Influence of water and sodium diuresis and furosemide on urinary excretion of vitamin B(6), oxalic acid and vitamin C in chronic renal failure

Urinary excretion of vitamin B(6), oxalic acid and vitamin C was investigated in 15 healthy subjects during maximal water diuresis and in the group of 12 patients in polyuric stage of chronic renal failure without dialysis treatment receiving a diet containing high sodium chloride (15g/day). Urinary excretions of the same parameters were investigated in another group of 15 patients in polyuric stage of chronic renal failure without dialysis treatment after i.v. administration of 20 mg furosemide. Urinary excretion of vitamin B(6), oxalic acid and vitamin C significantly increased during maximal water diuresis while during high intake of sodium chloride the urinary excretions of these substances were not affected. The results suggest that urinary excretion of vitamin B(6), oxalic acid and vitamin C depends on the urinary excretion of water. Intravenous administration of 20 mg furosemide led to an increase of urinary excretion of vitamin B(6), oxalic acid and vitamin C in patients with chronic renal failure. The increased urinary excretion of vitamin B(6) and vitamin C is a new negative side effect of furosemide and increased urinary excretion of oxalic acid is a new positive side effect in patients with chronic renal failure.     

Re-evaluation of ascorbic acid deficiency in hemodialysed patients

In 92 uremic patients under chronic hemodialysis without ascorbic acid supplementation, serum ascorbic acid was measured before hemodialysis and between two sessions. The results indicated a more serious ascorbic acid deficiency of patients than in previous studies. This difference might be explained by the highly specific enzymatic method applied in the present study, excluding any potential interference of various serum reducing substances.     

Discordant rise in galactomannan antigenemia in a patient with resolving Aspergillosis, renal failure, and ongoing hemodialysis

We describe the case of a patient with improving invasive aspergillosis and paradoxically rising serum galactomannan levels in the presence of chronic renal failure and ongoing hemodialysis. Dialysate tested negative for galactomannan, demonstrating the inability of treatments such as hemodialysis to clear Aspergillus antigen from serum. In patients with renal failure and aspergillosis, rising serum galactomannan levels may not necessarily signify progressive infection.     

Serum ascorbic acid in patients undergoing chronic hemodialysis

Serum presupplementation ascorbic acid levels were subnormal in 8 out of 10 patients undergoing chronic hemodialysis with capillary film and capillary flow dialyzers, the mean duration of treatment being 11 months. Supplementation with 100 mg ascorbic acid daily for two weeks raised the ascorbic acid values to normal in 9 out of 10 patients. After supplementation with 500 mg daily, all patients had ascorbic acid levels exceeding the normal upper limit, and 3 of them had gastrointestinal side-effects. The mean blood pH value, measured in 24 patients on chronic hemodialysis, showed a significant, though slight, decrease during supplementation with 500 mg daily as compared with the mean presupplementation value, but no statistically significant changes were observed in blood bicarbonate, base excess or PCO2 values.     

Plasma erythropoietin levels in patients undergoing long-term hemodialysis

The anemia of chronic renal disease has been attributed primarily to a decrease in erythropoietin (EP) production. Results of this study show that measurable levels of plasma EP can be demonstrated in a majority of patients with end-stage renal failure who are undergoing long-term hemodialysis. These levels were not related to the type of renal disease, nor were they greatly affected by androgenic therapy or by nephrectomy. Although EP elevations in such patients were somewhat less than in nonuremic patients with comparable anemia, the presence of measurable EP levels suggests that impaired end-organ response may play a role in the anemia of chronic renal failure.     

Chronic T-lymphocyte activation in chronic renal failure: a study of hemodialysis, CAPD and pre-dialysis patients.

In this study we measured indices of T-lymphocyte activation in normal volunteers, chronic hemodialysis patients, CAPD patients and chronic renal failure patients not yet on dialysis. Serum IL-2 levels were elevated in patients compared to controls. Soluble IL-2 receptors were elevated in all three patient groups and were highest in CAPD patients. Clearance of IL-2 and soluble interleukin receptors was negligible in dialysis and renal failure patients. Hemodialysis patients had a significantly lower percentage of CD3-positive cells than all other groups. Hemodialysis with a variety of membrane/bath combinations did not significantly affect any of the parameters measured. This study provides some support for the hypothesis that chronic T-cell activation is present in renal failure.     

