The effects of L-cysteine and N-acetyl-L-cysteine on homocysteine metabolism and haemostatic markers, and on cardiac and aortic histology in subchronically methionine-treated Wistar male rats

Methionine is the precursor of homocysteine, a sulfur amino acid intermediate in the methylation and transsulfuration pathways; methionine-rich diets were used to induce hyperhomocysteinemia, and cardiovascular pathology was often observed. Other sulfur amino acids interfere with this metabolism, i.e., L-cysteine (Cys) and N-aceyl-L-cysteine (NAC), and probably also affect cardiovascular system. Their effects are controversial due to their ability to act both as anti- or pro-oxidant. Thus, this study aimed to elucidate their influence on levels of homocysteine, folate and vitamin B12, levels of different haemostatic parameters (fibrinogen, D-dimer, vWF Ag, vWF Ac) in rat serum or plasma as well as their effects on cardiac and aortic tissue histology in subchronically methionine-treated rats. Wistar albino rats were divided into 4 experimental groups: (a) control group (0.9% sodium chloride 0.1-0.2 mL/day) (n = 10) (K); (b) DL-methionine (0.8 mmol/kg/bw/day) (n = 10) (M); (c) DL-methionine (0.8 mmol/kg/bw/day) + L-cysteine (7 mg/kg/bw/day) (n = 8) (C); (d) DL-methionine (0.8 mmol/ kg/bw/day) + N-acetyl-L-cysteine (50 mg/kg/bw/day) (n = 8) (N). All substances were applied i.p., treatment duration 3 weeks. Lower levels of vitamin B12 in all the groups were found. Folate was reduced only in N group. Decreased fibrinogen was noted in C and N groups and increased D-dimer only in C. VWF activity was reduced in M and C groups. Deleterious effects in heart were observed, especially after Cys and NAC application. Aortic tissue remained unchanged. In conclusion, it could be said that sulfur amino acids have the significant impact on cardiovascular system in subchronically methionine-treated rats. This study points out the relevance of their complex interactions and deleterious effects mediated by either direct influence or procoagulant properties.

Anxiety-related behavior in hyperhomocysteinemia induced by methionine nutritional overload in rats: role of the brain oxidative stress

The aim of this study was to examine the effects of a methionine-enriched diet on anxiety-related behavior in rats and to determine the role of the brain oxidative status in these alterations. Adult male Wistar rats were fed from the 30th to 60th postnatal day with standard or methionine-enriched diet (double content comparing with standard diet: 7.7 g/kg). Rats were tested in open field and light-dark tests and afterwards oxidative status in the different brain regions were determined. Hyperhomocysteinemia induced by methionine-enriched diet in this study decreased the number of rearings, as well as the time that these animals spent in the center of the open field, but increased index of thigmotaxy. Oxidative status was selectively altered in the examined regions. Lipid peroxidation was significantly increased in the cortex and nc. caudatus of rats developing hyperhomocysteinemia, but unaltered in the hippocampus and thalamus. Based on the results of this research, it could be concluded that hyperhomocysteinemia induced by methionine nutritional overload increased anxiety-related behavior in rats. These proanxiogenic effects could be, at least in part, a consequence of oxidative stress in the rat brain.

Role of cystatin C and renal resistive index in assessment of renal function in patients with liver cirrhosis

AIM: To evaluate the clinical significance of cystatin C and renal resistive index for the determination of renal function in patients with liver cirrhosis.

METHODS: We conducted a study of 63 patients with liver cirrhosis. A control group comprised of 30 age and gender-matched healthy persons. Serum cystatin C was determined in all study subjects and renal Doppler ultrasonography was made. Estimated glomerular filtration rate from serum creatinine (GFR_Cr) and cystatin C (GFR_Cys) was calculated.

