Biomedical subjects

D Sobotová

Publications and source records attributed to D Sobotová.

18 recordsLinked to original sources

PubMed2003

[Fibrillary immunotactoid glomerulonephritis--an unusual cause of irreversible kidney failure].

Fibrillary-immunotactoid glomerulopathy (FITGP) is a rare cause of nephrotic syndrome. In this patient, male 65-years-old, respectively, fibrillary glomerulonefritis (FGN) was diagnosed by percutaneous renal biopsy. Clinically, the disease manifested with long term proteinuria and nephrotic syndrome without any associated systemic disorder. Histologically, glomeruli showed deposition of PAS+, fuchsinophilic and Orange G+ material in the mesangium and basal membranes. Strong granular immunofluorescent IgG, C3, kappa and lambda light chains deposition was present in the mesangium. Electronmicroscopically, depositions of fibrillary material in the expanded mesangium and in the peripheral basal membranes were found. Randomly distributed nonbranching fibrils measured 18-28 nm. After 18 months of follow-up, the therapy with corticosteroids and Cylosporin A was without effect, and the disease progressed into chronic renal failure, and after 24 months of biopsy the patient is undergoing hemodialysis now.

Aged↗

PubMed2001

[Optimal therapy with erythropoietin (EPO) in patients with renal anemia on hemodialysis therapy].

Treatment of anaemia of renal origin by recombinant erythropoietin (EPO) is well established and is considered to be an integral part of therapy in patients with chronic renal failure. An open, non-controlled and multicenter study was designed with aim to verify the dosage of EPO, necessary to reach and maintain rational correction of renal anaemia in a representative group of patients in chronic haemodialysis (HD) treatment. Target range of haemoglobin (Hb) was defined to be 100-120 g/l in adult patient, length of maintenance phase of follow-up 6 months. 183 patients from z 8 HD centres were included to the study, in this number 83 (45.4%) men and 100 (54.6%) women, aged 59.8 +/- 14.4 years (min. 20 and max. 87 years). During the next 6 months haemoglobin levels raised from baseline value Hb0 100 g/l to Hb1 102.9, resp. Hb2-104.9, Hb3 106.1, Hb4 107.5, Hb5 108.2 and Hb6 108.1 g/l; while mean total weekly doses of EPO/kg (TWD/kg) in the respective period corresponded to TWD/kg0 62 IU, resp. TWD/kg1 66 IU, TWD/kg2 67 IU, TWD/kg3 62 IU, TWD/kg4 64 IU, TWD/kg5 60 IU, TWD/kg6 56 IU. Clinical complications (inflammatory state, bleeding...) that could in different extent reduce the effectivity of EPO treatment were observed in 50 cases. No serious clinical complications that could be attributed to EPO treatment were found. On basis of results of our study, it is justified to assume that target range of Hb between 100-120 g/l can be reached with relatively modest increase of EPO dosage in comparison to current praxis in HD centres in CR, and that following cautious dosing of EPO (comparable to the dosing schema in our study) the treatment should not be connected with the development of major clinical complications.

Adult↗

PubMed2000

[Diagnosis of malacoplakia in a transplanted kidney by needle biopsy].

Malakoplakia is an uncommon inflammatory condition rarely involving parenchyma of transplanted kidney. We report a 44-year-old female recipient of a cadaveric renal allograft treated with cyclosporin A and prednisone. After transplantation, E. coli and Citrobacter bacteruria occurred and three years later decreased graft function developed. Percutaneous needle biopsy was performed and diagnosis of malakoplakia was established. Histologically, interstitial sheets of plasmocytes and histiocytes with periodic acid-Shiff positive cytoplasm containing Michaelis-Gutmann bodies were present. Ultrastructurally, phagolysosomes containing membrane fragments and various developmental stages of inclusions to fully developed Michaelis-Gutmann bodies were found. The patient was treated with co-piperacillin and subsequently pefloxacin and renal functions improved after six months follow-up. Our case suggests that malakoplakia represents an abnormal defective histiocytic response to the infection in the setting of immunosuppressive therapy.

Biopsy, Needle↗

PubMed1999

[Hypertension in hemodialyzed uremic patients].

