Kości i nerki. Szkielet czy centrum metaboliczne?

Od dawna uważano, że kości stanowią podporę i szkielet organizmu, jednak pełnią one również wiele innych funkcji. Wyniki intensywnych badań przeprowadzonych u zwierząt i ludzi udowodniły, że tkanka kostna jest mocno zaangażowana w procesy metaboliczne nie tylko lokalne, ale i obwodowe. Osteokalcyna — polipeptyd wydzielany przez osteoblasty — stała się obiektem zainteresowania z uwagi na jej związek z adiponektyną oraz działaniem pośrednim i bezpośrednim na komórki beta trzustki. Efektem jej działania jest między innymi obniżenie insulinooporności. U chorych z przewlekłą chorobą nerek zawsze jest zachwiany metabolizm kostny. Niewykluczone, że osteokalcyna i inne peptydy wydzielane przez kości pełnią w tej chorobie istotną rolę w łańcuchu patofizjologicznym, którego konsekwencją są zdarzenia sercowo- -naczyniowe i dalsza progresja choroby. Forum Nefrologiczne 2011, tom 4, nr 1, 1–

Pacjenci wysokoimmunizowani jako problem dzisiejszej transplantologii — opis przypadku i przegląd literatury

Udowodniono, że przeszczepienie nerki jest najlepszą metodą leczenia nerkozastępczego. W grupie oczekujących na przeszczepienie nerki coraz większy odsetek stanowią biorcy wysokoimmunizowani, czyli tacy, u których przeciwciała limfocytotoksyczne (PRA) liczą 80% i więcej. Czas oczekiwania na dawcę w tej grupie jest najdłuższy. By uniknąć nadmiernego oczekiwania, podejmowane są działania mające usunąć krążące przeciwciała przeciw dawcy (DSA) i ograniczyć ich produkcję. Postępowanie to jest zwane desensytyzacją (odczulaniem). W artykule omówiono dostępne metody desensytyzacji, ich skuteczność i działania niepożądane. Opisano również przypadek czwartej transplantacji nerki u pacjentki wysokoimmunizowanej — jako problem, z którym medycyna ma coraz częściej do czynienia

Pacjent przewlekle dializowany z podejrzeniem zespołu Wiskotta-Aldricha — opis przypadku

Wiskott-Aldrich Syndrome (WAS) is a rare,X-linked recessive disorder. This genetic diseaseconcernschanges in a specific cytoplasmicprotein (WASp) mainly expressed inhematopoieticstem cells. The missense mutationsin the WASp gene lead to severeimmunodeficiencyand trombocytopenia. The case presentsa young patient with suspicion ofWAS.The clinical course was complicated and fatalin prognosis as the patient developedrecurrentinfections, trombocytopenia, renal insufficiencyand dissection of aorta. Wehighlight the importancefor seeking potential underlying causes incase of unexplainedtrombocytopenia coexistingwith renal insufficiency.Zespół Wiskotta-Aldricha (WAS) jest rzadką chorobądziedziczoną recesywnie, sprzężoną z chromosomemX. Zaburzenie dotyczy genu dla białka o tej samej nazwie(WASp), którego ekspresja ujawnia się w komórkachkrwiotwórczych. Efektem są zaburzenia odpornościz towarzyszącą trombocytopenią. Zaprezentowanoopis przypadku pacjenta, u którego podejrzewano WAS.U opisywanego chorego już w dzieciństwie występowałynawracające infekcje bakteryjne, postępująca małopłytkowośći niewydolność nerek. Na ostateczny niekorzystnyprzebieg choroby i zgon chorego wpłynęłopowikłanie w postaci tętniaka rozwarstwiającego aorty.Autorzy zwracają uwagę na konieczność poszukiwaniaprzyczyn niewyjaśnionej małopłytkowości u pacjentówz przewlekłą chorobą nerek

Preparation of the donor to the removal of organs — the most common clinical problems

Przeszczepienie narządu to najskuteczniejsza metoda leczenia, gdy dochodzi do jego niewydolności. W procesie transplantacji ważne jest przygotowanie dawcy tak, aby możliwe było pobranie wielonarządowe. Na przeszkodzie temu stoi wiele procesów patofizjologicznych rozwijających się po śmierci mózgu. W części przypadków mają one bezpośredni związek z powstającą „burzą cytokinową”, a część problemów wynika z samego pobytu dawcy na oddziale intensywnej terapii — zwiększa się ryzyko rozwoju zakażeń szpitalnych. W pracy zaprezentowano najczęstsze problemy stojące na przeszkodzie pobrania jak największej liczby narządów w celu ocalenia życia innym pacjentom.An organ transplantation is the most effective method of treatment when the organ is becoming insuficient. In the process of the transplant arrangements it’s important to prepare donor for multiorgan donation. Many pathophysiological processes after the brain death making it imposible. In some cases those disorders are caused by cytokines and in the others higher risk of nosocomial infection during the treatment in ICU. In this article were presented the most common problems of multiorgan donation, which make donation impossible or less effective

Expression of KIM-1, VEGF and bFGF in the transplanted kidney as predictive factors of kidney allograft function

