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Kamińska D, Hożejowski R, Chamienia A, Dębska-Ślizień A, Idasiak-Piechocka I, Oko A, Baranowicz-Gąszczyk I, Załuska W, Mazanowska O, Krajewska M. Conversion From Immediate-Release to Prolonged-Release Tacrolimus in Kidney Transplant Patients With Tremor: A Case Series Study. Transplant Proc 2024:S0041-1345(24)00080-0. [PMID: 38453593 DOI: 10.1016/j.transproceed.2024.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/23/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND/AIM Tremor is common with tacrolimus treatment and is linked with peak blood drug concentrations. We investigated the effect of switching from immediate-release tacrolimus (IR-TAC) to MeltDose prolonged-release tacrolimus (LCPT) on tremor in kidney transplant recipients experiencing tremor at therapeutic levels of IR-TAC. METHODS The Activities of Daily Living Subscale (ADL, range 0-48, lower = better) of the Essential Tremor Rating Scale was used to assess the effect of therapy change on speech, occupational impairment and social activities over a 12-month follow-up period. RESULTS The study included 18 patients (mean age = 45.6 y, range 26-73; median (IQR) time from transplant = 1.1 y (0.6-1.5), with baseline IR-TAC trough concentrations (C0) ranging from 4.2 to 9.4 ng/mL (mean C0 = 6.7 ± 1.3 ng/mL). After the switch to LCPT, the mean ADL score improved from baseline 11.2 to 8.4 after 7 to 14 days (an 18% improvement, P < .001). This improvement was sustained after 3 months (ADL score = 5.0, 46% improvement vs baseline), 6 months (ADL score = 4.4, 48% improvement vs baseline), and 12 months (ADL score = 3.6, 63% improvement vs baseline); all P < .001. Despite a 40% reduction in LCPT daily doses (mean -1.9 mg/day compared to IR-TAC), the achieved C0 was constant during the course of the 12-month observation (P = .755). The renal function remained stable after conversion (eGFR 12 months vs baseline = +1.1 mL/min/1.73 m2, 95% CI: -5.6 to +7.9). CONCLUSION Conversion to LCPT may alleviate symptom burden and improve daily activities in kidney transplant recipients experiencing tremor within therapeutic IR-TAC concentrations.
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Affiliation(s)
- Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
| | | | - Andrzej Chamienia
- Department of Nephrology, Transplantology and Internal Diseases, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Diseases, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Ilona Idasiak-Piechocka
- Department of Nephrology, Transplantology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Oko
- Department of Nephrology, Transplantology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Lublin, Poland
| | - Oktawia Mazanowska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
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Zakrocka I, Kocki T, Urbańska E, Załuska W. Effects of Fenofibrate and Gemfibrozil on Kynurenic Acid Production in Rat Kidneys In Vitro: Old Drugs, New Properties. Life (Basel) 2023; 13:2154. [PMID: 38004294 PMCID: PMC10672417 DOI: 10.3390/life13112154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/16/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Kidney dysfunction significantly increases the cardiovascular risk, even in cases of minor functional declines. Hypertriglyceridemia is the most common lipid abnormality reported in patients with kidney disorders. PPAR-α (peroxisome proliferator-activated receptor-α) agonists called fibrates are the main agents used to lower triglyceride levels. Kynurenic acid (KYNA) is a tryptophan (Trp) derivative directly formed from L-kynurenine (L-KYN) by kynurenine aminotransferases (KATs). KYNA is classified as a uremic toxin, the level of which is correlated with kidney function impairments and lipid abnormalities. The aim of this study was to analyze the effect of the most commonly used triglyceride-lowering drugs, fenofibrate and gemfibrozil, on KYNA production and KAT activity in rat kidneys in vitro. The influence of fenofibrate and gemfibrozil on KYNA formation and KAT activity was tested in rat kidney homogenates in vitro. Fenofibrate and gemfibrozil at 100 µM-1 mM significantly inhibited KYNA synthesis in rat kidney homogenates. Both fibrates directly affected the KAT I and KAT II isoenzyme activities in a dose-dependent manner at similar concentrations. The presented results reveal the novel mechanism of action of fibrates in the kidneys and suggest their potential role in kidney function protection beyond the well-known anti-hyperlipidemic effect.
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Affiliation(s)
- Izabela Zakrocka
- Department of Nephrology, Medical University, Jaczewskiego Street 8, 20-954 Lublin, Poland;
| | - Tomasz Kocki
- Department of Experimental and Clinical Pharmacology, Medical University, Jaczewskiego Street 8b, 20-090 Lublin, Poland; (T.K.); (E.U.)
| | - Ewa Urbańska
- Department of Experimental and Clinical Pharmacology, Medical University, Jaczewskiego Street 8b, 20-090 Lublin, Poland; (T.K.); (E.U.)
| | - Wojciech Załuska
- Department of Nephrology, Medical University, Jaczewskiego Street 8, 20-954 Lublin, Poland;
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Glowniak A, Petkanych M, Torres K, Załuska W. Remote-presence approach to cryoablation training: Beyond COVID-19. Med Educ 2023; 57:776-777. [PMID: 37186308 DOI: 10.1111/medu.15104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
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4
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Zakrocka I, Załuska W. The influence of cyclooxygenase inhibitors on kynurenic acid production in rat kidney: a novel path for kidney protection? Pharmacol Rep 2023; 75:376-385. [PMID: 36788192 DOI: 10.1007/s43440-023-00460-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Kidney diseases have become a global health problem, affecting about 15% of adults and being often under-recognized. Immunological system activation was shown to accelerate kidney damage even in inherited disorders. The kynurenine pathway is the main route of tryptophan degradation. A metabolite of kynurenine (KYN), kynurenic acid (KYNA), produced by kynurenine aminotransferases (KATs), was reported to affect fluid and electrolyte balance as a result of natriuresis induction. The accumulation of KYNA was shown in patients with impaired kidney function and its level was related to the degree of kidney damage. Cyclooxygenase (COX) inhibitors are well-known analgesics and most of them demonstrate an anti-inflammatory effect. Their main mechanism of action is prostaglandin synthesis blockade, which is also responsible for their nephrotoxic potential. Since the KYN pathway is known to remain under immunological system control, the purpose of this study was to analyze the effect of 9 COX inhibitors on KYNA production together with KATs' activity in rat kidneys in vitro. METHODS Experiments were carried out on kidney homogenates in the presence of L-KYN and the selected compound in 6 various concentrations. RESULTS Among the examined COX inhibitors only acetaminophen did not change KYNA production in rat kidneys in vitro. Additionally, acetaminophen did not affect the activity of KAT I and KAT II, whereas acetylsalicylic acid and ibuprofen inhibited only KAT II. The remaining COX inhibitors decreased the activity of both KATs in rat kidneys in vitro. CONCLUSION Our study provides novel mechanisms of COX inhibitors action in the kidney, with possible implications for the treatment of kidney diseases.
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Affiliation(s)
- Izabela Zakrocka
- Department of Nephrology, Medical University of Lublin, Jaczewskiego 8, 20-954, Lublin, Poland.
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Jaczewskiego 8, 20-954, Lublin, Poland
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5
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Steć A, Magryś A, Załuska W. The prevalence and risk factors for latent Mycobacterium tuberculosis infection in patients with chronic kidney disease. J Pre Clin Clin Res 2023. [DOI: 10.26444/jpccr/160170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
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Smarz-Widelska I, Syroka-Główka M, Janowska-Jaremek J, Kozioł MM, Załuska W. Atypical Hemolytic Uremic Syndrome after SARS-CoV-2 Infection: Report of Two Cases. Int J Environ Res Public Health 2022; 19:11437. [PMID: 36141710 PMCID: PMC9517572 DOI: 10.3390/ijerph191811437] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
Atypical hemolytic uremic syndrome (aHUS) is a life-threatening disease causing systemic thrombotic microangiopathy (TMA) due to the fact of complement dysregulation. Immune activation by viruses, including SARS-CoV-2, can lead to the development of an episode of aHUS against a background of genetic dysregulation in the complement pathway. This paper presents an analysis of two cases of aHUS-siblings diagnosed with familial disease, with a genetic predisposition to aHUS, in whom infection with SARS-CoV-2 was a strong trigger of disease recurrence. The quick recognition and treatment with eculizumab in the early stage of the disease resulted in a rapid improvement in clinical conditions and laboratory parameters.
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Affiliation(s)
- Iwona Smarz-Widelska
- Department of Nephrology, Cardinal Stefan Wyszynski Provincial Hospital, 20-718 Lublin, Poland
| | | | - Joanna Janowska-Jaremek
- Department of Nephrology, Cardinal Stefan Wyszynski Provincial Hospital, 20-718 Lublin, Poland
| | - Małgorzata M. Kozioł
- Chair and Department of Medical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 20-954 Lublin, Poland
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7
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Abstract
Anticoagulant-related nephropathy (ARN) is a novel and not well-studied cause of acute kidney injury (AKI). The prevalence of ARN varies significantly between studies and is estimated at 20% in patients treated with warfarin. Patients with ARN have a significantly higher mortality risk and an increased risk of chronic kidney disease (CKD). Unexplained AKI with hematuria are clinical manifestations of ARN. In most cases, ARN is diagnosed within the first 2 months of anticoagulant therapy, but later ARN occurrence is possible. Among the studied anticoagulants, most data concern warfarin toxicity, whereas cases of ARN caused by direct oral anticoagulants (DOACs) have also been presented. Tubular obstruction by red blood cell casts or hemoglobin and iron tubular toxicity are the postulated mechanisms of ARN. On the molecular level, the inhibition of thrombin and protease-activated receptor-1 (PAR-1), leading to endothelial susceptibility to damage or abnormal protein C endothelial signaling, is suggested to contribute to ARN. Older age, impaired kidney function, hypertension, and diabetes mellitus are the main risk factors for ARN, but their significance may differ between anticoagulants. From therapeutic options, the withdrawal of the anticoagulant and the administration of its antidote, as well as corticosteroids or N-acetylcysteine, are proposed. Since the number of patients with kidney diseases on anticoagulants increases, and DOACs are starting to be more useful in this group of patients, we aim to summarize the pathogenesis, clinical picture and possible ways of treatment of DOAC-induced ARN.
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Zakrocka I, Korolczuk A, Załuska W. ANCA vasculitis with rapid progressive glomerulonephritis after SARS-CoV-2 infection: cause or coincidence? Pol Arch Intern Med 2021; 132. [PMID: 34878237 DOI: 10.20452/pamw.16165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Mertowska P, Mertowski S, Wojnicka J, Korona-Głowniak I, Grywalska E, Błażewicz A, Załuska W. A Link between Chronic Kidney Disease and Gut Microbiota in Immunological and Nutritional Aspects. Nutrients 2021; 13:3637. [PMID: 34684638 PMCID: PMC8540836 DOI: 10.3390/nu13103637] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) is generally progressive and irreversible, structural or functional renal impairment for 3 or more months affecting multiple metabolic pathways. Recently, the composition, dynamics, and stability of a patient's microbiota has been noted to play a significant role during disease onset or progression. Increasing urea concentration during CKD can lead to an acceleration of the process of kidney injury leading to alterations in the intestinal microbiota that can increase the production of gut-derived toxins and alter the intestinal epithelial barrier. A detailed analysis of the relationship between the role of intestinal microbiota and the development of inflammation within the symbiotic and dysbiotic intestinal microbiota showed significant changes in kidney dysfunction. Several recent studies have determined that dietary factors can significantly influence the activation of immune cells and their mediators. Moreover, dietary changes can profoundly affect the balance of gut microbiota. The aim of this review is to present the importance and factors influencing the differentiation of the human microbiota in the progression of kidney diseases, such as CKD, IgA nephropathy, idiopatic nephropathy, and diabetic kidney disease, with particular emphasis on the role of the immune system. Moreover, the effects of nutrients, bioactive compounds on the immune system in development of chronic kidney disease were reviewed.
