74 research outputs found
ENCAPSULATING PERITONEAL SCLEROSIS ā THE ROLE OF COMPLEMENT
Peritonejska dijaliza (PD) najÄeÅ”Äa je kuÄna metoda dijalitiÄkog lijeÄenja i jednako je uÄinkovita kao i hemodijaliza. PotrbuÅ”nica bolesnika djeluje kao polupropusna membrana koja dopuÅ”ta difuziju izmeÄu dijalizata i cirkulirajuÄe krvi. Dugotrajna izloženost dijalizatu dovodi do njezina remodeliranja, Å”to rezultira kroniÄnom upalnom reakcijom s posljediÄnom fibrozom. Danas se rabe biokompatibilne dijalizne otopine koje sadrže manje ostatnih produkata degradacije glukoze Å”to u konaÄnici rezultira manjim oÅ”teÄenjem potrbuÅ”nice. Veza izmeÄu PD i sustava komplementa nije toliko oÄita, jer ne dolazi do izravnog kontakta dijalizata s krvi. MeÄutim, mezotelne stanice proizvode i luÄe razliÄite komponente komplementa, ukljuÄujuÄi C4, C3 i C5-C9. StaniÄni ostaci kao rezultat izravnog oÅ”teÄenja potrbuÅ”nice PD otopinama manje biokompatibilnosti, kao i protutijela protiv mikroorganizama mogu doprinijeti aktivaciji lokalnih komponenti komplementa tijekom lijeÄenja. Inkapsulirana sklerozirajuÄa upala potrbuÅ”nice (ISUP) je kliniÄki sindrom podmuklog nastanka, koji se kasno prezentira slikom kroniÄne pothranjenosti sa znakovima i simptomima povremene, akutne ili subakutne gastrointestinalne opstrukcije. Ultrasonografija, dijagnostiÄka primjena kontrasta topljivih u vodi i kompjuterizirana tomografija najÄeÅ”Äe su koriÅ”teni radioloÅ”ki testovi koji pomažu dijagnozi ISUP. Rezultati o moguÄoj terapijskoj primjeni inhibicije komplementa u lijeÄenju i/li prevenciji ISUP su obeÄavajuÄi, ali preostaje rjeÅ”avanje brojnih nedoumica na putu prema definitivnom zakljuÄku. Infekcija, fibroza i kardiovaskularni dogaÄaji povezani su s aktivacijom sustava komplementa. Ove Äinjenice predstavljaju moguÄnost za terapijsku intervenciju putem sustava komplementa s ciljem poboljÅ”anja biokompatibilnosti dijaliznih otopina, uÄinkovitosti dijalize i dugoroÄnog ishoda lijeÄenja.Peritoneal dialysis (PD) is the most widely used home dialysis technique and is as effective as hemodialysis for the treatment of end-stage renal disease. The peritoneum in the abdominal cavity of the patients acts as a semi-permeable membrane allowing diffusion between the dialysis ļ¬ uid and the circulation. More biocompatible solutions are now being used that contain less glucose degradation products, which results in reduced peritoneal damage. The link between the complement system and PD seems less obvious because there is no direct contact with blood. However, mesothelial cells produce and secrete different complement factors including C4, C3, and C5 to C9. Cellular debris as a result of direct peritoneal damage by bioincompatible PD ļ¬ uids, as well as antibodies against microorganisms could contribute to local complement activation during PD. Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome of insidious onset, presenting late as chronic malnourishment with signs and symptoms of intermittent, acute or subacute gastrointestinal obstruction. Ultrasonography, water-soluble contrast studies and computed tomography scanning are the most widely used radiological tests to aid the diagnosis of EPS. Results on complement inhibition in PD look promising, but many hurdles remain to be solved. Infection, ļ¬ brosis, and cardiovascular events are linked to the complement system. These results indicate the possibility of complement interventions in dialysis to improve biocompatibility, dialysis efļ¬ cacy, and long-term outcome
ENCAPSULATING PERITONEAL SCLEROSIS ā THE ROLE OF COMPLEMENT
