ISSN:1660-8151    

DOI:10.1159/000189491

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Hepatocyte growth factor (HGF) facilitates recovery from tissue injuries. We previously reported that serum HGF levels were elevated in chronic renal failure (CRF) patients. In the present study Western blot analysis of CRF patients’ sera showed the majority of their serum HGF was a single-chain precursor molecule. In CRF rats developed by 5/6 nephrectomy or high adenine diet, both HGF mRNA expression levels and tissue HGF concentrations were increased in liver and spleen. The results suggest that HGF production increases in CRF, which may be a response to chronic progressive renal injuries in an endocrine manne

ISSN:1660-8151    

DOI:10.1159/000189492

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Body composition using standard anthropometric methods and dual-energy X-ray absorptiometry (DEXA) was determined in a cross-sectional study among 26 pediatric renal transplant recipients. At the same time, spiroergometry exam, pulmonary function tests, dynamometry and tremometry exams were performed in all patients. Fat body mass obtained by DEXA correlated inversely with maximal physical load during spiroergometry exam (r2 = 0.51, p = 0.0001). The study demonstrates good tolerance of increased physical load in children after renal transplantation. An inverse relationship was found between fat body mass and physical performance. Exercise training programs for children after renal transplantation are therefore suggested.

ISSN:1660-8151    

DOI:10.1159/000189493

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

A prospective randomized trial of use of donor-specific transfusion and cyclosporine given 24 h before operation was performed in living related renal transplant recipients. The benefits, disadvantages and effect on graft and patient outcome was analyzed. Cyclosporine was started 72 h before operation and 48 h before donor-specific transfusion (DST). Fifteen patients received DST while another 15 age- and sex-matched living related renal allograft recipients on similar immunosuppression served as controls. Patient and donor demographics were similar in the two groups. The DST group had significantly fewer rejection episodes than the control group (0.26 vs. 1.1 rejection episode per patient, p < 0.01). There were fewer episodes of acute rejection in the first 3 months posttransplant in the DST group. Hyperresponder recipients (as tested by mixed lymphocyte cultures) also benefitted by DST which significantly reduced the number of acute rejection episodes (0.25 vs. 1 episode per hyperresponder patient, DST vs. control, p < 0.05). The need for dialysis, incidence of infections and other complications were similar in the two groups. Graft function at 3,6,9 and 12 months after transplant was significantly better in the DST group (p < 0.05). Graft survival at 1 year in DST group (85.5%) was not statistically different than control (74.8%). In conclusion, DST and cyclosporine given 24 h before live related renal transplantation is effective in improving graft function and reducing the number of acute rejection episodes which could have a beneficial effect on long-term graft survival.

ISSN:1660-8151    

DOI:10.1159/000189494

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Since kidney transplant recipients are at enhanced risk for developing severe upper gastrointestinal disease and Helicobacter pylori (Hp) is an important pathogen in active gastritis and peptic ulcer, we performed gastroduodenoscopic examination, coupled with assessment of Hp colonization in 29 renal allograft recipients complaining of recurrent dyspepsia. Results were compared with those of 25 chronically hemodialyzed patients and 16 subjects free from renal disease, also suffering from upper gastrointestinal symptoms of similar severity. We found that while transplant recipients have had a high prevalence of Hp infection (62 vs. 34.6% in dialysis and 43.6% in control dyspeptic patients), active gastritis was clearly less frequently seen in these patients than in control subjects (transplant group: 6.9%, dialysis 3.8%, control 31.3%) and peptic ulceration was totally absent. Prevalence of Hp colonization was even higher in renal graft recipients on triple posttransplant immunosuppression (82%). In dyspeptic transplant and dialysis patients, colonization with Hp did not account for development of active inflammatory lesions, an association frequently seen in subjects free from renal disease and immunosuppressive therapy.

ISSN:1660-8151    

DOI:10.1159/000189495

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

In the present study, we have estimated plasma nonrefilling rate and assessed its relationship to blood pressure stability during hemodialysis (HD) with normal or high sodium dialysate and during high flux hemodiafiltration (HDF). In standard HD, the greater plasma nonrefilling rate resulted in the larger decrease in blood pressure (α = -6.7 ± 0.2 mm Hg/%, p < 0.01, n = 75). When compared to standard HD, high flux HDF (n = 6) altered neither plasma refilling nor blood pressure stability. Finally, the restrictive usage of high sodium dialysate reduced plasma nonrefilling rate (21 ± 3 vs. 16 ± 2%, p < 0.05, n = 10) and the magnitude of decrease in blood pressure (16 ± 6 vs. 9 ± 4mm Hg, p < 0.05) without increase in interdialytic weight gain. Our data indicate relative safety of high performance HDF, and warrant judicious use of high sodium dialysate for the HD patients with hypotensive epi

ISSN:1660-8151    

DOI:10.1159/000189496

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The possible beneficial effect of regular exercise training on the progression of chronic renal failure was studied in a prospective randomized controlled study. Thirty patients with a median glomerular filtration rate (GFR) of 25 ml/(min·1.73 m2) (range 10-43) were randomized to physical training (30 min of bicycling daily or an equal amount of other physical activities) or to maintenance of the usual lifestyle. The median maximal work capacity increased significantly in the exercise group and remained unchanged in the control group during a median observation time of 20 months whereas the rate of progression judged by the slope of GFR versus time plot was equal in the two groups. Hence, the beneficial effect of exercise training, earlier observed in rat studies, could not be reproduced in our patients. Physical exercise had no untoward effect on progression of renal disease

