Serum beta-2-microglobulin (beta-2-M) levels in heart transplant patients (HTP)

The present paper aim to answer following questions: 1. What is serum beta-2-M levels in HTP? 2. Does significant correlations between serum beta-2-M levels and serum creatinine levels or creatinine clearance (inulin clearance) exit? 3. Does any significant correlation between serum beta-2-M levels and blood cyclosporine A concentration exit? Three groups of subjects were studied. The first group consisted of 33 heart transplant patients (HTP), the second group consisted of 12 patients with small decline kidney function, and the third one consisted of 36 healthy subjects. In all examined subjects serum beta-2-M (RIA) creatinine, creatinine and inulin (steady state dosis method) clearance were assessed.

CONCLUSION

1. In observed HTP serum beta-2-M level is significantly higher then in controls and patients with small decline kidney function; 2. A significant correlation between kidney function and -2-M level in HTP as well as in other examined groups subjects exit; 3. Presence a significant positive correlation between serum beta-2-M level and blood cyclosporine A concentration suggest that beta-2-M level can be a good parametr to define cyclosporine A tubular toxicity.

[The effect of hemodialysis with frequent use of cuprophan and polysulfone membranes on activation of complement in patients with chronic renal failure]

During haemodialysis in patients with chronic renal failure plasma proteins have contact with dialysis membranes. Complement activation is one of effects of this contact. Intensity of this activation depends on structure of material that the membrane is made of, and it is a determinant of hemocompatibility of dialysis membrane. Our studies were designed to evaluate complement activation during haemodialysis in patients with chronic renal failure and therefore measurements of concentration of C3c factor in serum of hemodialyzed patients were performed. Furthermore, changes in concentration of C3c factor in serum during first and second use of cuprophan and polysulfone dialysis membrane were compared. An artificial kidney Fresenius 4008E, polysulfone dialyzers F5, cuprophan dialyzers C121 and acetate dialysing solution were used in the study. For the purpose of our study we have selected 10 patients hemodialyzed three times a week for 4 hours (5 of them suffered from diabetic nephropathy and the rest of our patients had chronic pyelonephritis) and 10 healthy subjects. Serum concentration of C3c was measured before haemodialysis, in 15', 60' and 240' minute of haemodialysis; measurement were performed on first and second use (after reutilization) of polysulfone and cuprophan membranes, respectively. C3c concentration in blood samples was measured with special reagent kits (turbidometric method). Statistically significant increase of serum C3c level was observed in studied group of patients in 15th minute of first use of cuprophan dialysing membrane. When values of C3c concentration in patients' serum during 60' and 15' of haemodialysis on first use of cuprophan membrane were compared, it was shown that there was a statistically significant decrease of serum C3c level in 60th minute of haemodialysis.

RESULTS

1. Haemodialysis in patients with chronic renal failure is associated with complement activation via the alternative pathway. 2. Maximal activation of complement pathway takes place in 15th minute of the first haemodialysis with use of cuprophan membrane. 3. Usage of the polysulfone dialyzer has no influence on concentration of C3c factor in serum during haemodialysis 4. Polysulfone membranes are characterized with higher haemocompatibility than cuprophan membranes.

[Circadian rhythm of blood pressure in patients with chronic kidney failure in the course of diabetes treated with peritoneal dialysis]

In order to evaluate the disturbances in circadian rhythms of blood pressure in 10 patients with chronic renal failure treated with CAPD, we performed blood pressure monitoring during the two following twenty-four hour periods. 40 healthy young male volunteers were included as a control group. They were divided into two subgroups: men whose parents have or have not hypertension. We used Oxford Medilog ABP equipment. Optimal CAPD parameters were confirmed by calculation Kt/V and pcr. To evaluate circadian rhythms in blood pressure we used Cosinor analysis, and to calculate the day-night blood pressure differences we used Student's t-test. In our study we did not find circadian rhythms of systolic, diastolic and mean arterial pressure in CAPD patients. There were also no statistically significant day-night blood pressure differences. The lack of circadian rhythms in blood pressure and statistically significant day-night differences can be explained in patients as the result of volume expansion and other abnormalities such as the lack of diurnal rhythm in atrial natriuretic peptide, rHuEpo therapy, sympathetic overactivation and others.

