Biomedical subjects

Bolesław Rutkowski

Publications and source records attributed to Bolesław Rutkowski.

At least 19 recordsLinked to original sources

PubMed2007

Beneficial effect of treatment with cyclosporin A in a case of refractory antisynthetase syndrome.

We report a case of idiopathic inflammatory myopathy accompanied with the presence of anti-Jo1 antibodies and complicated by diffuse parenchymal lung disease (antisynthetase syndrome). Efficacy of different therapeutic agents, including corticosteroids, cyclophosphamide and cyclosporin A, is described. We present beneficial effect of cyclosporin A and corticosteroids regimen, and confirm no benefits of plasmapheresis. An interesting association of the disease onset with toxoplasmosis infection is discussed and difficulties regarding diagnosis of cardiac involvement are addressed. We also review other case reports of this rare disorder of poor prognosis.

Cyclosporine↗

PubMed2007

Tonic chemoreflex activation contributes to the elevated muscle sympathetic nerve activity in patients with chronic renal failure.

OBJECTIVE: Sympathetic activation may contribute to both cardiovascular morbidity and the progression of chronic kidney disease. The role of the chemoreceptors in determining sympathetic nerve discharge in patients with chronic renal failure (CRF) is unknown. We tested the hypothesis that tonic activation of excitatory chemoreceptor afferents contributes to the elevated sympathetic activity in patients with CRF. METHODS: Utilizing a double-blind, randomized, vehicle-controlled design, we examined the effects of chemoreflex deactivation on muscle sympathetic nerve activity (MSNA). We compared effects of breathing 100% oxygen for 15 min with effects of breathing room air for 15 min in 12 stable patients with CRF and in 12 control individuals with similar age, gender, blood pressure and body mass index. RESULTS: The baseline MSNA was elevated significantly in the patients with CRF as compared with the control individuals (50 +/- 2 vs 42 +/- 2 bursts/min; P < 0.05). Reductions in systolic blood pressure and pulse pressure in response to the administration of 100% oxygen were significantly different from those observed during administration of room air in patients with CRF. In patients with CRF, MSNA decreased by 29 +/- 7% (P < 0.01) during hyperoxia but did not change during administration of room air (5 +/- 6%; P = NS). By contrast, neither 100% oxygen or room air changed any measures in control individuals. CONCLUSIONS: Tonic activation of excitatory chemoreflex afferents contributes to increased efferent sympathetic activity to muscle circulation and to blood pressure control in patients with CRF. These findings may have important implications for understanding mechanisms underlying the link between CRF and cardiovascular disease.

Administration, Inhalation↗

PubMed2006

Bioelectrical impedance analysis before versus after a hemodialysis session in evaluation of nutritional status.

OBJECTIVE: The objective of our study was to evaluate whether bioelectrical impedance analysis (BIA) performed 15 minutes after a hemodialysis (HD) session is clinically useful in nutrition status assessment in comparison with BIA performed before HD. Because of better reliability, it is postulated in the literature that BIA measurements should be performed 1 to 5 hours after HD sessions. However, the measurements 1 to 5 hours after HD sessions are inconvenient in clinical practice. Furthermore, the currently published BIA reference values for the HD population are based on the measurements taken before HD sessions. METHODS: The study group consisted of 29 HD patients who were in a stable clinical condition. BIA measurements were performed by means of BIA 101 System (Akern RJL Systems, Florence, Italy). The correlation coefficients were surveyed between traditional indices of nutritional status, such as body mass index (BMI) and plasma concentrations of protein, albumin, and nonprotein nitrogen blood urea nitrogen (BUN) (measured before HD) on one hand, and BIA parameters (taken before and 15 minutes after HD) on the other hand. RESULTS: Statistically significant correlations occurred between such BIA parameters as (1) phase angle and BMI or albumin, or total protein or BUN and (2) body cell mass and BMI or BUN. The differences between correlation coefficients achieved either before or after HD were statistically nonsignificant. CONCLUSIONS: BIA measurements in the studied group of patients did correlate with traditional indices of nutritional status. The correlation coefficients were not significantly influenced by the time of performing BIA measurements. The obtained correlations confirm that BIA performed 15 minutes after an HD session may be a useful tool in evaluation of nutritional status of stable HD patients in clinical practice.

