Matrix metalloproteinase-2 (MMP-2) gene polymorphism and cardiovascular comorbidity in type 2 diabetes patients.

OBJECTIVE: Matrix metalloproteinases (MMPs) play an important role in pathogenesis of atherosclerosis and vascular disease. We hypothesized that MMP-2 might be a susceptibility gene for cardiovascular disease (CVD) in diabetes. The aim of this study was to evaluate the association between C(-1306)T functional polymorphism in the MMP-2 gene and risk of CVD in type 2 diabetes patients. METHODS: We examined 1090 patients with T2DM and 612 controls. All subjects were genotyped for the C(-1306)T polymorphism by polymerase chain reaction (PCR) and restriction analysis. RESULTS: A significant decrease of T allele frequency was observed in patients with CVD versus those with no CVD (OR 0.44, 95% CI 0.36-0.52, p<0.0001). In contrast, OR for CC genotype was 2.19 (1.79-2.68, p<0.0001), conferring 2-fold greater odds for CVD. When the distribution of C(-1306)T was compared in subgroups with different clinical phenotypes of CVD, patients with stroke had the lowest frequency of T allele (6% vs. 11%), compared to entire CVD+ group (p<0.05). CONCLUSIONS: T2DM patients carrying the T allele of MMP-2 C(-1306)T polymorphism have a significantly reduced risk of CVD. The C(-1306)T polymorphism is associated with susceptibility to stroke in T2DM patients.

[Preliminary results of research on a new marker of idiopathic membranous nephropathy: anti-PLA2R]. / Wyniki wstepne badan nad nowym markerem idiopatycznej nefropatii bloniastej: anty-PLA2R).

UNLABELLED: Idiopathic membranous nephropathy (IMN) is a chronic glomerular disease. It is result of new discovery that the production of anti-PLA2R autoantibodies, reacting with phospholipase A2 receptor on the surface of podocytes. Specific antibodies occur in IMN patients blood in exacerbated of disease, and disappear during remission. It suggest that analyse of these parameter can prove quick diagnosis to recognize and monitoring treatment process. The aim of our work was to determine anti-PLA2R in patients with suspected IMN and persons during/after treatment in order to monitor the effectiveness of therapy. MATERIAL AND METHODS: The study group consisted of 22 patients. Patients were divided into two groups: Group A--patients with symptomatic nephrotic syndrome in the course of membranous nephropathy; Group B--patients diagnosed with IMN who monitored the effectiveness of therapy. We collected the serum samples for all patients and determined of anti-PLA2R autoantibodies by indirect immunofluorescence test. RESULTS: Antibodies were detected in 12 patients (54.54%): diagnosed (n = 5) and monitor (n = 7). All of patients with exacerbated disease process in monitored group had positive test results. CONCLUSIONS: Our data suggest that anti-PLA2R is a sensitive diagnostic method and good for monitoring of disease activity, but nevertheless a need for further research on a larger group of patients to confirm that the test is a reliable source of diagnostic information.

Altered tissue electrical properties in women with breast cancer--preliminary observations.

INTRODUCTION AND OBJECTIVES: In the United States, breast cancer (BC) is the most common non-skin cancer. In Poland, it is estimated that the number of new breast cancer cases affects about 13,500 women each year. There are many methods for nutritional status assessment. One of them is bioimpedance analysis (BIA). Direct bioimpedance measures (resistance, reactance, phase angle (PA)) determined by bioelectrical impedance analysis (BIA) detectf changes in tissue electrical properties. The study was conducted to investigate whether there are any tissue electrical differences in patients with breast cancer. MATERIALS AND METHODS: The direct bioimpedance measures determined by bioelectrical impedance analysis (BIA) were performed on 34 patients with BC and 34 healthy volunteers. The measurements were made with ImpediMed bioimpedance analysis SFB7 BioImp v1.55 (Pinkenba Qld 4008, Australia). RESULTS: Reactance and resistance at 50 kHz was found to be significantly greater in patients with BC than in the control group (53.59° ± 1.53 vs. 47.26° ± 1.25, respectively, p=0.0031; 603.24° ± 15.38 ohm vs. 515.87° ± 11.48 ohm, respectively, p=0.00004). CONCLUSION: Pre-surgical patients diagnosed with BC have altered tissue electrical properties. Further observations of a larger patient group would be valuable to calculate survival, validate the prognostic significance of PA, and monitor nutritional and therapeutic interventions in this patient population.

Complement factor H gene polymorphism and risk of cardiovascular disease in end-stage renal disease patients.

The main cause of increased mortality in end-stage renal disease (ESRD) is cardiovascular disease (CVD). Complement factor H (CFH) may affect risk of CVD. Our study investigates a role of CFH Y402H polymorphism as a potential risk factor of CVD in a large group of patients. A group of 1200 patients with ESRD and 818 healthy controls were genotyped for the Y402H (T1277C) polymorphism. There was a significant difference in genotype frequencies between patients with CVD and those without CVD and healthy controls (p<0.001). Homozygosity for the C allele in CVD patients was associated with an odds ratio of 7.28 (95 % CI 5.32-9.95). No significant difference was found between patients without CVD and controls. Multivariate logistic regression analysis showed that Y402H genotype was independently associated with cardiovascular comorbidity in ESRD patients. This is the first study suggesting an association between CFH gene polymorphism and susceptibility to CVD in dialyzed patients.