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Affiliation(s)
- Paulina Mertowska
- Department of Experimental Immunology, Medical University of Lublin, 4a Chodzki Street, 20-093 Lublin, Poland; (P.M.); (S.M.); (E.G.)
| | - Sebastian Mertowski
- Department of Experimental Immunology, Medical University of Lublin, 4a Chodzki Street, 20-093 Lublin, Poland; (P.M.); (S.M.); (E.G.)
| | - Julia Wojnicka
- Department of Pathobiochemistry and Interdisciplinary Applications of Ion Chromatography, Medical University of Lublin, 1 Chodzki Street, 20-093 Lublin, Poland; (J.W.); (A.B.)
| | - Izabela Korona-Głowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 1 Chodzki Street, 20-093 Lublin, Poland
| | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 4a Chodzki Street, 20-093 Lublin, Poland; (P.M.); (S.M.); (E.G.)
| | - Anna Błażewicz
- Department of Pathobiochemistry and Interdisciplinary Applications of Ion Chromatography, Medical University of Lublin, 1 Chodzki Street, 20-093 Lublin, Poland; (J.W.); (A.B.)
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 8 Jaczewskiego Street, 20-954 Lublin, Poland;
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10
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Smarz-Widelska I, Grywalska E, Morawska I, Forma A, Michalski A, Mertowski S, Hrynkiewicz R, Niedźwiedzka-Rystwej P, Korona-Glowniak I, Parczewski M, Załuska W. Pathophysiology and Clinical Manifestations of COVID-19-Related Acute Kidney Injury-The Current State of Knowledge and Future Perspectives. Int J Mol Sci 2021; 22:7082. [PMID: 34209289 PMCID: PMC8268979 DOI: 10.3390/ijms22137082] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/26/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023] Open
Abstract
The continually evolving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in a vast number of either acute or chronic medical impairments of a pathophysiology that is not yet fully understood. SARS-CoV-2 tropism for the organs is associated with bilateral organ cross-talks as well as targeted dysfunctions, among which acute kidney injury (AKI) seems to be highly prevalent in infected patients. The need for efficient management of COVID-related AKI patients is an aspect that is still being investigated by nephrologists; however, another reason for concern is a disturbingly high proportion of various types of kidney dysfunctions in patients who have recovered from COVID-19. Even though the clinical picture of AKI and COVID-related AKI seems to be quite similar, it must be considered that regarding the latter, little is known about both the optimal management and long-term consequences. These discrepancies raise an urgent need for further research aimed at evaluating the molecular mechanisms associated with SARS-CoV-2-induced kidney damage as well as standardized management of COVID-related AKI patients. The following review presents a comprehensive and most-recent insight into the pathophysiology, clinical manifestations, recommended patient management, treatment strategies, and post-mortem findings in patients with COVID-related AKI.
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Affiliation(s)
- Iwona Smarz-Widelska
- Department of Nephrology, Cardinal Stefan Wyszynski Provincial Hospital in Lublin, 20-718 Lublin, Poland;
| | - Ewelina Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (A.M.); (S.M.)
| | - Izabela Morawska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (A.M.); (S.M.)
| | - Alicja Forma
- Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Adam Michalski
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (A.M.); (S.M.)
| | - Sebastian Mertowski
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (A.M.); (S.M.)
| | - Rafał Hrynkiewicz
- Institute of Biology, University of Szczecin, 71-412 Szczecin, Poland;
| | | | - Izabela Korona-Glowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, Chodźki 1, 20-093 Lublin, Poland;
| | - Miłosz Parczewski
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, 71-455 Szczecin, Poland;
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 20-954 Lublin, Poland;
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Paduch R, Urbanik-Sypniewska T, Kutkowska J, Chorągiewicz T, Matysik-Woźniak A, Zweifel S, Czarnek-Chudzik A, Załuska W, Rejdak R, Toro MD. Ozone-Based Eye Drops Activity on Ocular Epithelial Cells and Potential Pathogens Infecting the Front of the Eye. Antioxidants (Basel) 2021; 10:antiox10060968. [PMID: 34208703 PMCID: PMC8235398 DOI: 10.3390/antiox10060968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 12/24/2022] Open
Abstract
Confirmation of the biological effectiveness of new ophthalmic preparations introduced in the market is an important element in maintaining the safety of using this type of medications. This study aimed to investigate the activity of Ozodrop® on human corneal and conjunctival epithelial cells, as well as its antibacterial and antifungal activity. Cytotoxicity analyses of ocular surface epithelial cells were performed in vitro by MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide) and Neutral Red uptake assays. The level of nitric oxide released by the cells was assessed by the Griess method. The reduction of the DPPH (2,2-diphenyl-1-picrylhydrazyl) free radical by the tested formulation was analyzed. Microbiological tests were also performed. It was found that the Ozodrop® preparation exhibited biological activity, but was less active than the reference antibiotics and the anti-yeast agent. The cytotoxic activity of the Ozodrop® formulation was dependent on the time of cell exposure to it. No toxic effect was observed in the short-term, for up to 3 h. It appeared after 24 h of exposure of the cells to the preparation. The drops showed antioxidant activity in the specified concentration range. They also stimulated the release of nitric oxide, mainly by corneal epithelial cells. The Ozodrop® formulation exhibits biological activity that can be considered useful in the treatment of infections in the front part of the eye.
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Affiliation(s)
- Roman Paduch
- Department of Virology and Immunology, Faculty of Biology and Biotechnology, Institute of Biological Sciences, Maria Curie-Skłodowska University, Akademicka 19, 20-033 Lublin, Poland
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Chmielna 1, 20-079 Lublin, Poland; (T.C.); (A.M.-W.); (R.R.); (M.D.T.)
- Correspondence: ; Tel.: +48-81-5375940
| | - Teresa Urbanik-Sypniewska
- Department of Genetics and Microbiology, Maria Curie-Skłodowska University, Akademicka 19, 20-033 Lublin, Poland; (T.U.-S.); (J.K.)
| | - Jolanta Kutkowska
- Department of Genetics and Microbiology, Maria Curie-Skłodowska University, Akademicka 19, 20-033 Lublin, Poland; (T.U.-S.); (J.K.)
| | - Tomasz Chorągiewicz
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Chmielna 1, 20-079 Lublin, Poland; (T.C.); (A.M.-W.); (R.R.); (M.D.T.)
| | - Anna Matysik-Woźniak
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Chmielna 1, 20-079 Lublin, Poland; (T.C.); (A.M.-W.); (R.R.); (M.D.T.)
| | - Sandrine Zweifel
- Department of Ophthalmology, University of Zurich, 8091 Zurich, Switzerland;
| | - Aleksandra Czarnek-Chudzik
- Department of Diagnostic and Microsurgery of Glaucoma, Medical University of Lublin, Chmielna 1, 20-079 Lublin, Poland;
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Poland;
| | - Robert Rejdak
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Chmielna 1, 20-079 Lublin, Poland; (T.C.); (A.M.-W.); (R.R.); (M.D.T.)
| | - Mario Damiano Toro
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Chmielna 1, 20-079 Lublin, Poland; (T.C.); (A.M.-W.); (R.R.); (M.D.T.)
- Department of Ophthalmology, University of Zurich, 8091 Zurich, Switzerland;
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Zakrocka I, Baranowicz-Gąszczyk I, Załuska W. Haemochromatosis in a kidney transplant recipient: a case report. BMC Nephrol 2021; 22:201. [PMID: 34051741 PMCID: PMC8164756 DOI: 10.1186/s12882-021-02416-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iron overload is inevitably related to chronic kidney disease (CKD) treatment. Haemochromatosis leads to multiorgan damage and is associated with increased mortality. Primary haemochromatosis is the most common autosomal recessive disease in white populations. In most cases, the classic form of hereditary haemochromatosis is caused by mutations, mainly C282Y and H63D, in the haemochromatosis gene (HFE). Secondary haemochromatosis can be triggered by iron administration and blood transfusions. Haemochromatosis is rarely reported in kidney transplant recipients. Atypical factors may evoke haemochromatosis in patients without HFE mutations or other standard risk factors. CASE PRESENTATION In the current study, we present a patient who started to have haemochromatosis symptoms after kidney transplantation. A 37-year-old man after kidney transplantation from a deceased donor was admitted to the hospital due to high serum ferritin levels and impaired graft function. The patient's past medical history included arterial hypertension, embolization of both renal arteries and necrosis of the left femoral head. Glomerulonephritis was suspected as a cause of CKD; however, severe kidney failure was diagnosed, kidney biopsy was not performed, and the patient started intermittent haemodialysis. While on dialysis to treat anaemia, the patient had received erythropoietin and iron intravenously, and the maximal serum ferritin level was 2115 ng/ml. After kidney transplantation, ferritin levels started to increase rapidly, with a maximum level of 9468 ng/ml one and a half years after surgery. His genetic study showed HFE C282Y heterozygosity. Symptoms of haemochromatosis, such as skin hyperpigmentation, elevated activity of aminotransferases, impaired glucose tolerance and heart failure, were observed. Therapeutic phlebotomy was started, and 36 procedures were performed. After treatment, graft function significantly improved, most haemochromatosis symptoms resolved, and the serum ferritin level significantly decreased. CONCLUSIONS Haemochromatosis can occur in heterozygotic HFE patients after kidney transplantation. Iron administration, infections, type of immunosuppression and liver dysfunction should be considered potential triggers of haemochromatosis in this group of patients.
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Affiliation(s)
- Izabela Zakrocka
- Department of Nephrology, Medical University of Lublin, Jaczewskiego street 8, 20-090, Lublin, Poland.
| | - Iwona Baranowicz-Gąszczyk
- Department of Nephrology, Medical University of Lublin, Jaczewskiego street 8, 20-090, Lublin, Poland
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Jaczewskiego street 8, 20-090, Lublin, Poland
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Pietras-Baczewska A, Nowomiejska K, Brzozowska A, Toro MD, Załuska W, Sztanke M, Sztanke K, Rejdak R. Antioxidant Status in the Vitreous of Eyes with Rhegmatogenous Retinal Detachment with and without Proliferative Vitreoretinopathy, Macular Hole and Epiretinal Membrane. Life (Basel) 2021; 11:453. [PMID: 34069386 PMCID: PMC8158770 DOI: 10.3390/life11050453] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: The aim of the study was to test the hypothesis that the antioxidant status in the vitreous body of eyes, which had been vitrectomized due to rhegmatogenous retinal detachment (RRD) with or without proliferative vitreoretinopathy (PVR), is higher than in eyes vitrectomized due to other retinal diseases. (2) Methods: four patient groups were analyzed: 22 eyes of patients with RRD without PVR, 27 eyes with RRD and PVR, 22 eyes with macular hole (MH) and 10 eyes with epiretinal membrane (ERM). Spectrophotometric methods were used to determine the total antioxidant status (TAS) values as well as superoxide dismutase (SOD) and glutathione reductase (GR) activities in the vitreous fluid samples. (3) Results: no significant differences in TAS values and antioxidant enzyme activities were observed among patient with RRD with and without PVR and with MH and ERM. The longer the duration of RRD leading to PVR and better postoperative visual acuity, the higher the TAS level. No significant differences were found between "macula on" and "macula off" subgroups within the RRD group and the RRD combined with PVR group. (4) Conclusions: The preliminary results do not support the thesis that the antioxidant status of vitrectomized eyes is different in patients with RRD with or without PVR in comparison to patients with MH and ERM. In patients with RRD, PVR presence and detached macula do not affect the values of TAS, SOD and GR in the vitreous fluid. The duration of the disease influences TAS in the vitreous in eyes with RRD complicated with PVR.
