[Toll-like receptors (TLR) in the pathogenesis of kidney diseases]. / Receptory Toll-podobne (TLR) w patogenezie chorób nerek.

In the present work general characteristics and occurrence of TLR receptors have been presented. The participation of TLR receptors in kidney pathology in experimental models in the course of urinary system infection, acute renal failure and interstitial fibrosis has been discussed. In addition, the importance of TLRs in various forms of glomerular nephritis and in haemodialytic patients as well as in postrenal-transplant patients has been shown. It is believed that in lipopolysaccharide-induced renal failure in the course of infections caused by Gram negative bacteria TLR4 plays a fundamental role. In the event of damage of renal tubular epithelial cells by mechanical, toxic, or ischemic factors activation of TLRs induces inflammatory processes leading to acute renal failure. In the course of progressive fibrosis of renal interstitial tissue TLR 2 and 4 receptors are stimulated, which results in the fact that immunological and structural cells of renal tissue release chemokines and cytokines, which causes increased inflow of leucocytes and intensification of interstitial nephritis and progressive fibrosis. The study on experimental models on mice MLR (mixed lymphocyte reaction) with genetically conditioned lupus-like disease showed that, CpG-DNA stimulation as a TLR 9 specific agonist intensifies inflammatory symptoms in mice. Similarly in apoferritin induced glomerulopathy (model of immune complex disease) CpG-DNA nucleotide increased glomerulopathy symptoms. It has been proved that activation of mechanisms of inherent immunity through TLR4 receptors affects the frequency and intensity of acute rejections in human organ transplantations. Incidence of acute kidney and lung [transplant rejections was significantly lower in recipients with mutated variants of Toll-like receptor 4 (TLR-4 Asp 299Gly and TLR-4-Tyr399-IIe).

[Coronary heart disease in patients with end-stage renal disease on maintenance dialysis. Part I: epidemiology, pathology of atherosclerosis, and diagnosis]. / Choroba niedokrwienna serca u chorych leczonych nerkozastepczo. Czesc I. Epidemiologia, patologia zmian miazdzycowych, diagnostyka.

Cardiovascular diseases are the major cause of mortality in patients with end-stage renal disease (ESRD) undergoing dialysis. Among ESRD patients the atherosclerotic process progresses more dynamically than in the general population because of exposure to additional, non-traditional risk factors. Diagnosis of coronary artery disease based on history data, physical examination, and additional tests can be difficult due to the coexistence of many disorders and the influence of dialysis treatment. Studies to investigate the pathology of atherosclerosis in patients undergoing dialysis are needed.

[Coronary heart disease in patients with end-stage renal disease on maintenance dialysis. Part II: prophylaxis and treatment]. / Choroba niedokrwienna serca u chorych leczonych nerkozastepczo. Czesc II. Profilaktyka i leczenie.

Patients with end-stage renal disease (ESRD) and coronary heart disease have a very high risk of cardiovascular mortality. We describe results of recent studies on prevention and treatment strategies. Although the outcomes of revascularization methods, i.e. coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), in ESRD patients are worse than in the general population, CABG and PCI significantly improve survival of the ESRD population. The studies suggest more favorable results with CABG compared with PCI. Patients with a kidney transplant and coronary artery disease (CAD) have better prognosis. In this population, the long-term results of revascularization (CABG and PCI) are comparable. Studies should be focused on optimizing and individualizing revascularization methods, preventing restenosis after PCI, and improving invasive cardiology techniques and anti-aggregation treatments.

[Immunosuppressive drug therapy during pregnancy after kidney transplantation]. / Leczenie immunosupresyjne kobiet ciezarnych z przeszczepiona nerka.

The authors expounded present state of knowledge concerning immunosuppressive drugs therapy during pregnancy after kidney transplantation. Pregnancy is uncommon in women with end-stage renal disease treated with dialysis and in most cases it ends with pregnancy failure. Resuming the normal function of the ovaries after kidney transplantation substantially increases the chances of conception and successful pregnancy. The immunosuppression scheme and dosage of drugs used in pregnant women are vital to both the normal course of pregnancy and delivery of a healthy child. Considering the safety of the fetus it is acceptable to use prednisone, azathioprine, cyclosporine and tacrolimus. Due to the necessity to administer immunosuppressive drugs in relatively small doses, an important factor conditioning the normal course of pregnancy is maintaining a 1- or 2-year interval between the kidney transplantation and the conception.

