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The paper presents general principles of rational cooperation of general practitioners and other specialists with nephrologist dedicate special attention concerning the slowing progression of renal failure and beneficts for patients as a result of early referral to nephrologist. The management of patients with chronic renal failure in the predialysis period and their preparation for renal replacement therapy was also described.

Intradialytic anticoagulation is an essential element of the dialysis procedure. Patients with end stage renal failure, due to the repetitive nature of dialysis sessions are exposed in a chronic manner to side effects of drugs applied during the procedure. Popular administration of unfractionated heparin, concerning its unstable pharmacokinetic profile may cause thrombocytopenia, enhance hyperkalemia, osteoporosis, and lipid disturbances. In the past years, a clinical alternative to unfractionated heparin have become, as well as in dialysis therapy, low molecular weight heparins. Beside the beneficial pharmacokinetic aspect, these heparins are characterized by decreasing number and less intensified side effects associated with their administration.

The paper contains the overview of the definition, clinical features, pathomechanism and the risk factors of the radiocontrast-induced nephropathy. Authors reviewed the methods of prevention and treatment of the renal failure induced by radiocontrast media with the special attendance to the results of the latest clinical trials.

Continuous increase of the number of patients with chronic kidney failure which require renal replacement therapy, in Poland as all as over the world, demands the analysis of epidemiological situation concerning renal diseases. Early diagnosis of nephropathy permits not only an adequate treatment, but also facilitates the introduction of the therapy that slows the progression of kidney failure. The aim of the pilot study PolNef was an attempt to evaluate the epidemiology of renal diseases in Poland on the basis of a randomly selected population from a city numbering 60 thousand people. As a screening test, allowing to distinguish patients requiring further diagnostic of nephropathy, the microalbuminuria dipstick test accompanied by blood pressure measurement and questionnaire was accepted. Microalbuminuria was detected in more than 18% of the population investigated up till now. It was more frequent in male, in obese, and in smokers. More than 33% of all participants consulted by the nephrologist required permanent nephrological care and for the next 32% another nephrological consultation in 6 to 12 month should be ordered. Decreased clearance of creatinine was found in above 17% participants and 6 patients were referred for further treatment because of new diagnosis of renal tumor. Identification in investigated population patients with of an early stage of kidney disease needs further nephrological diagnosis and treatment is especially important from the point of view of every single patient and also may bring substantial economic benefits for health protection system as well.

Background: Accelerated vascular calcification is an important cause of excess mortality in patients on dialysis therapy. The aim of the study was to evaluate the trends in coronary artery calcification (CAC) score (CaSc) during a 1-year period in a group of stable peritoneal dialysis (PD) patients and identify factors that may be associated with CaSc changes., Methods: Sixty-one stable patients (28 women, 33 men) on PD therapy with a mean age of 50.4 +/- 13.6 years were included. Forty-seven patients survived the entire study period on PD therapy and were suitable for the final analysis. CaSc was assessed at baseline and after 12 months by using multislice spiral computed tomography. Proinflammatory cytokines (interleukin-6, tumor necrosis factor-alpha [TNF-alpha]), acute-phase proteins (C-reactive protein [CRP], fibrinogen), calcium-phosphate balance, and lipid profile were assessed at baseline and after 6 and 12 months., Results: Median CaSc was 22.6 Agatston units (range, 0 to 5,502.8 Agatston units) at baseline and increased to 84 Agatston units (range, 0 to 5,001.3 Agatston units) at a 1-year follow-up (P < 0.05). In the entire group of patients, 3 subgroups were identified: patients with progression (n = 21; P = 0.02 for the difference between initial versus follow-up CaSc), patients with regression (n = 12; P = 0.05), and subjects without change in CaSc after 1 year (n = 14). Patients without progression showed no calcifications at baseline and follow-up and were younger, less overweight, and characterized by significantly lower mean TNF-alpha, leptin, and CRP levels during 1 year compared with both progressors and regressors. Mean serum phosphate and calcium x phosphate product (Ca x P) values were gradually increasing from regressors through the no-calcification group to progressors (P < 0.01 for phosphate levels, P < 0.02 for Ca x P product). Significant correlations were found between changes in CaScs and mean values for phosphate (R = 0.44; P < 0.0005) and Ca x P product (R = 0.38; P < 0.005)., Conclusion: Chronic nonspecific inflammation does not directly attribute to progression in CaScs. Calcium-phosphate balance abnormalities appear to be the only important factors promoting CAC, although a permissive or promoting role of inflammation cannot be ruled out.

