The influence of hypothyroidism and substitution treatment on thyroid hormone conversion ratios and rT3 concentration in patients with end-stage renal failure

Introduction: The increasing number of patients with end-stage renal disease (ESRD) requires seeking new opportunities to improve their quality of life, not only because of kidney disease but also due to other disturbances, such as thyroid hormone disorders. The objective of the study was to evaluate the influence of coexisting hypothyroidism and thyroid hormone therapy in patients with ESRD on thyroid hormone conversion ratios and rT3 concentration. Material and methods: The study involved 85 patients aged 26 to 87 years, with a mean age of 59.62 ± 15.45 years. Four groups of patients were examined: G1 group — 25 persons without RF and hypothyroidism, G2 — 26 patients with ESRD treated with haemodialysis (HD), G3 — 12 patients with ESRD treated with HD and newly diagnosed hypothyroidism, and G4 — 22 HD patients with hypothyroidism treated with thyroid hormones substitution. The concentrations of TSH, T4, T3, fT4, fT3, and rT3 were measured and the fT3/fT4, T3/T4, and rT3/T4 conversion ratios and rT3/T3 ratio were calculated. Concentrations of protein, hsCRP, Hg, and blood gases were also checked; the anion gap was calculated. Results: Patients from group G1 through G2 to G3 were older (ptrend = 0.002), with lower Hb level (ptrend < 0.001), with lower pH (ptrend < 0.001), with increased anion gap (ptrend < 0.013) and CRP concentrations (ptrend < 0.001), and decreased total protein level (ptrend < 0.001). There were increased TSH values (ptrend < 0.001) and lower T4 (ptrend = 0.024), fT3 (ptrend < 0.001), T3 (ptrend < 0.001), and rT3 (ptrend = 0.008) levels. rT3/T3 ratio did not change, the rT3/T4 ratio tended to decrease (ptrend = 0.065) similarly to T3/T4 ratio (ptrend = 0.063), and the fT3/fT4 ratio also decreased (ptrend = 0.005). It seems that the treatment of thyroid disease in patients with renal failure, treated with haemodialysis, is not associated with change of rT3 and conversion factor levels. Conclusions: The concentration of rT3 in HD patients in relation to healthy persons tends to decrease, and hypothyroidism increases this tendency in these patients. Hormone substitution treatment does not eliminate the influence of RF on inhibition of rT3 production. In patients with ESRD, hypothyroidism additionally reduces the conversion of thyroid hormones examined by fT3/fT4 and to a lesser extent T3/T4 ratios

Treatment of autosomal dominant polycystic kidney disease — current status

Autosomalnie dominująca wielotorbielowatość nerek (ADKPD) jest najczęstszą genetycznie uwarunkowaną chorobą nerek, występującą z częstością 1:1000 urodzeń. Przyjmuje się, że 10% osób poddanych leczeniu nerkozastępczemu z powodu schyłkowej niewydolności nerek choruje na ADPKD. Celem niniejszej pracy jest omówienie aktualnego stanu wiedzy na temat leczenia i postępowania z chorymi na ADPKD.Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetically determined kidney disease, with an incidence of 1:1000 births. 10% of end stage renal disease that require renal replacement therapy is caused by ADPKD. The aim of this paper is to review current status of treatment and management of ADPKD patients

Natural history of intracranial aneurysms in autosomal dominant polycystic kidney disease

Autosomal-dominant polycystic kidney disease (ADPKD) is a relatively frequent genetic disorder that is associated with increased prevalence of intracranial aneurysms (IAs). However, evidence on the natural history of IAs in ADPKD is suboptimal. That leads to difficulties in development of recommendations on surveillance on patients with IAs in their medical history, or the need for repeat imaging for IAs in those with a negative result of the initial screening. The aim of the article is to present our experience on the natural history of IAs in ADPKD patients. Material and methods Thirty-four ADPKD patients, managed at our outpatient department, with imaging for intracranial aneurysms performed at least twice, were included into present retrospective analysis. Results Among 8 patients with an IA in their medical history, no new IA was observed during 93 patient-years of follow-up. In 6 patients with untreated, unruptured IAs, IA growth was observed in 2 cases during 32 patient-years of follow-up. Finally, among 20 patients with a negative result of initial screening, 2 new IAs were noticed during 115 patient-years of follow-up, including 1 patient with a positive family history for an IA, and 1 patient without a family history. Conclusions Our observations support repeat imaging for IAs in patients with ADPKD, positive family history of IA, and negative result of initial screening. Additionally, efforts should be made to develop clinical and/or laboratory risk factors for IAs development in ADPKD patients without family history of IA, which enable to identify patients who should undergo repeat imaging for IAs

miRNA-16 as a predictive factor for intracranial aneurysms in autosomal dominant polycystic kidney disease

Introduction. Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic renal disorder. It leads to multiple extra-renal complications, with intracranial aneurysms (IA) among the most serious. Biological markers could become tools in identifying patients at risk of an IA. MicroRNAs 16 (miR-16) and 25 (miR-25) have been proposed as being markers of IAs in the general population. In the current study, we attempted to discover if they may also be considered markers of IAs in ADPKD. Material and methods. 64 renal transplant recipients with ADPKD were included. After magnetic resonance angiography of the brain, they were divided into a case group (IA+, n = 13) and a control group (IA-, n = 51). Expression of miRNAs in plasma was analysed by qRT-PCR. Results. The expression of miR-16 was higher in the control (IA-) group. There was no statistically significant difference between the groups in terms of miR-25 expression. Conclusions and clinical implications. MicroRNA-16 is a potential marker of IAs in renal transplant recipients with ADPKD. It may become a tool to identify patients who should undergo screening for an IA

Principles of management of patients with autosomal dominant polycystic kidney disease (ADPKD), candidates for kidney and/or liver transplantation — recommendations of the PTT Working Group, part II

These guidelines address management of patients with autosomal dominant polycystic kidney disease who are candidates for kidney and/or liver transplantation. The guidelines include such issues as qualifying for transplantation, indications for nephrectomy, indications for simultaneous kidney and liver transplantation, qualification of a living donor, and qualification for renal replacement therapy in patients with a failing transplanted kidney

Clostridium Difficile Infection in Transplant Recipients

Abstract: Infections belong to most common complications of immunosuppressive therapy used in transplant recipients, and the treatment of infections increases the risk for Clostridium difficile infection (CDI) in this group. As a result, CDI is one of the most common reasons of diarrhea in this population. Additionally, it may lead to serious complications, including death. Therefore, CDI should be included into the differential diagnosis in every case of diarrhea in a transplant recipient. The aim of the article is to review on the pathogenesis, clinical manifestations, diagnostics, and treatment of CDI in the recipients of solid organ transplantation