17 research outputs found
HEPATITIS C VIRUS AND CHRONIC PROGRESSIVE KIDNEY DISEASE GUIDELINES FOR DETECTION, EVALUATION, TREATMENT AND PREVENTION OF INFECTION TRANSMISSION IN HEMODIALYSIS UNITS; PROCEDURE FOR INFECTED PATIENTS-CANDIDATES FOR KIDNEY TRANSPLANTATION AND PROCEDURE FOR PATIENTS SUSPECTED OF HCV INFECTION-RELATED KIDNEY DISEASE
Infekcije s virusom hepatitisa C (HCV) pripadaju u relativno Äeste komplikacije kod bolesnika koji se dugotrajno lijeÄe dijalizom. U postupniku su prikazane smjernice za seroloÅ”ku i molekularnu dijagnostiku hepatitisa C u bolesnika s kroniÄnom bolesti bubrega, preporuke za lijeÄenje HCV infekcije u tih bolesnika i prevenciju prijenosa HCV u jedinicama za hemodijalizu. U posebnom su poglavlju navedene upute za postupak s bolesnicima koji su inficirani s HCV prije i nakon transplantacije bubrega. U posebnom poglavlju dane su smjernice za lijeÄenje bolesti bubrega koje su posljedica HCV infekcije.Hepatitis C virus (HCV) infection is a relatively frequent complication among long-term dialysis patients. The paper presents guidelines for serologic and molecular diagnosis of hepatitis C in patients with chronic kidney disease, recommendations for the treatment of HCV infection in these patients and the prevention of transmission of HCV in hemodialysis units. A separate chapter provides guidance on the management of patients who are infected with HCV before and after kidney transplantation, and guidelines for the treatment of renal disease resulting from HCV infection
Bone mineral density in adolescents with chronic kidney disease: a follow-up study
Cilj istraživanja jest odrediti promjenu koÅ”tane gustoÄe u bolesnika adolescentne dobi s kroniÄnim zatajenjem bubrega i odrediti utjecaj visine i težine, odnosno veliÄine skeleta na koÅ”tanu gustoÄu. U ispitivanju je sudjelovalo 30 bolesnika, prosjeÄne dobi 13,5Ā±3,5 godina. Svim ispitanicima denzitometrijski je odreÄena mineralna gustoÄa kosti na kralježnici i cijelom skeletu metodom dvoenergetske apsorpciometrije X zraka (DXA). Laboratorijski su odreÄeni kalcij, fosfor i PTH u serumu i izraÄunat je klirens kreatinina. ProsjeÄno vrijeme izmeÄu poÄetnoga i kontrolnoga mjerenja bilo je 15,7 mjeseci. UtvrÄenje znaÄajan porast visine i težine u ispitanika, ali su u oba mjerenja antropometrijske varijable bile ispod referentnoga prosjeka (Z vrijednost za visinu i težinu < -1). Mineralna gustoÄa skeleta na kralježnici i cijelom skeletu je takoÄer znaÄajno porasla izmeÄu dva mjerenja, ali nakon korekcije prema visini i težini, taj porast viÅ”e nije bio znaÄajan. Zato je kod djece s kroniÄnim zatajenjem bubrega potrebno izvrÅ”iti korekciju koÅ”tane gustoÄe u odnosu na njihovu visinu i težinu, obzirom daje brzina njihovoga
rasta usporena.The aim of this follow-up study was to analyze the change of bone mineral density in adolescents with chronic kidney disease and to determine the influence of height, weight and bone size on bone density The study included 30 patients, aged 13.513.5 years. Regular biochemistry included serum calcium, phosphorus and PTH. Bone mineral density (BMD) was measured by dual energy absorptiometry (DXA). The mean time between baseline and follow up measurements was 15.7 months. Despite the significant increase in weight and height in all participants, anthropometric variables were below one standard deviation from reference values in both measurements (Z value < -1, for height and weight). After correction for height and weight, the increase of BMAD between two measurements was not significant. It is necessary to correct the bone density for height and weight in children with chronic kidney disease, due to their retarded growth velocity