Annual mortality on renal replacement therapy is about 10% in Western Europe and reaches 20% in the United States. The reasons responsible for this excess mortality include among others advanced age, high prevalence of diabetes and comorbid conditions, susceptibility to infections, and cancer. An additional cause that should be considered is late referral to overall renal care and for renal replacement therapy. It has been demonstrated recently that early referral may provide many advantages for the patient, such as prevention of organ damage secondary to uremia and even delay the onset of end-stage renal disease. These benefits prompted numerous recommendations for timely referral, both for dialysis and for long-term renal follow-up. Despite available guidelines for nephrology referral the current practice is still suboptimal, resulting in delayed initiation of dialysis and clinical outcomes that are not ideal. There is an urgent need in the renal community to change the current practice of referral. Beyond the benefits for patients, society may also expect potential cost effectiveness from early renal care.

Unlabelled: Acetaminophen is found to be potentially hepatotoxic drug. Both, acute acetaminophen intoxication (dose >10 g) and therapeutic dose administration in the case of glutathion depletion (chronic alcohol abuse) hepatotoxic effect may occur. Late N-acetylcysteine (NAC) administration does not prevent liver injury. Molecular Adsorbents Recirculating System (MARS) is useful liver support device based on albumin dialysis for saving time for spontaneous liver regeneration or bridging technique to liver transplantation., Case Series: Two cases admitted to the Department in 19 and 20 hour post-ingestion of hepatotoxic paracetamol doses as confirmed by toxiocological examination (serum paracetamol concentration). Despite of NAC administration the signs of the liver injury (progressive encephalopathy and jaundice, decreased prothrombin activity) developed. On day four post exposure according to King's College of Medicine London criteria both cases were qualified to MARS therapy. Albumin dialysis of 8 hour duration was performed in both cases and a full recovery with normalization of the liver function was noted. Patient three: patient with the liver and the kidney insufficiency due to alcohol-paracetamol syndrome admitted to the Department of Clinical Toxicology for MARS therapy. Five performed dialysis resulted in the liver function improvement. The patient was disqualified from the liver transplant because of heart failure, pneumonia, hyperthyroidism and alcoholism. Patient died because of heart failure.

Background: Continuous ambulatory peritoneal dialysis (CAPD) is an alternative to the hemodialysis mode of terminal renal failure treatment. Nutritional status impairment is common among patients with end-stage renal disease, and its laboratory surrogates predict increased morbidity and mortality risk in patients on chronic haemodialysis or peritoneal dialyses. The aetiology of malnutrition is multifactorial and delayed gastric emptying is also considered to be a significant factor. The aim of this study was to estimate the direct influence of indwelled dialysate in the peritoneal cavity on gastric emptying in patients treated with CAPD., Material and Methods: the study group included 20 patients (9 males, 11 females) aged 50,1 +/- 11 years (range: 39-75 years) with chronic renal failure treated with CAPD for 18.4 +/- 14.7 months. All patients were non-diabetic and had no other than chronic uraemia co-morbidity known to influence autonomic nervous system function and gastric motility. The control group included 15 healthy volunteers matched by age, sex and body weight. Dialysis adequacy parameters were calculated based on 24-hour urine and dialysate collections. Gastric emptying was estimated with dynamic abdominal scintigraphy. We compared the results of gastric emptying tests performed in dialysed patients with and without dialysate liquid in the peritoneal cavity and related the values to those of the control subjects., Results: In the study group, weekly values of dialysis parameters were within the ranges considered satisfactory in terms of uraemia control. All parameters of gastric emptying were significantly delayed and prolonged in terminal renal failure patients, but the results have shown no significant differences between those with and without indwelling dialysate., Conclusions: Based on the results we conclude that gastric emptying in subjects with chronic renal failure treated with CAPD is markedly delayed compared to healthy subjects. There was no significant effect of indwelling dialysate in the peritoneal cavity on gastric emptying rates found, based on the observation that its removal was not associated with any noticeable improvement of gastric emptying. The data strongly contraindicate the theory of peritoneal dialysate volume being the cause of this reversible disorder and indicate that the role of other possible factors leading to the development of gastropathy in those patients should be investigated.

