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1.
Cytokines and adhesion molecules in renal vasculitis and lupus nephritis 总被引:20,自引:1,他引:19
Tesar V; Masek Z; Rychlik I; Merta M; Bartunkova J; Stejskalova A; Zabka J; Janatkova I; Fucikova T; Dostal C; Becvar R 《Nephrology, dialysis, transplantation》1998,13(7):1662-1667
Background: Plasma levels of some pro-inflammatory
cytokines and soluble adhesion molecules have been suggested to be useful
parameters to assess the activity of antineutrophil cytoplasmic antibody
(ANCA)-positive vasculitis and lupus nephritis. We hypothesized that the
renal activity of these diseases is better reflected by the urinary
excretion and fractional excretion of these molecules.
Methods: Plasma levels and urinary excretion of tumour
necrosis factor-&agr; (TNF-&agr;), interleukin (IL)-6, IL-8, and
the soluble cell adhesion molecules sICAM-1 and sVCAM-1 were measured by
enzyme-linked immunosorbent assay (ELISA) in 15 patients with ANCA-positive
renal vasculitis (eight active, ANCA-A; six in remission, ANCA-R), six
patients with active lupus nephritis (LN), 15 patients with IgA nephropathy
(IgAN) and nine healthy subjects. Fractional excretion of selected
cytokines and adhesion molecules was also calculated.
Results: Patients with ANCA-A had increased urinary
excretion and fractional excretion of TNF-&agr; (9.27±3.19%
vs 0.58±0.02%, P<0.01), IL-6
(120.79±65.83% vs 1.89±0.34%,
P<0.01) and increased fractional excretion of IL-8
(23.34±6.38% vs 2.56±1.07%,
P<0.01) and sVCAM-1 (0.81±0.33% vs
0.03±0.02%, P<0.01) compared with controls. Urinary
excretion of TNF-&agr; and IL-6 and fractional excretion of
TNF-&agr;, IL-6 and IL-8 were higher in ANCA-A than in ANCA-R. Patients
with LN had increased plasma TNF-&agr; (20.52±2.01 pg/ml
vs 12.33±0.23 pg/ml, P<0.05) and
sVCAM-1 (1537.88±276.36 ng/ml vs
692.26±44.42 ng/ml, P<0.05) and increased urinary
excretion of TNF-&agr; (2.81±0.51 &mgr;g/mol creat
vs 0.98±0.05 &mgr;g/mol creat,
P<0.01), IL-8 (35.78±14.03 &mgr;g/mol creat
vs 12.46±5.19 &mgr;g/mol creat,
P<0.05) and sVCAM-1 (48.98±20.20 &mgr;g/mol creat
vs 2.92±1.35 &mgr;g/mol creat,
P<0.01) compared with controls. Patients with IgAN had, in
comparison with controls only increased plasma TNF-&agr;
(18.10±0.57 pg/ml vs 12.33±0.23
pg/ml, P<0.05). Conclusions: Urinary excretion
and fractional excretion, but not plasma levels of selected proinflammatory
cytokines (TNF-&agr;, IL-6 and IL-8) were increased in patients with
active ANCA-positive renal vasculitis, but not in ANCA positive vasculitis
in remission. These parameters may be useful to monitor the activity of
this disease. 相似文献
2.
Does long-term treatment of renal anaemia with recombinant erythropoietin influence oxidative stress in haemodialysed patients? 总被引:3,自引:3,他引:0
Sommerburg O; Grune T; Hampl H; Riedel E; van Kuijk P; Ehrich J; Siems W 《Nephrology, dialysis, transplantation》1998,13(10):2583-2587
Background. Patients with end-stage renal failure
undergoing haemodialysis (HD) are exposed to oxidative stress. Increased
levels of malondialdehyde (MDA) were demonstrated in plasma of uraemic
patients, indicating accelerated lipid peroxidation (LPO) as a consequence
of multiple pathogenetic factors. The aim of our investigation was to
examine the role of renal anaemia in oxidative stress in HD patients.
Methods. MDA and 4-hydroxynonenal (HNE) were measured
in three groups of patients undergoing HD: group I comprised eight patients
with a blood haemoglobin (Hb) <10 g/dl (mean Hb=8.1±1.3
g/dl), and group II were eight patients with a Hb <10 g/dl (mean
Hb=12.4±1.9 g/dl); none of these 16 patients had been treated
with human recombinant erythropoietin (rHuEpo). Group III comprised 27
patients with a mean Hb of 10.5±1.6 g/dl after long-term rHuEpo
treatment. Results. Mean plasma concentrations of both
MDA and HNE were significantly higher
(P<0.0001) in all 43 HD patients than in 20
healthy controls (MDA 2.85±0.25 vs
0.37± &mgr;M, HNE 0.32± vs
0.10±0.01 &mgr;M). Comprising the three groups, it was shown
that HD patients with a Hb <10 g/dl had significantly higher plasma
levels of LPO products (MDA 3.81±0.86 &mgr;M, HNE
0.45±0.07 &mgr;M) than HD patients with a Hb > 10
g/dl (MDA 2.77±0.58 &mgr;M, HNE 0.25±0.05
&mgr;M), and than HD patients treated with rHuEpo (MDA
2.50±0.12 &mgr;M, HNE 0.29±0.03 &mgr;M).