[The effect of hypervolemia on electrolyte level and and level of volume regulating hormones in patients with autosomal dominant polycystic kidney disease]

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most frequent autosomal dominant diseases. Apart from kidneys it also includes alimentary system, nervous system, cardiovascular system. ADPKD is associated with endocrinal disorders of the hormones regulating volume, arterial blood pressure and water and electrolyte balance such as: ARO, AVP, Aldo. 24 patients with ADPKD (12 with normal renal function-gr. III, 12 with advanced renal insufficiency-gr. IV) and 15 healthy subjects to compare with-gr. I and 16 patients with advanced renal insufficiency of other origin than ADPKD-gr. II were examined. In all groups the levels of Aldo, AVP and ARO in blood and Na+, K+ and creatinine concentrations in blood serum were examined Also an excretion of Na, K, creatinine with urine and clearances: CNa, CK, CKrea and filtration fractions: FENa and FEK were determined. Arterial blood pressure was measured in all groups. The above described parameters were studied in standard conditions in patients in supine position and fasting-survey I; directly after intravenous infusion of 1000 ml 0.16 M NaCl at 16.7 ml/min for 1 h-survey II and two hours after intravenous infusion-survey III. Isotonic intravenous infusion of natrium chloride increased central blood volume in the examined patients (induced hypervolemia). The received results were compared among groups in standard conditions (before infusion) as well as reaction of all groups to increased central volemia was compared. On the basis of the received results it was observed that the patients with ADPKD with normal renal function (gr III) show a significant increase of ARO, AVP, arterial blood pressure what differs them from healthy individuals (gr. I). The increased values of the above mentioned parameters were typical for the patients with chronic renal insufficiency regardless to a cause of the failure (gr. II). Consequently, patients with ADPKD showed some hormonal disorders typical for patients with advanced renal insufficiency despite fairly big difference in creatinine level and renal function condition among groups. Comparing the groups with advanced renal insufficiency (gr. II and gr. IV) it was shown that despite the same creatinine and electrolytes level in blood serum they exhibited different renine activity of serum and arterial blood pressure. These parameters were higher in the group with ADPKD. After volume expansion by 1000 ml 0.16 M NaCl infusion no significant differences between renal response to induced hypervolemia in patients with ADPKD and control groups were observed. The received results show that the patients with ADPKD exhibit disorders in hormonal regulation, water and electrolyte balance and in value of arterial blood pressure regardless to a degree of renal function. Thus genetic disease alone predisposes to the above mentioned disorder. Nevertheless, patients with ADPKD show normal mechanisms of renal volemic regulation in volume expansion conditions that can be compared to control groups. It also means that renal response to induced hypervolemia is similar in all the examined groups and is independent of renal function degree.

[Circadian rhythm of blood pressure in patients with chronic renal failure treated with hemodialysis]

In our study we tried to assess the abnormalities in circadian blood pressure variations in 20 patients with chronic renal failure treated with hemodialysis. In this group of patients we controlled blood pressure during 48-hours (including the dialytic and the interdialytic day). We used Oxford Medilog ABP equipment. As a control we included 40 healthy men, divided into two subgroups; men whose parents had or had not hypertension (20 men in each subgroup). To confirm the optimal HD parameters we controlled Kt/V and per. To evaluate circadian rhythms in blood pressure we used Cosinor analysis, and to assess the day-night blood pressure differences we used Student's t-test. We did not find that circadian rhythms in blood pressure in HD patients were existed. We found that in HD patients systolic blood pressure was higher at daytime of dialytic day, subsequently fell down to lower levels at night-time and next day, and returned to higher levels the next night (before the next hemodialysis). It can be connected with alterations in body fluid status during dialysis. Other disturbances in circadian rhythms in blood pressure can be explained as the results of other disturbances that existed in patients with chronic renal failure such as the lack of diurnal rhythm in secretion of atrial natriuretic factor, sympathetic overactivation, rHuEpo therapy and others.

