Chory dializowany otrzewnowo z upośledzeniem ultrafiltracji

Spadek ultrafiltracji należy do najważniejszych problemów klinicznych dializy otrzewnowej. Jest też wskaźnikiem nieadekwatnej dializy, w wielu przypadkach źle rokującym pod względem możliwości kontynuacji tej formy leczenia nerkozastępczego. W niniejszej pracy wymieniono przyczyny zaburzeń ultrafiltracji. Przedstawiony opis przypadku zaburzeń ultrafiltracji dotyczy pacjentki pozostającej od 10 lat w programie dializy otrzewnowej, u której z czasem rozwinęła się nadprzepuszczalność otrzewnej. Odnosząc się do opisanego przypadku, wskazano kryteria rozpoznania zaburzeń ultrafiltracji, przedstawiono metody diagnostyczne w tym zakresie i zaproponowano algorytm postępowania diagnostycznego, a także możliwości postępowania terapeutycznego. Forum Nefrologiczne 2010, tom 3, nr 2, 101-10

Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients

During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21–87) years; median time on PD 19 (3–100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores (αu), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters—rather than solute transport parameters—are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane

Effects of a recombinant gene expression on ColE1-like plasmid segregation in Escherichia coli

<p>Abstract</p> <p>Background</p> <p>Segregation of expression plasmids leads to loss of recombinant DNA from transformed bacterial cells due to the irregular distribution of plasmids between the daughter cells during cell division. Under non-selective conditions this segregational instability results in a heterogeneous population of cells, where the non-productive plasmid-free cells overgrow the plasmid-bearing cells thus decreasing the yield of recombinant protein. Amongst the factors affecting segregational plasmid instability are: the plasmid design, plasmid copy-number, host cell genotype, fermentation conditions etc. This study aims to investigate the influence of transcription and translation on the segregation of recombinant plasmids designed for constitutive gene expression in <it>Escherichia coli </it>LE392 at glucose-limited continuous cultivation. To this end a series of pBR322-based plasmids carrying a synthetic human interferon-gamma (hIFNγ) gene placed under the control of different regulatory elements (promoter and ribosome-binding sites) were used as a model.</p> <p>Results</p> <p>Bacterial growth and product formation kinetics of transformed <it>E. coli </it>LE392 cells cultivated continuously were described by a structured kinetic model proposed by Lee et al. (1985). The obtained results demonstrated that both transcription and translation efficiency strongly affected plasmid segregation. The segregation of plasmid having a deleted promoter did not exceed 5% after 190 h of cultivation. The observed high plasmid stability was not related with an increase in the plasmid copy-number. A reverse correlation between the yield of recombinant protein (as modulated by using different ribosome binding sites) and segregational plasmid stability (determined by the above model) was also observed.</p> <p>Conclusions</p> <p>Switching-off transcription of the hIFNγ gene has a stabilising effect on ColE1-like plasmids against segregation, which is not associated with an increase in the plasmid copy-number. The increased constitutive gene expression has a negative effect on segregational plasmid stability. A kinetic model proposed by Lee et al. (1985) was appropriate for description of <it>E. coli </it>cell growth and recombinant product formation in chemostat cultivations.</p

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Gammapatia monoklonalna o znaczeniu nerkowym – trudności diagnostyczne i terapeutyczne