[Analysis of some risk factors of coronary artery calcification in peritoneal dialysis patients]. / Badanie niektórych czynników ryzyka kalcyfikacji naczyn wiencowych u pacjentów leczonych dializa otrzewnowa.

Cardiovascular disease (CVD) is a major cause of death in peritoneal dialysed patients (PD-pts). Coronary artery calcification (CAC) is likely to affect the development of CVD. Purpose of our study was to evaluate coronary artery calcification and risk factors of this calcification in PD-pts. We studied 62 patients (38 F, 24 M) undergoing peritoneal dialysis (PD). Coronary calcification was examined by ECG-gated multidetector CT (Light Speed Ultra) using Agatson (AG) and volumetric (V) methods. Patients were divided into 3 groups depending on mean value of estimated CAC: group A-no calcification, group B-CAC maximal value 400 mm3, group C-CAC value more than 400 mm3. As risk factors of CAC were evaluated: patients age, sex, dialysis duration, serum concentration of Ca, P, homocysteine CRP and fibrinogen, as well as, CaxP product, intact PTH; presence of diabetes or hypertension. Coronary artery calcification was detected in 68% of patients. In the whole observed population positive correlation between CAC determined by AG and V methods and CRP (r = 0.36, p < 0.05) as well as patients age (r = 0.5, p < 0.01) was observed. There was also positive correlation between CAC and fibrinogen concentration (AG CAC r = 0.58, p < 0.05; V CAC r = 0.72, p < 0.05). When compared group C with the groups A and B cardiovascular complications were in this group more frequent than in the last two: 4 patients from group C died because of cardiovascular complications.

[Ultrasonographic evaluation of kidneys in type-2 diabetes patients without overt nephropathy and with chronic renal failure]. / Ultrasonograficzna ocena nerek chorych na cukrzyce typu 2 bez objawów jawnej nefropatii i w okresie zaawansowanej niewydolnosci nerek.

Ultrasonographic evaluation of the kidney size is a useful method for assessment of the progression and in some cases the type of nephropathy. Diabetic nephropathy in type 2 diabetes is not only the cause of chronic renal failure (CRF), but also non-diabetic renal diseases. Besides giving the clinical picture, USG evaluation can be useful for qualification of the main cause of CRF in type 2 diabetes patients (pts). In the study we attempted to evaluate if type 2 diabetic pts without nephropathy have significant changes in the USG kidney picture compared with type 2 diabetic pts with CRF. The study was conducted on two groups of type 2 diabetic pts. Group I consisted of 44 pts (18 men, 26 women) without overt nephropathy with mean creatinine clearance (CrC) calculated by Cockcroft-Gault formula 78.7 +/- 3 ml/min. Group II consisted of 48 pts (23 men, 25 women) with CRF: 30 pts with mean CrC 25.8 +/- 2 ml/min and 18 CAPD (continuous ambulatory peritoneal dialysis) pts. The mean age was similar in both groups (62.5 vs 64.5). Small kidney was defined when USG kidney length was less than 9 cm. In Group I 33 pts (75%) had normal size kidneys, 11 pts (25%) had small kidneys with postinflammatory changes, and 3 pts had single cysts. In Group II 9 pts (18.8%) had normal size kidneys. We found small kidneys in 39 pts (81.2%) and single cyst in 7 pts (15%). None of the patients had acquired cystic kidney disease. In our study we found that most of type 2 diabetic pts with CRF had small kidneys which means that they had ischemic, hypertonic or inflammatory nephropathy accompanying type 2 diabetes.

[Factors influencing signal-averaged ECG parameters in hemodialysis patients]. / Czynniki wplywajace na parametry usrednionego EKG wysokiego wzmocnienia u pacjentów leczonych hemodializami.

The aim of the present study was to estimate the influence of hemodialysis process (HD) on the signal-averaged ECG (SAECG) parameters and to evaluate possible factors promoting SAECG parameters disturbances in the group of hemodialysis patients (HD-pts). 55 selected HD-pts entered the study. SAECG parameters (QRS duration, root-mean-square of the terminal 40 ms of the QRS--RMS40, low-amplitude signal duration--LAS40), were measured pre and postdialysis. Total (TBW), extracellular (ECW) and intracellular body water (ICW) calculated per kg of HD-pts body weight were estimated pre and postdialysis by using whole body bioimpedance. Two dimentional echocardiography was performed before HD. Serum levels of interleukin-6 (IL-6), tumor necrosis factor-alpha, CRP and intact parathormon were measured before HD. LP were found only before HD in 12.73% of patients. HD induced the decrease of LAS40 duration and the increase of RMS40 value in the of group of LP positive HD-pts (p<0.001 in both cases). The values of TBW and ECW calculated per kg of body weight as well as IL-6 and CRP levels were significantly higher in the LP positive in comparison with the LP negative patients (p=0.006 and 0.004 respectively). Induced by HD changes of RMS40 correlated with pre vs postdialysis values of TBW (r=0.499, p=0.001) and ECW (r=0.556, p<0.001) calculated per kg of body weight. Our study revealed that, that abnormal SAECG parameters and LP are frequently detected in HD-pts. The presence of LP in HD-pts in great part depends on the functional abnormalities (especially on the HD-pts hydration status) corrected by the HD process. The clinical significance of the proinflammatory factors (IL-6 and CRP) needs further investigation.