RESULTS: We confirmed significant differences in values of cystatin C between patients with different stages of liver cirrhosis according to Child-Pugh (P = 0.01), and a significant correlation with model of end stage liver disease (MELD) score (r_s = 0.527, P < 0.001). More patients with decreased glomerular filtration rate were identified based on GFR_Cys than on GFR_Cr (P < 0.001). Significantly higher renal resistive index was noted in Child-Pugh C than in A (P < 0.001) and B stage (P = 0.001). Also, a significant correlation between renal resistive index and MELD score was observed (r_s = 0.607, P < 0.001). Renal resistive index correlated significantly with cystatin C (r_s = 0.283, P = 0.028) and showed a negative correlation with GFR_Cys (r_s = -0.31, P = 0.016).

CONCLUSION: Cystatin C may be a more reliable marker for assessment of liver insufficiency. Additionally, cystatin C and renal resistive index represent sensitive indicators of renal dysfunction in patients with liver cirrhosis.

Effect of Long-term Topiramate Therapy on Serum Bicarbonate and Potassium Levels in Adult Epileptic Patients

BACKGROUND

Topiramate (TPM) is a sulfamate-substituted monosaccharide that is structurally different from other antiepileptic drugs. TPM inhibits carbonic anhydrase activity, which is associated with loss of bicarbonate from the kidney and consequently metabolic acidosis or electrolyte imbalance.

OBJECTIVE

The objectives of the study were to investigate the influence of TPM therapy on bicarbonate and potassium levels in adult epileptic patients.

METHODS

Data were collected from 59 adult patients on monotherapy or co-therapy of TPM and other antiepileptic drugs. Serum bicarbonate and potassium levels were available from all patients. Steady-state TPM trough concentrations were determined in blood samples by high-performance liquid chromatography. Data analysis was performed by SPSS software (version 17, Chicago, IL).

RESULTS

Patients were divided into group A (duration of therapy shorter than or equal to 5 years) and group B (duration of therapy longer than 5 years). Significant difference (P < 0.05) in serum bicarbonate levels was observed between these 2 groups. Bicarbonate levels were linearly related to the TPM therapy duration. No correlation was found between the TPM dose or patient age and bicarbonate or potassium levels, as well as between therapy duration and potassium level. Linear regression analysis showed no significant association among 54 available TPM trough concentrations and bicarbonate or potassium levels.

CONCLUSIONS

Results highlight the frequent occurrence of lower bicarbonate level associated with prolonged TPM therapy. Monitoring bicarbonate levels in patients on long-term TPM therapy might be useful.

Vascular endothelial growth factor in peritoneal dialysis patients

BACKGROUND

Vascular endothelial growth factor (VEGF) is a glycoprotein which exerts mitogenic effects on endo thelial cells, enhances neoangiogenesis and microvascular permeability, influences leukocyte kinetics when upreg ulated by hypoxia and high-glucose concentration in experimental conditions and in human pathology. Peritoneal synthesis of VEGF has been demonstrated in patients on peritoneal dialysis (PD) treated with glucose-based dialy sate solutions.

METHODS

The aim of the study was to determine the serum and peritoneal effluent VEGF concentrations in patients on chronic PD and to assess the relationship between age, gender, comorbidities, dialysis modality and vintage, therapy with erythropoiesis stimulating agents (ESA), angiotensin-converting enzyme inhibitors (ACEi) and statins and VEGF concentrations. Data on the use of ACEi, ESA, and statins were collected from patients' medical histories. VEGF was measured in serum and peritoneal effluent using the quantitative sandwich enzyme immunoassay (ELISA) kits (Quantikine® Human VEGF, R&D Systems, USA & Canada). Complete blood count and standard biochemical analyses (serum glucose, urea, creatinine, total protein, albumin, cholesterol, triglycerides, sodium, potassium, chloride, iron, total iron-binding capacity, ferritin, fibrinogen, C-reactive protein, and intact parathyroid hormone) were performed in fasting venous blood samples. Dialysis and residual components of Kt/V and normalized weekly creatinine clearance were calculated based on 24-hour urine and effluent collections. Peritoneal transport type was determined using the peritoneal equilibration test.

