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Hypothyroidism in patients with renal failure (RF) causes many metabolic and clinical problems, and both these diseases can mutually exacerbate their disturbances., Aim: The aim of this study was to evaluate the effect of hypothyroidism, and end-stage renal disease (ESRD) on conversion of thyroid hormones (TH) in patients with ESRD treated with chronic hemodialysis (HD)., Materials and Methods: The study was performed in 74 patients, including 41 women (K) and 33 men (M) aged 28-83 y.o. in 4 groups: G1 - 12 people with ESRD treated with HD and with newly diagnosed hypothyroidism without substitution (6 K and M 6) aged 66,83±12,90 y.o., G2 - 26 patients with ESRD treated with HD without hypothyroidism (10 F, 16 M) aged 58,85±15,52 y.o., G3 - 11 hypothyroid patients without RF (9 K, 2 M) aged 54,73±21,26 y.o., G4 - 25-persons from control group of healthy subjects (16 M, 9 M) aged 51,24±12,58 y.o. In all subjects the concentration of TSH and TH (T4, T3, fT4, TSH, FT3, rT3) were measured and values of conversion factors (T3/T4, FT3/ fT4, rT3/fT4 and rT3/fT3) and binding TH to protein factors (fT4/T4 and fT3/T3) were calculated., Results: Lower concentration of T3 (p=0.012), fT3 (p<0.001) i fT4 (p=0.014) was found in patients without hypothyroidism than in healthy subjects. Renal failure with concomitant hypothyroidism intensify the disturbances of T4 to T3 conversion (p=0.034) and hypothyroidism with concomitant renal failure disrupts binding of T3 to proteins (p=0.001). FT3 to fT4 ratio in renal failure with concomitant hypothyroidism group was significantly lower than in each other group. rT3 concentrations were the highest in healthy subjects., Conclusions: Concomitance of hypothyroidism and end-stage renal disease reduces the conversion of thyroxine to triiodothyronine, but does not increase the production of rT3. Hypothyroidism significantly increases the disorders of thyroid hormones in end-stage renal disease. There is decreased tendency to bind of thyroid hormone to protein in hypothyroidism in patients with end-stage renal disease.

In the article, the authors discuss proliferation signal inhibitors (PSI), a group of medicines used in immunosuppressive therapy after renal transplantation. They present the mechanism of action of this class, side effects and drug interactions important in clinical practice. In addition, they present the available drugs and their practical application.

Acute tubule-interstitial nephritis is a heterogeneous group of inflammatory diseases which affect renal parenchyma and tubules, mostly as a result of the immune-mediated injury. They are the important cause of acute kidney injury accounting for 5-15% of all its causes. In subsequent years, with the development of pharmacotherapy, the incidence of drug-induced nephrotoxicity has been increasing. The other causes of the acute tubule-interstitial nephritis are autoimmune and inflammatory diseases, infections, neoplasms and electrolyte abnormalities. The diagnostics are complex and treatment of the disease is not always easy. The following overview provides a summary of causes of acute tubule-interstitial nephritis, clinical picture of the disease, the diagnosis and treatment.

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.

Anemia is one of the most common problems of patients with advanced chronic kidney disease (CKD). Its main causes in this population are: iron deficiency and a decreased renal synthesis of erythropoietin. Up to the 80's of the twentieth century, treatment of anemia in CKD was limited to blood and red blood cells transfusions. However during last three decades there has been a huge progress in the field, starting with introduction into clinical practice of human recombinant erythropoietin (rHuEPO), followed by an appearance of agents with a longer duration of action, darbepoetin alfa and methoxy polyethylene glycol-epoetin beta, all of which are shortly reviewed in this paper.

Metabolic acidosis is defined as a decrease of bicarbonates in the blood, below normal range, with a reduction of blood pH. It is a common disorder in chronic kidney disease (CKD). Clinically apparent fairly late (GFR < 30 ml/min/m2), although usually mild, it can have adverse effects on important functions of the human body. In the article the pathomechanism of metabolic acidosis in CKD, its influence on human body and treatment is shortly reviewed.

Recent epidemiological studies show significant prevalence of chronic kidney disease (CKD) in the general population. Diuretics are critical in therapy ofvolume overload and hypertension commonly encountered in these patients. However, they frequently demonstrate relevant diuretic resistance, and from the other hand diuretic overdose may lead to dehydratation and worsening of kidney function. In this paper the main principles of diuretic treatment in CKD are described, including the diuretic agent and its dose selection, as well as adverse effects of the therapy.