慢性肾功能衰竭患者血透前后血浆leptin和血清VEGF、HGF检测的临床意义

目的：探讨了慢性肾功能衰竭（CRF）患者血透前后血浆leptin和血清VEGF、HGF水平的变化及意义。方法：应用放射免疫分析和酶联法对32例CRF患者进行了血透前后血浆leptin和血清VEGF、HGF检测,并与35名正常健康人作比较。结果：CRF在血透前血浆leptin和血清VEGF、HGF水平非常显著地高于正常人组（P〈0.01）。结论：CRF患者存在高leptin、VEGF、HGF血症。血透可增加leptin、VEGF和HGF的清除率,具有重要的临床价值。     

Reversal of severe lactic acidosis with thiamine in a renal allograft recipient

A 48-year-old female patient with end-stage renal failure developed unexplained severe lactic acidosis (LA) associated with hyperglycemia during robotic-assisted laparoscopic renal transplantation. Initial treatment with sodium bicarbonate and insulin infusion were ineffective in treating acidemia. Postoperatively, intravenous administration of thiamine resulted in rapid improvement of LA and blood sugar levels. Uremia and chronic hemodialysis might be the causes behind the quantitative/qualitative deficiency of thiamine unmasked during the surgical stress. Though a rare entity, acute thiamine deficiency should be considered in the differential diagnosis of unexplained severe LA in patients with chronic kidney disease and hemodialysis who undergo major surgery or admitted to critical illness care units.     

慢性肾衰患者外周血IL-18水平及血液透析对其的影响

为探讨慢性肾衰竭 (CRF )患者外周血IL 18表达量的变化以及血液透析 (HD )对其表达的影响 ,选取 10名健康志愿者及 2 9例CRF患者 ,应用ELISA测定血浆IL 18水平 ,同时采用半定量逆转录多聚酶链反应 (RT PCR )技术 ,检测PBMC中IL 18mRNA表达量。结果是未行HD的CRF患者血浆IL 18水平及PBMCIL 18mRNA表达量较正常对照组增高 ,差异有显著统计学意义 (P <0 0 1) ,单次HD对CRF患者血浆IL 18水平及基因表达无明显影响 (P >0 0 5 ) ,但长期维持HD则可使CRF患者外周血IL 18水平及基因表达增高 (P <0 0 5 )。提示外周血IL 18的高表达可能参与CRF的发病过程及HD相关并发症的发生发展     

Oxalate bone disease--an emerging form of renal osteodystrophy

Rosette-like arrays of highly birefringent calcium oxalate crystals are commonly seen in the marrow space of bone biopsy specimens taken from patients with primary hyperoxaluria, particularly if complicated by renal failure. Similar deposits have been described in chronic hemodialysis patients with secondary forms of oxalosis. Large multinucleated histiocytes may be seen surrounding these crystal deposits. Many of these cells are histologically indistinguishable from osteoclasts. We present a patient in whom this histiocytic reaction appeared to be of sufficient magnitude to stimulate bone resorption and to cause severe osteodystrophy. This observation, and those of other investigators reviewed in the discussion, suggest that oxalate deposition within bone may contribute to the pathogenesis of uremic osteodystrophy in chronic renal failure patients with primary or secondary types of oxalosis.     

The relationship between anticardiolipin antibodies and vascular access occlusion in patients on hemodialysis

Vascular access occlusion is frequently seen in some patients on hemodialysis. There are different opinions about pathogenesis of recurrent access thrombosis. Anticardiolipin (aCL) antibodies have been suggested to be involved in thrombosis and can be found in a high proportion of patients with chronic renal failure. We investigated the relationship between vascular access occlusion and the level of aCL antibodies in hemodialysis patients. We measured serum IgG and IgM aCL antibodies and protein C levels in 50 patients on hemodialysis having no fistule thrombosis (group 1), in 33 patients on hemodialysis with fistule thrombosis (group 2), and 20 nondialyzed patients with chronic renal failure (group 3). There were no differences in age and duration on hemodialysis (p > 0.05). No significant correlation was found between protein C and platelet counts in all groups (p > 0.05). In group 1, aCL IgG and IgM were 2%. In group 2, aCL IgG and IgM were 6.06% and 0%, respectively. In group 3, aCL IgG and IgM were negative. We did not find any significant difference between aCL IgG and IgM in all groups (p > 0.05). No association was found between aCL antibodies and vascular access thrombosis in our patients on hemodialysis.     

