Assuntos
Ciclosporina/sangue , Transplante de Rim/imunologia , Ciclosporina/farmacocinética , Ciclosporina/uso terapêutico , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Humanos , Imunossupressores/sangue , Imunossupressores/farmacocinética , Imunossupressores/uso terapêuticoAssuntos
Transplante de Rim/fisiologia , Doadores Vivos , Cônjuges , Adulto , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/tratamento farmacológico , Sobrevivência de Enxerto , Teste de Histocompatibilidade , Humanos , Terapia de Imunossupressão/métodos , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tailândia , Fatores de TempoAssuntos
Autoanticorpos/sangue , Linfócitos B/imunologia , Teste de Histocompatibilidade , Transplante de Rim/imunologia , Adolescente , Adulto , Criança , Contraindicações , Citotoxicidade Imunológica , Seguimentos , Sobrevivência de Enxerto , Humanos , Transplante de Rim/mortalidade , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Taxa de Sobrevida , Linfócitos T/imunologia , Fatores de Tempo , Doadores de TecidosRESUMO
Plasma procoagulant activities of factors XII, XI, IX, and VIII and plasma concentrations of factor XII antigen and high molecular weight kininogen (HMK) were determined in nine men with chronic renal failure (CRF) associated with long-standing spinal cord injury (SCI) treated with hemodialysis. The results were compared with those obtained in a group of 10 ambulatory CRF patients and 8 normal volunteers (control group). Congenitally deficient plasmas were used as the substrate for the measurement of procoagulant activities in a one-stage clotting assay. Monospecific antibodies were employed in the measurement of factor XII antigen and HMK using gradient plate immunodiffusion and rocket immunoelectrophoresis. Factor XII coagulant activity and antigen concentration were significantly increased in the SCI group. The mean values for plasma factor XI and IX activities in the SCI group were comparable with those observed in the ambulatory patients and normal control group. However, marked variations in factor XI and IX levels were noted among the SCI patients with a few instances of mild to moderate factor deficiencies and several cases of markedly elevated levels. Factor VIII activity was markedly increased, with only two of the nine patients exhibiting normal values. HMK concentration in the SCI group was comparable with values obtained for the other groups. Following dialysis, factor XII antigen concentration rose and factor XI activity fell slightly but significantly. The results indicate that the combination of CRF and long-standing SCI is associated with marked aberrations of intrinsic coagulation pathway. The underlying mechanisms and the clinical consequences of these abnormalities are not known and require further investigation.
Assuntos
Transtornos da Coagulação Sanguínea/etiologia , Falência Renal Crônica/etiologia , Diálise Renal , Traumatismos da Medula Espinal/complicações , Adulto , Fator IX/análise , Fator VIII/análise , Fator XI/análise , Fator XII/análise , Humanos , Falência Renal Crônica/terapia , Cininogênios/sangue , Masculino , Pessoa de Meia-Idade , Precursores de Proteínas/análiseRESUMO
We studied prostacyclin as a substitute for heparin in 12 patients who underwent maintenance hemodialysis. All subjects underwent initial hemodialysis with prostacyclin as the sole anticoagulant; 10 of the 12 were restudied during heparin hemodialysis. Few adverse reactions occurred during prostacyclin hemodialysis in the 10 patients in whom dialysis was performed against a bicarbonate-containing dialysate; however, significant hypotension developed in two subjects when an acetate bath was used. Platelet aggregation progressively decreased during prostacyclin hemodialysis (p less than 0.02), but not during heparin hemodialysis, and returned toward control values after hemodialysis. Platelet thromboxane release decreased during both prostacyclin and heparin hemodialysis. Intradialytic percent decrements in serum urea nitrogen and creatinine were greater during prostacyclin than heparin administration (42 +/- 2.9 percent versus 36 +/- 2.6 percent [p less than 0.05] and 33 +/- 2.6 percent versus 29 +/- 2.1 percent [0.05 less than p less than 0.1], respectively). The plasma concentrations of 6-keto-prostaglandin-F1 alpha, a prostacyclin metabolite, reached peak levels by 120 minutes of hemodialysis and declined biexponentially toward predialysis concentrations during 120 minutes after hemodialysis, thereby providing an index of cumulative prostacyclin dosage. We conclude that prostacyclin is not only a safe alternative to heparin anticoagulation during hemodialysis, but that prostacyclin might also increase the efficiency of hemodialysis.
Assuntos
Anticoagulantes , Epoprostenol , Epoprostenol/uso terapêutico , Prostaglandinas , Diálise Renal/métodos , 6-Cetoprostaglandina F1 alfa/análogos & derivados , 6-Cetoprostaglandina F1 alfa/imunologia , Adulto , Epoprostenol/efeitos adversos , Feminino , Heparina/uso terapêutico , Humanos , Falência Renal Crônica/reabilitação , Masculino , Pessoa de Meia-Idade , Agregação Plaquetária/efeitos dos fármacos , Prostaglandinas/uso terapêutico , Radioimunoensaio , Tromboxano B2/imunologiaRESUMO
We evaluated neutrophil adhesive function in patients undergoing chronic hemodialysis using either prostacyclin or heparin as antithrombotic agents. Patients underwent successive hemodialyses with prostacyclin (4 ng/kg/min) and heparin. There were no significant differences noted in neutrophil adhesive function during either dialysis: transient neutropenia developed in each case; impaired neutrophil adhesiveness to plastic developed during both dialyses; neutrophil aggregation was diminished when compared to predialysis responses during both dialyses. Furthermore, the number of circulating Fc-receptor-bearing neutrophils fell significantly during both prostacyclin and heparin hemodialysis. Our study demonstrates that substitution of prostacyclin for heparin in doses that do not cause hypotension, does not prevent neutropenia or alter the diminished neutrophil adhesiveness that occurs during heparin hemodialysis.