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Biomedical subjects

F Kokot

Publications and source records attributed to F Kokot.

At least 109 records · Page 6Linked to original sources
PubMed1996

[Dosage of drugs in patients with kidney diseases].

There are several reasons, why dosing of drugs in renal patients must be of special concern of the treating doctor. These are the followings: 1. The kidneys are the main eliminating organ for many drugs. This is the reason, why the concentration of drugs in renal parenchyma may reach toxic levels and exert irreversible damage on different morphological structures of this organ. 2. Many drugs are a priori nephrotoxic. In the case, such drugs must be used in renal patients, very careful monitoring of renal function is mandatory in order to avoid serious adverse effects. 3. In patients with failing excretory renal function, and especially in patients on haemodialysis or peritoneal dialysis treatment, knowledge of altered pharmacodynamics and pharmacokinetics of drugs caused both by the uraemic state and renal replacement therapy, is indispensable. 4. Dosing of drugs, in patients with impaired excretory renal function is dependent upon their distribution volume, metabolic half-time, extrarenal clearance, renal clearance by the residual renal parenchyma and target therapeutic level. 5. From the above said it follows, that drug dosing in patients, with renal failure must be based on thorough pathophysiological, clinical and pharmacological knowledge.

Humans↗
PubMed1996

Acute failure of the transplanted kidney--pathophysiology, diagnosis and prevention.

Acute failure of the transplanted kidney is a major problem in the early posttransplant phase and is recognized as a major cause of graft loss. Early renal transplant dysfunction is mainly due to ischemic damage (acute tubular necrosis), rejection, infection, and cyclosporin A toxicity. Less common causes include bleeding, ureteral obstruction, urinary leak, venous thrombosis, and stenosis or occlusion of the renal transplant artery. Recent advances in both invasive (renal biopsy) and non-invasive (imaging and biochemical) techniques have improved specificity and sensitivity of the diagnosis of the acute renal failure. Several procedures which aim to prevent the kidney transplant failure have recently been introduced. Although they were shown to reduce the incidence of early allograft failure, their influence on the long-term graft survival remains to be proven.

Acute Disease↗
PubMed1996

Function of endocrine organs in kidney transplant patients.

Several factors are involved in the persistence of endocrine alterations after renal transplantation, among which the following are to be mentioned: 1) duration of chronic uraemia before renal transplantation; 2) residual function of the patients' native kidneys; 3) quality of function of the renal graft; 4) modulation of secretion, transport, and degradation of hormones, and/or 5) altered target organ responsiveness to hormones induced by immunosuppressive drugs (glucocorticoids, azathioprine, cyclosporin A) or altered internal environment. In kidney transplant patients the following endocrine abnormalities are to be mentioned: dissociation of the physiological relationship between aldosterone synthesis and function of the renin-angiotensin system, abnormal volumetric regulation of arginine vasopressin secretion, suppressed responsiveness of cortisol secretion to stimulatory manoeuvres, persistent secondary hyperparathyroidism, relative deficiency of insulin (induced by glucocorticoid therapy), with consequent carbohydrate intolerance or even diabetes mellitus, suppressed response of gastrin and pancreatic hormone secretion to a test meal, and reduced responsiveness of atrial natriuretic peptide secretion to central hypervolaemia. Episodes of acute graft rejection are characterized by endocrine alterations similar to those seen in patients with acute or chronic renal failure.

Endocrine Glands↗
PubMed1995

Abnormal function of renal tubules in patients with simple renal cysts.

