[Late abdominal wall leaks of dialysis fluid--own experience in conservative treatment]

The late abdominal wall leaks (LAWL) of dialysis fluid is a serious technical complication of continuous ambulatory peritoneal dialysis (CAPD). Manifestation of LAWL is a significant diagnostic and therapeutic problem. The aim of our study was to establish of diagnostic procedure and the methods of treatment of LAWL. The group of 80 patients treated with CAPD was observed during one-year-period. LAWL appeared in 8 patients from this group. LAWL was diagnosed by: physical examination, abdominal circumference measurement, ultrasound examination of abdominal wall. Patients with LAWL were temporary transferred from CAPD to automated peritoneal dialysis (APD). After applied treatment the remission of leakage was observed. Basing on performed observation we concluded, that physical examination, abdominal circumference measurement and ultrasound examination of abdominal wall are the basal diagnostic methods of LAWL and that temporary change of dialysis method from CAPD to APD is an effective method of LAWL treatment.

TrkA mediates developmental sympathetic neuron survival in vivo by silencing an ongoing p75NTR-mediated death signal

Developmental sympathetic neuron death is determined by functional interactions between the TrkA/NGF receptor and the p75 neurotrophin receptor (p75NTR). A key question is whether p75NTR promotes apoptosis by directly inhibiting or modulating TrkA activity, or by stimulating cell death independently of TrkA. Here we provide evidence for the latter model. Specifically, experiments presented here demonstrate that the presence or absence of p75NTR does not alter Trk activity or NGF- and NT-3-mediated downstream survival signaling in primary neurons. Crosses of p75NTR-/- and TrkA-/- mice indicate that the coincident absence of p75NTR substantially rescues TrkA-/- sympathetic neurons from developmental death in vivo. Thus, p75NTR induces death regardless of the presence or absence of TrkA expression. These data therefore support a model where developing sympathetic neurons are "destined to die" by an ongoing p75NTR-mediated apoptotic signal, and one of the major ways that TrkA promotes neuronal survival is by silencing this ongoing death signal.

Rate of Staphylococcus aureus nasal carriage in immunocompromised patients receiving haemodialysis treatment

Specimens from the nose and throat were collected from 28 long-term haemodialysed patients. Staphylococcus aureus strains were isolated from sixteen patients who been on haemodialysis for over 113 months. Cytokine levels, as well as full blood cell differential counts and cell surface antigens were determined in these patients. The serum concentration of TGF-beta was significantly higher in patients carrying Staphylococcus aureus. CD14 and HLA-DR molecule expression on monocytes, as well as NK cell percentage was significantly different in S. aureus carriers. Our preliminary results suggest that immune status imbalance in haemodialysed patients could be related to the high incidence of S. aureus nasal carriage and infections.

[Relationships between hyperparathyroidism and Helicobacter pylori infection in long-term hemodialysis patients]

In the accessible literature we did not find data about the connection between Helicobacter pylori (H. pylori) infection and parathyroid hormone (PTH) abnormalities in patients on hemodialysis (HD pts). It is known that hyperparathyroidism is connected with stimulation of gastrin synthesis as well with increased acidity of gastric juice. We speculate that it should be connected with susceptibility to H. pylori infection in HD pts. The aim of our study was the assessment of relationships between PTH abnormalities and parameters of H. pylori infection expressed by concentration of IgG antibodies against H. pylori and histologically performed urease test. The study was conducted in 65 (37 M, 28 F) stable HD pts. They were dialyzed for 6 to 288 months (102.9 +/- 84.5). Simultaneously in 25 HD pts qualified for renal transplantation biopsy specimens taken during gastroscopy were examined by a histological test and urease test (CLO-test). According to the PTH concentration HD pts were divided into 3 groups with PTH < 100 pg/ml; with PTH 100-350 pg/ml and with > 350 pg/ml. Positive IgG H. pylori test > 24 U/ml was found in 60 (92%) HD pts. Mean IgG H. pylori concentration was similar in tree groups of HD pts. (82 vs 91 vs 88 U/ml) and did not differ significantly from control group. We found significant negative correlation between IgG H. pylori concentration and time on dialysis therapy (r = -0.50067, p = < 0.0001). Positive test in biopsy specimen was found in 14 HD pts (56%). PTH level in this group of HD pts not differ significantly from PTH level in pts with negative test (426 vs 398 pg/ml) and IgG H. pylori concentration was significantly higher in positive pts than in negative pts (104 vs 48 U/ml).

