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Clinical effectiveness of recombinant human erythropoietin (Epo) administered subcutaneously (sc) was examined in 19 anemic patients. The patients were given Epo twice weekly 2000 U (67 +/- 12 U/kg/week). The results were compared to the group of 20 patients receiving Epo intravenously (i.v.) in doses from 156 +/- 57 U/kg/week to 205 +/- 105 U/kg/week, thrice weekly (control group). According to our findings the target hematocrit level was reached within 12.4 +/- 10 weeks in patients treated sc and 9.6 +/- 5.8 weeks in the control group. The Epo dose required to achieve the increase of Hb by 1 g% was 534 +/- 347 U/kg in patients treated sc and 973 +/- 534 U/kg in the control group. Achievement to target level of hematocrit required lower total amount of Epo units in patients receiving Epo sc (844 +/- 754 vs 1958 +/- 1496 U/kg). Cost of treatment of 1 patient taking Epo sc was significantly lower. The decreasing of frequency of Epo administration was utilized in 17 patients, from twice weekly to once weekly 400 U. After 6 months of the treatment Hb remained unchanged. We conclude that subcutaneous administration of Epo, once weekly is an efficient and convenient method of treatment of renal anemia.

Unlabelled: In order to assess the effect of long term erythropoietin (EPO) therapy on the nutritional status of hemodialysed (HD) patients 2 groups of HD patients were studied: I-EPO treated for 72 +/- 8 mo, 12 patients, HD for 138 +/- 66 mo, II-control group, 14 patients with Ht 30%, HD for 121 +/- 35 mo. At the onset and after 6 years of follow up patients underwent the following examination: length, body weight, body mass index, body fat stores, arm muscle circumference and total serum protein, serum albumin, lymphocyte count, creatinine, urea, cholesterol and PTH. In EPO group mean BMI, body fat, arm muscle circumference, visceral protein and total lymphocyte count were not change. In control group the decrease in height, body weight, BMI, body fat stores, arm muscle circumference and albumin were observed. Elevation of PTH estimated in half of patients in EPO group and 75% of patients in control group could influence the nutritional status of hemodialysed patients., Conclusion: 1. Nutritional status of majority of hemodialysed patients was not change during six years EPO therapy. 2. Non EPO treated patients showed the decrease of anthropometric measurements and serum albumin.

In order to assess the effect of erythropoietin (Epo) treatment on amino acids profile in hemodialysis patients (HD pts) 2 groups of pts were analyzed: I-12 pts HD for 146 +/- 71 months, Epo treated for 64 +/- 10 months, II-17 pts HD for 120 +/- 39 months, non Epo treated, mean Hb 11.5 +/- 1.2 g/dl. Controls consisted of 11 healthy individuals. Amino acids were estimated by HPLC OPA method. In group I blood levels of leucine (p < 0.03), valine (p < 0.002) were decreased and alanine (p < 0.05) was increased when compared to controls. In this group, blood levels of methionine, tyrosine and asparagine were elevated (p < 0.04) when compared to group II but they were lower (about 30%) then in controls. In group II pts showed reduced levels of valine (p < 0.008), leucine (p < 0.001), methionine (p < 0.0001), tyrosine (p < 0.003), asparagine (p < 0.04), whereas serine, glutamate and alanine (p < 0.04) were increased when compared to controls. Essential to nonessential amino acids ratios in group I, II and controls were as follows: 0.17; 0.12; 0.49 respectively. There were not substantial differences in amino acids in pts with elevated or normal PTH level in both HD groups. Long term EPO treatment only partially corrected changes in amino acids levels in pts with chronic renal failure.

