Nephrology and renal replacement therapy in Romania.

BACKGROUND: In the context of the transformation of the Health Systems of Central and Eastern European countries, the role of professional associations is increasing, especially as regards data collection, analysis, and implementation of programmes for development of nephrology and renal replacement therapy (RRT). METHODS: The Romanian Renal Registry sent questionnaires to the heads of Haemodialysis and Nephrology Centres. The need for renal replacement therapy was deduced from the annual incidence (127 patients p.m.p.) of chronic renal failure. RESULTS: Although the rates of increase in the numbers of Nephrology Departments (+82%), HD Centres (+142%), and total number of patients alive on RRT (+196%) from 1991 to 1995 were higher than the European mean, only 27-30% of the incident patients (459 of 1000-1200 patients) could be provided with RRT. Sixty-two percent of the need for RRT in the age group 25-44 years was met, while only 20% of children (age < 15 years) and people over 55 years requiring RRT received this treatment. Primary renal diseases in patients on RRT were glomerulonephritis (49%) or interstitial nephropathies (23%); diabetic nephropathies, nephroangiosclerosis and systemic diseases were rare (4, 2, and 1% respectively). Most of the CRF patients (88%) were treated by HD. Renal transplantation and peritoneal dialysis were seldom performed (8 and 4%). The cost of HD treatment in Romania (87 USD) is low, even though dialyser reuse is not common practice. CONCLUSIONS: The increase in renal replacement therapy in Romania was mainly due to the expansion of the number of haemodialysis centres. Although a significant progress was realized, only one-third of the patients needing RRT could be treated in Romania in 1995.

Effect of hemodialysis on lipid peroxidation and antioxidant system in patients with chronic renal failure.

Plasma and blood lipid peroxidation, activity of erythrocyte superoxide dismutase (SOD), and serum antioxidant activity (AOA) in uremic patients were examined before and 15 and 30 minutes after the start of dialysis. Hemodialysis was found to produce increased lipid peroxidation in plasma and blood and a simultaneous decrease of SOD activity. The extracellular antioxidant systems were evaluated by the assay of ceruloplasmin level, which did not modify significantly during the dialysis. Our data indicate that the time since the start of dialysis is an important, but not unique factor, influencing possible oxidative damage during hemodialysis.

Polymorphism of C3 components and the B factor in patients with chronic renal failure, dialyzed iteratively.

The value of C3, of the cleavage C3 components and of the B factor were determined in 25 normal controls and in 22 patients with chronic renal failure (CRF), iteratively dialyzed. Low values of C3 and progressive hypomorphism of the cleavage components of C3 were observed in the patients at the three moments of determination. The activity of the B factor was also found significantly decreased in the patients. Our results indicated an activation of the complement alternative pathway in the dialyzed patients but the activation through the classic pathway, could not be excluded either. It is concluded that this activation might be due to the initial disease which generated CRF but also to some factors transported by hemodialysis.

Changes in some digestive enzymes after a seven-day orbital flight.

Changes in some digestive enzymes (amylase, lipase, uropepsinogen) were studied in the serum and urine of one of the participants in the Soviet-Romanian seven-day space flight on the Soyuz 40-Saliut 6 complex. On the first day after landing it was found an increased total serum and urinary amylase, resulting from the separate increase of pancreatic and salivary amylase, determined by Skude and Ihse's method [14]. In both serum and urine, pancreatic amylase was found in higher amounts than the salivary one. Lipase was also increased. These modifications are in general in keeping with those recorded after different flights of similar duration and are part of the anabolic response. The pancreatic and salivary amylase were first investigated separately. Under the same conditions uropepsinogen was decreased, an unexpected result. Serum gastrin was increased, in agreement with a generally increased digestive activity.