The effect of therapy with small doses of mega-3 polyunsaturated fatty acid on renal reserve and metabolic disturbances in patients with primary IGA glomerulopathy

Renal reserve is believed to be diagnostic dynamic method for accessing both early renal failure and renal vascular reactivity. The aim of our study was to follow renal reserve during 12 month therapy with omega-3 polyunsaturated fatty acids. Omega-3 was given orally of a: 540 mg of eicosapentaenic acid and 810 mg of docosaheksenic acid daily. Before and after 12 month of therapy renal reserve (expressed as % change of basal creatinine clearance) was estimated during i.v. dopamine infusion in dose 2 ug/min/b.w. Twelve month therapy was associated with increase of renal reserve (respectively 14.86 +/- 16.35 vs 30.25 +/- 14.27%), HDL cholesterol (respectively 47.55 +/- 11.49 vs 58.05 +/- 7.89 mg/dl) and decrease 24 hrs proteinuria (respectively 3.31 +/- 2.01 vs 1.31 +/- 1.37 g/24 h), total cholesterol TCH (respectively 251.15 +/- 50.91 vs 214.15 +/- 24.09 mg/dl), LDL cholesterol (respectively 170.0 +/- 47.22 vs 124.15 +/- 17.93 mg/dl), serum uric acid (respectively 7.53 +/- 1.01 vs 5.59 +/- 0.88 mg/dl), fasting insulinemia (respectively 11.27 +/- 5.28 vs 9.20 +/- 4.80 U/ml) for p < 0.05. The statistically significant correlation coefficient were found only between following parameters: % renal reserve vs insulin (r = -0.55, p < 0.05), delta 24 h proteinuria vs delta TCH (r = 0.69, p < 0.05), delta 24 h proteinuria vs delta LDL (r = 0.51, p < 0.05). Our study suggest that omega-3 therapy improves renal reserve and its effect is to some extend related to improvement of some metabolic disturbances. Also this therapy ameliorate proteinuria which is linked with lipid lowering effect of omega-3.     

Early detection of renal diseases-urgency or clever choice?

Economical end medical benefits of early referral and nephrological care were presented in patients with very early stages of renal disease.     

Effect of 12-month therapy with omega-3 polyunsaturated acids on glomerular filtration response to dopamine in IgA nephropathy

BACKGROUND: Omega-3 polyunsaturated acids therapy is efficient in primary IgA nephropathy. It is unknown whether doses of omega-3 smaller than those given previously are still effective. The aim of the study was to examine the effect of omega-3 therapy on renal vascular function in relation to proteinuria and urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG). METHODS: 20 IgA patients aged 36.5 +/- 10.77 with creatinine clearance (Cr(cl)) 105.71 +/- 27.3 ml/min and proteinuria 3.31 +/- 2.01 g/24 h were given orally 810 mg EPA and 540 mg DHA daily for 12 months. Before and at the end of the study, 24-hour proteinuria, serum homocysteine, and Cr(cl) were measured. At the same time, renal vascular function was estimated as dopamine-induced glomerular filtration response (DIR). DIR was measured as: two 120-min lasting Cr(cl) (before and during 2 microg/kg b.w./min i.v. dopamine). RESULTS: The results obtained during follow-up were as follows (baseline vs. after therapy): DIR 14.9 +/- 16.4 vs. 30.3 +/- 14.3% (p < 0.01); urine protein 2.31 +/- 2.01 vs. 1.31 +/- 1.37 g/24 h (p < 0.01); (Cr(cl)) 105.71 +/- 27.3 vs. 103.9 +/- 20.9 ml/min (n.s.); NAG 8.3 +/- 1.8 vs. 6.0 +/- 1.2 U/g(creat) (p < 0.01), and homocysteine 16.2 +/- 3.15 vs. 13.8 +/- 2.6 micromol/l (p < 0.05). The only correlation found was linear correlation between basal DIR and DIR change (r = -0.570; p < 0.010) and basal NAG (r = -0.460; p < 0.50). CONCLUSIONS: Omega-3 supplementation is associated with the improvement of both renal vascular function and tubule function.     

