Subcutaneous r-HuEPO therapy in CAPD patients: dose determination and clinical experience.

We present our results on the efficacy and safety of low dose r-HuEPO given subcutaneously in the treatment of anaemia in CAPD. We have studied 10 stable patients (5 males, 5 females) on CAPD. In our study subcutaneous r-HuEPO was administered twice a week for 6 months. Mean initial dose of r-HuEPO was 67.3+/-21.7 U/kg/week, and maintenance dose was 35.8+/-12.1 U/kg/week. The target Hb concentration was 10-12 g/dl. All patients responded to r-HuEPO. During treatment significant increases of haemoglobin concentration (p<0.05), haematocrit (p<0.05), red cell count (p<0.05) and reticulocyte count (p<0.05) were observed. We found no significant changes in total white cell or platelet counts. Long-term r-HuEPO treatment did not influence significantly plasma levels of electrolytes (Na, K, Ca), urea and creatinine. We found no significant changes in ultrafiltration volumes. In the present study the mean systolic and diastolic blood pressures did not change. Liver function tests were normal at the beginning and at the end of the study. r-HuEPO treatment was associated with a decrease of ferritin (455+/-90 vs. 224+/-83 microg/l. Oral or intravenous iron substitution became necessary in 6 patients. Side effects in our study were minimal; one patient had myalgia after the first seven doses but this disappeared as treatment was continued. Two patients reported pain (mild) at the injection site. In the present study, the correction of anaemia was accompanied by a substantial improvement in the quality of life, mainly in capacity for work, household and social activities.

[Pulmonary embolism as a complication of nephrotic syndrome--case report and therapeutic management]. / Zatorowatosc pluc wiklajaca zespól nerczycowy--opis przypadku, postepowanie terapeutyczne.

A case of a 41-year-old man, who was treated due to severe steroid and immunoresistant nephrotic syndrome is described. During the pulsed steroid therapy the patient underwent a pulmonary embolism and developed the post-infarction cavern and abscess of the lung. In this study the case history, complications, diagnostic procedures and therapeutic management were described. The probable mechanism of the described complications was carefully discussed.

[Evaluation of sialic acid levels in serum and degree of sialic acid in gamma-globulin fraction and C-reactive protein in hemodialysed patients]. / Ocena poziomu kwasów sialowych w surowicy krwi oraz stopnia sializacji frakcji gamma-globulinowej i bialka C-reaktywnego u chorych hemodializowanych.

Regulation of immunological processes associated with complement system activation and immunoglobulin binding depends, among others, on the presence of sialic acids. In haemodialysed patients an increase is found of serum sialic acid level. The purpose of the work was the determination of sialic acid content in gamma-globulins and C-reactive protein, that is in immunologically active glycoproteins. The relationship was also studied between the amount of sialic acids and the level of immune complexes. After examination of a group of 15 haemodialysed patients increased degree of sialization of gamma-globulins was found, as compared with a control group. However, the degree of sialization of C-reactive protein in these patients was decreased in relation to the control group. The changes observed in sialic acid content in gamma-globulins and C-reactive protein in haemodialysed patients modify the function and persistence in circulation of these glycoproteins which may be one of the causes of immunological disturbances in these patients.

The effect of subcutaneous recombinant human erythropoietin (r-Hu EPO) in CAPD patients with renal anaemia.

Several factors may contribute to the pathogenesis of uraemic anaemia but there is general agreement that inadequate secretion of erythropoietin is the main cause. Recombinant human erythropoietin (r-Hu EPO) is today widely used in the treatment of patients with renal anaemia. Initial studies were conducted on patients receiving haemodialysis (HD) using intravenous dosing, and number of reports have confirmed the efficacy and safety of the hormone. However, there is still limited information on the use of r-Hu EPO in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The cost of this treatment was initially very high. The optimal way of administration of the drug and optimal dosage is still under discussion. More studies are needed to optimize treatment from a clinical as well as an economic point of view. We therefore present our result on the efficacy and safety of low dose r-Hu EPO given subcutaneously in th treatment of anemia in CAPD patients.