Basic endocrinological disorders in chronic renal failure

The aim of this study was to look at basic endocrinological disorders in chronic kidney disease, acquainting endocrinologists with information about the definition and classification of kidney diseases and basic metabolic disorders in uraemia. Secondary hyperparathyroidism, insulin resistance and hyperinsulinism, growth hormone disorders and the possibility of growth hormone treatment, the reasons for and the consequences of hyperprolactinaemia are presented in a practical way. Thyroid hormones management, a problem which requires further study, is portrayed extensively. Hypothalamic–pituitary–adrenal axis disorders are equally complex and not yet fully examined. We have largely concentrated on the practical aspects of diagnostics of the presented disorders.The aim of this study was to look at basic endocrinological disorders in chronic kidney disease, acquainting endocrinologists with information about the definition and classification of kidney diseases and basic metabolic disorders in uraemia. Secondary hyperparathyroidism, insulin resistance and hyperinsulinism, growth hormone disorders and the possibility of growth hormone treatment, the reasons for and the consequences of hyperprolactinaemia are presented in a practical way. Thyroid hormones management, a problem which requires further study, is portrayed extensively. Hypothalamic–pituitary–adrenal axis disorders are equally complex and not yet fully examined. We have largely concentrated on the practical aspects of diagnostics of the presented disorders

Zaburzenia funkcji hormonalnej tkanki tłuszczowej oraz zaburzenia w zakresie hormonów płciowych u chorych z przewlekłą niewydolnością nerek

The authors discussed disorders in adipocytokines’ function in chronic renal failure (CRF) and their clinical implications. Adipocytokines’ concentrations in CRF are in most cases elevated, which is associated with decreased level of their excretion. This may cause number of clinical implications such as inflammation, loss of appetite, development of protein energy wasting (PEW) syndrome and the progress of artherosclerosis, what leads to increased mortality in a group of patients with end-stage renal disease (ESRD). Disturbances in sexual hormones function are also characteristic for CRF. Disorders in fertility, sexual life and decreased quality of life are observed in patients with CRF. Therapeutic procedure is complicated and not fully effective. (Pol J Endocrinol 2012; 63 (zeszyt edukacyjny I) 7–16)Autorzy omówili w niniejszym artykule zaburzenia w funkcji hormonalnej tkanki tłuszczowej, związane z przewlekłą niewydolnością nerek, i ich implikacje kliniczne. Stężenia produkowanych przez tkankę tłuszczową adipocytokin w przewlekłej niewydolności nerek (CRF) najczęściej wzrastają, co wiąże się ze zmniejszaniem ich wydalania. Powoduje to wiele implikacji klinicznych: wzrost stanu zapalnego, spadek apetytu, rozwój zespołu wyniszczenia białkowo-energetycznego (PEW) i rozwój miażdżycy prowadzący do nadumieralności chorych ze schyłkową niewydolnością nerek (ESRD). Zaburzenia te przyczyniają się również do rozwoju zaburzeń w zakresie działania hormonów płciowych z obniżeniem jakości życia, funkcji seksualnych i rozwojem zaburzeń emocjonalnych. Postępowanie terapeutyczne jest złożone i nie do końca skuteczne. Endokrynol Pol 2012; 63 (zeszyt edukacyjny I) 7–16

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

The patient with diabetes type 2 and obesity on the peritoneal dialysis programme — case study

Cukrzycowa choroba nerek stanowi powikłanie zarówno cukrzycy typu 1, jak i typu 2. W populacji polskiej wzrasta liczba osób starszych z cukrzycą typu 2 powikłana przewlekłą choroba nerek (PChN). W przypadku progresji choroby (GFR20 ml/min/1,73 m2) zachodzi konieczność rozpoczęcia dializoterapii, a metodą z wyboru jest ciągła domowa dializa otrzewnowa (CCDO). Szczególną grupę stanowią pacjenci z otyłością, z wywiadem potwierdzającym przebyte zabiegi operacyjne, u któryc hte dwa czynniki stanowią ryzyko ograniczenia skuteczności wybranej metody leczenia. Przedstawiono opis przypadku chorego z cukrzycą typu 2 powikłaną niewydolnością nerek w poszczególnych okresach 26 lat trwania choroby (1988–2014), leczonego od 4 lat dializą otrzewnową (początkowo CCDO, a następnie ADO). Trudny proces leczenia tego pacjenta w okresie powikłań narządowych cukrzycy wymagał indywidualizacji programu leczenia. Adekwatna dializoterapia uzyskana w procesie modyfikacji schematów i technik dializoterapii nie rozwiązała jednak wszystkich problemów. Złożony charakter CChN stanowi dodatkową trudność, zwłaszcza w leczeniu starszych chorych realizujących przez wiele lat program leczenia cukrzycy i jej powikłań.The reins diabetical disease state complication both diabetes type 1 how and type 2. The number of elderly people with diabetes type 2 complicated with chronic renal disease grows up in Polish population. In case of progression of disease (GFR 20 ml/min/1.73 m2) the necessity of beginning sets the dializotherapy, and the method with choice is the continuous home peritonaeal dialysis (CHPD). Patients with obesity, with confirming interview crossed operating interventions, make up special group, at which these two factors make up the risk of limitation of effectiveness the chosen method of treatment. The diabetic patient (diabetes type 2) with obesity and chronic renal failure was being described during 26 years of duration of the disease (1988–2014), treated from 4 years with the peritonaeal dialysis (initially the CHPD, and then the ADO). He required the individualization of programme of treatment. However the adequate got in process of modification of pattern of the dialysis and the technician of the method did not solve all problems. In the treatment of older patients, especially with diabetes and renal failure, the additional difficulty is the programme of treatment of diabetes and complications