Bone mineral density in adolescents with chronic kidney disease: a follow-up study
Cilj istraživanja jest odrediti promjenu koÅ”tane gustoÄe u bolesnika adolescentne dobi s kroniÄnim zatajenjem bubrega i odrediti utjecaj visine i težine, odnosno veliÄine skeleta na koÅ”tanu gustoÄu. U ispitivanju je sudjelovalo 30 bolesnika, prosjeÄne dobi 13,5Ā±3,5 godina. Svim ispitanicima denzitometrijski je odreÄena mineralna gustoÄa kosti na kralježnici i cijelom skeletu metodom dvoenergetske apsorpciometrije X zraka (DXA). Laboratorijski su odreÄeni kalcij, fosfor i PTH u serumu i izraÄunat je klirens kreatinina. ProsjeÄno vrijeme izmeÄu poÄetnoga i kontrolnoga mjerenja bilo je 15,7 mjeseci. UtvrÄenje znaÄajan porast visine i težine u ispitanika, ali su u oba mjerenja antropometrijske varijable bile ispod referentnoga prosjeka (Z vrijednost za visinu i težinu < -1). Mineralna gustoÄa skeleta na kralježnici i cijelom skeletu je takoÄer znaÄajno porasla izmeÄu dva mjerenja, ali nakon korekcije prema visini i težini, taj porast viÅ”e nije bio znaÄajan. Zato je kod djece s kroniÄnim zatajenjem bubrega potrebno izvrÅ”iti korekciju koÅ”tane gustoÄe u odnosu na njihovu visinu i težinu, obzirom daje brzina njihovoga
rasta usporena.The aim of this follow-up study was to analyze the change of bone mineral density in adolescents with chronic kidney disease and to determine the influence of height, weight and bone size on bone density The study included 30 patients, aged 13.513.5 years. Regular biochemistry included serum calcium, phosphorus and PTH. Bone mineral density (BMD) was measured by dual energy absorptiometry (DXA). The mean time between baseline and follow up measurements was 15.7 months. Despite the significant increase in weight and height in all participants, anthropometric variables were below one standard deviation from reference values in both measurements (Z value < -1, for height and weight). After correction for height and weight, the increase of BMAD between two measurements was not significant. It is necessary to correct the bone density for height and weight in children with chronic kidney disease, due to their retarded growth velocity
OUTCOME OF RENAL TRANSPLANTATION IN PATIENTS WITH CHRONIC VIRUS HEPATITIS
Cilj rada bio je pokazati rezultate lijeÄenja transplantacijom bubrega bolesnika s terminalnim zatajenjem funkcije bubrega lijeÄenih dijalizom s kroniÄnim C/B virusnim hepatitisom. Retrospektivno smo analizirali rezultate transplantacijskog lijeÄenja tih bolesnika od 1985. do 2009. godine u KBC-u Zagreb: funkciju i preživljenje transplantiranog bubrega, preživljenje bolesnika, jetrenu funkciju, te komplikacije transplantacijskog lijeÄenja: epizode akutnog odbacivanja, pojavnost dijabetesa melitusa, te proteinurije. Analizirali smo podatke transplantacijskog lijeÄenja 91 bolesnika, od toga 50 muÅ”karaca i 41 žene, prosjeÄne dobi 40,9 godina, prethodno lijeÄenih dijalizom 7,8 godina, a prosjeÄno praÄenje nakon transplantacije iznosilo je 7,3 godine. NajÄeÅ”Äe dijagnoze koje su dovele do kroniÄnog zatajenja funkcije bubrega bile su: kroniÄni glomerulonefritis, refluks nefropatija, tubulointersticijski nefritis, hipoplazija/aplazija bubrega i policistiÄna bolest bubrega. 