Proteinuria as a predictor of risk of cardiovascular disease: a new insight

Mortality and morbidity due to cardiovascular disease is one of the fundamental health problems at present. Proteinuria is not only commonly recognized factor of progression of chronic renal diseases, but is also independent risk factor for cardiovascular complications. Lately, the value of albuminuria as a prognostic factor in the course of cardiovascular diseases has increased its significance. Not long ago, there was considered that only microalbuminuria (quantity of excreted albumins in urine above 30 to 300 mg daily) indicates on increased risk of complications of such diseases as arterial hypertension or diabetes. However, observational studies, as well as interventional studies lead us to verify that view. It turned out that in the general population the number of cardiovascular complications leading to death increases in proportion to the quantity of albumins excreted in urine. Moreover, it was found that the relationship is continuous in a wide range of albuminuria even at value below the lower limits accepted now as normal levels, i.e., 30 mg per day corresponding with urinary albumin concentration 20 mg/L. It means that not only the quantity of excreted albumins but also the presence of albumin in urine indicate a higher risk of cardiovascular death. It may be assumed therefore that the presence of albumin in urine gives the evidence of unfavorable functional state of the circulatory system followed by fatal consequences. Therefore, the presence of albuminuria ought to be considered in quality and quantity aspects.     

Countrywide molecular survey of methicillin-resistant Staphylococcus aureus strains in Poland

The present investigation was undertaken to assess the proportion of methicillin-resistant Staphylococcus aureus (MRSA) strains among hospital-acquired isolates and to determine the clones of MRSA currently circulating in Poland by using a number of molecular techniques. Between January and May 2005, methicillin resistance was investigated among a total of 915 S. aureus isolates collected from 39 hospitals. A total of 208 (22.7%) isolates were positive for the mecA gene by PCR. The molecular characterization of MRSA isolates was carried out by the multiple-locus variable-number tandem repeat fingerprinting, pulsed-field gel electrophoresis, multilocus sequence typing, and staphylococcal chromosomal cassette mec (SCCmec) typing methods. The Hungarian (PFGE B; ST239, SCCmec type III [ST239-III]), Iberian (ST247-I), and Berlin (ST45-IV) clones were predominant, representing approximately 52.9, 11.5, and 10.0% of the MRSA isolates, respectively. A decline in the proportion of earlier MRSA clones, such as ST5-IV (a Pediatric clone), ST80-IV) (a Mediterranean clone), ST239-III (a Polish and Brazilian clone), and ST30-IV (a southwest Pacific clone) was observed. Additionally, the emergence of an MRSA clone with SCCmec type V, possibly representing a community-acquired strain, was observed in two hospitals during this study.     

Current epidemiology and practice patterns in prevention and treatment of PD-related infections in Poland

Background

Peritoneal dialysis (PD) related infections are associated with technique failure and mortality. The aim of this multicentre study was to examine epidemiology, treatment and outcomes of PD-related infections in Poland as well as practice patterns for prevention of these complications in the context of current ISPD recommendations.

Methods

A survey on PD practices in relation to infectious complications was conducted in 11 large Polish PD centres. Epidemiology of peritonitis and exit-site infections (ESI) was examined in all patients treated in these units over a 2 year period.

Results

The study included data on 559 PD patients with 62.4% on CAPD. Practice patterns for prevention of infectious complications are presented. The rate of peritonitis was 0.29 episodes per year at risk, with Gram positive microorganisms responsible for more than 50% of infections and 85.8% effectively treated. Diagnosis and treatment followed ISPD guidelines however most units did not provide an anti-fungal prophylaxis. Although neither of the centres reported routine topical mupirocin on catheter exit-site, the rate of ESI was low (0.1 episodes per year at risk), with Staphylococcus aureus as most common pathogen and full recovery in 78.3% of cases.

Conclusion

The study shows rewarding outcomes in prevention and treatment of PD-associated infections, mainly due to a thorough compliance with the current ISPD guidelines, although some deviations from the recommendations in terms of practice patterns have been observed. More studies are needed in large numbers of patients to differentiate the importance of specific recommendations and further support the guidelines.

