[Activity of the renin-angiotensin-aldosterone system in euglycemic type I diabetic patients on intensive insulin treatment without diabetic neuropathy]

Arterial hypertension increase progression of late diabetic complications. Renin-angiotensin-aldosterone system plays an important role in the regulation of arterial pressure. The aim of the study was the assessment of plasma renin activity (PRA) and aldosterone (aldo) in type I euglycaemic diabetic patients on intensive insulin treatment without autonomic neuropathy. 30 type I diabetic patients (including 11 with nephropathy defined as urinary albumin excretion > 30 mg/24 h and 19 without albuminuria) were admitted into the trial. Mean age 31.9 + 1.4 years, duration time of disease was 9.1 + 1.5 years, HbA1c level 7.6 + 0.25%; GFR 124.7 + 3.9 ml/min/1.73 m2 (135.8 + 5.1 in subgroup with nephropathy and 118.2 + 5.08 in non-nephropathic group). Blood samples were taken during normal sodium intake (120 mmol/24 h) after 0.5 h supine. PRA was significantly lower in type I diabetics vs control (0.27 + 0.04, 0.61 + 0.09 pmol/l/s respectively-p < 0.005). PRA was significantly lower both in nephropathic and non-nephropathic diabetic group vs control (respectively 0.22 + 0.06 and 0.31 + 0.05-p < 0.05). Aldo in diabetic patients and in subgroups with and without nephropathy was significantly lower vs controls (respectively 173 + 12.9, 165.1 + 14.4, 182.1 + 18.8 and 257.1 + 24.1 pmol/l; p < 0.01, p < 0.05). Significant differences in hormonal changes between diabetic patients with and without nephropathy were not found. Basing upon the results we conclude that in euglycemic intensively insulin treated type I diabetic patients without neuropathy presented decreased level of PRA and aldo. Early stage of diabetic nephropathy does not influence the examined hormones level.

[Secretion of atrial natriuretic peptide and vasopressin during hemodialysis in patients with chronic renal failure]

Two groups of subjects (uraemic and control) were studied. The uraemic group consisted of 30 patients treated by HD (haemodialysis). The mean age was x +/- SD-35.4 +/- 8.4 years, duration of haemodialysis treatment 42.8 +/- 12.1 months, cuprophan dialyzers and acetate containing solution--35 mEq/l--were used, duration of HD-4 hours 3 times weekly, predialysis serum creatinine was 1060 +/- 218 mumol/l (12.8 +/- 2.5 mg%). The control group comprised 23 healthy subjects (mean age 33.0 +/- 8.0 years, serum creatinine level 88.4 +/- 14 mumol/l (1.0 +/- 0.16 mg%). In all examined subjects the following experimental protocol was used. Blood pressure (BP) was determined at about 8 a.m. after an overnight rest. Then blood samples were withdrawn for estimation of ANP, AVP, sodium and potassium, protein, osmolality and creatinine concentrations. Between 8 and 12 a.m. all examined uraemic subjects were dialysed. After each hour of dialysis BP was measured and blood samples were taken. ANP (Peninsula Lab. Kids.) and AVP (DRG) were measured using RIA method, and other biochemical parameters using routine methods. Plasma creatinine and plasma ANP levels significantly decreased, but AVP significantly increased after HD.

CONCLUSIONS

1. In all uraemic subjects, plasma ANP and AVP levels were significantly higher than in control subjects; 2. During haemodialysis with ultrafiltration a significant increase AVP level and decrease ANP level was observed; 3. A significant correlation between ANP concentration and blood pressure may suggest participation of above mentioned hormone in pathogenesis of hypertension in patients with uraemia; 4. It's possible, in pathogenesis plasma AVP increase takes part plasma ANP decrease, too.