RESULTS

Samples from 63 PD patients (39 males and 24 females, average age 61.97 ± 11.01 years) were analyzed. The average serum and effluent VEGF concentrations (231.84 ± 173.91 pg/mL and 38.39 ± 49.38 pg/mL, respectively) correlated significantly (p = 0.002). No significant difference was found in serum and effluent VEGF concentrations in relation to demographic characteristics, comorbidities, dialysis modality, therapy with ESA, ACEi, and statins. Patients treated with PD longer than 5 years had significantly higher serum VEGF levels (p < 0.05). Correlation analysis showed a statistically significant relationship between statin therapy and lower effluent VEGF concentration (p = 0.030). Serum VEGF concentration significantly correlated with fibrinogen serum concentration (p = 0.034) and glycemia (p = 0.004). Effluent VEGF concentration significantly correlated with cholesterolemia (p = 0.004).

CONCLUSIONS

Serum VEGF concentrations were significantly higher in long term PD patients, and peritoneal effluent VEGF concentrations were significantly lower in patients receiving statins, suggesting a protective effect of those drugs on peritoneal membrane.

The importance of defining serum MMP-9 concentration in diabetics as an early marker of the rupture of atheromatous plaque in acute coronary syndrome

Acute coronary syndrome (ACS) is the main cause of mortality in diabetics. Acute myocardial infarction (AMI) in diabetics is much more often than in non-diabetics. MMP-9 activity could ease the formation of atherosclerosis, destabilization and plaque rupture as well as thrombocyte aggregation.

THE AIM OF THIS STUDY IS TO EXAMINE

MMP-9 defining in serum in diabetics; the impact of diabetes mellitus on atherosclerosis and MMP-9 level; relation between serum values of MMP-9 and markers of glycoregulation and lipid status, respectively.

RESULTS

The greatest concentration of both total and active MMP-9 serum has been noted in diabetics group with ACS. Both total and active MMP-9 values, in group with diabetes and ACS showed significantly important difference regarding the values in control group. Total and active MMP-9 showed statistically important correlation between the values of glycated hemoglobine A1c (HbA1c) and inverse correlations with values of subfraction HDL3.Active MMP-9 showed statistically important inverse correlation with value of HDL cholesterol.

IN CONCLUSION

According to the results, it has been thought that active MMP-9 shows a certain degree of atherosclerotic changes on blood vessels better than total MMP-9. MMP-9, active one, could present an early marker of atherosclerosis, especially on coronary blood vessels, in diabetics with type 2.

Risk factors for aortic valve calcification in patients on regular hemodialysis

INTRODUCTION

Aortic valve calcification (AVC) accelerates development of aortic valve stenosis and cardiovascular complications. Hyperphosphatemia is one of the key risk factors for aortic valve calcification.

AIM

The aim of this study was to evaluate the prevalence of AVC in patients on regular hemodialysis and to assess the impact of different factors on its appearance.

METHOD

The study investigated a total of 115 patients treated in the Hemodialysis Department of the Urology and Nephrology Clinic at the Kragujevac Clinical Center in Serbia. The variables investigated were: serum albumin, C-reactive protein (CRP), homocysteine, total cholesterol, LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), triglycerides (TG), Apolipoprotein A-I (Apo A-I), Apolipoprotein B (Apo B) and lipoprotein (a), calcium, phosphate and parathormone, and calcium-phosphorus product (Ca x P). Patients were evaluated by echocardiography for AVC. Statistical analysis included univariate and multivariate logistic regression analysis.

RESULTS

Univariate regression analysis showed that serum phosphate levels and Ca x P are the most important risk factors for AVC (p<0.001). Multivariate logistic regression analysis revealed that hyperphosphatemia is an independent risk factor for AVC (p<0.001).

CONCLUSION

Hyperphosphatemia is an independent risk factor for aortic valve calcification.

Cardiac troponins and left ventricular hypertrophy in hemodialysis patients

BACKGROUND

Cardiovascular diseases are the leading cause of death in hemodialysis patients. Left ventricular (LV) hypertrophy is an important predictor of cardiovascular morbidity and mortality in these patients. Cardiac troponins (cTnT and cTnI) are indicators of myocardial cell damage.