Furthermore, an inverse correlation between plasma concentration of LPO
products and haemoglobin levels was seen (r=0.62,
P<0.0001). Conclusion.
Radical generation in HD patients might be caused in part by
renal anemia itself. Treatment with rHuEpo may decrease radical generation
effectively in HD patients due to the increase in the number of red blood
cells and blood haemoglobin concentration. Keywords:
erythropoietin; haemodialysis; HNE; lipid peroxidation; MDA;
renal anaemia
相似文献
3.
Insulin resistance is a common denominator of post-transplant diabetes mellitus and impaired glucose tolerance in renal transplant recipients 总被引:5,自引:4,他引:1
Midtvedt K; Hartmann A; Hjelmes; th J; Lund K; Bjerkely B 《Nephrology, dialysis, transplantation》1998,13(2):425-429
Background. Post-transplant diabetes mellitus is a
known complication of steroid therapy in renal transplant recipients. Both
insulin resistance and insulin deficiency have been shown to be necessary
for development of post-transplant diabetes mellitus. It is not known
whether recipients with impaired glucose tolerance have similar degree of
insulin resistance or deficient insulin response as recipients with
post-transplant diabetes mellitus. Methods. To address
this question, we used an oral glucose tolerance test to categorize 46
renal transplant recipients on triple immunosuppressive medication to
groups with normal glucose tolerance, impaired glucose tolerance or
post-transplant diabetes mellitus. Insulin sensitivity was measured using a
hyperinsulinaemic euglycaemic clamp. Insulin response was calculated from
the increase in serum insulin concentration during the oral glucose
tolerance test. Results. Twenty-five were categorized
to normal glucose tolerance, 15 to impaired glucose tolerance and six to
post-transplant diabetes mellitus. There were no statistically significant
differences between the groups regarding prednisolone dose, azathiprine
dose, use of {beta}-blocker, age, gender, weight, waist-hip ratio, body
mass index, donor source, smoking habits, or first-degree relatives with
histories of diabetes mellitus. The impaired glucose tolerance and
post-transplant diabetes mellitus groups showed a significant reduction in
insulin-stimulated glucose disposal rate (mg/kg.min)
compared to the normal glucose tolerance group (4.6±1.6 and
3.4±1.3 respectively vs 7.1±2.4,
P<0.05). The insulin response (picomol/l) was
not different between the normal glucose tolerance and impaired glucose
tolerance groups but was significantly reduced in the post-transplant
diabetes mellitus group (448±310 and 450±291
respectively vs 170±128,
P<0.05).Conclusion.
Insulin resistance is a common denominator of post-transplant
diabetes mellitus and impaired glucose tolerance in renal transplant
recipients. 相似文献
4.
Eugenio Pompeo Willy Coosemans Paul De Leyn George Denette Dirk Van Raemdonck Tony Lerut 《Surgery today》1997,27(8):729-734
A total of 28 colon esophageal replacements performed in children for long gap esophageal atresia (22 patients), and intractable
caustic stricture (6 patients) were reviewed. Emphasis was placed on identifying the pros and cons of the different reconstruction
techniques: intrathoracic route (ITR) (19 patients) and retrosternal route (RSR) (9 patients). No hospital mortality occurred,
whereas a higher morbidity rate occurred among patients operated on using the ITR as opposed to the RSR (68%vs 55%;P not significant). Six patients developed an anastomotic fistula (21% with the ITRvs 22% with the RSR;P not significant), whereas an anastomotic stenosis occurred in 13 patients (67% with the RSR, and 37% with the ITR;P<0.07). Overall, dysphagia was the most prevalent symptom at 3 months follow-up, but had significantly decreased at the final
follow-up (54%vs 16%;P<0.0027). Functional results improved significantly during the follow-up (score 1–2vs score 3–4; Fisher test:P=0.001). However, despite the higher morbidity rate, better functional results were achieved using the ITR as opposed to the
RSR. 相似文献
5.
Navarro J; Marcen R; Teruel J; del Rio R; Gamez C; Mora C; Ortuno J 《Nephrology, dialysis, transplantation》1998,13(1):113-117
Background: We analysed amino-acid losses during
haemodialysis, their influence on plasma amino-acid concentration, and
their possible effects on nutritional state. Methods:
Five patients were dialysed with three membranes: cuprophan (CUP),
polysulphone (PS), and polyacrylonitrile AN69 (PAN). We compared
anthropometric and biochemical parameters after 6 months in patients
dialysed with CUP respect to patients with PAN.
