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Kidney transplantation is the best treatment for end-stage renal failure. It prolongs the patient's life, improves quality of life and reduces costs associated with renal replacement therapy. Increasingly, newer immunosuppressive regimens allow for the proper functioning of the transplanted organ for many years. The progress in transplantation, qualification patients in older age for the procedure and longer survival of kidney graft lead to an increase in the number of patients receiving immunosuppressive drugs. They are exposed to various side effects associated with long-term suppression of the immune system, including an increased risk of cancer development. The most common malignancies (40- 50%) diagnosed in renal transplant recipients are skin cancers. Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the most common types of tumors occurring in this population. The use of immunosuppression resulted in the increase of the incidence of tumors that in the general population are relatively rare such as melanoma, Merkel cell cancer, Kaposi's sarcoma, anogenital cancer as well as sebaceous carcinoma.

Acute renal graft failure or delayed graft function (DGF) is defined as a necessity at least one hemodialysis during first week after transplantation. Approximately 20% of patients require temporary dialysis after kidney transplantation. There are many different factors, donor, recipient and transplant-related, that can trigger DGF. In the article a pathophysiology, clinical picture, treatment and prevention of the disorder have been shortly summarized.

Obesity is a factor limiting access to kidney transplantation because of the high risk of perioperative complications, worse graft function and patients' survival. We present a case of an obese patient (BMI-38 kg/m2) with hypertension, diabetes and end-stage kidney disease caused by chronic glomerulonephritis treated with hemodialysis, who was excluded from transplantation because of obesity. The patient underwent Roux-en-Y gastric by-pass surgery as a preparation for kidney transplantation.

Introduction: Transplantation is the best way of treatment in end-stage renal disease. Kidney transplantation is the most common among all transplantations of vascularised organs. The development of transplantational immunology, as well as the improvement of schemes of immunosuppressive treatment decrease the number of episodes of acute rejection. They also allow perennial functioning of the transplanted organ. However, the necessity to dampen the immune system, through the delivery of immunosuppressive drugs (to prevent rejection), contributes to a deterioration in the ability of the body to fight infections. Patients after kidney transplantation are in the group at special risk of bacterial, viral and fungal infections, which poses an essential therapeutic problem. The aims of this work were: the retrospective analysis of infections in patients after kidney transplantation, analysis of etiologic factors and the form of clinical infections, and the establishment of the risk factors of infections in the recipients of kidney transplant., Material and Methods: 147 patients hospitalized from 1.01.2007 to 31.12.2008 at the Department of Nephrology and Kidney Transplantation in the Independent Public Provincial Hospital in Szczecin were considered in the study. The data were obtained from medical records, i.e. operative reports on kidney transplant, patient's history, and the results of microbiological and serological examinations., Conclusions: 1. High risk of infection occurred in the case of: low compatibility in the human leukocyte antigen system, long cold ischemia time, and in recipients who required higher doses of corticosteroids. 2. Prompt diagnosis of the infection and the early implementation of suitable therapy seems to be fundamental for the effectiveness of treatment and the prevention of further infectious complications in patients after kidney transplantation.

With the development of kidney transplantation procedure the number of patients returning to dialysis after losing their graft function is gradually increasing. Early return to dialysis after an unsuccessful kidney transplantation is associated with a worse prognosis. Patients with end stage transplanted kidney failure may be qualified again for the treatment of both peritoneal dialysis or hemodialysis. They represent an increased risk of complications as compared to patients without a history of previous kidney transplantation because they usually have high commorbidity, receive immunosuppressive therapy and during re-qualification to dialysis usually have no efficient vascular access or peritoneal catheter implanted. Graft loss in the early stages after procedure, because of fulminant rejection, vascular thrombosis or lack of primary organ function is associated with immunosuppression withdrawal while leaving a failing kidney is an indication to maintain it in a reduced form. The indication for removal of an inefficient transplant after more than 12 months are: symptoms of its intolerance manifested by acute rejection, pain in the area of the graft, fever, severe anemia, increase of blood pressure and inflammatory markers. Removal of the graft may be associated with a temporary increase in immunization of the patient. Patients meeting the clinical conditions for transplantation should be considered for another kidney transplant as preemptive transplantation or as soon as possible after dialysis start. Although kidney retransplantation results are slightly worse when compared with the first transplant, it still has an advantage over dialysis.