慢性肾功能衰竭血液透析患者皮肤瘙痒原因及护理对策

目的 分析慢性肾功能衰竭血液透析患者皮肤瘙痒原因及护理对策。方法 选择2018年3月~2019年3月在我院进行血液透析合并皮肤瘙痒的56例慢性肾功能衰竭患者临床资料,分析皮肤瘙痒原因,并给予并发症针对性护理对策,观察临床治疗总有效率,比较护理前后瘙痒症状评分。结果 56例患者中34例为电解质代谢障碍,占60.71%;17例为氮质代谢产物刺激皮肤,占30.35%,5例为过敏反应,占8.92%;通过对症护理后,总有效率为91.07%;护理后瘙痒症状评分为（2.11±0.33）分,低于护理前的（3.77±0.18）分,差异有统计学意义（P＜0.05）。结论 皮肤瘙痒是慢性肾功能衰竭血液透析患者常见的并发症,主要与电解质代谢障碍、氮质代谢产物刺激皮肤以及过敏反应相关,临床给予针对性护理对策,治疗总有效率高,瘙痒症状明显减轻。     

慢性肾功能衰竭患者血透前后血浆leptin和NPY检测的临床意义

目的：探讨了慢性肾功能衰竭患者血透前后血浆leptin和NPY水平的变化及意义。方法：应用放射免疫分析对31例慢性肾功能衰竭患者进行了血透前后血浆leptin和NPY水平的变化,并与35名正常健康人作比较。结果：慢性肾功能衰竭患者在血透前血浆leptin和NPY水平非常显著地高于正常人组（P〈0.01）,血透后1周与正常人组比较仍有显著性差异（P〈0.05）。结论：慢性肾功能衰竭患者存在高leptin和NPY血症,血透有增加leptin和NPY的消除率,具有重要的临床价值。     

In vivo and in vitro degradation of urea and uric acid by encapsulated genetically modified microorganisms

This study was undertaken to characterize the capacity of a combination of genetically modified bacteria to lower elevated levels of urea and uric acid and thus to serve as a potential adjunct to maintenance dialysis in patients with chronic renal failure. Two strains of genetically modified bacteria expressing enzymes, urease to degrade urea and uricase to degrade uric acid, were identified, combined, and dispersed in 600-microm alginate microcapsules suitable for oral administration. In 24 h in vitro experiments, 5 mL of these capsules completely cleared 95% of the urea and >99% of the uric acid from 100 mL of a challenge solution formulated to the concentration of these solutes in a presenting hemodialysis patient. The process of urea degradation was found to be intracellular and each bacterial strain was specific for its substrate. Solute degradation in vivo was evaluated with a chemically induced model of acute renal failure, using Sprague-Dawley rats. Orally administered capsules were found to remain in the gastrointestinal tract for at least 6 h. The severity of azotemia and hyperuricaemia after chemical induction of acute renal failure was reduced by 64 and 31%, respectively, on administration of the capsules. Reduction of urea concentration (but not uric acid concentration) in vivo required coadministration of an ion-exchange resin to adsorb ammonia. Oral delivery of a combination of genetically modified microorganisms should be further explored in chronic renal failure models as a useful adjunct to dialysis or to immunosorption for the treatment of uremia.     

生长激素对慢性肾衰患者的免疫调节作用

生长激素(GH)是一种亲水性球蛋白,主要分泌于腺垂体.同时免疫器官,如胸腺、脾脏和外周血细胞,也可分泌GH,而GH受体在各种淋巴细胞中也有表达.GH除能够促进机体生长、代谢外,还具有一定的免疫调节作用.慢性肾衰患者存在着明显的免疫抑制,细胞免疫及体液免疫均受损,在长期血透患者中表现明显,如高感染性疾病并发率,注射疫苗后的反应性较差,恶性肿瘤发生率较正常人偏高.同时慢性肾衰患者也存在着生长激素抵抗现象,血液循环中生长激素水平正常甚至偏高,但生物活性偏低.慢性肾衰儿童生长较正常儿童迟缓,成人蛋白质分解代谢增强,合成代谢不足,而外源性生长激素在慢性.肾衰中的应用可起到一定的免疫调节作用.     

维持性血液透析患者行冠状动脉搭桥术的临床分析

目的通过分析2例尿毒症维持性血液透析(HD)患者冠状动脉搭桥术(CABG)围手术期资料,探讨维持性血液透析患者行CABG的安全性。方法回顾性分析2例尿毒症维持性血液透析患者行冠状动脉搭桥术的临床资料。结果手术前一天均给予无肝素透析,术后均行持续床旁血液滤过透析(CHDF)。1例患者经完善的围手术期处理,手术成功,患者存活,生活质量明显改善;1例患者术后第3天于血液透析后死于心包填塞。结论维持性血液透析患者经过积极、周密的术前准备,术中及术后处理,可以接受冠状动脉搭桥术,可达到改善症状、提高生活质量、延长生命的目的。CHDF是慢性肾功能衰竭患者围手术期有效维持水、电解质平衡的透析方式。     

Complement activation in patients with renal failure as detected through the quantitation of fragments of the complement proteins C3, C5, and factor B