Results: Total losses of amino acids were higher with
PAN than with PS and CUP (6.1±2.3 vs
3.8±1.3, P <0.05, and 3.7±1.3 g/session, P
<0.01 respectively). Losses of essential amino acids (EAA) and
non-essential amino acids (NEAA) were also higher with PAN respect to PS
and CUP (1.8±0.8 vs 1±0.3 and
0.8±0.3, and 4.3±1.6 vs
2.8±1 and 2.9±1.1 g/session, P <0.05). The
percentage reduction for plasma EAA and NEAA were lower with CUP respect to
PS and PAN (11±5% and 20±14% vs
25±10% and 33±11%, and 30±11% and
25±17% respectively, P <0.05). There was no difference in
the nutritional state between patients with CUP and PAN. However, plasma
valine in patients with PAN was lower than in those with CUP
(1.88±0.12 vs 2.13±0.32 mg/dl)
and almost reached statistical significance.
Conclusions: New synthetic membranes are advantageous
with respect to conventional ones, but a disadvantage is the higher
amino-acid losses, especially with polyacrylonitrile. Long-term studies are
necessary to evaluate the impact of amino-acid losses on nutritional state
in patients dialysed with these membranes. 相似文献
6.
Calcified plaque is common in the carotid and femoral arteries of dialysis patients without clinical vascular disease 总被引:15,自引:10,他引:5
Savage T; Clarke A; Giles M; Tomson C; Raine A 《Nephrology, dialysis, transplantation》1998,13(8):2004-2012
Background. Cardiac and vascular mortality are common
in end-stage renal disease (ERSD) and are often attributed to accelerated
atherosclerosis. Subjects and methods. We studied 24
non-diabetic ESRD patients without cardiac or vascular disease (M = 12, F =
12) and 24 age-, sex- and race-matched healthy controls. All underwent
B-mode ultrasound for carotid and femoral intima-media thickness (IMT) and
plaque (% stenosis) together with blood pressure (BP), and echocardiograms
to determine left ventricular mass. Results. Both BP
and mean IMT were similar in patients and controls. However, discrete
plaque was present in 71% (17/24) of patients compared with 21% (5/24) of
controls (P = 0.001), and % stenosis was greater in
patients (carotid 12.2 ± 11% vs 2.3
± 5.9%, P <0.0004; femoral 16.4
± 19.1% vs 3.1 ± 6.4%,
P <0.003). Plaque was soft/atheromatous in 3 of
the 5 controls, but not in any of the 17 patients (P =
0.007), all of whom had calcified lesions. BP and cholesterol were not
correlated with IMT or plaque in patients, but in control subjects carotid
IMT was correlated with systolic BP (r = 0.66,
P <0.0005) and diastolic BP
(r = 0.45, P <0.03). In
patients, the only independent variables related to vascular morphology
were serum albumin which was inversely related to IMT
(P <0.03) and to plaque (carotid
P <0.05, femoral P
<0.02) and age, which was related to femoral plaque only
(P <0.04). Left ventricular end-diastolic
internal dimension not LVMI, correlated positively with carotid IMT
(P <0.04). Conclusion. Our
results show that calcified plaque is common in ESRD patients and
hypoalbuminaemia may be an associated factor. Keywords:
B-mode ultrasound; carotid and femoral artery; end-stage renal
disease; calcification
相似文献
7.
Prevalence, determinants, and clinical significance of hyperhomocyst(e)inaemia in renal-transplant recipients 总被引:1,自引:0,他引:1
Ducloux D; Ruedin C; Gibey R; Vautrin P; Bresson-Vautrin C; Rebibou J; Chalopin J 《Nephrology, dialysis, transplantation》1998,13(11):2890-2893
Background: Previous studies have demonstrated that
hyperhomocyst(e)inaemia is present in patients with impaired renal function
and is correlated with cardiovascular disease. Because conflicting data are
available on the prevalence, determinants, and clinical significance of
hyperhomocyst(e)inaemia in renal-transplant recipients, we conducted the
largest cross-sectional study on homocysteine determinants and clinical
correlates in renal transplant recipients. Methods:
Plasma homocyst(e)ine concentrations and factors known to influence
homocysteine metabolism were analysed in 224 renal transplant recipients.
Atherosclerotic complications were evaluated with respect to plasma
homocysteine concentrations. Results: Mean plasma
homocyst(e)ine was 21.3±9.7 &mgr;mol/l. After adjusting for
age, gender, transplant duration and creatinine clearance, patients with
and without cyclosporin A (CsA) had similar plasma homocyst(e)ine
concentrations (16.9±5.9 &mgr;mol/l in CsA(+) patients
vs 16.3±5.2 &mgr;mol/l in CsA(-)
patients; P=0.3). We found a significant inverse relationship between
plasma homocyst(e)ine and folate concentrations in both CsA(+) (r=-0.243;
P<0.005) and CsA(-) (r=-0.396; P<0.05) patients. Patients
with a past history of cardiovascular events had higher plasma
homocyst(e)ine concentrations (25.2±11.7 mmol/l
vs 20.5±8.8 mmol/l; P<0.005).