AIM

The aim of this study was to determine prevalence of LV hypertrophy, prevalence of elevated serum cTnT and cTnI in hemodialysis patients, and identify the correlation between cardiac troponins and LV hypertrophy.

METHODS

The study included 115 hemodialysis patients (71 men and 44 women), mean age 53.30 +/- 12.17 years, mean time on dialysis 4.51 +/- 4.01 years and average Kt/Vsp 1.17 +/- 0.23. Mean serum cTnT was 0.14 +/- 0.23 ng/ml, mean serum troponin I 0.20 +/- 0.48 ng/ml. Mean LV posterior wall thickness in diastole (LVPWd) was 11.44 +/- 2.09 mm, mean LV interventricular septal wall thickness in diastole (IVSd) 11.21 +/- 2.12 mm, mean LV end diastolic volume index (iLVEDV) 100.80 +/- 34.62 mL/m2 and mean LV mass index (LVMi) 143.85 +/- 41.21 g/m2.

RESULTS

We found statistically significant positive correlations (p <0.05) between serum troponin T concentration, IVSd, LVPWd and iLVEDV. A highly significant positive correlation (p < 0.01) was found between serum troponin T and LVMi. One-year follow-up showed that patients with cardiac troponin T > 0.10 ng/ml and cardiac troponin I > 0.15 ng/ml had significantly lower (p < 0.01) survival rate than patients with troponin T < or = 0.10 ng/ml and troponin I < or = 0.15 ng/ml.

CONCLUSION

A significant positive correlation exists between serum troponin T concentration and echocardiographic indicators of LV hypertrophy in hemodialysis patients. Patients with higher serum levels of cardiac troponins have lower survival rates during one year follow up.

[Tubular kidney function in patients with type 2 diabetes mellitus, microalbuminuria and proteinuria]

INTRODUCTION

Diabetes mellitus (DM) and hypertension are the most frequent causes of kidney function damage. Many different tests are developed to detect reversible functional kidney changes (detection of microalbuminuria and selective urinary enzymes).

OBJECTIVE

The aim of our study was to examine tubular kidney function in type 2 DM patients with different proteinuria levels, and to compare these results with healthy people.

METHOD

The patients with type 2 DM and creatinine clearance >80 ml/min were included in the study. According to the levels of proteinuria, the patients were classified in three groups: group I--patients with proteinuria <300 mg/24 h, and no microalbuminuria; group II--the patients with proteinuria <300 mg/24 h and microalbuminuria >20 mg/24 h; and group III--the patients with proteinuria >300 mg/24 h. The control group consisted of healthy subjects.

RESULTS

The study revealed that in type 2 DM patients and normal global kidney function, fractional excretions of sodium, potassium, and phosphates as well as renal phosphate concentrations were not adequately sensitive markers to detect damage in tubular kidney function in DM. There were some changes of urate fractional excretion in these patients: this value was significantly lower in patients with microalbuminuria compared with those with proteinuria >300 mg/24 h, as well as in the control group (p < 0.05). Hormone dependent tubular kidney activity, urinary osmolarity, and urea fractional excretion in all patients were within normal ranges.

CONCLUSION

It is evident that routine laboratory analyses are not sensitive markers to detect early changes of kidney function in type 2 DM.

Damage of tubule cells in diabetic nephropathy type 2: urinary N-acetyl-beta-D-glucosaminidasis and gamma-glutamil-transferasis

BACKGROUND/AIM

A damage of tubular epithelial cells is followed by the release of cell enzymes and production of proinflammatory compounds, which lead to the tubulointerstitial damage. The aim of this study was to examine the function of renal tubules in the patients with diabetes mellitus type 2 (DM type 2) and the various proteinuria degrees, to establish the damage of the proximal tubule cells caused by DM type 2 by determining urinary N-acetyl-beta-D-glucosaminidasis (beta-NAG) and gamma-glutamil-transferasis (gamma-GT) activity in urine, as well as to compare the obtained results in the examined groups of patients with the values in the healthy examinees.

