Renal replacement therapy in an era of socioeconomic changes--report from the Polish Registry.
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Humans↗
Biomedical subjects
Z Szewczyk
Publications and source records attributed to Z Szewczyk.
[The effect of long term erythropoietin treatment on levels of free amino acids in patients with long term hemodialysis].
In order to assess the effect of erythropoietin (Epo) treatment on amino acids profile in hemodialysis patients (HD pts) 2 groups of pts were analyzed: I-12 pts HD for 146 +/- 71 months, Epo treated for 64 +/- 10 months, II-17 pts HD for 120 +/- 39 months, non Epo treated, mean Hb 11.5 +/- 1.2 g/dl. Controls consisted of 11 healthy individuals. Amino acids were estimated by HPLC OPA method. In group I blood levels of leucine (p < 0.03), valine (p < 0.002) were decreased and alanine (p < 0.05) was increased when compared to controls. In this group, blood levels of methionine, tyrosine and asparagine were elevated (p < 0.04) when compared to group II but they were lower (about 30%) then in controls. In group II pts showed reduced levels of valine (p < 0.008), leucine (p < 0.001), methionine (p < 0.0001), tyrosine (p < 0.003), asparagine (p < 0.04), whereas serine, glutamate and alanine (p < 0.04) were increased when compared to controls. Essential to nonessential amino acids ratios in group I, II and controls were as follows: 0.17; 0.12; 0.49 respectively. There were not substantial differences in amino acids in pts with elevated or normal PTH level in both HD groups. Long term EPO treatment only partially corrected changes in amino acids levels in pts with chronic renal failure.
Adult↗
[Treatment with human recombinant erythropoietin and nutritional status of patients on lon term dialysis].
UNLABELLED: In order to assess the effect of long term erythropoietin (EPO) therapy on the nutritional status of hemodialysed (HD) patients 2 groups of HD patients were studied: I-EPO treated for 72 +/- 8 mo, 12 patients, HD for 138 +/- 66 mo, II-control group, 14 patients with Ht 30%, HD for 121 +/- 35 mo. At the onset and after 6 years of follow up patients underwent the following examination: length, body weight, body mass index, body fat stores, arm muscle circumference and total serum protein, serum albumin, lymphocyte count, creatinine, urea, cholesterol and PTH. In EPO group mean BMI, body fat, arm muscle circumference, visceral protein and total lymphocyte count were not change. In control group the decrease in height, body weight, BMI, body fat stores, arm muscle circumference and albumin were observed. Elevation of PTH estimated in half of patients in EPO group and 75% of patients in control group could influence the nutritional status of hemodialysed patients. CONCLUSION: 1. Nutritional status of majority of hemodialysed patients was not change during six years EPO therapy. 2. Non EPO treated patients showed the decrease of anthropometric measurements and serum albumin.
Adult↗
Calcification of the mitral valve annulus and of the aortic valve in patients with transplanted kidneys.
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Adult↗
[Treatment of anemia in patients after long term hemodialysis with human recombinant erythropoietin].
Clinical effectiveness of recombinant human erythropoietin (Epo) administered subcutaneously (sc) was examined in 19 anemic patients. The patients were given Epo twice weekly 2000 U (67 +/- 12 U/kg/week). The results were compared to the group of 20 patients receiving Epo intravenously (i.v.) in doses from 156 +/- 57 U/kg/week to 205 +/- 105 U/kg/week, thrice weekly (control group). According to our findings the target hematocrit level was reached within 12.4 +/- 10 weeks in patients treated sc and 9.6 +/- 5.8 weeks in the control group. The Epo dose required to achieve the increase of Hb by 1 g% was 534 +/- 347 U/kg in patients treated sc and 973 +/- 534 U/kg in the control group. Achievement to target level of hematocrit required lower total amount of Epo units in patients receiving Epo sc (844 +/- 754 vs 1958 +/- 1496 U/kg). Cost of treatment of 1 patient taking Epo sc was significantly lower. The decreasing of frequency of Epo administration was utilized in 17 patients, from twice weekly to once weekly 400 U. After 6 months of the treatment Hb remained unchanged. We conclude that subcutaneous administration of Epo, once weekly is an efficient and convenient method of treatment of renal anemia.