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Affiliation(s)
- Agata Pietras-Baczewska
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (K.N.); (M.D.T.); (R.R.)
| | - Katarzyna Nowomiejska
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (K.N.); (M.D.T.); (R.R.)
| | - Agnieszka Brzozowska
- Department of Mathematics and Medical Biostatistics, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Mario Damiano Toro
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (K.N.); (M.D.T.); (R.R.)
- Faculty of Medicine, Collegium Medicum Cardinal Stefan Wyszynski University, 01-815 Warsaw, Poland
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Małgorzata Sztanke
- Department of Medical Chemistry, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Krzysztof Sztanke
- Laboratory of Bioorganic Synthesis and Analysis, Chair and Department of Medical Chemistry, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Robert Rejdak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland; (K.N.); (M.D.T.); (R.R.)
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14
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Dolar-Szczasny J, Bucolo C, Zweifel S, Carnevali A, Rejdak R, Załuska W, Czarnek-Chudzik A, Toro MD. Evaluation of Aqueous Flare Intensity in Eyes Undergoing Intravitreal Bevacizumab Therapy to Treat Neovascular Age-Related Macular Degeneration. Front Pharmacol 2021; 12:656774. [PMID: 33995079 PMCID: PMC8121376 DOI: 10.3389/fphar.2021.656774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/25/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose: To evaluate the effect of repeated intravitreal bevacizumab injections on blood-aqueous barrier permeability in eyes with neovascular age-related macular degeneration (AMD). Patients and Methods: Forty-eight consecutive patients with neovascular AMD received 3 intravitreal bevacizumab injections (1 mg) every 30–40 days. Subjects were followed for a period of 4 months and were examined at baseline, 1 day and 1 month after each injection. A control group comprised of 19 neovascular AMD patients waiting to begin anti-vascular endothelial growth factor (VEGF) therapy. Anterior chamber (AC) inflammation was evaluated with biomicroscopy and laser flare photometry. Results: None of the subjects treated with bevacizumab had detectable ocular inflammation during follow-up. An analysis for variance (ANOVA) of the mixed-effects model has shown neither an effect between treatment and control group (p = 0.921), nor over the time course of the follow-up (p = 0.773). Before treatment, median AC inflammation was 6.7 photons/ms (range: 3.5–18.2 photons/ms). One month after the first, second, and third injections, median laser flare was 6.4, 6.8, and 6.6 photons/ms, respectively, none of which were significantly different from baseline (all p > 0.05). Blood-aqueous barrier permeability did not change between injections and was not different from the control group. Conclusion: Inflammation induced by intravitreal bevacizumab was not detected by examination or flare photometry. This suggests that monthly bevacizumab dosing seems to be safe. The absence of AC inflammation could also reflect the known anti-inflammatory properties of anti-VEGF agents.
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Affiliation(s)
| | - Claudio Bucolo
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Sandrine Zweifel
- Department of Ophthalmology, University of Zurich, Zurich, Switzerland
| | - Adriano Carnevali
- Department of Ophthalmology, University "Magna Graecia", Catanzaro, Italy
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Lublin, Poland
| | | | - Mario Damiano Toro
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland.,Department of Ophthalmology, University of Zurich, Zurich, Switzerland.,Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
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15
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Dolar-Szczasny J, Toro MD, Dworzańska A, Wójtowicz T, Korona-Glowniak I, Sawicki R, Boguszewska A, Polz-Dacewicz M, Tomasiewicz K, Załuska W, Rejdak R, Bagnoli P, Rusciano D. Ocular Involvement of SARS-CoV-2 in a Polish Cohort of COVID-19-Positive Patients. Int J Environ Res Public Health 2021; 18:2916. [PMID: 33809199 PMCID: PMC8001647 DOI: 10.3390/ijerph18062916] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 12/25/2022]
Abstract
The coronavirus SARS-CoV-2 responsible for the current human COVID-19 pandemic has shown tropism toward different organs with variable efficiency, eyes included. The purpose of this study has been to investigate the presence of detectable SARS-CoV-2 infection in ocular swabs in patients affected by COVID-19. A consecutive series of 74 COVID-19-positive patients (age 21-89) were enrolled at two Polish COVID-19 hospitals for 4 months and were characterized by PCR for the presence of the SARS-CoV-2 genetic material in nasopharyngeal (NP) and ocular swabs, while their respiratory and ocular symptoms were noted. Almost 50% of them presented with severe/critical respiratory involvement, and some degree of eye disease. No tight correlation was observed between the presence of ocular and respiratory symptoms. Three male patients presenting with severe/critical lung disease tested positive in ocular swab, however with mild/moderate ocular symptoms. In conclusion, our study lends further support to the view that overt ocular infection by the SARS-CoV-2 virus is not such a frequent occurrence.
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Affiliation(s)
- Joanna Dolar-Szczasny
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (J.D.-S.); (M.D.T.); (R.R.)
| | - Mario D. Toro
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (J.D.-S.); (M.D.T.); (R.R.)
- Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University, 01-815 Warsaw, Poland
| | - Anna Dworzańska
- Department of Infectious Diseases, Medical University of Lublin, 20-059 Lublin, Poland; (A.D.); (K.T.)
| | - Tomasz Wójtowicz
- Department of Ophthalmology, Specialist Hospital of Radom, 26-610 Radom, Poland;
| | - Izabela Korona-Glowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Rafał Sawicki
- Department of Biochemistry and Biotechnology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Anastazja Boguszewska
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-059 Lublin, Poland; (A.B.); (M.P.-D.)
| | - Małgorzata Polz-Dacewicz
- Department of Virology with SARS Laboratory, Medical University of Lublin, 20-059 Lublin, Poland; (A.B.); (M.P.-D.)
| | - Krzysztof Tomasiewicz
- Department of Infectious Diseases, Medical University of Lublin, 20-059 Lublin, Poland; (A.D.); (K.T.)
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland; (J.D.-S.); (M.D.T.); (R.R.)
| | - Paola Bagnoli
- Department of Biology, University of Pisa, 56126 Pisa, Italy;
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16
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Kowalczyk M, Toro MD, Rejdak R, Załuska W, Gagliano C, Sikora P. Ophthalmic Evaluation of Diagnosed Cases of Eye Cystinosis: A Tertiary Care Center's Experience. Diagnostics (Basel) 2020; 10:diagnostics10110911. [PMID: 33171856 PMCID: PMC7695142 DOI: 10.3390/diagnostics10110911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background: We aimed to identify diagnosed cases of ocular cystinosis and describe clinical, epidemiological and therapeutic characteristics. Methods: This is a descriptive and retrospective case series. All patients underwent a full check-up examination every 4–6 months by ophthalmologists, nephrologists and other required specialists. Results: Of the seven cases, six (85.7%) were females and one (14.2%) was male. The infantile nephropathic form of cystinosis was observed in five patients and the juvenile nephropathic form in two patients. No patients with the ocular form of cystinosis were identified. Corneal cystine crystals (CCC) were found in all analyzed patients. Severe ocular and general complications of the disease that had been standing for years, connected to the infantile nephropathic form, delayed diagnosis or inappropriate treatment, were observed only in two patients. All patients received topical therapy. No adverse events related to the therapy were observed. Conclusions: Cystinosis is a rare, progressive disease. Early diagnosis and treatment prevent serious complications from numerous systemic organs. Patients require constant systematic monitoring by various specialists.
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Affiliation(s)
- Malgorzata Kowalczyk
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, 20079 Lublin, Poland; (M.K.); (R.R.)
| | - Mario Damiano Toro
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, 20079 Lublin, Poland; (M.K.); (R.R.)
- Faculty of Medicine, Collegium Medicum Cardinal Stefan Wyszyński University, 01815 Warsaw, Poland
- Correspondence: ; Tel.: +48-608-047-052; Fax: +48-81-532-61-49
| | - Robert Rejdak
- Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, 20079 Lublin, Poland; (M.K.); (R.R.)
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 20954 Lublin, Poland;
| | - Caterina Gagliano
- Ophthalmology Clinic, San Marco Hospital, University of Catania, 95123 Catania, Italy;
| | - Przemyslaw Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, 20079 Lublin, Poland;
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17
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Grywalska E, Smarz-Widelska I, Korona-Głowniak I, Mertowski S, Gosik K, Hymos A, Ludian J, Niedźwiedzka-Rystwej P, Roliński J, Załuska W. PD-1 and PD-L1 Expression on Circulating Lymphocytes as a Marker of Epstein-Barr Virus Reactivation-Associated Proliferative Glomerulonephritis. Int J Mol Sci 2020; 21:ijms21218001. [PMID: 33121190 PMCID: PMC7663145 DOI: 10.3390/ijms21218001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 12/22/2022] Open
Abstract
Alterations to the programmed cell death protein-1 (PD-1) pathway were previously shown to be involved in a poorer prognosis for patients with proliferative glomerulonephritis (PGN). Here, we investigated the association between several infectious agents and the expression of PD-1 and its ligand (PD-L1) on T and B lymphocytes in patients with PGN and nonproliferative glomerulonephritis (NPGN). A cohort of 45 newly-diagnosed patients (23 with PGN and 22 with NPGN) and 20 healthy volunteers was enrolled. The percentage of peripheral blood mononuclear cells expressing PD-1 and PD-L1 antigens was determined by flow cytometry. We found PD-1 and PD-L1 expression on T and B lymphocytes was higher in PGN patients than in NPGN patients and controls. We also found that reactivation of the Epstein-Barr virus (EBV) correlated with the expression of PD-1/PD-L1 antigens in patients with PGN. Further receiver operating characteristic analysis indicated that PD-1 expression could distinguish EBV-positive PGN patients from those with NPGN or healthy controls. The use of PD-1 expression as a non-invasive marker of PGN should be further investigated.
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Affiliation(s)
- Ewelina Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (K.G.); (J.L.); (J.R.)
- Correspondence: ; Tel.: +48-8144-86420
| | - Iwona Smarz-Widelska
- Department of Nephrology, Cardinal Stefan Wyszynski Provincial Hospital in Lublin, 20-718 Lublin, Poland;
| | - Izabela Korona-Głowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Sebastian Mertowski
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (K.G.); (J.L.); (J.R.)
| | - Krzysztof Gosik
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (K.G.); (J.L.); (J.R.)
| | - Anna Hymos
- Department of Otolaryngology and Laryngeal Oncology, Medical University of Lublin, 20-954 Lublin, Poland;
| | - Jarosław Ludian
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (K.G.); (J.L.); (J.R.)
| | | | - Jacek Roliński
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (K.G.); (J.L.); (J.R.)
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 20-954 Lublin, Poland;
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18
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Zakrocka I, Baranowicz-Gąszczyk I, Korolczuk A, Załuska W. Guillain-Barre syndrome: a typical paraneoplastic syndrome in a kidney transplant recipient with allograft renal cell carcinoma: a case report and review of the literature. BMC Nephrol 2020; 21:434. [PMID: 33054714 PMCID: PMC7560006 DOI: 10.1186/s12882-020-02095-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an autoimmune polyneuropathy affecting the peripheral nervous system. This neurological disorder has been previously reported in bone marrow transplant recipients but is uncommon after kidney transplantation. Viral infections and calcineurin inhibitors are the main triggers of GBS in renal transplant recipients. CASE PRESENTATION In this report, we present a case of a 47-year-old male patient 12 years after his second kidney transplantation who developed GBS due to papillary renal cell carcinoma. Infectious and drug-related origins of GBS were excluded. Despite intensive treatment, graftectomy was performed, after which neurological symptoms resolved. CONCLUSIONS In kidney transplant recipients, paraneoplastic aetiology should be considered in the differential diagnosis of GBS.