[Effect of health resort treatment on the circadian rhythm of follicle-stimulating hormone (FSH), lutropin (LH), and testosterone in male patients with diabetes mellitus]

In diabetic patients disturbances of pituitary-gonadal axis are observed. The aim of the study was to investigate whether in male diabetic patients the circadian rhythms of FSH, LH and testosterone are maintained normal and whether the treatment in a health resort affects the circadian rhythms of investigated hormones. The study regards 5 male patients with insulin dependent diabetes mellitus type I and in 10 male patients with diabetes mellitus type II. In order to assess the circadian rhythm serum FSH, LH and testosterone were determined four times a day at 6.00, 12.00, 18.00 and 24.00. Serum concentration of FSH and LH was determined by LIA and testosterone by RIA. The investigation was done twice: on the third day of a health resort treatment and then on the 23rd day of the treatment. The results were analysed using the Cosinor test. It has been shown that the circadian rhythm of LH, FSH and testosterone is maintained in diabetic patients. During the health resort treatment the midline value (mesor) of serum concentration and the amplitude of of circadian rhythms of LH and testosterone increased in diabetic patients, whereas the FSH circadian rhythm did not change. During the health resort treatment a significant change of testosterone circadian rhythm acrophase from 7.32 to 5.16 was observed in diabetic patients.

[Pregnancy course in women with terminal kidney failure treated with hemodialysis]

According to the European Dialysis and Transplantation Association at least 250 patients on each 1 million of inhabitants in Europe is treated with renal replacement therapy. One can assumed that if only half of above mentioned are women then from 5 to 10 of them can conceive pregnant. It's likely that number of pregnant women with end-stage renal disease depending on different forms of renal replacement therapy will increase. These facts determined us to present study concerning to course of pregnancy in women with end-stage renal disease treated with haemodialysis.

[Increased cholesterol content in erythrocyte membranes of patients with chronic renal failure treated with hemodialysis]

The investigate whether the blood rheological disturbances occurring in hemodialyzed patients are related to the erythrocyte lipid composition, cholesterol and phospholipid content was studied of the erythrocyte membrane. The study included 40 patients with chronic renal insufficiency. 34 of them had hypertension and proteinuria. The cholesterol/phospholipid ratio was significantly higher in the patients after hemodialysis (mean 2.48; SD 0.14) compared with the patients before hemodialysis (mean 2.08; SD 0.19). There was a significant increase of cholesterol in subgroup with hypertension and proteinuria. A significant correlation was found between membrane cholesterol/phospholipid ratio and serum levels of LDL-cholesterol.

[Level of atrial natriuretic peptide (ANP) in plasma of patients with chronic renal failure during hemodialysis]

Two groups of subjects (uraemic and control) were studied. The group A consisted of 20 patients treated by HD (haemodialysis). The mean age was x +/- SD--36.6 +/- 7.3 years, duration of haemodialysis treatment 32.8 +/- 7.7 months, cuprophan dialyzers and acetate containing solution--35 mEq/l--were used, time of HD--4 hours 3 times weekly, predialysis serum creatinine was 876 +/- 189 mumol/l (9.8 +/- 2.1 mg%). This group of patients was subdivided in two groups. The group I comprised 9 patients with hypotensive episodes that occurred during HD (systolic blood pressure < 90 mmHg), and the group II comprised 11 patients without hypotensive episodes. The control group comprised 20 healthy subjects (mean age 36.7 +/- 12.1 years, serum creatinine level 77 +/- 16 mumol/l (0.9 +/- 0.2 mg%). In all examined subjects the following experimental protocol was used. Blood pressure (BP) was determined at about 8 a.m. after an overnight rest. Then blood samples were withdrawn for estimation of ANP, haematocrit value (Ht), haemoglobin (Hb) and creatinine concentrations. Between 8 and 12 a.m. all examined uraemic subjects were dialyzed. After each hour of dialysis BP was measured and blood samples were taken. ANP (Peninsula Lab.Kids.) was measured using RIA method, and other biochemical parameters using routine methods. Serum creatinine and plasma ANP levels significantly decreased after HD. No significant differences were seen between the both uraemic groups. No significant correlations between systolic blood pressure, ANP level in examined group were observed.

