ISSN:1660-8151    

DOI:10.1159/000186434

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

We have studied the role of interleukin-2 (IL-2) and its receptors in the impaired in vitro lymphocyte response characteristic of hemodialysis patients treated by means of cuprophane membranes. The proliferative response of T lymphocytes as well as T-cell-dependent B cell proliferation after stimulation with mitogens was significantly reduced in hemodialysis patients. The in vitro production of IL-2 after such stimulation in parallel cultures was found to be similar in patients and in controls. The expression of IL-2 receptor on the lymphocyte cellular membrane in the hemodialysis group was also similar to controls. The in vitro proliferative response of uremic lymphocytes to exogenous IL-2, however, was significantly depressed suggesting a reduced availability of biologically active IL-2 receptor. The release of soluble IL-2 receptor by lectin-stimulated lymphocytes in culture was also significantly lower in the patient group; yet, hemodialysis patients has a strikingly elevated level of plasma soluble IL-2 receptor, and similar high levels were also found in three other groups of end-stage renal disease patients dialyzed by means of cellulose acetate, polysulfone and polyacrylonitrile membranes, as well as in a group of uremic patients on conservative treatment. In the hemodialysis patient group a significant positive correlation between levels of soluble IL-2 receptor and the duration of hemodialysis was found. Since soluble IL-2 receptor has been reported to down-regulate lymphocyte responses, the elevation in plasma levels of soluble IL-2 receptor in hemodialysis patients may be a pathogenetic factor in the progressive development of impaired immunity associated with end-stage renal disease.

ISSN:1660-8151    

DOI:10.1159/000186435

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The effect of peritoneal dialysate on the capacity of peripheral blood polymorphonuclear (PMNL) and mononuclear leukocytes (MNC) to release leukotriene B4 (LTB4) and tumor necrosis factor alpha (TNFα) was investigated in vitro. Following density gradient separation, aliquots of 5 × 106 PMNL or MNC were incubated in peritoneal dialysis fluid containing 1.5% glucose or Hanks’ buffer ( = control) for 1–2 h at 37°C. TNFα and LTB4 production was stimulated with Escherichia coli lipopolysaccharide (LPS) and calcium ionophore A23187, respectively. MNC incubated in buffer and LPS produced (mean ± SD) 1,006 ± 522 pg TNFα/5 × 106 cells; no significant amounts of TNFα were detectable in the presence of dialysate. An inhibition of TNFα release was also observed in MNC exposed to bicarbonate-buffered dialysates (pH 7.40) and 4.25% and 1.5% glucose solution with physiologic osmolality. Incubation of PMNL in Hanks’ buffer followed by A23187 stimulation led to production of 29.1 ± 19.2 ng LTB4/5 × 106 cells, whereas glucose-incubated cells were refractory to ionophore stimulation ( < 0.l ng LTB4/5 × 106 cells). The failure of dialysate-exposed leukocytes to release inflammatory mediators in response to adequate stimuli may contribute to the impairment of cellular host defense in the setting of continuous ambulatory p

ISSN:1660-8151    

DOI:10.1159/000186436

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

We measured the serum parathyroid hormone (PTH) levels in 20 patients treated with continuous ambulatory peritoneal dialysis before and after oral treatment with 24,25-dihydroxyvitamin D3- 24,25(OH)2D3. This metabolite was given in addition to existing treatment with 1α-OH-D3 and calcium carbonate. Administration of 24,25(OH)2D3 led to a significant decrease in PTH levels (intact molecule) from 382 ± (SE) 65 to 245 ± 54 pg/ml in 9 patients whose initial levels were extremely high (p = 0.01). No side effects were observed. On the average, calcium values were unchanged and within the normal range throughout the study period; however, a few episodes of mild asymptomatic hypercalcemia occurred which responded quickly to reduction of the calcium carbonate dosage. The present study suggests that oral administration of 24,25(OH)2D3 combined with 1α-OH-D3 is safe and capable of suppressing the raised serum PTH levels of end-stage renal disease patients without the danger of significant hypercalce

