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The purpose of the study was to examine the state of upper parts of the digestive tract, prevalence of Helicobacter pylori infection and its relation to the pathology revealed in patients with chronic renal insufficiency after kidney transplantation.
Sixty patients with chronic renal failure (CRF) were studied for the rates of lipid peroxidation (LPO), the state of the antioxidative system (AOS) as well as for the morphofunctional state of biomembranes in renal tubules measured by excretion of low-molecular compounds tested in urine x by means of proton nuclear magnetic resonance spectroscopy. The control group numbered 35 patients with glomerulonephritis free of functional disturbances in the kidneys. The increased values of malonic dialdehyde levels in red blood cells and blood serum and those of diene conjugates in red blood cell membranes provide evidence for a significant increase of the LPO levels. Furthermore, depression of the AOS was revealed, manifested by the decreased levels of blood serum alpha-tocopherol as well as by unstable levels of superoxide dismutase in red blood cells. In the presence of the high LPO levels significant tubular dysfunctions were progressing, parallel with aggravation of renal function. Disturbances detected in excretion and reabsorption of amino acids (leucine, alanine, glycine, valine, histidine), thin organic acids and ketone bodies in CRF patients point to the existence of disturbances in tubular membranes. Tubular dysfunction appears to be caused by the disturbances of the biomembrane morphofunctional states induced by the high levels of free radical oxidation as well as by the AOS function failure.
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A state of the kallikrein-kinin system, activity of proteolysis inhibitors were studied simultaneously with the functional activity of neutrophils and content of lysozyme in blood serum of 21 patients with chronic kidney insufficiency. Two types of alterations in the kallikrein-kinin system were found in 13 patients maintained on hemodialysis: in four patients content of kallikrein was increased 8-fold as compared with normal level with a decrease in content of prekallikrein, while in nine patients activity of kallikrein was similar to control values but content of prekallikrein was still further decreased. Content of alpha 1-proteinase inhibitor (PI) was distinctly decreased (2-2.5-fold) in these patients, however, the decrease of the inhibitor was not observed in four patients; activity of alpha 2-macroglobulin tended to decrease. The ratio of active neutrophils and content of lysozyme were increased in blood serum of the majority of the patients. Hemodialysis, activation of the kallikrein-kinin system and stimulation of neutrophils appear to be responsible for a decrease in PI activity. The decrease in the PI activity and stimulation of the kallikrein-kinin system suggest that impairments in regulation of proteolysis could be corrected by means of exogenous proteinase inhibitors. In crisis of allogenic kidney rejection activities of PI and prekallikrein were decreased. Drastic, uneven alterations of the patterns studied were detected in pyo-inflammatory complications not related to the rejection crisis.
A total of 28 patients were examined. Of them 17 were exposed to systematic hemodialysis, 11 examinees sustained transplantation of the kidney. Dynamic scintigraphy was performed with a computerized gamma-camera. The authors studied the kinetics of the blood discharge of Tc99m-labelled sodium 1-hydroxyethane-1,1 diphosphonate and its accumulation in the osseous tissue. In supine position of the patient a collimator could demonstrate simultaneously pelvic spines, ortal bifurcations and femoral trochanters. Immediately after the administration of the agent the recording was started: 8 frames for the first 2 min, then 38 frames for 38 min by the matrix 64 X 64. Blood REP levels were found by subtraction of the value of its activity in the projection of postero superior pelvic spine from the values in the site of the aortal bifurcation. The authors revealed that in case of osteomalacia the REP blood elimination coefficient (K1) was less than 0.1 min-1 and proposed to use it for distinguishing osteomalacia from other patterns of renal osteodystrophy. Factors that could change the amount of K1 values are discussed.
27 patients suffering from end stage diabetic renal failure were treated by hemodialysis (HD) [8], continuous ambulatory peritoneal dialysis (CAPD) [13] or kidney allotransplantation after previous dialysis (KT) [13]. The mean age of the patients was 39.8 +/- 9.8, 44.8 +/- 11.3 and 33.8 +/- 5.7 for HD, CAPD and KT groups respectively. The cumulative patient survival after 1 and 2 years of treatment was 24%/0%, 56%/0% and 70%/50% for HD, CAPD and KT treatment. The cumulative allotransplant survival amounted to 40% after 1 year and to 20% after 2 and 3 years. Causes of death included cardiovascular complications in 7 patients, especially during HD treatment; infections occurred in 6 patients during CAPD treatment and after kidney allografting. Hypertension persisted during HD treatment and disappeared in 1/3 of the patients after KT. Nonlethal cardiovascular problems were observed during all treatment regimens and were more prominent in HD patients. In 2 patients, 3 amputations of the legs had to be performed after KT. Visual power deteriorated in more than half of the patients on HD and in one third during CAPD; it remained stable in half of the patients after KT. Neuropathy deteriorated during HD, was stable during CAPD and improved after KT. Rehabilitation was better during CAPD or after KT than during HD. The results of kidney replacement therapy in diabetics are worse than in non diabetic patients due to extrarenal organ damage. Early renal transplantation might prove to ameliorate this situation.
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The retrospective study under report assessed the diagnostic capability of colour Doppler sonography (CDS) with measurement of the resistive index (RI) in the long-term follow-up of patients with renal allografts. 210 CDS examinations were performed in 115 patients. The time since transplantation ranged from 6 months to 22 years. The RI was correlated to laboratory parameters of renal allograft function (serum creatinine, urinary protein levels and serum-cyclosporine). In 97 of 210 examinations, serum creatinine was elevated (> 1.5 mg% or an increase of more then 0.3 mg% within the last 6 months). In 35 out of these examinations RI was > 70%, in 62 RI was < or = 70%. Thus, with a threshold RI of 70%, sensitivity of the RI in the diagnosis of renal allograft dysfunction is 36% and specificity 62%, respectively. There was no significant difference in the RI between examinations of allografts with normal function (68.2% +/- 7.5%) and those with dysfunction (68.5% +/- 8.5%). Furthermore, there was no significant correlation between the RI and any of the laboratory parameters. CDS with calculation of the RI cannot differentiate in the long-term follow-up between allografts with normal function and those with dysfunction.
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