Biocompatibility assessment of peritoneal dialysis solutions with a new in vitro model of preconditioned human HL60 cells.

The purposes of this study were to test the human promyelocytic cell line HL60 for its usability as a new cell model for the immune barrier of the peritoneum, and to investigate the impact of different peritoneal dialysis (PD) solutions in the model. HL60 cells were stimulated by retinoic acid and recombinant human granulocyte and macrophage colony-stimulating factor to differentiate into neutrophilic granulocytes. Cells were incubated in different commercially available PD solutions.

Protein A immunoadsorption in a pregnant woman with habitual abortion.

The role of antibodies in the occurrence of recurrent spontaneous miscarriage is well known. However there are many controversial issues in the management of habitual abortion. This paper describes the effect of Protein A immunoadsorption on serum levels of these antibodies and its impact on a case of a successfully treated woman in a outpatient department without need for a central venous catheter.

Immunoadsorption of sensitized kidney transplant candidates immediately prior to surgery.

Patients with anti-human leucocyte antigen (HLA) antibodies from previous transplantation, blood transfusion are highly sensitized and at risk to hyperacute renal graft loss. As these antibodies are identified to be of pathogenic importance, an effective removal may allow successful transplantation. Six 'high risk patients' [panel-reactive antibodies (PRA) >30% or retransplanted patients with an acutely rejected first graft within 6 months from surgery] were treated by protein A immunoadsorption (IA) immediately prior to transplantation.

Improvement of multiple organ functions in hepatorenal syndrome during albumin dialysis with the molecular adsorbent recirculating system.

Recently, significant improvement of renal function and prolongation of survival were reported in hepatorenal syndrome (HRS) patients treated with the Molecular Adsorbent Recirculating System (MARS). As no impact on extrarenal organ function was documented, this trial looked into multiple organ function changes during MARS in HRS patients. Eight HRS patients (4 male, mean age 42.

Liver support by extracorporeal blood purification: a clinical observation.

Liver failure associated with excretory insufficiency and jaundice results in an endogenous accumulation of toxins involved in the impairment of cardiovascular, kidney, and cerebral function. Moreover, these toxins have been shown to damage the liver itself by inducing hepatocellular apoptosis and necrosis, thus creating a vicious cycle of the disease. We report a retrospective cohort study of 26 patients with acute or chronic liver failure with intrahepatic cholestasis (bilirubin level > 20 mg/dL) who underwent a new extracorporeal blood purification treatment.

Diagnostic value of urinary alanine aminopeptidase and N-acetyl-beta-D-glucosaminidase in comparison to alpha 1-microglobulin as a marker in evaluating tubular dysfunction in glomerulonephritis patients.

To estimate the diagnostic value of tubular parameters, the urinary alanine aminopeptidase (AAP), N-acetyl-beta-D-glucosaminidase (NAG) and the alpha(1)-microglobulin (a1M) of 150 patients with histologically proven glomerulonephritis (GN) were determined. In addition, the reabsorption rate of the proximal tubule and the fractional excretion of sodium, the free water clearance and the renal function were assessed by inulin and p-aminohippurate (PAH) clearance. Compared to healthy controls, urinary AAP, NAG and a1M were found significantly elevated in GN patients.

Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial.

In hepatorenal syndrome (HRS), renal insufficiency is often progressive, and the prognosis is extremely poor under standard medical therapy. The molecular adsorbent recirculating system (MARS) is a modified dialysis method using an albumin-containing dialysate that is recirculated and perfused online through charcoal and anion-exchanger columns. MARS enables the selective removal of albumin-bound substances.

Protein A immunoadsorption (i.a.) in renal transplantation patients with vascular rejection.

Vascular rejection after renal transplantation is connected with a higher frequency of allograft dysfunction or graft loss. Plasmapheresis as an adjunctive therapy in the treatment of humoral mediated acute graft rejection was compared with protein A immunoadsorption. Eleven patients with acute graft rejection and high titers of cytotoxic HLA-Ab and/or signs of vascular rejection at graft biopsy (performed in 9 patients) have been treated.

Microcirculation of the fingernail fold in CAPD patients: preliminary observations.

Objective: To study changes in the peritoneal microcirculation during continuous ambulatory peritoneal dialysis (CAPD) by studying change in the microcirculation of the fingernails of CAPD patients.

Setting: A university department.

Design: A cross-sectional study of 10 nondiabetic patients on CAPD.

Increased serum level of total homocysteine in CAPD patients despite fish oil therapy.

It has been shown that serum total homocysteine (HC) is a risk factor for vascular disease which characterizes endothelial damage. The incidence of vascular disease is increased in continuous ambulatory peritoneal dialysis (CAPD) patients. Our aim was to investigate: (1) whether concentration of HC correlates with atherosclerotic and inflammatory events, and (2) if fish oil therapy can retard the disturbance in lipid metabolism which promotes atherosclerosis.

[Measuring the thickness of the peritoneum as a dialysis membrane using various osmolar concentrations of dialysis fluid].

Thickness measurements solutions on the rat peritoneum using peritoneum using peritoneal dialysis solutions of various osmolalities show a marked reduction of the distances between capillaries and peritoneal surface with increasing osmolality. This may caused by a dehydration of the peritoneum and support the so-called canaliculus theory. If the dehydration of the peritoneum may outlast temporal the dialysis cycle with higher osmolar solution, it could be an explanation for the efficacy of following low-molecular solutions.

