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Biomedical subjects

B Rutkowski

Publications and source records attributed to B Rutkowski.

At least 73 records · Page 4Linked to original sources
PubMed1996

Classification of lipid disorders in chronic hemodialyzed patients.

The aim of our study was to introduce the classification given by the European Atherosclerosis Society (A B C D E groups) for monitoring lipid disorders in chronic renal failure patients during the first year of dialysis therapy (DT). Studies were carried out in 41 chronically uremic patients (19 F, 22 M). Before the start of DT, and then every 2 months, following parameters were determined in the serum: total cholesterol, HDL-cholesterol and triglycerides. Moreover, electrophoresis of serum lipoproteins were also performed. At the start of the DT 63% of chronically uremic patients had normal values of basic lipid parameters, but this number decreased to only 29% after the first year of DT. We conclude that the modified A B C D E classification of lipid disorders in hemodialyzed patients is more convenient than the classic Fredrickson one used before.

Adolescent↗
PubMed1996

[Oral calcitriol pulse therapy in treatment of secondary hyperparathyroidism in patients with long term hemodialysis].

Oral calcitriol pulse therapy slowly becomes a method of choice in the treatment of secondary hyperparathyroidism in hemodialysis patients. It appears to be equally effective and simultaneously significantly cheaper than an intravenous therapy. In last year we have applied such a treatment to 12 hemodialysis patients with severe secondary hyperparathyroidism (iPTH range: 447-1228 pg/ml). All of them were hemodialysed 3 times a week with dialysate Ca+2 level 1.25-1.75 mM/l. Calcium carbonate was administered to maintain serum Ca level between 9.0-11.0 mg/dl and phosphate below 6.0 mg/dl. The patients were given calcitriol at dose 0.1 microgram/kg once a week, but it was obligatory to take a drug at bedtime, at least two hours after the last meal, a day before hemodialysis. During the treatment we divided the patients into two groups: I-patients who responded to our treatment (7/12); II-treatment was unsuccessful (5/12). In this group we decided to increase the dose of calcitriol to 0.075 micrograms/kg twice a week after 6 months use of a previous one. We have achieved statistically significant decrease of parathormone (p < 0.001) and alkaline phosphatase (p < 0.02) in group I and after the increase the dose of calcitriol there occurred the decrease of parathormone (p < 0.05) and alkaline phosphatase (p < 0.002) in group II. Simultaneously we have observed a great clinical improvement. Our results confirm the fact that even severe secondary hyperparathyroidism can be successfully treated with oral calcitriol pulse therapy. Administering of high doses of calcitriol at bedtime increases safety of this procedure-we have not observed any case of hypercalcemia.

Adult↗
PubMed1996

[Evaluation of platelet membrane structure in patients with chronic glomerulonephritis (CGN)].

The structure of platelet membrane determines platelet surface glycoprotein receptors and correct cell function. Meanwhile different diseases and drugs may induce changes in this structure. The aim of this study was to determine structure of platelet lipid bilayer in patients with chronic glomerulonephritis (CGN) in comparison to control group. Studies were carried out in 30 patients with nephrotic syndrome (NS) and 30 patients without this syndrome and 15 controls. Electron spin resonance phenomenon with spin labelling, was used for estimation of platelet membrane structure. CGN patient platelets showed lower order parameter A/C and increased rotation correlation time tau in comparison with healthy subjects. It indicated abnormal platelet membrane structure in these patients. The negative significant correlation between parameter A/C and plasma fibrinogen concentration of NS patients has been found (r = -0.5; p < 0.05). Additionally the value of an order parameter (A/C) has significantly positively correlated with serum triglycerides concentration in patients with NS and spontaneous platelet aggregation (r = 0.52, p < 0.05). Conclusion. 1. CGN patient platelets have revealed disorders of lipid bilayer structure. 2. These disorders could be responsible for decreased platelet aggregation observed in CGN patients in comparison to healthy controls.

Adult↗
PubMed1996

[Evaluation of factors influencing platelet aggregation in patients with chronic glomerulonephritis (CGN)].