METHODS

A complete examination of renal function and selective enzymuria was performed in 37 patients with DM type 2, and 14 healthy examinees as the controls. The patients were divided in three groups according to the degree of proteinuria. The first group consisted of the patients with diabetes without microalbuminuria; the second one consisted of the patients with proteinuria of < 300 mg/24 h, and microalbuminuria of > 20 mg/24 h, while the third one included the patients with proteinuria of > 300 mg/24 h.

RESULTS

In the patients with DM type 2 and the preserved global renal function, fractional excretion of sodium, potassium and phosphates, as well as renal threshold of phosphates concentration, were not sensitive parameters for discovering the damage of the renal tubule function. The determination of beta-NAG activity proved to be the most sensitive parameter for early discovering of tubule cells damages. The difference among the examined groups was statistically highly significant.

CONCLUSION

The increased presence of beta-NAG in the urine of DM type 2 patients, pointed out an early tubular disorder and damage of cells, while gamma-GT was a less sensitive indicator of this damage.

[Cardiac troponins and left ventricular hypertrophy in hemodialysis patients]

INTRODUCTION

Cardiovascular diseases are the most frequent cause of death among hemodialysis patients. Left ventricular hypertrophy is a potent predictor of cardiovascular morbidity and mortality in those patients. Cardiac troponins (cTnT and cTnI) are indices of myocardial cell damage. The study was aimed to investigate the impact of left ventricular hypertrophy on serum cardiac troponin concentrations.

MATERIAL AND METHODS

The study included 115 patients (71 men and 44 women) at the mean age of 53.30+/-12.17 years, treated with regular hemodialyses for 4.51+/-4.01 years, with mean left ventricle mass index LVMi 143.85+/-41.21 g/m2 and mean Kt/Vsp 1.17+/-0.23. According to echocardiographic findings of the left ventricle the patients were divided into four groups: the first group included patients with concentric left ventricular hypertrophy, the second group were the patients with eccentric left ventricular hypertrophy, the third group consisted of patients with left ventricular dilatation, and the fourth group were patients with normal left ventricular morphology. The mean serum troponin T value in the first group was 0.13+/-0.16 ng/ml, in the second group 0.20+/-0.32 ng/ml, in the third group 0.07+/-0.09, and in the fourth group 0.03+/-0.03 ng/ml.

RESULTS

Patients with concentric left ventricular hypertrophy showed significantly greater (p<0.05) and patients with eccentric left ventricular hypertrophy showed highly significantly greater (p<0.01) serum troponin T concentrations in comparasion to patients with normal left ventricular morphology.

CONCLUSION

Serum cardiac troponin T concentration can also be used to estimate left ventricular hypertrophy in clinically stable patients on hemodialysis, in the absence of acute coronary syndrome.

[Correlation of C-reactive protein with echocardiographic parameters of hypertrophic and ischemic heart disease in patients on regular hemodialyses]

INTRODUCTION

Cardiovascular diseases are the most frequent cause of morbidity and mortality in patients on hemodialysis. The reason for this is a high prevailance of risk factors for the development of cardiovascular complications with these patients. Microinflammation is one of the risk factors for the development of atherosclerosis of coronary arteries in patients on hemodialysis. The study was aimed at investigating correlation between microinflammation parameter C-reactive protein (CRP) and echocardiographic parameters of left ventricular hypertrophy and left ventricular dilatation (left ventricular mass index-LVMi, left ventricular end-diastolic volume index-EDVi) and echocardiographic parameters of ischemic heart disease and systolic function (systolic thickness of interventricular septum-StIVS, systolic thickness of left ventricular posterior wall-StPWLV, amplitude of motion of interventricular septum-AmmIVS, amplitude of motion of left ventricular posterior wall-AmmPWLV, left ventricular fractional shortening-LVFS, left ventricular ejectional fraction-LVEF).

MATERIAL AND METHODS

The research was conducted on 115 patients (M:F 7/:44) regularly treated by hemodialysis, average age 53.30+/-12.17 years, average length of dialysis 4.51+/-4.01 years and average Kt/Vsp index 1.17+/-0.23.