ISSN:1660-8151    

DOI:10.1159/000189497

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Although it has been well documented that chronic hemodialysis (HD) patients are highly susceptible to infectious diseases, the reasons for this have yet to be clarified. The present study was thus designed in order to better define this issue. Fifty-eight stable chronic HD patients without any evidence of infection were selected for the study. Blood samples were collected before and after HD from the same patient to determine the effect of HD. Reactive oxygen species (ROS) production in polymorphonuclear cells (PMNC) was measured by chemiluminescence using luminol. When the PMNC collected after HD were stimulated in vitro with a calcium ionophore (A23187), they produced a larger amount of ROS than that obtained from healthy volunteers [mean 7.4 × 105 photon counts (n = 58) vs. 3.0 × 105 photon counts (n = 17); p < 0.01]. A higher production of ROS after HD was seen in patients using membranes such as cellulose triacetate, polymethylmetacrylate and cellulose diacetate, whereas cuprophane did not seem to augment ROS production at all. On the other hand, when the PMNC after HD were stimulated with phorbol myristate acetate, their photon counts (mean 4.3 × 107) were comparable to those before HD (mean 3.5 × 107), and to those of PBMC obtained from healthy volunteers (mean 4.1 × 107). It was thus suggested that the enhanced ROS production of PMNC was related to some stimuli, possibly even to the assay used to measure ROS. The phagocytotic activity and bactericidal effect ofPBMC were measured by coculturing 1 × 105 PMNC with 1 × 105 CFU of Escherichia coli. Similar phagocytotic activities were noted in the PMNC from healthy volunteers and chronic HD patients before and after HD: the mean number of phagocytosed bacteria (log10 CFU) was 3.3, 3.3, and 3.3, respectively. However, in the case of a bactericidal effect, only the PMNC from healthy volunteers, but not the PMNC from HD patients, could effectively kill the bacteria, since the number of bacteria in PMNC decreased from 103.3 to 102.1. The PMNC from HD patients could not kill the bacteria regardless of the characteristics of the membranes. It was thus concluded that the PMNC of chronic HD patients possess an intact phagocytotic activity which impaired bacterial killing, and was probably due to an abnormality occurring in the ROS production p

ISSN:1660-8151    

DOI:10.1159/000189498

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Pruritus is a common symptom among patients undergoing long-term hemodialysis. However, its etiology remains unclear. In an attempt to clarify its cause we tried to correlate pruritus and its intensity with several serological variables in 94 hemodialysis patients. Our results show that higher serum aluminum concentrations are found in dialysis patients with pruritus (p = 0.008) and that the intensity of pruritus is also significantly related to the aluminum concentration (p = 0.007). The intensity of pruritus was also correlated with the calcium-phosphate product (p = 0.03). Our findings suggest that prolonged exposure to aluminum in patients with chronic renal failure might be involved in the pathogenesis of uremic pruritus and elevated calcium-phosphate product seems to be an additional factor predisposing to pruritus.

ISSN:1660-8151    

DOI:10.1159/000189499

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Using light and electron microscopy, we performed an immunohistochemical study of endothelial leukocyte adhesion molecule-1 (ELAM-1), vascular cell adhesion molecule-1 (VCAM-1), and intercellular adhesion molecule-1 (ICAM-1) in 15 patients with IgA nephropathy to clarify the localization of these adhesion molecules. The normal portions of 2 kidneys removed due to localized carcinoma and 3 biopsies from patients without glomerular disease were used as a control. By light microscopy, ELAM-1 VCAM-1 and ICAM-1 all showed positive staining in IgA nephropathy, with the intensity of staining following the sequence ICAM-1 > VCAM-1 > ELAM-1. ELAM-1 and VCAM-1 showed a patchy distribution of moderate staining in the tissues, including the mesangium, crescents, adhesions, and tubules. In contrast, there was marked linear ICAM-1 staining throughout the vascular walls. ELAM-1 and VCAM-1 were positive on the basolateral surfaces of a few proximal tubular epithelial cells in association with inflammatory cell infiltration, while ICAM-1 was found on the brush border. ICAM-1 was positive in the glomerular capillary walls and interstitial vessels of the control kidney tissue, while ELAM-1 and VCAM-1 were virtually absent. By electron microscopy, ELAM-1 positivity on the urinary surface of the parietal/visceral epithelial cells was often associated with adherent mononuclear cells in the urinary space. VCAM-1 positivity was increased in the perinuclear space and/or cytoplasm of mesangial cells as well as at the mesangial cell-endothelial cell interface. These findings suggest that ELAM-1 and VCAM-1 may be more closely related than ICAM-1 to the major histopathological changes occurring in IgA nephropathy, including mesangial expansion, formation of crescents and adhesions, and tubulointerstitial injury.

ISSN:1660-8151    

DOI:10.1159/000189500

出版商:S. Karger AG    

年代:1997

数据来源: Karger