CONCLUSION

We did not find significant relationship between PTH abnormalities and H. pylori infection in HD pts. Longer period of dialysis therapy is connected with decreased ability to produce antibodies againts H. pylori.

Relationship between some prognostic markers of HD patients and serum erythropoietin, insulin-like growth factor-1, leptin, parathormone and testosterone

Iseki et al. [1] have shown that serum levels of albumin (Alb), creatinine (Cr) and BMI are significant predictors of death in haemodialyzed patients (HD pts). In our study we decided to assess the relationship between the levels of Alb, Cr, BMI and substances which have a known metabolic effect on nutritional status in HD pts: endogenous erythropoietin (Epo), insulin-like growth factor-1 (IGF-1), leptin (Lep), parathormone (PTH), and testosterone. The study was conducted in 53 (28M, 25F) stable HD pts. Serum levels of endogenous Epo and PTH were estimated by CLIA; IGF-1, Lep, testosterone, sex hormone binding globulin were estimated by RIA. The multiple regression analysis was done between Alb, Cr, BMI and Epo, IGF-1, PTH and Lep for all HD pts together and free androgen index (FAI) for men and women separately. Correlations: the level of serum albumin did not correlate significantly with any of the measured substances. Serum creatinine level significantly correlated only with the level of IGF-1 (p=0.02), BMI was significantly correlated with serum endogenous Epo (p<0.01), leptin (p=0.004) and FAI (p<0.005) both in men and women. We concluded that the higher concentrations of endogenous Epo, IGF-1 and testosterone could be correlated with a better prognosis in HD patients.

[Evaluation of the relationship between possible control of anemia in hemodialysis patients and the concentration of leptin]

There are many growth factors (GFs), which stimulate the proliferation and maturation of erythroid progenitors. The main one is erythropoietin (Epo). Epo acts in concert with other GFs. Recently it was suggested that leptin (Lep) could be involved in a very early stage of erythropoiesis (E). The aim of this study was to analyse the relations between ability of idiopathic compensation of anemia by hemodialysis patients (HD pts) and concentration of Lep in HD men and women separately. The study was performed in 25/13M, 12F/HD pts, who idiopathically compensate anemia (group 1) and 29/16M, 13F/HD pts who required rHuEpo therapy (group 2). The mean Lep level in all women together was significantly higher than in all HD men together (26.9 +/- 6.3 ng/mL vs 6.8 +/- 0.9 ng/mL) but BMI was similar in men and women. We did not find significant differences in level of Lep in both studied groups of HD pts. Perhaps the lower influence of Epo and testosterone on E in HD women is compensated by significantly higher Lep concentration.

The p75 neurotrophin receptor mediates neuronal apoptosis and is essential for naturally occurring sympathetic neuron death

To determine whether the p75 neurotrophin receptor (p75NTR) plays a role in naturally occurring neuronal death, we examined neonatal sympathetic neurons that express both the TrkA tyrosine kinase receptor and p75NTR. When sympathetic neuron survival is maintained with low quantities of NGF or KCl, the neurotrophin brain-derived neurotrophic factor (BDNF), which does not activate Trk receptors on sympathetic neurons, causes neuronal apoptosis and increased phosphorylation of c-jun. Function-blocking antibody studies indicate that this apoptosis is due to BDNF-mediated activation of p75NTR. To determine the physiological relevance of these culture findings, we examined sympathetic neurons in BDNF-/- and p75NTR-/- mice. In BDNF-/- mice, sympathetic neuron number is increased relative to BDNF+/+ littermates, and in p75NTR-/- mice, the normal period of sympathetic neuron death does not occur, with neuronal attrition occurring later in life. This deficit in apoptosis is intrinsic to sympathetic neurons, since cultured p75NTR-/- neurons die more slowly than do their wild-type counterparts. Together, these data indicate that p75NTR can signal to mediate apoptosis, and that this mechanism is essential for naturally occurring sympathetic neuron death.