Conclusion: Homocyst(e)inaemia is closely related to
renal function and folate concentration in renal-transplant recipients. CsA
does not seem to have direct effects on homocysteine metabolism.
Hyperhomocyst(e)inaemia is associated with cardiovascular disease in
renal-transplant recipients. Prospective placebo-controlled
homocysteine-lowering therapy studies are required in this patient
category. 相似文献
8.
Aucella F; Vigilante M; Scalzulli P; Musto P; Crisetti A; Modoni S; Carotenuto M; Stallone C 《Nephrology, dialysis, transplantation》1998,13(5):1194-1199
Background: In chronic renal failure, desferrioxamine
(DFO) may improve erythropoiesis independent from its aluminium (Al)
chelating effect. The mechanism of this action is still unknown.
Methods: To verify whether DFO influences
proliferation of erythropoietic precursors, we studied 10 patients on
chronic haemodialysis, free from malignancies or other haematological
diseases, iron deficiency, bone marrow fibrosis, and Al toxicity. Al
accumulation was excluded by the DFO test. Peripheral blood samples were
drawn for basal burst-forming unit-erythroid (BFU-E) assay. Mononuclear
cells were isolated by density gradient centrifugation with Ficoll-Hypaque,
and incubated for 15 days with three different experimental conditions: (a)
low-dose recombinant human erythropoietin (rHuEpo) (3 U/ml); (b) high dose
rHuEpo, (30 U/ml); (c) both DFO (167 &mgr;g/ml) and rHuEpo (3 U/ml). We
determined TIBC, transferrin, ferritin, reticulocytes, hypochromic
erythrocytes, soluble transferrin receptor (sTR), haemoglobin (Hb), and
haematocrit (Hct) at baseline and then every 14 days. Patients received 5
mg/kg DFO infused during the last hour of each dialysis session for 6
weeks; six patients remained in the study for an additional 6 more weeks.
BFU-E assays were set up after 6 and 12 weeks of DFO therapy.
Results: At baseline DFO had small effect on BFU-E
proliferation (33.9±25 vs
30.4±25.9) and high-dose rHuEpo had a significant effect
(45.15±27 vs 30.4±25.9,
P<0.01). After 6 weeks of DFO therapy a significant increase in
BFU-E proliferation was observed in all culture conditions
(78.25±32 vs 30.45±25.9 standard
culture, P<0.01; 110.9±30
vs45.15±27 high dose rHuEpo, P<0.01;
98.75±32 vs 45.15±27 DFO
culture, P<0.01). Moreover, the increase in BFU-E proliferation was
significant greater with DFO culture than standard culture (P<0.01).
The same trend was found at the third BFU-E assay, performed in only six
patients, when all culture conditions showed a further increase of
erythroid precursor proliferation. However, the DFO culture was not
significantly greater than the standard culture, while the high-dose rHuEpo
was significantly greater than the DFO culture. Patients in group 1 (n=10),
had a significant increase in reticulocytes (1.5±0.6
vs 1.72±0.3, P<0.01) and of
hypochromic erythrocytes (HE) (5.6±5.1 vs
14.4±12.7, P<0.01), while sTR, Epo, Hb, and Hct were only
minimally increased. Ferritin decreased significantly (448±224
vs 196±215, P<0.01) and TIBC and
transferrin were unchanged. Conclusions: Thus DFO
increases erythroid activity by BFU-E proliferation and increases
reticulocytes in haemodialysis patients. Such an effect may be related to
increased iron utilization. DFO may be a useful tool for anaemic patients
with good iron stores and without Al overload. Key
words: desferrioxamine; erythroid progenitors; erythropoiesis;
haemodialysis
相似文献
9.
Maintenance cyclosporin monotherapy after renal transplantation-clinical predictors of long-term outcome 总被引:1,自引:0,他引:1
Touchard G; Hauet T; Van Weydevelt F; de Ligny B; Peyronnet P; Lebranchu Y; Toupance P N'Doye O; Busson M 《Nephrology, dialysis, transplantation》1997,12(9):1956-1960
Background. There is considerable debate about whether
maintenance cyclosporin (CsA) monotherapy is advisable or not in renal
transplantation. Methods. Between August 1984 and
December 1989, 463 adult patients received a first cadaver graft. Initial
immunosuppression was sequential: antilymphocyte or antithymocyte globulins
(10-14 days), prednisone and azathioprine were combined and CsA was
introduced (6-8 mg/kg/day) when the antilymphocyte or antithymocyte
globulins were discontinued. When the graft function was stable and the
peak of preformed lymphocytotoxic antibodies was &les:25% and/or the
number of rejection episodes was ⩽1, the steroid therapy was
stopped within 1.5-3 months after transplantation, and azathioprine within
3-12 months. Patients with both anti HLA antibodies >25% and more
than one rejection episode were excluded. Cyclosporin doses were adapted
for whole-blood trough levels between 100 and 200 ng/ml (monoclonal
antibody radioimmunoassay or high-performance liquid chromatography).