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Affiliation(s)
- Izabela Zakrocka
- Department of Nephrology, Medical University, Jaczewskiego street 8, 20-090, Lublin, Poland.
| | | | | | - Wojciech Załuska
- Department of Nephrology, Medical University, Jaczewskiego street 8, 20-090, Lublin, Poland
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19
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Mertowski S, Lipa P, Morawska I, Niedźwiedzka-Rystwej P, Bębnowska D, Hrynkiewicz R, Grywalska E, Roliński J, Załuska W. Toll-Like Receptor as a Potential Biomarker in Renal Diseases. Int J Mol Sci 2020; 21:ijms21186712. [PMID: 32933213 PMCID: PMC7554805 DOI: 10.3390/ijms21186712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 02/08/2023] Open
Abstract
One of the major challenges faced by modern nephrology is the identification of biomarkers associated with histopathological patterns or defined pathogenic mechanisms that may assist in the non-invasive diagnosis of kidney disease, particularly glomerulopathy. The identification of such molecules may allow prognostic subgroups to be established based on the type of disease, thereby predicting response to treatment or disease relapse. Advances in understanding the pathogenesis of diseases, such as membranous nephropathy, minimal change disease, focal segmental glomerulosclerosis, IgA (immunoglobulin A) nephropathy, and diabetic nephropathy, along with the progressive development and standardization of plasma and urine proteomics techniques, have facilitated the identification of an increasing number of molecules that may be useful for these purposes. The growing number of studies on the role of TLR (toll-like receptor) receptors in the pathogenesis of kidney disease forces contemporary researchers to reflect on these molecules, which may soon join the group of renal biomarkers and become a helpful tool in the diagnosis of glomerulopathy. In this article, we conducted a thorough review of the literature on the role of TLRs in the pathogenesis of glomerulopathy. The role of TLR receptors as potential marker molecules for the development of neoplastic diseases is emphasized more and more often, as prognostic factors in diseases on several epidemiological backgrounds.
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Affiliation(s)
- Sebastian Mertowski
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (J.R.)
- Correspondence: (S.M.); (P.N.-R.); (E.G.)
| | - Paulina Lipa
- Department of Genetics and Microbiology, Institute of Microbiology and Biotechnology, Faculty of Biology and Biotechnology, Maria Curie-Skłodowska University, Akademicka 19 St., 20-033 Lublin, Poland;
| | - Izabela Morawska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (J.R.)
| | - Paulina Niedźwiedzka-Rystwej
- Institute of Biology, University of Szczecin, Felczaka 3c, 71-412 Szczecin, Poland; (D.B.); (R.H.)
- Correspondence: (S.M.); (P.N.-R.); (E.G.)
| | - Dominika Bębnowska
- Institute of Biology, University of Szczecin, Felczaka 3c, 71-412 Szczecin, Poland; (D.B.); (R.H.)
| | - Rafał Hrynkiewicz
- Institute of Biology, University of Szczecin, Felczaka 3c, 71-412 Szczecin, Poland; (D.B.); (R.H.)
| | - Ewelina Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (J.R.)
- Correspondence: (S.M.); (P.N.-R.); (E.G.)
| | - Jacek Roliński
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (J.R.)
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 20-954 Lublin, Poland;
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Pietribiasi M, Waniewski J, Załuska W, Wójcik-Załuska A, Leypoldt JK. Comparison of two single-solute models of potassium kinetics during hemodialysis. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2020.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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21
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Zakrocka I, Targowska-Duda K, Wnorowski A, Kocki T, Jóźwiak K, Turski W, Załuska W. P0016EFFECT OF GEMFIBROZIL ON KYNURENINE AMINOTRANSFERASE ACTIVITY AND KYNURENIC ACID PRODUCTION IN RAT KIDNEY. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background and Aims
Hypertriglyceridemia is the most common lipid disorder in chronic kidney disease. Lifestyle changes and fibrates administration are main methods of lowering triglycerides’ level. PPARα (peroxisome proliferator-activated receptor-α) activation is the primary mechanism of action of fibrates.
A tryptophan metabolite, kynurenic acid (KYNA), is produced from L-kynurenine (L-KYN) by kynurenine aminotransferases (KATs). KAT I and KAT II isoenzymes are the best analyzed KATs. KYNA acts predominantly as a nonselective antagonist of ionotropic glutamatergic receptors, particularly N-methyl-D-aspartate (NMDA) type, which are highly expressed in the kidney. Natriuretic and hypotensive effects of KYNA are well described. Diet rich in fatty acids was reported to elevate central and peripheral KYNA level.
The goal of presented study was to analyze the influence of gemfibrozil, one of the fibrates given to treat hypertriglyceridemia, on KYNA production and the activity of KAT isoenzymes: KAT I and KAT II, in rat kidney in vitro. Additionally, the molecular docking of gemfibrozil to KAT I and KAT II structures was performed to study drug-enzyme interaction. On the final step the microarray datamining was carried out to investigate whether gemfibrozil affects the expression of KAT-coding genes.
Method
The effect of gemfibrozil on KYNA synthesis together with KAT I and KAT II activity was tested in rat kidney homogenates in vitro after 2 hours incubation in the presence of L-KYN and gemfibrozil. The drug was examined at the concentration of 1 µM, 10 µM, 50 µM, 100 µM, 500 µM and 1 mM. Production of KYNA was analyzed using the high performance liquid chromatography (HPLC) with fluorometric detector.
Results
Gemfibrozil at 100 µM, 500 µM and 1 mM decreased KYNA production in kidney homogenates in vitro to 66% (P < 0.05), 58% (P < 0.01) and 41% (P < 0.01) of control value, respectively. At 100 µM, 500 µM and 1 mM concentration gemfibrozil lowered renal KAT I activity in vitro to 68% (P < 0.05), 56% (P < 0.01) and 52% (P < 0.01) of control value, respectively. Moreover, gemfibrozil at 500 µM and 1 mM concentration decreased kidney KAT II activity in vitro to 47% (P < 0.001) and 26% (P < 0.001) of control value, respectively. Results of the molecular docking suggested that gemfibrozil may affect the active site of both KAT I and KAT II. Publicly available microarray datasets suggested that the expression of KAT-coding genes does not change after gemfibrozil administration.
Conclusion
Gemfibrozil decreases KYNA production in rat kidney in vitro through inhibition of KAT I and KAT II isoenzymes. Presented results indicate a novel mechanism of gemfibrozil’s action in the kidney. Its potential role in nephrotoxicity needs verification in upcoming studies.
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Affiliation(s)
- Izabela Zakrocka
- Medical University of Lublin, Department of Nephrology, Lublin, Poland
| | | | - Artur Wnorowski
- Medical University of Lublin, Department of Biopharmacy, Lublin
| | - Tomasz Kocki
- Medical University of Lublin, Department of Experimental and Clinical Pharmacology, Lublin, Poland
| | | | - Waldemar Turski
- Medical University of Lublin, Department of Experimental and Clinical Pharmacology, Lublin, Poland
| | - Wojciech Załuska
- Medical University of Lublin, Department of Nephrology, Lublin, Poland
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22
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Zakrocka I, Pachowicz M, Baranowicz-Gąszczyk I, Chrapko B, Korolczuk A, Załuska W. Renal cell carcinoma in a kidney transplant recipient: rare clinical manifestations. Pol Arch Intern Med 2020; 130:449-451. [PMID: 32022790 DOI: 10.20452/pamw.15176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Izabela Zakrocka
- Department of Nephrology, Medical University of Lublin, Lublin, Poland.
| | - Marcin Pachowicz
- Department of Nuclear Medicine, Medical University of Lublin, Lublin, Poland
| | | | - Beata Chrapko
- Department of Nuclear Medicine, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Korolczuk
- Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Lublin, Poland
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Mertowski S, Grywalska E, Gosik K, Smarz-Widelska I, Hymos A, Dworacki G, Niedźwiedzka-Rystwej P, Drop B, Roliński J, Załuska W. TLR2 Expression on Select Lymphocyte Subsets as a New Marker in Glomerulonephritis. J Clin Med 2020; 9:jcm9020541. [PMID: 32079183 PMCID: PMC7073934 DOI: 10.3390/jcm9020541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/16/2022] Open
Abstract
Toll-like receptor (TLR) signaling may be involved in autoimmune kidney disorders and has been implicated in proliferative and non-proliferative glomerulonephritis (PGN and NPGN). In this study, we investigated the expression of TLR2 on T and B lymphocytes in relation to selected clinical parameters in patients with PGN and NPGN. We collected peripheral blood from the ulnar vein of patients with PGN (n = 15) or NPGN (n = 22) and healthy volunteers (n = 20). The percentage of peripheral blood mononuclear cells expressing TLR2 was determined with flow cytometry. TLR2 expression on T and B lymphocytes was increased in PGN patients compared with NPGN patients and controls (p ≤ 0.001). In patients with PGN, TLR2 expression correlated negatively with the serum concentrations of IgG and albumin and positively with urine protein excretion. Receiver operating characteristic (ROC) analysis indicated that TLR2 expression is a highly specific marker to distinguish PGN patients from NPGN patients and controls, especially on CD4+ T lymphocytes. Its use as a non-invasive marker of disease should be further investigated.
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Affiliation(s)
- Sebastian Mertowski
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin 20-093, Poland; (K.G.); (J.R.)
- Correspondence: (S.M.); (E.G.); Tel.: +48-8144-86420
| | - Ewelina Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin 20-093, Poland; (K.G.); (J.R.)
- Department of Immunology, St. John’s Cancer Centre, Lublin 20-090, Poland
- Correspondence: (S.M.); (E.G.); Tel.: +48-8144-86420
| | - Krzysztof Gosik
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin 20-093, Poland; (K.G.); (J.R.)
| | - Iwona Smarz-Widelska
- Department of Nephrology, Cardinal Stefan Wyszynski Provincial Hospital in Lublin, Lublin 20-718, Poland;
| | - Anna Hymos
- Department of Otolaryngology and Laryngeal Oncology, Medical University of Lublin, Lublin 20-954, Poland;
| | - Grzegorz Dworacki
- Department of Immunology, Poznan University of Medical Sciences, Poznan 60-806, Poland;
| | | | - Bartłomiej Drop
- Department of Informatics and Medical Statistics, Medical University of Lublin, Lublin 20-090, Poland;
| | - Jacek Roliński
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Lublin 20-093, Poland; (K.G.); (J.R.)
- Department of Immunology, St. John’s Cancer Centre, Lublin 20-090, Poland
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Lublin 20-954, Poland;
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Grywalska E, Smarz-Widelska I, Mertowski S, Gosik K, Mielnik M, Podgajna M, Abramiuk M, Drop B, Roliński J, Załuska W. CTLA-4 Expression Inversely Correlates with Kidney Function and Serum Immunoglobulin Concentration in Patients with Primary Glomerulonephritides. Arch Immunol Ther Exp (Warsz) 2019; 67:335-349. [PMID: 31177287 PMCID: PMC6732130 DOI: 10.1007/s00005-019-00548-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/21/2019] [Indexed: 12/01/2022]
Abstract
Major causes of chronic kidney disease are primary proliferative and nonproliferative glomerulonephritides (PGN and NPGN). However, the pathogenesis of PGN and NPGN is still not fully understood. Cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) is a T-cell membrane receptor that plays a key role in T-cell inhibition. Despite its role in autoimmunological diseases, little is known about the involvement of CTLA-4 in the pathogenesis of PGN and NPGN. The objective of this study was to determine the role of CTLA-4 in the pathogenesis of PGN and NPGN by evaluating the frequencies of T and B lymphocytes expressing CTLA-4 and the serum concentration of the sCTLA-4 isoform in patients with PGN and NPGN in relation to clinical parameters. The study included peripheral blood (PB) samples from 40 PGN and NPGN patients and 20 healthy age- and sex-matched volunteers (control group). The viable PB lymphocytes were labeled with fluorochrome-conjugated monoclonal anti-CTLA-4 antibodies and analyzed using flow cytometry. The serum concentration of sCTLA-4 was measured using ELISA. The frequencies and absolute counts of CD4+/CTLA-4+ T lymphocytes, CD8+/CTLA-4+ T lymphocytes and CD19+/CTLA-4+ B lymphocytes and the serum sCTLA-4 concentration were lower in PGN and NPGN patients that in the control group. Reduced sCTLA-4 expression was associated with a lower concentration of serum immunoglobulins. Our results indicate that deregulation of CTLA-4 expression may result in continuous activation of T cells and contribute to the pathogenesis of PGN and NPGN.
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Affiliation(s)
- Ewelina Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Chodzki 4a, 20-093, Lublin, Poland.
| | - Iwona Smarz-Widelska
- Department of Nephrology, Cardinal Stefan Wyszynski Provincial Hospital in Lublin, Lublin, Poland
| | - Sebastian Mertowski
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Chodzki 4a, 20-093, Lublin, Poland
| | - Krzysztof Gosik
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Chodzki 4a, 20-093, Lublin, Poland
| | - Michał Mielnik
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Martyna Podgajna
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Chodzki 4a, 20-093, Lublin, Poland
| | - Monika Abramiuk
- The First Department of Gynecologic Oncology and Gynecology, Medical University of Lublin, Lublin, Poland
| | - Bartłomiej Drop
- Department of Informatics and Medical Statistics, Medical University of Lublin, Lublin, Poland
| | - Jacek Roliński
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, Chodzki 4a, 20-093, Lublin, Poland
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Lublin, Poland
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Zakrocka I, Targowska-Duda KM, Wnorowski A, Kocki T, Jóźwiak K, Załuska W, Turski WA. FP026DICLOFENAC INHIBITS KYNURENINE AMINOTRANSFERASE ACTIVITY AND KYNURENIC ACID PRODUCTION IN RAT KIDNEY. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nalepa D, Czarkowska M, Załuska W, Jakubowska K, Chruściel P. Electrical bioimpedance in patients after ischemic stroke, a civilization disease. Ann Agric Environ Med 2019; 26:46-50. [PMID: 30922028 DOI: 10.26444/aaem/84849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Ischemic stroke is caused by artery blockage, resulting in damage to brain tissue. A significant factor in the further treatment of a patient is not only the time to reach a specialist centre, but also the state of hydration of the organism. Clinical situations involving the excess or deficiency of water can have extremely serious consequences for the functioning of the body and subsequent stroke-related disorders. One of the increasingly common methods of evaluating the composition of the human body is by electrical bioimpedance. OBJECTIVE The aim of the study was to assess the state of human body hydration measured by bioimpedance in patients with an early stage of ischemic stroke. MATERIAL AND METHODS The examination involved 81 patients with ischemic stroke in the Neurology Department, Subdivision of Stroke Treatment at the Province Specialist Hospital in Lublin, Poland, in 2015. Measurement of the composition and outer and intracellular space of the human body by the Whole Body Bioimpedance (WBIA) method was performed using the Body Composition Monitor (BCM) (Fresenius Medical Care GmbH, Bad Homburg, Germany). RESULTS A group of patients were been examined with the use of the BIA apparatus three times: on the first, seventh, and tenth day of hospital stay, to determine the level of body hydration. Comparative analysis of data showed that on the first day of hospitalization all the measurements of electrical bioimpedance parameters in the patients were significantly different from those of the control group. In the case of TBW, ECW, ICW, the patients' scores were significantly higher than those of the control group. Only with respect to the over-hydration index, the patients achieved a significantly lower score than the control group. CONCLUSIONS Assessment of hydration status in patients with a diagnosed stroke indicates a slight dehydration in relation to the control group, but falling within the scope of normovolaemia, according to bioimpedance measurement standards.
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Affiliation(s)
- Dorota Nalepa
- Faculty of Social Sciencesband Humanities, State Higher Vocational School Memorial of Prof. Stanisław Tarnowski in Tarnobrzeg, Poland
| | | | - Wojciech Załuska
- II Faculty of Medicine with English Language Division, Lublin, Poland
| | - Klaudia Jakubowska
- Chair of Development in Nursing, Faculty of Health Sciences, Lublin, Poland
| | - Paweł Chruściel
- Chair of Development in Nursing, Faculty of Health Sciences, Lublin, Poland
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Prystupa A, Kiciński P, Luchowska-Kocot D, Sak J, Prystupa TK, Tan YH, Panasiuk L, Załuska W. Factors influencing serum chemerin and kallistatin concentrations in patients with alcohol-induced liver cirrhosis. Ann Agric Environ Med 2019; 26:143-147. [PMID: 30922045 DOI: 10.26444/aaem/100536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION In Poland, an increasing number of patients are hospitalized due to liver diseases. One of the common liver diseases is cirrhosis, which can be caused by alcohol, viral hepatitis, autoimmune processes and metabolic diseases. MATERIAL AND METHODS The study included 99 patients with alcoholic cirrhosis from the Lublin region of Eastern Poland. The control group consisted of 20 healthy individuals without liver disease who did not abuse alcohol. The concentrations of serum kallistatin and chemerin were determined using ELISA kits. OBJECTIVE The aim of the study is to evaluate serum levels of kallistatin and chemerin in patients with different stages of alcoholic liver cirrhosis. RESULTS The highest chemerin level was found in the control group - 182.6±80.4 ng/ml. In other stages of liver cirrhosis, the following levels were observed: 175.7±62.7 ng/ml in Child-Pugh stage A (Ch-P A), 150.2±59.7 ng/ml in Ch-P B and 110.3±73.6 ng/ml in Ch-P C. Significant differences in chemerin levels between controls and Ch-P C patients (p=0.01), as well as between the Ch-P A patients and Ch-P C patients (p=0.02), were demonstrated. The highest kallistatin level was demonstrated in the control group - 8.2±3.5 μg/ml. In other stages of liver cirrhosis, the following concentrations were found: 7.2±27 μg/ml in Ch-P A, 4.4±2.2 μg/ml in Ch-P B and 3.5±1.9 μg/ml in Ch-P C. Statistically significant differences were observed between controls and Ch-P B patients (p<0.001), controls and Ch-P C patients (p<0.001), Ch-P A and Ch-P B patients (p=0.01), as well as Ch-P A and Ch-P C patients (<0.001). CONCLUSIONS The levels of chemerin and kallistatin decrease with progression of liver damage during alcoholic liver cirrhosis. The impairment of its synthetic function leads to reductions in levels of the adipokines studied.
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Affiliation(s)
- Andrzej Prystupa
- Department of Internal Medicine, Medical University, Lublin, Poland.
| | - Paweł Kiciński
- Department of Experimental Haematooncology, Medical University, Lublin, Poland.
| | | | - Jarosław Sak
- Department of Ethics and Human Philosophy, Medical University, Lublin, Poland.
| | | | - Yung-Hsu Tan
- Students' Scientic Society, Medical University, Lublin, Poland.
| | - Lech Panasiuk
- Department of Internal Diseases and Hypertension, Institute of Rural Health, Lublin, Poland
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Pietribiasi M, Waniewski J, Wójcik-Załuska A, Załuska W, Lindholm B. Model of fluid and solute shifts during hemodialysis with active transport of sodium and potassium. PLoS One 2018; 13:e0209553. [PMID: 30592754 PMCID: PMC6310262 DOI: 10.1371/journal.pone.0209553] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022] Open
Abstract
Background Mathematical models are useful tools to predict fluid shifts between body compartments in patients undergoing hemodialysis (HD). The ability of a model to accurately describe the transport of water between cells and interstitium (Jv,ISIC), and the consequent changes in intracellular volume (ICV), is important for a complete assessment of fluid distribution and plasma refilling. In this study, we propose a model describing transport of fluid in the three main body compartments (intracellular, interstitial and vascular), complemented by transport mechanisms for proteins and small solutes. Methods The model was applied to data from 23 patients who underwent standard HD. The substances described in the baseline model were: water, proteins, Na, K, and urea. Small solutes were described with two-compartment kinetics between intracellular and extracellular compartments. Solute transport across the cell membrane took place via passive diffusion and, for Na and K, through the ATPase pump, characterized by the maximum transport rate, JpMAX. From the data we estimated JpMAX and two other parameters linked to transcapillary transport of fluid and protein: the capillary filtration coefficient Lp and its large pores fraction αLP. In an Expanded model one more generic solute was included to evaluate the impact of the number of substances appearing in the equation describing Jv,ISIC. Results In the baseline model, median values (interquartile range) of estimated parameters were: Lp: 11.63 (7.9, 14.2) mL/min/mmHg, αLP: 0.056 (0.050, 0.058), and JpMAX: 5.52 (3.75, 7.54) mmol/min. These values were significantly different from those obtained by the Expanded model: Lp: 8.14 (6.29, 10.01) mL/min/mmHg, αLP: 0.046 (0.038, 0.052), and JpMAX: 16.7 (11.9, 25.2) mmol/min. The relative RMSE (root mean squared error)averaged between all simulated quantities compared to data was 3.9 (3.1, 5.6) %. Conclusions The model was able to accurately reproduce most of the changes observed in HD by tuning only three parameters. While the drop in ICV was overestimated by the model, the difference between simulations and data was less than the measurement error. The biggest change in the estimated parameters in the Expanded model was a marked increase of JpMAX indicating that this parameter is highly sensitive to the number of species modeled, and that the value of JpMAX should be interpreted only in relation to this factor.
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Affiliation(s)
- Mauro Pietribiasi
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
- * E-mail:
| | - Jacek Waniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Alicja Wójcik-Załuska
- Department of Rehabilitation and Physiotherapy, Medical University of Lublin, Lublin, Poland
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Lublin, Poland
| | - Bengt Lindholm
- Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
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Abstract
The filtration coefficient in the Starling equation is an important determinant of plasma refilling during hemodialysis. A method for calculating from clinical data an estimate of the filtration coefficient, called the refilling coefficient, was proposed in the past. The assumption behind this method was that the only drive for refilling is the increase in plasma oncotic pressure, and the remaining Starling forces have negligible effect. The refilling coefficient was observed to decrease during hemodialysis, and this was interpreted as a change in the filtration coefficient. The purpose of our study was providing an alternative explanation for the behavior of the refilling coefficient and, using clinical data and mathematical modeling, to predict the values of the immeasurable Starling forces and provide the theoretical basis for the interpretation of the refilling coefficient as the filtration coefficient. Blood volume and bioimpedance data from 23 patients undergoing hemodialysis were used to calculate the refilling coefficient according to the original formulation and to fit a two-compartment model of protein and fluid transport. The changes in the other Starling forces were non-negligible, ranging from 19% to 60% of plasma oncotic pressure. The results showed that the decrease observed in the refilling coefficient is likely caused by neglecting important changes in the Starling forces while deriving the equation for the refilling coefficient. When these Starling forces were taken into account, constant filtration coefficient and dynamic refilling coefficient provided an equivalent description of the data in most cases. However, this was not true for a subgroup of sessions, which suggests that additional factors may also be responsible for the observed decrease in the refilling coefficient.
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Affiliation(s)
- Mauro Pietribiasi
- 1 Department of Modeling and Supporting of Internal Organs Functions, Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Alicja Wójcik-Załuska
- 2 Department of Rehabilitation and Physiotherapy, Medical University of Lublin, Lublin, Poland
| | - Wojciech Załuska
- 3 Department of Nephrology, Medical University of Lublin, Lublin, Poland
| | - Jacek Waniewski
- 1 Department of Modeling and Supporting of Internal Organs Functions, Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
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Prystupa A, Kiciński P, Luchowska-Kocot D, Sak J, Prystupa T, Chen KH, Chen YC, Panasiuk L, Załuska W. Afamin and adropin in patients with alcohol-induced liver cirrhosis. Ann Agric Environ Med 2018; 25:527-531. [PMID: 30260179 DOI: 10.26444/aaem/92650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of the study was to determine serum concentrations of afamin and adropin in patients with alcoholic liver cirrhosis and to define their correlation with the stage of disease. The study included 99 patients with alcoholic cirrhosis from the region of Lublin, (Eastern Poland). Liver cirrhosis was diagnosed based on clinical features, history of heavy alcohol consumption, laboratory tests and abdominal ultrasonography. The control group consisted of 20 healthy individuals without liver disease who did not abuse alcohol. The serum afamin and adropin concentrations were determined using ELISA kits. The concentration of afamin was found to be significantly lower in patients with compensated alcoholic liver cirrhosis, i.e. P-Ch B (85.1±40.6 μg/ml) and P-Ch C (56.4±32.3 μg/ml) individuals, compared to the control group (135.9±43.6 μg/ml); p-value was <0.01 and <0.001, respectively. As far as adropin is concerned, a reverse relationship was demonstrated: the highest concentration was found in patients with P-Ch C (11.7±5.7 ng/ml) cirrhosis. Furthermore, the above concentration was significantly higher compared to patients with P-Ch A cirrhosis (7.2±2.8 ng/ml; p<0.05) and controls (7.5±2.6 ng/ml; p<0.05). The concentration of afamin decreases with the severity of alcoholic liver cirrhosis, which most likely results from impaired hepatic synthesis. Otherwise, the higher the stage of disease according to the Child-Pugh score, the higher the concentration of adropin.
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Affiliation(s)
- Andrzej Prystupa
- Department of Internal Medicine, Medical University of Lublin, Lublin, Poland.
| | - Paweł Kiciński
- Department of Experimental Hematooncology, Medical University of Lublin, Lublin, Poland.
| | | | - Jarosław Sak
- Department of Ethics and Human Philosophy, Medical University of Lublin, Lublin, Poland.
| | - Tomasz Prystupa
- Independent Public Teaching Hospital No 4 in Lublin, Poland.
| | - Ko-Hsin Chen
- Students' Scientific Society, Medical University of Lublin, Lublin, Poland
| | - Yu-Chieh Chen
- Students' Scientific Society, Medical University of Lublin, Lublin, Poland
| | - Lech Panasiuk
- Department of Internal Diseases and Hypertension, Institute of Rural Medicine, Lublin, Poland
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Lublin, Poland
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Kotlińska-Hasiec E, Rutyna RR, Rzecki Z, Czarko-Wicha K, Gagała J, Pawlik P, Załuska A, Jaroszyński A, Załuska W, Dąbrowski W. The effect of crystalloid infusion on body water content and intra-abdominal pressure in patients undergoing orthopedic surgery under spinal anesthesia. ADV CLIN EXP MED 2017; 26:1189-1196. [PMID: 29264874 DOI: 10.17219/acem/63140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Crystalloids are frequently used for the correction of spinal anesthesia-induced hypotension, intraoperative bleeding, or vaporisation from surgical wounds. OBJECTIVES The aim of this study was to observe the effect of perioperative crystalloid infusion on intraabdominal pressure (IAP), volume excess (VE), total body water (TBW), and extracellular body water (ECW) in patients undergoing elective orthopedic surgery under spinal anesthesia. MATERIAL AND METHODS Adult patients undergoing hip or knee replacement were studied. Changes in VE, TBW, ECW, and IAP were observed in patients who received restrictive fluid therapy (group R) and in patients who received liberal fluid therapy (group L). IAP was measured in the urinary bladder. All parameters were measured at 4 points in time: just before anesthesia (baseline value, A); just after surgery (B); 3 h after surgery (C); and on the morning of postoperative day 1 (D). Additionally, IAP was measured after anesthesia, just before surgery (A1). RESULTS The mean baseline values of IAP, ECW, TBW, and VE were comparable between groups L and R. The induction of anesthesia reduced IAP in both groups (p < 0.001). IAP and VE increased in both groups after surgery. Significantly higher values of IAP, however, were noted in group L at time points B, C, and D. TBW and ECW increased after surgery in group L. In group R, ECW slightly increased only at time point C. IAP strongly correlated with ECW in group L (p < 0.001, r = 0.62). CONCLUSIONS Spinal anesthesia reduces IAP. A perioperative increase in body water content and IAP mainly depends on the volume of the infused crystalloids.
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Affiliation(s)
- Edyta Kotlińska-Hasiec
- Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Poland
| | - Rafał R Rutyna
- Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Poland
| | - Ziemowit Rzecki
- Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Poland
| | - Katarzyna Czarko-Wicha
- Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Poland
| | - Jacek Gagała
- Department of Orthopedic Surgery and Traumatology, Medical University of Lublin, Poland
| | - Paulina Pawlik
- Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Poland
| | - Alicja Załuska
- Department of Physiotherapy, Medical University of Lublin, Poland
| | | | | | - Wojciech Dąbrowski
- Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Poland
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Prystupa A, Kiciński P, Luchowska-Kocot D, Błażewicz A, Niedziałek J, Mizerski G, Jojczuk M, Ochal A, Sak JJ, Załuska W. Association between Serum Selenium Concentrations and Levels of Proinflammatory and Profibrotic Cytokines-Interleukin-6 and Growth Differentiation Factor-15, in Patients with Alcoholic Liver Cirrhosis. Int J Environ Res Public Health 2017; 14:ijerph14040437. [PMID: 28430124 PMCID: PMC5409638 DOI: 10.3390/ijerph14040437] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/14/2017] [Accepted: 04/16/2017] [Indexed: 12/12/2022]
Abstract
According to some authors, serum selenium levels are strongly associated with the severity of liver diseases, including liver cirrhosis. The aim of this study was to determine the relationship between the concentration of selenium and pro-inflammatory and profibrotic cytokines—interleukin-6 (IL-6) and growth differentiation factor 15 (GDF-15) in patients with alcoholic liver cirrhosis. The parameters studied were determined in the serum of 99 patients with alcoholic liver cirrhosis divided based on the severity of disease according to the Child-Turcotte-Pugh criteria. In patients with liver cirrhosis, the serum selenium concentration was statistically lower, whereas serum IL-6 and GDF-15 concentrations were higher than those in the control group. Moreover, the concentration of selenium negatively correlated with the levels of GDF-15 and IL-6. The above results may indicate a role of selenium deficiency in the pathogenesis and progression of alcoholic liver disease.
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Affiliation(s)
- Andrzej Prystupa
- Department of Internal Medicine, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland.
| | - Paweł Kiciński
- Department of Family Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland.
| | - Dorota Luchowska-Kocot
- Department of Medical Chemistry, Medical University of Lublin, Chodźki 4a (Collegium Pharmaceuticum), 20-093 Lublin, Poland.
| | - Anna Błażewicz
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4a (Collegium Pharmaceuticum), 20-093 Lublin, Poland.
| | - Jarosław Niedziałek
- Individual Medical Practice, Lublin, Ludwika Hirszfelda 5/11, 20-092 Lublin, Poland.
| | - Grzegorz Mizerski
- Department of Family Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland.
| | - Mariusz Jojczuk
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland.
| | - Andrzej Ochal
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland.
| | - Jarosław J Sak
- Department of Ethics and Human Philosophy, Medical University of Lublin, Staszica 4/6 (Collegium Maximum), 20-059 Lublin, Poland.
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland.
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Jaroszynski A, Dereziński T, Jaroszyńska A, Zapolski T, Wąsikowska B, Wysokiński A, Jawień A, Załuska W, Horoch A. Association of anthropometric measures of obesity and chronic kidney disease in elderly women. Ann Agric Environ Med 2016; 23:636-640. [PMID: 28030936 DOI: 10.5604/12321966.1226859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION AND OBJECTIVE Growing evidence suggests that obesity is an important contributor to the development of chronic kidney disease (CKD). The relationship between obesity and CKD is complex and not completely understood, and the best anthropometric index of obesity in predicting CKD is controversial. This study aimed to determine the best anthropometric index of obesity in predicting CKD in a population of elderly women. MATERIALS AND METHODS Anthropometric indexes of obesity including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WheiR) and waist-to-hip-ratio (WHR), were obtained in 730 selected females. Biochemical measurements including blood glucose, lipid profile, and 2-h postprandial blood glucose were performed. GFR was estimated by using CKD-EPI equation. RESULTS The prevalence of CKD stage ≥ 3 was 12.2%. Overweight and obesity was found in 50% and 36% of participants, respectively. Increased central fat distribution, as defined by WheiR, WC and WHR, was found in 89.6%, 91.7% and 89.4% individuals, respectively. Univariate linear regression analysis showed positive correlations between CKD and age (p<0.001), BMI (p<0.001), WC (p<0.001), WHR (p=0.007), WheiR (p<0.001), diabetes (p=0.002), as well as triglicerydes (p=0.031), and negative correlation between CKD and HDL level (p=0.017). Multivariable analysis demonstrated that hypertension, diabetes, WC and WheiR were independent predictors of CKD. The area under the receiver operating characteristics curve was best for WheiR (0.647), followed by WC (0.620), BMI (0.616), and WHR (0.532). CONCLUSIONS Abdominal obesity is an important predictor of CKD. Of commonly used anthropometric parameters of obesity WheiR ≥ 0.6 is particularly associated with CKD in elderly females.
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Affiliation(s)
| | | | | | - Tomasz Zapolski
- Department of Cardiology, Medical University of Lublin, Poland
| | | | | | - Arkadiusz Jawień
- Department of Vascular Surgary and Angiology Nicolaus Copernicus University, Bydgoszcz, Poland
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Pietribiasi M, Waniewski J, Załuska A, Załuska W, Lindholm B. Modelling Transcapillary Transport of Fluid and Proteins in Hemodialysis Patients. PLoS One 2016; 11:e0159748. [PMID: 27483369 PMCID: PMC4970790 DOI: 10.1371/journal.pone.0159748] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/07/2016] [Indexed: 11/18/2022] Open
Abstract
Background The kinetics of protein transport to and from the vascular compartment play a major role in the determination of fluid balance and plasma refilling during hemodialysis (HD) sessions. In this study we propose a whole-body mathematical model describing water and protein shifts across the capillary membrane during HD and compare its output to clinical data while evaluating the impact of choosing specific values for selected parameters. Methods The model follows a two-compartment structure (vascular and interstitial space) and is based on balance equations of protein mass and water volume in each compartment. The capillary membrane was described according to the three-pore theory. Two transport parameters, the fractional contribution of large pores (αLP) and the total hydraulic conductivity (LpS) of the capillary membrane, were estimated from patient data. Changes in the intensity and direction of individual fluid and solute flows through each part of the transport system were analyzed in relation to the choice of different values of small pores radius and fractional conductivity, lymphatic sensitivity to hydraulic pressure, and steady-state interstitial-to-plasma protein concentration ratio. Results The estimated values of LpS and αLP were respectively 10.0 ± 8.4 mL/min/mmHg (mean ± standard deviation) and 0.062 ± 0.041. The model was able to predict with good accuracy the profiles of plasma volume and serum total protein concentration in most of the patients (average root-mean-square deviation < 2% of the measured value). Conclusions The applied model provides a mechanistic interpretation of fluid transport processes induced by ultrafiltration during HD, using a minimum of tuned parameters and assumptions. The simulated values of individual flows through each kind of pore and lymphatic absorption rate yielded by the model may suggest answers to unsolved questions on the relative impact of these not-measurable quantities on total vascular refilling and fluid balance.
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Affiliation(s)
- Mauro Pietribiasi
- Institute of Biocybernetics and Biomedical Engineering, Warsaw, Poland
- * E-mail:
| | - Jacek Waniewski
- Institute of Biocybernetics and Biomedical Engineering, Warsaw, Poland
| | - Alicja Załuska
- Department of Rehabilitation and Physiotherapy, Medical University of Lublin, Lublin, Poland
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Lublin, Poland
| | - Bengt Lindholm
- Baxter Novum and Renal Medicine, Karolinska Institutet, Stockholm, Sweden
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Pietribiasi M, Katzarski K, Załuska A, Załuska W, Lindholm B, Waniewski J. SP395COMPARISON OF DIFFERENT APPROACHES TO POTASSIUM MODELLING DURING HAEMODIALYSIS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw170.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Debowska M, Wojcik-Zaluska A, Da˛browski W, Poleszczuk J, Ksiazek A, Załuska W, Waniewski J. MP481CHANGES IN PULSE WAVE AT THE STARTUP AND AT THE TERMINATION OF HEMODIALYSIS SESSION. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw194.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Szeliga-Król J, Zubilewicz R, Panasiuk-Kamińska K, Załuska W, Urbańczuk M, Jaroszyński A. Comparison of the Cockroft–Gault, simplified Modification of Diet in Renal Disease, and Chronic Kidney Disease Epidemiology Collaboration formulas in the determination
of chronic kidney disease advancement. fmpcr 2016; 3:348-351. [DOI: 10.5114/fmpcr/62806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
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Jaroszyński A, Jaroszyńska A, Siebert J, Dąbrowski W, Niedziałek J, Bednarek-Skublewska A, Zapolski T, Wysokiński A, Załuska W, Książek A, Schlegel TT. The prognostic value of positive T-wave in lead aVR in hemodialysis patients. Clin Exp Nephrol 2015; 19:1157-64. [PMID: 25724127 PMCID: PMC4679784 DOI: 10.1007/s10157-015-1100-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 02/16/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Given that cardiac disease is the leading cause of mortality in hemodialysis (HD) patients, identification of patients at risk for cardiac mortality is crucial. The aim of this study was to determine if positive T-wave amplitude in lead aVR (TaVR) was predictive of cardiovascular (CV) mortality and sudden cardiac death (SCD) in a group of HD patients. METHODS AND RESULTS After exclusion, 223 HD patients were prospectively followed-up for 25.43 ± 3.56 months. Patients were divided into TaVR negative (n = 186) and TaVR positive (n = 37) groups. Myocardial infarction, diabetes and beta-blocker therapy were more frequent in positive TaVR patients. Patients with upright TaVR were older, had higher left ventricular mass index, lower ejection fraction, higher calcium × phosphate product, higher troponin T level, higher prevalence of ST-T abnormalities, and increased width of QRS complex and QT interval, compared with patients with negative TaVR. A Kaplan-Meier analysis showed that the cumulative incidences of CV mortality as well as SCD were higher in patients with positive TaVR compared with those with negative TaVR (log-rank, p < 0.001 in both cases). A multivariate analysis selected age [hazard ratio (HR) 1.71, p < 0.001], heart rate (HR 1.42, p = 0.016), and positive TaVR (HR 2.21, p = 0.001) as well as age (HR 1.88, p < 0.001), and positive TaVR (HR 1.53, p = 0.014) as independent predictors of CV mortality and SCD, respectively. CONCLUSION In HD patients, positive TaVR is an independent and powerful predictor of CV mortality as well as SCD. This simple ECG parameter provides additional information beyond what is available with other known traditional risk factors and allows the identification of patients most at risk of CV events.
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Affiliation(s)
- Andrzej Jaroszyński
- Department of Family Medicine, Medical University of Lublin, Staszica 11, 20-081, Lublin, Poland.
| | - Anna Jaroszyńska
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Janusz Siebert
- Department of Family Medicine, University Center for Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Wojciech Dąbrowski
- Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Jarosław Niedziałek
- Department of Family Medicine, Medical University of Lublin, Staszica 11, 20-081, Lublin, Poland
| | | | - Tomasz Zapolski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | | | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Lublin, Poland
| | - Andrzej Książek
- Department of Nephrology, Medical University of Lublin, Lublin, Poland
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Prystupa A, Kiciński P, Sak J, Boguszewska-Czubara A, Toruń-Jurkowska A, Załuska W. Proinflammatory Cytokines (IL-1α, IL-6) and Hepatocyte Growth Factor in Patients with Alcoholic Liver Cirrhosis. Gastroenterol Res Pract 2015; 2015:532615. [PMID: 26448742 PMCID: PMC4558446 DOI: 10.1155/2015/532615] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/06/2015] [Indexed: 02/07/2023] Open
Abstract
Background. The aim of the study was to assess the activity of interleukin-1α, interleukin-6, and hepatocyte growth factor protein (HGF) in serum of patients with alcoholic liver cirrhosis. Materials and Methods. Sixty patients with alcoholic liver cirrhosis treated in various hospitals were randomly enrolled. The stage of cirrhosis was assessed according to the Child-Turcotte-Pugh scoring system. The control group consisted of ten healthy persons without liver disease, who did not drink alcohol. Additionally, the group of alcoholics without liver cirrhosis was included in the study. The activity of interleukin-1α, interleukin-6, and HGF in blood plasma of patients and controls was measured using the sandwich enzyme immunoassay technique with commercially available quantitative ELISA test kits. Results. Higher concentrations of HGF protein were demonstrated in patients with Child class B and Child class C liver cirrhosis, compared to controls and alcoholics without liver cirrhosis. Moreover, significantly higher concentrations of HGF protein were found in patients with Child class C liver cirrhosis compared to patients with Child class A liver cirrhosis (p < 0.05). The concentrations of interleukin-1α in patients with Child class B and Child class C liver cirrhosis were significantly higher in comparison with controls. Significantly higher concentrations of interleukin-6 were demonstrated in Child class C, compared to Child class A.
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Affiliation(s)
- Andrzej Prystupa
- Department of Internal Medicine, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland
| | - Paweł Kiciński
- Department of Family Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
| | - Jarosław Sak
- Department of Ethics and Human Philosophy, Medical University of Lublin, Staszica 4/6, 20-059 Lublin, Poland
- Department of Nephrology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
| | - Anna Boguszewska-Czubara
- Department of Medical Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland
| | - Anna Toruń-Jurkowska
- Department of Mathematics and Medical Biostatistics, Medical University of Lublin, Jaczewskiego 4, 20-954 Lublin, Poland
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland
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Prystupa A, Szpetnar M, Boguszewska-Czubara A, Grzybowski A, Sak J, Załuska W. Activity of MMP1 and MMP13 and amino acid metabolism in patients with alcoholic liver cirrhosis. Med Sci Monit 2015; 21:1008-14. [PMID: 25863779 PMCID: PMC4403549 DOI: 10.12659/msm.892312] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Alcoholic liver disease remains one of the most common causes of chronic liver disease worldwide. The aim of this study was to assess the usefulness of metalloproteinases (MMP1 and MMP13) as diagnostic markers of alcoholic liver disease and to determine the changes in free amino acid profile in the patients with alcoholic liver cirrhosis. Material/Methods Sixty patients with alcoholic liver cirrhosis treated in various hospitals of the Lublin region were randomly enrolled. The control group consisted of 10 healthy individuals without liver disease, who did not drink alcohol. Additionally, a group of alcoholics (22 persons) without liver cirrhosis was included in the study. The activity of MMP-1 and MMP-13 in blood plasma of patients and controls was measured using the sandwich enzyme immunoassay technique with commercially available quantitative ELISA test kits. Amino acids were determined by automated ion-exchange chromatography. Results No significant differences were observed in the activity of MMP-1 in alcoholics with or without liver cirrhosis or in controls. Increased serum MMP-13 was found in patients with liver cirrhosis (stage A, B, C) compared to the control group. Patients with alcoholic liver cirrhosis (stage A, B, C) demonstrated reduced concentrations of glutamic acid and glutamine compared to the control group. Plasma levels of valine, isoleucine, leucine, and tryptophan were significantly lower in patients with alcoholic liver cirrhosis (stage C) than in controls. Conclusions MMP-13 can be useful to confirm the diagnosis of alcoholic liver cirrhosis, but levels of MMP-1 are not significantly increased in patients with liver cirrhosis compared to controls. The serum branched-chain amino acid (BCAA) is markedly reduced in patients with stage C alcoholic liver cirrhosis.
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Affiliation(s)
- Andrzej Prystupa
- Department of Internal Medicine, Medical University of Lublin, Lublin, Poland
| | - Maria Szpetnar
- Department of Medical Chemistry, Medical University of Lublin, Lublin, Poland
| | | | | | - Jarosław Sak
- Department of Ethics and Human Philosophy, Medical University of Lublin, Lublin, Poland
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Lublin, Poland
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Rajaratnam M, Prystupa A, Lachowska-Kotowska P, Załuska W, Filip R. Herbal medicine for treatment and prevention of liver diseases. J Pre Clin Clin Res 2015. [DOI: 10.26444/jpccr/71468] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kozioł M, Sikora A, Kozioł-Montewka M, Smarz-Widelska I, Orłowska-Kowalik G, Pyszna W, Załuska W, Ksiazek A. [Preliminary results of research on a new marker of idiopathic membranous nephropathy: anti-PLA2R]. Pol Merkur Lekarski 2014; 36:171-174. [PMID: 24779214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Idiopathic membranous nephropathy (IMN) is a chronic glomerular disease. It is result of new discovery that the production of anti-PLA2R autoantibodies, reacting with phospholipase A2 receptor on the surface of podocytes. Specific antibodies occur in IMN patients blood in exacerbated of disease, and disappear during remission. It suggest that analyse of these parameter can prove quick diagnosis to recognize and monitoring treatment process. The aim of our work was to determine anti-PLA2R in patients with suspected IMN and persons during/after treatment in order to monitor the effectiveness of therapy. MATERIAL AND METHODS The study group consisted of 22 patients. Patients were divided into two groups: Group A--patients with symptomatic nephrotic syndrome in the course of membranous nephropathy; Group B--patients diagnosed with IMN who monitored the effectiveness of therapy. We collected the serum samples for all patients and determined of anti-PLA2R autoantibodies by indirect immunofluorescence test. RESULTS Antibodies were detected in 12 patients (54.54%): diagnosed (n = 5) and monitor (n = 7). All of patients with exacerbated disease process in monitored group had positive test results. CONCLUSIONS Our data suggest that anti-PLA2R is a sensitive diagnostic method and good for monitoring of disease activity, but nevertheless a need for further research on a larger group of patients to confirm that the test is a reliable source of diagnostic information.
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Prystupa A, Mróz T, Wojciechowska K, Mróz K, Prystupa T, Nowicki G, Załuska W, Filip R. Clinical approach to visceral pain in irritable bowel syndrome - pathophysiology, symptoms, and treatment. Ann Agric Environ Med 2013; Spec no. 1:8-13. [PMID: 25000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Visceral pain has been defined as a pain resulting from activation of pain receptors localized in mucous membrane, serous membrane, and smooth muscles of hollow organs. The great majority of these organs are innervated by parasympathetic and sympathetic outflows. Afferent nerve fibres are involved in conduction of both acute and persistent pain and hyperalgesia. Visceral pain differs significantly from other types of pain in the way it originates and in clinical presentation. It can be misleading as a symptom, producing several problems in the diagnostic process. Sometimes, severe visceral pain is observed in the course of non-lifethreatening functional gastrointestinal disorders, while slight abdominal discomfort may be a first symptom of malignant tumours. For many years, the treatment of visceral pain has been considered as not satisfactory enough and covered a wide variety of pharmacological substances. For example, the complex therapy of pain and other manifestations associated with irritable bowel syndrome include psychotherapy/behavioural therapy, bulk-forming agents, probiotics, laxatives, antidiarrheals, antibacterial agents, antispasmodics, and antidepressants. The current knowledge about the pathogenesis of visceral pain gives a rationale for the development of new, more efficacious drugs with a positive benefit/risk ratio. Unfortunately, experience gained so far with the use of some agents affecting serotoninergic transmission in the gastrointestinal tract have shown a serious danger associated with their administration for patients with irritable bowel syndrome.
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Affiliation(s)
- Andrzej Prystupa
- Department of Internal Medicine, Medical University, Lublin, Poland
| | - Tomasz Mróz
- Department of Experimental and Clinical Pharmacology, Medical University, Lublin, Poland
| | - Katarzyna Wojciechowska
- Department of Paediatric Haematology and Oncology and Transplantology, Medical University, Lublin, Poland
| | - Katarzyna Mróz
- Department of Neurology, District Hospital, Lubartów, Poland
| | - Tomasz Prystupa
- Student Research Association, Medical University of Lublin, Poland
| | - Grzegorz Nowicki
- Department of Expert Medical Assistance with Emergency Medicine Unit, Medical University, Lublin, Poland
| | | | - Rafał Filip
- Department of Clinical Endoscopy, Institute of Rural Health, Lublin, Poland
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Makara-Studzińska M, Ksiazek P, Koślak A, Załuska W, Ksiazek A. [Prevalence of depressive disorders in patients with end-stage renal failure]. Psychiatr Pol 2011; 45:187-195. [PMID: 21714208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM The depressive symptoms are common in patients with end-stage kidney disease but they are often undiagnosed and can complicate the renal replacement therapy. The aim of this study was to identify significant differences in frequency and severity of depressive symptoms among patients with end-stage renal disease depending on what form of treatment they are undergoing--hemodialysis, peritoneal dialysis and patients after kidney transplantation. METHODS 323 patients with end-stage renal failure were examined. Among them 206 patients were hemodialysed, 64--undergoing the peritoneal dialysis and 53 patients were the recipients of kidney transplants. We used a self-constructed questionnaire and Beck Depression Inventory (BDI). RESULTS Beck Depression Inventory reflects mild and moderate intensification of symptoms. The results obtained by the use of BDI show the mild and moderate intensification of the depressive symptoms in the study group. The majority of patients suffering from depression were found in the group of patients undergoing peritoneal dialysis, to a lesser degree in the hemodialysis subgroup and among these, depression had moderate intensity. Patients after kidney transplantation were found to be at a smaller risk of depression comparing to dialysed patients. CONCLUSIONS End-stage renal disease may affect the occurrence of depressive symptoms, the treatment may also play a role in the formation and intensity. We formulated the conclusions of our study carefully, taking into account a multitude of other existing causal factors.
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Bednarek-Skublewska A, Smoleń A, Jaroszyński A, Załuska W, Ksiazek A. Effects of vitamin D3 on selected biochemical parameters of nutritional status, inflammation, and cardiovascular disease in patients undergoing long-term hemodialysis. Pol Arch Med Wewn 2010; 120:167-174. [PMID: 20502401 DOI: 10.20452/pamw.917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Vitamin D3 has diverse biological effects extending beyond the maintenance of calcium and phosphorus homeostasis and ensuring the proper functioning of the body. OBJECTIVES This study evaluated the levels of vitamin D3 and its association with nutritional status, immunological activity, and selected markers of cardiovascular disease in patients on long-term hemodialysis (HD). PATIENTS AND METHODS We measured 25-hydroxyvitamin D3 (25(OH)D3) levels in a group of 84 patients (mean age, 65 years; average time on dialysis, 32.5 months) and investigated correlations between 25(OH)D3 levels and the following parameters: albumin, body mass index, hemoglobin (Hb), interleukin 6 (IL-6), interleukin 10, C-reactive protein, asymmetric dimethylarginine (ADMA), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and comorbidity score. RESULTS A mean 25(OH)D3 level was 15.4 +/-7.2 ng/ml and only 5% of patients had 25(OH)D3 levels above the normal value of 30 ng/ml. There was no statistically significant difference in 25(OH)D3 levels between women and men (P = 0.06). A negative correlation was observed between 25(OH)D3 and IL-6 (R = -0.31, P = 0.009) and ADMA (R = -0.26, P = 0.03), as well as a positive correlation between 25(OH)D3 and Hb (R= 0.21, P = 0.05). There was no association between 25(OH)D3 levels and nutritional status. CONCLUSIONS A significant vitamin D3 deficiency observed in the majority of patients undergoing long-term HD contributes to the development of chronic inflammation, anemia, and indirectly, to endothelial cell injury.
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Ksiazek P, Makara-Studzińska M, Załuska A, Kaim R, Załuska W. [Medical conditions of depression in end-stage renal disease patients treated on hemodialysis]. Przegl Lek 2009; 66:1036-1039. [PMID: 20514901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED Depression is the most common psychological problem encountered among patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) and is associated with increased morbidity and mortality in these patients. Chronic inflammation is known to play an important role in the pathophysiology of depression, and levels of proinflammatory cytokines are increased in chronic renal failure (CRF) patients. The objective of this study was to examine the prevalence and degree of depression as measured using Beck Depression Inventory (BDI) in relation with nutrition, inflammation and biochemical dialysis adequacy parameters. METHODS 200 healthy volunteers and 206 patients on hemodialysis were enrolled in this study. Depressive symptoms were measured with the Beck Depression Inventory (BDI). RESULTS Medium and moderate stage of depression symptoms occurred in 70% of HD patients. Serum CRP levels were significantly different among HD patients with medium and moderate stage of depressive symptoms.
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Affiliation(s)
- Piotr Ksiazek
- Katedra i Zakład Zdrowia Publicznego, Uniwersytetu Medycznego w Lublinie
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Jaroszyński AJ, Głowniak A, Sodolski T, Załuska W, Widomska-Czekajska T, Ksiazek A. Effect of haemodialysis on signal-averaged electrocardiogram P-wave parameters. Nephrol Dial Transplant 2005; 21:425-30. [PMID: 16221710 DOI: 10.1093/ndt/gfi175] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The P-wave signal-averaged electrocardiogram (SAECG) is a non-invasive technique considered to indicate an increased risk for paroxysmal atrial fibrillation. The study was designed to evaluate the effect of the haemodialysis (HD) process on SAECG parameters in the group of selected HD patients. METHODS Forty-seven HD patients (without relevant cardiac diseases) were included. SAECGs were performed pre- and post-dialysis together with evaluating extracellular body water (ECW) by using bioimpedance and biochemical measurements. For each SAECG, filtered P-wave duration (FPD) and root mean square voltage of the final 20 ms of filtered P-wave (RMS20) were established. RESULTS The duration of either pre- or post-dialysis FDP was higher in HD patients than in the control group (P<0.001 and P = 0.005, respectively). The voltage of either pre- or post-dialysis RMS20 was reduced in HD patients compared with controls (P<0.001 in both cases). HD induced a decrease in the duration of the FDP and a significant increase in the voltage of RMS20 (P<0.001 in both cases). Stepwise multiple regression identified independent predictors of pre- and post-dialysis FDP as: (1) age; (2) pre- and post-dialysis ECW/kg body weight, respectively and; (3) pre- and post-dialysis haemoglobin levels, respectively. In the case of RMS20, we did not find any independent predictors either pre- or post-dialysis. CONCLUSIONS Our study revealed that P-wave SAECG parameters are abnormal in a significant portion of HD patients and improved with HD process. We have also demonstrated that patients' age, volume status as well as the presence of anaemia are important factors influencing P-wave SAECG parameters in HD patients.
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Swatowski A, Wizemann V, Załuska W, Ksizek A. Thoracic impedance measurements during orthostatic change test and during hemodialysis in hemodialyzed patients. ASAIO J 2005; 50:581-5. [PMID: 15672792 DOI: 10.1097/01.mat.0000144588.73907.eb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Measurements were performed before and after hemodialysis (HD) in the supine and upright positions (orthostatic change test) and during HD session every 30 minutes in recumbent position on 11 HD patients. Two hydration states were compared: hyperhydration and normal hydration. Each patient served as his own control. Blood pressure and total body bioimpedance were obtained simultaneously. Thoracic impedance values (Zo) obtained during HD were significantly greater in the normal hydration state. There was strong correlation between Zo gain and total ultrafiltration; however, Zo gain divided through total ultrafiltration (calculated for every 100 ml) was also higher in this state. The ratio Zo/R (where R is resistance of total body bioimpedance) was stable during HD but was significantly higher in the normal hydration state. Zo gain during the orthostatic change test was significantly higher after HD than before HD in both hydration states. The anticipated difference in Zo gains between both hydration states was not significant. After echocardiographic analysis of patients, we determined that cardiac dysfunction or valvular defects in four patients were likely responsible for opposite reaction on orthostatic change test. During our measurements, we observed the influence of Zo changes on episodes such as intradialytic hypotension or acute atrial fibrillation. Thoracic impedance is an intriguing method for controlling pathophysiology of fluid distribution, but it requires the accurate definition of a patient's hemodynamics and strong conditions during measurement. During our measurements, we observed the influence of such episodes as intradialytic hypotension or acute atrial fibrillation on Zo changes.
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Jaroszyński AJ, Załuska W, Bober E, Ksiazek A. [Factors producing increase of QRS complex amplitude during hemodialysis]. Przegl Lek 2005; 62:270-3. [PMID: 16334530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
An increase of total amplitudes of QRS complexes induced by the hemodialysis (HD) procedure is a common phenomenon in hemodialysed patients. The aim of the study was to define factors responsible for the growth of QRS complex amplitude as a result of HD. The study was carried out on a group of 48 patients. Before and after HD procedure basic biochemical blood tests were performed and the following parameters calculated for each patient: (a) the total amplitude of QRS complex, (b) the total volume of body water (TBW), the extracellular volume (ECW), and the intracellular volume (ICW), as well as the TBW, ECW and ICW indices standardized against the patient body weight. The levels of albumin, total protein, intact PTH (iPTH), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-alpha) were determined before HD. The rates of Kt/V and normalized protein catabolic rate (nPCR) were calculated. The total amplitude of QRS complexes before HD was 13.09 +/- 3.3 mV and it increased significantly after HD to the value of 17.68 +/- 4.03 mV (p<0.001). An increase of QRS amplitude was observed in 35 patients (72.92%). The results of the study revealed, that the most important factor responsible for the growth of the total amplitude of QRS complexes after HD procedure is the value and changes in the ECW volume. The validation of the correlations disclosed in our study between the increase of the total amplitude of QRS complexes and IL-6 )positive correlation), and the nPCR value (negative correlation) require further studies on large groups of HD patients as well as a retrospective analysis of patients' survival rates.
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