Adult↗
Acute rejection and delayed graft function--risk factors of graft loss.
Acute graft rejection and delayed function are considered to be the major risk factors of short-term as well as long-term graft survival. We studied the impact of these factors on graft outcome among 109 renal transplant recipients. All recipients were treated with triple drug protocol. The recipients were divided into two groups: I group included 57 patients with delayed graft function (DGF), II group included 52 patients with immediate graft function (IGF). We studied graft survival, incidence of acute rejection, serum creatinine levels and the cause of graft loss for patients in both groups. Acute rejection episodes occurred in 49% of patients from DGF group and 45% of patients from IGF group. Graft survival in IGF group was better than in DGF group. Actuarial graft survival at 1, 2, 3 and 4 years in examined groups was 84%, 82%, 72%, 65% vs. 92%, 86%, 84%, 84%, respectively. One-year graft survival in patients with acute rejection from DGF group and IGF group was significantly lower than in patients who remained rejection free (69%, 74% vs. 94%, 96%). We concluded that delayed graft function decreases long-term graft survival, while immediate graft function has an excellent impact on graft outcome. Acute graft rejection is the strongest risk factor of graft loss.
Adult↗
[Effect of recombinant human erythropoietin on kinetics of alloantibodies in patients awaiting renal allograft].
Iterative transfusions are one of the most important mechanism of the induction as well as maintenance anti-HLA antibodies. We evaluated the evolution of PRA (panel reactive antibodies) in 46 sensitized patients during and after withdrawal of blood transfusion. Twenty nine of them (22 women and 7 men in age 38 +/- 7 years) were treated with EPO for 13 to 60 months. With EPO therapy anemia improved, allowing transfusions withdrawal in 19 patients. PRA level decreased from 62 +/- 23% to 42.5 +/- 25% after 1 year of therapy. At 2 year PRA reduced to 37.7 +/- 30% and remained on this level at 3 year. PRA levels became negative in 4 patients, decreased in 11 (by 35%) and remained high in 7 patients. The results of the patients were compared with 17 sensitized patients (9 women, 8 men in age of 40 +/- 10) who did not receive EPO and only part of them required sporadicly transfusions (mean 3 unit of blood) during last 2-3 years. PRA levels decreased from 59 +/- 20% to 45 +/- 22% at 3 year. PRA became negative in 6 patients. The reduction in PRA levels in this group of patients was lower than in EPO treated patients (24.3% vs 14%) as well as in fewer number of patients PRA droped (53% vs 63%). Analysis of risk factors for persistent high levels of alloantibodies showed, that female sex and DR2 phenotype were significant factors.
Adult↗
A case of severe anti-neutrophil cytoplasmic antibody (ANCA)-positive crescentic glomerulonephritis and asymptomatic gastric cancer.
A 64-year-old man presented with symptoms of systemic immune disease dominated by rapidly progressive glomerular injury with highly positive ANCA of cytoplasmic distribution. The clinical course was characterized by dependence upon the intensity of immunosuppression, which has finally led to development of fungal septicaemia and death. The post mortem examination revealed occult gastric cancer with regional lymphatic involvement and crescentic glomerulonephritis, while failing to substantiate clinical findings of systemic vasculitis. This is, to our knowledge, the first case of ANCA-positive glomerulonephritis accompanying visceral malignancy and as such raises the question of whether it results from a simple coincidence or a causal relationship.
Adenocarcinoma↗
[DNA metabolism in lymphocytes of patients with lupus nephropathy].