Cyclosporin monotherapy was attempted in 234 of the 463 patients.
Results. At the end of the investigation in January
1993 (follow-up time >36 months, mean 60.5±4.5 months),
135 patients were receiving CsA without steroids or azathioprine. The 99
CsA monotherapy failures were due to rejection episodes in 48 cases, CsA A
nephrotoxicity in 26 cases, and other causes in 25 cases, including five
deaths and four with poor compliance. Renal function was stable in patients
with successful CsA monotherapy: mean creatininaemia was 124±10
&mgr;mol/l at the time of CsA monotherapy inclusion and
129±10 &mgr;mol/l at the end of follow-up (mean time of CsA
monotherapy 52±6 months). The parameters for predicting
monotherapy success were age (43.2 versus 27.8,
P=0.0014), timing of trial inclusion ⩾6 months post-transplant
(7.9&;plusmn; versus 5.3&;plusmn;3.1 months,
P=0.04), and excellent and stable renal function at the time of inclusion
(124±10 versus 145±32
&mgr;mol/l, P<0.001). Conclusions.
Maintenance CsA monotherapy was effective in 58% of low-immunological-risk
first-graft patients and probably did not jeopardize overall results of our
first grafts: patient and graft survival were respectively 90 and 73% at 6
years. We propose this policy to avoid long-term complications of
glucocorticoid and azathioprine in selected compliant recipients with low
immunological risk, follow-up time post-transplantation >6 months,
and stable creatinaemia levels. 相似文献
10.
Insulin resistance precedes microalbuminuria in patients with insulin-dependent diabetes mellitus 总被引:4,自引:1,他引:3
Background. Insulin resistance has been associated
with hypertension and with renal complications in patients with type 1
diabetes mellitus. Causal relationships have not been fully explained.
Methods. We investigated whether insulin resistance
precedes microalbuminuria by measuring insulin resistance with a
euglycaemic clamp in combination with indirect calorimetry in 16
uncomplicated type 1 diabetic patients and in six healthy control subjects.
The patients had over 10 year duration of diabetes, and were expected to
experience either a complication-free or complicated disease course within
the next few years. They have thereafter been followed for the development
of microalbuminuria for 3 years. Results. In a
euglycaemic insulin clamp glucose disposal was lower in diabetic patients
compared with control subjects (7.5±2.9 and 12.6±2.0
mg/kg LBM/min; P<0.002), mainly due to impaired
glucose storage (4.3±2.3 vs
8.6±1.6 mg/kg LBM/min; P<0.001).
Three years later seven IDDM patients had albumin excretion rate over 30
mg/24 h; glucose disposal (5.5±2.1 vs
9.0±2.2 mg/kg LBM/min; P<0.01) had
been lower in patients who developed microalbuminuria compared with those
who remained normoalbuminuric. Conclusions. Insulin
resistance predicts the increment in urinary albumin excretion. Insulin
resistance depends mainly on impaired glucose storage in uncomplicated
IDDM. 相似文献
11.
Demuth K; Blacher J; Guerin A; Benoit M; Moatti N; Safar M; London G 《Nephrology, dialysis, transplantation》1998,13(2):373-381
Background. Plasma endothelin (ET) is elevated in
end-stage renal disease (ESRD), but the origin and consequences of this
increase remain unclear. In the present study we analysed the relationships
between plasma ET levels and cardiovascular alterations in ESRD.
Methods and results. Common carotid artery (CCA)
intima-media thickness (IMT) and diameter, atherosclerotic plaque
occurrence, and left ventricular (LV) geometry and function were determined
by ultrasound imaging in 76 haemodialysis patients and in 57 age-, sex-,
and blood pressure-matched controls. Arterial stiffness was evaluated via
carotid-femoral pulse wave velocity (CF-PWV), forearm post-ischaemic
vasodilation was measured by venous plethysmography, and plasma ET levels
were determined using a specific immunoenzymoassay. Compared with controls,
ESRD patients had elevated plasma ET levels (1.6±1.4
vs 4.6±3.8 pg/ml;
P<0.001), increased LV mass
(P<0.001), increased CCA-IMT
(P<0.001), a higher prevalence of
atherosclerotic plaques (P<0.001) and increased
CF-PWV (P<0.01). Plasma ET levels correlation
positively with LV outflow velocity integral (r=0.57;
P<0.0001), stroke index
(P<0.01), and baseline forearm blood flow
(P<0.001) which were all significantly higher
in ESRD patients than in controls (P<0.01).