Adult↗

PubMed2006

[Vitamin B-6 in chronic renal insufficiency].

Chronic diseases, including chronic renal insufficiency, predispose to deficiency of vitamin B-6. Prevalence of that phenomenon, the need and appropriate level of supplementation remain controversial. The paper is a review of literature concerning those topics. Causes of deficiency, as well as advantages and dangers of supplementation were referred.

Humans↗

PubMed2006

[Encapsulating peritoneal sclerosis--a serious complication of peritoneal dialysis with not characteristic symptoms].

Encapsulating peritoneal sclerosis (EPS) is a serious complication in patients on peritoneal dialysis (PD). We report the case of a 45 years old woman who developed EPS five years after being placed on CAPD. We did not observe any typical abdominal symptoms. Recurrent cloudy and blood stained dialysate as well as deterioration of adequacy were noted few month before histological verification. The results of radiological findings did not allow for precise diagnosis. A patient had undergone an operation because of massive bleeding to the renal cyst during which a completely walled up peritoneal cavity was revealed (the bowel loops were cocooned in thickened peritoneum). Histological examination of peritoneal specimen confirmed the diagnosis. The patient died due to inflammatory and bleeding complications one month after an operation.

Fatal Outcome↗

PubMed2006

[Endothelial dysfunction in peritoneal dialysis patients and its relationship to nutrition].

Endothelial dysfunction (ED) in peritoneal dialysis patients plays pivotal role in progression of atherosclerosis and hemostasis disturbances. Malnutrition is one of the most important complication of PD. Both ED and malnutrition cause higher rate of cardiovascular events in these patients. 32 PD patients were analyzed. Endothelial function was assessed by measurements of serum level of vWF:Ag; t-Pa:Ag; TM:Ag. Nutritional status assessment included: body mass index-BMI, MAMC measurements; and serum albumin, total protein, prealbumin, transferrin, cholesterol, insulin, insulin like growth factor-1 (IGF-1). There were higher levels of vWF:Ag but lower of t-PA:Ag and TM:Ag after 12 month of observation. Serum levels of prealbumin, insulin, cholesterol were stable, but there were lower levels of albumin, IGF-1, and higher of transferrin at the end of the follow up. There were no differences in anthropometric indices during the follow up. We found statistically significant linear correlations: t-Pa:Ag vs prealbumin; t-Pa:Ag vs cholesterol; TM:Ag vs albumin. In the course of 12 months observation of peritoneal dialysis patients we found deterioration of endothelial function, expressed by evaluated endothelial antigens. Some correlations found in our study might express close relationship between endothelial function markers and nutritional status.

Adult↗

PubMed2005

Renal protective effects of the renin-angiotensin-aldosterone system blockade: from evidence-based approach to perspectives.

The renin-angiotensin-aldosterone system (RAAS) blockade is currently the best-documented treatment strategy to delay the progression of chronic nephropathies. Angiotensin-converting enzyme inhibitors (CEIs) or angiotensin II type 1 receptor antagonists (ARBs) should be used in every normotensive and hypertensive patient with chronic proteinuric nephropathy of both diabetic and non-diabetic origin. The therapy should be initiated as early as possible, bearing in mind that the renoprotection is more effective if used before overt proteinuria or a reduction in kidney function is present. The therapy should be offered to all patients, regardless of renal function, as well as to subjects with severely impaired glomerular filtration. CEIs and ARBs should be administered in therapeutic doses as high as possible to achieve maximal possible proteinuria reduction and systemic blood pressure target <130/80 mm Hg, and 125/75 mm Hg in those subjects with renal insufficiency who present with proteinuria above 1 g/24 h. The combined therapy with the concomitant use of CEIs and ARBs should be offered to all patients with proteinuric non-diabetic chronic nephropathies who do not achieve full and persistent remission of proteinuria with CEI or ARB alone. The article reviews an evidence-based approach on the use of RAAS-inhibiting agents in kidney diseases, considers treatment strategies in different clinical situations and discusses some perspectives related to the implementation of the RAAS blockade in renal protection.

Angiotensin II Type 1 Receptor Blockers↗

PubMed2005

Randomized, controlled study of the effects of losartan versus enalapril in small doses on proteinuria and tubular injury in primary glomerulonephritis.