In the 1st part of this review dealing with FGF-23 its composition, mode of action, and regulatory mechanisms of its secretion were described. In the 2nd part of this review, regulatory activity in the calcium-phosphate homeo-stasis in different stages of chronic kidney disease (CKD) including dialyzed patients, subjects after parathyreoidectomy and patients after kidney transplantation were characterized. The aim of this part was to analyze the relationship between FGF-23 and left ventricular hypertrophy, vascular calcification and increased morbidity and mortality in patients with CKD. The current knowledge on FGF-23 has lead to suspect that in the nearest future it may serve as sensitive marker of early calcium-phosphate disturbances in patients with CKD.

Introduction: Transplantation is the preferred method of treatment of end-stage renal failure due to improvement in the quality of life and longer survival of patients. The process of graft rejection involves many mediators, including intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1). Recent research has revealed the genetic background of the synthesis ofadhesins. Several polymorphisms of genes coding for ICAM-1 and VCAM-1 have been described which may be functionally important through various rates of synthesis of the mediator. Genetic differences in the synthesis of adhesion molecules may affect graft function and predispose to acute or chronic rejection., Material and Methods: The study enrolled 270 Caucasian whites (104 females and 166 males), aged 21 to 76 years (mean 47.63 +/- 12.96), who underwent allogenic renal grafting. Groups of patients with delayed graft function (n = 85), acute rejection (n = 70), and chronic allograft nephropathy were formed (n = 62). Biopsy of the renal graft was done to verify progressive loss of function. Polymorphisms were identified with PCR-RFLP., Results and Conclusions: It was found that the GG genotype of the rs5498 polymorphisms of the ICAM1 gene is a significant risk factor of acute rejection and is correlated with elevated concentrations of creatinine in allogenic renal graft recipients. The TC genotype of the rs3170794 polymorphism of the VCAM1 promoter may be a risk factor of acute rejection in allogenic renal graft recipients. The G allele of the rs5498 polymorphism of the ICAM1 gene is significantly correlated with interstitial fibrosis and may also be correlated with other chronic histopathologic lesions seen in bioptates of the grafted kidney. There was no correlation of the rs1041163 and rs3170794 polymorphisms of the VCAM1 promoter with the severity of histopathologic lesions seen in bioptates of the grafted kidney.

Objectives: The aim of our study was to determine the endothelial function in patients with chronic kidney disease (CKD), stage V (end-stage renal disease--ESRD), before and during a one-year observation after kidney allotransplantation., Patients and Methods: We studied 40 patients with stabile graft function after their first kidney transplantation, including 21 females (mean age 41 +/- 12.5 yrs) and 19 males (mean age 43.6 +/- 13.3 yrs), treated already with hemodialysis because of ESRD., Results: After transplantation we observed significant decrease in serum creatinine concentrations (Cr) (7.32 +/- 2.07 mg/dl to 1.50 +/- 0.45 mg/dl at 6 months and 1.61 +/- 0.58 mg/dl after 12 months after transplantation). During 12 months we found changes only in plasminogen activator inhibitor-1 (PAI-1) levels. Von Willebrandt factor (vWf) levels remained unaltered during follow-up and total homocysteine (tHcy) concentration decreased, but this change was not statistically significant. There was no correlation between vWf and PAI-1 concentrations and other clinical and laboratory findings., Conclusions: In our study we did not find any improvement of endothelial function during the first year after kidney allotransplantation. The mean Cr concentration at the end of study was 1.6 mg/dl, which indicates the chronic kidney graft insufficiency. We conclude that despite kidney allotransplantation endothelial function is impaired like in CKD, but with more advanced abnormalities in the cardiovascular system.

In 16 patients (7 males, 9 females), aged 47.2 +/- 15.9 years, blood serum concentrations of osteocalcin, beta-crosslaps, parathormone, calcium, phosphate, creatinine and urea were determined before renal transplantation and 3 and 6 months following the procedure. Three as well as six months following renal transplantation significant decrease in blood serum concentration of osteocalcin and beta-crosslaps are found. A significant positive correlation between osteocalcin and beta-crosslaps concentration was found in each investigated period. Six-months observation revealed only partial correction of bone metabolism following renal transplantation.