The term monoclonal gammopathy of renal significance mGrS means a group of renal diseases re-sulting from the presence of the monoclonal protein produced by plasmatic cells or other clones of B cells. The patients with MGRS do not fulfill the diagnostics criteria both of multiple myeloma and other neoplasm originating from B cells. The involvement of different renal structures in the course of mGrS results the dysfunction of kidneys. The monoclonal protein may injure the glomerular struc-tures (including vascular) as well as tubular structures (interstitial in more wide sense). The early di-agnosis of mGrS is difficult and the late detection of the disease is connected with high risk of irre-versible renal damage. Therefore, the multidisciplinary cooperation – including general practitioners, nephrologists, hematologists and nephro-pathologists – is particularly important for the diagnostics and treatment of mGrS cases. This new hemato-nephrological meta-disease entity is connected with relatively high morbidity and mortality as well as relapses in transplanted kidney. The decision of the treatment initiation against the toxic clone in mGrS cases results mainly from the nephrological rea-sons. The article presents current diagnostic and therapeutic possibilities that may be used in mGrS patients. The main purpose of this article was to present the current state of knowledge regarding the diagnostics and treatment of MGRS.Termin gammapatia monoklonalna o znaczeniu nerkowym (MGRS, monoclonal gammopathy of renal significance) dotyczy grupy chorób nerek będącej skutkiem obecności białka monoklonalnego wydzielanego przez komórki plazmatyczne bądź inne klony komórek B. Chorzy, u których rozpoznaje się MGRS, nie spełniają kryteriów diagnostycznych szpiczaka plazmocytowego, a także innych nowotworów wywodzących się z komórek B. Dysfunkcja nerek związana z MGRS wynika z zajęcia różnych ich struktur. Białko monoklonalne może uszkadzać zarówno struktury kłębuszka nerkowego (także naczynia), jak i cewek nerkowych (szerzej – śródmiąższ). Wczesne rozpoznanie MGRS sprawia trudności diagnostyczne, natomiast późne wykrycie jest obarczone dużym ryzykiem nieodwracalnego uszkodzenia nerek. Ta nowa metajednostka hematonefrologiczna wiąże się z relatywnie wysoką zachorowalnością i śmiertelnością, w tym z nawrotami w przeszczepionej nerce. Z tego względu istotne znaczenie w poprawie skuteczności diagnostyki i leczenia chorych z MGRS ma współpraca wielospecjalistyczna – szczególnie obejmująca lekarzy rodzinnych oraz nefrologów, hematologów i nefropatologów. W przypadku MGRS podjęcie decyzji o leczeniu przeciwko toksycznemu klonowi wynika głównie z przesłanek nefrologicznych. W artykule przedstawiono aktualne możliwości zarówno diagnostyczne, jak i terapeutyczne u chorych z MGRS. Praca ma na celu przedstawienie aktualnego stanu wiedzy dotyczącego możliwości w zakresie diagnostyki i leczenia MGRS

Acute kidney failure complicating carbon monoxide poisoning

 BACKGROUND: Carbon monoxide, albeit common, is rarely associated with renal failure. We report a case of CO-associated kidney failure requiring short-term dialysis.CASE REPORT: A 33 year-old male was found unconscious in a bathroom equipped with a propane-gas heater. The duration of exposure to carbon monoxide was unknown. The patient was transported to a regional hyperbaric centre; the carboxyhaemoglobin concentration in the blood on admission was 38.3%. After 60 min of exposure to hyperbaric oxygen, he regained consciousness and was transferred to the toxicology department. Mild rhabdomyolysis with acute kidney failure was diagnosed and despite two subsequent hyperbaric sessions, haemodialysis was necessary. The kidney failure resolved within two weeks, and the patient made a full recovery.DISCUSSION AND CONCLUSIONS: Carbon monoxide mainly affects the central nervous system and the myocardium; renal failure may occur due to rhabdomyolysis and hypoxia. Therefore, all CO-poisoned patients should be closely monitored for their renal function. BACKGROUND: Carbon monoxide, albeit common, is rarely associated with renal failure. We report a case of CO-associated kidney failure requiring short-term dialysis.CASE REPORT: A 33 year-old male was found unconscious in a bathroom equipped with a propane-gas heater. The duration of exposure to carbon monoxide was unknown. The patient was transported to a regional hyperbaric centre; the carboxyhaemoglobin concentration in the blood on admission was 38.3%. After 60 min of exposure to hyperbaric oxygen, he regained consciousness and was transferred to the toxicology department. Mild rhabdomyolysis with acute kidney failure was diagnosed and despite two subsequent hyperbaric sessions, haemodialysis was necessary. The kidney failure resolved within two weeks, and the patient made a full recovery.DISCUSSION AND CONCLUSIONS: Carbon monoxide mainly affects the central nervous system and the myocardium; renal failure may occur due to rhabdomyolysis and hypoxia. Therefore, all CO-poisoned patients should be closely monitored for their renal function

The Nephrotoxicity of Drugs Used in Causal Oncological Therapies

In recent years, a dynamic development of oncology has been observed, resulting from the increasingly frequent occurrence of neoplasms and therefore, increasing population of patients. The most effective form of therapy for cancer patients is complex multidisciplinary specialized disease management, including nephro-oncology care. Different forms of renal function impairment are frequently diagnosed in cancer patients. They are caused by different co-morbidities existing before starting the oncologic treatment as well as the direct undesirable effects of this therapy which may cause temporary or irreversible damage of the urinary system—especially kidneys. According to different therapeutic programs, in such cases the degree of renal damage is often crucial for the possibility of further anti-cancer treatment. Medical personnel responsible for delivering care to oncology patients should be properly educated on current methods of prevention and treatment of renal complications resulting from anti-cancer therapy. The development of oncologic medicines design, including especially immuno-oncological agents, obliges us to learn new patomechanisms determining potential adverse effects, including renal complications. This publication is focused on the most important undesirable nephrotoxic effects of the frequently used anti-cancer drugs

Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients

During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21-87) years; median time on PD 19 (3-100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores ( u ), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, u was higher. Thus, fluid transport parameters-rather than solute transport parameters-are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane