Zbigniew Włodarczyk

PARATHORMON, CALCIUM, PHOSPHORUS, AND LEFT VENTRICULAR STRUCTURE AND FUNCTION IN NORMOTENSIVE HEMODIALYSIS PATIENTS

Clinical and experimental data suggest that Parathormon (PTH), calcium, and phosphorus participate in left ventricular hypertrophy (LVH) and affect myocardial contractility in end-stage renal disease. Cellular calcium overload and interstitial fibrosis induced by PTH may lead to impairment of left ventricular diastolic function. Hyperphosphatemia is an independent risk of cardiovascular mortality in dialysis patients. The aim of the study was to estimate the influence of PTH and calcium-phosphorus metabolism on left ventricular structure and function in hemodialysis patients, without hypertension and antihypertensive drug therapy (SBP = 126.2 ± 11.1 DBP = 75.8 ± 6.5 mmHg). Echocardiographic findings in a group of 22 normotensive HD patients had been compared to 43 hypertensive HD patients. Relationships between PTH, calcium-phosphorus metabolism and echocardiography in normotensive group were then evaluated. Left ventricular mass index (LVMI) was lower in normotensive patients: 128.3 ± 46.2 versus 165.8 ± 46.7 (p < 0.01). The prevalence of LVH was 55% in normotensive HD patients compared to 86% in hypertensive group (p < 0.01). In normotensive group we found correlation between PTH and LVMI (r = 0.44; p < 0.05). There were also significant relationships between calcium and posterior wall thickness (r = −0.44; p < 0.05), phosphorus and LVMI (r = 0.47; p < 0.05). A significant correlation was observed between both phosphorus, calcium × phosphorus product and E/A ratio: r = −0.47 and r = −0.43, respectively (p < 0.05 both). Disturbances of calcium-phosphorus metabolism and secondary hyperparathyroidism contributes to left ventricular hypertrophy, and impaired left ventricular diastolic function in normotensive hemodialysis patients.

Selenium concentrations and glutathione peroxidase activities in blood of patients before and after allogenic kidney transplantation

In animals and humans, the highest level of selenium (Se) occurs in the kidney. This organ is also the major site of the synthesis of the selenoenzyme glutathione peroxidase (GSH-Px). Decreased Se levels and GSH-Px activities in blood are common symptoms in the advanced stage of chronic renal failure (CRF). Blood samples for Se levels and GSH-Px activities measurements from patients were collected just before transplantation and 3, 7, 14, 30, and 90 d posttransplant. The Se levels in whole blood and plasma of patients before transplantation (79.5 and 64.5 ng/mL, respectively) were lower by 23% and 21%, respectively, as compared with controls (p<0.0001), and 7 d after operation, it further decreased in both components (p<0.01). Fourteen days after surgery, the levels reached the initial values and increased slowly in the later period. Red blood cell GSH-Px activity in patients in the entire period of the study did not differ from the control group. Plasma GSH-Px of patients before the surgery was extremely low (76 U/L) as compared with controls (243 U/L; p<0.0001) but increased rapidly to 115 U/L after 3 d, to 164 U/L after 14 d, and to 208 U/L after 3 mo posttransplant. In CRF patients, after kidney transplantation, plasma GSH-Px activity increased rapidly, approaching, after 3 mo, the values that were close to the normal levels. A negative correlation between creatinine level and plasma GSH-Px activity is observed in patients after kidney transplantation. Monitoring of plasma GSH-Px activity may be a useful additional marker of the transplanted kidney function.

The influence of calcineurin inhibitors on pulse wave velocity in renal transplant recipients.

Background. Pulse wave velocity (PWV) is a marker of the arterial wall stiffness and independent cardiovascular risk factor in hemodialysis patients. Cyclosporine A (CyA) and tacrolimus (TAC) are known to differ in the influence on cardiovascular risk factors in renal transplant recipients. Recent studies suggest that CyA may decrease arterial compliance. The aim of the study was to assess the influence of CyA and TAC on the PWV and arterial wall stiffness in renal transplant recipients. Methods. The study population consisted of two groups of cadaveric renal transplant recipients, 76 patients each, matched for age, sex, blood pressure, body mass index, and length of the post-transplant follow-up. PWV between carotid and femoral artery was measured using a Complior device. Fasting blood was sampled for serum creatinine, lipid profile, uric acid, glucose, and C-reactive protein. Results. Aortic pulse wave velocity—a marker of increased arterial stiffness—was significantly higher in CyA group compared with TAC group (9.33 ± 2.10 vs. 8.54 ± 1.35, respectively; p < 0.01). Uric acid, total cholesterol, triglycerides, and LDL-cholesterol concentrations were significantly higher in CyA group. Significant correlations were found between PWV and age, systolic and diastolic blood pressure, and fasting glucose in the CyA group, but only between PWV and age in TAC group. Conclusion. CyA-based immunosuppressive therapy is associated with an unfavorable profile of cardiovascular risk factors and increased arterial stiffness in renal transplant recipients.

