RHEOPHERESIS AND ITS USE IN THE TREATMENT OF DISEASES WITH IMPAIRED MICROCIRCULATION. A REVIEW.

Rheopheresis ranks among apheretic methods. It is a selective, extra-corporeal double cascade filtration treatment. First, the plasma is separated from blood elements in extra-corporeal circulation by passing through membrane filter. The plasma is then filtrated through the second filter in order to remove proteins with a high molecular mass, e.g. lipids, fibrinogen, α2-macroglobulin, von Willebrand factor, immunoglobulin IgM. The purified plasma is then returned together with the blood elements back to the patient. The aim of the procedure is to improve the microcirculation and rheological properties of the blood. Rheopheresis is well established method for the treatment of age-related macular degeneration, acute sensorineural hearing loss, calciphylaxis, systemic sclerosis or peripheral vascular disease.

Long-term peritoneal dialysis treatment provokes activation of genes related to adaptive immunity.

Permanent irritation of the peritoneum during peritoneal dialysis (PD) treatment leads to local chronic inflammation and subsequently activation of processes driving fibrogenesis in the long-term. The aim of the study was to compare the peritoneal effluent transcriptome of 20 patients treated less and 13 patients treated more than 2 years using microarray analysis. An increased expression of genes associated with an immune response was observed in long-term treated patients with well preserved peritoneal function, when compared to patients treated less than 2 years. From 100 genes highly expressed in long-term patients, a significant up-regulation of six was found by RT-qPCR: LY9 (lymphocyte antigen 9), TNSFR4 (tumor necrosis factor receptor superfamily, member 4), CD 79A (CD79a molecule), CCR7 (chemokine C-C receptor 7), CEACAM1 (carcinoembryonic antigen-related cell adhesion molecule 1) and IL2RA (interleukin 2 receptor alpha chain). Furthermore, the effluent cell population was analysed. A positive relationship between the number of granulocytes and NK cells on one hand, and duration of PD treatment on the other, was shown. We conclude, that the mechanisms of adaptive immunity promoting T helper 2 cells response are activated in the long-term before functional alterations develop. It consequently might trigger the fibrosis promoting processes.

Similar Microvascular Inflammation and Tubulointerstitial Injury in ABO-Incompatible and Matched ABO-Compatible Kidney Allografts.

ABO-incompatible (ABOi) kidney transplantation represents a viable tool to increase the donor pool for kidney transplantation, however, increased alloimmune response has been debated. The early outcomes of 25 low-risk ABOi kidney transplant recipients were compared with thoroughly matched 50 ABO-compatible (ABOc) ones. The matching process was based on gender and age of recipients and immunologic parameters, such as panel reactive antibodies, number of human leukocyte antigen mismatches, and transplantation era. Three-month protocol kidney graft biopsy Banff scores and 1-year clinical outcomes were compared. Apart from C4d positivity, no statistically significant differences were found regarding the Banff scores between the two groups. Similarly, microvascular inflammation and tubulointerstitial injury revealed no differences either. The eGFR at 3 months and 1 year was similar in both groups. In conclusion, blood group incompatibility yields no additional microvascular and tubulointerstitial graft injury if desensitization protocol was applied to low-risk kidney transplant recipients.

Analysis of fluid transport pathways and their determinants in peritoneal dialysis patients with ultrafiltration failure.

Ultrafiltration failure (UFF) is a serious complication of peritoneal dialysis (PD). The aim of the study was to analyze changes in water transport and their determinants in UFF patients over the time on PD. Standard peritoneal permeability analyses of 50 stable PD patients with UFF were analyzed. Fluid transport through small pores (SPT), free water transport (FWT) at 60 min, their contributions on total ultrafiltration (SPTC and FWTC), and their determinants were assessed. Patients were divided in Group I (UFF) treated for less than 24 months, Group II treated 24-60 months, and Group III treated for more than 60 months. Group I (UFF) was compared with Group I (non-UFF) matched for the duration of PD treatment and age. Transcapillary ultrafiltration (TCUF), SPT, FWT, and FWTC were significantly lower in Group III when compared to the other UFF groups. In this group also, negative relationship was present between FWT, the ultrafiltration coefficient LpA, and osmotic conductance to glucose on one hand and PD duration on the other. FWT was positively related to osmotic conductance to glucose in all groups. Group I (UFF) showed significantly higher solute transport, effective lymphatic absorption rate, lower TCUF, and lower FWT than Group I (non-UFF). The patterns of UFF in PD patients are dependent on the duration of treatment.

Ultrafiltration failure in peritoneal dialysis. Causes and clinical consequences.

Ultrafiltration failure (UFF) is the insufficient ability to remove excess fluid from the body by dialysis. In peritoneal dialysis (PD) this is a common complication, the frequency increases with duration of treatment. In this review a summary of peritoneal transport mechanisms and the conditions associated with UFF are discussed. The 2 most common circumstances in which ultrafiltration failure occurs, peritonitis and long-term PD treatment, are outlined more extensively. In addition a diagnostic approach and therapeutic options for the different causes of UFF are given.