Renal cancer accounts for about 2% of all cancers in general population. One of the risk factors is acquired cystic kidney disease developed in course of end- stage renal failure. About 2% of cases of renal cancer are associated with inherited syndromes. We present here the case of 18-year old boy with papillary bilateral renal cell carcinoma, which was found 3 years after renal transplantation, in the stage of graft failure, few days after graphtectomy, while looking for the reason of persistent fever.

Arterial hypertension (AHT) is common clinical symptom in 80% of patients at start of chronic dialysis and at 1 year remains overt in 50% of hemodialyzed and 30% of patients on peritoneal dialysis. The incidence of AHT post-transplant is 58% in long-term follow-up. The mechanism of AHT is complex, however in dialyzed patients the most common factor is (overt or hidden) fluid overload (volume-dependent AHT). It develops as a consequence of inadequate evaluation of body dry mass and/or insufficient dialysis technique. Post-transplant AHT may develop as side-effect of long-term calcineurine inhibitors and steroid therapy and/or high renin production by native kidneys. In patients with chronic allograft nephropathy complex pathology of renal failure becomes more important factor. The data concerning efficacy of bilateral native nephrectomy are inconsistent. NAPRTCS survey data show, that incidence of AHT is similar in nephrectomized and non-nephrectomized patients up to 5 years post-transplant. In nephrectomized dialyzed patients fluid overload is still a main cause of AHT. Many therapeutic modalities, both pharmacological and dialysis-related, are available to improve blood pressure regulation. Bilateral native nephrectomy should be regarded as the last option, mostly in patients with ongoing renal co-morbidities, such as heavy proteinuria or recurrent urinary tract infection.

Unlabelled: Growth deficiency is one of complications in chronic renal failure (CRF). In Poland recombinant human growth hormone (rhGH) was introduce to treatment in children with CRF in 1994. The aim of study was to evaluate causes of the end of rhGH treatment in children with CRF., Patients and Methods: Among 90 children with different stages of CRF treated with rhGH between 2000-2005 we analyzed 85 patients (33 in CRF and 52 in ESRD), in mean age 9.8 years (from 3 to 17.8 years) which finished therapy. RhGH was used subcutaneously, everyday in doses 1.1 j/kg/week. The anthropometric measurements were performed at the beginning and after one year of the study., Results: The mean time of treatment in 85 children was 18.4 months (1-60 months). The causes of the treatment termination were: renal transplantation in 40 pts (47%), increase of PTH serum level in 13 pts (15.3%), lack of treatment effect in 10pts (11.8%), height achievement at the level of 10c in 10 pts (11.8%), non compliance in 3 pts (3.5%), patient's decision of finishing therapy in 6 pts (7%) and the diagnosis of diabetes during rhGH treatment in 1 pts (1.2%), acute pancreatitis in 1pts (1.2%), epilepsy in 1 pts (1.2%). 25 (29.5%) of out 85 analyzed children had finished the study in the first year. In other 60 patients mean growth velocity was 8.1 cm/year (from 3.3 to 12.4 cm/year)., Conclusions: The main causes of the termination of rhGH treatment in children with CRF were renal transplantation and decompensated secondary hyperparathyroidism.

The authors expounded present state of knowledge concerning immunosuppressive drugs therapy during pregnancy after kidney transplantation. Pregnancy is uncommon in women with end-stage renal disease treated with dialysis and in most cases it ends with pregnancy failure. Resuming the normal function of the ovaries after kidney transplantation substantially increases the chances of conception and successful pregnancy. The immunosuppression scheme and dosage of drugs used in pregnant women are vital to both the normal course of pregnancy and delivery of a healthy child. Considering the safety of the fetus it is acceptable to use prednisone, azathioprine, cyclosporine and tacrolimus. Due to the necessity to administer immunosuppressive drugs in relatively small doses, an important factor conditioning the normal course of pregnancy is maintaining a 1- or 2-year interval between the kidney transplantation and the conception.

