Mercury-induced nephrotic syndrome: a case report and review of the literature.

A 42-year-old man was admitted to the Nephrology Department because of nephrotic syndrome. Eight months prior to admission he attempted suicide by intravenous self-injection of 2.5 ml of elemental mercury. Renal biopsy was performed. Light microscopy findings showed normal glomeruli and injury of proximal tubular cells. Immunofluorescence was negative, and electron microscopy study revealed diffuse effacement of podocyte foot processes and vacuolization of podocyte cytoplasm. Minimal change disease was diagnosed. The patient was treated with 2,3-dimercaptopropane-1-sulfonate, for mercury detoxification, and steroids. In one-year follow-up the 24-h urine protein excretion decreased from 30 γ to 0.186 g, and the renal function remain normal. The presented case indicates that mercury intoxication should be mentioned as a cause of secondary minimal change disease.

Distribution of UL144, US28 and UL55 genotypes in Polish newborns with congenital cytomegalovirus infections.

Human cytomegalovirus (HCMV) is the most common congenital infection. HCMV strains display genetic variability in different regions. Distribution of HCMV genotypes in the population of congenitally infected newborns from Central Poland and viral load in newborns' blood is described and discussed. HCMV isolates were analysed by sequencing at three sites on the genome: the UL144 tumour necrosis factor-alpha (TNFα)-like receptor gene, the US28 beta-chemokine receptor gene and the UL55 envelope glycoprotein B (gB) gene. The newborns' blood was examined for HCMV DNA with a nested (UL144, UL55) or heminested (US28) polymerase chain reaction, and the genotypes were determined by sequence analysis. HCMV DNA was detectable in 25 out of 55 examined newborns born by HCMV-infected mothers (45.5%). The blood viral load in mother-infant pairs was determined. Most of the newborns had identical virus genotype, gB2 (96%), UL144 B1 (88%) and US28 A2 (84%). These genotypes were detected in all newborns with asymptomatic congenital infection. The occurrence of UL144 B1 or US28 A2 genotypes in the babies examined was significant in comparison to other genotypes (p=0.0002 and p=0.040 respectively). There was no association between specific gB subtypes in all patients groups (p=0.463). There was no correlation between HCMV genotypes and the outcome.

Myoinositol may be a factor in uremic immune deficiency.

In 10 chronic uremic patients on regular hemodialysis treatment and 10 healthy subjects in vitro PHA-induced peripheral blood mononuclear cell (PBMNC) and T-cell enriched lymphocyte proliferative responses were found to be impaired in the presence of myoinositol in the concentration generally observed in the blood serum of chronic uremic patients on regular hemodialysis treatment (600 mumol/l), while it remained unchanged in the presence of myoinositol in the concentration observed in normal blood serum (30 mumol/l). However, both myoinositol concentrations did not affect PMA-induced PBMNC and T-cell enriched lymphocyte proliferative responses, which suggests that inhibitory effect of the high myoinositol concentration on PHA-induced immune cell proliferation is cell membrane-related. In addition, myoinositol (600 mumol/l) significantly depressed CD3, CD4 and HLA-DR antigen expression on PHA-activated PBMNC surface in chronic uremic patients and healthy subjects, while CD8 antigen expression remained unaffected. The results seem to indicate that myoinositol, in the concentrations observed in uremic blood serum, may possibly share the responsibility for uremic immune deficiency.

[Function of the left heart atrium during hemodialysis]. / Czynnosc lewego przesionka serca podczas hemodializy.

In 23 chronic uremic patients effect of four-hour hemodialysis on function the left atrium of the heart was investigated. The reference group consisted of 17 healthy subjects. The function was evaluated by cross-sectional Doppler echocardiography. Before hemodialysis maximal (LAmax) and minimal (LAmin) left atrial dimensions and left atrial dimension obtained in M-mode of long axis in parasternal projection (LAa), pre-ejection period (PEPlp), ejection time (ETlp), PEPlo/ETlp ratio and left atrial fiber shortening fraction (FS%lp) were significantly higher in chronic uremic patients than those found in healthy subjects. Four-hour hemodialysis induced decreases in these indices, but only a lowering of LAa, PEPlp/ETlp ratio was statistically significant in comparison with pre-dialysis period. No correlation was found between changes of the investigated indices of the left atrial function and body weight loss during hemodialysis.

Myoinositol incorporation into lymphocytes of chronic renal failure patients is impaired.

Incorporation of myo-[2-3H]-inositol into peripheral blood mononuclear cells (PBMNC) and T-cell enriched lymphocytes was evaluated in in-vitro experiments in chronic renal failure (CRF) patients and healthy subjects. Incorporation of myo-[2-3H]-inositol into the cells of CRF patients on conservative and haemodialysis treatment was found to be impaired in comparison with that observed in normal cells. Following PHA stimulation of the cells of CRF patients myo-[2-3H]-inositol incorporation decreased even further, while it increased in normal cells. Five-hour haemodialysis session significantly depressed myoinositol incorporation into PBMNC, while its incorporation into T-cell enriched lymphocytes remained unaffected. Myoinositol incorporation into PBMNC and T-cell enriched lymphocytes was inhibited by prostaglandins and leukotrienes and was inversely related to the extent of pertussis toxinsensitive G protein activation. Reduced myoinositol incorporation into uraemic PHA-stimulated PBMNC may depend at least in part on their enhanced PGE2 and LTB4 release accompanied by increased intracellular cAMP production. In CRF impaired myoinositol incorporation into immune cells may prove the disarrangement in the early events of transmembrane signal transduction, which may share the responsibility for the cell-mediated immune defect in these patients.