59,5% bolesnika imalo je dobru funkciju transplantiranog bubrega (serumski kreatinin do 200 umol/L). JednogodiÅ”nje preživljenje transplantiranog bubrega iznosilo je 93%, 5-godiÅ”nje 64%, 10-godiÅ”nje 39%. JednogodiÅ”nje preživljenje bolesnika iznosilo je 98%, 5-godiÅ”nje 72%, 10-godiÅ”nje 42%. Uredne vrijednosti jetrenih enzima (AST, ALT) imalo je 61% bolesnika, dok su poviÅ”ene vrijednosti zabilježene u 39% bolesnika. Epizode akutnog odbacivanja transplantiranog bubrega imalo je 56% bolesnika. Proteinurija je zabilježena u 27% bolesnika, dijabetes melitus u 18%, dok je poviÅ”ene vrijednosti arterijskog tlaka imalo 66% bolesnika. Bolesnici s kroniÄnim virusnim C/B hepatitisom lijeÄeni transplantacijom bubrega imali su loÅ”ije preživljenje transplantata, bolesnika, loÅ”iju funkciju transplantata no bolesnici bez kroniÄnog virusnog hepatitisa. Razlozi su veÄa uÄestalost epizoda akutnog odbacivanja transplantiranog organa, a prema podacima iz literature i veÄa uÄestalost infekcija (bakterijske infekcije, sepse), ÄeÅ”Äe i dulje hospitalizacije, veÄa uÄestalost malignih bolesti, te ÄeÅ”Äa kroniÄna alograft nefropatija. NajÄeÅ”Äi uzroci smrti bili su kardiovaskularne i cerebrovaskularne bolesti, te jetrena ciroza.The objective is to present results of renal transplantation in patients with end-stage renal disease and chronic virus C/B hepatitis. We retrospectively reviewed outcome of transplantation in patients having received renal allograft from 1985 to 2009 at Zagreb University Hospital Center: graft function, graft and patient survival, hepatic function, and complications of transplantation, i.e. episodes of acute rejection, manifestation of diabetes mellitus, and proteinuria. There were 91 patients, 50 men and 41 women, mean age 40.9. Patients were previously treated with dialysis for 7.8 years, with the mean follow-up after transplantation of 7.3 years. The most frequent diagnoses of end-stage renal disease were chronic glomerulonephritis, reflux nephropathy, tubulointerstitial nephritis, renal hypoplasia/aplasia, and polycystic renal disease. Good graft function (creatinine 200 Ī¼mol/L) was recorded in 59.5% of patients. One-year, 5-year and 10-year graft survival was 93%, 64% and 39%, and 1-year, 5-year and 10- year patient survival after transplantation was 98%, 72% and 42%, respectively. Normal values of liver chemistry (AST, ALT) were found in 59.5% and elevated values in 40.5% of patients. Episodes of acute rejection occurred in 56% of patients. Proteinuria was recorded in 27%, diabetes mellitus in 18% and elevated blood pressure in 66% of patients. Patients with chronic C/B virus hepatitis having undergone renal transplantation had worse graft function and worse graft and patient survival than patients without chronic hepatitis. The most common causes of death were cardiovascular diseases, cerebrovascular diseases and cirrhosis hepatitis
Henoch-Schƶnlein purpura nephritis in children: experience of the two tertiary care centers for pediatric and adolescent rheumatology of the Republic of Croatia from 2006 to 2017
Cilj istraživanja: Valjalo je utvrditi vrste bubrežnih komplikacija, indikacije za biopsiju, naÄine lijeÄenja te moguÄe ishode u bolesnika s Henoch-Schƶnleinovim purpurnim nefritisom (HSPN). Ispitanici i metode: Retrospektivna analiza podataka bolesnika s Henoch Schƶnleinovom purpurom (HSP) lijeÄenih u Klinikama za pedijatriju KliniÄkoga bolniÄkog centra Zagreb i KliniÄkoga bolniÄkog centra Split, u razdoblju od 2006. do 2017. godine, u kojih se razvila bubrežna bolest prema kriterijima EULAR/PRINTO/PRES-a. Rezultati: Od 378 bolesnika s HSP-om u 81 (21,4%) razvila se bubrežna bolest, u 43 djeÄaka (53,1%) i 38 djevojÄica (46,9%), s medijanom dobi 8,4 godine (2,5 ā 16,8). UoÄen je statistiÄki znaÄajan porast broja bolesnika s HSP-om tijekom jeseni i zime. Dob bolesnika pri dijagnozi pokazala se kao moguÄi prognostiÄki Äimbenik bubrežne bolesti. S poviÅ”enjem dobi bolesnika