Platelets (PLT) play an important role in hemostasis, modulation of immunological and inflammatory processes. There is also evidence that PLT takes part in the development of atherosclerosis and glomerulosclerosis. The aim of presented study was to determine morphological and functional changes of platelets and their relation to the lipid, protein and coagulation factors disturbances in patients with chronic glomerulonephritis (CGN). The studies were carried out in 60 patients with CGN diagnosed by renal biopsy: 30 patients without nephrotic syndrome (NS)-CGN and 30 patients with NS-CGN+NS. Protein and lipid disturbances, coagulation factors were estimated using routine laboratory methods. Platelet count (PLT), mean platelet volume (MPV) and modal platelet volume (PLT-Mode) were measured using Technicon H1 hematological autoanalyser. Platelet function was assessed by aggregometry using turbidimetric method (inductors: ADP 1-3 microM, collagen 50g/ml, epinephrine 0.25-5 microM). Spontaneous platelet aggregation (SPA) was measured in platelet rich plasma (PRP) without inductors for 15 min, in 1-2 hours after venesection. SPA was observed in 9 of 30 patients with CGN and in 19 of 30 patients with CGN+NS. MPV and PLT Mode were significantly higher in patient showing SPA compared with those without. Significant correlations between SPA and the concentration of plasma albumin (r = -0,70; p < 0.02) TG and CH-LDL (r = 0,61; p < 0.05) were found in CGN+NS patients. APTT was significantly shorter in patients showing SPA compared with those without and negative significant correlation between SPA and APTT was found. Platelet aggregation to inductors in CGN and CGN+NS patients was diminished compared with control group. Lack of second phase aggregation in response to aggregation inducers was observed in patients with SPA. Conclusions. 1. Platelet hyperaggregation play an important role in hypercoagulation state in CGN patients. 2. SPA in vitro was observed in majority of CGN+NS patients and in some without NS. 3. Pathomechanism of SPA is probably multifactorial (hypoalbuminemia, dyslipidemia, changes in concentration of coagulation parameters).

Adult↗
PubMed1996

[Significant negative correlation between fasting plasma insulin and ambulatory blood pressure in patients on chronic hemodialysis].

Positive correlation between blood pressure and insulin is well established in patients with essential hypertension. The aim of the present study was to examine the relationship between fasting plasma insulin level and ambulatory blood pressure (ABPM) in patients with chronic renal failure. The study group consisted of 20 patients (11 females, 9 males, mean age 39 +/- 12 years) on chronic haemodialysis (mean 2.5 years). Fasting plasma insulin (FPI) was measured by radioimmunoassay. The patients were investigated before and after haemodialysis. FPI significantly increased after haemodialysis from 18.4 +/- 12.0 to 40.1 +/- 31.9 mIU/l (p < 0.01), while creatinine concentration decreased from 1158 +/- 130 to 910 +/- 159 mumol/l (p < 0.001). Night-time systolic blood pressure (SBP) was significantly lower during the day of haemodialysis (141.9 +/- 19.6 mmHg vs. 136 +/- 27.7 mmHg, p < 0.05). 24-hour and daytime SBP was nonsignificantly lower after haemodialysis. 24-hour diastolic blood pressure (DBP) was significantly lower during the day of haemodialysis (92.9 +/- 12.5 mmHg vs. 87.3 +/- 14.3 mmHg, p < 0.05), as well as daytime (94.9 +/- 12.1 mmHg vs. 88.8 +/- 14.6 p < 0.05) and night-time DBP (88.9 +/- 16.0 mmHg vs. 83.8 +/- 17.4 mmHg p < 0.05). FPI was found to be significantly negatively correlated with 24-hour, daytime and night-time SBP on the day of haemodialysis (r = -0.63, p < 0.005; r = 0.64, (p < 0.005 and r = -0.54, p < 0.05, respectively). The significant negative correlation between FPI and 24-hour SBP suggests that insulin could reveal its hypotensive effect after the haemodialysis.

Adult↗
PubMed1996

[Relationship between some parameters of carbohydrate metabolism, proteinuria and glomerular filtration rate in patients with primary glomerulonephritis].

It is very well known that carbohydrate metabolism disturbances may affect progression of renal disease in patients with moderate renal insufficiency. The aim of this study was to analyse the relationship between glucose, insulin and changes of creatinine clearance and proteinuria in patients with primary glomerulonephritis and normal renal function. Thirteen non-treated patients with primary glomerulonephritis, were given 75 g glucose orally and area under insulin and glucose curves were estimated. Afterwards all patients were followed-up for 17.6 +/- 3.1 months and none of them was subjected to any pharmacological intervention. At the end of the study neither proteinuria nor creatinine clearance changed significantly. But significant linear correlations were found between pre-follow-up glucose and insulin and changes of daily proteinuria (r = 0.632, p < 0.05; r = 0.538, 0.05 < p < 0.1) respectively. No correlations were found between insulin and glucose area and changes of creatinine clearance. Authors analyze the potential role of some factors linking the glucose metabolism and proteinuria.

