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Biomedical subjects

A Wiecek

Publications and source records attributed to A Wiecek.

At least 217 records · Page 12Linked to original sources
PubMedDate not supplied

The intrarenal vascular resistance parameters measured by duplex Doppler ultrasound shortly after kidney transplantation in patients with immediate, slow, and delayed graft function.

BACKGROUND: Evaluation of pulsatility (PI) and resistive (RI) indexes by duplex Doppler ultrasound shortly after kidney transplantation reflects the exacerbation of interstitial edema. The aim of study was to characterize factors that influence PI and RI in patients with immediate (IGF), slow (SGF), or delayed (DGF) kidney graft function. PATIENTS AND METHODS: PI and RI were measured in 200 transplanted patients at 2 to 4 days postoperatively. We excluded patients with acute rejection episodes within the first month. IGF, which was defined as serum creatinine <264 micromol/L at 3 days, SGF, which was defined as creatinine >264 micromol/L by day 3 with a maximum of one dialysis, and DGF, which was defined as more than 1 dialysis were observed in 33.3%, 41.5%, and 25.2% of patients, respectively. The examined donor parameters were age, hypotensive episodes, catecholamine infusion, central venous pressure, and glomerular filtration rate. The recipient factors were age, history of hypertension, diabetes mellitus, ischemic heart disease, and stroke. Additionally cold ischemia time (CIT), HLA mismatch, and PRA were analyzed. RESULTS: The lowest PI and RI values were observed among patients with IGF (PI 1.37 [1.28 to 1.46]; RI 0.72 [0.69 to 0.74]); moderate values in SGF (PI 1.65 [1.52 to 1.78]; RI 0.78 [0.76 to 0.80]) and the highest values in DGF (PI 2.09 [1.83 to 2.35]; RI 0.83 [0.80 to 0.86]) differences that were highly significant. Hypotensive episodes and catecholamine infusion in the preharvest period had essential impacts on PI or RI values in the early posttransplant period. There was no significant correlation between PI or RI values and CIT. A slower ATN resolution was observed in DGF patients with higher PI values. CONCLUSION: Ischemic injury, which occurred mainly prior to organ harvesting, played a dominant role determining intrarenal resistance in the early posttransplant period.

Adult↗
PubMedDate not supplied

Simultaneous transabdominal bilateral nephrectomy in potential kidney transplant recipients.

BACKGROUND: Bilateral nephrectomy of potential kidney graft recipients is indicated for patients with recurrent infections in the polycystic kidneys or chronic pyelonephritis resulting from vesicoureteric reflux. The aim of this study was to analyze the frequency of complications after simultaneous bilateral transperitoneal nephrectomy. PATIENTS AND METHODS: Twenty hemodialysis patients (age 28 to 55 years) were referred for simultaneous bilateral nephrectomy between 1996 and 2004. Among the 18 patients with autosomal-dominant polycystic kidney disease, 11 experienced recurrent cysts or urinary tract infections and two, episodes of disabling flank pain. Five patients with extremely enlarged kidneys were asymptomatic. Two patients presented vesicoureteric reflux with chronic pyelonephritis. In all cases the kidneys were removed transperitoneally via a transverse or midline incision. RESULTS: Although no fatal outcome was recorded, three patients required brief hospitalizations in the intensive care unit. The only intraoperative complication was spleen injury in five patients. Surgical postoperative complications developed in nine patients (45%) including: extended drainage and delayed wound healing (n = 4), postoperative hernia (n = 3), prolonged abdominal pain (n = 3), perihepatic hematoma (n = 2), stress duodenal ulceration (n = 1), and subileus (n = 1). Five patients displayed thrombosis of their dialysis access, probably as a consequence of low blood pressure. After surgery 15 patients were placed on the waiting list and 10, successfully transplanted. CONCLUSION: Simultaneous transabdominal bilateral nephrectomy was associated with a high risk of postoperative complications, but may save the suffering associated with a repeated operation in potential kidney graft recipients who have an indication for bilateral nephrectomy.

Abdomen↗
PubMedDate not supplied

Surgical treatment of urological complications after kidney transplantation.

