Plasma amino acid patterns in normal Thais and in patients with chronic renal failure.

The effect of chronic renal failure (CRF) on the pattern of plasma free amino acid concentrations was studied in 22 healthy controls (group 1); 43 CRF patients of which serum creatinine levels were 2-4.9 mg/dl (group 2, n = 11), 5-10 mg/dl (group 3, n = 10), more than 10 mg/dl (group 4, n = 9), and chronically hemodialysed patients (group 5, n = 13). In all renal failure groups, plasma concentrations of eight free essential amino acids-isoleucine, leucine, lysine, methionine, threonine, tryptophan, tyrosine and valine and those of three non-essential amino acids-alanine, glutamate and serine were significantly lower than those in controls. Plasma concentrations of free arginine, cystine, glutamate and serine were significantly higher in CRF patients. Patterns of change of plasma aminogram were similar among CRF patients regardless of the stages of renal function or dialytic treatment. Stepwise changes of some plasma free amino acids were observed as renal function became worse. The molar ratios of plasma free valine/glycine, serine/glycine and tyrosine/phenylalanine were decreased accordingly. Our study confirms the presence of abnormal plasma aminogram, specifically that of essential amino acids, in CRF. Therapeutic intervention is warranted but still needs further investigations.

Monoclonal antibody (OKT3) rescue in refractory acute renal allograft rejection: report of 3 cases.

We report the first experience in Thailand with the use of OKT3 (monoclonal anti T lymphocyte antibody) in rescuing an acute rejection unresponsive to methylprednisolone pulses in 3 cadaveric renal transplant patients. The treatment regimen was 10 daily 5 mg intravenous injections of OKT3. In the first and second patients OKT3 was started on days 26 and 18 of the rejection episode. In the third one OKT3 was given when he became anuric secondary to severe acute rejection. Within 24 hours of the therapy, urine flow increased. A brisk diuresis and a decline in serum creatinine started within 4 days. The kidney function returned to normal within the 10-day course of therapy. Side effects were fever, conjunctivitis, stuffiness of nose and herpes infection.