Adult↗
PubMed1996

[The effect of administering Omega-3 acids on lipids in serum, functional state of erythrocyte membrane and function of the kidneys in patients with primary glomerulonephritis].

There are reports concerning profitable influence of unsaturated acids administration on blood pressure, inflammation and proteinuria. The aim of presented study was to estimate the effect of Omega-3 on plasma lipids and renal function in patients with primary glomerulopathies. The tested group consisted of 13 patients (7F and 6M) aged from 22 to 60 years, with primary glomerulopathies and normal renal function. They received Omega-3 (Fishproduct, iceland) 3 x 2 caps for three months. Before, after 2 and 3 months of treatment and 3 months after its discontinuation following parameters were estimated: total cholesterol, HDL and LDL cholesterol (HDL, LDL), triglycerides and an order parameter of erythrocyte lipid bilayer (S). Simultaneously N-acetylglutamate (NAG), creatinine clearance and 24-hours proteinuria were measured. For calculation t-Student test was used. In our study we found statistically significant increase of HDL after 2 and 3 months and decrease of LDL after 3 months of Omega-3 administration (p < 0.05). During the 2 and 3 months of treatment statistically significant decrease of NAG was noticed but a month after its discontinuation significant increase of NAG excretion was observed (p < 0.05). The S parameter in tested group of patients was higher than in healthy population but during Omega-3 administration the value of an order parameter of erythrocyte bilayer increased significantly (p < 0.01). On the base of given results we could conclude that unsaturated acids may have profitable influence on plasma lipids, functional status of erythrocyte membrane and probably proximal tubule function in patients with primary glomerulopathies.

Adult↗
PubMed1995

[Bacterial endocarditis in patients treated with maintenance hemodialysis].

UNLABELLED: Bacterial endocarditis (BE) is one of the most severe complications of hemodialysis (HD). The aim of the study was to analyse frequency and severity of BE in patients treated with HD in our dialysis unit. During the period 1969-1993276 patients were treated with HD in Gdańsk. In 23 cases (9F, 14M) HD treatment was complicated with BE. Patients were divided into two groups on basis of diagnostic criteria: I-13 patients (5F,8M) with BE diagnosed by means of clinical picture and positive blood culture.; II-10 (4F, 10M) with diagnosis additionally confirmed by echocardiography. In patients from group I BE was observed more often during the first 2 years of HD. In group II during 3-5 years of dialysis therapy, gram negative microorganisms were the most frequent etiological factors. The mean period of antibiotic therapy was 35 days. In all patients from group II changes in the bicuspid valve, in 60% of them additionally in aortic valve and in one patient also in the tricuspid valve were observed. In five patients changes in the parietal endocardium were also present. Development of organic valvular changes was observed in nine patients. Seven of 22 patients died during the acute phase of BE and two others from complications connected with BE. The longest survival of patients after BE was over 10 years. CONCLUSIONS: 1. The threat of BE in patients treated with HD decreased between 1987 and 1993 in comparison with the initial period of our HD station operations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Hepatitis B (HBV) and C (HCV) virus infections as an eventual cause of chronic hepatic damage in patients undergoing maintenance hemodialysis ].

In 67 hemodialysis patients with high prevalence of HBV infection (64/67-95.5%) the occurrence of anti-HCV antibodies in second generation enzyme immunoassay was 61.2% (41/67). Among 40/67 (59.7%) patients with actually or previously detected biochemical signs of chronic hepatic injury the H Bs antigen or/and/anti-HCV antibodies were positive in 38 (95.0%) cases. High prevalence of HBV and HCV infections in studied population and their connection with biochemical signs of chronic hepatic injury shows the necessity of introduction the intensive prophylaxis of those infections in polish hemodialysis centers.

Adult↗
PubMed1995

[Evaluation of acceptance rate and outcome of renal replacement therapy in patients with diabetic nephropathy--multicenter study].