Iterative transfusions are one of the most important mechanism of the induction as well as maintenance anti-HLA antibodies. We evaluated the evolution of PRA (panel reactive antibodies) in 46 sensitized patients during and after withdrawal of blood transfusion. Twenty nine of them (22 women and 7 men in age 38 +/- 7 years) were treated with EPO for 13 to 60 months. With EPO therapy anemia improved, allowing transfusions withdrawal in 19 patients. PRA level decreased from 62 +/- 23% to 42.5 +/- 25% after 1 year of therapy. At 2 year PRA reduced to 37.7 +/- 30% and remained on this level at 3 year. PRA levels became negative in 4 patients, decreased in 11 (by 35%) and remained high in 7 patients. The results of the patients were compared with 17 sensitized patients (9 women, 8 men in age of 40 +/- 10) who did not receive EPO and only part of them required sporadicly transfusions (mean 3 unit of blood) during last 2-3 years. PRA levels decreased from 59 +/- 20% to 45 +/- 22% at 3 year. PRA became negative in 6 patients. The reduction in PRA levels in this group of patients was lower than in EPO treated patients (24.3% vs 14%) as well as in fewer number of patients PRA droped (53% vs 63%). Analysis of risk factors for persistent high levels of alloantibodies showed, that female sex and DR2 phenotype were significant factors.

DNA metabolism in lymphocytes was evaluated in patients suffering from the nephrotic syndrome decompensation, basing on measurement of endonucleases (DNases) activity in these cells. The examination involved 17 patients, aged 27.7 +/- 7.11 with clinical and biochemical active disease, all with the nephrotic syndrome decompensation and erythrocytes in urine. A significant rise in the enzyme activity was observed in T and B lymphocytes (p < 0.001) in all the patients, with a distinct 3-fold increase in enzyme activity in B lymphocytes, when compared with the other cell populations. To elucidate the nature of the observed changes in DNases activity in systemic lupus erythematosus, nucleus proteins of the cells were separated electrophoretically in acrylamide gradient with immobilized DNA. Degradation processes in nucleic acids were considerably more efficient than the DNA synthesis in B lymphocytes of these cells. A smaller increase in the enzyme activity in T cells than in B lymphocytes results exclusively from more intense catabolism of nucleic acids not parallel to the intensified DNA synthesis in these cells.

Angiotensin converting enzyme inhibitors was given to 16 patients with glomerular nephritis in whom a complete remission of nephrotic syndrome could not be achieved with immunosuppressive-anti-inflammatory therapy. Captopril in the daily dose of 25-75 mg and enalapril in the daily dose of 10 mg were administered for 1-36 months (mean 12.6 months). Daily proteinuria decreased by 40-80% comparing with baseline value in 2/3 of patients. Total protein and albumin serum levels increased simultaneously. No changes in blood creatinine were noted in patients with initially normal renal functioning except one patient. Renal functioning was stable in 50% of patients with increased blood creatinine levels (mean 200 mumol/L). Blood creatinine was increasing in the remaining patients.

The increased number of the genitourinary system infection caused by Chlamydia trachomatis (Ch. Tr.), increased number of patients with dysuria or sterile leukocyturia gave stimulus to studies of 615 patients from Department of Nephrology and District Outpatient Nephrological Care Unit with regard to infections with that microbes. Material for investigations derived from urethra. Diagnostic examinations were performed using the Mc Coy cell culture and the immunofluorescence method. The infection was noted in 176 patients (119 women and 57 men) that is in 28.6% of cases studied. The mean age of patients was 42.7 +/- 12 years. Clinical symptoms such as dysuria or frequency were typical for that kind of infection. The most frequent abnormality was leukocyturia or leukocyturia accompanied by erythrocyturia noted in 66% of patients. Isolated erythrocyturia was observed in 24.4% of cases. It has been stated that anamnesis or routine laboratory examinations were not able to the identification of infection. In face of poorly characteristics of clinical picture of infection the infection with Ch.Tr. could be the cause of unsuccessful therapy in patients with signs of genitourinary tract infections.

A case of not expected turn in the course of mesangiocapillary glomerulonephritis in a 30-year old patient is presented. The patient has been treated with EACA. It confirms possible efficiency of EACA inhibitory effect on various immunological reactions. This new, unknown property of EACA justify some new concepts in pathogenetic mechanisms of glomerulopathy.

The activity and quantity of deoxyribonucleases in T and B lymphocyte cells isolated from peripheral blood of patients with transplanted kidney were investigated. Twenty three patients with transplanted organ, aged 35 +/- 9.7, treated with cyclosporin A and thirteen individuals after renal transplantation in age 34.8 +/- 6.3 treated conservatively were studied. The enzyme activity was defined as resting DNase activity (DNase 0). Where specifiel the reaction mixture was supplied either with 5 mM MgCl2 (DNaseMg2+) or 1 mM MnCl2 (DNase1 x Mn2+) or 2 mM MnCl2 (DNase2 x Mn2+). Two enzyme groups with molecular mass 32 kDa and 14 to 18 kDa were analyzed. It was evidenced that the nuclease activity in B lymphocyte isolated from patients treated with cyclosporin A after organ transplantation was quite close to the control subjects. On the contrary, the nucleases activity and quantity increased in T lymphocyte of the same patients and increasing in enzymes activity was depending upon haemodialysis period of time prior to organ transplantation. Enzymes activity correlate with clinical parameters typical for kidney transplant rejection. The activity and quantity of nucleases was slightly reduced in both T and B lymphocytes isolated from patients treated conservatively after organ transplantation. The useful of nuclease assay for monitoring of kidney transplant rejection is discussed.

The activity of three classes DNA-dependent RNA polymerases in T and B lymphocyte cells nuclei isolated from peripheral blood of patients with transplanted kidney were investigated. Twenty three patients with transplanted organ in age 35 +/- 9.7 treated simultaneously with cyclosporin A and small doses of prednisone and thirteen persons after renal transplantation in age 34.8 +/- 6.3 treated conservatively (azathioprine plus prednisone) were studied. The enzymes activity was assayed by the measurement of [3H] UTP incorporated into acid insoluble product in the presence of alpha-amanitin when specified. Both, "bound" and "free" enzymes activity was analysed. "Bound" polymerase is defined by the ability to transcribe endogenous template in the absence of exogenous DNA. "Free" enzyme was determined by the additional transcription on exogenous, calf thymus DNA as template. The quantity of polymerase I subunits by Western blotting was also analysed. It was shown that the polymerizing enzymes activity strongly depend upon haemodialysis period of time prior to organ transplantation as well as upon the treatment after transplantation. Characteristically in case of T lymphocyte isolated from patients treated with cyclosporin A, the transplant rejection process was accompanied by large increasing in polymerase activity especially in polymerase I. The correlation in polymerase activity and transplant rejection time was clearly observed. In case of lymphocyte cells isolated from patients with renal transplant treated conservatively, the polymerase activity in both T and B cell was slightly reduced. The useful of polymerase assay for monitoring of patients with renal transplant is considered.

Cefoperazone was used in the treatment of infections in 13 cases of chronic renal failure. In 8 cases recurrent urinary tract infections were diagnosed, septicaemia in 3 cases, pneumonia in 2. Cefoperazone 2-4 g daily was a very effective and well tolerated drug. Only one therapeutic failure was noted in a patient with mixed urinary tract infection (strains of Enterobacter cloacae and Klebsiella pneumoniae). No side effects developed, and in patients in the phase of moderate renal failure some decrease of serum creatinine was noted after the completion of treatment.

Just as in other inflammatory processes in glomerulonephritis also a great role has been ascribed recently to proteases released from phagocytes and mesangial cells. On the basis of original observation (clinical and experimental) of glomerulopathy inhibition by EACA, the authors present the concept of local antiproteolytic failure as the cause of protracted course of certain forms of glomerulonephritis.

Recombinant human erythropoietin (EPO) was administered i.v. to anaemic patients (pts) on hemodialysis in doses from 40 to 120/IU/kg 3 times a week. 20 out of 21 pts showed an increase in hemoglobin (Hb) level above 11 g/dl after 8-12 weeks. Maintenance doses to keep Hb value about 10 g/dl varied from 2 X 40 IU/kg to 3 X 40 IU/kg per week (subcutaneous). EPO improved the well-being and physical condition in all of pts. Six pts developed rise in blood pressure and most an increase in predialysis serum potassium and urea levels during first 16 weeks of treatment.