BACKGROUND: Pharmacological blockade of the renin-angiotensin-aldosteron system ameliorates glomerular and tubulointerstitial damage. For optimal renoprotection, high doses of angiotensin II converting enzyme inhibitors and angiotensin II subtype 1 receptor antagonists are commonly recommended, but cannot always be administered. The aim of this study was to evaluate the effects of low-dose (25 mg) losartan on proteinuria and tubular injury extent. MATERIAL/METHODS: This was an open, randomized, 12-month study on the effects of 25 mg of losartan (n=19) vs. 10 mg of enalapril (n=14) as a control on proteinuria, urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG), and blood pressure in patients with primary glomerulonephritis. The second part of the study was an uncontrolled assessment of the renal effects of 50-mg administration of losartan. RESULTS: There were no significant differences between the groups in the effects on proteinuria and NAG excretion. Losartan and enalapril reduced proteinuria by 32.8% (p<0.029) and 40.9% (p<0.021), respectively, but did not affect NAG excretion. The antiproteinuric effect of losartan, achieved without changes in blood pressure, was particularly evident in subjects with proteinuria >1.5 g/24 h and normal blood pressure. 50 mg of losartan caused a significant decrease in NAG excretion vs. the baseline (p<0.027). CONCLUSIONS: 25 mg of losartan and 10 mg of enalapril equally reduce proteinuria. The significant antiproteinuric effect of losartan was achieved despite no changes in blood pressure. There were no differences between the drugs regarding their influence on tubular injury extent. 50 mg of losartan seems to be the minimal dose to improve tubular status.

Adult↗

PubMed2005

Remarks on surgical strategy in creating vascular access for hemodialysis: 18 years of one center's experience.

The aim of the study is to evaluate surgical methods for creating vascular access for hemodialysis (HD) in patients with chronic renal failure. Over the last 18 years, 1,827 surgical procedures were performed in 722 patients (399 men and 323 women, mean age 43.7 +/- 17 years) in order to provide and maintain permanent vascular access for HD. Among all the surgical procedures, 992 were based on the construction of arteriovenous fistulas (AVF) and 835 were undertaken as secondary reparative surgical procedures. A total of 992 vascular accesses have been performed, including 904 AVF on upper and 14 on lower extremities as well as insertion of 74 permanent catheters. Radiocephalic AVF (RCAVF) was the principal type of AVF (58.8%). While constructing secondary angio-access after using RCAVF on the other extremity, fistulas with usage of brachial vessels were preferred. A total of 228 AVF of this type were created, including 143 brachiocephalic (BCAVF) and 85 brachiobasilic (BBAVF) AVF. Lately, synthetic grafts (arteriovenous graft, AVG) have been used more frequently, in 90 AVF. A brachial straight graft was the main type procedure performed, with polytetrafluoroethylene (95.6%). The patency of the fistulas has been evaluated. Kaplan-Meier survival curves were calculated to determine primary, primary-assisted, and secondary patency. Log-rank analysis was used to determine differences between curves. Primary, primary-assisted, and secondary patency at 12 months and 24 months were calculated. Comparing AVF patency in two patients' age periods (18-65 years, >65 years), it may be concluded that in the elderly group AVG provides better treatment for AVF. Finally, we conclude that a multidisciplinary approach to vascular access strategy offers the best option to achieve good functional AVF. Autogenous arteriovenous access should be regarded as the most suitable type in creating VA. However, individual conditions should be taken into consideration.

Arteriovenous Shunt, Surgical↗

PubMed2005

[Metabolic acidosis after kidney transplantation].

Metabolic acidosis is a common complication in patients after kidney transplantation. It is caused by inability of transplanted kidney to regenerate bicarbonate buffer. Although every type of acidosis may be present in these patients, the most frequent are renal tubular acidosis and uremic acidosis. Both insufficiency of graft and tubular dysfunction can be caused by ischemic damage, episodes of rejection and cyclosporine A--induced nephrotoxicity. Ketoacidosis due to a post-transplant diabetes mellitus and bicarbonate loss in patients after simultaneous pancreas/kidney transplantation are rarely observed. Each type of acidosis is responsible for serious metabolic disturbances that influence graft and patient survival. The proper diagnosis and appropriate treatment with oral supplements are essential.