Peritonejska dijaliza (PD) najÄeÅ”Äa je kuÄna metoda dijalitiÄkog lijeÄenja i jednako je uÄinkovita kao i hemodijaliza. PotrbuÅ”nica bolesnika djeluje kao polupropusna membrana koja dopuÅ”ta difuziju izmeÄu dijalizata i cirkulirajuÄe krvi. Dugotrajna izloženost dijalizatu dovodi do njezina remodeliranja, Å”to rezultira kroniÄnom upalnom reakcijom s posljediÄnom fibrozom. Danas se rabe biokompatibilne dijalizne otopine koje sadrže manje ostatnih produkata degradacije glukoze Å”to u konaÄnici rezultira manjim oÅ”teÄenjem potrbuÅ”nice. Veza izmeÄu PD i sustava komplementa nije toliko oÄita, jer ne dolazi do izravnog kontakta dijalizata s krvi. MeÄutim, mezotelne stanice proizvode i luÄe razliÄite komponente komplementa, ukljuÄujuÄi C4, C3 i C5-C9. StaniÄni ostaci kao rezultat izravnog oÅ”teÄenja potrbuÅ”nice PD otopinama manje biokompatibilnosti, kao i protutijela protiv mikroorganizama mogu doprinijeti aktivaciji lokalnih komponenti komplementa tijekom lijeÄenja. Inkapsulirana sklerozirajuÄa upala potrbuÅ”nice (ISUP) je kliniÄki sindrom podmuklog nastanka, koji se kasno prezentira slikom kroniÄne pothranjenosti sa znakovima i simptomima povremene, akutne ili subakutne gastrointestinalne opstrukcije. Ultrasonografija, dijagnostiÄka primjena kontrasta topljivih u vodi i kompjuterizirana tomografija najÄeÅ”Äe su koriÅ”teni radioloÅ”ki testovi koji pomažu dijagnozi ISUP. Rezultati o moguÄoj terapijskoj primjeni inhibicije komplementa u lijeÄenju i/li prevenciji ISUP su obeÄavajuÄi, ali preostaje rjeÅ”avanje brojnih nedoumica na putu prema definitivnom zakljuÄku. Infekcija, fibroza i kardiovaskularni dogaÄaji povezani su s aktivacijom sustava komplementa. Ove Äinjenice predstavljaju moguÄnost za terapijsku intervenciju putem sustava komplementa s ciljem poboljÅ”anja biokompatibilnosti dijaliznih otopina, uÄinkovitosti dijalize i dugoroÄnog ishoda lijeÄenja.Peritoneal dialysis (PD) is the most widely used home dialysis technique and is as effective as hemodialysis for the treatment of end-stage renal disease. The peritoneum in the abdominal cavity of the patients acts as a semi-permeable membrane allowing diffusion between the dialysis ļ¬ uid and the circulation. More biocompatible solutions are now being used that contain less glucose degradation products, which results in reduced peritoneal damage. The link between the complement system and PD seems less obvious because there is no direct contact with blood. However, mesothelial cells produce and secrete different complement factors including C4, C3, and C5 to C9. Cellular debris as a result of direct peritoneal damage by bioincompatible PD ļ¬ uids, as well as antibodies against microorganisms could contribute to local complement activation during PD. Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome of insidious onset, presenting late as chronic malnourishment with signs and symptoms of intermittent, acute or subacute gastrointestinal obstruction. Ultrasonography, water-soluble contrast studies and computed tomography scanning are the most widely used radiological tests to aid the diagnosis of EPS. Results on complement inhibition in PD look promising, but many hurdles remain to be solved. Infection, ļ¬ brosis, and cardiovascular events are linked to the complement system. These results indicate the possibility of complement interventions in dialysis to improve biocompatibility, dialysis efļ¬ cacy, and long-term outcome
Vascular Access for Hemodialysis
In this book chapter are described different types of vascular access for hemodialysis, its forms, indications, placement and complications. The chapter is dedicated to health care professionals dealing with chronic kidney disease patients undergoing hemodialysis treatment
The influence of erythropoietin treatment on oxidative stress parameters in cortex of rats exposed to transient middle cerebral artery occlusion
Background and Purpose: Erythropoietin (Epo) plays a central role in
process of erythropoiesis. Recently, its neuroprotective potential was reported in various experimental models of brain damage. However, the mechanism of Epo protection is still unclear. In the present study, we examined the effect of Epo administration on lipid peroxidation levels and antioxidant enzymesā (superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px)) activities in rat cortex following focal cerebral ischemia.