An increase of total amplitudes of QRS complexes induced by the hemodialysis (HD) procedure is a common phenomenon in hemodialysed patients. The aim of the study was to define factors responsible for the growth of QRS complex amplitude as a result of HD. The study was carried out on a group of 48 patients. Before and after HD procedure basic biochemical blood tests were performed and the following parameters calculated for each patient: (a) the total amplitude of QRS complex, (b) the total volume of body water (TBW), the extracellular volume (ECW), and the intracellular volume (ICW), as well as the TBW, ECW and ICW indices standardized against the patient body weight. The levels of albumin, total protein, intact PTH (iPTH), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-alpha) were determined before HD. The rates of Kt/V and normalized protein catabolic rate (nPCR) were calculated. The total amplitude of QRS complexes before HD was 13.09 +/- 3.3 mV and it increased significantly after HD to the value of 17.68 +/- 4.03 mV (p<0.001). An increase of QRS amplitude was observed in 35 patients (72.92%). The results of the study revealed, that the most important factor responsible for the growth of the total amplitude of QRS complexes after HD procedure is the value and changes in the ECW volume. The validation of the correlations disclosed in our study between the increase of the total amplitude of QRS complexes and IL-6 )positive correlation), and the nPCR value (negative correlation) require further studies on large groups of HD patients as well as a retrospective analysis of patients' survival rates.

The prevalence of hepatitis C virus (HCV) infection in dialyzed patients (pts) with end stage renal disease (ESRD) is higher than that of the general population. Generally it is thought that the course of hepatitis C is milder then in pts with normal renal function, but there is no agreement about natural history of HCV infection in dialyzed. Immunosuppressive therapy after renal transplantation (RTx) worsens the prognosis for pts with HCV infection. Additionally, actually available anti-HCV treatment is contraindicated after RTx due to the high risk of the graft rejection. That is the reason why antiviral therapy should be given before RTx and indications for treatment should be wider (treatment of HCV infection not only of hepatitis). The biggest number of papers addressed to anti-HCV treatment in dialyzed pts considers monotherapy with standard interferon. One out of two pegylated interferons was approved for dialyzed pts--but up to date there is no data about efficacy and safety of this compound in this group of pts. The use of ribavirin in ESRD pts is contraindicated due to the high risk of anemia.

Recipients of renal transplants have an increased risk of developing secondary malignancies. About 4% of patients who underwent kidney transplantation will develop cancer, and 1% of transplanted patients will develop lymphoproliferative disorders. According to clinical analyses and laboratory data, the main reason for increased risk of developing malignant disease in this group of patients, is their immunocompromised status due to immunosuppressive treatment. So called "strong" immunosuppressive drugs like antilymphocytic globulin (ALG), antithymocytic globulin (ATG), or monoclonal globulin OKT3 seem to favor the development of secondary malignancies much more than other drugs, like: corticosteroids, azathioprine (AZA), or cyclosporine (CsA). Secondary lymphoproliferative disorders are usually connected with reactivation of Ebstein-Barr virus infection. Patients with early onset (<1 year after the transplantation) have a favorable clinical course after withdrawal of immunosuppression. The subset of late-onset (>1 year) has usually much more aggressive clinical course and patients require intensive treatment. The general recommendation in these patients is to stop or to reduce the immunosuppressive treatment and to continue the chemotherapy in full dose. This treatment is often complicated by severe infections, but it offers a chance to achieve remission without worsening the function of transplanted organ. In this paper we are presenting five patients with secondary lympho- or myeloproliferative disorders after kidney transplantation and give an overview of the recent literature in this field.

This review refers to the advantages of simultaneous transplantation of kidney and intraportally implanted islets in patients with nephropathy in the course of diabetes type 1 treated with continuous ambulatory peritoneal dialysis.

Cyclosporine A (CsA) is one of the basic and often used immunosuppressive agents. It is used to prevent rejection of allogenic transplants and to cure many diseases with autoimmunological components. The development of transplantology and frequent presence of autoaggressive disorders causes increased use of CsA, which intensifies problem of side-effects. Gingival overgrowth, oral mucosa pathologies related with bacterial, viral and fungal infections and neoplasma are described as most frequent side-effects of cyclosporine A in the oral cavity. The aim of this study was to assess the frequency of presence of different types of oral mucosa lesions in cyclosporine A-treated patients after renal transplantation. Thirty renal transplant recipients aged 11-64 years (including 13 females and 17 males) with cyclosporine treatment period from 6 months to 10 years were examined. Pathological changes on the oral mucosa were noted in 18 patients (60%). The fungal infections were the most often observed pathology (46.7% of examined persons). In mycological tests Candida albicans was most often isolated. Other species: C. kefyr, C. parapsilosis and C. tropicalis were also found. In 4 cases cheilitis angularis was additionally diagnosed. In 16.7% of CsA-treated patients, pathological changes of epithelium with homogenic leucoplakia features were observed. Hypertrophic lesions of oral mucosa in 10% of cases and many small erosions of inflamed mucosa of hard palate in 1 case were also noted. Our observations show connection between incidence of oral mucosa pathologies and immunosuppressive treatment. This suggests that interdisciplinary cooperation is necessary for early start of prevention and treatment program.