[Pulmonary embolism as a complication of nephrotic syndrome--case report and therapeutic management]

A case of a 41-year-old man, who was treated due to severe steroid and immunoresistant nephrotic syndrome is described. During the pulsed steroid therapy the patient underwent a pulmonary embolism and developed the post-infarction cavern and abscess of the lung. In this study the case history, complications, diagnostic procedures and therapeutic management were described. The probable mechanism of the described complications was carefully discussed.

Transgenic mice expressing the intracellular domain of the p75 neurotrophin receptor undergo neuronal apoptosis

We have asked whether p75(NTR) may play a role in neuronal apoptosis by producing transgenic mice that express the p75(NTR) intracellular domain within peripheral and central neurons. These animals showed profound reductions in numbers of sympathetic and peripheral sensory neurons as well as cell loss in the neocortex, where there is normally little or no p75(NTR) expression. Developmental loss of facial motor neurons was not observed, but induced expression of the p75(NTR) intracellular domain within adult animals led to increased motor neuron death after axotomy. Biochemical analyses suggest that these effects were not attributable to a p75(NTR)-dependent reduction in trk activation but instead indicate that the p75(NTR) intracellular domain may act as a constitutive activator of signaling cascades that regulate apoptosis in both peripheral and central neurons.

Influence of some immune factors on the IL-6 and soluble IL-2 receptors in haemodialysed patients

In respect to the immune deficiency state of long-term haemodialysed patients, both cytokines and their receptor disturbances have been taken into consideration. The purpose of our study was to evaluate the effect of uraemic and haemodialysis factors on the interleukin-6 and interleukin-2 soluble receptor levels and the reactivity after influenza vaccination. We have found that IL-6 and IL-2 receptor levels were statistically significantly elevated (98.8 +/- 39 pg/ml and 1557 +/- 544 U/ml, respectively) in serum of haemodialysed patients. The fact that increased immune complexes statistically correlated with soluble IL-2 receptor levels (p < 0.01) was very interesting for us. In order to study the immunological response after vaccination, 10 patients have been investigated after influenza vaccination. Plasma samples were collected before, as well as 1 and 4 weeks after vaccine administration. Antibody titres measured by haemagglutinin inhibition showed decreased antibody levels in haemodialysed patients. We conclude that the interleukin disturbance and the elevated interleukin-2 receptor levels together with the presence of circulating immune complexes can influence in some way the immune response of haemodialysed patients.

Plasma erythropoietin level and iron reserves in haemodialysis patients with and without acquired cystic kidney disease

Concentration of erythropoietin (Epo) and iron reserves (IR) belong to the essential factors determining erythropoiesis in haemodialysis patients. Patients on dialysis with acquired kidney disease (ACKD+) can control anaemia better than patients without acquired kidney disease (ACKD-). Therefore we decided to check if plasma Epo levels and IR differ significantly in both groups of patients. Forty chronically haemodialyzed patients after ultrasound diagnosis were divided into 18 patients (45%) with ACKD+ and 22 (55%) without ACKD-. In both groups of patients we compared their plasma levels of Epo and IR. Plasma erythropoietin and ferritin levels were measured by enzymatic immunoassay. Iron reserves were estimated by the formula: IR = 400 x [ln (ferritin)-ln (50)]. In the ACKD+ group 72% of patients and in the ACKD- group 32% of patients did not require rHu Epo therapy. Plasma levels of erythropoietin and iron reserves did not differ significantly between ACKD+ and ACKD- patients. There must be also other factors than erythropoietin levels and iron reserves regulating erythropoiesis in these patients.

[Comparison of the ability to control anemia in patients on hemodialysis and peritoneal dialysis considering iron reserves and plasma erythropoietin]

It is known, that patients undergoing CAPD have less severe anaemia than those receiving hemodialysis (HD). In addition they require smaller doses of rHuEpo to control anaemia than HD pts. We have decided to compare plasma erythropoietin (pEpo) and iron reserves (IR) in these both groups of pts. 17 pts on CAPD and 50 pts on HD were diagnosed. 35% pts on CAPD and 52% pts on HD required permanent rHuEpo treatment to maintain hemoglobin (Hb) concentration above 9.5g/dl and Ht above 30%. Plasma EPO and ferritin levels were measured by enzymatic immunoassay. IR were estimated by formula: IR = 400x [ln (ferritin) - ln(50)]. Compared to CAPD, HD pts had higher IR (405 +/- 76 vs. 358 +/- 120 mg) but differences are not statistically significant. Plasma Epo level (geom. mean) was statistically significant higher p = 0.025 in HD pts compared to CAPD pts (8.68, range 2-53 vs. 5.21 range 2-15 mV/ml) Hb concentrations did not differ significantly between pts on CAPD and HD. CAPD pts controlled anaemia better than HD pts despite lower concentration of endogenous erythropoietin.

[Complication due to intraperitoneal dialysis catheter insertion]

During the last 6 years 300 stylet and Tenckhoff catheters were inserted into the peritoneal cavity. In 5 cases an abdominal viscus has been perforated or injured. The complications were twice a perforation of bowel, twice a perforation of bladder and once an injury of aorta. The authors discussed the therapeutic procedure (conservative or operative) and the late consequences of those complications.

Comparison of plasma erythropoietin concentrations and iron status in hemodialyzed patients not requiring and requiring rHuEpo therapy

Fifty patients treated with chronic hemodialysis (HD) were observed for 1 year. 24 of them (48%) did not require treatment with recombinant human erythropoietin (rHuEpo) (group I) because the permanent hemoglobin (Hb) concentration was > 5.9 mmol/l (9.5 g/dl), hematocrit > 30%. The remaining 26 patients (group II) permanently or periodically required rHuEpo treatment. After 6 months of initial observation and after 6 months of clinical study we made a comparison of endogenous erythropoietin (Epo) and iron status in two groups of patients. Patients not requiring treatment with rHuEpo had statistically significant higher Epo concentration and lower iron reserves than patients on rHuEpo treatment. We did not find significant differences in Hb, albumin and creatinine between patients in both groups. Hb concentration did not correlate with the level of Epo, serum creatinine, transferrin saturation, ferritin, iron reserves and time of dialysis therapy in both groups. In both groups we found a significant negative correlation between the concentration of Epo and iron stores. Our results indicate that in patients on HD treatment, plasma Epo level appears to depend either directly or indirectly on iron status.

Influence of intraperitoneal gentamicin on peritoneal transport in IPD patients

We have investigated the effect of intraperitoneal gentamicin on dialysis efficiency in 10 intermittent peritoneal dialysis (IPD) patients. The following parameters were measured: net ultrafiltration (UF); concentration ratios (D/P) of urea, creatinine, potassium; peritoneal clearances (ml/min) of urea, creatinine, potassium; mass transfer of sodium (MTNa); sodium sieving index (SCNa). It has been found that gentamicin significantly decreased D/P urea (p < 0.056) and D/P creatinine (p < 0.05). We found also a significant decrease of mean clearances of urea (p < 0.05) and creatinine (p < 0.05). The mean clearance of potassium did not significantly change. There was no significant change in UF, MTNa and SCNa. Our preliminary data suggest that gentamicin decreases the permeability of the peritoneum for certain low molecules in IPD patients, which may have a negative impact on dialysis efficiency.

[Comparison of selected parameters of dialysis quality in hemodialysis patients not requiring and requiring treatment with erythropoietin]

After 1/2 year long clinical observation 50 maintenance hemodialyzed patients were divided into two groups. Group I consisted of patients with haemoglobin concentration exceeded 9.5 g/dl and hematocrit above 30%, not treated with rHuEPO. Patients of group II permanently or periodically required treatment of rHuEPO to maintain haematological parameters written above. Then mean maintaining dose of rHuEPO was 5,500 units weekly. The concentrations of haemoglobin, albumin, creatinine, transferrin, KT/V and body mass index (BMI) handled as parameters of quality of dialysis therapy (PQD) of two groups were compared. Lack of treatment with rHuEPO in hemodialyzed patients of group I, with adequate Hb concentration, does not change significantly PQD in comparison with patients of group II treated with rHuEPO.

[Comparison of clinical parameters of chronically hemodialyzed patients not requiring treatment with erythropoietin and patients treated with erythropoietin]

50 patients with terminal renal failure treated with chronic haemodialysis were examined. 24 of them (48%) did not require treatment with erythropoietin (rHuEPO) because of permanent haemoglobin concentration was 9.5 g/dl (5.91 mmol/l) and hematocrite more than 30%. Clinical data of two groups of patients were compared: 1) patients not requiring treatment with rHu EPO, 2) patients requiring treatment with rHu EPO. Attention was paid to the sex, age, the kind of disease which caused renal failure, the duration of dialysotherapy, liver function, HBs antigenemia, presence anti-HCV antibodies, ultrasonographic estimation of patients own kidneys; liver. Patients who did not require treatment with rHu EPO were older, longer treated with chronic haemodialysis and more frequently cysts in their own kidneys were seen. Any significant differences were not observed in both groups of patients as regards their antigenemia HBs or presence of anti HCV-antibodies. The important cardiovascular disease was observed more frequently in patients requiring treatment with rHu EPO.

[Evaluation of platelet function during treatment with recombinant human erythropoietin (r-HuEPO) in patients hemodialyzed and dialyzed peritoneally]

In eight patients with terminal renal insufficiency treated with repeated haemodialyses (group I) and six patients treated with intermittent peritoneal dialysis (group II), the effect was studied of treatment with r-HuEPO on the platelet count and activity. In the studied patients the following was determined: platelet count, ADP-induced aggregation, circulating aggregates, and the third (PF3) and fourth (PF4) platelet factors. The studies were performed before the introduction of r-HuEPO and during the treatment--after achieving of haematocrit increase in the patients to 30%. No significant increase was observed of platelet count or activity. In none of the studied patients the development of thrombotic complications was observed with haematocrit increase to 30%. In both studied groups during the treatment with r-HuEPO a significant increase was found of haemoglobin concentration, red blood cell count, and haematocrit value in relation to the values before starting the treatment.

[Carpal tunnel syndrome in hemodialysed patients]

A case of carpal tunnel syndrome in female patient treated with hemodialyses for 10 years is presented. Surgical management was applied with positive result. Histological examination of tissue collected during surgery has shown the deposits of amyloid-like substance in carpal tunnel. The authors discuss current concepts of carpal tunnel syndrome pathogenesis in hemodialysed patients.

[Effectiveness of peritoneal dialysis using dialysis fluid of modernized composition]

In six patients with terminal renal failure the effectiveness was assessed of intermittent peritoneal dialyses (IPD) using the dialysing fluid of modernised composition. On the basis of the obtained results the values were calculated of the total sodium (TMTNa) and potassium (TMTK) elimination glomerular filtration rate, and the sodium elimination index. The values were calculated of the dialysing clearance of urea, creatinine, potassium, and inorganic phosphorus. The correlations were analysed between the dialysing clearance of studied substances and the body area of patients, the duration of dialysis, and glomerular filtration rate. The results were compared with the effectiveness of peritoneal dialysis carried out with the dialysing fluids of formerly used electrolyte composition.