Need for rehabilitation in renal replacement therapy involving allogeneic kidney transplantation.

Physical rehabilitation is a form of therapy that complements medical treatment for allogenic kidney transplantation recipients. The aim of this research was to assess the effectiveness of motor therapy among a population of allogenic kidney recipients. Physical rehabilitation was conducted both in the clinic after renal transplantation and over 1 year after the procedure. The 67 patients included 26 women and 41 men of overall average age 44.45 years. The cohort was divided into two subgroups: those undertaking regular exercise (n = 35) and a control subgroup (n = 32). The rehabilitation program covered recuperation, isometric, coordination, relaxation, and breathing exercises. Moreover, the following elements were assessed several times: respiratory system (peak expiratory floor [PEF] test), circulatory system, namely, arterial blood pressure and in some cases electrocardiograph, along with the motor system examining upper extremity strength and movement range in distal joints in the upper and the lower extremities. Biochemical blood analysis examined hemoglobin, total protein and albumin, transaminase activity, lactate dehydrogenase, isoenzymes (LD1-5), and creatine kinase (CK), along with CK-MB and CK-MM. A significant improvement was observed in the range of movement in the radiocarpal joint (P < .05) and an increased PEF value (P < .05). Among the total kidney transplantation recipients, 81.3% of patients subjected to rehabilitation and 77.8% the control subgroup accepted the need for long-term motor exercise. The analysis of the implemented rehabilitation program, and biochemical analyses confirmed the need to establish rehabilitation centers, for example, in dialysis centers and/or transplant institutes, for patients subjected to renal replacement therapy, and particularly after successful kidney transplantation.

Physical rehabilitation and risk of atherosclerosis after successful kidney transplantation.

Regular physical activity is usually associated with significant health benefits, but therapeutic exercise is seldom routine in renal transplant recipients. We report a randomized clinical trial of exercise training after renal transplantation. Sixty-nine patients were randomly recruited on the first or second day after kidney transplantation into two groups: exercise intervention (PT) and standard care (CT) as controls. The exercise training program consisted of tailored exercises to be performed under a physiotherapist's supervision for 15 to 30 minutes every second hospital day. At that time, biochemical markers of graft function were assessed including specific tests for atherosclerosis. Repeated measures analysis of variance was performed to determine differences between the two groups. We found an inverse correlation between total homocysteine as well as interleukin-18 (IL:18) levels and muscle strength of the upper limbs (r = -.78, P < .0001). There was a positive correlation between muscle strength and improved graft function in the PT group versus CT groups (r = .05; P < .05). Hyperhomocysteinemia and high IL-18 expression in renal allograft recipients may be independent markers of early atherosclerosis development.

Proteolytic enzymes activities in patients after myocardial infarction correlate with serum concentration of TGF-beta.

Myocardial infarction (MI) is caused by occlusion of coronary artery and insufficient oxygen supply to a certain area of myocardium. Its necrosis appears as a result of MI. The process of tissue repair after MI is very complicated and it is influenced by numerous factors, including growth factors and proteolytic enzymes. The aim of the study was to determine serum transforming growth factor beta (TGF-beta) concentration on day 2 and 7 after MI and to asses the relationship of this growth factor with serum proteolytic activity of collagenase and elastase. In addition, the effect of fibrynolytic treatment on these factors was evaluated. About 100 patients with MI were enrolled to the study. The control group consisted of 50 healthy individuals. We observed that TGF-beta1 concentration correlated positively with collagenase activity on the second day after MI and that it also correlated positively with elastase activity on day 2 and 7 after MI. Moreover, treatment with streptokinase (SK) caused a significant increase of TGF-beta serum concentration. Our data indicate that TGF-beta1 may be one of the factors involved in tissue repair process after MI. Its effect seems to be mediated by collagenase and elastase and may change with the time that elapsed after MI.

[Selected parameters of antioxidant capacity in renal allograft recipients]. / Wybrane wskazniki systemu przeciwutleniajacego u biorców allogennej nerki.

UNLABELLED: Various oxidant species, oxygen free radicals (OFR) implicated in patients with chronic renal diseases treated with dialysis and after cadaveric renal transplantation. Oxidative stress occurs when free radical generation exceeds antioxidant defence. We therefore examined markers of lipid peroxidation and antioxidant potential in blood (serum, plasma, RBC) of very carefully (clinically and biochemically) selected 102 subjects (56 female and 46 male, mean age 37.5 +/- 7 years). Included were 51 renal allograft recipients (RARs); 15 patients with glomerulopathies (GL); 36 healthy age- and sex-matched volunteers as a control group (C). All RARs were divided into two subgroups: RARs-A (n = 28) were treated with triple drug therapy including cyclosporin A (CsA) and RARs-Z (n = 23) were on double drug regimen: prednisone, azathioprine. Patients with coronary artery disease (CAD), diabetes, serum creatinine concentration > 2.0 mg/dl, acute rejection and infections were excluded. We used several automated assays to estimate: malondialdehyde (MDA); total radical-trapping antioxidant potential (TRAP), glutathione peroxidase (GPx), glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), vit. E and lipid profiles. Patients of RARs-A were found to have significantly elevated triglycerides; cholesterol-LDL; MDA; TRAP and decreased activity of RBC glutathione peroxidase as compared with those of RARs-Z and group C. IN CONCLUSION: our data show that oxidative stress (with prooxidant effect of CsA partly at least), with reduced in antioxidant potential of defences system is associated with kidney transplantation.

