Parameters influencing blood erythropoietin levels of renal transplant recipients during the early post-transplantation period.

AIM: Renal transplantation is accompanied by restoration of renal function and endogenous erythropoietin production. The purpose of this study was to investigate the time-related changes of endogenous erythropoietin secretion in the early renal post-transplant period and the influence of various parameters to this process. METHODS: Fifty-eight patients were enrolled in the study and followed up for 3 months after successful renal transplantation. Erythropoietin levels were measured at regular intervals and correlated with renal function, cold ischemia time and immunosuppressive regimen used. RESULTS: Two peaks of serum erythropoietin levels were observed: an early peak that occurred within two days after transplantation and a late one, between weeks 2 and 4, which resulted in increased blood hemoglobin levels. Factors that were found to correlate with erythropoietin levels were delayed graft function, cyclosporine use and prolonged cold ischemia time. Serum creatinine did not correlate to erythropoietin levels although the reduction of serum creatinine preceded the rise of erythropoietin levels. Normal hemoglobin values were restored about three months after successful renal transplantation. CONCLUSION: Serum erythropoietin levels increase during the early post-transplantation period resulting in correction of anemia three months after a successful renal transplantation. Restoration of allograft function is a prerequisite for erythropoietin secretion, while cold ischemia time and immunosuppressive regimen affect graft function.

Factors influencing blood pressure control in children and adolescents.

OBJECTIVE: To investigate the incidence of increased blood pressure among children and adolescents and its relation with the anthropometric indexes, fasting insulin, insulin sensitivity indexes and lipid levels. BACKGROUND: Sufficient evidence suggests that the incidence of essential hypertension among children and adolescents is rapidly increased parallel to the incidence of obesity among these subjects. METHODS: We investigated 154 school-aged children; 77 males and 77 females, aged 11.28+/-2.99 (4-18) years old. After an overnight (12 h) fasting, we measured the following: anthropometric parameters, insulin (micro units/ml), glucose (mg/dl), cholesterol (mg/dl), cholesterol-HDL (mg/dl), cholesterol-LDL (mg/dl), triglycerides (mg/dl), uric acid (mg/dl), systolic and diastolic blood pressure (BP) (mmHg), HOMA-R index, QUICKI index and estimated glomerular filtration rate (eGFR). RESULTS: Boys showed greater body weight than girls as well as greater height and waist circumference. High normal systolic and diastolic BP measurements were more frequent among boys (HN-SBP: 27.2% vs. 16.8%, P=0.002. HN-DBP: 23.3% vs. 16.8%, P=0.05), but girls showed a higher frequency of systolic and diastolic high BP (H-SBP: 5.2% vs. 3.8%, P=0.6 (NS). H-DBP: 10.4% vs. 3.8%, P=0.05). Girls showed higher insulin levels and HOMA-R index values than boys, as well as higher levels of total cholesterol, triglycerides and LDL-cholesterol. Boys exhibited greater values of estimated glomerular filtration rate than girls. The most important factors influencing systolic and diastolic BP were the waist circumference (central obesity) and the body weight. Fasting insulin levels showed a biphasic effect upon systolic and, especially, diastolic BP. Normoinsulinemia exhibited a positive effect upon systolic and diastolic BP but high insulin levels exhibited a negative effect upon diastolic BP. No considerable effect of lipid parameters was found upon BP. CONCLUSIONS: Our results suggest that anthropometric indexes, particularly central obesity and body weight play the most important role in BP control among children and adolescents. Girls exhibit greater frequency of high BP than boys, as well as greater frequency of other metabolic syndrome risk factors. Insulin levels and insulin sensitivity are important factors influencing BP control. Insulin, per se, plays a pivotal role in BP control, normoinsulinemia produce a positive effect upon BP, but high insulin levels exert a hypotensive action.

Magnetic resonance imaging in the evaluation of the pericardium. A pictorial essay.

