Local calcitriol injections as a suppressive treatment of secondary hyperparathyroidism in chronic dialysis patients.

AIM: A prospective study was made of the effectiveness of repeatable local calcitriol injections therapy to suppress secondary hyperparathyroidism resistant to conventional therapy in chronic dialysis patients. METHODS: Under ultrasonographic guidance, six injections at an interval of two days were performed in 14 chronic dialysis patients. The total amount of calcitriol to be injected each time was estimated as 100% of the calculated gland volume. Calcitriol was given in doses 1 mug of medicine per 1 cubic cm (as measured by USG) of parathyroid tissue. Parathormone concentration, total calcium, ionized calcium, phosphate, and alkaline phosphatase levels were assessed on the first and last day of the treatment period. RESULTS: Prior to therapy, the mean gland volumes were 0.62 (0.15-3.0) ml, and they increased to 0.85 (0.2-3.9) after 14 days (NS). Seven patients were found to have decreased their PTH levels to 909 +/- 387 pg/mL after 14 days of treatment when compared with the first day mean values of 1588 +/- 440 pg/mL (p < 0.05). After completion of the therapy, four patients were reported to be free from any clinical symptoms of ostalgia or arthralgia. Others reported an alleviation of pain. CONCLUSIONS: Parathyroid adenoma injection is an alternative method of treatment for some patients resistant to treatment by means of vitamin D3 pulses or intravenous administration of calcitriol. The success of treatment is to a great extent determined by proper selection of patients and the taking of decisions when the period of secondary hyperparathyroidism is not very advanced.

[Assessment of plasminogen activator inhibitor-1 and von Willebrand factor as a markers of endothelial function in patients with end-stage kidney disease after allotransplantation during a one-year follow-up]. / Ocena steienia inhibitora aktywatora plazminogenu typu 1 i czynnika von Willebranda jako markerów czynnosci sródblonka u pacjentów w okresie schylkowej niewydolnosci nerek po allotransplantacji w obserwacji rocznej.

OBJECTIVES: The aim of our study was to determine the endothelial function in patients with chronic kidney disease (CKD), stage V (end-stage renal disease--ESRD), before and during a one-year observation after kidney allotransplantation. PATIENTS AND METHODS: We studied 40 patients with stabile graft function after their first kidney transplantation, including 21 females (mean age 41 +/- 12.5 yrs) and 19 males (mean age 43.6 +/- 13.3 yrs), treated already with hemodialysis because of ESRD. RESULTS: After transplantation we observed significant decrease in serum creatinine concentrations (Cr) (7.32 +/- 2.07 mg/dl to 1.50 +/- 0.45 mg/dl at 6 months and 1.61 +/- 0.58 mg/dl after 12 months after transplantation). During 12 months we found changes only in plasminogen activator inhibitor-1 (PAI-1) levels. Von Willebrandt factor (vWf) levels remained unaltered during follow-up and total homocysteine (tHcy) concentration decreased, but this change was not statistically significant. There was no correlation between vWf and PAI-1 concentrations and other clinical and laboratory findings. CONCLUSIONS: In our study we did not find any improvement of endothelial function during the first year after kidney allotransplantation. The mean Cr concentration at the end of study was 1.6 mg/dl, which indicates the chronic kidney graft insufficiency. We conclude that despite kidney allotransplantation endothelial function is impaired like in CKD, but with more advanced abnormalities in the cardiovascular system.

[An analysis of microorganisms isolated from blood samples of patients treated at the Department of Nephrology and Internal Diseases]. / Analiza drobnoustrojów izolowanych z krwi chorych leczonych w Klinice Nefrologii Nadcisnienia Tetniczego i Chorób Wewnetrznych.

UNLABELLED: The development of invasive medical procedures involves a decrease of prevalence of generalized infections. Hemodialysed patients are at higher risk of infection. The aim of this study was to analyze microorganisms isolated from blood samples of patients treated at the Department of Nephrology and Internal Diseases of the Medical University in Bydgoszcz. MATERIAL AND METHODS: The analysis was based on 959 blood samples obtained from 248 patients during the investigation period from 01.02.2001 to 30.11.2002. Among patients included in this analysis 52.0% were males, 48.0% females. The age oscillated between 18 and 95 years, average 58.6 +/- 17.6. Blood cultures were processed in the blood culture monitoring systems. Identification of isolated microorganisms was based on their morphological and biochemical features. Antibiotic sensitivity tests were conducted according to the recommendations of the NCCLS and National Reference Centre for Drug-Sensitivity of Microorganisms. RESULTS: Positive culture results were obtained for 151 (15.8%) samples. 1114 (75.5%) strains of Gram(+) bacteria and 36 (23.8%) strains of Gram(-) bacteria and one Candida albicans strain were isolated. The results of antibiotic sensitivity tests are also presented. High prevalence of CNS strains in our research may suggest contamination of the samples with normal skin flora, since those strains were usually only isolated one time. It might also be the result of the profile of the Department. CONCLUSIONS: The prevention of vascular access-related septicaemia is a vital element of the care of the hemodialysed patient, as it is a well-established risk factor of generalized infections. Elaborating of local standards for empirical antibiotic therapy of generalized infections based on the epidemiological data of a particular department or hospital ward is necessary.

[Seasonal profile of calcium-phosphate metabolism in hemodialysis patients with secondary hyperparathyroidism]. / Roczny profil gospodarki wapniowo-fosforanowej u chorych hemodializowanych z wtórna nadczynnoscia przytarczyc.

Sunlight UV plays an important role in synthesis of active vitamin D3. Vitamin D3 concentration depends on seasonal sunlight exposure. It was not state, whether these changes may act on secondary hyperparathyroidism (SHP) in hemodialysis (HD) patients. The aim of our analysis was to assess the relationship between seasons and parameters of Ca-P metabolism in HD patients with SHP. We studied 30 pts (F = 17, M = 13), aged 20-72 years (mean 49 +/- 13), duration of HD therapy 3-132 months (mean 54.4 +/- 43.7), treated with alphacalcidol (1 alpha OHD3) due to SHP. Blood was collected for PTH, Ca, P concentrations in January (1), April (IV), July (VII) and October (X); also doses of CaCO3 and 1 alpha OHD3 were analyzed. The day duration was: 7 hours and 51 minutes (I), 12.53 (IV), 16.37 (VII) and 11.39 (X), respectively. PTH concentration was significantly higher in I vs IV (882 +/- 588 vs 691 +/- 511 pg/ml, p < 0.05) and higher in X vs VII (831 +/- 600 vs 701 +/- 525 pg/ml, p < 0.05), despite drug dosage did not differ. Calcium concentration was lower in I vs IV and X, and phosphate concentration was lower in I compared to IV, VII i X. These changes suggest presence of seasonal rhythm of PTH concentration in HD patients with SHP. When assessing the effectiveness of SHP therapy, the season of the year when PTH concentration was tested should be taken into account.