Angiotensinogen gene M235T polymorphism is not associated with diabetic nephropathy. The Diabetic Nephropathy Study Group

BACKGROUND

There is agreement that a family history of hypertension (HT), is a predictor for the risk of diabetic nephropathy (DN) in patients with type 2 diabetes, and possibly also type 1 diabetes. It follows that genes related to the risk of hypertension must also be considered candidate genes for DN. The 235T allele of the angiotensinogen gene was found to be related to primary HT.

METHODS

To examine whether it is predictive for DN as well, we examined the angiotensinogen gene polymorphism in 230 healthy local controls, 423 patients with type 1 diabetes (n = 180 with DN; n = 243 without DN) and 663 patients with type 2 diabetes (n = 310 with DN; n = 353 without DN). The angiotensinogen gene M235T polymorphism was determined using PCR amplification.

RESULTS

The following results were obtained (i) no significant difference of genotype distribution (type 1: MM/MT/TT (%) 27.6/57.2/15.2 vs 27.2/56.1/16.7 (P = 0.92); type 2; MM/MT/TT (%) 31.7/48.2/2/20.1 vs. 32.9/46.8/20.3 (P = 0.93) or allele frequencies (type 1: M 0.56 vs. 0.55 (P = 0.795); type 2; M 0.56 vs. 0.56 (P = 0.86)) was found, between diabetic patients with or without DN, (ii) no difference was found between normotensive and hypertensive diabetic patients.

CONCLUSION

The data argue against a role of the angiotensinogen gene M235T polymorphism in the manifestation of diabetic nephropathy or hypertension in diabetic patients.

[Effects of opiate receptor blockade with naloxone on prolactin (PRL) secretion in patients with diabetes type I (IDDM) with chronic renal failure treated with hemodialysis (HD)]

The aim of the study was to answer the questions: 1) does the prolactin secretion in the TRH test (0.4 mg i.v.) differ in haemodialyzed patients with diabetes nephropathy in the end stage renal failure in comparison to haemodialyzed chronic renal failure patients with non-diabetic nephropathy and healthy subjects; 2) does the opiate receptors blockade with naloxone (2 mg i.v.) modify the prolactin secretion during the TRH test in those patients. 39 subjects were studied. The patients were divided into three groups: group I: 12 haemodialyzed patients with IDDM and diabetic nephropathy in the end stage renal failure, group II: 15 haemodialyzed chronic renal patients with non-diabetic nephropathy and the control group: 12 healthy persons. The basic prolactin secretion and area over basic value (AOBV) of the prolactin were estimated. Prolactin concentration was measured by LIA. 1) The basic prolactin secretion was significantly higher in the patients with chronic renal failure. 2) The basic prolactin secretion in IDDM patients with diabetic nephropathy in the end stage renal failure treated with haemodialysis was significantly lower than in haemodialyzed patients with chronic renal failure of non-diabetic etiology. 3) TRH and TRH with naloxone caused significant increase of prolactin secretion in all investigated groups, but the increase is significantly lower in chronic renal failure patients than in healthy subjects. 4) Naloxone decreases significantly the prolactin secretion during TRH test only in haemodialyzed patients with chronic renal failure of non-diabetic etiology.

[Influence of hemodialysis on changes in cerebral artery blood flow velocity in patients with chronic renal failure]

The effect of hemodialysis on the cerebral circulation have been inadequately studied. Because of repeatability, safety and non-invasiveness transcranial Doppler sonography is well suited for evaluation of cerebral circulation and for estimation of cerebral blood flow during hemodialysis as well. The aim of our study was to find out whether hemodialysis affects the velocity of blood flow in extra- and intracranial arteries and in what way. 41 patients aged 18-71 (mean 43.9 +/- 13) years suffering from chronic renal failure made up the investigation group. We investigated 17 men and 24 women. Doppler examination was done to each dialized patient immediately before and then 120 and 240 minutes after the onset of hemodialysis. We used pulsed wave Doppler (TC2-64B, EME). Mean blood flow velocities were obtained from extracranial (CCA, ICA, ECA) and intracranial vessels (MCA, ACA, PCA). Simultaneously the series of biochemical blood parameters and arterial blood pressure were monitored. On the basis of investigation results the following conclusion have been drawn: Hemodialysis significantly affects on changes of blood flow velocities in extra-an intracranial arteries. Above mentioned changes consist in decrease of blood flow velocity in both CCA, left ICA, both MCA and PCA and right ACA.