DNA metabolism in lymphocytes was evaluated in patients suffering from the nephrotic syndrome decompensation, basing on measurement of endonucleases (DNases) activity in these cells. The examination involved 17 patients, aged 27.7 +/- 7.11 with clinical and biochemical active disease, all with the nephrotic syndrome decompensation and erythrocytes in urine. A significant rise in the enzyme activity was observed in T and B lymphocytes (p < 0.001) in all the patients, with a distinct 3-fold increase in enzyme activity in B lymphocytes, when compared with the other cell populations. To elucidate the nature of the observed changes in DNases activity in systemic lupus erythematosus, nucleus proteins of the cells were separated electrophoretically in acrylamide gradient with immobilized DNA. Degradation processes in nucleic acids were considerably more efficient than the DNA synthesis in B lymphocytes of these cells. A smaller increase in the enzyme activity in T cells than in B lymphocytes results exclusively from more intense catabolism of nucleic acids not parallel to the intensified DNA synthesis in these cells.
Adult↗
Is an increase of deoxyribonucleases activity in uraemic lymphocytes caused by their augmented synthesis in these cells?
Deoxyribonucleases activity in T and B lymphocytes isolated from 45 patients with chronic renal failure and 30 control subjects was measured. The results obtained clearly show a dramatic increase in enzyme activity in both T and B lymphocyte cells isolated from uraemic patients when compared with the control cell. The increase in enzyme activity was limited to the group of relatively small nucleases ranging from 14 kDa to 18 kDa. Since it was shown previously that these nucleases are among the cleavage products of the largest subunit of DNA-dependent RNA polymerase class I, it is suggested that a characteristic feature of the lymphocyte cell isolated from uraemic patients is increase of RNA polymerase lability, thus resulting in RNA synthesis decrease. Amongst toxins increasing catabolism of the active polymerase enzyme, a significant correlation with the vise of lymphocyte Mg2+ and Mn2+ ions was disclosed.
Adult↗
DNA-dependent RNA polymerase enzymes affected in uraemic lymphocyte cells.
The DNA-dependent RNA polymerase activity and endonucleases in uraemic lymphocyte cells were investigated. It was found that the activity and quantity in three classes of polymerases are remarkably reduced. The reduction in enzyme activity is accompanied by increasing endonuclease activity. The relationship of polymerase enzymes with endonucleases is discussed.
Adult↗
Uraemic lymphocytes: analysis of their nuclease activity.
The nuclease activity in T and B lymphocytes isolated from patients with chronic renal failure and control subjects was studied. The data obtained show a slight increase in nuclease activity in T and B cells isolated from uraemic patients as compared to the control cells. The increase in enzyme activity was limited to the group of relatively small nucleases with molecular weights ranging from 14 kDa to 18 kDa. It was documented previously that these nucleases are among the cleavage products of the largest subunit of DNA-dependent RNA polymerase I, which is responsible for ribosomal RNA synthesis. Thus, we suggest that the characteristic feature of lymphocytes isolated from uraemic patients is lowering of their metabolic activity. Amongst toxins increasing catabolism of the active enzyme, a significant correlation with the rise of lymphocyte Mg2+ and Mn2+ ions was disclosed.
Adult↗
Increase in deoxyribonuclease activity in uraemic lymphocytes is caused by the cleavage of the largest polymerase I subunit.
Deoxyribonucleases and DNA-dependent RNA polymerase activities in T and B lymphocytes isolated from patients with chronic renal failure and control subjects were studied. The data clearly shows that the nuclease activity in T and B cells isolated from uraemic patients is remarkably enhanced when compared to the control cells. Concomitant with the enhancement in enzyme activity, the reduction in RNA polymerase I activity and quantity was observed. It was found that the increase in nuclease activity and quantity was limited to the group of relatively small nucleases with molecular weights ranging from 14 kDa to 18 kDa. It has been reported previously that these nucleases are among the cleavage products of the largest subunit of DNA-dependent RNA polymerase I. Thus we suggest that the depressed metabolic activity is a characteristic feature of the uraemic lymphocyte cells and the observed increased in DNase activity in those cells is a result of polymerase I degradation.
