[Does uremic pruritus in hemodialyzed patients disappear only with replacement therapy?]. / Nestaje li uremijski svrbez hemodijaliziranih bolesnika samo dodatnim lijecenjem?

Uremic itching is an "orphan" symptom, almost equally frustrating patients and physicians. It is an unpleasant sensation and a subjective experience which is difficult to qantitate. Studying the frequency of itching among the chosen group of chronic dialysis patients, there were two questions to be answered: 1) Does the itching correlate causatively to the standard laboratory parameters? and 2) Does the itching disappear with only supplementary treatment? At the commencement of the research a sequence of laboratory parameters, presence and intensity of itching were determined, and the presence of itching 3 months afterwards. Itching of the 3rd, 4th and 5th grade was present in 44 patients (37.9%) at the beginning. Patients with itching did not differ from those without itching regarding mean predialysis values of urea, creatinine, uric acid, hematocrit, calcium, phosphorus, alkaline phosphatase, i-PTH, ALT, bilirubin, Kt/V and total heparin doses received during single dialysis procedure. Among those with itching there were not significantly more patients older than 60 years of age (chi 2 = 0.273; p > 0.05). Three months afterwards itching disappeared without particular treatment in 8 of 44 patients (22.7%), and appeared in 14 of 72 (19.5%) patients without itching at the beginning of the investigation. In conclusion, no correlation was found between uremic itching and standard laboratory parameters. Itching in chronic dialysis patients is considered to be a temporary symptom that often disappears without supplementary treatment.

Changes in sex hormones during an oral glucose tolerance test in healthy premenopausal women.

OBJECTIVE: To assess the effect of an acute elevation in circulating insulin on serum androgen levels in healthy obese women with different body-fat distributions. DESIGN: Controlled clinical study. SETTING: The Endocrinology Unit of an academic medical center. PATIENT(S): Seventy healthy premenopausal women participated: 27 women with upper-body obesity, 22 women with lower-body obesity, and 21 normal-weight women as controls. INTERVENTION(S): A 75-g oral glucose tolerance test (OGTT) was performed for all participants. MAIN OUTCOME MEASURE(S): Anthropometry and serum concentrations of glucose, insulin, free T, DHEAS, androstenedione, E2, and sex hormone-binding globulin (SHBG) at fasting, 60 minutes, and 120 minutes after oral glucose loading. RESULT(S): Although androgens and E2 levels in all three groups declined modestly, there were no statistically significant differences in response of the sex hormones to an OGTT in the two obese groups and normal-weight women. No correlation was found between changes in sex-hormone levels during an OGTT and insulin rise. Increased body mass index and more pronounced abdominal fat localization resulted in basal hyperinsulinemia, markedly exaggerated glucose-induced insulin levels, and hyperandrogenism, as was evident by significantly elevated free T and low SHBG serum levels. CONCLUSION(S): There were no statistically significant differences in androgen response to acute hyperinsulinemia during an OGTT between obese women with different regional fat distributions and lean controls.

Simulation model of defective insulin receptors as byproducts of receptor recycling.

Our simulation model assumes that the defective insulin-binding receptors in non-insulin-dependent diabetes (NIDDM) patients result from functional receptor recycling. The model is a short program written in MS DOS 5.0 Qbasic. MODEL DESIGN: Receptors with intracellular portions damaged in the process of recycling are considered defective since they bind insulin but do mediate insulin effects, or recycle. Their occurrence depends on the average activation rate of functional receptors. The insulin-binding receptors (defective and functional) are objects of slow and time-dependent turnover defined by the turnover rate. Recycled receptors rejoin functional receptors or enter the pool of defective receptors. The waste in the functional receptors' pool is covered by a limited amount of newly synthesized receptors. The defective receptors often accumulate in cases of increased activation of functional receptors. SIMULATION RESULTS: The insulin-binding receptor quantity is determined, in the model, only by the number of newly synthesized receptors, reflecting the intensity of insulin stimulation. Synthesis is increased following variable insulin stimulations and decreased after sustained, intensive insulin stimulation. The number of functional receptors inversely reflects the average activation rate of functional receptors compared with the insulin-binding receptors turnover rate. High activation rates can diminish the proportion of functional receptors to less than 5% of that of all insulin-binding receptors. The model predicts that cells bearing only functional receptors show progressively shortened half-lives of receptors, reflecting the receptor activation intensity. On the other hand, cells bearing both defective and functional receptors show stable receptors' half-lives (20-36% of the defective receptors' half-life). Simulation results suggest that reduced functional receptor proportions in NIDDM patients might reflect the imbalance between the activation of functional receptors and the slow catabolism of defective receptors.

