ISSN:1660-8151    

DOI:10.1159/000189274

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The aim of our study was (1) to verify whether haemodialysis (HD) with cuprophane (CUP) and polyacrylonitrile (PAN) membranes is associated with the release of vasoactive leukotriene (LT) C4 and chemotactic LTB4 and (2) to analyse the respective roles of lipoxygenase and cyclo-oxygenase metabolites of arachidonic acid in membrane bio-incompatibility. The investigation was performed in 10 uremic patients using hollow-fibre dialysers and dialysed successively, in random order, with CUP and PAN membranes. The arterial and venous (from dialyser) blood was sampled for the measurement of biochemical parameters, plasma LTC4, LTB4 and prostaglandins (PG) 6-keto-F1α, E2, F2α and thromboxane B2 before and after 15, 30 and 240 min of HD. Eicosa-noids were measured by RIA after prior extraction and HPLC separation. Results: CUP HD was associated with a marked early leukopenia and a delayed decrease in blood pO2. Simultaneously, plasma LTB4 and LTC4 increased significantly in arterial blood after 30 min of HD and in venous blood at the end of session of 240 min. Cyclo-oxygenase metabolites increased as well, but nonsignificantly, with a maximum at the end of HD. PAN HD did not significantly change white blood cell count, pO2 or plasma eicosanoid levels. Conclusion: CUP membranes stimulate the release of proinflammatory and vasoactive LTB4 and LTC4. PAN membrane haemodialysis is without such side effects. The release of LTs may be an additional valuable marker of membrane bioincompatibilit

ISSN:1660-8151    

DOI:10.1159/000189275

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Hypotension is frequently encountered during hemodialysis (HD). One of the main factors of the HD-induced hypotension is acute reduction of circulating plasma volume by water removal, which is induced by the poor plasma refilling from the extravascular space into vessels. The determinants of plasma refilling, however, have not been clearly identified. Recently, we devised a mathematical model of water transport in HD patients, which can estimate the plasma-refilling coefficient (Kr) during HD. In the present study, we evaluated the factors determining plasma refilling by using this model. In 13 patients undergoing regular HD, the changes of Kr during HD were calculated from the model. Levels of ANP, cGMP, cAMP, endothelin, angiotensin II and vasopressin were measured before and after HD. Kr fell from 750.4 ± 558.0 to 112.8 ± 81.9 ml/mm Hg/h during HD. The rate of water removal during HD showed no significant correlation with the changes of Kr. Among the hormones and nucleotides measured here, plasma ANP level and cGMP were significantly correlated with Kr (r = 0.78, p < 0.01 and r = 0.62, p < 0.01, respectively). Our findings suggest that severe reduction in the level of serum ANP during HD, which is induced by water removal, plays some role in HD-induced hypotension through the attenuation of plasma refilling in HD patient

ISSN:1660-8151    

DOI:10.1159/000189276

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The biocompatibility of a 1.1% amino acid-containing peritoneal dialysis fluid (AA-PDF) was compared to that of a 2.27% glucose-based peritoneal dialysis fluid (G-PDF). Peritoneal macrophages (PMO), isolated from the peritoneal dialysis (PD) effluents of 10 chronic ambulatory PD patients, were tested for their phagocytosis capacity and peak chemiluminescence response. A subset of PMO was cultured for 24 h with and without lipopolysaccharide (LPS) to study the release of interleukin-1β (IL-lβ) and 8 (IL-8). As control, the interleukin release by blood monocytes of healthy donors was tested. The opsonic activity of the PD effluent was tested as well. Compared to PMO isolated from G-PDF, PMO from AA-PDF showed a significantly better phagocytosis capacity. There was no difference in the peak chemiluminescence response between PMO from AA-PDF and G-PDF. The release of IL-1β by unstimulated PMO isolated from the two fluids did not differ. Compared to control monocytes, however, PMO from both fluids showed a considerable spontaneous release of IL-1β. When stimulated with LPS, IL-1 β production by PMO from G-PDF exceeded that of PMO from AA-PDF (p < 0.002). The release of IL-8 by PMO from G-PDF was significantly higher in comparison with PMO from AA-PDF, both spontaneously and after stimulation with LPS (p < 0.02). The opsonic activity of undiluted and to 75% diluted effluents was significantly higher for G-PDF than for AA-PDF (p < 0.01). Thus, compared to the regularly used G-PDF, the phagocytosis capacity as measure for PMO function seems to be better preserved after in vivo exposure to AA-PDF. In addition, the higher release of IL-1β and IL-8 by PMO isolated from G-PDF suggests a stronger intra-abdominal activation of PMO, with G-PDF acting as a chemical inflammatory agent. Whether the lower opsonic activity of the AA-PDF is more important for biocompatibility than the other parameters is not clear. Therefore, it is concluded that, although macrophage function is better preserved, it is not proven that the 1.1% AA-PDF studied has an improved biocompatibility compared to 2.27%