Adult↗
Deoxyribonuclease activity in T and B lymphocytes of haemodialysed patients with uraemia.
Deoxyribonuclease (DNase) activity and metal ion concentrations in lymphocytes of patients with chronic renal failure and in healthy controls were studied. The data suggest that T and B lymphocyte nuclei of patients with renal failure show increased DNase activity when compared to their healthy counterparts. It is suggested that the enhancement of enzyme activity is a result of increased metal ion concentration rather than increased enzyme copy count. The data strongly suggest that haemodialysis of uraemic patients is more effective for improvement of lymphocyte metabolism than the conservative chemical treatment.
Adult↗
Management of acute nephritis with the epsilon-aminocaproic acid: fact or epiphenomenon?
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Acute Disease↗
Antilymphocyte globulin with a small dose of cyclosporine A and prednisone as the induction of immunosuppression in renal allograft recipients.
In attempt to avoid a detrimental synergism between CsA and renal ischemia in the immediate postoperative period, ALG (425 lymphocytotoxic units/kg) with small doses of CsA (6-8 mg/kg) and P were applied as the initial immunosuppressive therapy in 14 recipients of cadaveric kidneys. ALG was administered for 5 to 14 days and 2 days before withdrawing ALG, Aza (2 mg/kg) was introduced. Results of this protocol were compared with those of 19 pts treated with CsA (12 mg/kg) and P. All the pts were followed for at least 12 months. The duration of posttransplant anuria was significantly reduced in the ALG/CsA/P group (p < 0.02). The sCr concentration after 12 months of observation was significantly lower (p < 0.05), no alterations in urinalysis were detected, the number of hypertensive pts was decreased. The acute rejection rates were equivalent in both groups, however 3 of 4 rejections in ALG/CsA/P group were resistant to steroids and occurred in pts with shortened period of ALG administration. The one year patient and graft survival in the ALG/CsA/P and control groups were respectively: 78.5%, 71.4% and 89.4%, 78.9%. Severe infectious complications in the group treated with ALG/CsA/P occurred in pts who were subsequently treated with OKT3.
Acute Disease↗
[Chlamydia trachomatis infection of the urogenital system in our clinical experience].
The increased number of the genitourinary system infection caused by Chlamydia trachomatis (Ch. Tr.), increased number of patients with dysuria or sterile leukocyturia gave stimulus to studies of 615 patients from Department of Nephrology and District Outpatient Nephrological Care Unit with regard to infections with that microbes. Material for investigations derived from urethra. Diagnostic examinations were performed using the Mc Coy cell culture and the immunofluorescence method. The infection was noted in 176 patients (119 women and 57 men) that is in 28.6% of cases studied. The mean age of patients was 42.7 +/- 12 years. Clinical symptoms such as dysuria or frequency were typical for that kind of infection. The most frequent abnormality was leukocyturia or leukocyturia accompanied by erythrocyturia noted in 66% of patients. Isolated erythrocyturia was observed in 24.4% of cases. It has been stated that anamnesis or routine laboratory examinations were not able to the identification of infection. In face of poorly characteristics of clinical picture of infection the infection with Ch.Tr. could be the cause of unsuccessful therapy in patients with signs of genitourinary tract infections.
Adult↗
Deoxyribonuclease activity in lymphocytes of patients with chronic renal failure treated conservatively.
The activity of nucleases and concentrations of highly important metal ions in T and B lymphocytes were examined. The source of lymphocyte was the blood of patients with chronic renal failure and activity of enzyme as well as ion concentrations were compared to the control group. Concomitant with the increase in enzyme activity was an increase of metal ion concentrations assayed in both T and B lymphocytes isolated from patients with renal disease. The data suggest that the enhancement of nuclease activity is a result of increased enzyme polypeptide synthesis and its stimulation by metal ions. Utilization of the nuclease test for monitoring uraemic toxicity is considered.
Adult↗