RESULTS

Average CRP was 7.50+/-9.34 mg/l, EDVi 100.80+/-34.62 ml/m2, StPWLV 54.17+/-14.03%, and AmmPWLV 6.09+/-1.58 mm. Statistically significant positive correlation between serum concentration CRP and EDVi (p=0.221) was found. Highly statistically important significant negative correlation was proved between the serum CRP concentration and StPWLV (p=-0.249) and AmmPWLV (p=-0.289).

CONCLUSION

Microinflammation is a possible risk factor for the development of atherosclerosis of coronary artheries in patients on hemodialysis.

[Left ventricular hypertrophy in patients on hemodialysis: importance of anemia]

INTRODUCTION

Cardiovascular diseases are the most frequent cause of mortality in hemodialysis patients. Left ventricular hypertrophy is the main risk factor for development of cardiovascular morbidity and mortality in patients on hemodialysis. Anemia is the only main risk factor for the development of left ventricular hypertrophy in patients on hemodialysis. The aim of this study was to examine the impact of anemia in the development of left ventricular hypertrophy, and correlation between anemia and echocardiographic parameters for the assessment of left ventricular hypertrophy.

MATERIAL AND METHODS

The research was conducted on 115 patients (M:F 71:44) regularly treated by hemodialysis, average age 53.30+/-1.2.17 years, average length of dialysis 4.51+/-4.01 years and average Kt/Vsp index 1.17+/-0.23. Depending on the level of hemoglobin, the patients were divided into three groups. The basic parameters investigated were the following: hemoglobin, hematocrite, serum concentrations of albumin, CRP, total cholesterol, HDL cholesterol, LDL cholesterol, and triglyceride serum concentrations, parathormon, diastolic thickness of interventricular septu-mIVSd, diastolic thickness of left ventricular posterior wall, relative wall thickness-RWT, left ventricular mass index-LVMi, index of left ventricular end-diastolic volume-iLVEDV. The results were statistically analyzed using ANOVA, Kruskal-Wallis test, Student t-test, Mann-Whitney U test, Univariate logistic regression analysis test, and Multivariate logistic regression analysis test.

RESULTS

The patients with hemoglobin <80 g/l had a very significantly higher (p<0.01), while the patients with hemoglobin 80-100 g/l had a significantly higher (p<0.05) left ventricular mass index than patients with hemoglobin >100 g/l. The univariate logistic regression analysis has showed that lower HDL cholesterol, anemia, higher systolic arterial pressure and higher mean arterial pressure cumulatively lead to the development of left ventricular hypertrophy. Multivariate logistic regression analysis established anemia as an independent risk factor for the development of left ventricular hypertrophy.

CONCLUSION

Anemia is an independent risk factor for the development left ventricular hypertrophy. Identification of patients with increased risk for development of left ventricular hypertrophy and application of appropriate therapy to attain target values of risk factors, result in the regression of left ventricular hypertrophy, reduced cardiovascular morbidity and mortality rates and improved quality of life in patients treated with regular hemodialyses.

Estrogen and ischemic heart disease in females

Introduction: Although ischemic heart disease (IHD) develops in both genders under the influence of the same risk factors, it is much less frequent among female population, which is mostly assigned to favorable effects of estrogen. Objective: Since latest investigations have pointed to higher incidence of disease in female population, the objective of our study was to examine the relation between estrogen and other clinical and biochemical parameters significant for its manifestation. Method: The relation between estrogen levels and frequency of obesity, diabetes, hypertension as well as the levels of total, HDL, LDL i VLDL cholesterol, triglycerides, Lp(a), apoprotein A i B i PAI-1 was analyzed in 50 (25 pre- and postmenopausal) patients, treated due to IHD in the Health Center, Krusevac, in 2002 year. Results: Low concentration of estrogen was found in 22 (44%) patients. In addition, frequency of diabetes, obesity and risky levels of high atherogenic lipid fractions (total and LDL cholesterol, Lp(a), apoprotein B) was insignificantly higher, whereas the concentrations of PAI 1, triglycerides and HDL cholesterol were lower, with significant correlation between estrogen level and PAI-1 (T=0.32, p<0.05). Conclusion: Despite all past investigations, numerous questions related to high incidence of IHD among premenopausal women, have remained open - whether it occurs as a consequence of reduced estrogen synthesis, lower expression of estrogen receptors, their modified function or maybe concomitant influence of other risk factors, not necessarily connected with sex, that eliminate protective effects of this hormone.