veÄi su izgledi za razvoj bubrežne bolesti, pri Äemu se u dobi od 1 do 17 godina sa svakom godinom vjerojatnost razvoja nefritisa poveÄava u prosjeku oko 2,25%. Jednak broj bolesnika imao je istodobno hematuriju i proteinuriju (44,45%) te izoliranu hematuriju (44,45%), a njih samo 11,1% izoliranu proteinuriju. Biopsija bubrega obavljena je u 37 bolesnika (45,7%), a najviÅ”e bioptiranih bolesnika bilo je iz skupine s istodobnom hematurijom i proteinurijom (70,3%). Djeca s izoliranom hematurijom odnosno s izoliranom proteinurijom najÄeÅ”Äe su lijeÄena glukokortikoidima, dok su djeca s istodobnom hematurijom i proteinurijom najÄeÅ”Äe lijeÄena glukokortikoidima i inhibitorima enzima koji konvertira angiotenzin. Imunosupresivnim lijekovima lijeÄeno je ukupno 16% bolesnika, meÄu kojima je najviÅ”e onih iz skupine s istodobnom hematurijom i proteinurijom (69,2%). Samo se u jednog bolesnika (1,2%) razvilo bubrežno zatajenje uz potrebu za primjenom dijalize, dok je ishod ostalih ocijenjen kao dobar. ZakljuÄak: Najvažniji Äimbenik konaÄnog ishoda bolesnika s HSP-om jesu bubrežne komplikacije. Da bi se ovi bolesnici mogli optimalno lijeÄiti, potrebno je donijeti konsenzus o indikacijama za biopsiju bubrega u HSPN-u te validirati postojeÄe patohistoloÅ”ke klasifikacije radi utvrÄivanja koja od njih najbolje korelira s nepovoljnim ishodom bolesti.Aim: To determine types of renal complications, indications for biopsy, treatment methods and possible outcomes in patients with Henoch-Schƶnlein purpura nephritis. Patients and methods: Retrospective
analysis of medical data of HSP patients treated at the Department of Paediatrics, University Hospital Centre Zagreb, and the Department of Paediatrics, University Hospital Centre Split, during the period from 2006 to 2017, who developed kidney disease according to EULAR/PRINTO/PRES criteria. Results: Out of 378 patients diagnosed with HSP, 81 (21.4%) developed kidney disease, out of whom 43 boys (53.1%) and 38 girls (46.9%), with the median age 8.4 years (2.5 16.8).. A statistically significant increase of patients with HSP was during autumn and winter. There is a greater chance of nephritis with the increase of patients age at diagnosis. For every year (from 1 to 17 years) the chances increase by around 2.25%. Equal number of patients, 44.45%, had both hematuria and proteinuria or isolated hematuria, and only 11.1% isolated proteinuria. Renal biopsy was performed in 37 patients (45.7%), and most biopted patients were from concurrent hematuria and proteinuria group (70.3%). Children with isolated hematuria or with isolated proteinuria were most often treated with corticosteroids while children with hematuria and proteinuria were most often treated with corticosteroids and angiotensin- -converting enzyme inhibitors. Immunosuppressives were used in 16% of the patients, including most of those in the group with concurrent hematuria and proteinuria (69.2%). Only one patient (1.2%) developed renal insufficiency with the need for dialysis, while the outcome of the others was evaluated as good. Conclusion: Renal complications are the most important factor in the outcome of patients with HSP. For the optimal treatment of these patients it is necessary to bring consensus about the indications for kidney biopsy in HSP, and also to validate the existing pathohistological classification to affirm which one best correlates with the adverse outcome of the disease
VIRAL HEPATITIS - CROATIAN CONSENSUS STATEMENT 2013