Local recurrence and distant metastases 18 years after resection of the greater omentum hemangiopericytoma

BackgroundHemangiopericytoma occurs with increasing frequency in 5th decade of life and has prediction for retroperitoneum and extremities. A case of a local recurrence and metastases of hemangiopericytoma is described.Case presentationRecurrence of hemangiopericytoma in the greater omentum and the jejunal mesentery as well as metastases in the retroperitoneal space were diagnosed in a 61-year-old patient who had a hemangiopericytoma of the greater omentum excised 18 years before.ConclusionBecause of the rarity of this disease and its typical clinical course associated with late recurrence and metastases, the authors decided to present this case emphasizing the necessity of systematic oncological follow-up after the end of treatment.

Glutathione and glutathione peroxidase activities in blood of patients in early stages following kidney transplantation

This study focuses on glutathione (GSH) level in red blood cells, as well as on glutathione peroxidases (GSH-Px) activities in red blood cells and in plasma of chronic renal failure (CRF) patients following renal transplantation. We want to focus our main attention on plasma GSH-Px, the selenoenzyme that is synthesized primarily in the kidney. In CRF patients, activity of this enzyme is significantly reduced, and the reduction decreases with the progress of the disease, reaching in the end-stage 20% to 30% of the activity of healthy patients. We have shown that following renal transplantation the activity of plasma GSH-Px is restored very rapidly, and 2 weeks after surgery it reached the value of the control group. Red blood cell GSH level is significantly higher in CRF patients, and following transplantation, no significant changes were observed. Red blood cell GSH-Px activity before transplantation was the same as in healthy patients and did not change significantly after surgery.

Long graft cold ischemia time is associated with increased arterial stiffness in renal transplant recipients.

BACKGROUND Increased pulse wave velocity (PWV), an indicator of arterial stiffness, is associated with greater cardiovascular risk among renal transplant recipients. PWV depends on recipient-related factors and, as shown in recent studies, also on donor age. There is a lack of information whether graft-related factors influence arterial function in recipients. Graft cold ischemia time (CIT) significantly influences renal transplant outcomes. It was shown in an experimental model of aortic grafting that increased CIT promoted arteriosclerosis. The aim of the present study was to evaluate the relationship between renal graft CIT and PWV. METHODS Carotid-femoral PWV were measured in 103 cadaveric kidney recipients of mean age 45 +/- 12 years. We analyzed clinical data of recipient and donor ages, genders, body mass index, blood pressure, CIT, delayed graft function, and type of immunosuppressive therapy to compare patients with CIT < 24 (n = 24) versus CIT > or = 24 hours (n = 79). RESULTS PWV was lower among patients with shorter CIT (8.3 +/- 1.6 vs 9.2 +/- 2.0 respectively; P < .05). No significant differences were observed between the groups regarding donor and recipient ages, blood pressure, glomerular filtration rate, or immunosuppressive and cardiovascular therapy. A significant positive correlation was noted between PWV and CIT (r = .23; P = .019). Multiple regression analysis demonstrated that recipient age, therapy with cyclosporine, fasting glucose, systolic blood pressure, and CIT were independently associated with PWV. CONCLUSIONS Long CIT was associated with increased arterial stiffness. Further studies are necessary to understand the cause effect relationship of this finding.

Diffusion-weighted MR imaging of transplanted kidneys: Preliminary report.