Background: Lipofuscin is believed to be the last product of lipid peroxidation. Elevated serum lipofuscin in chronic renal insufficiency and in multiple organ failure after major surgery has been detected., Aim: To compare serum lipofuscin level after renal transplantation with hemodialysed patients and healthy adults., Material and Methods: Lipofuscin has been determined according to Tsuchida with Roumen's modification and expressed in arbitrary units (u.), in serum of 56 healthy adults, 11 renal transplant recipients and nine hemodialysed patients. Blood was collected before hemodialysis in uremic patients, or within 24 h after renal transplantation., Results: Serum lipofuscin in hemodialysed patients and renal recipients was significantly higher about 80% and 180% respectively, comparing to healthy adults., Conclusion: Elevated serum lipofuscin levels after renal transplantations show high oxidative stress due to several mechanisms of lipid peroxidation in this group of patients.

Renal transplantation is considered the only good long-term therapy for chronic renal failure. Better surgical techniques and recent advances in immunosuppressive therapy allow patients to survive for many years, free from any complications due to rejection. However, cutaneous lesions can be a significant problem for this group of patients. Immunosuppression predisposes them to infections--predominantly viral, but also fungal and bacterial ones, as well as malignant tumours like basal cell carcinoma, squamous cell carcinoma, melanoma and Kaposi's sarcoma. The review of the current literature on skin manifestations in renal transplant recipients is done.

In spite of improved one year renal allograft survival long-term results of renal transplantation did not change since several years. Progressive decline of graft function developing few years after renal transplantation remains a significant problem in renal replacement therapy. The clinical manifestation of progressive impairment of the kidney transplant is heterogeneous and the differential diagnosis of chronic graft rejection is difficult, even if histopathological examination is performed. Improvement of immunosuppressive therapy and avoidance of nonimmunologic factors which increase the risk of graft failure seem to influence markedly function of kidney grafts.

Unlabelled: Various oxidant species, oxygen free radicals (OFR) implicated in patients with chronic renal diseases treated with dialysis and after cadaveric renal transplantation. Oxidative stress occurs when free radical generation exceeds antioxidant defence. We therefore examined markers of lipid peroxidation and antioxidant potential in blood (serum, plasma, RBC) of very carefully (clinically and biochemically) selected 102 subjects (56 female and 46 male, mean age 37.5 +/- 7 years). Included were 51 renal allograft recipients (RARs); 15 patients with glomerulopathies (GL); 36 healthy age- and sex-matched volunteers as a control group (C). All RARs were divided into two subgroups: RARs-A (n = 28) were treated with triple drug therapy including cyclosporin A (CsA) and RARs-Z (n = 23) were on double drug regimen: prednisone, azathioprine. Patients with coronary artery disease (CAD), diabetes, serum creatinine concentration > 2.0 mg/dl, acute rejection and infections were excluded. We used several automated assays to estimate: malondialdehyde (MDA); total radical-trapping antioxidant potential (TRAP), glutathione peroxidase (GPx), glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), vit. E and lipid profiles. Patients of RARs-A were found to have significantly elevated triglycerides; cholesterol-LDL; MDA; TRAP and decreased activity of RBC glutathione peroxidase as compared with those of RARs-Z and group C., In Conclusion: our data show that oxidative stress (with prooxidant effect of CsA partly at least), with reduced in antioxidant potential of defences system is associated with kidney transplantation.

The case of lingual cancer in the 25-years old man treated in 2nd ENT Department Silesian Medical Academy in Zabrze was presented in this paper. The patient has been treated from 1989 due to chronic pyelonephritis finished with the renal insufficiency. In 1991 the renal graft was performed and in 1993 graftectomy due to its rejection. In 1991-1993 the long-term immunosuppression was taking including medicines like Cyclosporin, Imuran, Azatioprin and Encorton. The aim of this study was to consider the influence of immunosuppression therapy on lingual cancer appearance in our patient.