After adjustment for age, blood pressure, haemoglobin levels, gender and
body dimensions, plasma ET levels were significantly correlated to LV mass
(r=0.46; P<0.001), CCA-IMT
and CCA intima -media cross-sectional area (r=0.41;
P<0.001), and CF-PWV
(p<0.05). Post-ischaemic forearm vasodilation
was decreased in ESRD (85±31 vs
119±28%; P<0.001) and there was a
negative correlation between post-ischaemic flow recovery and ET levels
(r=-0.49; P<0.001). In
ESRD patients, plasma ET levels were positively and independently
correlated with the prevalence of CCA atherosclerotic plaque
(P<0.01). Conclusions.
These results indicate that the increased plasma ET levels in
ESRD patients are associated with left ventricular hypertrophy and arterial
intima-media thickening, suggesting that increased ET concentrations in
ESRD patients may be of pathophysiological significance in the process of
cardiovascular remodelling. 相似文献
12.
Dotsch J; Hanze J; Knufer V; Steiss J; Dittrich K; Seidel A; Rascher W 《Nephrology, dialysis, transplantation》1998,13(7):1686-1689
Background: Adrenomedullin (AM), a smooth-muscle
relaxant peptide, is stimulated by cytokines and bacterial endotoxins. We
hypothesized that urinary-tract infections may be associated with elevated
urinary AM excretion. Methods: AM in urine was
quantified in eleven children with urinary-tract infection and 11 age- and
sex-matched controls by radioimmunoassay. RT-PCR was used to demonstrate
local AM mRNA expression in the urinary tract.
Results: In healthy controls but not in diseased
children there was a significant correlation between AM and creatinine in
urine (r-0.91, P<0.001). AM levels in children with urinary tract
infection were significantly higher than in controls (0.6±0.41
vs 0.15±0.14 ng/&mgr;mol creatinine;
P<0.001; (means±SD)). There was a significant correlation
between white cell count and AM in urine (r-0.78, P<0.001). AM mRNA
was expressed in renal tissue, renal pelvis, ureter, bladder, and urethra.
Conclusion: The smooth-muscle relaxant peptide
adrenomedullin that is synthesized in tissue of the human urinary tract is
elevated in urine of patients with urinary-tract infections. A possible
consequence might be the interference with the ureteral anti-reflux
mechanisms. 相似文献
13.
Safety and efficacy of pulse and daily calcitriol in patients on CAPD: a randomized trial 总被引:2,自引:1,他引:1
Moe S; Kraus M; Gassensmith C; Fineberg N; Gannon F; Peacock M 《Nephrology, dialysis, transplantation》1998,13(5):1234-1241
Background: Calcitriol therapy is the mainstay of
therapy for the treatment of secondary hyperparathyroidism. Oral
administration of calcitriol is necessary in CAPD patients, but no studies
have directly compared different routes of administration in this patient
population. Methods: To determine if the peak serum
calcitriol level (pulse therapy) is more important than the total delivered
dose, we randomized CAPD patients with mild to moderate secondary
hyperparathyroidism to receive either pulse (3.0 &mgr;g twice a week,
n=10) or daily (0.75 &mgr;g a day, n=8) oral calcitriol in comparable
weekly doses. The main comparison was the rate of decline of serum intact
parathyroid hormone (PTH) levels to reach the desired end-point of 100
pg/ml. The patients were dialysed with low-calcium dialysate and received
only calcium-containing phosphate binders. Results:
Pharmacokinetic analysis after a single dose of 3.0 &mgr;g (pulse)
vs 0.75 &mgr;g (daily) revealed 1,25(OH)2-vitamin
D levels to be higher in the pulse group at 3 and 6 h, but equivalent by 12
h. The area under the curve for 1 week of daily and 1 week of pulse therapy
was equal. The patients in the 2 arms had equivalent basal serum levels of
PTH (pulse=562±291 vs
daily=454±113 pg/ml), calcium (pulse=2.32±0.20
vs daily=2.32±0.12 mmol/l) and phosphorus
(pulse=1.32±0.52 vs
daily=1.35±0.26 mmol/l). The time required for the PTH to
decrease to 100 pg/ml and rate of decline in PTH were similar (time:
pulse=14.2±6.8 weeks, daily=12.2±7 weeks; rate:
pulse=7.4±4.2 vs daily=8.4±4.2%
PTH/week; P=NS). The serum calcium increased similarly in both groups.
Hypercalcaemia (>2.9 mmol/l) was rare (pulse=3, daily=2 episodes).
