Particular fractions of microproteinuria in patients with stabile angina pectoris and without a clinical nephropathy.

The determination of microalbuminuria is a valuable method in the diagnosis of renal and vascular diabetes or hypertension complications. Recently, microalbuminuria appeared to be the predictor of coronary heart diseases (CHD). The presented study comprised 26 patients with stable angina pectoris (AP) and 27 healthy volunteers. We simultaneously evaluated microproteinuria during the first morning and afternoon miction and the 24-h blood pressure. Amongst patients with AP all urine protein concentrations were increased (results in g/mol creatinine): alpha-1-microglobulin (1.04 + 0.13 vs. 0.47 + 0.05, p < 0.001) albumin (0.95 + 0.15 vs. 0.61 + 0.05, p < 0.05) and IgG (1.00 + 0.17 vs. 0.55 + 0.05, p < 0.01) were higher, in comparison to control group values. Indices for diurnal blood pressure rhythm were significantly lower in the AP group for both systolic (1.07 + 0.01 vs. 1.14 + 0.01 p < 0.001) and diastolic (1.09 + 0.02; vs. 1.21 + 0.03 p < 0.01) pressures. A physiological increase of albumin from the afternoon sample was only observed in the control group. Thus, our AP patients demonstrated signs of subclinical nephropathy in both the proximal tubuli and glomeruli.

[The effect of human recombinant erythropoietin on distribution of membrane phospholipids in blood platelets of patients with uremia treated with repeated hemodialysis]. / Wplyw ludzkiej rekombinowanej erytropoetyny na rozmieszczenie fosfolipidów blonowych krwinek plytkowych u chorych z mocznica leczonych powtarzanymi hemodializami.

An important role in the formation of hemostasis defects in uremic patients is attributed to platelet dysfunction. An essential role in platelet structure and function is played by membrane phospholipids (PL). They are asymmetrically distributed within the platelet membrane: outer surface is composed mainly of sphingomyelin (Sph) and phosphatidylcholine (PC). During platelet activation a translocation of phosphatidylserine (PS) and phosphatidylethanolamine (PE) from inner to outer membrane surface is observed. Phosphatidylinositol (PI) is not translocated. Lipid abnormalities are common in uremic patients. According to some authors erythropoietin (EPO) has been reported to alter lipid metabolism. In our recent works a positive influence of EPO on platelet PL composition in uremic patients has been indicated. The aim of this study was the assessment of the EPO influence (applied 4000 U per week) on platelet membrane PL distribution in chronically hemodialyzed patients. The PL distribution was determined using nonpenetrating tracer (TNBS) by Vale method, and using high purified phospholipases hydrolysis according to Chap method. Our results indicate that during EPO therapy the PS, PE, Sph and PC exposition at the outer surface of platelet membrane (in patients hemodialyzed without EPO widely disturbed compared with healthy controls) approaches to normal values. These results confirm our recent observations that EPO profoundly interferes with lipid metabolism. The smaller PS exposition at the outer platelet surface during EPO treatment suggests less platelet activation, and might partially explains the positive EPO influence on platelet hemostasis.

Day/night ratio of microproteinuria and blood pressure rhythm in type II diabetes.

The paper discusses the results of the studies conducted with a group of patients with type II diabetes without clinical nephropathy. The aim of the study was to attempt to determine the markers for early stages of diabetic nephropathy in NIDDM patients. The following examinations were carried out: the level of selected microproteinuric components, 24 h monitoring of arterial blood pressure, and electrocardiogram (ECG). Among the patients examined, the level of alfa-1-microglobulin, albumin and immunoglobulin G (IgG) in diabetic patients was higher than in the control group, and the increased activity of beta NAG was observed. The 24 h profile of blood pressure and the ratio afternoon/night of albumin excretion flattened in the majority of diabetic patients. The results of the study suggest that the proximal tubules and the membranes of renal glomeruli are damaged as early as during the period of subclinical diabetic nephropathy.

[Microproteinuria and circadian rhythm of blood pressure in patients with arterial hypertension]. / Mikroproteinuria i rytm dobowy cisnienia u pacjentów z nadcisnieniem tetniczym.

Microproteinuria is a recognized sign of early nephropathy in the course of arterial hypertension. There is few data concerning the excretion of proteins other than albumin in this group of patients. The aim of the study was to examine circadian rhythm of alfa-l-microglobulin (AlMG), albumin (ALB), immunoglobulin G (IgG) excretion and N-acetyl-beta-glukosaminidase (beta NAG)-activity, then to compare the results with the results of 24 hour ambulatory monitoring of arterial blood pressure in patients with arterial hypertension. The study comprised 28 patients. The control group included 27 healthy volunteers. Albumin concentration was determined by Beckman ICS2 nephelometer, using Beckman and Dako reagents. Blood pressure and ECG were monitored by analysis with ABP-system (AMP-USA). In patients with arterial hypertension significantly higher levels of ALB, AlMG, IgG and increased beta NAG activity were observed in morning urine samples. Despite hypotensive treatment blood pressure values were slightly, though significantly higher than in the control group. Among patients in the study circadian BP rhythm was disturbed. The results obtained suggest that in this group of patients subclinical nephropathy develops involving renal glomeruli and proximal tubules--probably resulting from vascular and humoral disorders, with accompanied hypertension.

[Change of platelet function after the beginning of repeated hemodialysis treatment in patients with uremia]. / Zmiana czynnosci krwinek plytkowych po rozpoczeciu leczenia powtarzanymi hemodializami u chorych z mocznica.

The disturbances of platelet function in end-stage renal failure varies in dialysed and non-dialysed patients. We examined some platelet function in 11 uremic patients treated conservatively (TC) and, again in the same patients, 3-month after the beginning of repeated hemodialysis treatment (HD). The blood samples were taken before hemodialysis. In TC patients normal platelet count, prolonged bleeding time, normal platelet aggregation, unchanged PF4 activity and decreased PF3 availability were shown, compared with control group. In HD patients also normal platelet count and prolonged bleeding time were noted, but increased platelet aggregation, increased PF4 activity and PF3 availability were observed, compared with control group and with TC patients. We conclude that in TC patients rather decreased platelet function was observed; after the beginning of hemodialysis treatment some platelet function became significantly enhanced, which suggests platelet activation. Moreover, in HD patients the disturbances of platelet function before dialysis were shown, then it is possible that platelet activation persists in interdialytic period.