ISSN:1660-8151    

DOI:10.1159/000189277

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

To investigate the possible toxic effects of long-term low-dose exposure to Al-containing agents in 55 patients with chronic renal insufficiency (CRI), 37 patients received Al(OH)3 1 tablet 3 times per day (about 302 mg/day of elemental Al) for 3 months and another 18 were used as a control group. The hematological, iron status and Al data were measured before and after the study. CRI patients who had ingested Al-containing agents for 3 months had significant decreases in hematological parameters and increases in serum Al and daily urinary Al excretion. Serum ferritin negatively correlated with serum Al (r = -0.586, p < 0.0005), and hemoglobin (Hb) positively correlated with renal Al clearance (r = 0.573, p < 0.0005) and logarithmic transformation of serum Al (r = -0.437, p < 0.01) in these patients, despite no significant correlations between initially basal hematological and Al parameters. But there were no significant differences between variables of Al and hematological parameters before and after 3 months of follow-up in the control group. All factors correlating with Hb were measured with stepwise regression analysis; renal Al clearance, creatinine clearance (Ccr) and serum iron were the most significant correlation factors with Hb. After Ccr and serum iron had been adjusted, Hb (b = 0.069 ± 0.02; p < 0.05) still positively correlated with renal Al clearance. Comparing patients who had reduced Hb (at least 0.5 g/dl) and those who did not, the response group had a lower basal (Ccr, a higher serum Al and a lower renal Al clearance after Al loading for 3 months. In conclusion, Al does play a role in the significant reduction of Hb and hematocrit in CRI patients after Al loading for 3 months, and patients with a lower Ccr may easily develop Al-induced hematologically toxic effects. Al-containing agents should be used with care in long-term therapies of CRI patients

ISSN:1660-8151    

DOI:10.1159/000189278

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Lipocortin-1 a 37-kDa member of the annexin family of proteins, originally evoked interest as one of the second messengers for the anti-inflammatory actions of glucocorticoids. Studies showed that glucocorticoids inhibited the proliferation of various cell types and lipocortin-1 mediated growth inhibition of glucocorticoids in a human lung adenocarcinoma cell line. The presence of specific lipocortin-1-binding sites (receptor-like molecules) on monocytic cells has been demonstrated. This study was performed to evaluate the effects of hydrocortisone and recombinant human lipocortin-1 on cultured human mesangial cells (CHMC), and the effects of anti-lipocortin-1 antibody on the hydrocortisone-induced inhibition of CHMC proliferation. The existence of specific binding sites for lipocortin-1 was also investigated. Lipocortin-1 inhibited CHMC proliferation in a dose-dependent manner as determined by [3H]thymidine uptake and cell count. Growth of CHMC was inhibited to 18% of the control in the presence of 5 μg/ml of lipocortin-1. Similar growth-inhibitory activity by lipocortin-1 was observed in CHMC activated by platelet-derived growth factor. Hydrocortisone also inhibited cell proliferation in a dose-dependent manner. One to 5,000 dilution of anti-lipocortin-1 antibody reversed hydrocortisone-induced inhibition of CHMC proliferation partially, whereas concentrations over 1:1,000 reversed the inhibition completely. Flow cytometry analysis as well as indirect immunofluorescent microscopy revealed specific binding sites on the surface of CHMC. These results support the hypothesis that corticosteroids act by inducing CHMC to synthesize or secrete lipocortin-1 and that lipocortin-1 generates proliferation-suppressive signal(s) through specific binding sites on CHMC

ISSN:1660-8151    

DOI:10.1159/000189279

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Directional atherectomy (DA) was developed as a new therapeutic modality for coronary artery disease. For the past 3 years, we have applied DA intervention to vascular access failure with either poor blood flow rate or high venous pressure. DA intervention was performed on 27 lesions of 16 hemodialyzed patients. A reduction of stenosis to less than 20% of that before treatment was judged a technical success, and the rate of technical success was 84%. All patients showed adequate blood flow rates after DA intervention, indicating initial success. Although restenotic events occurred frequently, repeated DA interventions could be performed successfully. The patency rate at 1 month after DA intervention was 100%, at 3 months 93%, at 6 months 92% and at 12 months 75%. The short-term patency rate of DA was more satisfactory than the results of percutaneous transluminal angioplasty as reported by several investigators. Regarding the site of stenosis, restenotic events were relatively fewer in the lesions occurring at the native vein compared to those at graft-venous anastomotic sites. Eccentric-type stenosis was also associated with fewer restenotic events than circumferential-type stenosis. These results suggest that eccentric-type stenosis at the native vein is the most suitable lesion for the application of DA intervention in terms of long-term patency. As no severe complications occurred after DA intervention, this would appear to be a useful therapeutic modality for the correction of vascular access failure.