The pathogenesis of hypertension in haemodialyzed uraemic patients is multifactorial. The following are involved: sodium and water retention as a result of the impaired excretory capacity of the kidneys, excessively increased activity of the RAAS and sympathetic nerve, increased levels of the vascular constrictor endothelin-1, cumulation of endogenous inhibitors of NO synthesis and reduced formation of vasodepressor factors. As to other factors in the development of hypertension raised intracellular calcium associated with hyperparathyroidism may participate, the stiffness of calcified arteries, erythropoietin treatment and preexisting essential hypertension. Treatment comprises salt restriction below 5 g/day, systematic control of the volume of extracellular fluid by ultrafiltration during every haemodialysis to the level of so-called dry weight and pharmacological treatment in patients where volume control dos not suffice. All drug groups are used. In their selection contraindications are taken into consideration as well as co-morbidity, the dialyzability of antihypertensive drugs and compelling evidence. In patients with a preserved residual diuresis furosemide is administered--125-750 mg/day. Beta-blockers are indicated in patients with IHD, in particular after IM. Calcium blockers are recommended in ventricular hypertrophy and diastolic dysfunction, when beta-blockers are contraindicated and in elderly patients. ACEI indicated in congestive heart failure and left ventricular hypertrophy with systolic dysfunction. Inhibitors of AT1 receptors are an alternative in case of undesirable effects od ACEI. Alpha-blockers and central alpha agonists are used mainly in combinations. In case of failure the haemodialyzation method can be altered or changing the patients to CAPD may be considered. The relationship between BP and the survival of haemodialyzed patients is bimodal. An adverse effect is exerted by a high as well as low BP and in particular by interdialyzation hypotension. The target BP for the haemodialyzed population has not been defined so far. There is, however, evidence that a high BP is independently associated with the de novo development of IHD and MAP above 106 mm Hg with de novo development of cardiac failure. MAP below 98 mm Hg minimalizes the development and progression of left ventricular hypertrophy and MAP below 106 mm Hg the development of heart failure. Long-term survival for 15 and more years is statistically significantly associated with MAP lower than 99 mm Hg.

Humans↗

PubMed1999

[Hypertension after kidney transplantation].

Hypertension is the most frequent non-rejection complication after transplantation of the kidney. It is encountered in 60 to more than 80% of recipients, depending on the investigated population and the definition of hypertension. It develops also in recipients who were normotensive before transplantation. While in dialyzed uraemic patients in the pathogenesis the most important part is played by hypervolaemia, after transplantation most frequently immunosuppressive treatment plays a part. The objective of our study was to assess the incidence of hypertension in the 1st and 2nd year after transplantation resp., the achieved blood pressure level (BP) the method of hypertension therapy in the group of recipients having immunosuppression treatment with corticoids, cyclosporin A (CyA) and mycophenolate mofetil (MFM). The group comprises 58 recipients of cadaverous renal grafts, 35 men (mean age 44.4 +/- 10.7 years and 23 women (mean age 44.8 +/- 12.6 years). 53 recipients (91.4%) had a graft for the first time, 5 recipients (8.6%) had already a second renal transplantation. Thirteen men (37%) and 8 women (35%) had a functioning graft for at least two years. The blood pressure was assessed by the auscultation method during every ambulatory control examination, with the patient sitting, on the upper extremity on the contralateral extremity with an arteriovenous fistula. The rate of ambulatory check-up examinations depended on the time after discharge from hospital following transplantation: in the first month 1x a week, in the second to third month 1x in two weeks, from the 4th month usually once a month. The BP reading at the end of the first and second year resp. after transplantation was obtained by calculating the mean value of three consecutive readings: from the ambulatory check-up at the end of the 1st and 2nd year resp. after transplantation and the preceding and subsequent check-up examination. Hypertension was defined as a BP exceeding 130/85 mm Hg or a median arterial pressure (MAP) higher than 100 mm Hg. MAP was calculated from the mean value of the SBP and DBP according to the formula: MAP = DBP + 1/3(SBP-DBP).

Adult↗

PubMed1997

[Controlled clinical study of Consupren versus cyclophosphamide in chronic glomerulonephritis. II. Adverse effects].

BACKGROUND: The second part of the study was designed to assess Consupren side effects. METHODS AND RESULTS: The groups of patients studied were described in Part I. Side affects typical of Cy-A were evaluated only in the CS group. Gastrointestinal intolerance, only mild and temporary, was observed in 31%, neurotoxicity in 44%, hypertrichosis in 37%, nephrotoxicity in 25%, and gingival hypertrophy in 19%. Mean values of systolic and diastolic blood pressure did not change significantly in the course of treatment. When changes in blood pressure were individually investigated in particular patients, they were found in 31% in the CS group and in none in the K group. Mean values of uric acid non-significantly increased in the CS group and, on individual investigation, hyperuricaemia was observed in 31%. Mean values of serum potassium did not alter significantly. Signs of possible hepatotoxicity were found in 37% patients of the CS group. In this group, there was a significant decrease in haemoglobin mean values and a decrease in haemoglobin of more than 25 g/l was observed in 44% of CS group patients. In the K group significant decrease in mean leukocyte count was noted, but no patient developed real leukopenia. CONCLUSIONS: The occurrence of side effects was comparable to data known from the literature.

Chronic Disease↗

PubMed1997

[A controlled clinical trial of Consupren versus cyclophosphamide in chronic glomerulonephritis].