Conclusions: This study demonstrates that pulse and
daily calcitriol are similarly effective and safe for the treatment of mild
to moderate secondary hyperparathyroidism in CAPD patients despite higher
peak levels of 1,25(OH)2-vitamin D with pulse therapy. Key
words: calcitriol; calcium balance; CAPD; dialysis;
hyperparathyroidism; renal osteodystrophy
相似文献
14.
Mohsen Nafar Farhat Farrokhi Mohammad Vaezi Amir-Ebrahim Entezari Fatemeh Pour-Reza-Gholi Ahmad Firoozan Behzad Eniollahi 《International urology and nephrology》2009,41(3):687-693
Background Serum levels of soluble CD30 (sCD30) have been considered as a predictor of acute kidney allograft rejection. We have evaluated
the pre-transplant and post-transplant levels of sCD30 with the aim of determining its value in predicting and diagnosing
kidney rejection.
Methods We measured sCD30 serum levels before kidney transplantation, 5 days post-operatively, and at creatinine elevation episodes.
The predictive value of sCD30 for diagnosing acute rejection (AR) within the first 6 post-operative months was assessed in
203 kidney recipients from living donors.
Results Pre-transplant and post-operative levels of serum sCD30 were 58.10 ± 52.55 and 51.55 ± 49.65 U/ml, respectively (P = 0.12). Twenty-three patients experienced biopsy-proven acute rejection, and 28 had acute allograft dysfunction due to non-immunologic
diseases. The pre-transplant sCD30 level was not different between patients with and without AR. However, post-transplant
sCD30 was higher in the AR group. The median serum level of post-transplant sCD30 was 52 U/ml in the AR group and 26.3 U/ml
in a control group (P < 0.001). The relative changes of sCD30 on day 5 were higher in patients with AR (P = 0.003). Based on post-transplant sCD30 levels, we were able to differentiate between kidney recipients who experienced
an AR within 6 months post-surgery and those without an AR (cutoff value 41 U/ml; sensitivity 70%; specificity 71.7%). The
level of sCD30 during periods of elevated serum creatinine was not independently associated with the diagnosis of AR.
Conclusion Post-transplant sCD30 levels and their relative changes are higher in patients experiencing AR. We propose further studies
on the post-transplant trend of this marker for the prediction of AR. 相似文献
15.
Background. Intravenous iron supplementation is often
necessary in recombinant human erythropoietin (r-HuEPO)-treated
haemodialysis (HD) patients, but rarely in r-HuEPO-treated peritoneal
dialysis (PD) patients. This may be due to differences in iron absorption
or blood loss. Method. Iron absorption (whole-body
counting after ingestion of a radiolabelled iron test dose) and iron
metabolism were compared in eight iron-replete r-HuEPO-treated PD patients
(serum ferritin 100-500 &mgr;g/l) and 68 healthy iron-replete controls
(sufficient iron in bone marrow specimen). Results.
Mucosal uptake (13.4±9.8), mucosal transfer
(0.34±0.18) and iron retention (4.9±4.0) in PD
patients was significantly lower than in controls (42.9±18.8%,
P<0.0001, 0.63±0.18,
P<0.0001, and 28.0±16.7%,
P<0.0001). Conclusion.
Iron absorption is impaired in PD patients, as we have shown
previously for HD patients. One reason for higher iron needs in HD patients
may be higher blood losses due to the dialysis procedure and blood sampling
for laboratory tests. 相似文献
16.
Inflammatory reactions after vascular prosthesis implantation: A comparison of gelatin-sealed and unsealed dacron prostheses 总被引:1,自引:0,他引:1
Junichi Utoh Yoshimasa Miyauchi Hiraaki Goto Hiroyuki Obayashi Tomomi Hirata 《Surgery today》1996,26(4):258-261
Despite widespread use of the gelatin-sealed knitted Dacron prosthesis (GDP) in clinical practice owing to its zero porosity, the biological impacts of this graft are still controversial. We conducted a randomized controlled study on 50 patients undergoing abdominal aortic aneurysm repair to evaluate the inflammatory reaction to GDP (n=25) and unsealed knitted Dacron prostheses (UDP, n=25). There were no significant differences in the mean age, size of the aneurysm, operative time, blood loss, or transfusion requirements between the GDP and UDP groups. During the first 7 postoperative days (PODs), slight fever and leukocytosis were noticed in both groups. Significant differences in maximum body temperature, leukocyte count, and plasma C-reactive protein concentration were observed between the GDP and VDP groups on POD 14: 37.2±0.5°C vs 36.9±0.3°C (P=0.019), 8,151±1,788/l vs 6,914±1,501/l (P=0.015), and 32.6±27.5mg/l vs 19.0±15.8mg/l (P=0.048), respectively. By POD 21, however, there were no detectable differences in these variables. Thus, we concluded that GDP caused an inflammatory reaction in the 2nd week after implantation, but ultimately there were no significant differences from UDP by the 3rd week. 相似文献
17.