[Use of laser-doppler perfusion for evaluation of microcirculation in patients with diabetes type I]. / Zastosowanie metody laserowo-dopplerowskiej dla oceny mikrokrazenia u chorych z cukrzyca typu 1.

UNLABELLED: The purpose of this study was to investigate the foot skin microcirculation in type 1-diabetic patients. The study group comprised 67 patients divided into four subgroups: 13 women and 11 men healthy and had no family history of diabetes; 19 women and 24 men had type 1-diabetes. The studied measurements included 7 parameters determined during rest and post occlusive hyperaemia. They were performed with laser Doppler fluxmetry using surface probe localised in distal part of the lower limbs. The most significant data localised the probe in thumb. The maximum of hyperaemic response (MAX) was significantly lower in the diabetic patients as compared to the healthy subjects (p < 0.01). The time of peak flow (TM) was higher (p < 0.01) in diabetic patients as compared to the control subjects. The half time of hyperaemia (TH) was significant longer (p < 0.05) for diabetic groups. CONCLUSION: The laser Doppler method is helpful to identify patients with risk development diabetic complications. The most valuable data is MAX, TM and TH, the best localisation of the probe seems to be the most distal point of thumb.

[The effect of hypolipidemia treatment on the function of kidney transplanted from cadavers]. / Wplyw leczenia hipolipemicznego na czynnosc nerki przeszczepionej ze zwlok.

The high prevalence of hypercholesterolemia (HCh) in kidney transplant recipients probably contributes to the high cardiovascular mortality of these patients. Additionally, HCh is a contributing factor to the progression of renal failure. We conducted a prospective, randomised study with low dose Lovastatin in 42 kidney transplant recipients during 32 weeks, focusing on side effect and kidney function 42 consecutive patients with kidney transplanted in our Institute, with stable renal function (creatinine level < 160 mmol/l) treated with ciclosporine, azathioprine, prednisone were enrolled for the study (regardless of the initial cholesterol level). Every second patient was given Lovastatin 20 mg/night. In the Lovastatin group total cholesterol (TC) and LDL concentration were significantly lower after 6 months of treatment (TC was reduced from 242.5 +/- 12.8 to 220 +/- 15.4 mg/dl, p < 0.05) in Lovastatin group whereas in control group it increased nonsignificantly. Similarly LDL in Lovastatin group decreased from 140.0 +/- 7.0 to 121.3 +/- 10.8 mg/dl, p < 0.02 whereas in control group it increased from 143.6 +/- 5.4 to 169.9 +/- 10.3 mg/dl, p < 0.01. HDL and trigliceride concentrations were unchanged. The Lovastatin treatment did not results in more adverse events than the placebo treatment. Notably, the tendency to increase creatinine level in Lovastatin group was observed from 1.59 +/- 0.17 to 1.74 +/- 0.22 in Lovastatin group versus 1.89 +/- 0.22 to 2.21 +/- 0.35 mg/dl (NS). Low dose Lovastatin treatment seems to be safe and efficient cholesterol-lowering procedure. However we did not observe beneficial effect on kidney graft function.

[Endothelin (ET) in kidneys]. / Endotelina (endothelin--et) w nerkach.

Peptides from endothelin family (ET-1, ET-2, ET-3), synthesized by the endothelial cells, are now known to exert diverse biological effects on wide variety of cell types and tissues mainly through two subtypes of receptors (A- and B-type ET receptors). Tissue distribution and mechanism of action of ET peptides and their receptors are reviewed. The biological role of ET peptides and receptors in health as well as in renal disease is discussed.

[Tuberculosis in patients after kidney transplantation]. / Gruzlica u chorych po przeszczepieniu nerki.