Hrvatske konsenzus konferencije o virusnim hepatitisima održane su 2005. i 2009. g. (1). S obzirom na brojne nove spoznaje o epidemiologiji, dijagnostici i lijeÄenju virusnih hepatitisa (poglavito kroniÄnog hepatitisa C genotipa 1) u protekle Äetiri godine, 28. veljaÄe 2013. g. održana je nova Hrvatska konsensus konferencija o virusnim hepatitisima u Zagrebu. Sažeti tekst ove Hrvatske konsenzus konferencije o virusnim hepatitisima sadrži prikaz novih spoznaja o epidemiologiji virusnih hepatitisa, seroloÅ”koj i moĀ¬lekularnoj dijagnostici virusnih hepatitisa, odreÄivanju polimorfizma promotora gena za IL-28, procjeni stadija fibroze, algoritmu dijagnostiÄkog praÄenja bolesnika, lijeÄenju kroniÄnog hepatitisa C (genotipovi 1-6) i hepatitisa B, lijeÄenju specijalnih populacija (djeca, bolesnici na dijalizi, bolesnici lijeÄeni transplantacijom, osobe s HIV/HCV koinfekcijom) i nuspojavama lijeÄenja.Croatian Consensus Conferences on Viral Hepatitis took place in 2005 and 2009. Considering the numerous novel concepts on the epidemiology, diagnosis and management of viral hepatitis (chronic hepatitis C genotype 1 in particular) that have emerged in the past four years, a new Croatian Consensus Conference on Viral Hepatitis was held in Zagreb on February 28, 2013. The abridged text of the Croatian Consensus Conference on Viral Hepatitis 2013 presents the new concepts on the epidemiology of viral hepatitis, serologic and molecular diagnosis of viral hepatitis, determination of the IL-28 gene promoter polymorphism, fiĀ¬brosis grading, algorithm for patient diagnostic follow up, treatment of chronic hepatitis C (genotypes 1-6) and hepatitis B, treatĀ¬ment of special populations (children, dialysis patients, transplanted patients, individuals with HIV/HCV co-infection), and therapy side effects
VIRAL HEPATITIS - CROATIAN CONSENSUS STATEMENT 2013
Hrvatske konsenzus konferencije o virusnim hepatitisima održane su 2005. i 2009. g. (1). S obzirom na brojne nove spoznaje o epidemiologiji, dijagnostici i lijeÄenju virusnih hepatitisa (poglavito kroniÄnog hepatitisa C genotipa 1) u protekle Äetiri godine, 28. veljaÄe 2013. g. održana je nova Hrvatska konsensus konferencija o virusnim hepatitisima u Zagrebu. Sažeti tekst ove Hrvatske konsenzus konferencije o virusnim hepatitisima sadrži prikaz novih spoznaja o epidemiologiji virusnih hepatitisa, seroloÅ”koj i moĀ¬lekularnoj dijagnostici virusnih hepatitisa, odreÄivanju polimorfizma promotora gena za IL-28, procjeni stadija fibroze, algoritmu dijagnostiÄkog praÄenja bolesnika, lijeÄenju kroniÄnog hepatitisa C (genotipovi 1-6) i hepatitisa B, lijeÄenju specijalnih populacija (djeca, bolesnici na dijalizi, bolesnici lijeÄeni transplantacijom, osobe s HIV/HCV koinfekcijom) i nuspojavama lijeÄenja.Croatian Consensus Conferences on Viral Hepatitis took place in 2005 and 2009. Considering the numerous novel concepts on the epidemiology, diagnosis and management of viral hepatitis (chronic hepatitis C genotype 1 in particular) that have emerged in the past four years, a new Croatian Consensus Conference on Viral Hepatitis was held in Zagreb on February 28, 2013. The abridged text of the Croatian Consensus Conference on Viral Hepatitis 2013 presents the new concepts on the epidemiology of viral hepatitis, serologic and molecular diagnosis of viral hepatitis, determination of the IL-28 gene promoter polymorphism, fiĀ¬brosis grading, algorithm for patient diagnostic follow up, treatment of chronic hepatitis C (genotypes 1-6) and hepatitis B, treatĀ¬ment of special populations (children, dialysis patients, transplanted patients, individuals with HIV/HCV co-infection), and therapy side effects
Citokini u serumu bolesnika s kroniÄnim hepatititsom C na hemodijalizi [Cytokine serum levels in patients with chronic hepatitis C infection of regular hemodialysis]
Serum cytokine concentrations were determined in this study in hepatitis C virus infected patients on chronic hemodialysis.