CONCLUSIONS

1. In all uraemic subjects, plasma ANP level was significantly higher than in control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

[Concentration of chromium in blood serum of patients with chronic renal failure]

A group of 66 patients with chronic renal failure (CRF) was studied. 42 of them (21 to 63 years old) were treated with haemodialysis and 24 of them (20 to 63 years old) were treated without dialysis. A group of 16 healthy subjects, 19 to 73 years old, were also studied. The blood samples in non-hemodialyzed patients and healthy subjects were taken only once after cannula had been inserted into the antebrachial vein. The blood samples in hemodialyzed patients were withdrawn four times: just before dialysis, during haemodialysis after the first hour of dialysis (from the arterial and from venous line of the dialyser) and after haemodialysis. Chromium concentrations in serum in all examined groups and chromium concentrations in the dialysis fluid as well as in the demineralized water used for dialysis were measured by flame atomic absorption spectrophotometry. In all patients with CRF serum chromium concentration was significantly higher than in the controls. During haemodialysis a decrease of serum chromium concentration was observed. Significant correlations between chromium concentration and creatinine concentration, haemoglobin concentration, haematocrit value, erythrocytes were observed.

CONCLUSIONS

1. Serum chromium concentration in patients with CRF was significantly higher than in normals. 2. No significant differences were found in serum chromium concentration between subgroups of patients with chronic renal failure. 3. Haemodialysis decreases significantly serum chromium concentration.

[The influence of recombinant human erythropoietin (rHu-EPO) on circadian rhythm of prolactin secretion in patients with chronic renal failure treated with hemodialysis]

Patients with chronic renal failure (CRF) have high serum prolactin level. In healthy subjects the circadian rhythm of prolactin secretion is well known. This study aimed to investigate, if the circadian rhythm of prolactin was maintained in patients with CRF treated with haemodialysis despite hyperprolactinaemia, and how the treatment with erythropoietin influenced the circadian rhythm of prolactin. Serum prolactin was determined four times a day at 6:00, 12:00, 18:00, 24:00 in 30 patients with CRF and in 15 healthy subjects. In the patients with CRF this investigation was both done on the day with haemodialysis and on the day without haemodialysis. The patients were divided into two groups: the first one included patients treated with erythropoietin and the second one included patients not treated with erythropoietin. The results of the investigation were analysed using the Cosinor test. Serum concentration of hormones was determined by LIA. It was shown that the circadian rhythm of prolactin was maintained in patients with CRF both on the day with and without haemodialysis. Both in patients with CRF and in healthy subjects the circadian rhythm indicated the highest serum concentration of prolactin in the night hours i.e. 22:30-1:00. In patients treated with erythropoietin a significantly lower average day concentration of prolactin was observed in comparison with patients not treated with erythropoietin.

[Releasing activity of superoxide radicals by neutrophils and monocytes in hemodialyzed patients with chronic renal insufficiency]

Superoxide anion (O2-.) production by neutrophils and monocytes was measured in the peripheral blood of 23 patients hemodialyzed for 14 years. The O2-. production by these cells decreased as the time of hemodialysis advanced. The correlation between O2-. production and peripheral blood smears was also evaluated. Patients with higher neutrophils percentages had lower O2-. production by neutrophils and monocytes. These results indicate that an abnormally increased counts of neutrophils and monocytes in peripheral blood of hemodialyzed patients may depress immunoregulatory function. In addition, decreased O2-. production by these cells should be considered when assessing the defence mechanism and susceptibility to infection of these patients.

[T3, T4 and TSH serum levels in patients on long-term treatment for epilepsy]

The serum T3, T4 and TSH concentrations were assessed by RIA method in 25 (14 females, 11 males) long-term treated (mean treatment duration 12.8 years) epileptic patients. The mean serum T3, T4 and TSH levels were lower than in control group according to clinical picture of epilepsy and treatment applied. The lowest mean serum TSH concentration was in patients with known aetiology of epilepsy. Patients with tonic-clonic seizures had lower serum levels of all hormones measured in comparison with the patients with partial seizures. Mean serum T3, T4 and TSH levels were low in patient group receiving valproic acid. The lowest mean TSH serum concentration as compared to control group was in the patients treated with phenytoin. None of the epileptic patients developed clinical symptoms of hypothyreoidism.