Infection caused by Mycobacterium tuberculosis is common among population in Poland. We analyzed the effect of tuberculosis (TB) on patients and graft survival in the group of renal allograft recipients (RAR), treated in our center. Among 1669 renal allograft recipients transplanted from 1981 to 1992, tuberculosis developed in 33 (2%) patients (16 M/17F, age: 22-57 years). The patients were on following immunosuppressive regiments" Pred+Aza+CsA (12 pts), Pred+Aza (12), Pred+CsA (6) and Pred+Aza+CsA+ATG (3). Acute rejection was diagnosed in 27 of them and was treated with methyloprednisone pulses, and in a few cases additionally with ATG (2 pts) or OKT3 (1 pt). In two pts TB had been diagnosed and successfully treated in the past. In 6 pts, on chest X-ray done immediately before transplantation, healed primary lesion (Ghon complex) had been seen. In 16 pts TB developed in the early posttransplant period (median: 3.8 +/- 1.8, range: 1-6 months) and in 17--late after transplantation (median: 31.2 +/- 1.8, range: 13-156 months). In 19 pts symptoms developed soon after treatment of acute rejection. Clinical manifestations include pulmonary TB (30 pts) and extrapulmonary lesions (15 pts): pleural TB (3 pts), miliary TB (5 pts), tuberculous lymphadenitis (1 pt), uveitis (1 pt), renal allograft (2 pts), skeletal (2 pts) and GI tract (1 pt). Diagnosis of TB was made based on clinical presentation and radiologic findings and it was confirmed by positive cultures in 18 pts, by tissue biopsy in 4 pts and by autopsy examination in 9 pts. Treatment regimen included one of the following drug combinations: INH+EMB+RMP (20 pts), INH+RMB+RMP+PZA (10 pts) or INH+EMB+SM (3 pts). Three pts died before TB was recognized and 4 deaths occurred after treatment was started. All these pts developed renal failure. 26 pts were treated for 3-12 months (median, range: 7.8 +/- 2.9) and in 24 of them complete remission was achieved. In this group renal function remained stable in 16 pts and 6 pts developed terminal failure due to chronic rejection. Authors conclude: 1. TB remains a frequent complication in RAR but can be successfully treated when diagnosed early. 2. Extrapulmonary TB is common in RAR. 3. TB deteriorates one year patients (75%) and graft (49%) survivals.

[The immunobiological effects of nitrogranulogen. I. Effect of nitrogranulogen on laboratory and clinical parameters in patients with primary glomerulopathies]. / Badania nad immunobiologicznym dzialaniem nitrogranulogenu. Czesc II. Wplyw nitrogranulogenu na parametry laboratoryjne i kliniczne u chorych z pierwotnymi glomerulopatiami.

The administration of nitrogranulogen in a dose of 0.01 mg/kg in patients with primary glomerulopathies caused a significant reduction in proteinuria in 10 out of 12 cases. In one patient the effects was striking (fall of proteinuria from 10 g/24 hrs to trace amounts). A trend towards the normalization of helper T lymphocytes (CD4+) was noted as well as a significant drop in NK lymphocytes. No side effects or drug-related complications were observed.

Nitrogranulogen enhances IL-1 production but decreases cellular sensitivity to this cytokine.

An alkylating agent, nitrogranulogen, enhances the in vitro production of interleukin 1 by human monocytes. On the other hand, the drug inhibits proliferative responses of mouse thymocytes to exogenously added IL-1. Our results may shed light on the mechanisms of anti-inflammatory action of immunosuppressive agents.

Immune monitoring after renal transplantation. II. Post-transplant disturbances in the CD3 complex expression may be caused by immunosuppression.

The in vitro effect of major immunosuppressive agents on the CD3-TCR complex expression on T cells was studied. Cyclosporine and azathioprine caused a marked diminution of alpha/beta, but not gamma/delta and CD3 chains detectability. Prednisolone effect was less manifested. Our data suggest that the reported decrease in alpha/beta chains expression on T cells from renal allograft recipients may be caused by post-transplant immunosuppression.

Rejection-associated upregulation of the alpha/beta-T cell receptor expression on T cells of renal allograft recipients.

Peripheral T lymphocytes of renal allograft recipients were phenotyped for their expression of the CD3-T cell receptor (TCR) complex. The majority of T cells from patients with stable graft function had normal CD3 but diminished TCR alpha/beta heterodimer expression, while TCR gamma/delta + T cells were increased in some cases. Acute rejection was associated with an increase in TCR alpha/beta + T cells to normal levels.

Long-term immunosuppressive therapy of idiopathic membranoproliferative glomerulonephritis.

Fifty cases of idiopathic membranoproliferative glomerulonephritis were followed up for an average of 10 +/- 0.9 (SE) years. Forty of them, who presented a nephrotic syndrome, were treated by immunosuppressive drugs (prednisone, azathioprine, chlorambucil, cyclophosphamide) for 79 +/- 9.7 (SE) months. Cumulative survival ratio for 5, 10 and 15 years after enrollment was 0.90, 0.82 and 0.77 and after appearance of first symptoms or signs of kidney disease as determined by anamnestic data 0.97, 0.91 and 0.90 accordingly. Triple-drug therapy (prednisone and azathioprine combined with chlorambucil or cyclophosphamide) was more effective in improving proteinuria than other immunosuppressive regimens. No serious side effects were encountered.