Dimitrov, H.

Ganchev, T.

Negrev, N.

Nenov, D.

English

Varna Medical University Press: Journals

PLASMA THROMBOCYTOPOIETIN ACTIVITY IN CHRONIC R E N A L F A I L U R E PATIENTS ON HEMODIALYSIS AND HEMOPERFUSION H. Dimitrov, N. Negrev, T. Ganchev, D. Nenov Key-words: thrombocytopoietin — chronic renal failure — hemodialysis — hemoperfusion I t is well known that hemostatic disorders are a common feature in chronic renal failure ( C R F ) patients. Thrombocyte functions are most often affected — the aggregation and adhesiveness are suppressed and thrombocyte factor 3 libera-tion diminishes. Thrombocyte count alters more rarely (1). The aforementioned aspects of the problem are analysed in the literature available. However, the role and importance of thrombocytopoietin ( T P ) — a basic humoral regulator of throm-bocyte homeostasis (4) were not yet discussed. This interest is supported by the fact that kidney plays an important role in thrombocytopoietin forming mecha-nisms (4). The aim of the present study is to determine plasma T P ac t iv i ty ( T P A ) in C R F patients set on periodic hemodialysis ( H D ) before and after both H D and hemoperfusion ( H P ) and to compare it wi th that of healthy individuals and C R F patients without H D treatment. The data obtained could enlighten the role of T P in the mechanisms of normal hemostasis restitution and maintenance of an adequate thrombocyte level in C R F patients on periodic H D ( P H D ) . i Material and method The t r ia l covered a total of 17 individuals as followed: 12 C R F patients on P H D , 2 ones on H P / H D , 2 ones with C R F without H D treatment, and 3 healthy persons (controls). Patient 's blood was steri l ly taken before and immediately af-ter H D . It was done in the morning on an empty stomach by using anticoagulant (heparin) when the other individuals were concerned. Separated plasma was fro-zen unti l its testing. T P A testing was performed by using of 188 white male mice-recipients after Penington's (1970) routine biological isotope method (6). The changes of 7 5 Se methionine incorporation in newly formed thrombocytes of test-mice under the influence of the examined plasma was tested. The data received were processed by use of variat ion statistic methods. Results and discussion The results were presented on table 1. The analysis of the data showed that C R F patients on P H D could be divided into two groups. The first one was charac-terized with a higher in i t ia l T P A — 5,80=0,46 as compared wi th that of the controls that is statist ically unreliable. I t is an interesting fact that after H D plasma T P A reduces significantly in these patients (p<0,001). I n i t i a l plasma T P A levels differ statistically significantly in the two patients' groups on P H D w i t h an increased and a decreased T P A after P H D (p<0.001) . Plasma thrombDcytopoietin activity.. 65 Therefore, H D causes a significant plasma T P A increase in C R F patients on P H D wi th lower in i t ia l levels and a significant plasma T P A decrease in those with higher ones in comparison wi th that of the controls. After a combined H P / H D treatment plasma T P A is significantly reduced (p<0,001) . The comparison of ini t ia l plasma T P A levels of a l l patients' groups wi th the control ones presents a real interest (see table 1). The in i t ia l T P A is lower in patients on P H D reacting with a T P A increase after H D , in C R F patients without H D treatment as wel l as in those wi th a combined H P / H D one which is statistically insignificant. Only the in i t ia l plasma T P A in patients on P H D which then decreases after H D is higher than that of the controls. T a b 1 е 1 75Selenomethionine incorporation in newly-formed mice thrombocytes under the influ­ence of plasma from CRF patients on PHD with HP/HD and without HD tatistical indexes Patients with chronic renal failure Controls Without On PHD with TP increase . On P H D with TP decrease Patients on H P / H D HD before after before after before after Sx 4,75 3,34 0,46 0,51 p>0,10 2,37 4,45 0,30 0,27 p<0,001 5,80 1,80 0,46 0,16 p<0,001 3,93 1,53 0,49 0,24 p< 0,001 There is a tendency towards lower plasma T P levels in most C R F patients as tfmpared wi th that of the healthy controls. I t is very difficult to interpret these results because of the lack of similar investigations and the participation of many factors related wi th T P biogenesis regulation in normal conditions and C R F pa­tients. The fact that H D corrects considerably the hemostatic disorders in these patients is indirectly confirmed by our own findings for a significant plasma T P A increase after H D in almost 2/3 of the patients on P H D . Plasma T P A increase presents a precondition for