The present study aimed to assess the function of proximal and distal tubules in patients with simple renal cysts. Thirty-one patients with simple renal cysts and 10 healthy subjects were examined. Based on the cyst fluid/plasma sodium ratio, 25 cysts were found to be of proximal origin and 6 of undetermined origin. In all patients cyst fluid and plasma concentrations of beta-2-microglobulin (beta-2-MG), sodium, potassium, calcium, phosphorus and total protein were assessed. Urinary excretions of sodium, potassium, calcium, phosphorus, beta-2-MG and Tamm-Horsfall protein (THP) were also estimated. Fractional excretion of beta-2-MG was calculated. The concentrations of beta-2-MG in fluid obtained from cysts of proximal origin were significantly higher than in fluid from cysts of undetermined origin (2.26 +/- 0 36 vs. 0.65 +/- 0.13 mg/l, p = 0.0004). Concentrations of THP (6.85 +/- 1.21 vs. 3.14 +/- 1.06 micrograms/ml, p < 0.05), and potassium (4.39 +/- 0.07 vs. 3.13 +/- 0.44 mmol/l, p < 0.05) were also higher in fluid from proximal cysts than in fluid from cysts of undetermined origin. Plasma beta-2-MG concentration was significantly higher in patients with proximal and undetermined cysts than in the control group (4.35 +/- 0.34 and 4.11 +/- 0.74 vs. 1.89 +/- 0.1 mg/l, p < 0.001). Urinary beta-2-MG excretion was also significantly higher in both groups of patients than in healthy subjects (474.8 +/- 165.9 and 346 +/- 94 vs. 100.2 +/- 19.6 micrograms/24 h, p < 0.05). Urinary THP excretion was significantly higher in patients with proximal cysts than in healthy subjects (31.0 +/- 5.1 vs. 16.3 +/- 2.5 mg/24 h, p < 0.05). From the results obtained in this study it seems that patients with simple renal cysts of proximal origin are characterized by abnormal tubular handling of beta-2-MG, and calcium and THP excretion. Thus, in patients with proximal cysts presence of a latent renal tubulopathy seems to be likely.

Adult↗
PubMed1995

Function of endocrine organs in hemodialyzed patients of long-term erythropoietin therapy.

Endocrine abnormalities in patients with chronic renal failure are well documented. The present study aimed to assess the influence of long-term erythropoietin (EPO) therapy on endocrine abnormalities in hemodialyzed patients. Two groups of hemodialyzed patients, each of which comprised 17 subjects, were examined. The first group was treated by EPO (EPO group) while the second one did not receive this hormone (No-EPO group). A complete biochemical and hormonal check-up was performed before and at the 3, 6, 9, and 12 month points of the study period. Normal values for the estimated parameters were obtained in appropriately selected sex- and age-matched healthy subjects. After EPO therapy, an increase of the hematocrit value from 21.8 +/- 0.9 to 32.6 +/- 0.9% was observed, which was accompanied by a significant decline of plasma ferritin and saturation of transferrin. In patients of the No-EPO group, a significant although less marked rise of the hematocrit value (21.4 +/- 0.4 to 24.2 +/- 0.6%) was also noticed. EPO therapy did not change plasma levels of electrolytes (Na, K, Ca, inorganic phosphate), osteocalcin, creatinine, glucose, and alkaline phosphatase as well as plasma concentrations of calcium-related hormones (PTH, calcitonin, 1,25[OH]2D3), vasopressin, and triiodothyronine. EPO treatment induced a significant decrease in somatotropin, prolactin, follitropin, lutropin, ACTH, cortisol, plasma renin activity, aldosterone, noradrenaline, adrenaline, dopamine, glucagon, pancreatic polypeptide, and gastrin plasma levels and an increase in plasma insulin, estradiol, testosterone, atrial natriuretic peptide, thyrotropin, and thyroxine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[The effect of short-term erythropoietin therapy on selected parameters of cell mediated and humoral immunity in hemodialyzed uremic patients].

This study aimed to assess the influence of short-term therapy with recombinant human erythropoietin (rhEPO) on selected parameters of humoral and cell mediated immunity in haemodialyzed uraemic patients (HDP). In 12 HDP before, and after 1 and 3 months of rhEPO therapy the following parameters were assessed: nitroblue tetrazolium (NBT) test, NBT test after latex stimulation, number of B, T and CD4 and CD4- and CD8-positive T lymphocytes, serum concentrations of IgG, IgA and IgM. The number of granulocytes with a positive NBT test was significantly higher after 3 months of rhEPO therapy. The number of granulocytes with a positive NBT test after latex stimulation increase both after 1 and 3 months of rhEPO therapy but significantly only after 3 months of treatment. The number of CD4-positive T lymphocytes increased significantly after 3 months of rhEPO therapy, while the number of CD8-positive lymphocytes decreased significantly after 1 month of therapy. The CD4/CD8 ratio increased significantly after 3 months of rhEPO therapy. Serum IgA concentration increased significantly after 1 and 3 months, while serum IgG level only after 3 months of rhEPO therapy. From the results obtained in this study it follows that rhEPO therapy exerts a positive effect on function of both T and B lymphocytes in haemodialyzed uraemic patients.