Introduction: Transplantation is now a common treatment for kidney failure. However, it is associated with numerous complications, among which is rejection. Currently, factors that can predict the function of the transplanted kidney are being sought. This study aimed to investigate whether the expression of KIM-1 (kidney injury molecule-1), VEGF (vascular endothelial growth factor) and bFGF (basic fibroblast growth factor) assessed in the transplanted kidney before transplantation can be a predictive marker of the later function of the transplanted kidney and the occurrence of complications such as delayed graft function (DGF) and acute rejection (AR). Material and methods: The study group included 44 kidney allograft recipients who underwent kidney transplantation. Results: There were no statistically significant correlations between KIM-1, VEGF and bFGF gene expression in transplanted kidney biopsies and the occurrence of DGF and AR. The expression of the bFGF gene correlated significantly with the creatinine levels before and on the first day after transplantation. There were no statistically significant correlations between creatinine levels and expression of the KIM-1 and VEGF genes. There was also no statistically significant correlation between bFGF, KIM-1 and VEGF gene expression in the transplanted kidney and later eGFR and diuresis values. A statistically significant negative correlation was found between bFGF and serum potassium levels before transplantation and up to one month after transplantation. KIM-1 expression correlated significantly negatively with pre-transplant serum potassium levels. VEGF expression correlated significantly negatively with potassium levels 2 and 24 months after transplantation. Conclusions: The present results suggest that the expression of KIM-1, VEGF and bFGF assessed in the transplanted kidney before transplantation is not a significant predictor of the later function of the transplanted kidney. The expression of the bFGF gene correlates with the creatinine levels before and on the first day after transplantation. The expression of KIM-1, VEGF and bFGF may correlate with potassium serum levels

The risk of an epidemic outbreak in southern Ukraine

The humanitarian crisis that followed the military aggression against Ukraine is getting worse. The war which has continued since February 2022 has already caused irreparable health damage in the local community, which is affected by such acts of Russian terror as the destruction of the Kakhovka dam on the Dnieper River. As a result of the explosion and destruction of the dam, which occurred on 6 June 2023, over 2,500 square kilometres of land were flooded and around 17,000 residents had to be evacuated

The Role of Endocan in Selected Kidney Diseases

Endocan, previously referred to as an endothelial-cell-specific molecule-1 (ESM-1) is a member of a proteoglycan family that is secreted by vascular endothelial cells of different organs, mainly lungs and kidneys. It is assumed to participate in endothelial activation and the triggering of inflammatory reactions, especially in microvasculatures. Thanks to its solubility in human fluids, i.e., urine and blood plasma, its stability and its low concentrations in physiological conditions, endocan has been proposed as an easily available, non-invasive biomarker for identifying and predicting the course of many diseases. Recently, endocan has been studied in relation to kidney diseases. In general, endocan levels have been linked to worse clinical outcomes of renal dysfunction; however, results are conflicting and require further evaluation. In this review, authors summarize available knowledge regarding the role of endocan in pathogenesis and progression of selected kidney diseases

The Role of MicroRNAs in Selected Forms of Glomerulonephritis

Glomerulonephritis (GN) represents a collection of kidney diseases characterized by inflammation within the renal glomeruli and small blood vessels. The lesions that occur in other nephron structures mainly result from the harmful effects of proteinuria. In recent years, an emphasis has been placed on gaining a better insight into the pathogenesis and pathophysiology of GN in order to facilitate diagnoses and provide efficient and targeted treatments of the disease. Owing to the advanced molecular and genetic diagnostic techniques available today, researchers have been able to elucidate that most cases of GN are determined by genetic risk factors and are associated with the abnormal functioning of the immune system (the immunologically mediated forms of GN). MicroRNAs (miRNAs) are a group of single-stranded, non-coding molecules, approximately 20 nucleotides in length, that act as regulatory factors in the post-transcriptional processes capable of regulating the expression of multiple genes. In this paper we present the available research aiming to determine effects of miRNAs on the development and progression of GN and discuss the potential role of miRNAs as new diagnostic markers and therapeutic targets

Assessment of Selected Anthropometric Parameters Influence on Balance Parameters in Children

Background and Objectives: Balance is the ability of an organism to maintain its position in space. Balance disorders in children can lead to injuries and limited physical activity. Balance maintenance changes throughout puberty as well as in response to external factors. The study aimed to evaluate the influence of anthropometric parameters on balance in children aged 10 to 13 years. Materials and Methods: 308 children were accessed to eligibility to participate in the study. After considering the inclusion and exclusion criteria the study included 223 participants (123 boys and 100 girls) aged 10 to 13 from elementary schools in Szczecin. The stabilometry of examineted children was performed using the SIGMA balance platform. Results: It was shown that the balance parameters in children aged 10 to 13 worsen with increasing body mass and height, and do not correlate with age. Conclusions: Rapid diagnosis and identification of postural disorders in children make it possible to start targeted physical exercises and to make the therapeutic process more effective and complex. Future research is needed to obtain more data and draw conclusions crucial for physiotherapy practice