[Effect of hemodialysis with cuprophane and polysulfone membranes on counts of leukocytes, granulocytes, monocytes, lymphocytes and lymphocyte subsets]

In patients with chronic renal failure treated with haemodialysis many disorders of specific and unspecific immunity were observed. Several different parameters such as direct interaction with dialyzer membrane, hypersensitivity to components within the membrane, complement activation, or presence of endotoxins in the dialysis fluid or water supply can activate the immune system during haemodialysis and cause immunity disorders. This study aimed to compare the biocompatibility of two different dialysis membranes on the ground of the influence on the counts of immunity cells in the first hour of haemodialysis when the interaction between blood and membrane were the greatest. In 18 patients with CRF granulocytes, monocytes, lymphocytes B and T, T4 and T8 cells were counted just before haemodialysis, 15 minutes and 60 minutes after the start of haemodialysis. In all patients the investigation was done first using the cuprophane dialysis membrane and then using polysulfone dialysis membrane. The cell populations were differentiated by flow cytometry on Fascan using the conjugated monoclonal antibodies. During the first 15 minutes of haemodialysis with cuprophane membrane the amount of all investigated cells populations decreased significantly. With polysulfone membrane only monocytes decreased significantly in the first 15 minutes of haemodialysis. These results indicate that the polysulfone membrane is more biocompatible than the cuprophane one and suggest that using the biocompatible membranes some disorders of immunity system in this patients can be prevented.

[Lipid peroxidation, antioxidant enzyme activity and trace element concentration in II and III trimester of pregnancy in pregnant women with diabetes]

The aim of the study was to evaluate the concentration of malondialdehyde (MDA)--end product of lipid peroxidation, activity of antioxidant enzymes: superoxide dismutase (CuZn-SOD), glutathione peroxidase (GSH-Px), and catalase (Cat) as well as selenium (Se), zinc (Zn) and copper (Cu) concentration in erythrocytes in 63 patients divided into the three groups: I--control group, II--normal pregnancy, III--pregnant type I diabetics. All parameters were investigated in hemolysate of erythrocytes. MDA concentration increased significantly in pregnant women when compared with control group, as well as in pregnant diabetics when compared with healthy pregnant women. The activity of GSH-Px decreased significantly in pregnant diabetics in comparison with groups I and II. The activity of CuZn-SOD and Cat was significantly lower in III group than in control group. The concentration of Se and Zn decreased, and the concentration of Cu increased significantly in pregnant diabetics in comparison with the other groups. No differences in concentration of MDA, Se, Zn, Cu and activity of GSH-Px were found between particular trimesters in studied patients. The activity of CuZn-SOD and Cat were significantly higher in III trimester than in II one in pregnant diabetics while the activity of GSH-Px remained unchanged during pregnancy.

CONCLUSIONS

Increased lipid peroxidation and the lack of compensatory mechanisms--an increase in antioxidant enzymes activity as well as disorder of trace elements concentration are found in pregnant type I diabetics.

[Lipid peroxides and vitamin E in plasma and plasma lipoproteins in blood of patients with chronic hemodialysis]

To investigate a possible oxidative modifications of plasma lipoproteins in chronic hemodialyzed patients, lipid peroxide concentrations in plasma and in VLDL, LDL and HDL were investigated in 40 patients receiving regular dialysis treatment (RDT). Additionally, vitamin E in this patients was also determined. The serum and lipoprotein lipid peroxides concentrations were significantly increased in RDT in comparison with 36 healthy subjects. The concentrations of the main lipoprotein antioxidant--vitamin E were significantly lower in RDT patients. There was an inverse correlation (r = -0,767; p < 0.02) between vitamin E and peroxides concentration in LDL. Furthermore, a significant increase of lipid peroxides in LDL were observed after hemodialysis. The results indicates vitamin E deficits in patients undergoing chronic hemodialysis.