Influence of proteinuria on the lipoprotein (a) metabolism disorder

Background/Aim. Proteinuria causes lipid metabolism abnormalities. The aim of the present study was to examine the influence of proteinuria on the lipoprotein (a) metabolism disorder. Methods. The study included 60 patients of the male-famele ratio (M : F = 32 : 28), mean age 37.15?9.85 years with, the average endogenous creatinine clearance 86.27?19.81 ml/min, and the average body mass index (BMI) 24.18?2.23 kg/m2. Regarding the level of glomerular proteinuria, the patients were divided into four groups. The first (control) group, with proteinuria levels less than 0.25 g/24h, included 15 patients (M : F = 6 : 9), mean age 34.66?4.82 years, the mean clearance of endogenous creatinine 99.70?12.94 ml/min, and mean BMI 23.28?3.50 kg/m2. The second group, with proteinuria between 0.25 and 1.0 g/24 h, includ 15 patients (M : F = 9 : 6) with primary glomerulonephritis, mean age 37.87?9.65 years, the mean clearance of endogenous creatinine 82.85?18.48 ml/min, and mean BMI 23.83?1.57 kg/m2. The third group include 15 patients (M : F = 8 : 7) with primary glomerulonephritis, with proteinuria between 1.0 and 3.0 g/24 h, mean age 35.67?13.29 years, the mean clearance of endogenous creatinine 82.85?18.48 ml/min, and mean BMI 23.83?1.57 kg/m2. The fourth group, with proteinuria higher than 3.0 g/24 h, included 15 patients (M : F = 9 : 6) with primary glomerulonephritis, mean age 40.40?9.75 years, the mean clearance of endogenous creatinine 80.16?20.80 ml/min, and mean BMI 24.83?1.44 kg/m2. In order to assess the influence of proteinuria on the lipoprotein (a) metabolism abnormalities we investigated 24-hour proteinuria, the colloid osmotic pressure (COP) of plasma, and the serum concentration of lipoprotein (a). The results were statistically analyzed using ANOVA, Kruscal-Wallis test, Mann-Whitney U test, ?2 test and Spearman test. Results. Statistically, the patients with proteinuria over 3.0 g/24 h had the significantly higher values of lipoprotein (a) in serum as compared to the control group, and the patients with proteinuria about 0.25-1.0 g/24 h. The patients with proteinuria between 1.0-3.0 g/24 h had the statistically significantly higher values of lipoprotein (a) in serum than the control group (proteinuria < 0.25 g/24 h). There was a highly statistically significant negative correlation between serum albumin concentration, COP and the concentration of lipoprotein (a) in serum. There was a highly statistically significant positive correlation between 24-hour proteinuria and the concentration of lipoprotein (a) in serum. Conclusion. Proteinuria leads to the deterioration of lipoprotein (a) abnormalities.