Unlabelled: Determination of circadian of prolactine (PRL) profile and its relationship to selected clinical and laboratory indices in end-stage renal disease (ESRD) patients undergoing hemodialysis, peritoneal dialysis as well as those in predialysis period was the aim of the study. Investigations were carried out in 38 patients with ESRD aged 36 to 79 yr. (medium 59 +/- 11 yr.), (20 male, 18 female, 7 treated with peritoneal dialysis, 25 undergoing hemodialysis, 6 in predialysis period) and the control group consisting of 7 healthy volunteers (4 male and 3 female). Serum concentration of PRL was evaluated at 3:00, 7:00, 12:00, 18:00, 22:00. The influence of different dialysis methods, blood concentration of parathormone, hemoglobin, total protein, erytropoietin (EPO), C-reactive protein, EPO therapy and duration of dialysis therapy on the PRL profile was analyzed. Results were analyzed according to medium obtained values of daily PRL profiles and individual indexes of variation of the daily concentration. Impaired circadian PRL profile was found in the all of followed groups comparing to the control, which was based on flatting of the curve and decreasing of the nightly pick of secretion PRL. None of analyzed factors had normalized the PRL profile curve., Conclusions: The PRL profile in ESRD patients treated with hemodialysis, peritoneal dialysis and in predialysis period is changed. The PRL profile curve is flatted and there was no night pick of PRL secretion in the patients. PRL level was shown to increase with progress of the disease, and the highest levels were in hemodialysed patients. EPO treatment, general appearance improvement, increased hemoglobin level and any of studied different dialysis method did not normalize the altered PRL profile.

Unlabelled: Evaluation of metoclopramide (MTC) test values in end-stage renal disease patients undergoing hemodialysis with different level of hyperprolactinemia was aim of the study. Clinical value of application of the MTC test and influence of different laboratory and clinical factors including erytropoietin treatment were examined. Sixty-eight hemodialysed patients (31 male and 37 female) aged 20-74 yr. (medium 48 +/- 13 yr.) underwent the MTC test, the control group consisted of 8 healthy volunteers (4 male and 4 female). 10mg of MTC was given i.v. and serum level of PRL was determined in 0, 30 and 60 min. after injection. Significant suppression of PRL stimulation in the patients was shown as compared with the controls after 30 min and delayed decrease of the curve values was found. An increase in the PRL level after 60 min in investigated group was lower than in control. Lower relative enhance of PRL level in 30 min was found and slower decrease after 60 min. Despite the slower decrease PRL level was lower in the patients than in the controls after 60 min. The highest relative increase in PRL level after 30 min was observed in the patients with lowest initial level of PRL (r=-0.471; p<0.001). Erytropoietin administration improved the response in the test (p=0.005) without relationship to the duration of erytropoietin treatment. There was influence of hemoglobin level on the results of the test., Conclusions: Results of the MTC test in end-stage renal disease patients is inadequate and the PRL response is diminished. Diagnostic value of the test in end-stage renal disease patients is low. Erytropoietin administration improves although not to the normal values the results of the MTC test.

We analysed medical documentation of 65 patients with alcoholic cirrhosis admitted to the Internal Diseases Department with Dialysis Ward in the hospital in Wolomin between 2002 and 2004 year. Patients were divided into 3 groups according to renal disfunction: patients with HRS-1, patients with HRS-2 and patients with cirrhosis without renal failure. Each diagnosis was established basing on criteria of International Ascites Club. Different factors, which may influence a development of HRS, such as large--volume paracentesis without plasma expansion, bacterial infections, gastrointestinal bleeding and nephrotoxic drugs were analysed. Patients were treated with terlipressin and intravenous albumin infusions, antibiotics, diuretics, dopamine, haemodialysis and paracentesis. 10 patients (3 with HRS-1.5 with HRS-2 and 2 without renal failure) died, which is 15.4% of the all group. The mortality in the group of patients with HRS is high but complex treatment may be effective. Nowadays liver transplantation is the most effective method.

Due to a high frequency of autoimmune diseases in patients with ESRF we observed for 4 years 8 patients treated with HD with high level of TPOAb and 8 patients without TPOAb. Aim of the study was to estimate the role of TPOAb as a prognostic factor of hypothyreosis. We observed in a 4-years follow-up significant increase of TSH (p<0.05) in patients with high TPOAb level. fT3 and fT4 did't change in this time. In the group without TPOAb we observed significant (p<0.01) decrease of fT3 probably due to the disturbances in T4 to T3 conversion. Our results don't permit us to draw a final conclusions but induce us to further observation of hypothyreosis development in patients with ESRF.

Unlabelled: Left ventricular hypertrophy (LVH) in course of the systemic hypertension (HT) is found as independent risk factor for ventricular arrhythmia and sudden cardiac death., Objects: The aim of the study was to evaluate the relationship between occurrence of LVH and electrical instability. Study group included 64 patients (pts) with mild to moderate HT, without clinical signs of coronary artery disease. Pts were divided into two group: with and without LVH (LVH was diagnosed by echocardiography (ECHO) when left ventricular mass index (LVMI) was > 106 g/m2 for women, and > 111 g/m2 for men). By 12-lead ECG QTc, dispersion QT (QTd) were calculated. From SAECG the QRS duration (tQRS), the root mean square of the last 40 ms of the filtered QRS complex (RMS40) and the duration of the terminal low amplitude QRS signal < 40 microV (LAS 40) were calculated. Ventricular arrhythmias were recorded during 24 hour Holter monitoring and classified into the Lown classification., Results: No difference in QTd between two groups was observed. Nobody has nonsustained ventricular tachycardia in 24-hour Holter monitoring. In group with LVH tQRS was longer and RMS higher in SAECG than in group without LVH., Conclusion: LVH in hypertensive pts influences the increase of electrical instability that is evaluated by SAECG.