[Changes in levels of atrial natriuretic peptide (ANP) in patients with chronic renal failure during physical exertion]

Many endocrine abnormalities were reported in patients with chronic renal failure (CRF), including elevated ANP, but little is known on ANP vaso-regulatory effects during exercise. This study is aimed to find whether plasma ANP rises during exercise in patients with CRF, as it does in normal subjects, and whether there is a difference between this response in both those groups. 36 subjects were studied, divided into three groups: I--CRF patients treated conservatively (nondialyzed), II--CRF patients, dialyzed, III--healthy subjects. Plasma ANP was measured at rest and then immediately after submaximal treadmill work load according to modified Bruce protocol with continuous ecg and blood pressure monitoring. In the CRF nondialyzed patients the metabolic equivalent (MET) was significantly lower than in the other groups. The myocardial oxygen consumption, estimated as double product quotient, was the lowest in the nondialyzed CRF patients. A significant increase of the plasma ANP was seen in all subjects studied, significantly higher in the CRF patients than in the control healthy subjects. No correlations were found between the plasma ANP level and other measured parameters.

[Systolic and diastolic function of the left ventricle in patients with chronic renal failure during hemodialysis]

Effect was studied of acetate haemodialysis with ultrafiltration (HD) on left ventricular (LV) systolic and diastolic function of 25 uraemic patients (age: 19-49 years, x = 33.6, SD = 8.9) treated by HD. M-Mode, 2D-, and Doppler-echocardiography was performed to determine LV filling pattern, LV end-systolic (LVIDS) and end-diastolic diameter (LVIDD) immediately before and after each hour of HD. Values of LV mass index (LVMI), fractional shortening (FS), ejection fraction (EF) and velocity of circumferential fiber shortening (Vcf) were also assessed. Simultaneously creatinine, magnesium, potassium, natrium and ionized calcium concentrations were measured, together with body weight and blood pressure. Left ventricular dimensions and LVMI were greatly increased in uremic patients as compared to 25 healthy subjects of similar age. HD resulted in a significant (p < 0.005) lowering of creatinine and potassium concentrations, a nonsignificant decrease of sodium and magnesium levels and in a significant (p = 0.05) increase a significant decrease of LVIDD, LVIDS, Ve,Ve/Va (p < 0.05) and a nonsignificant increase of FS, EF and Vcf. An effective volume depletion HD has no significant influence on left ventricular systolic function and a negative influence on its filling pattern.

[Release of superoxide anions by lymphocytes in patients with chronic renal failure]

The aim of the present study was to find the answer was sought to following question: 1. is the superoxide anions release by lymphocytes after zymosan or phorbol myristate acetate stimulation elevated in patients with chronic renal failure?; 2. are there differences in superoxide anions release between groups of patients with chronic renal failure treated conventionally and those treated by haemodialysis? and 3. does dialysis with cuprophan membrane influence superoxide anions release in patients with chronic renal failure? 36 patients with chronic renal failure and 23 healthy subjects (control) were observed. All patients were divided in 2 groups: 1.12 patients conventionally treated (group 1) and 2.24 patients treated by haemodialysis (group 2). The subjects were studied in the early morning, after eight hour rest and in supine position. In patients of the group 2 blood samples were drawn immediately before and after haemodialysis. In all patients of the group 2 non-reutilized cuprophan dialysers and acetate buffer were used. In patients of the group 1 and in the controls blood samples were withdrawn only once. From the blood samples lymphocytes were isolated and stimulated by zymosan or phorbol myristate acetate. Superoxide anions release was measured using Babior method. Statistical analysis was performed using ANOVA test. A 95% confidence limit (p < 0.05) was used. O2.- release by lymphocytes in patients with chronic renal failure after zymosan (29,.1 +/- 1.0 nmol/min/10(7) lymphocytes) as well as phorbol myristate acetate (29.9 +/- 0.9 nmol/min/10(7) lymphocytes) was significantly higher than in healthy subjects (19.8 +/- 0.4 nmol/min/10(7) lymphocytes and 20.0 +/- 0.4 nmol/min/10(7) lymphocytes respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

[Myoglobinuria. Clinical aspects]

General data is presented on myoglobin structure and function, the pathomechanism of myoglobinuria and on its main causes. Attention was also paid to the most serious result of massive rhabdomyolysis-acute renal failure, taking into account the mechanism of its development. Apart from traumatic causes of myoglobinuria and myoglobinaemia, where the usefulness of these determinations is unquestionable, certain other diseases were compared in which the determination of the concentration of this haemoprotein is of important practical aspect.

