In the I-st group, in 6 from 42pts with urological hematuria in PCM, what means 5.2% of the whole group and 14% of the subgroup with urological hematuria, in further standard urological examination bladder carcinoma was found. In the II-nd group, positive result of urinary cytology (GI to GIII) was found in 7pts, what means 5.4% of the whole group. Results of urine cytology were confirmed later in the standard urological examination, which detected bladder carcinoma in all these patients. In the III-rd group, bladder carcinoma was found in all 22pts with urological hematuria in PCM. In 19 patients from this subgroup, urinary cytology was positive for UN (GI to GIII). In the remaining 3pts results of urinary cytology were false negative. False positive result of urinary cytology occurred in one from 9pts with glomerular hematuria and clinical or morphological (in renal biopsy) evidence of glomerulonephritis. On the results of the study, we propose--as an obligatory--in every case of recurrent hematuria of urological origin in PCM, examination of fresh urinary sediment with classical oncological cytology, especially if the patient belongs to the high risk group for urotheliale neoplasms.

[Retroperitoneal fibrosis with antiphospholipid syndrome: a coincidence or common autoimmunological etiology?]. / Zwlóknienie zaotrzewnowe z zespolem antyfosfolipidowym--koincydencja czy wspólne podloze autoimmunologiczne?

The term "retroperitoneal fibrosis" means pathophysiologically differentiated entities which are leading to development of pathological masses of connective tissue in retroperitoneal space. The etiology of the disease has not been clearly established up to now. Recently advanced hypothesis suggests that existence of the pathological masses of connective tissue in retroperitoneal space is a consequence of autoimmunological response to insoluble, oxidized lipoprotein of atheromatous plaque called ceroid, penetrating into periaortal space through atheromatic wall of aorta. On the basis of recently observed case of 43-years old woman with retroperitoneal fibrosis and antiphospholipid syndrome the possibility of common autoimmunological etiology of both entities is discussed.

[Sulodexide in the treatment of right hand necrosis in diabetic patient performing exchanges of continuous ambulatory peritoneal dialysis (CAPD) by himself]. / Sulodeksyd w leczeniu martwicy niedokrwiennej palców prawej dloni u chorego na cukrzyce wykonujacego samodzielnie wymiany dializ otrzewnowych technika CADO.

The usefulness of sulodexide in the treatment of severe necrosis of right hand in 42 diabetic patient performing by himself CAPD exchanges is described. Very good results of this treatment, induced us to discuss clinical indications for this drug, which--according to our opinion--is particularly recommended for treatment of severe vascular complications in patients with diabetes and irreversible renal failure.

[Therapeutic plasma exchanges with cyclophosphamide in the treatment of rapidly progressing glomerulonephritis]. / Skojarzenie leczniczej wymiany osocza z cyklofosfamidem w leczeniu gwaltownie postepujacego klebuszkowego zapalenia nerek.

On the basis of two cases of rapidly progressive glomerulonephritis with over 50% crescents in percutaneous renal biopsy, anti-GBM antibodies in one case and progressive renal failure in both cases, successful treatment with plasma exchanges and aggressive immunosuppression according to our own protocol is presented and discussed with literature.

[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).

[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.

[Goodpasture's syndrome--continuing clinical problem]. / Zespól Goodpasture'a--stale aktualny problem kliniczny.

On the case of too late diagnosed Goodpasture's syndrome with further fatal clinical course necessity of early diagnosis and aggressive immunosuppressive therapy is stressed.

[Acute renal failure in the course of rhabdomyolysis after status epilepticus]. / Ostra niewydolnosc nerek w przebiegu rabdomiolizy wiklajacej stan padaczkowy.

A 24 years old woman with sclerosis multiplex was admitted to our hospital after generalized seizures. In the first days of observation occurred symptoms of acute renal failure and liver damage with hemolysis. The differential diagnosis allowed us to recognize acute renal failure in the course of rhabdomyolysis. After a few hemodialysis normal renal function was achieved.

[Screening for renovascular hypertension in own material (1986-1998)]. / Badania przesiewowe nadcisnienia tetniczego naczyniowo-nerkowego w materiale wlasnym (1986-1998).

In 370 patients (pts) with hypertension(HT) in years 1986-1998 (168F + 202M, mean age 46 yrs) screening value of the following tests was evaluated: standard initial angioscintigraphy DTPA 99mTc(SA) in all pts(1-st screening group), significance of clinical suspicion on renovascular hypertension (RVHT) in the group of 74 pts (II-nd screening group). Captopril tests: renin captopril test(RCT) and isotopic captopril test (ICT) were performed in all 370 pts. Classical renal angiography as a reference test for renal artery stenosis (RAS) was performed in all pts suspected for RVHT on the basis of clinical anamnesis and or positive results of captopril tests. Results were as follows. Initial SA being abnormal in the whole group, appeared to be more significant for RAS only in the case of profound one side renal ischemia (GFR lower than 30% of total GFR). Resistance to three antihypertensive drugs, diastolic blood pressure > 120 mmHg and sudden onset of Ht, found in all 74 pts from the II-nd group, were the most significant clinical symptoms of RVHT, because critical RAS was found in 41, that is 55% of pts from the II-nd group. At least one positive CT was found in 37 from 42 pts with critical RAS in angiography with RTC being more sensitive and ICT more specific for hemodynamically significant RAS. The following screening protocol for RVHT was presented and discussed: precise clinical anamnesis followed by angiography or captopril tests according to the severity of clinical symptoms, aim of the study as well as accessibility and laboratory reproducibility of the captopril tests.