Material and Methods: Focal cerebral ischemia was induced in male
HanoverWistar rats (250ā350 g) by right middle cerebral artery occlusion (MCAO) model for 1 hr. After 23 hrs of reperfusion, ischemic animals were sacrificed and the levels of lipid peroxidation, SOD and GSH-Px activities were determined spectrophotometrically in the right cortex. Ischemic animals received either vehicle or Epo (5000 IU/kg, intraperitoneally) immediately or 3 hrs after MCAO, and were sacrificed 23 hrs or 21 hrs later, respectively. Sham operated, vehicle treated animals served as the control group.
Results and Conclusion: Focal cerebral ischemia significantly increased the level of oxidative lipid damage parameters in the right cortex as compared to the control group without affecting SOD and GSH-Px activities. The decrease in level of lipid peroxidation after Epo treatment was registered but it was not statistically significant. Our results indicate that focal cerebral ischemia caused neuronal damage in the right cortex and that Epo treatment was not effective in preventing above mentioned alteration
ANDERSON-FABRY NEPHROPATHY ā CURRENT THERAPEUTIC OPTIONS AND FUTURE PERSPECTIVES
Anderson-Fabryjeva bolest uzrokovana je nedostatnom aktivnoÅ”Äu enzima Ī±-galaktozidaze A Å”to rezultira nakupljanjem glikosļ¬ ngolipida u lizosomima stanica razliÄitih organskih sustava. Bolest se nasljeÄuje X-vezano te je zastupljena u oba spola, no u muÅ”karaca, koji su hemizigoti za mutirani gen, simptomi se ispoljavaju ranije uz izraženiji fenotip. Nakupljanje u stanicama bubrega uzrokuje isprva reverzibilne, a potom i ireverzibilne patoloÅ”ke promjene u svim segmentima nefrona Å”to dovodi do proteinurije i bubrežne disfunkcije s postepenom progresijom do terminalnog stadija bubrežnog zatajenja. U ovom radu osvrnuli smo se na trenutne terapijske moguÄnosti u obliku intravenske enzimske nadomjesne terapije agalzidazom alfa i agalzidazom beta uz noviju peroralnu metodu lijeÄenja molekularnim Å”aperonima. Razmotreni su trenutni dosezi istraživanja genske terapije ugradnjom funkcionalnog GLA gena u genom bolesnika, Å”to je buduÄnost lijeÄenja nasljednih bolesti. Pravovremeno prepoznavanje i lijeÄenje Anderson-Fabryjeve bolesti znaÄajno smanjuju mortalitet i morbiditet pacijenata te poveÄavaju njihovu kvalitetu života.Anderson-Fabry disease is a lysosomal storage disorder caused by insufficient Ī±-galactosidase A enzyme activity. It is a hereditary X-linked disease that affects both men and women, although males express more typical symptoms at earlier age since they are hemizygotes for the mutated gene. Accumulation of glycosphingolipids in kidney cells has an impact on all nephron segments and causes proteinuria with progressive renal dysfunction, which can ultimately end in terminal renal failure. In this review of the literature, we present therapeutic options including intravenous enzyme replacement therapy with agalsidase alpha and agalsidase beta and oral treatment with molecular chaperons for patients with amenable mutations. Moreover, we investigated current progress in gene therapy of Fabry disease, which is an evolving field with promising results. Timely recognition and early start of treatment significantly reduces morbidity and mortality of patients with Fabry disease, leading to improved quality of life
VOLUME ASSESSMENT IN THE ACUTE HEART AND RENAL FAILURE