Urological complications after kidney transplantation develop in 2.5% to 14.1% of recipients. The aim of the study was to analyze postoperative urological complications that required surgical treatment. Thirty-three urological complications developed in 30 among 321 patients (9.3%). Complications were divided into two groups: I, related to urine retention (60.6%); and II, related to urine leakage (39.4%). For 70% of group I, in patients a double pigtail ureteral stent was inserted; for 53.8% of group II, a vesicoureteric reanastomosis was performed. Good urine outflow was achieved in 90.0% of patients. Total early graft loss was 20% of patients. Urological complications related to stenosis or leakage can be treated with ureteral stent insertion or vesicoureteral reanastomosis. Hemorrhage or infection coexisting with a urological complication increased the risk of early graft loss. Long-term graft survival among patients after successful treatment of urological complications was similar to that of patients without them.

Adult↗
PubMedDate not supplied

[The effect of treatment with enalapril versus losartan on levels of insulin resistance in patients with essential hypertension].

Insulin resistance and hyperinsulinaemia are presumed to participate in the pathogenesis of essential hypertension (EH). Insulin resistance is characterised by an impaired insulin-mediated glucose uptake. Participation of the renin-angiotensin system in the development of hyperinsulinaemia in EH patients has not been unanimously proven. The present study aimed to asses the influence of antihypertensive therapy with angiotensin converting enzyme inhibitor (ACEI, enalapril = 10 mg/day) (9 male patients) or angiotensin II AT-1 receptor blocker (A II RB = losartan 50 mg/day) (9 male patients) respectively on insulin sensitivity in patients with EH. 3-hours euglycaemic clamp test with constant infusion of insulin (50 mU/m2/min) was performed twice: before and after 8 weeks of therapy with ACEI or A II RB respectively. The control group (CG) consisted of 12 healthy males (clamp test was performed once). Serum insulin concentration (I) was estimated by radioimmunoassay. Glucose disposal rate (M-value = mg/kg/min) and tissue insulin sensitivity (M/I value = mg/kg/min per mU/l) were calculated in subjects of the CG and in patients with EH before and after antihypertensive therapy with ACEI or A II RB, respectively. In CG the M-value (7.38 +/- 0.13) and tissue insulin sensitivity (M/I = = 6.76 +/- 0.19) were significantly higher than in EH before treatment with ACEI (M-value = 5.44 +/- 0.16; M/I = = 4.57 +/- 0.18) or A II RB (M-value = 5.75 +/- 0.21; M/I = 4.77 +/- 0.31), respectively. ACEI therapy was followed by a significant increase of both M (6.82 +/- 0.25) and M/I (5.68 +/- 0.25) values. In contrast to ACEI, treatment with A II RB did not influence neither M (5.75 +/- 0.21) nor M/I (4.79 +/- 0.21) values respectively. In contrast to A II RB, ACEI shows a beneficial effect on insulin sensitivity in EH patients. This effect does not seem to be mediated by an influence on the AT-1 receptor.

Adult↗
PubMedDate not supplied

[Treatment of anemia in patients with renal failure using erythropoietin obtained by genetic recombination].

In 5 haemodialyzed patients with end-stage renal failure an effect of human recombinant erythropoietin (r-huEpo) on haemoglobin, haematocrit and iron metabolism was studied. After 12 weeks of the treatment, a significant increase in haemoglobin and haematocrit but significant decrease in plasma ferritin were noted. During r-huEpo treatment, one patients presented clinical symptoms of increased blood coagulation whereas another patients an increase in blood pressure. r-huEpo did not influence leukocytes and platelets count as well as liver function tests. Our results suggest, that r-huEpo is highly effective and safe in the treatment of anaemia in patients with chronic uraemia. Iron metabolism, blood pressure and blood coagulation must be monitored during therapy with r-huEpo.

Adult↗
PubMedDate not supplied

Water immersion (WI) induced alterations of plasma vasopressin (AVP) levels in patients with noninflammatory acute renal failure (NARF) and in patients with chronic renal failure (CRF).

Water immersion (WI) induced alterations of plasma vasopressin (AVP), plasma osmolality, plasma volume (PV) and plasma sodium and potassium concentration were examined in 12 patients with noninflammatory acute renal failure (NARF) at the anuric/oliguric phase, 20 patients with chronic renal failure (CRF) and 15 healthy persons. In all examined groups a significant increase of PV and decrease of plasma osmolality and AVP after WI was observed. In patients with NARF the increase of PV was significantly greater than in CRF and in healthy persons. In patients with NARF a significantly greater decrease of plasma sodium concentration after WI was also noted than in patients with CRF and in healthy persons. Only in healthy persons, but not in patients with acute or chronic renal failure a significant correlation between PV or decrease of plasma osmolality and WI induced decrease of plasma AVP level was stated. We conclude that patients with NARF and CRF are characterized by an inappropriate volumetric and osmotic regulation of AVP secretion.