[Circadian rhythm of lutropin and follitropin in patients with chronic renal failure]

Dysfunction of the hypothalamic-pituitary-gonadal axis in patients with chronic renal failure is well documented. This study was aimed to answer the following questions: 1. Is there the circadian rhythm in serum concentration of lutropin and follitropin preserved in male patients with chronic renal failure. 2. Does hemodialysis, used in treatment of uremia, influence LH and FSH circadian variations. 3. Is there statistically significant difference between hormonal circadian rhythm determined on the day of hemodialysis and on the interdialytic day. Circadian patterns of LH and FSH and their characteristics were studied in 32 uremic men and 16 healthy men. 16 uremic males were non-dialyzed and 16 were hemodialyzed. In all investigated cases the basal serum concentrations of LH and FSH were measured 8-times a day at 3-hour intervals. LH and FSH serum concentrations were determined using an immunoradiometric assay. To estimate the circadian rhythms of the investigated hormones COSINOR computer analysis was used. The following results were obtained: 1. Significantly higher basal LH concentration in hemodialyzed patients, compared with the control group. 2. Absence of significant differences in LH serum concentration between hemodialyzed patients (on the day of dialysis and on the following day) and non-dialyzed patients. 3. Absence of LH circadian rhythm in both non-dialyzed and hemodialyzed uremic patients. 4. Existence of LH circadian rhythm in healthy subjects. 5. Significantly higher serum FSH concentration in hemodialyzed patients compared with healthy subjects.

[Prolactin secretion in diabetic nephropathy of patients with diabetes mellitus type I (IDDM)]

Disturbances of prolactin secretion occur both in the chronic renal failure and in diabetes mellitus. The study aimed to investigate if the diabetic nephropathy as a cause of chronic renal failure disturbs prolactin secretion. The study was conducted in 5 groups of patients: group I-12 patients with IDDM without diabetic nephropathy; group II-12 patients with IDDM with diabetic nephropathy treated conservatively; group III-16 patients with chronic renal failure of non-diabetic origin; group IV-12 patients with IDDM with end stage renal failure in the course of diabetic nephropathy treated with haemodialysis; group V-16 patients with end stage renal failure of non diabetic origin treated with haemodialysis. 12 healthy subjects served as the control group. In all investigated groups as well as in the control group the TRH test was performed. The mean serum prolactin concentration was estimated in the investigated groups just before the intravenous TRH injection and then after 15, 30, 45, 60 and 120 minutes. The mean area over the basic value (AOBV) of prolactin was also assessed. The patients with IDDM without diabetic nephropathy did not differ from healthy subjects both in the basic and TRH induced prolactin secretion. Basic and TRH induced prolactin secretion in patients with diabetic nephropathy both conservatively treated and treated with haemodialysis were lower than in patients with the same stage of chronic renal failure of non-diabetic origin.

[The effect of many years of hemodialysis therapy on hypophyseal-gonadal axis function in males with chronic renal insufficiency]

The study aims at evaluating an effect of hemodialyses duration on LH, FSH, and testosterone secretion in males with chronic renal insufficiency. Secretion of these hormones was assessed with LH-RH stimulation test in 41 men with chronic renal insufficiency and 15 healthy controls. Increased LH and FSH and decreased testosterone serum levels were seen in men with chronic renal insufficiency in comparison with healthy controls, independently of hemodialysis therapy duration. Duration of the treatment with hemodialyses has no significant effect on LH levels. Testosterone and FSH levels were significantly higher in patients treated over 50 months than those treated for shorter periods. Reactivity of LH secretion in LH-RH stimulation test was lower in patients dialysed for less than 100 months whereas in patients dialysed for over 100 months it was normal. Reactivity of testosterone secretion was higher in patients dialysed for over 50 months that those dialysed for shorter periods of time.