Akutno bubrežno oÅ”teÄenje (ABO) je bitan kliniÄki Äimbenik, poglavito u bolesnika koji se lijeÄe u jedinici intenzivnog lijeÄenja. Prema mnogim studijama, predstavlja kljuÄni Äimbenik rizika smrtnosti, neovisno o demografskim karakteristikama ispitanika i težini bolesti. Pojavnost i smrtnost vezano uz taj kliniÄki entitet variraju pa se zbog toga javila potreba za primjenjivim klasifikacijskim sustavom koji bi pomoga u postavljanju dijagnoze, standardizaciji definiranja jaÄine bubrežnog oÅ”teÄenja te prognozi ishoda. Tako je 2004. godine utvrÄena RIFLE (Risk-Injury-Failure-Loss-End-stage renal disease, engl.), a 2007. AKIN (Acute Kidney Injury Network, engl.) podjela ABO. U kliniÄkim jedinicama za lijeÄenje kroniÄnog zatajivanja srca, hipervolemija (koja se u literaturi obiÄno naziva dobivanje na težini) se uzima kao biljeg srÄane dekompenzacije. PoÄetak lijeÄenja kontinuiranim metodama nadomjeÅ”tanja bubrežne funkcije poboljÅ”ava preživljenje u tih bolesnika na naÄin da se prevenira akumulacija tekuÄine u organizmu te posljediÄna hipervolemija. Prevencija, a ne samo ispravak hipervolemije, bi trebala biti indikacija za poÄetak lijeÄenja vantjelesnim kontinuiranim metodama za uklanjanje viÅ”ka tekuÄine,
neovisno o potrebi za klirensom odreÄenih molekula. Oligurija je definirana proizvodnjom urina manjom od 0,3 ml/kg/sat u najmanje 24 sata. Svaka odgoda lijeÄenja oligurije može dovesti do ABO te je stoga njeno rano prepoznavanje izuzetno važno.
Bolesnici u jedinicama intenzivnog lijeÄenja s oliguriÄnim ABO su izloženi poveÄanom riziku neravnoteže tjelesne tekuÄine zbog sustavne upale, smanjenog onkotskog tlaka plazme te poveÄane kapilarne permeabilnosti. Osim toga, posebice su izloženi riziku za razvoj hipervolemije te je zbog toga restriktritvana strategija unosa tekuÄine u tih bolesnika prijeko potrebita kad god je to moguÄe.Acute kidney injury (aki) is an important clinical issue, especially in the setting of critical care. it has been shown in multiple studies to be a key independent risk factor for mortality, even after adjustment for demographics and severity of illness. there is wide agreement that a generally applicable classification system is required for aki which helps to standardize estimation of severity of renal disfunction and to predict outcome associated with this condition. thatās how rifLe (risk-injury-failure-Loss-end-stage renal disease), and akiN (acute kidney injury Network) classifications for aki were found in 2004 and 2007, espectively. in the clinical setting of heart failure, a positive fluid balance (often expressed in the literature as weight gain) is used by disease management programs as a marker of
heart failure decompensation. oliguria is defined as urine output less than 0,3 ml/kg/h for at least 24 h. since any delay in treatment can lead to a dangerous progression of the aki, early recognition of oliguria appears to be crucial. critically ill patients with oliguric aki
are at increased risk for fluid imbalance due to widespread systemic inflammation, reduced plasma oncotic pressure and increased capillary
leak. these patients are particulary at risk of fluid overload and therefore restrictive strategy of fluid administration should be used. objective, rapid and accurate volume assessment is important in undiagnosed patients presenting with critical illness, as errors may
result in interventions with fatal outcomes. the historical tools such as physical exam, and chest radiography suffer from significantlimitations. as gold standard, radioisotopic measurement of volume is impractical in the acute care enviroment. Newer technologies
offer the promise of both rapid and accurate bedside estimation of volume status with the potential to improve clinical outcomes. Blood assessment with bioimpendance vector analysis, and bedside ultrasound seem to be promising technologies for this need
The influence of erythropoietin treatment on oxidative stress parameters in cortex of rats exposed to transient middle cerebral artery occlusion
Background and Purpose: Erythropoietin (Epo) plays a central role in
process of erythropoiesis. Recently, its neuroprotective potential was reported in various experimental models of brain damage. However, the mechanism of Epo protection is still unclear. In the present study, we examined the effect of Epo administration on lipid peroxidation levels and antioxidant enzymesā (superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px)) activities in rat cortex following focal cerebral ischemia.