Acidosis, Renal Tubular↗

PubMed2005

Enzymatic examination of potential interaction between statins or fibrates and consumed Tricholoma equestre.

The enzymatic investigations were done in 56 patients, including 30 females and 26 males in the age range 18-76 (mean 52 +/- 12). Thirty two of them (57.1%) suffered from type 2 diabetes. All the patients consumed voluntarily Tricholoma equestre; 43 of them only once from 70 to 150 g, and 13 patients from two to four times for 4 consecutive days (between 300 g and 1200 g). Twenty seven patients, because of hyperlipidemia, took statins (simvastatin á 20 mg--15 patients, lovastatin á 20 mg--6 patients, fluvastatin á 80 mg--3 patients, atorvastatin á 20 mg--3 patients) and seven took fibrates (4 patients-- enofibrate á 267 mg, and 3 patients--ciprofibrate á 100 mg). Two subjects ingested both simvastatin á 20 mg and fenofibrate á 267 mg. Three to six days after the last mushroom dish, blood samples were taken from patients to examine the serum creatine kinase (CK), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities. The biochemical analyses were performed by means of the kinetic spectrophotometry using the autoanalyzer Architect ClI8200 with Abbott proprietary reagents. Statistical analysis was performed by means of t-Student test. Tricholoma equestre taken by patients in a total amount from 70 g to 1200 g for four consecutive days did not cause the significant increase in serum CK, AST, ALT activities. Similar mushroom dishes consumed by patients constantly using statins or fibrates also did not increase significantly the serum CK, AST, ALT activities. Patients treated with statins or fibrates may eat Tricholoma equestre in reasonable amount according to the established tradition.

Adult↗

PubMed2005

Regression of long standing anorexia nervosa following acute renal failure caused by gentamicin intoxication.

A female patient aged 22 with fully developed symptoms of anorexia nervosa presented the following metabolic disturbances: persistent hyperuricemia, hyponatruria, (sometimes with sodium lack in urine) as well as frequent hyponatremia and hyper-uricosuria. The patient's low arterial blood pressure (70/40 mm Hg on average) was not improved by pharmacological treatment, and only high oral doses of table salt (20-70 g/24 h) did prove effective in the therapy. The subject passed seven renal calculi composed of sodium urate and uric acid. Numerous urinalyses did not reveal any changes, and bacterial cultures of the urine were also negative. After 14 years of anorexia nervosa, the patient was treated for pneumonia with gentamicin at doses of 2 x 80 mg/24 h. Following third dose of the antibiotic, the patient developed acute renal failure and was treated by haemodialysis for six weeks. The renal function came gradually to the norm. Simultaneously, all the anorexia nervosa symptoms subsided along with sodium metabolism disturbances, while purine metabolism disorders got considerably alleviated. The patient started to have her menstrual cycles again, gained 12 kg in body weight, and one year afterwards bore a son. A further 10-year follow-up period was free of any pathological changes except for a slight hyperuricemia. To the best of our knowledge, the similar case has not been reported in the medical literature and electronic data bases.

Acute Kidney Injury↗

PubMed2005

[Early diagnosis of renal diseases--preliminary results from the pilot study PolNef].

Continuous increase of the number of patients with chronic kidney failure which require renal replacement therapy, in Poland as all as over the world, demands the analysis of epidemiological situation concerning renal diseases. Early diagnosis of nephropathy permits not only an adequate treatment, but also facilitates the introduction of the therapy that slows the progression of kidney failure. The aim of the pilot study PolNef was an attempt to evaluate the epidemiology of renal diseases in Poland on the basis of a randomly selected population from a city numbering 60 thousand people. As a screening test, allowing to distinguish patients requiring further diagnostic of nephropathy, the microalbuminuria dipstick test accompanied by blood pressure measurement and questionnaire was accepted. Microalbuminuria was detected in more than 18% of the population investigated up till now. It was more frequent in male, in obese, and in smokers. More than 33% of all participants consulted by the nephrologist required permanent nephrological care and for the next 32% another nephrological consultation in 6 to 12 month should be ordered. Decreased clearance of creatinine was found in above 17% participants and 6 patients were referred for further treatment because of new diagnosis of renal tumor. Identification in investigated population patients with of an early stage of kidney disease needs further nephrological diagnosis and treatment is especially important from the point of view of every single patient and also may bring substantial economic benefits for health protection system as well.