[Scanning electron microscopy study of the peritoneum as a dialysis membrane--a morphological study on the etiology of sclerosing peritonitis].

Scanning electron microscopy investigations of the surface of rat peritoneum were performed after application of isotonic saline solution and peritoneal dialysis solutions with osmolalities of 375, 528, and 680 mosmol x kg-1 and intraabdominal stay periods of 15, 30, and 45 minutes. Severe morphological changes of the peritoneal surface were shown as clotting and atrophy of microvilli, detachment of surface cells from the basement layer, destruction of the basal lamina and appearance of rough-fibrous submembranous connective tissue, which was observed even after application of isotonic saline solution into the abdominal cavity. In conclusion, sclerosing peritonitis is caused by a fruitless inflammation reaction of the organism against the unphysiological function of the peritoneum as dialysis membrane forced upon peritoneal dialysis.

[Nutritional problems in patients treated with chronic dialysis].

A food with a protein content of 100-110 g a day determined for dialysis patients was analysed for total weight, water content, protein content, energy content, potassium content and phosphate content during 13 days. During this time 152 individual nutritive substances were offered, which were classified into the group of meats and sausages, egg, milk, milk-products, bakery-goods, potatoes and vegetables. It is to be stated that highly significant positive correlations between the weight of the daily taken food and its content of water, protein, energy, potassium and phosphate are existing, whereby a quantity of 1 kg a day is preferred.

[Determination of caries activity levels in children aged 4-6 years by the modified Snyder test].

Modified Snyder Test, which is a good instrument in motivating the patient and determining the effectiveness of preventive programs, is used commonly in Public Health Research programs for measuring the the caries activity levels. In our study, by using modified Snyder Test instead of Snyder Test, which is more preferable because of its' simplicity in application, we determined the caries activity levels of the children, aged between 4-6 years, which remained as an unexamined group in our population up to date. In our study, consisting of fifty children, caries rate was found to be 36% depending on WHO's criteria, while caries percentile for each tooth was 5.

[Optimization of peritoneal dialysis using diffusion curves].

By taking peritoneal diffusion curves of several substances characterizing the uraemia it is possible, taking into consideration a creatinine clearance of 0.1 ml X s-1, to calculate the quantity of dialysate necessary for this, regarding also the residual renal function at a differently long duration of the dialysis cycle. Moreover, by this way also the clearances of other investigated substances can be calculated.

[Peritoneum as dialysis membrane--a morphologic study].

Different histological staining methods allow a deeper insight into the light microscopic structures of the biomembrane peritoneum. To the wellknown model of the peritoneal resistances according to existing results two other resistances shall be added, namely capillary pericytes and the submesothelial basal membrane. The peritoneal interstice, consisting of muscle and collagenic fibres as well as elastica fibres is penetrated by a well-formed network of reticulum fibres.

[A new procedure for the revision and reposition of functionless peritoneal dialysis catheters].

The most important requirement for satisfactory transperitoneal dialysis is faultless functioning of the Tenckhoff catheter. Suddenly occurring functional disturbances are often caused by wrong positioning and by envelopment of the catheter by tissue, which require surgical correction. A technique for successfully locating and replacing a transperitoneal catheter by means of an operation laparoscope is described.

[Observation of the course of 4-year ambulatory peritoneal dialysis in the treatment of chronic uremia].

It is reported on a 4-year chronic peritoneal dialysis due to decompensated retention of substances normally contained in the urine in chronic pyelonephritis. Under a treatment regimen of 3.6 dialyses with 20 1 of wash each satisfying values of creatinine, haemoglobin and total protein in the serum were found.

[Blood detoxication procedures in extra-renal diseases].

In a survey concerning the application of haemodialysis, ultrafiltration, haemofiltration, haemoperfusion and separation of plasma in the treatment of non-renal diseases clinically tested methods are discussed. The therapy of endogenic and exogenic poisonings as well as the removal of hyperhydrations of different genesis using extracorporeal systems can be clarified scientifically with the help of clinical course and laboratory findings. The separation of plasma on membrane opens new possibilities of therapy of above all immunologically conditioned diseases.

[Clinical and histological studies on the course of glomerulonephritis].

It is reported on 37 patients in whom on the basis of the clinical suspicion of a glomerulonephritis a biopsy of the kidneys was carried out, and after treatment in these patients a rebiopsy was carried out 21 months later in order to examine clinical and histological changes during this period. Hereby could be established that the rebiopsy only six times evoked an apparant improvement, whereas the other cases showed clinical findings or deterioration and only in half the cases a correspondence between clinical and histological developmental tendencies was recognizable. As conclusion indications to rebiopsy are proposed.

[Comparative clinical and histological studies in the diagnosis of isolated proteinuria and hematuria].

In 311 patients with clinical suspicion to glomerulonephritis biopsies of the kidneys were performed. In these cases in 82% the histological or tentative diagnosis, respectively, of a glomerulonephritis could be made. As diseases preceding the glomerulonephritis relapsing tonsillitides are occupying the first place, whereas scarlet fever, otitides, furunculoses and sinusitides were observed more infrequently.