Determining the enzymatic activities of iodothyronine 5’-deiodinases in renal medulla and cortex

Wstęp: Zaburzenia hormonów tarczycy u pacjentów z przewlekłą chorobą nerek (PChN) są wynikiem zaburzeń konwersji T4 do T3. Znaczenie nerek w konwersji hormonów tarczycy nie jest w pełni poznane. Działania różnych typów dejodynaz jodotyroninowych w strukturach nerek, nie zostały jeszcze określone. Celem badań było określenie aktywności dejodynazy typu 1 (D1) i typu 2 (D2) w korze i rdzeniu nerek u chorych z rakiem nerki. Materiał i metody: Próbki kory i rdzenia nerek (10 pacjentów) lub tylko samej kory (13 pacjentów) były pobrane z przeciwnego bieguna tej samej nerki do guza , z nerek usuniętych z powodu raka. Resekcje wykonano u 23 chorych (7 kobiet i 16 mężczyzn) w wieku 52&#8211;82 lat. Wyniki: Aktywność D1 w korze nerki wynosiła 3,785 &#177; 2,041 fmol 125I/mg białka/min., a aktywność D2 wynosiła 0,236 &#177; 0,125 fmol 125I/ mg białka/min. Znaleziono silną, dodatnią korelację pomiędzy aktywnością D1 i D2 w korze nerki (r = 0,890, p < 0,001). Aktywność D1 w rdzeniu nerek wynosiła 2,157 &#177; 2,176 fmol 125I/mg białka /min., a aktywność D2 wynosiła 0,168 &#177; 0,095 fmol 125I/mg białka/min. Zaobserwowano również dodatni związek pomiędzy aktywnością D1 i D2 w rdzeniu nerek (r = 0,661, p = 0,038). Stwierdzono silną dodatnią korelację aktywności D1 w korze i rdzeniu (r = 0,794, p = 0,006) oraz brak korelacji aktywności D2 w korze i rdzeniu (r = 0,224, p = 0,553). Wnioski: Wyniki przedstawionej pracy sugerują, że aktwność dejodynaz 1 i 2 zarówno w korze jak i w rdzeniu nerki może miec wpływ na metabolizm hormonów tarczycy. To ustalenie może mieć znaczenie kliniczne dla chorych z upośledzoną funkcją nerek. (Endokrynol Pol 2013; 64 (3): 182&#8211;185)Introduction: Thyroid hormone disorders in patients with chronic kidney disease (CKD) are a result of impaired conversion of T4 to T3. The importance of kidneys in thyroid hormones conversion is not fully understood. The activities of different types of iodothyronine deiodinases in the kidney structures have not been determined yet. The aim of this study was to determine the activity of deiodinase type 1 (D1) and type 2 (D2) in renal cortex and medulla in renal cancer patients. Material and methods: Samples of renal cortex and medulla (ten patients) or renal cortex alone (13 patients) were taken from kidneys resected because of malignant cancer, from a site opposite to the cancer. Resections were performed in the 23 patients (seven female and 16 male) who were 52&#8211;82 years old. The material was stored at &#8211;72 oC. Results: Activity of D1 in renal cortex was 3.785 &#177; 2.041 fmol 125I/mg protein/minute and activity of D2 was 0.236 &#177; 0.125 fmol 125I/mg protein/minute. There was a strong positive correlation between D1 and D2 activities in renal cortex (r = 0.890, p < 0.001). Activity of D1 in renal medulla was 2.157 &#177; 2.176 fmol 125I/mg protein/minute, and activity of D2 was 0.168 &#177; 0.095 fmol 125I/mg protein/minute. A positive correlation between D1 and D2 in renal medulla (r = 0.661, p = 0.038) was observed as well. Activities of D1 in cortex and medulla were strongly and positively associated (r = 0.794, p = 0.006), whereas there was no correlation between the activities of D2 in cortex and medulla (r = 0.224, p = 0.553). Conclusions: Results presented in this study suggest that both cortical and medullary D1 and D2 may be involved in thyroid hormone metabolism. This finding could be of clinical relevance in patients with impaired renal function. (Endokrynol Pol 2013; 64 (3): 182&#8211;185

Ostry zespół sercowo−nerkowy: powrót funkcji nerek po leczeniu nerkozastępczym

Utilisation of invasive treatment in the form of elective dialysis end extracorporeal ultrafiltration as a method of complementaryto pharmacotherapy was presented by the example of the patient with acute decompensated heart failure with diagnosedcardiorenal syndrome type 1. Such procedure reduced symptoms of overhydration, restored sensitivity to oral diureticsand allow to obtain a partial return of renal function, improved prognosis and quality of life of the patient

Practical aspects of a low-protein diet

The updated 2020 Kidney Disease Outcome Quality Initiative (KDOQI) guidelines resulted in an increased interest in the use of a low-protein diet in patients with chronic kidney disease. In Poland, from March 2021, patients can be enrolled, provided that they meet certain criteria, into the therapeutic program including the use of a low-protein diet and ketonanalogues of aminoacids. However, it is very important to properly educate medical personnel and patients so that the KDOQI recommendations are implemented in clinical practice and bring benefits by slowing the progression of the chronic kidney disease