ISSN:1660-8151    

DOI:10.1159/000189280

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The function of renal allografts in patients who had received pretransplant immunoadsorption in order to remove cytotoxic anti-HLA antibodies was studied. We reviewed 6 patients who received a graft which functioned beyond 3 months; the mean follow-up period was 76 (range 62-89) months. Two grafts have been lost from chronic rejection, at 12 and 62 months, respectively. The mean plasma creatinine levels at 1 and 5 years were 169 (range 143-211) μmol/l and 155 (range 92-235) μmol/l, respectively (1.91, range 1.62-2.39, mg/dl and 1.75, range 1.04-2.66, mg/dl, respectively). The major source of morbidity during long-term follow-up has been the occurrence of renal artery stenosis in 5 patients and renal vein stenosis in 1. In conclusion, the 5-year graft survival and function was good in patients who received immunoadsorption and whose grafts survived beyond the first 3 months after transplantatio

ISSN:1660-8151    

DOI:10.1159/000189281

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Simultaneous kidney-pancreas (SKP) transplantation is associated with increased risk of kidney rejection (KR) due to an unknown mechanism. The aim of this study is to analyze the characteristics of KR in 44 SKP transplantations under quadruple immunosuppressive therapy and to evaluate the response to treatment and its effect on renal allograft survival and renal function. The mean follow-up was 25 ± 14 months. Seventy-seven percent of the patients (34 of 44) presented an acute renal allograft rejection. Sixty-six percent (29 of 44) had one rejection episode and 11 % (5 of 4) 2 episodes. KR was early (85% in the first month after transplantation), intense (3.7-fold increase in creati-nine) and had great clinical features. Twenty-eight percent of the patients had an early relapse during the first month after treatment. KR did not affect the survival of the renal allograft in the short-term (1 and 2 years). Overall, 62% were corticosensitive (CS) and the remaining 38% were corticoresistant (CR). The group with an isolated rejection without relapse was CS in 69% of the cases, achieved complete remission in 73% and renal function was not affected at 1 and 2 years [115 ± 26 μmol/l (1.3 ± 0.3 mg/dl) and 150 ± 53 μmol/l (1.7 ± 0.6 mg/dl)] in comparison with the group without rejection [97 ± 18μmol/l(l.l ± 0.2 mg/dl) and 115 ± 35μmol/l(1.3 ± 0.4 mg/dl); p = NS]. On the other hand, the group with an early relapse of the first rejection and the group with two rejections were principally CR (62 and 60%, respectively), had partial remission with treatment (50 and 60%) and had worse renal function at 1 and 2 years [212 ± 71 μmol/l (2.4 ± 0.8 mg/dl) and 221 ± 53 μmol/l (2.5 ± 0.6 mg/dl)] than in the group with isolated KR (p < 0.05 and p < 0.001). In conclusion, despite intense immunosuppressive treatment, the frequency of rejection of a renal allograft in SKP is high. The response to treatment is satisfactory and does not affect the survival of the allograft in the short-term. However, multiple episodes or early relapse of rejection are associated with higher

ISSN:1660-8151    

DOI:10.1159/000189282

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Clinicopathological and morphometric analysis of glomerular hypertrophy was conducted using biopsies from 89 patients with minimal change nephrotic syndrome (MCNS). Of the 89 patients, in 69 with complete remission and in 20 with one or more relapses, various clinical and morphometric parameters were compared to 15 normal controls. Proteinuria was more severe and serum creatinine (Cr) concentration significantly higher in patients with relapse of proteinuria. The morphometric analysis showed that the sizes of (1) glomerular tufts and (2) glomerular capillaries were significantly larger in patients in the relapse group than in the remission or control groups, but no difference in the size of Bowman’s capsule was found between the two MCNS subgroups. The intertubular capillaries were narrower in patients who failed to reach prompt complete remission. A negative correlation between intra- and extra-glomerular capillary size was evident (r = -0.83, p < 0.001).A definitive correlation was detected between the circumference of glomerular capillary loops and the degree of proteinuria (r = 0.89, p < 0.001). The mean tubulocapillary diffusion distance was significantly longer in biopsies of the patients in relapse and showed a close significant correlation with serum Cr level (r = -0.87, p < 0.001) and intertubular capillary size (r = -0.87, p < 0.001). These data suggest that extra- and intraglomerular hemodynamic alterations in MCNS lead to glomerular hypertrophy, and dilatation of the glomerular capillary loop plays a key role in the relapse of MCN

ISSN:1660-8151    

DOI:10.1159/000189283

出版商:S. Karger AG    

年代:1996

数据来源: Karger