[Changes in selected parameters of bone turnover resulting from use of different calcium concentrations in dialysate of patients treated with CAPD]. / Zmiennosc wybranych parametrów przemiany kostnej przy zastosowaniu dwóch róznych stezen wapnia w plynie dializacyjnym u pacjentów dializowanych otrzewnowo.

Renal osteodystrophy is a common complication occurring in patients with end stage disease. Using dialysis solutions with different concentrations of calcium undoubtedly has an influence on calcium-phosphorus homeostasis and bone turnover. The aim of the study was to examine the influence of dialysate with calcium concentrations of Ca 1.75 mmol/l and Ca 1.25 mmol/l on selected parameters of bone turnover. The study was performed on 12 clinically stable patients treated with CAPD. After 24 weeks of the treatment with Ca 1.75 mmol/l solution the initial investigation was performed. The next step was to switch to dialysate with the Ca level of 1.25 mmol/V. After 2, 12, and 24 weeks of the treatment with solutions of low calcium level the concentrations of PTH, osteocalcin, total calcium, and ionized calcium, phosphorus were calculated. We have observed that the level of PTH and osteocalcin was increased significantly at the time of treatment with Ca 1.25 mmol/l solution. We have also observed a decrease in concentration of total and ionized calcium. We did not observe any change of phosphorus concentrations in the serum of treated patients.

[28-year-old woman with Goodpasture's syndrome and nonspecific colitis]. / Zespól Goodpasture'a wspólistniejacy z nieswoistym zapaleniem jelit u 28-letniej kobiety.

Goodpasture's syndrome usually becomes manifest with progressive glomerulonephritis and pulmonary hemorrhage. The diagnostic hallmark is the demonstration of anti-basement membrane anti-alpha3 type IV collagen antibodies (anti-GMB antibodies) in patient sera. Herein is reported the case of 28-year-old woman with Goodpasture's syndrome who developed the acute symptoms of nonspecific colitis which required surgical intervention. Immunosuppression along with plasmapheresis was successful in the treatment of life-threatening pulmonary hemorrhage, but not for the improvement of renal function.

Comparison between some anthropometric measurements in adequately treated peritoneal dialysis and hemodialysis patients.

Some anthropometric measurements are usually used to estimate the nutritional status of dialysis patients. The aim of our study was the comparison of some anthropometric measurements in patients adequately (from the clinical point of view) treated with peritoneal dialysis (PD) and hemodialysis (HD). The study was performed on 40 chronic dialysis (both: PD and HD), non-diabetic patients, without any inflammatory process. The patients were divided into two groups, 20 patients in each: I peritoneal dialysis patients (PD-pts), II--hemodialysis patients (HD-pts). In each patient body mass index (BMI), total body water (TBW), lean body mass (LBM), fat body mass (FBM), upper limb musculature (ULM), mid arm circumference in tension and in rest MAC-t and MAC-r), triceps skinfold thickness (TSF) and dialysis index (Kt/V) were determined. The obtained values were analyzed statistically and compared between the groups. In peritoneal dialysis the patients' higher values of BMI, FBM, MAC and TSF (p < 0.01), as well as higher LBM and ULM (p < 0.05) than those in hemodialysis patients were observed. TBW was not statistically different in the PD and HD patients (p > 0.05). Mean Kt/V values observed were as follows: 2.16 +/- 0.48 in PD patients vs 1.05 +/- 0.35 in the HD patients; (p < 0.01). We conclude that adequately treated, from the clinical point of view the PD patients had better anthropometric indicators of nutritional status than the adequately treated HD patients.

Hypercalcemia in patients treated with CAPD.

The aim of this study was to examine the frequency of the occurence of hypercalcemia in patients treated with CAPD using solutions with the calcium concentration Ca 1.75 mmol/l and Ca 1.25 mmol/l. The study was performed on 11 patients treated with CAPD and lasted 48 weeks. The patients were treated with the calcium dialysate solutions Ca 1.75 mmol/l for 24 weeks. Then they swiched to Ca 1.25 mmol/l. The study was performed at the begining (0) after 2, 12 and 24 weeks of treatment with each kind of dialysate solutions. The measurements of only total calcium revealed three episodes of hypercalcemia--one in the 12th week and two in the 24th week. While the measurements of ionised calcium were performed we diagnosed 12 episodes of hypercalcemia. Four in each examined period--in the 2nd, 12th, 24th week. We did not observe the episodes of hypercalcemia during the treatment with the dialysate solution Ca 1.25 mmol/l.