BACKGROUND: Experience gained from recent studies shows, that Cyclosporine-A (Cy-A) may decrease proteinuria (PU) in some forms of chronic glomerulonephritis (GN) with the nephrotic syndrome. The aim of this study was to test the efficacy of Czech-made Cy-A, Consupren. METHODS AND RESULTS: 30 patients with chronic GN, confirmed by biopsy and PU higher than 3 g/d, corticodependent or corticoresistant, were randomized according to the month of birth to either therapy with Consupren at an initial dose of 5 mg/kg/d (CS group, after dropout of 3 patients who did not finish the treatment, n = 16) or Cyclophosphamide at a dose of 1.5 mg/kg/d (K group, n = 11), and prednisone maintained at the original dose in both groups. The treatment was stopped after six months or after achieving remission. The main criterion of efficacy was PU. The decrease in mean values, statistically evaluated by Holm's procedure was highly significant in the CS group and non-significant in the K group. A similar evaluation of PU corrected by glomerular filtration rate was significant in both groups. Partial or complete remission was reached in 50% of CS group patients and in 34% of K group patients (NS). In the CS group a significant increase in the mean values of albumin and gama-globulin, and a decrease in cholesterol levels were observed. In the K group, these changes were non-significant. CONCLUSIONS: In patients with chronic GN and the nephrotic syndrome, the efficacy of Consupren treatment gives comparable, or even better results versus treatment with Cyclophosphamide.

Adult↗

PubMed1996

[Kidney transplantation at the Brno Transplantation Center].

The transplantation activity in the Brno TC has increased significantly since 1994 and there are now 30 transplantations per 1 million population of the catchment area per year. It is, however, necessary to get more organ donors to attain the national average of 40 renal transplantations per 1 million inhabitants per year, which is also the average value in advanced European countries. With the use of immunosuppression with cyclosporin A the one, five and ten-year survival of grafts increased by 20, 35 and 15% resp., as compared with the period of conventional immunosuppression. The greatest losses of grafts were recorded in the Brno TC during the first year after transplantation and they accounted roughly for 25% during immunosuppression without and immunosuppression with cyclosporin A. The graft losses due to rejection declined from 63 to 21%. However, there was no decline of graft losses for non-immune reasons which accounted during all investigated time intervals for cca 20%. The ratio of graft losses on surgical--urological grounds did not change (before cyclosporin A, 5.9%, and with immunosuppression with cyclosporin A 6.6%). Also graft losses due to the recipient's death declined only insignificantly (14.4% before CyA and 8.4% with CYA). The most frequent causes of death of recipients were infections (40%), followed by cardiac deaths and haemorrhagic conditions (17% in both instances). The high rate of infections is due to aggressive immunosuppressive regimes and large doses of corticoids. Revision of immunosuppressive regimes and protective procedures is necessary. Haemorrhagic conditions such as disseminated coagulopathies remain unexplained so far. The cardiac deaths are associated above all with the rising age of renal transplant recipients and in the majority these deaths could not be prevented (acute myocardial infarctions and sudden deaths at home).

Adolescent↗

PubMed1993

[Arthropathy and para-arthropathy in uremic patients on regular hemodialysis].

Arthropathies and para-arthropathies occur in two thirds of regularly haemodialyzed uraemic subjects. The incidence does not depend on age but the period of haemodialyzation treatment. After five years of treatment the articular apparatus is affected in 100%. In women, as compared with men, the joints of the upper extremities, in particular the small joints of the hands are significantly more frequently affected.

Adult↗

PubMed1991

Changes in the T-lymphocyte subpopulation (CD+/CD8+) in the blood of patients following kidney transplant and during the acute rejection episode.

A study was made of changes in the ratio of CD4+/CD8+ in patients who had received cadaverous kidneys and who were under treatment with a combination of cyclosporin A + azathioprine + cor ticosteroids. The results showed that one month after the transparent there was a significant drop (P less than 0.05) in the immunoregulation index compared with the pretransplantation values. Throughout the whole period a correlation (r = -0.65, P less than 0.05) was found between the CD4+/CD8+ ratio and serum, creatinine. In recipients with acute rejection episode no significant difference was found between the CD4+/CD8+ values before the rejection episode (7 +/- 1 days and 3 +/- 1 days) and after it was diagnosed. The introduction of monoclonal antibodies specific for determinants in T-lymphocyte transplantation. Many authors have investigated changes in the CD4+ (helper inducer) to subpopulations (1) made possible immunological monitoring following the organ CDB+ (cytotoxic suppressor) ratio following the organ transplant (2, 3, 4, 5). Some reports (6, 7) have indicated that during rejection of a transplanted kidney there is a rise in the immunoregulation index (CD4+/CD8+), while other works (8, 9) failed to confirm this. Our work presents the dynamics of changes in the CD4+/CD8+ ratio in peripheral blood of recipients of cadaverous kidney transplants, and points to changes in the immunoregulation index before and during acute rejection episodes.

Acute Disease↗

PubMed1989

A T-helper/suppressor ratio in renal allograft recipients after various long-term immunosuppressive regimens.

The response of T-helper and T-suppressor cells to various immunosuppressive regimens was studied in long surviving cadaveric renal allograft recipients. Eight patients were immunosuppressed with Azathioprine and corticosteroids, 12 recipients were treated with a combination of Cyclosporin A, corticosteroids and Azathioprine for 1 year. Both regimens decreased the Th/Ts ratio significantly as compared with healthy controls (p less than 0.05). No correlation between the Th/Ts ratio and the serum creatinine concentration was found. Likewise, the Th/Ts ratio did not correlate with Cyclosporin A blood levels.

Adult↗

PubMed1988