Material and Methods: Focal cerebral ischemia was induced in male
HanoverWistar rats (250ā350 g) by right middle cerebral artery occlusion (MCAO) model for 1 hr. After 23 hrs of reperfusion, ischemic animals were sacrificed and the levels of lipid peroxidation, SOD and GSH-Px activities were determined spectrophotometrically in the right cortex. Ischemic animals received either vehicle or Epo (5000 IU/kg, intraperitoneally) immediately or 3 hrs after MCAO, and were sacrificed 23 hrs or 21 hrs later, respectively. Sham operated, vehicle treated animals served as the control group.
Results and Conclusion: Focal cerebral ischemia significantly increased the level of oxidative lipid damage parameters in the right cortex as compared to the control group without affecting SOD and GSH-Px activities. The decrease in level of lipid peroxidation after Epo treatment was registered but it was not statistically significant. Our results indicate that focal cerebral ischemia caused neuronal damage in the right cortex and that Epo treatment was not effective in preventing above mentioned alteration
Health-related quality of life in patients on renal replacement therapy
U medicinskoj znanosti mjerenje zdravlja, praÄenje kvalitete života i kvalitete života
vezane uz zdravlje (KŽVZ) predstavljaju prihvaÄene instrumente za procjenu utjecaja bolesti i
razliÄitih postupaka lijeÄenja na bolesnikovo tjelesno ili emocionalno stanje u svakodnevnim
aktivnostima. KŽVZ predstavlja dio opÄeg koncepta kvalitete života koji se odnosi specifiÄno na
zdravlje osobe, a oznaÄava mjerenje funkcioniranja, blagostanja i opÄe percepcije zdravlja bolesnika
u tri domene: fiziÄkoj, mentalnoj i socijalnoj. Instrumenti za mjerenje KŽVZ temelje se
na konceptu zdravlja koji je viŔedimenzionalan, a izvor informacija je sam bolesnik. Mogu se
klasificirati kao generiÄki ili specifiÄni. GeneriÄki instrumenti procjenjuju koncept zdravlja koji
predstavlja temeljnu humanu vrijednost i odnose se na zdravstveno stanje i blagostanje svakog
pojedinca, neovisno o dobi, bolesti ili naÄinu lijeÄenja. SpecifiÄni instrumenti usmjereni su
na specifiÄnu bolest, stanje ili lijeÄenje. Rezultati istraživanja KŽVZ u bolesnika u zavrÅ”nom
stupnju bubrežnog zatajenja pokazali su nižu kvalitetu života kao i funkcionalni status bolesnika
u usporedbi s opÄom populacijom. Prema navedenim podacima KŽVZ predstavlja novu
mjeru ishoda lijeÄenja bolesnika na hemodijalizi. U brojnim je studijama potvrÄeno da KŽVZ,
mentalna i fiziÄka komponenta zasebno, predstavljaju nezavisne pretkazivaÄe za poveÄan rizik
od smrti i hospitalizacije bolesnika lijeÄenih nadomjeÅ”tanjem bubrežne funkcije.In the medical field health status measurement, quality of life and health-related
quality of life (HRQOL) assessment are adopted instruments to evaluate the effects that a
disease and different treatment or intervention have on patientās physical or emotional
state in everyday activities. HRQOL as the subset of overall concept of quality of life that relates
specifically to a personās health refers to the measure of the patientsā functioning,
well-being and general health perception in three domains: physical, psychological and social.
HRQOL instruments are based on multidimensional health concept, in which the source
of information is patient. Available instruments are classifiable as generic or specific. Generic
instruments assess health concepts that represent basic human values and are relevant to
everyoneās health status and well-being and are not specific for age, disease or treatment.
Specific instruments focus on the specific disease, condition or treatment. Reports on HRQOL
in end-stage renal disease patients have shown impairment of quality of life and functional
status compared with general population. There is evidence that HRQOL predicts outcomes
in hemodialysis patients. Many studies have found that HRQOL, physical and mental
components, are independent predictors for higher risk of death and hospitalization among
patients on renal replacement therapy
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