Summary Background An aim of this study was to assess the feasibility of DWI in the early period after kidney transplantation. We also aimed to compare ADC and eADC values in the cortex and medulla of the kidney, to estimate image noise and variability of measurements, and to verify possible relation between selected labolatory results and diffusion parameters in the transplanted kidney. Material/Methods Examinations were performed using a 1.5 T MR unit. DWI (SE/EPI) was performed in the axial plane using b-values of 600 and 1000. ADC and eADC measurements were performed in four regions of interest within the renal cortex and in three regions within the medulla. Relative variability of results and signal-to-noise ratio (SNR) were calculated. Results The analysis included 15 patients (mean age 52 years). The mean variability of ADC was significantly lower than that of eADC (6.8% vs. 10.8%, respectively; p<0.0001). The mean variability of measurements performed in the cortex was significantly lower than that in the medulla (6.2% vs. 11.5%, respectively; p<0.005). The mean SNR was higher in the measurements using b600 than b1000, it was higher in ADC maps than in the eADC maps, and it was higher in the cortex than in the medulla. ADC and eADC measured at b1000 in the cortex were higher in the group of the patients with eGFR ≤30 ml/min./1.73 m2 as compared to patients with eGFR >30 ml/min./1.73 m2 (p<0.05). Conclusions Diffusion-weighted imaging of transplanted kidneys is technically challenging, especially in patients in the early period after transplantation. From a technical point of view, the best quality parameters offer quality ADC measurement in the renal cortex using b1000. ADC and eADC values in the renal cortex measured at b1000 present a relationship with eGFR.

Results of renal transplantation from expanded criteria deceased donors – a single-center experience

BACKGROUND Transplantation of kidneys retrieved from extended criteria donors is one of the options to expand the pool of available grafts, shorten the waiting time and increase the availability of this method of treatment. However, some factors (eg, donor age) may impair the results of transplantation. MATERIAL/METHODS This study was a retrospective assessment of 327 patients who underwent renal transplants during the period 1995-2005, with kidneys harvested from expanded criteria donors (ECD) as defined by the United Network for Organ Sharing (UNOS). They formed 2 groups: group 1 (ECD - younger, n=255) consisted of recipients of kidneys obtained from donors aged 50-59 years; group 2 (ECD - older, n=72) consisted of patients who received kidneys from donors ≥ 60 years old. An analysis of the 1-, 3- and 5-year survival of grafts and patients and evaluation of graft function were performed. RESULTS graft survival was significantly better in group 1 (ECD-younger) vs. group 2 (ECD-older), as was renal graft function. Survival 3 and 5 years after transplantation was 87.7% vs. 81.9%, 73.1% vs. 66.6%, and 60.1% vs. 51.7%, respectively. Delayed graft function occurred significantly more frequently in group 2 (group 1 vs. group 2-28.8% vs. 34.6%, p=0.0001). CONCLUSIONS The transplantation of kidneys obtained from older donors fulfilling ECD definition is associated with shorter graft survival, deteriorated function and more frequent renal delayed graft function. However, this did not increase the mortality of recipients.

Psychological principles in regard to the interview with the deceased donor's family.

The purpose of this article is to present the most important rules of the interview process with the family of a patient who has been diagnosed with brain death. Based on data from the literature and their own clinical experience, the authors also describe the psychological mechanisms that make contact with the family of a potential donor particularly difficult. The paper also discusses successive stages in the process of building contact with the family from the perspective of the dual advocacy approach that, in the light of recent data from the literature, can significantly increase the likelihood of the familys acceptance of organ donation, offering both the specific theoretical foundations as well as the strict principles in regard to the interview. The article contains practical suggestions for dealing with difficulties that can arise at all stages of contact with the family: making contact, providing information, providing information about brain death and talking with the family about organ donation from a deceased relative.

A brain dead woman, giving birth in the 23rd week of pregnancy, used as an organ donor: A case report

BACKGROUND Maternal brain death during pregnancy is an exceptional case when somatic support might be continued despite diagnosed death. There are only a few cases of maternal brain death during pregnancy reported in the literature and detailed data regarding the frequency of such cases are lacking. CASE REPORT The case of a 40-year-old woman, diagnosed brain dead due to a subarachnoid and intracranial hemorrhage in the 21st week of pregnancy is presented. The patient was admitted to the neurosurgery department and then to the intensive care unit, where brain death was diagnosed. The medical team decided to perform a caesarean section, and a living female infant was delivered. After delivery, maternal kidneys were recovered and successfully transplanted. CONCLUSIONS This challenging case indicates that prompt diagnosis of maternal brain death is required to facilitate decision-making regarding somatic support prolongation to save the life of the fetus, as well as to allow procurement of the maternal organs.