ISSN:1660-8151    

DOI:10.1159/000186437

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Intermittent oral administration of high dose 1,25(OH)2vitamin D3 was conducted in 7 patients associated with treatment-resistant secondary hyperparathyroidism (2nd HPT) on hemodialysis (HD) therapy. Each patient had a long history of HD therapy (range: 101–181 months, 145 ± 29 months). Although serum calcium levels were maintained under the upper limit of the normal range with the appropriate dose of 1α(OH)vitamin D3 every day before the present therapy, 2nd HPT could not have been controlled. The dose of 2–3 μg of l,25(OH)2vitamin D3 3 times a week could successfully suppress serum levels of parathyroid hormone (iPTH) in all 7 patients after 20–32 weeks. The vitamin was given in the evening before each HD session and the dose and frequency of administration were dependent of the serum calcium level in each patient. After 20 weeks the iPTH-C and iPTH-intact levels decreased significantly from 35.0 ± 15.8 to 18.6 ± 11.7 ng/ml and from 533.2 ± 200.0 to 249.5 ± 136.2 pg/ml, respectively. The frequency of harmful elevations of serum calcium levels was not significantly increased in comparison with that in the previous period of the study, because serum calcium levels were strictly monitored with frequent checks. In conclusion, we could safely obtain an effect similar to the intravenous administration of the vitamin through the intermittent administration of a high oral dose 1,25(OH)2vitamin D3 in the treatment of refractory 2nd HPT in patients o

ISSN:1660-8151    

DOI:10.1159/000186438

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Twenty-three normoalbuminuric (N) and 7 microalbuminuric (M) insulin-dependent diabetes mellitus (IDDM) patients were studied under (near) normoglycaemic conditions. They were reasonably well controlled during the period preceding the renal function test (HbA1: N = 7.6 ± 1.3%, M = 8.0 ± 2.2%; normal < 6.0%). Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured using the clearances of 125I-thalamate and 131I-hippuran, respectively. The renal reserve filtration capacity (RRFC) was tested by using a combination of a liquid mixed meal and an amino acid infusion. Blood glucose levels were kept as constant as possible throughout the testing procedure, both under baseline (BL) conditions and after stimulation (S). Under such (near) normoglycaemic conditions, no BL GFR values exceeding 150 ml/min/1.73 m2 could be established. Furthermore, a RRFC could be established in all patients. Both groups showed a comparatively larger increase in GFR (N 13.0 ± 3.8%, M 10.8 ± 3.6%) than in ERPF (N 4.8 ± 7.0%, M 2.2 ± 5.8%; %Δ GFR vs. % ΔERPF p < 0.01), resulting in a higher filtration fraction (FF) during stimulation (N: BL FF 0.25 ± 0.03 vs. S FF 0.27 ± 0.03, p < 0.0l; M: BL FF 0.25 ± 0.01 vs. S FF 0.27 ± 0.01, p < 0.05). This suggests afferent vasodilation during stimulation in these (near) normoglycaemic, reasonably well-controlled IDDM patients, a situation comparable to that in non-diabetic subjects. Thus, reasonably well-controlled normoglycaemic N or M IDDM patients appear to have a (virtually) normal renal function, a normal renal vascular reactivity, and a normal RRFC. In our opinion, these results emphasize the importance of strict metabolic control in IDDM patients to prevent continuous afferent vasodilation and hype