Aims of the study. To determine differences in serum cytokine concentrations between hepatitis C virus (HCV) positive and HCV-negative patients on chronic hemodialysis, and differences in serum cytokine levels between HCV-RNA positive and HCV-RNA negative patients. To investigate the relation between circulating cytokines and liver enzymes in HCV-positive patients and their role in pathogenesis of chronic HCV infection. To study the relation between viral load and cytokines in patients with chronic hepatitis C.
Patients and methods. The study included 31 patients on chronic hemodialysis with chronic hepatitis C, and 28 HCV negative patients on chronic hemodialysis. 113 healthy subjects participated as controls.
In the sera of patients and healthy controls, the concentrations of the following cytokines were determined on a microchip: IL-2, IL-4, IL-6, IL-8, IL-1, IL-1Ī², IL-10, INF-, VEGF, EGF, MCP-1 and TNF-
Results. The concentrations of proinflammatory cytokines IL-1Ī², TNF- , IL-8, IL-6, MCP-1 and VEGF were higher in subjects on hemodialysis than in healthy subjects. There was no significant difference in INF-, IL-10 and IL-1 levels. HCV positive patients had significantly higher concentrations of IL- 6, TNF- and IL-1Ī² proinflammatory cytokines and lower IL-4 and EGF levels than healthy subjects. In comparison to HCV negative patients, HCV positive patients had higher IL-2 concentration. Hepatitis C genotype had no significant effect on the serum level of cytokines except on TNF- which was significantly reduced in patients with genotype 1a infection.
The consequence of HCV infection is increased concentration of ALT and GGT transaminases, particularly in patients with confirmed viral RNA. CRP levels do not significantly differ between HCV positive and HCV negative patients. Different hepatitis C genotypes do not show selective effect on serum concentrations of transaminases, CRP and ferritin.
Conclusion. Increased formation of Th2 cytokines was not observed in this study in HCV infected patients on chronic hemodialysis. The study did not confirm the hypothesis that the inability to eradicate chronic HCV infection in dialysis patients was the consequence of increased formation of Th2 cytokine
Cytokine serum levels in patients with chronic hepatitis C infection of regular hemodialysis
U ovom istraživanju mjerili smo serumske koncentracije citokina u bolesnika na kroniÄnoj hemodijalizi zaraženih hepatitisom C.
Cilj istraživanja: utvrditi razlike u serumskim koncentracijama citokina izmedju HCV pozitivnih i HCV negativnih bolesnika na kroniÄnoj hemodijalizi te razlike u serumskim koncentracijama citokina izmeÄu HCV-RNA pozitivnih i HCV-RNA negativnih bolesnika. Istražiti odnos izmeÄu cirkulirajuÄih citokina i jetrenih enzima u HCV pozitivnih bolesnika te njihovu ulogu u patogenezi kroniÄne HCV infekcije. Istražiti odnos virusnog optereÄenja i citokina u bolesnika s kroniÄnim C hepatitisom.
Bolesnici i metode: u istraživanje je ukljuÄeno 31 bolesnika na kroniÄnoj hemodijalizi s kroniÄnim hepatitisom C te 28 hepatitis C negativnih bolesnika na kroniÄnoj hemodijalizi. Kao kontrola poslužilo je 113 zdravih ispitanika.
U serumu bolesnika i zdravih ispitanika odreÄena je koncentracija slijedeÄih citokina na citokinskom mikroÄipu: IL-2, IL-4, IL-6, IL-8, IL-1, IL-1Ī², IL-10, INF-, VEGF, EGF, MCP-1 i TNF- .