Adult↗
PubMed1995

[levels of erythropoietin in serum of patients with primary hyperparathyroidism].

UNLABELLED: The present study aimed assess the relationship between erythropoietin (EPO) and parathormone (PTH) secretion in patients with primary hyperparathyroidism (PHP). Seventeen patients with PHP and 24 patients with uncomplicated cholelithiasis were examined before and during 14 days after surgical treatment. In PHP patients plasma EPO levels were significantly higher than in patients with cholelithiasis (31.5 + 4.3 vs 14.1 + 0.9 mU/ml, p < 0.01). After cholecystectomy transient increase of plasma EPO level was noticed postoperatively during the first 6 days. Such an increase of plasma EPO was absent in PHP patients after removal of the cause of primary hyperparathyroidism. Only in PHP patients a significant negative correlation was found preoperatively between plasma EPO level and Hct value or creatinine clearance respectively. CONCLUSIONS: 1. Patients with PHP are characterized by significantly elevated plasma EPO levels which are related to the degree of anaemia and decrease of GFR. 2. In patients with PHP presence of significant relationship between EPO and PTH secretion could not be proven.

Adult↗
PubMed1995

[The role of "hemochromatosis alleles" in the pathogenesis of polyglobulia after renal transplantation].

43 kidney recipients were followed up for 12 months after renal transplantation. In 13 patients treated with cyclosporin A for 6 months polyglobulia was found, which subsided after conversion of immunosuppressive therapy. A highly significant correlation was found between the presence of the antigen A3 and the polyglobulia in kidney recipients treated by cyclosporin A. The serum ferritin level was not elevated in kidney recipients who were carriers of the "hemochromatosis alleles". Results obtained in this study seem to justify the following conclusions: 1. Kidney recipients who are carriers of "hemochromatosis alleles" show a threefold higher risk of posttransplant polyglobulia. 2. Presence of "hemochromatosis alleles" is not an absolute predictor of polyglobulia in patients after kidney transplantation. 3. Both etiology and pathogenesis of posttransplant polyglobulia do not seem to be homogeneous. Cyclosporin A, in contrast to azathioprine, seems to have a promoting effect on the development of posttransplant polyglobulia. Therefore treatment of kidney transplant patients with cyclosporin A, who are carriers of "hemochromatosis alleles", needs careful monitoring.

Adult↗
PubMed1995

[The influence of opioid receptor blockade on the behavior of selected biochemical and hormonal parameters in patients with renovascular hypertension studied under water immersion conditions].

10 patients with renovascular hypertension (HRV) and 12 healthy persons were examined under water immersion (WI) conditions without and after blockade of opioid receptors with 2 mg of naloxone. Blood pressure, body mass, change of plasma volume, plasma molality, PRA, and serum values of AVP, aldosterone and catecholamines were evaluated. There were no significant changes between the two examined groups before and after WI. It seems that the drop in blood pressure induced by WI is not only the result of diminished activation of RAAS. The role of opioid receptors in controlling blood pressure and other evaluated parameters is likely in both examined groups.

Adult↗
PubMed1995

[Level of erythropoietin during autologous transplantation of stem cells from bone marrow and peripheral blood].

Using RIA method, serum erythropoietin (EPO) levels were measured in 13 patients undergoing autologous bone marrow transplantation (ABMT) and 4 patients with autologous peripheral blood stem cell transplantation (APBSCT) before and at the end of conditioning regiment as well as at the 3rd, 7th, 10th, 14th, 20th i 30th day after ABMT in correlation with actual haemoglobin (Hb) value. Statistically significant increase in EPO level was observed at days 0 to +14 (p < 0.01) with the maximum at day 3. The correlation between increased EPO level and decreased Hb was observed.

Adolescent↗
PubMed1995

[Influence of long-term erythropoietin (rHuEPO) therapy on the function of the pituitary-gonadal axis in hemodialyzed male patients with end stage renal failure].