ISSN:1660-8151    

DOI:10.1159/000186439

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The authors investigated the protective effects of the urinary trypsin inhibitor urinastatin on acute renal failure induced in rats by gentamicin (240 mg/kg body weight i.p. for 3 days) and by mercuric chloride (3 mg/kg s.c.). In rats injected with gentamicin, glomerular filtration rate (GFR), renal plasma flow (RPF), and percent fractional sodium excretion (%FENa) were 151 ± 51 μl/min/100 g body weight, 0.69 ± 0.31 ml/min/100 g and 0.73 ± 0.32, respectively, whereas in rats given 100,000 U of urinastatin the renal function was significantly ameliorated (GFR 318 ± 43 μl/min/100 g RPF 1.41 ± 0.35 ml/min/100 g), although the %FENa (0.46 ± 0.26) was not significantly improved. A 50,000-unit dose of urinastatin prevented the deterioration of renal function to some extent following administration of gentamicin: GFR 219 ± 66 μl/min/100 g and RPF 0.93 ± 0.43 ml/min/100 g. In the study using mercuric chloride, treatment with 75,000 U of urinastatin protected the kidney from HgCl2 poisoning, yielding values of 294 ± 93 μl/min/100 g (GFR), 1.03 ± 0.41 ml/min/100 g (RPF), and 1.44 ± 0.72 μl/min/100 g (%FENa) as compared with respective values of 169 ± 48 μl/min/100 g, 0.7 ± 0.18 ml/min/100 g, and 2.22 ± 1.35 in the untreated rats. Renal histology revealed mild to moderate tubular epithelial changes in untreated rats, but preservation of an almost normal tubular structure in urinastatin-treated r

ISSN:1660-8151    

DOI:10.1159/000186440

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The diagnosis of persistent or recurrent hyperparathyroidism after total parathyroidectomy with autograft in the forearm needs a correct assessment of graft function. In 6 patients with relapsing hyperparathyroidism after total parathyroidectomy with forearm implant, total ischaemic blockade of the arm bearing the parathyroid graft, produced a ‘temporal implantectomy’ with reduction of iPTH in those with graft hyperfunction. In 2 patients with proved supernumerary gland, total ischaemia of the ‘graft’ was not followed by iPTH changes. Total ischaemic blockade of the arm bearing the parathyroid graft is a valuable method for a correct assessment of graft function. It gives useful information in order to avoid or indicate a reoperation of the neck in patients who had previously undergone parathyroi

ISSN:1660-8151    

DOI:10.1159/000186441

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Chronic renal failure during childhood may be associated with delayed cognitive development. From 10 children with chronic renal failure, aged 2–59 months, plasma and cerebrospinal fluid (CSF) purines and pyrimidines have been determined. A marked increase of pseudouridine and cytidine was demonstrated in CSF of 10 and 8 children, respectively. The plasma concentration of pseudouridine was increased in a varying degree to a maximal value of more than 10 times the upper limit of normal. The plasma concentration of cytidine showed only moderately elevated values. In 3 children the study of CSF and plasma was repeated 6 weeks after the start of continuous ambulatory peritoneal dialysis. The abnormal concentrations of pseudouridine and cytidine were still present in CSF and plasma. Further studies are necessary to elucidate the cause of this unknown biochemical aberration of the central nervous syste

ISSN:1660-8151    

DOI:10.1159/000186442

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

To assess the effect of substantial increases in blood hemoglobin (Hb) caused by treatment with recombinant human erythropoietin (rhEPO) on exercise capacity in maintenance hemodialysis patients, we evaluated 10 patients (7 men and 3 women) at a mean age of 44.3 ± 8.4 years on maintenance hemodialysis for a mean of 29.7 ± 30.2 months by treadmill exercise to exhaustion. The patients were tested before administration of rhEPO and after a minimum 1 g/dl rise in Hb. With a change in Hb from 7.1 ± 1.4 to 9.8 ± 2.1 g/dl, peak oxygen consumption (VO2 peak) with exercise increased 50.3 ± 9% (T1 = 15.1 ± 5.3, T2 = 22.7 ± 4.6 ml O2/kg/min, p < 0.05). Respiratory exchange ratio (RER) at a given submaximal exercise level (3 mph, 6% of elevation) decreased significantly (T1 = 1.13 ± 0.24, T2 = 0.92 ± 0.08, p < 0.05). The rhEPO-mediated increase in Hb was associated with an increased VO2 peak – an improvement of the peak exercise capacity and a reduced submaximal RER – reflecting a reduction in anaerobic metabolism at activities of

ISSN:1660-8151    

DOI:10.1159/000186443

出版商:S. Karger AG    

年代:1991

数据来源: Karger