Rezultati: U ispitanika na hemodijalizi poviÅ”ena je koncentracija proupalnih citokina IL-1Ī², TNF-, IL-8, IL-6 i MCP-1 i VEGF u odnosu na zdrave ispitanike. Nije bilo znaÄajne razlike u INF-, IL-10 i IL-1. Hepatitis C pozitivni bolesnici imaju znaÄajno poviÅ”enu koncentraciju proupalnih citokina: IL- 6, TNF- i IL-1Ī² a sniženu koncentraciju IL-4 i EGF u odnosu na zdrave ispitanike. U usporedbi s hepatitis C negativnim bolesnicima, hepatitis C pozitivni bolesnici imaju poviÅ”enu koncentraciju IL-2.
Genotip hepatitisa C nema znaÄajan uÄinak na serumske koncentracije citokina osim na TNF- , koji je znaÄajno snižen u bolesnika zaraženih genotipom 1a.
Zaraženost virusom hepatitisa C ima za posljedicu poviÅ”ene koncentracije transaminaza ALT i GGT, naroÄito u bolesnika s dokazanom virusnom RNA. Razine CRP znaÄajno se ne razlikuju izmeÄu hepatitis C pozitivnih i hepatitis C negativnih bolesnika. Razni genotipovi hepatitisa C ne pokazuju selektivan uÄinak na serumske koncentracije transaminaza, CRP i feritina.
ZakljuÄak: U ovom istraživanju nije naÄeno poveÄano stvaranje Th2 citokina u bolesnika zaraženih hepatitisom C na kroniÄnoj hemodijalizi. Istraživanje nije potvrdilo hipotezu da je nemoguÄnost iskorjenjivanja kroniÄne HCV infekcije u bolesnika na dijalizi posljedica poveÄanog stvaranja citokina tipa Th2.Serum cytokine concentrations were determined in this study in hepatitis C virus infected patients on chronic hemodialysis.
Aims of the study. To determine differences in serum cytokine concentrations between hepatitis C virus (HCV) positive and HCV-negative patients on chronic hemodialysis, and differences in serum cytokine levels between HCV-RNA positive and HCV-RNA negative patients. To investigate the relation between circulating cytokines and liver enzymes in HCV-positive patients and their role in pathogenesis of chronic HCV infection. To study the relation between viral load and cytokines in patients with chronic hepatitis C.
Patients and methods. The study included 31 patients on chronic hemodialysis with chronic hepatitis C, and 28 HCV negative patients on chronic hemodialysis. 113 healthy subjects participated as controls.
In the sera of patients and healthy controls, the concentrations of the following cytokines were determined on a microchip: IL-2, IL-4, IL-6, IL-8, IL-1, IL-1Ī², IL-10, INF-, VEGF, EGF, MCP-1 and TNF-
Results. The concentrations of proinflammatory cytokines IL-1Ī², TNF- , IL-8, IL-6, MCP-1 and VEGF were higher in subjects on hemodialysis than in healthy subjects. There was no significant difference in INF-, IL-10 and IL-1 levels. HCV positive patients had significantly higher concentrations of IL- 6, TNF- and IL-1Ī² proinflammatory cytokines and lower IL-4 and EGF levels than healthy subjects. In comparison to HCV negative patients, HCV positive patients had higher IL-2 concentration. Hepatitis C genotype had no significant effect on the serum level of cytokines except on TNF- which was significantly reduced in patients with genotype 1a infection.
The consequence of HCV infection is increased concentration of ALT and GGT transaminases, particularly in patients with confirmed viral RNA. CRP levels do not significantly differ between HCV positive and HCV negative patients. Different hepatitis C genotypes do not show selective effect on serum concentrations of transaminases, CRP and ferritin.
Conclusion. Increased formation of Th2 cytokines was not observed in this study in HCV infected patients on chronic hemodialysis. The study did not confirm the hypothesis that the inability to eradicate chronic HCV infection in dialysis patients was the consequence of increased formation of Th2 cytokine