Summary Using sensitive and highly specific enzyme-linked immunosorbent assays fragments of the complement proteins C3, C5, and factor B were quantitated in patients with renal failure. During hemodialysis on new cuprophan membranes raised levels not only of C3a, but in addition of activated C3, C5a, and Ba were demonstrated. In patients with chronic renal failure and end-stage renal disease plasma concentrations of Ba and activated C3 were markedly elevated independent of hemodialysis. This finding is taken as an indication of a continuous recruitment of the alternative pathway of complement in these patients. As the detected complement protein fragments are known to exert immune regulatory functions these findings may imply that these peptides are involved in the maintenance of the immune suppressed state in renal failure.Abbreviations ABTS 2.2 azino-di (3-ethyl-benzthiazoline sulfonate) - actC3 activated C3 - APC alternative pathway of the complement system - CPC classial pathway of the complement system - CRF chronic renal failure - EDTA ethylenediaminetetraacetic acid - ELISA enzyme-linked immunosorbent assay - ESRD end-stage renal disease - mAb monoclonal antibody     

Prevalence of hepatitis B, hepatitis C, GB virus C/hepatitis G and TT viruses in predialysis and hemodialysis patients

Patients with chronic renal failure on hemodialysis have a high risk of infections with viruses such as hepatitis B (HBV), hepatitis C (HCV), GB virus C/hepatitis G (GBV-C/HGV) and TT (TTV) viruses. The prevalence of HBV, HCV, GBV-C/HGV and TTV in patients with chronic renal failure who are on conservative management before entering into a hemodialysis program (predialysis) in comparison with hemodialyzed patients was studied to elucidate whether the high prevalence of these viruses is influenced by that observed in the predialysis stage. The presence of hepatitis B virus surface antigen (HBsAg), HCV RNA, GBV-C/HGV RNA and TTV DNA was analyzed in sera from 80 patients with chronic renal failure (35 on predialysis and 45 on hemodialysis). HBsAg, HCV RNA, GBV-C/HGV RNA and TTV DNA were detected in one (2.8%), six (17.1%), eight (22.5%) and 16 (45.7%) of the 35 patients on predialysis. Two (5.7%) of these patients were coinfected with HCV and GBV-C/HGV, whereas six (17.1%) had GBV-C/HGV and TTV coinfection. In the 45 hemodialyzed patients, HBsAg, HCV RNA, GBV-C/HGV RNA and TTV DNA were detected in one (2.2%), two (4.4%), seven (15.5%) and 26 (57.7%). One (2.2%) patient had HBV and TTV coinfection, two (4.4%) HCV and TTV coinfection whereas four (8.8%) were coinfected with GBV-C/HGV and TTV. No differences regarding age, gender, previous surgery and number of transfusions were found between infected and uninfected patients within and between both groups. In conclusion, the prevalence of the viruses studied in predialysis may influence their prevalence in dialysis units.     

Uremic polyneuropathy

Uremic polyneuropathy is probably the most common complication of chronic renal failure. About 70 percent of dialysis patients regularly have uremic polyneuropathy, in 30 percent the neuropathy is moderate or severe. Coexistence of muscle weakness and atrophy, areflexia, sensory loss and graded distribution of neurologic deficit in a patient with renal disease suggests the presence of uremic polyneuropathy. During longterm hemodialysis, the symptoms of polyneuropathy stabilize, but they improve only in relatively few patients. Complete recovery, occurring over a period of 6 to 12 months, usually follows successful renal transplantation.     

Disturbance of the autonomic nerve system in patients with chronic renal failure--represented by variation coefficient of R-R intervals in the ECG as a parameter

Autonomic nerve dysfunction in patients with chronic renal failure has of late become an issue to be investigated. R-R intervals in resting electrocardiograms were measured to evaluate activities of the cardiac parasympathetic nerve system. A total of 140 patients with chronic renal failure were studied to be compared with 20 normal controls (cont.) and 39 with diabetes mellitus (DM). Of these patients 15 were subjected to conservative treatment (CRF), while 125 patients were undergoing hemodialysis due to chronic renal failure-100 of them derived from chronic glomerulonephritis (HD) and 25 from diabetes mellitus (DM.HD). The variation coefficient of the R-R interval (CVRR) was measured after the subject patients had rested for over 15 minutes before a dialysis session. The mean CVRR were 2.15 +/- 1.25% in CRF group, 2.36 +/- 1.37% in HD and 1.37 +/- 0.99% in DM.HD. These values were significantly lower than in control group (4.70 +/- 2.64%). On the other hand, the value in DM.HD group, as shown above, was significantly lower than in HD. In CRF group the CVRR values lowered as residual renal functions decreased. No significant correlations between CVRR S and the duration of hemodialysis treatment were noted among the groups. In HD group the CVRR S were significantly lower in patients with hypotensive tendency during hemodialysis than in those who enjoyed good control of blood pressure. These results suggest that the measurement of CVRR S can be of help in evaluating autonomic nerve dysfunction in patients with chronic renal failure.