Effects of proteinuria on apolipoprotein metabolism disorders

Introduction Proteinuria causes lipid metabolism abnormalities. Material and methods The study included 60 patients (M:F 32:28), mean age 37.15? 9.85 years, with average glomerular filtration rate (GFR) 86.27? 19.81 mL/min, and average BMI 24.18?2.23 kg/m2. Regarding the level of glomerular proteinuria, patients were divided into four groups. The first group, with proteinuria levels less than 0.25 g/24h, included 15 patients (M:F 6:9) (control group), average age 34.66?4.82 years, with mean GFR 99.70? 12.94 mL/min, and mean BMI 23.28?3.50 kg/nr. The second group, with proteinuria between 0.26 and 1.0 g/24h, comprised 15 patients (M:F 9:6) with primary glomerulonephritis, mean age 37.87?9.65 years, with mean GFR 82.85?18.48 mL/min and mean BMI 23.83?1.57 kg/m2. The third group consisted of 15 patients (M:F 8:7) with primary glomerulonephritis, with proteinuria between 1.1 and 3.0 g/24h, average age 35.67? 13.29 years, mean GFR 82.85?I8.48 mL/min, and mean BMI 23.83?1.57 kg/m2. The fourth group, with proteinuria over 3.0 g/24h, included 15 patients (M:F 9:6) with primary' glomerulonephritis, mean age 40.40?9.75 years, with mean GFR 80.16?20.80 mL/min, and mean BMI 24.83?1.44 kg/m2. In order to assess the influence of proteinuria on apoprotein metabolism abnormalities we investigated apo A-l apo B, apo E and the apo A-I/apo B ratio. Results Results were statistically analyzed using Student's t-test, and the Mann-Whitney U test. Statistically, patients with proteinuria over 3.0 g/24h have significantly higher apoprotein B and apoprotein E values in the serum, as well as apo B/apo A-l compared to control subjects, and patients with proteinuria around 0.26-1.0 g/24h and proteinuria around 1.1-3.0 g/24h. Proteinuria leads to deterioration of apoprotein abnormalities. .

Troponin T levels in detection of perioperative myocardial infarction after coronary artery bypass surgery

OBJECTIVES

The present study was designed to evaluate the clinical relevance of serum cardiac troponinT (cTnT) assay in detection of perioperative myocardial infarction (PMI) after coronary artery bypass grafting (CABG).

MATERIALS AND METHODS

The clinical utility of cTnT was compared to that of total CK, CKMB mass, CKMB activity and myoglobin. Serial venous blood samples were obtained before surgery and 4, 8, 16, 24, 48 and 72 hours after aortic unclamping (AU) in 42 patients who underwent CABG. We had 6 PMI patients, 24 patients with minor myocardial damage (MMD) and 12 without ischemic myocardial changes (no IMC).

RESULTS

In discriminating no IMC from PMI the diagnostic sensitivity, specificity and the predictive values of cTnT were superior to that of CKMB mass, CKMB activity, myoglobin and total CK during 72 hours after AU. In discriminating MMD from PMI the diagnostic performance for CKMB mass and CKMB activity was superior to that of cTnT during the first 24 hours. After 24 hours the diagnostic performance for cTnT was improved but began to decline for CKMB isoenzymes. The discriminatory power of myoglobin measurements was lower than that of cTnT and CKMB mass.

CONCLUSION

Our results indicate that troponin T is an accurate marker for the detection and monitoring of perioperative myocardial damage, especially 24 hours after AU.

[Effect of proteinuria on transport of sodium, potassium and chloride ions in renal tubules]

Functional and structural damages of tubulointerstitium are caused by proteinuria. The aim of this study was to assess the influence of different proteinuria levels on Na+, K+, Cl- tubular transport. We examined 50 patients (24 males, 26 females), mean age 46.50 +/- 13.08 years, with mean creatinine clearance of 87.29 +/- 31.17 mL/min. They were separated in three groups, depending on proteinuria value. The first group with proteinuria less than 0.3 g/24 h included 19 persons (7 males, 12 females), mean age 45.12 +/- 13.28 years, with mean creatinine clearance of 94.27 +/- 34.70 mL/min. The second group of 18 patients (8 males, 10 females), mean age 45.39 +/- 12.64 years, had proteinuria of 0.3-3.0 g/24 h and mean creatinine clearance of 90.07 +/- 31.89 mL/min. The third group had proteinuria level higher than 3.0 g/24 h and mean creatinine clearance of 73.25 +/- 20.44 mL/min. It included 13 patients (9 males, 4 females), mean age 50.08 +/- 13.73 years. As a parameter of proteinuria influence on tubular transport of Na+, K+ and Cl-, fractional excretion of these electrolytes, was studied. Student's T test, Mann Whitney U test and c2 test were used for statistical analysis. No statistically significant influence of proteinuria was found on Na+, K+ and Cl tubular transport.