Acute Kidney Injury↗
PubMedDate not supplied

Water immersion induced alterations of plasma atrial natriuretic peptide (ANP), diuresis and natriuresis in kidney transplant patients.

UNLABELLED: The present article aimed to study the intactness of the physiological mechanism of ANP secretion in 64 kidney transplant patients treated with cyclosporine A + prednisone (CyA group--35 patients) or azathioprine + prednisone + promethasine respectively (Aza group or--29 patients). The control group comprised 15 healthy persons. ANP plasma levels were assessed before and 1 h and 2 h after neck out water immersion (WI). Higher basal ANP levels were found in patients of the CyA and Aza group than in normals (significantly higher in patients of the CyA group). WI induced an increase of plasma volume (PV) which was of comparable magnitude in all examined groups. It was accompanied by a significant increase of plasma ANP, diuresis and of natriuresis, which was significantly lower in transplanted patients than in normals. Only in healthy persons a significant positive correlation was found between the WI induced increase of plasma ANP and diuresis and natriuresis respectively. CONCLUSIONS: 1) kidney transplant patients are characterized by an intact, although reduced response of ANP secretion, diuresis and natriuresis to central hypervolaemia; 2) WI induced increase of diuresis and natriuresis does not seem to be only dependent upon ANP secretion in kidney transplant patients; 3) kind of immunosuppressive therapy seems to be of importance in the pathogenesis of altered ANP secretion in kidney transplant patients.

Adult↗
PubMedDate not supplied

[Effect of water immersion on levels of atrial natriuretic peptide in patients with chronic renal failure].

An effect of a 2-hour water immersion on the blood serum ANP was investigated in 20 haemodialysed patients with chronic renal failure and in 15 healthy individuals. Water immersion produced an increase in volume in both healthy individuals and the patients of similar degree. Baseline ANP concentration (290.0 +/- 21.9 pg/mL) was significantly higher in the dialysed patients than that in healthy individuals (66.0 +/- 5.5 pg/mL). Water immersion decreased mean arterial pressure (previously significantly higher in the patients) in both healthy individuals and examined patients, significantly increased secretory renal function (significantly higher in healthy individuals than in the examined patients), and increased ANP (previously significantly higher in healthy subjects). A significant correlation between ANP level in blood serum and changes in volume was seen only in healthy individuals. The obtained results suggest a contribution of other than changed volume factors of ANP release regulation and other than ANP factors to pathomechanism of post-immersion drop of the arteria blood pressure and increased secretory renal function in both healthy individuals and patients with renal failure.

Adult↗
PubMedDate not supplied

Water immersion induced alterations of atrial natriuretic peptide in patients with noninflammatory acute renal failure.

Water immersion (WI) induced alterations of plasma atrial natriuretic peptide (ANP), circulating plasma volume (PV), plasma, sodium and potassium level and mean blood pressure (MAP) were examined in 12 patients with noninflammatory acute renal failure (ARF) and in 15 healthy persons. In patients with ARF a significantly elevated basal ANP level (138.67 +/- 12.9 pg/ml versus 74.54 +/- 4.1 pg/ml in healthy persons and elevated MAP (111.9 +/- 3.5 mmHg in patients versus 87.3 +/- 1.8 mmHg in healthy persons) were found. WI induced a significant increase of plasma ANP level in both examined groups which was significantly more marked in healthy persons (152.42 +/- 12.82 pg/ml) than in patients with ARF (85.75 +/- 12.62 pg/ml). WI was accompanied by a significantly more marked reduction of MAP (22.6 +/- 2.9 mmHg) and sodium level (6.09 +/- 0.63 mmol/l) in patients with ARF than in healthy persons (12.07 +/- 1.52 mmHg and 4.2 +/- 0.11 mmol/l respectively). In contrast to healthy persons in patients with ARF WI did not induce enhanced diuresis. In patients with ARF a significantly more marked increase of PV was found than in controls. Data obtained in this study seem to prove preservation of the physiological regulatory mechanism of ANP secretion in ARF patients but reduction of ANP release induced by central volume expansion. The importance of elevated basal plasma levels in the maintenance of ARF has not been proven.

Acute Kidney Injury↗