Kaposi's sarcoma in renal transplant recipients.

Kaposi's sarcoma (KS) is a spindle-shaped vascular cell tumor that occurs in the skin, lymphoid, respiratory and gastrointestinal tissues. It may resemble aggressive malignant neoplasm in HIV-related or in post-transplant types but classic form may behave as benign, potentially controllable and reversible hyperplasia. KS lesions from the onset are dispersed and multicentric. KS probability increases in solid organ transplant recipients (approximately 3/1000 patients). KS occurrence is associated with: type and dose of immunosuppression, chronic stimulation by foreign allograft antigens, viral infections (Herpes virus 8), anti rejection and induction therapy, etc. 90% of KS cases appear as dark blue or purplish macular lesions that may form nodular tumors. Histological picture shows networks of spindle shaped cells and vascular spaces surrounded by an endothelial cell layer. There is no uniform schema of KS treatment in renal transplant recipients. Immunosuppression must be reduced to the lowest levels which preserve allograft function. CsA should be converted to mofetil mycophenolate or mTOR-inhibitors. After conversion to MMF regression of KS was observed, although low therapeutic MMF doses seem to be appropriate. Sirolimus seems to inhibit the growth of established vascularized tumors and this effect is best realized with relatively low immunosuppressive doses of drug.

[Individualization of the choice of renal replacement therapy in patients with diabetic nephropathy on the basis of medical, psychological and social considerations]. / Indywidualizacja wyboru metody leczenia nerkozastepczego chorych z nefropatia cukrzycowa w oparciu o wzgledy medyczne, psychologiczne i spoleczne.

This work presents general rules for qualifying patients with end-stage renal failure in the course of diabetic nephropathy for renal replacement therapy by haemodialysis or peritoneal dialysis. Both medical and social considerations conditioning the choice of the dialytic therapy and the most frequent problems characteristic of each method were discussed in the paper. Much attention was focused on the psychological aspect of accepting the disease and the possibilities of emotional disorder in a patient and on the social aspect defining interpersonal relations within patient's family and environment.

[Alport's syndrome--case report]. / Zespól Alporta--opis przypadku.

The history and clinical findings of 30-year man with Alport's syndrome are presented. The main features of Alport's syndrome are hereditary chronic nephritis leading to renal failure resulting in death and sensory-neural deafness. Ocular features include anterior lenticonus, macular and peripheral flecks resembling fundus albipunctatus. The etiology of this syndrome is unknown. It has been suggested that there may be a metabolic defect in the biosynthesis of collagen with changes in the glomerular basement membrane, cochlea and capsule of the lens. The retinal flecks may also be related to the different underlying glial cells, Mullers cells producing thick basement membrane. It is concluded that diagnosis of fundus albipunctatus should not be made in the absence of full renal investigation and audiometry.

[Antiphospholipid antibodies in the transplanted kidney pathology]. / Przeciwciala antyfosfolipidowe w patologii przeszczepionej nerki.

The purpose of the paper was to estimate clinical problems of the antiphospholipid antibodies (PAF), the mechanisms of their development and function in general thrombotic complications. Special attention has been paid to thrombotic complications in the transplanted kidney. In the group of patients with early renal allograft failure PAF are more frequent than in patients with functioning grafts. The presence of antiphospholipid antibodies in patients prior to the transplantation may indicate the patients' susceptibility to thrombotic complications and failure of the transplanted kidney function. In the case of less intensive coagulation the lifetime of the functioning kidney may be considerably shortened. So far, no satisfactory anticoagulation therapy has been developed. Patients were treated with warfarin, heparin as well as fractionated heparin and intravenous immunoglobulin, aspirin and prednisone. The anticoagulation therapy should be applied in compliance with the laboratory markers of coagulation and with special emphasis put on the general health status of a patient.