The present study aimed to assess the influence of long-term therapy with recombinant human erythropoietin (rHuEPO) for 12 months on follitropin (FSH), lutropin (LH), testosterone (TE) and estradiol (E2) serum concentrations in hemodialyzed males with chronic renal failure. Two groups of hemodialyzed males with chronic renal failure were examined. The first one consisted of 20 male patients with uraemia and renal anaemia (haematocrit value < 28%). Eleven of them were treated with rHuEPO for 12 months in order to achieve and maintain a target haematocrit value (Hct) of 30-35% (EPO group). The remaining 9 male patients were only carefully monitored both clinically and biochemically (No-EPO group). Patients of both groups (EPO and No-EPO) were intensively supervised according to the same clinical and biochemical protocol. Before (0) and after 3, 6, 9 and 12 months of the study, blood samples were withdrawn for the estimation of blood haemoglobin concentration, Hct, erythrocyte count, serum ferritin concentration, transferrin saturation and serum concentrations of FSH, LH, TE and E2. In patients of the EPO group a marked increase while of the No-EPO group, a slight, but statistically significant increase of the Hct value was found after 9 and 12 months and of E2 concentration after 3, 6, 9 and 12 months of clinical monitoring. In contrast in patients of the EPO group a statistically significant decrease of serum FSH and LH concentrations (during the first 9 months of treatment) and an increase of serum TE and E2 concentrations was observed. From results obtained in this study the following conclusions may be drawn: 1. The degree of anaemia does influence significantly the hormonal profile of the pituitary-gonadal axis in haemodialyzed males with chronic renal failure. 2. rHuEPO therapy for 12 months does exert a significant, although transitory (confined to the first 6-9 months of therapy) suppressive effect on serum follitropin and lutropin levels but increases serum testosterone and estradiol levels in these patients. 3. Alterations of both haematological parameters and of hormone serum levels of the pituitary-gonadal axis observed in EPO treated patients do not seem to be due only to the administration of this hormone.

Adult↗
PubMed1995

[Etiology and outcome of acute renal failure in elderly patients].

Etiology, clinical course and prognosis were analysed in 346 patients with anuric/oliguric acute renal failure (ARF) treated in the Department of Nephrology, Silesian University School of Medicine in Katowice from January 1984 to December 1993. 41 of them were over 65 years of age (mean age 70.9 +/- 0.7 years) while 305 were younger (mean age 40.6 +/- 0.7 years). According to etiology patients with ARF of both groups were allocated into following subgroups: medical, urological, obstetric, rhabdomyolysis, toxic, traumatic and surgery. Total mortality was similar in both groups of patients (34.0% in older and 40.6% in younger patients respectively). Mean hospitalization time was also similar in both groups of patients with ARF (23.8 +/- 2.3 and 22.0 +/- 0.8 days respectively). Medical, urological and surgical factors were the most frequent causes of ARF in the elderly while traumatic causes and intoxications were extremely rare in these patients. Mortality in the individual etiological groups of ARF was of similarly magnitude in both examined groups. These results suggest that older age does not significantly worsen the outcome of ARF.

Acute Kidney Injury↗
PubMed1995

[Influence of long-term treatment with human recombinant erythropoietin on secretion of hormones regulating carbohydrate metabolism in hemodialyzed patients with chronic uremia].

The study aimed to assess the influence of long-term rhuEPO treatment on secretion of pancreatic hormones (insulin, glucagon). A total of 27 haemodialyzed and 9 healthy subjects were examined. Nine patients with uraemic anaemia were treated with rhuEPO for 12 months (EPO group) while another nine patients did not receive rhu-EPO (non-EPO group), but were monitored biochemically and clinically as patients of the EPO group. The third group (HD) comprised nine haemodialyzed patients with a haematocrit value of > 30%, without rhu-EPO therapy. In all subjects plasma levels of glucose, insulin (IRI) and glucagon (Glu) were estimated before and after administration of the test meal. Patients of the EPO and non-EPO group were examined before and after 6 and 12 months of rhu-EPO treatment (EPO group) or clinical monitoring (non-EPO group) respectively, while only one test was performed in patients of the HD group and healthy subjects. During the observation period fasting glicaemia did not change. Six months of rhu-EPO therapy was followed by an increase of fasting insulinaemia and decrease of basal plasma level of glucagon. At that time point rhu-EPO therapy also increased the response of IRI and Glu to the test meal and the insulin/glucose index. After 12 months of rhu-EPO therapy basal insulinaemia and insulin/glucose index returned to the pretreatment value while plasma level of glucagon and the response to the test meal were lower than pretreatment one. Our results suggest that rhu-EPO treatment exerts a profound effect on carbohydrate metabolism and secretion of IRI. Glu, which seems to be dependent upon duration of rhu-EPO therapy and not only, or exclusively to improvement of the haematological status.

Adult↗