Long-term linear growth of children with severe steroid-responsive nephrotic syndrome 总被引:2,自引:0,他引:2
The present study was designed to evaluate the risk of permanent linear growth impairment in a selected group of 42 children with steroid-dependent nephrotic syndrome (SDNS) and 14 children with frequently relapsing nephrotic syndrome (FRNS). Longitudinal height measurements were available in all patients from the onset of the disease for a mean follow-up of 11.7±3.5 years. During the prepubertal period, patients lost 0.49±0.6 height SD score (HtSDS) (P<0.001). Twenty-three patients have reached their final height with an average loss of 0.92±0.8 HtSDS from the onset of their disease (P<0.001) and 0.68±0.7 from their target HtSDS (P<0.001). The pubertal growth spurt was mildly delayed in male but not female patients. Steroid therapy, calculated as the mean duration of prednisone (PDN) treatment or as the average cumulative PDN dose, was the only predictor of poor growth evolution. Partial catch-up growth occurred after PDN withdrawal. Children with early onset NS and adolescent patients, who were still receiving PDN after the age of 9 years in girls and 11 years in boys, were at higher risk for HtSDS loss. In conclusion, children with severe steroid-responsive NS are at risk of permanent growth retardation secondary to prolonged courses of steroid treatment. 相似文献
18.
Ducloux D Bamoulid J Courivaud C Gaugler B Rebibou JM Ferrand C Chalopin JM Borg C Tiberghien P Saas P 《Transplant immunology》2011,25(1):56-60
Background
Prolonged CD4 T cell lymphopenia after polyclonal antithymocyte globulins (ATG) is associated with an increased rate of cancers. Here, we examined whether pre-transplant thymic function estimated by TREC levels is predictive of cancer occurrence following ATG treatment.Patients and methods
The impact of TREC on cancer occurrence was analyzed in 115 consecutive incident renal transplant recipients having received ATG.Results
Mean follow-up was 7.5 ± 2.6 years. After ATG induction, patients with the lowest pre-transplant TREC values had lower post-transplant CD4+ and CD4+ CD45RA+ CD45RO− T cell counts, and a higher frequency of T cells with a regulatory phenotype (CD127+CD4+CD25+Foxp3+). Log-transformed pre-transplant TREC values were significantly lower in patients who developed cancer after transplantation (p < 0.0001). The cumulative incidence of cancer was higher in patients having the lowest pre-transplant TREC values (T1 [low]: 47.4%, T2 [medium]: 12.5%, and T3 [high]: 2.7%; p < 0.0001). In multivariate analysis, pre-transplant TREC value was the only predictive factor of cancer (HR, 0.39; 95% CI, 0.16 to 0.97, for one log (TREC/106 PBMC); p = 0.046).Conclusions
Pre-transplant thymic function is associated with an increased rate of post-transplant cancer in patients having received ATG. Omitting ATG in recipients with low pre-transplant TREC values should be considered. 相似文献19.
N.M. Abdelhamid Y.-C. Chen Y.-C. Wang C.-H. Cheng T.-J. Wu C.-F. Lee T.-H. Wu H.-S. Chou K.-M. Chan W.-C. Lee R.-S. Soong 《Transplantation proceedings》2017,49(1):92-97
Background
The prognosis of patients after liver transplantation (LTx) with high Model of End-Stage Liver Disease (MELD) score (>30) is predicted, but patients with lower MELD scores (<30) have no conclusive studies of pre- and post-transplant risk factors that influence the long-term outcome.Methods
This retrospective study reviewed 268 recipients with MELD score <30, from 2008 to 2013 in our institution, for evaluation of pre-transplant risk factors including patients' clinical background data, pre-transplant lymphocyte subpopulation, and early post-transplant infection complication as predictors for long-term survival after LTx.Results
The post-transplant patients' survival estimates were 90.7%, 85.1%, and 83.6% at 1, 3, and 5 years, respectively. In multivariate analysis, age >55years, presence of ascites, cluster of differentiation (CD)3 < 93.2 (count/μL), CD4/CD8 <2.4, fungal infection, and more than one site of fungal colonization significantly influenced survival (P = .0003, P = .002, P = .04, P = .004, P < .0001, and P > .0001, respectively). We also noticed that these five factors accumulatively influence the long-term survival rate; this means that in the presence of any two risk factors, the 5-year survival can still be 88.4%, whereas in the presence of any three risk factors, the survival rate dropped to only 57.1%.Conclusions
Older patients in the presence of pre-transplant low immune cell number and ascites in association with post-transplant fungal infection are the independent risk factors in MELD scores <30 LTx groups for long-term survival. Patients in these groups with any of the three factors had inferior long-term survival results. 相似文献20.
De L. Yang PhD MD Qi W. Xu PhD MD Xiao M. Che PhD MD Jin S. Wu PhD MD Bin Sun PhD MD 《Surgical neurology》2009,72(6):682-689