     

Intestinal epithelium regeneration in rats receiving methotrexate and a trial of regulating this regeneration with pentagastrin and glucagon

The study was carried out in three groups of rats: group I of 36 rats received methotrexate, group II of 36 rats were given methotrexate, pentagastrin and glucagon, group III of 12 rats served as control. For histological examination the ileum was taken from the animals killed on days 1, 2, 3, 4, 7 and 9 after the last injection of methotrexate. Besides histological examinations the mitotic index and the number of cells in crypt longitudinal-section were determined. Relatively low doses of methotrexate caused characteristic changes in the intestinal mucosa: disappearance of mitotic figures, shortening of crypts particularly on the first day after the last dose of methotrexate. On the following days regeneration processes were noted causing an excessive epithelial proliferation observed up to the 9th day after the last dose of methotrexate. This indicates that the mobilized mechanisms of epithelial proliferation stimulation exert their effect fairly long. In the group receiving methotrexate administration of pentagastrin and glucagon contributed to the increased number of mitoses in crypt epithelium and the number of cells on crypt longitudinal-section. These observations are an evidence of a beneficial effect of the hormones administered to the rats in the regeneration of the ileal epithelium damaged by the cytostatic agent.     

Aldosterone antagonist therapy and its relationship with inflammation,fibrosis, thrombosis,mineral-bone disorder and cardiovascular complications in peritoneal dialysis (PD) patients

Background

High aldosterone level may contribute to pathogenesis of hypertension, vessels damage and cardiovascular system deterioration in chronic kidney disease patients. Besides its classical action via mineralocorticoid receptor, aldosterone is also involved in cell growth, inflammation, oxidative stress, endothelial dysfunction and exerts fibroproliferative effects. The aim of the study was to assess whether aldosterone antagonist treatment may influence serum level of inflammatory, fibrosis, thrombosis and mineral-bone metabolism markers in peritoneal dialysis (PD) patients and blood pressure, aortic stiffness, echocardiographic indices after 12 months of treatment.

Methods

Twenty-two patients on PD were assigned to spironolactone treatment in dose of 50 mg daily during 12 months. Fifteen PD patients were assigned to control group. Echocardiographic indices, PVW, SBP, DBP (mean values from ABPM) and biochemical parameters such as: aldosterone, osteopontin, IL-6, selectin-P, TGF-β, PTH, MMP-2 were performed at the beginning and after 12 months in spironolactone and control group.

Results

There were no statistically significant differences in echocardiographic indices, PWV, BP (ABPM readings) and biochemical markers: MMP-2, serum aldosterone, TGF-β, IL-6, selectin-P, PTH level after 12 months of spironolactone treatment. There was statistically significant rise in osteopontin level after 12 months of spironolactone treatment. Episodes of life-threatening hyperkalemia were not reported.

Conclusions

Aldosterone antagonists use in PD patients seems to be safe. Longer duration or higher dosage of spironolactone seems to be more effective in improving cardiovascular system status in PD patients. Further studies are required to determine relationship between mineralocorticoid receptor blockade and mineral-bone disturbances in PD patients.

     

Antibiotic susceptibility of bacterial strains isolated from urinary tract infections in Poland

Worldwide data show that there is increasing resistance among urinary tract pathogens to conventional drugs. The aim of this study was to obtain data on susceptibility patterns of pathogens responsible for urinary tract infections (UTIs) in Poland to currently used antimicrobial agents. A multicentre study of 141 pathogens from hospital-acquired infections and 460 pathogens from community-acquired infections was carried out between July 1998 and May 1999. The most prevalent aetiological agent was Escherichia coli (73.0%), followed by Proteus spp. (8.9%) and other species of Enterobacteriaceae (9.6%). Few community infections were caused by Gram-positive bacteria (2.2%). Gram-positive cocci were isolated more frequently from a hospital setting (14.1%) and the most common were Enterococcus spp. (8.5%). Pseudomonas aeruginosa was found only among hospital isolates and was responsible for 10.7% of infections. E. coli isolates from both community and hospital infections were highly susceptible to many antimicrobial agents with the exception of those isolates producing extended-spectrum beta-lactamases (ESBLs). Of all Enterobacteriaceae tested, 38 strains (6.9%) were capable of producing ESBLs.