more effective and qualitative thrombocytopoiesis because, as already mentioned (7), thrombocyte functions are essentially distur­bed in those patients. I t is obvious that H D procedure eliminates certain inhibi­tors or toxic substances from the plasma of these patients. Probably, they are urae-mic toxins which thrombocytopoietic inhibitory effect is already known (2). Th i s tendency towards higher T P A after H D than the in i t i a l one is established in one female patient at the 12 t h hour after H D . A similar plasma erythropoietin increase after H D in C R F patients has been already found out in our previous investi­gation (2). That very presence of an increased T P A in most patients on P H D can be probably the reason for more seldom thrombocytopenia and most often normal thrombocyte count. The explanation of plasma T P A reduction in'l/3ofJthe patients on P H D (with high in i t ia l ac t iv i ty) is difficult, too. I t is a point to note the stat is t ical ly re­l iably higher in i t ia l plasma T P A than the control one in these patients (p<0,001) . I t is probable that certain plasma components which are required for demonstrat­ing T P A are washed away, or that some ones remain in the plasma to inhibit this 5 Scripta scientifica medica 66 H . Dimitrov, N. Negrev, Т. Ganchev, D. Nenov act ivi ty . Th is speculative explanation is part ial ly supported by J . Stewart et a l . (7), and, especially, by T . Christopher, et a l . (3) who report that low molecular components retention in plasma after H D is the factor partially improving hemo­static disorders and thrombocyte functions. The definitive clearance of the me­chanisms giving rise to these differences and changes requires a parallel follow-up of the dynamics of thrombocyte count, the changes of the megakaryocyte line, e t c The considerable T P A reduction after H P / H D combination by 61,07 per cent (p<0,001) gives an evidence that some substances necessary for plasma T P A demonstration probably remain in plasma or move away in these cases, too. Most l ike ly , H P which leads to sorption of higher-molecular substances and to a better expressed well-known transitory thrombocytopenia helps additionally to this phenomenon. I t can be concluded that plasma T P A increases in 2/3 and decreases in 1/3 of C R F patients on P H D . H D increases significantly the low ini t ia l plasma T P A but decreases more considerably the high one. There is a trend toward lower T P A in C R F patients in comparison with that of healthy individuals. H P / H D combi­nation reduces significantly plasma T P A . R E F E R E N C E S 1. A n a g n o s t o u , A . , W. F r i e d , N . K u r t z m a n , Hematological , conse­quences of renal failure. — I n : Pathophysiology of renal disease, 1980, 2184—2212. — 2. В е r -к е s s у, S. , A . F a l u d i . Ann. Clin. Rev., 6, 1974, 65—67. — 3. C h r i s t o p h e r , Т . , V . С a m b i , L . H a г к е r, et a l . Trans. Amer. Soc. Artif. Intern. Organs, 17, 1971, 92. — 4. M c D o n a l d , T . P . Experim. Haematol., 4, 1976, 27—31. — 5. N е n о v , D . , T . G a n ­c h e v . I n : Donausymp. Nephrol., I I . Budapest, 26—28. I X . 1977. Friedberg, 1978, 113— 116. — 6. P е n i n g t о n, D . G . Brit. Med. J . , 1, 1970, 606—608. — 7. S t e w a r t , J . , P . C a s t a l d i . Q. J. Med., 36, 1967. 409. ТРОМБОЦИТОПОЭТИНОВАЯ АКТИВНОСТЬ ПЛАЗМЫ У БОЛЬНЫХ ХРОНИЧЕСКОЙ ПОЧЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ, ЛЕЧИВШИХСЯ МЕТОДАМИ ГЕМОДИАЛИЗА И ГЕМОПЕРФУЗИИ X . Димитров, Н. Негр ев, Т. Ганчев, Д. Ненов Р Е З Ю М Е Исследована тромбоцитопоэтиновая активность с помощью биологического метода — тестирования плазмы больных хронической почечной недостаточностью, лечившихся консер­вативно методами гемодиализа и гемоперфузии. Активность определялась посредством про­центного включения 7 5 _ с е л е н о м е х и о н и н а в новообразующиеся тромбоциты самцов белых крыс. Авторами впервые установлено повышение тромбоцитопоэтиновой активности у 2/3 больных на периодическом гемодиализе, а у 1/3 больных — понижение. Понижение тромбо-цитопоеэтиновой активности у больных последней группы авторы связывают с диализирова-нием тромбоцитопоэтина или веществ, необходимых для проявления плазменной тромбоци­топоэтиновой активности. Комбинированное лечение методами гемодиализа и гемоперфу­зии понижает тромбоцитопоэтиновую активность. 

PLASMA THROMBOCYTOPOIETIN ACTIVITY IN CHRONIC RENAL FAILURE PATIENTS ON HEMODIALYSIS AND HEMOPERFUSION

https://journals.mu-varna.bg/index.php/ssm/article/download/3115/2533

PLASMA THROMBOCYTOPOIETIN ACTIVITY IN CHRONIC RENAL FAILURE PATIENTS ON HEMODIALYSIS AND HEMOPERFUSION

Abstract

Similar works

Full text

Available Versions

Varna Medical University Press: Journals