Urinary excretion of ceruloplasmin in relation to some other serum proteins in patients with proteinuria.
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Biomedical subjects
Publications and source records attributed to L Arisz.
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The morphological basis of the glomerular permeability to proteins is reviewed and a survey is given of the studies done with ultrastructural tracer substances. In the normal GCW two structures have been considered important as a possible barrier to macromolecules: the GBM and the epithelial slit pore and slit diaphragm. The currently available evidence indicates that under normal conditions most plasma proteins do not penetrate beyond the subendothelial layer of the GCW. However, it is probable that the epithelial slit diaphragm acts as a secomdary barrier to macromolecules. In glomerular proteinurai the transport of anionic macromolecules through the GCW is increased, but the passage of uncharged macromolecules (PVP, dextran) is less than in the normal glomerulus. The number of anionic sites in the GCW is much smaller than in the normal glomerulus and there is a change in the normal arrangement of the foot processes and a decrease in the number of slit pores. At present, it is still incompletely understood in which way these changes are related to each other. Assuming the presence of focal leaks in the GCW, a possible sequence of events leading to glomerular proteinuria is discussed.
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Simultaneous measurement of transcapillary ultrafiltration (TCUF), lymphatic absorption rate (LAR), and intraperitoneal volume (IPV) was performed by means of intraperitoneally-administered polydisperse dextran 70 in nine CAPD patients during a 4 hr dialysis dwell (glucose 1.36%). The recovery of dextran was 88 +/- 1%. LAR, calculated as the amount of dextran lost, divided by the dialysate dextran concentration, was 1.30 +/- 0.12 ml/min. The time course of TCUF could be described as a hyperbola. Therefore, the application of the Lineweaver-Burke plot made it possible to calculate TCUFmax (median 641 mL) and its half-time (t50: median 211 min). delta IPV4h, calculated as the difference between the Lineweaver-Burke adjusted TCUF4h and LA4h, was correlated with measured delta IPV4h after drainage (r = 0.89, p less than 0.001). The latter was dependent upon LAR (r = -0.71) and effective peritoneal surface area, as represented by mass transfer area coefficients (MTC) of low molecular weight solutes (creatinine r = -0.76, glucose r = -0.81). High MTC values of these solutes were exponentially related to a short t50 (creatinine r = -0.76). LAR was correlated with the MTC of intraperitoneally administered inulin (r = 0.83). Dextran 70 had no measurable effect on solute transport. It is concluded that dextran 70 is a useful marker for the measurement of peritoneal fluid kinetics, even during CAPD with a low glucose concentration in the dialysate.
OBJECTIVE: To investigate whether or not a change in dialysate interleukin-8 (IL-8) concentration precedes the onset of clinically overt peritonitis and is significant in the recruitment of granulocytes during continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis. DESIGN: CAPD patients stored their overnight effluent at 4 degrees C, which was routinely thrown away after 2 days. If peritonitis developed, patients delivered their effluent of the preceding two nights and the peritonitis effluent for analysis. A control study was performed 1 to 3 months after recovery. Dialysate samples were analyzed for number of cells, differential cell count, IL-8 and elastase concentrations, and their neutrophil chemoattractive capacity. In addition, serum samples during peritonitis were analyzed for IL-8 concentrations. RESULTS: Ten peritonitis episodes in 7 patients were analyzed. Numbers of neutrophils and levels of dialysate IL-8 and elastase started to increase 4 to 12 hours before the first peritonitis effluent. The dialysate/serum IL-8 ratio was 423.5 during peritonitis and 7.0 in the postperitonitis controls. There was a significant correlation between the number of neutrophils and IL-8 concentration in the dialysate. The in vitro neutrophil chemotaxis was increased toward the peritonitis effluents, as compared to control effluents. Incubation of the peritonitis effluents with anti-IL-8 monoclonal antibody blocked the increase in neutrophil chemotaxis above control levels by an average of 26.7%. CONCLUSION: IL-8 is produced in the peritoneal cavity during CAPD treatment and may mediate part of the neutrophil recruitment and degranulation in the initial phase of a CAPD peritonitis.