Development of dialysis methods and progress in kidney and pancreas transplantation allowed to treat an increasing number of patients suffering from diabetic nephropathy (D.N.). This report evaluates availability and results of treatment in these patients. 31.12.93 in Gdansk and Bydgoszcz area there were treated 519 patients, including 43 (8.2%) with D.N. It is impossible to evaluate the demand for renal replacement therapy in patients with D.N., because there is no exact data concerning diabetic patients with progressing renal failure. Up to now 88 patients with D.M. (68 with IDDM, 20 with NIDDM) were treat in this area. Most of them (92%) were treated with hemodialysis is and only a few with CAPD, 13 patients received a kidney graft. The average patient survival on dialysis treatment in NIDDM patients was 15 months and in IDDM patients was 11 months. Deaths were mainly caused by cardiovascular complications. The results of renal replacement therapy in these patients cannot be compared with data from other re ports, because the treatment was introduced at advanced stage of D.N. in patients with systemic complications (serum creatinine in IDDM was 9.7 md% and in NIDDM was 6.2% mg%). Following conclusions can be drawn from our observations: 1. There is a need for close cooperation between diabetologist and nephrologist in repeat of evaluation of the demand for renal replacement therapy and time for its institution in a particular patient. 2. The choice of method of renal replacement therapy depends on clinical findings in a particular patient but also on methods available in a particular center. 3. Improvement of therapy outcome can be achieved primarily by earlier institution of dialysis (serum creatinine below 5 m5%).

Adolescent↗
PubMed1995

[Clearance, reabsorption and excretion of free and bound L-carnitine in children].

Acylcarnitines are by-products of fatty acid, pyruvate and some xenobiotics metabolism excreted in urine. We compare the renal handling of free and acylcarnitine in a group of 15 healthy children in relation to sodium and urea excretion and to sodium fractional tubular reabsorption (FTR%) and fractional excretion (FE%). Urea and sodium were determined by routine laboratory method; free and acylcarnitines by enzymatic one. FTR% and FE% were determined as a % of filtration load. Linear regression was used for calculation of correlation coefficient "r" from paired data. Low correlation (r = 0.25; p = 0.42) between urea and free carnitine excretion was observed; for excretion of acylcarnitine and urea correlation was much higher (r = 0.61; p < 0.03). Excretion of free correlation was negatively correlated with sodium FTR (r = -0.86; p < 0.001) and there was no correlation at all for acylcarnitine excretion and sodium FTR. It can be assumed:-neither excretion nor reabsorption of acylcarnitines are Na-dependent;-renal handling of free and total carnitines proceeds on different mechanisms.

Adolescent↗
PubMed1995

[Development of renal transplantation in the Gdansk center].

The kidney transplantation is one of the renal replacement therapy methods, which prolongs live of the patients with the end stage renal disease for many years. Moreover, this method is well known, safe and not so expensive as dialysotherapy. Our purpose was to present the 15-year activity of the transplantation center in Gdańsk. The first renal transplantation took place on the 31st of March 1980 and there have been 137 renal transplantations in Gdańsk until now. We can divide the time between the 31st of March 1980 and the end of 1994 into two periods: I from 31.03.80 to 31.12.89 and II from 1991 to 1994. During the first were 46, and during the second were 91 renal transplantations performed. It means that since the second half of 1991 the activity of the center in Gdańsk has increased. The graft function was noted in 29 patients (63%) during the first period and in 75 (82%) during the second. The acute graft failure was observed in the most of the cases mentioned above. The 5-year living of the transplanted patients and the dialysed patients is comparable and amounts to 90%. Infections were the main reason of death during the first period, and cardiovascular complications during the second. The 5-year graft's functioning is 60%. Nowadays the results of the kidney transplantation center in Gdańsk are good and comparable with the results of other centers in Poland and Europe. Our center, as similar ones in Poland is prepared to extend the kidney transplantation activity. So it is necessary to intensify an effort to gain more organs for transplantations.

Cause of Death↗
PubMed1995

[Concentration of adenine nucleotides in blood of predialysis patients with chronic renal failure].

Intraerythrocyte and blood level ATP concentration is increased in CRF. But little is known on the blood concentration of ADP and AMP in CRF. HPLC was applied to evaluate the ATP, ADP, AMP concentration in blood of 25 CRF patients, with serum creatinine from 2.4 mg/dl to 14.4 mg/dl treated conservatively. Controls were healthy people, with normal renal function. In CRF ATP was higher (p < 0.001) and ADP, AMP and hypoxanthine were lower (p < 0.001) then in controls. Also ATP correlated (r = 0.78; p < 0.001) with serum phosphate and (r = 0.40; p < 0.05) with serum creatinine in CRF patients. Adenine nucleotides turnover is increased in CRF and this process is related to severity of the disease.

Adenosine Diphosphate↗