[The effect of cellulose diacetate dialysis membranes on lipids and lipoproteins in uremic patients]. / Utjecaj dijalizne membrane od celuloznog diacetata na lipide i lipoproteine uremicara.

The patients treated with hemodialysis have marked cardiovascular morbidity and mortality. Furthermore, lipid and lipoprotein disorders in these patients are well known. Since lipid and lipoprotein disorders are undoubtedly associated with cardiovascular morbidity and mortality, treatment of this group of patients should aim also at the correction of these disorders. The effect of hemodialysis with cellulose diacetate membranes on plasma lipids and lipoproteins was studied in 13 female patients followed-up for 4.5 months. Total cholesterol, triglycerides, HDL and LDL cholesterol, and apolipoproteins (a), AI and B were determined in each patient at the beginning and at the end of the study. Significant increases in HDL cholesterol (0.95 +/- 0.30-1.09 +/- 0.32 mmol/l), apolipoprotein B (1.14 +/- 0.35-1.35 +/- 0.36 g/l), and apolipoprotein (a) (272.38 +/- 281.66-357.36 +/- 400.30 U/l), nonsignificant increases in total cholesterol (5.61 +/- 1.18-5.63 +/- 1.23 mmol/l), LDL cholesterol (3.30 +/- 1.05-3.69 +/- 1.32 mmol/l) and apolipoprotein AI (1.03 +/- 0.25-1.11 +/- 0.19 g/l), and nonsignificant decrease in triglycerides (3.07 +/- 1.49-2.74 +/- 1.37 mmol/l) were found in the study. In conclusion, only some of the observed changes in plasma proteins and lipoproteins are beneficial for the patients.

Haemodynamic changes and exercise tolerance in dialysis patients treated with erythropoietin.

The aim of our study was to evaluate cardiovascular function at rest and during exercise in dialysis patients before and after treatment with Epo and to examine the changes in left ventricular mass as the consequence of treatment for anaemia. We applied echocardiography and radionuclide ventriculography at rest and after exercise in our research. Following treatment with Epo there was a decrease in the initially high cardiac output (CO) and cardiac index (CI) from 7.5 to 6.31/min and from 4.3 to 3.61/min/m2 respectively. No changes were noted in mean diastolic (DPB) and mean blood pressure (MBP), as well as the initially increased peripheral resistance index (TPRi) of 2582.3 +/- 2097.3 dyn-s-cm-5.m2. Nevertheless, end-diastolic (EDV) and end-systolic (ESV) volume were significantly decreased (P < 0.05), but the ejection fraction (EF) remained unchanged (73.9%). The decrease in the mean values for left ventricular mass (LVM) was significant only within the subgroup of dialysed patients who initially had larger left ventricular mass (P < 0.01). The functional capacity of the CV system measured during exercise increased from four metabolic equivalents (METs) to 6 METs (P < 0.01). A significant increase in blood volume was also observed following treatment of anaemia. The haemodynamic consequences of Epo therapy for the treatment of anaemia were quite positive. However, we would like to point out certain concerns regarding the dialysed patients with initially lower values for left ventricular mass and cardiac output, since the patients within this group developed left ventricular hypertrophy and an increase in cardiac output.

[Evaluation of genetic factors in the variability of menarche]. / Ocjena genetskog faktora u varijabilnosti menarhe.

The purpose of the study was to assess the correlation of menarche and the similarity of other features of pubertal development at the onset of menarche in sisters compared to girls which are not in kinship. The longitudinal study was performed in school girls in the city of Osijek. Seventy-four pairs of sisters i.e. 148 girls aged 9 to 15 years in which the menstrual cycle had not started were embraced. The "nonrelated pairs" were formed within the same group of girls. Results showed the significant intrapair correlation of menarcheal age between sisters whereas the correlation in nonrelated pairs did not exist. The body height at the onset of menarche in both groups of pairs--sisters and nonrelated girls--was positively correlated, but significance was on higher level in sisters. Body weight varied in a large range; the intraclass correlation being significant in pairs of sisters only. Menarche appeared in almost equal distribution of breast stage as it was found in other studies. However, breast stage showed considerably higher concordance in sisters than in the nonrelated pairs. The pubic hair stage at menarche also showed higher similarity in sisters which speaks in favour of genetic influence on mutual relationship of certain sequences in pubertal development. Results confirm that age of menarche as well as the total, complex course of pubertal development are under high influence of genetic factors.