Urological complications constitute significant problem following renal transplantation. Incidence ranges from 4 to 14% in graft recipients. The most important aspects concerning these complications are early diagnosis and prompt treatment, any delay in diagnosis and management may lead to deterioration of renal graft function or graft loss. The following case report discusses management of hydronephrosis in renal graft caused by ureter stenosis due to scarring and fibrosis of its distal end after remote kidney transplantation. The patient was a 33-year-old woman with previous history of end stage renal failure in the course of chronic glomerulonephritis. A triple drug immunosuppressive regimen consisting of Azathioprine (AZT), Cyclosporine A and Encorton (AZT + CsA + Encorton) was administered during a period of three years after kidney transplantation. At this time AZT administration was discontinued due to chronic viral hepatitis type B. Episodes of expansion sensation (discomfort) and graft pain were reported by the patient which after 3 days were followed by a period of oliguria and then anuria. The patient was admitted to the Department of Nephrology CMUJ, where ultrasound imaging revealed graft hydronephrosis. In the presence of such clinical and biochemical indications due to acute graft failure, one hemodialysis session, was performed. The patient was transferred to the Urological Department CMUJ where ureter exploration was attempted, but was unsuccessful. Subsequently percutaneous nephrostomy was performed which lead to immediate diuresis. Next, distal ureter stenosis (located by the urinary bladder) was surgically removed and reimplantation of the ureter was carried out. Due to early diagnosis and surgical reconstruction of the transplanted ureter, renal graft function returned to normal requiring only one hemo-dialysis session.

Increased susceptibility to infection is observed in patients with chronic renal failure (CRF). Therefore, when antibiotic therapy is indicated, it is reasonable to use a drug which is usually reserved as a second-choice antibiotic in other patients. Antibiotic prevention before surgical procedures with a high risk of infection, especially before renal transplantation is also often necessary. Evaluation of Biotrakson (ceftriakson) (produced in Poland) efficacy in patients with CRF was the aim of this study. The antibiotic was administered in a single, complete prophylactic dose or once daily when given therapeutically in 25 patients: 13 with end-stage renal disease treated with hemodialysis, 5 with end-stage renal disease treated with peritoneal dialysis, 4 with chronic renal failure, 1 with acute renal failure treated with peritoneal dialysis, 2 after renal transplantation. The antibiotic was given for local and generalised bacterial infections in 10 patients; in 15 the drug was administered prophylactically before serious surgical procedures (including 10 patients before renal transplantation). Resolution of infection was observed in 9 out of 10 treated patients (90%). When the antibiotic was given prophylactically, its efficacy was assessed as good in 8 of 10 patients (80%) after renal transplantation and in 4 of 5 patients (80%) after other surgical procedures. There were no significant adverse side effects in any patient. Biotrakson is, therefore, an effective drug for therapeutic and preventive use in patients with renal failure.

Dyslipidemia is one of the first metabolic dysfunction observed among patients with end stage renal disease. It can also induce acceleration of renal tissue damage. Kidney transplantation may cause recovery of some dysfunction in lipid metabolism while influencing deterioration of others. The aim of this study was to monitor dynamics of basic lipid parameters in the first year after kidney transplantation. The sample included 25 patients (9W, 16M), aged 18-59, avg. 36. We have measured concentration of the following parameters in blood serum: triglycerides (TG), total cholesterol (CH-C) and apolipoprotein B (Apo B). Simultaneously, functions of transplanted kidney were tested with use of routine methods. The immunosuppressive treatment of patients followed the scheme: cyclosporine + prednisolone + azathioprine. The treatment influence on lipid disorders was measured by relevant correlation coefficients. The obtained results point to the observation that in the first year after kidney transplantation the TG concentration gradually decreases, with simultaneous continuous increase of CH-C concentration, mainly due to LDL concentration increase. No influence of immunosuppressive treatment on lipid parameters was observed. However, lipid dysfunction, especially TG, correlated with kidney function.