[The evaluation of some parameters of hearing in patients treated by long-term hemodialysis]. / Ocena wybranych parametrów narzadu sluchu u chorych poddawanych dlugotrwalej hemodializie.

Audiologic examinations were performed in 10 patients with chronic renal failure treated by long hemodialysis. Hearing loss was found in 4 ears (20%). We didn't find correlation between the hearing loss and the levels of sodium, potassium or uremic toxin. After using tympanometry and audiological tests we conclude that hemodialysis "per se" does no harm to the function of middle ear and cochlea.

Modification of some lymphocyte functions in vitro by opioid receptor agonists and antagonist in chronic uremic patients and healthy subjects.

In ten chronic uremic patients on regular hemodialysis treatment in vitro experiments revealed that stimulation of opioid receptors with morphine did not significantly change the mitogen-induced proliferative response of peripheral blood lymphocytes and interleukin-2 (IL-2) receptor expression on PHA-stimulated lymphocytes, while it appreciably decreased surface transferrin (Trf) receptor expression on PHA-stimulated lymphocytes. However, metenkephalin inhibited mitogen-induced proliferation and surface Trf receptor expression on uremic lymphocytes without affecting IL-2 receptor expression on PHA-stimulated cells. In ten healthy subjects opioid receptor agonists did not significantly affect mitogen-induced proliferation of lymphocytes, except for the inhibitory effect of 10(-8) M morphine in relation to lymphocytes stimulated with an optimal pokeweed mitogen (PWM) concentration. At the same time, opioid receptor agonists depressed surface IL-2 and Trf receptor expression on PHA-stimulated normal lymphocytes. In most of our experiments naloxone itself, a non-selective competitive opioid receptor antagonist, decreased mitogen-induced lymphocyte proliferation and IL-2 and Trf receptor expression on PHA-stimulated lymphocytes. Moreover, most frequently naloxone did not reverse inhibitory effects of opioid receptor agonists on lymphocytes. The results seem to indicate that opioid receptor stimulation by high metenkephalin concentrations, which are observed in the uremic blood plasma, may share the responsibility for immunodeficiency in chronic uremic patients. Next, in the presence of opioid receptor agonists directions of changes in the mitogen-induced proliferative response may not follow the alterations of IL-2 and Trf receptor expression on both uremic and normal lymphocytes. Finally the results also suggest that naloxone may possibly exert effects which are independent of its action on opioid receptors on lymphocytes.

[Effect of hemoperfusion on plasma oxidizing capacity and erythrocyte sensitivity to oxidation in patients with chronic uremia]. / Wplyw hemoperfuzji na wlasciwosci utleniajace osocza i wrazliwosc krwinek czerwonych na utlenianie u chorych na przewlekla mocznice.

An effect of haemoperfusion on plasma oxidizing capacity and erythrocyte sensitivity to oxidation was investigated in patients with the chronic uremia. It was found that plasma oxidizing capacity measured with NTB reduction is more pronounced in patients with the chronic uremia than in normal subjects. Oxidizing capacity of plasma is increased at the beginning of haemoperfusion. This effect is clearly seen during single pass of blood through the column with activated carbon. Erythrocyte sensitivity to oxidation following their suspension in the normal saline with phosphate buffer and measured with ascorbic-cyanate test does not differ significantly in patients with the chronic uremia and healthy subjects and does not change markedly during haemoperfusion.

[Spontaneous rupture of the spleen as a cause of death of a patient with uremia]. / Samoistne pekniecie sledziony jako przyczyna zgonu u chorego z mocznica.

A case of spontaneous rupture of the spleen in young patient with uremia treated with hemodialyses is presented. A course of the disease was acute with severe shock leading to patient's death. Possible edema of the spleen and subcapsular hematomas related to the uremic coagulopathy and the use of heparin during hemodialyses may be the factors predisposing to the rupture of the spleen.

Degranulation of peripheral blood neutrophils during haemoperfusion in chronic uraemics.

In 10 chronic uraemics activities of some lysosomal enzymes were determined in peripheral blood neutrophils and plasma during haemoperfusion with charcoal cartridge Adsorba 300 C (Gambro). Blood plasma activities of arylsulfatases, beta-N-acetylglucosaminidase and beta-glucuronidase did not significantly change during haemoperfusion, while lysozyme activity was significantly increasing. Neutrophil contents of these enzymes decreased. The determinations of these enzyme activities revealed a positive outlet-inlet difference in blood plasma and a negative outlet-inlet difference in neutrophils during the first 20 minutes of the procedure. The results suggest that during haemoperfusion degranulation of the peripheral blood neutrophils occurs.