[Osmotic resistance in erythrocytes in patients with chronic renal insufficiency]. / Osmotska rezistencija eritrocita u bolesnika s kronicnom bubreznom insuficijencijom.

Anemia, almost always found in patients with the end-stage chronic renal failure, had been first related to secondary hyperparathyroidism in 1934. Parathormone leads to anemia in different ways, one being the lowered osmotic resistance. The osmotic resistance of erythrocytes in 57 patients with a progressive stage of chronic renal failure treated at the Hemodialysis Unit of the General Hospital Osijek was examined. The aim of the study was to establish the relationship between osmotic resistance and parathormonal level. The average value of the osmotic resistance median (ORM) in erythrocytes of the patients with chronic renal failure (0.37 +/- 0.03) was lower than in healthy probands (0.39 +/- 0.02). The difference was statistically significant (p < 0.001). No correlation was found between the C-terminal parathormone and the average values of erythrocytic ORM in the whole group or in the subgroup of 7 patients with pathological values of erythrocytic ORM. In patients treated with calcium antagonists, the average erythrocytic ORM value was not significantly lower than in patients who were not on such medications. Allowing the assumption that active parathormone has a high share in the C-terminal parathormone, we conclude that the lowered osmotic resistance of erythrocytes is not necessarily found in patients with chronic renal failure.

[Acquired renal cysts in patients on chronic hemodialysis treatment]. / Stecene ciste bubrega u bolesnika lijecenih kronicnom hemodijalizom.

The kidneys of chronic hemodialysis patients are subject to different morphological modifications, although they are in fact functional. One of those modifications, cystic transformation of the kidneys, is the object of this study. Seventy-nine chronic hemodialysis patients treated at the Hemodialysis Centre of the Osijek General Hospital underwent ultrasonographic examinations in 1987. Subsequently, the rest of 56 patients underwent scanning again. Only the group of patients that could be followed up for the two-year period was analysed. It has been noticed that the number of patients having cysts has been higher after some time (19 to 47), as well as of those having more than 3 cysts (2 to 8) and of those having bilateral cysts (4 of 19 to 37 of 47). The patients having more than 3 cysts in the kidney do not essentially differ in age, daily diuresis, average hematocrit values and kidney size from the patients having solitary cysts or from those without any cyst. On the other side, those patients take significantly more time to be treated by chronic hemodialysis. Following the results obtained in this study, we conclude that cystic transformation of the kidneys in chronic hemodialysis patients is the benign disease. The findings pointing out at solitary cysts among this group of patients may also present a stage in the development of acquired multicystic kidney transformation. Only partial reliability of diagnosing the disease by ultrasonography and benignity suggest that regular ultrasonographic controls of those patients are not necessary.

[Osmotic resistance in erythrocytes in patients with chronic kidney insufficiency]. / Osmotska rezistencija eritrocita u bolesnika s kronicnom bubreznom insuficijencijom.

Anemia almost always found in patients with end-stage chronic renal failure has long been known to be related to secondary hyperparathyroidism. Parathormone leads to anemia in different ways, one being the lowered osmotic resistance. In the present paper we report on the osmotic resistance of erythrocytes in 57 patients with a progressive stage of chronic renal failure treated at the Hemodialysis Centre of the Osijek General Hospital. The aim of our study was to establish the relationship between the osmotic resistance and parathormonal level. The average value of the osmotic resistance median (ORM) in erythrocytes of patients with chronic renal failure (0.37 +/- 0.03) was lower than in healthy probands (0.39 +/- 0.02). The difference was statistically significant (t = 2.93, p less than 0.01). No correlation between C-terminal parathormone and the average values of erythrocytic ORM in the whole group or in the subgroup of 7 patients with pathologic values of erythrocytic ORM was found. In patients treated with calcium antagonists, the average value of erythrocytic ORM was not significantly lower than in patients not on these drugs. Allowing the assumption that active parathormone has a high share in C-terminal parathormone, we conclude that the lowered osmotic resistance of erythrocytes is not necessarily found in patients with chronic renal failure.