The present study aimed to assess the influence of opioid receptors on vasopressin (AVP) secretion in 12 kidney transplant patients (KTP) with stable graft function, and in 15 healthy subjects (control). Significantly lower basal plasma AVP levels were found in KTP than in controls. After blockade of opioid receptors by naloxone a significant increase of plasma AVP levels were observed in both examined groups. This increase was significantly higher in KTP than in healthy subjects. From data presented in this study participation of opioid receptors in the regulation of AVP secretion is highly likely both in KTP and controls. This participation seems to be significantly greater in KTP than in healthy subjects.

It is a general opinion that the renal transplant patients may show the decrease of immunity which manifests by their increased susceptibility to bacterial, viral and fungal infections. One of the important non-specific defensive factors of the organism participating in the protection against infections is lysozyme. It is the purpose of the present paper to estimate the lysozyme activity in the un- and diluted serum in the renal transplant patients and to determine the possible mechanism of the observed deviations. 32 renal transplant patients (24 men and 8 women) aged of 16 up to 50 were investigated, being in the period of 1 until 4 years after transplantation. In the investigation the kind of immunosuppressive treatment used was considered which served the purpose of dividing the total group of patients into two subgroups: one treated with cyclosporine (12 patients) and the other treated with azathioprine (20 patients). The control group consisted of 20 healthy persons, matching by age, sex and living place the group investigated. In both groups investigated and control, were determined: lysozyme activity in the serum of the undiluted and diluted blood, total leukocyte number, the absolute number of peripheral blood neutrophils as well as their adherence to fibres was evaluated. In the renal transplant patients compared with the control group and in the separated subgroups, no statistically significant differences were found concerning leukocyte count, absolute neutrophil count and adherence of those cells.(ABSTRACT TRUNCATED AT 250 WORDS)

In renal transplant patients the plasma and leukocytes bactericidal activity was estimated towards the vivid bacterial cells of the standard strain of Staphylococcus aureus Oxford 209P. Considering the kind of the immunosuppression used, the patients were divided into two subgroups. The first subgroup comprised the patients treated with cyclosporin A and prednisone (12 persons) and the second one--the patients treated with azathioprine and with prednisone (19 persons). The control group consisted of 20 healthy persons. In the renal transplant patients significantly more bacterial cells survived the incubation with plasma and peripheral blood leukocytes and the reduction of bactericidal activity of the leukocytes alone was also found. The reduction of bactericidal activity of the peripheral blood leukocytes observed in the patients of the group tested may have resulted from the inefficient microbicidal systems of those cells. The kind of the immunosuppressive treatment did not seem to affect the bactericidal activity of the leukocytes and plasma examined in the renal transplant patients peripheral blood. It may be supposed that the increased susceptibility of those patients to bacterial, viral and mycotic infections is due in part to the reduced bactericidal capability of the peripheral blood leukocytes.

Acute rejection is characterized by renal ischaemia which in turn is a triggering factor of EPO synthesis. This fact justified our present studies which aimed to assess the influence of acute rejection (AR) on plasma EPO level in KTP. A total of 17 KTP were examined some days before AR (I), at the onset of AR (II), immediately (III) and some days after (IV) discontinued therapy of AR episodes by methylprednisolone. The control group consisted of 16 healthy subjects. KTP 2-3 weeks after renal transplantation showed relative EPO deficiency both during efficient excretory function and rejection episodes. At acute graft rejection episodes a marked increase of plasma EPO level was found. Results presented in this study suggest absence of the physiological relationship between EPO secretion and erythropoiesis 2-3 weeks after transplantation.

In 64 kidney transplant patients (KTP) (35) treated by cyclosporine A (CyA)+ prednisone and 29 treated by azathioprine (Aza)+ prednisone and promethazine and in 15 healthy subjects plasma adrenalin (A), noradrenaline (NA), plasma renin activity (PRA) and mean arterial pressure (MAP) in basal conditions and after water immersion test (WI) were measured. In basal conditions the A and PRA were higher, but NA was normal. After WI statistically significant decrease of MAP, PRA, A and NA were observed in all examined groups. In KTP mean decrease MAP, PRA and A was higher, but NA lower than in normals. No significant correlation between A or NA and PRA, and MAP and A or NA was observed. In KTP the change in sympathetic+ activity was observed. Participation of catecholamines and renin in the pathogenesis of hypertension in KTP is not dominant. Kind of immunosuppressive therapy (CyA or Aza) haven't significant influence on A, NA nad PRA levels.