Magnetic resonance (MR) is an ideal technique for the evaluation of the pericardium since it enables the combination of high resolution anatomical images of the pericardial layers with functional information concerning the impact of pathology on diastolic heart function and cardiac filling in particular. In comparison with echocardiography, which remains the first choice technique for the study of the pericardium, MR provides larger fields of view allowing the visualisation of the entire chest, higher spatial and contrast resolution and greater reproducibility. The technique becomes particularly useful when ultrasound imaging does not provide adequate diagnostic information or requires further characterisation; ''non-echoic'' patients, loculated pericardial effusions, focal thickening of the layers and pericardial masses are usually better assessed with MR. The method also provides valuable diagnostic information for establishing the diagnosis of constrictive pericarditis and to differentiate this condition from restrictive cardiomyopathy. The aim of this paper is to present the role of MR imaging in the assessment of a patient with suspected pericardial disease, and discuss the MR technique, anatomy and the main pathological conditions.

Plasma levels of soluble cellular adhesion molecules in patients with arterial hypertension. Correlations with plasma endothelin-1.

Background: Several reports have shown that circulating, soluble cellular adhesion molecules and endothelin-1 (ET-1) are implicated in the pathophysiological events of atherosclerosis and may reflect the endothelial dysfunction characterizing this disorder. Methods: To evaluate the expression of these factors in arterial hypertension (AH), we measured plasma levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble P-selectin (sP-selectin), and ET-1 in 60 untreated patients with mild to moderate AH (hypercholesterolemic: n=31, normocholesterolemic: n=29) and 30 sex- and age-matched normocholesterolemic normotensive controls. Results: Hypertensive patients exhibited significantly higher levels of sICAM-1 (234+/-21 vs. 187+/-12 ng/ml, P<0.005), sVCAM-1 (681+/-42 vs. 589+/-23 ng/ml, P<0.005), sP-selectin (89+/-17 vs. 55+/-11 ng/ml, P<0.01) and ET-1 (6.2+/-0.7 vs. 2.4+/-0.3 pg/ml, P<0.01) than did normotensive controls. The normocholesterolemic hypertensives had lower levels of sICAM-1, sVCAM-1 (P<0.01), sP-selectin and ET-1 (P<0.05) than hypercholesterolemic hypertensives, but higher levels than normotensive controls (P<0.05). In hypertensives, plasma ET-1 was significantly correlated with mean arterial pressure (r=0.51, P<0.03) and sICAM-1 levels (r=0.64, P<0.01). In hypercholesterolemic hypertensives, LDL cholesterol was also significantly correlated with plasma levels of sICAM-1 (r=0.53, P<0.04) and sP-selectin (r=0.41, P<0.05). Conclusions: Plasma levels of soluble cellular adhesion molecules are elevated in hypertensive patients in comparison to normotensive controls and may be related to plasma ET-1 activity. The coexistence of hypercholesterolemia may enhance the plasma soluble adhesion molecule activity induced by AH.

Serum profiles of granulocyte-macrophage colony-stimulating factor and C-C chemokines in hypertensive patients with or without significant hyperlipidemia.

The present study investigates the differences in serum activity of granulocyte-macrophage colony-stimulating factor, macrophage chemoattractant protein-1, and macrophage inflammatory protein-1alpha between hypertensive patients with and without significant hyperlipidemia before receiving any medical treatment. The serum activity of the studied inflammatory factors is more elevated in hypertensive patients with significant hyperlipidemia and may be associated with atherosclerotic inflammatory process induced by the coexistence of 2 major cardiovascular risk factors.

C3 polymorphism in beta-thalassemia.

The distribution of phenotypes and gene frequencies of the third component of complement (C3) were studied in 106 beta-thalassemic patients and in 112 carriers of the beta-thalassemia trait. A statistically significant association was found between the C3F gene and homozygous beta-thalassemia. It can be suggested that this association may be related with the high incidence of infections encountered in these patients.