[Concentrations of lead in blood of patients with chronic renal failure]

Several groups have reported increased blood lead (Pb) concentrations in patients with chronic renal failure (CRF) and haemodialysed but normal concentrations were observed by the others. The present study aimed to assess: 1. Pb concentrations in patients with CRF and influence of the haemodialysis on these concentrations. 2. The influence of the erythropoietin (EPO) therapy on the Pb concentrations. 3. The influence of long-term haemodialysis therapy on the Pb concentrations. 101 patients with CRF and 23 healthy subjects were examined. Patients with CRF were divided into two groups: nonhaemodialysed (group I) and haemodialysed (group II). Group two consisted of some subgroups: treated with EPO;--without EPO therapy;--haemodialysed 1-50 months;--51-100 months and > 100 months. Creatinine, Pb, haemoglobin and haematocrit concentrations were measured in all examined patients. Significantly higher Pb concentrations in CRF patients comparing to healthy subjects were found. Among CRF patients significantly lower Pb concentrations were observed in group I and did not differ from those in the control group. After haemodialysis Pb blood concentrations significantly decreased in all examined subgroups. In EPO subgroup in comparison with CRF patients without EPO therapy lower but not significantly Pb concentrations were observed. No significant changes between short and long-term haemodialysed patients were found.

CONCLUSIONS

1. Blood lead concentrations are significantly higher in CRF patients in comparison with healthy subjects. 2. In CRF patients a slight Pb concentration decrease after haemodialysis is observed. 3. EPO treatment has no influence on Pb blood concentrations in examined patients. 4. Long-term haemodialysis treatment has only a slight influence on Pb concentrations in CRF patients.

[Level of myoglobin in serum of patients with epilepsy after generalized tonic-clonic seizure]

In 11 patients with epilepsy serum myoglobin level determinations were performed by the RIA method 10 minutes, 1 hour, 4, 12, and 24 hours after tonic-clonic seizure and were compared with myoglobin concentrations in a group of 30 healthy persons. A statistically significant increase of myoglobin concentration was shown already in the first hour after the seizure with maximal level, almost five times exceeding the baseline level in the fourth hour, and slightly lower--four times exceeding the baseline--12 hours after the seizure. The correlative studies, comparing the profile of myoglobinaemia with the clinical picture (duration of the disease, age and sex, presence or lack of EEG changes, type of therapy used) showed no statistical significance.

[Concentration of myoglobin in serum in patients with heart transplantation]

The studies were carried out, the aim of which was the answer to question what are the changes of myoglobin concentration in patients after heart transplantation. For this purpose, 31 healthy persons being the control group (C) and 15 patients after heart transplantation (HTP) were studied. In both groups myoglobin concentration was determined by the RIA method, finding no statistically significant differences in changes of this parameter between the two studied groups. However, the nephrotoxic effect was confirmed of cyclosporin A which was continuously taken by the patients after heart transplantation, expressed as the decrease of creatinine clearance.

[Effect of opioid receptor blockade with naloxone on secretion of atrial natriuretic peptide (ANP) in patients with kidney transplantation]

This paper aimed to assess the influence of opioid receptors on plasma level of atrial natriuretic peptide (ANP) in 12 kidney transplant patients (KTP) with stable graft function and in 15 healthy subjects (control). In KTP significantly higher plasma levels of ANP were found under basal conditions than in control subjects. After blockade of opioid receptors by naloxone a significant decline of plasma ANP was noticed, which was significantly more marked in KTP than in normals. Data obtained in this study suggest, that opioid receptors do influence plasma ANP levels both in KTP and healthy subjects. This influence seems to be significantly more marked in KTP than in normals. Hyperendorphinism seems to be involved in the pathogenesis of elevated plasma ANP levels in KTP.