[Albumin excretion with urine in a population of healthy individuals]

Increased urine albumin excretion is the significant prognostic factor for diabetes, hypertension and coronary artery disease. Divergences of the evaluation of albuminuria in different ethnic groups were found. The aim of our study was to evaluate albumin excretion in large group of healthy individuals. 301 healthy subjects (110 female and 191 male), age 20-60 years (mean 32.9 +/- 9.7), were admitted. A questionnaire including data concerning familial history, smoking habits was fulfilled. Subsequently nighttime urine sample was collected in all examined subjects and albumin to creatinine ratio (A/K) was counted. A/K value varied between 0.03-14.1 mg/mmol of creatinine median 1.18. Significantly higher albuminuria in female v male group was found (respectively 1.39; 0.14-14.1 and 1.03; 0.03-11.4 p < 0.05). Reference value for albuminuria was estimated at 3.35 mg/mmol in whole group, and respectively 4 mg/mmol in female and 2.6 mg/mmol in male. There were not differences in A/K ratio in relation to familial history however smoking men excreted more albumin v non smoking (respectively 1.27, 0.03-11.4 and 0.95, 0.14-14.1 mg/mmol p < 0.005). Performed analysis allowed to calculate the value for albuminuria in healthy subjects. Analysis also showed significant influence of gender and smoking habits and no influence of familial history for albumin excretion.

[Influence of treatment using recombinant tumor necrosis factor alpha (hrec TNF alpha) on circadian rhythm of cortisol secretion in patients with advanced neoplastic disease]

Tumor Necrosis Factor alpha is one of cytokines administered in immunotherapy of advanced neoplastic disease. Its action is exerted through immune endocrine and central nervous systems. The purpose of this study was to assess the influence of hrec TNF alpha administration in patients with advanced neoplasms on the level of cortisol in serum and its circadian rhythm. Serum cortisol was determined several times a day before and just after hrec TNF alpha first immunotherapeutic cycle. The results of the investigation were analysed with the Cosinor test. Serum concentration of hormone was determined using radioimmunoassay method. The results of this study showed the decreasing influence of hrec TNF alpha administration on cortisol secretion by adrenals with no disturbances in that circadian rhythm.

IN CONCLUSION

It might be possible that some side effects of hrec TNF alpha administration are connected with the decreasing cortisol level.

[Does multiple use of a cuprophan dialyser influence levels of chromium and cadmium during hemodialysis in patients with chronic kidney failure?]

42 patients between 21 and 63 years of age with chronic renal failure (CRF) treated with haemodialysis and 16 healthy subjects between 19 and 72 years of age were observed. All patients were divided in two groups: 15 patients treated with haemodialysis with cuprophan dialyser used first time and 27 patients treated with haemodialysis with cuprophan dialyser used more than three times. The blood samples in haemodialyzed patients were withdrawn four times: just before dialysis, during haemodialysis (after one hour of dialysis at both ends of the dialyzer) and after haemodialysis. Chromium and cadmium concentration in all examined groups, in dialysis fluid and in demineralized water were measured by flame atomic absorption spectrophotometry. During haemodialysis a decrease of serum chromium concentration and an increase of serum cadmium concentration in two groups of haemodialyzed patients were observed. No significant differences in serum chromium and cadmium concentration before dialysis, during dialysis and after dialysis were observed between two groups of haemodialyzed patients.

CONCLUSION

The multiple use of cuprophan dialser did not influence significantly serum chromium and cadmium concentration in haemodialyzed patients.

Increased prevalence of salt sensitivity of blood pressure in IDDM with and without microalbuminuria

In insulin-dependent diabetes mellitus (IDDM) elevated exchangeable sodium (Na) levels are found even in the absence of hypertension, but it is not known whether this is associated with increased sensitivity of blood pressure to sodium level. To clarify this issue we compared 30 patients with IDDM (19 without and 11 with microalbuminuria, i.e. more than 30 mg albumin/day) and 30 control subjects matched for age, gender and body mass index. The subjects were studied on the 4th day of a low-salt diet (20 mmol/day) under in-patient conditions and were subsequently changed to the same diet with a high-salt supplement, yielding a total daily intake of 220 mmol Na/day. Circadian blood pressure, plasma renin activity (PRA), plasma atrial natriuretic factor (p-ANF), plasma cyclic guanosine 5'-phosphate (p-cGMP) and urinary albumin were measured. The proportion of salt-sensitive subjects, i.e. showing increment of mean arterial pressure > or = 3 mmHg on high-salt diet, was 43% in diabetic patients (50% of diabetic patients with and 37% without microalbuminuria) and 17% in control subjects (p < 0.05). Lying and standing PRA levels on low- or high-salt diet were significantly lower in diabetic patients than in control subjects. Salt-sensitive diabetic patients had significantly higher lying ANF on high-salt (38.7 +/- 4.2 pmol/l vs 20.1 +/- 2.3 pmol/l, p < 0.005) than on low-salt diet. The results suggest that (i) the prevalence of sodium sensitivity is high in IDDM (ii) sodium sensitivity is found even in the absence of nephropathy as indicated by albuminuria.