Aged↗

PubMed2005

[Late drug-induced hyperkalemia in a patient with congestive heart failure].

Patients with congestive heart failure are at risk for hiperkaliemia because of coexisting comorbidities and use of multiple medications that impair potassium excretion--such as angiotensin-converting enzyme inhibitors or spironolactone. This is the case report about the patient with late drug-induced hyperkalemia. Causes and prevention methods used against development of this adverse event were explained.

Aged↗

PubMed2005

[Groin hernia in the patients receiving CAPD].

Continuous ambulatory peritoneal dialysis (CAPD) is a popular way of treatment of the patients with renal failure. There were 1365 patients on CAPD in Poland in the year 2001. Higher frequency of groin and abdominal hernias was reported in those patients. 10% of dialysed patients developed hernia in the first five years of the therapy. The main problems of hernia repair in the CAPD patients are: increased pressure in abdominal cavity caused by dialysate volume, higher risk of peritonitis, poor prognosis in the complicated cases temporarily or permanently converted to hemodialysis (HD) and the insufficiency of healing process. Complications accorded to hernia repair are the third most often reason of conversion to HD. Conducted studies on hernia repair did not lead to the introduction of the world standard. Authors propose to introduce an unified protocol to improve treatment results. Main guidelines of hernia treatment in CAPD patients are: 1) consultation of the surgeon cooperating with dialysis center in qualification to CAPD, and in the case of hernia symptoms in CAPD patients, 2) application of tension-free methods (PHS recommended), 3) administration of antibiotic prophylaxis, 4) application of local or epidural anesthesia, 5) no necessity of discontinuation of CAPD procedures.

Antibiotic Prophylaxis↗

PubMed2005

[Heart and kidneys].

During last fifty years several investigations were performed enabling detection and description of close relationships between kidneys and heart. It is dealing both with connections important for maintenance of homeostasis and with pathological disturbances. On the other hand there are no doubts that chronic kidney diseases, and especially their chronic failure, are connected with development of deep cardio-vascular changes. This interrelationship is becoming more clear when similiarities between factors causing progress of renal failure and development of cardio-vascular changes on the othe hand are concluded. So the main important issue is early prevention and after recognition of their existence early specific therapy.

Comorbidity↗

PubMed2004

Long-term therapy with recombinant human erythropoietin increases CD8+ T-cell apoptosis in haemodialysis patients.

BACKGROUND: We intended to assess the intensity of apoptosis in the CD4+ and CD8+ T-lymphocytes of haemodialysis (HD) patients on recombinant human erythropoietin (rHuEpo). METHODS: The expression of Fas, tumour necrosis factor-alpha receptors (TNFRI and TNFRII) and the CD28 molecule on lymphocytes was evaluated in 15 HD patients before and during treatment with rHuEpo. In cultures of peripheral blood mononuclear cells (PBMCs) stimulated with rHuEpo, phytohaemagglutinin and camptothecin, our measures of apoptosis were the percentages of cells with subdiploid DNA content and of annexin V-stained cells. Results, Therapy with rHuEpo did not affect CD4+ T cells but decreased the percentage of CD8+ T cells in peripheral blood. The intensity of apoptosis in both CD4+ and CD8+ T cells at baseline was lower in HD patients than in healthy volunteers, and increased in those treated with rHuEpo. In vitro, rHuEpo did not induce apoptosis in PBMCs. The percentage of CD8+Fas+ T cells was constant, while that of CD8+TNFRI+ cells declined during follow-up. There was an increase in the percentage of CD28+ T cells, mainly in the CD8+ compartment, as early as 1 month after the introduction of rHuEpo. CONCLUSIONS: Treatment with rHupo caused a decline of CD8+ T cells in HD patients, which most probably was mediated via the TNFRI-related apoptotic pathway and was independent of Fas expression. Apoptosis in vitro was not directly influenced by rHuEpo, suggesting that the process in vivo was only initiated by rHuEpo supplementation.

Antigens, CD↗

PubMed2004

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.

Adolescent↗