[Level of total plasma carnitine in patients with chronic renal failure in the course of diabetes and other etiologies treated with hemodialysis]

In uraemic patients disturbances in carnitine metabolism are observed. Aim of the study was to assess total carnitine level in haemodialyzed patients and influence of dialyzer type on this level before, during and after haemodialysis (HD). We examined 46 patients divided into 3 groups: I--16 non-diabetic uraemic patients haemodialyzed using polysulfone dialyzer; II--10 diabetic patients haemodialyzed using polysulfone dialyzer, III--20 non-diabetic uraemic patients haemodialyzed with cuprophane dialyzer. Total plasma carnitine level was estimated using colorimetric method according to Wieland et al. Total carnitine level in diabetic haemodialyzed patients was significantly lower comparing to non-diabetic ones but in both groups a significant decrease during HD was present. Dialyzer type had no influence on carnitine elimination.

[Use of fructosamine serum level measurements for diagnosis of insulin-dependent diabetic in pregnancy]

In this study it has been tested the usefulness of serum glycosyl protein (fructosamine) to diagnose diabetic pregnant women requiring insulin therapy. The analysis was performed on the base of obtained results of glucose tolerance test, glycemia level in diurnal profile, fructosamine level and its relationship to albumin level and total protein amount in serum pregnant women with carbohydrates intolerance. Calculated specificity and sensitivity of above mentioned measurements was too low. We can not concluded that it is necessary to include insulin-therapy in diabetic pregnancy on the base of fructosamine serum level even corrected by protein or albumin serum level.

[Does an association between angiotensin I converting enzyme gene polymorphism and the prevalence of diabetic nephropathy in patients with diabetes type II exist?]

In type I diabetic patients association has been found between the insertion/deletion (I/D) polymorphism in the gene of angiotensin converting enzyme and the presence of diabetic nephropathy. The aim of that study was to assess this association in a cohort of type II diabetics. We examined 109 patients of more than 10 years duration of type II diabetes. Nephropathy (defined as at least confirmed albuminuria > 30 mg/24h) was present in 37 subjects. The I/D polymorphism was analyzed with PCR technique. Allele frequencies in the overall diabetic population did not differ significantly from the normal population. Distribution of genotypes was not significantly different between examined patients with and those without nephropathy. We conclude that the distribution of ACE gene polymorphism is similar in diabetic subjects and in general population and there is not association between I/D polymorphism and nephropathy in type II diabetic patients.

[Activity of superoxide dismutase in erythrocytes and leukocytes and levels of zinc and copper in blood of patients with diabetes. Effect of diabetic treatment on examined parameters]

The purpose of the present work was to assess the relationship of leukocyte and erythrocyte superoxide dismutase activity to its cofactors concentrations i.e. zinc and copper in plasma and erythrocyte in diabetic patients and treatment variability. 104 patients were included in the study. 23 persons were in the control group. All patients were divided into 2 groups (NIDDM and IDDM). Patients with NIDDM were divided into 3 subgroups depending on treatment (insulin, gliclazide, dietary treated). In all groups, there were assessed following parameters: the leucocyte and erythrocyte SOD activity according to the method of Misra and Fridovich, and zinc and copper concentrations in plasma and erythrocyte, which were measured by flame absorption spectrophotometry. Statistical analysis was performed using the CRISP program.

CONCLUSION

1. The leukocyte and erythrocyte superoxide dismutase activity is significantly lowered in diabetes mellitus. 2. In diabetic patients both in type I and type II as in the healthy people, there is a close correlation between SOD activity and its cofactors i.e. zinc and copper erythrocyte concentrations. 3. Insulin and gliclazide treatment increases SOD activity and delays late diabetic complications.