Systematic increase of dialysis patient number in the world places an enormous responsibility upon the nephrological society in analyzing the epidemiological situation concerning renal diseases. Early diagnosis of renal disease permits treatment of not only the damaging effects of nephropathy on the kidney but also facilitates introduction of therapy that slows progression of complications due to renal insufficiency. Consequences of such strategy may allow for avoidance of terminal renal failure and to a significant degree may slow down for many years the further progression of chronic renal failure and its' impending results. The aim of the initiated pilot study is an attempt to evaluate the epidemiology of renal diseases in Poland on the basis of screening tests performed on a selected patient city in population numbering 60 thousand. In the first stages of the program, questionnaires will be distributed in order to select the patients that will require more detailed diagnostic procedures and nephrological care. Patient identification in the early stages of disease should bring not only better patient quality of life through adequate treatment but also substantial economic benefits, such as decrease in percentage of patients that will progress to terminal renal failure requiring expensive dialysis treatment.

Case report was presented of a 22 year old pregnant patient with diagnosed intrauterine fetal death, who developed HELLP syndrome and acute renal failure. Immediate hemodialysis treatment was initiated that permitted management of pulmonary edema; subsequent plasmapheresis eliminated not only elevated bilirubin and toxins liberated to circulation from the dead intrauterine fetus but also allowed for patient recovery. The HELLP Syndrome requires careful obstetric supervision and if possible treatment in the Intensive Care Unit.

Biological samples can be investigated with atomic force microscopy (AFM) in either of two imaging modes: contact mode or tapping mode. Applications of fluid tapping mode AFM in biology and medical sciences are constantly growing and the data obtained with this technique are improving, especially in terms of resolution. Even dynamic processes can be observed almost as they would occur in vivo. AFM is a proven imaging technique that has recently gained attention in biomaterials due to its ability to analyze surface properties, non-destructively at nanometer-level resolution in ambient air or in fluid environments.

Plasmapheresis is one of the methods of extracorporeal blood purification used for many decades for the treatment of different kidney and extrarenal diseases, mainly of autoimmunological nature. The main disadvantage of this method is the lack of selectivity and the risk of infections associated with plasma used for supplementation. Hence, the efforts are made to establish an alternative blood purification treatment that might be used in renal diseases instead of plasmapheresis. These alternative methods should be more selective in certain pathogenic factors elimination and result in less risk for patient, both acute and delayed. Recently two such methods were applied more frequently to everyday nephrological practice, i.e. LDL-apheresis and immunoadsorption. The present paper aims to review the current state of knowledge regarding use of two mentioned methods in kidney diseases. Despite their very high costs both of them if used early in certain, refractory nephropathies may ameliorate their clinical course and significantly improve the prognosis. In addition they may significantly reduce the overall costs of therapy due to avoidance of unnecessary immunosuppression, prolonged hospitalization and finally--costs of postponed renal replacement therapy.

Background: Low molecular weight proteins (LMWP) are considered uremic toxins. There is controversy whether in peritoneal dialysis (PD) the elimination of these toxins is influenced mainly by dialysis or by residual renal function (RRF)., Material/methods: The aim of our study was to evaluate the relationship between serum levels of selected LMWPs, dialysis adequacy, and RRF in PD patients. 27 stable subjects were studied, mean age 50+/-11, dialyzed for a median period of 10 months. Serum activity of acid RNA-se and alkaline RNA-se was measured by spectrophotometry, and serum alpha1-microglobulin ((alpha) 1M) concentration by ELISA. Kt/V and weekly creatinine clearance (wClCr) were assessed as adequacy indices (both as the sum of renal and dialysis components) and RRF as the mean of residual urea and creatinine clearances., Results: Significant inverse correlations were found between RRF and (alpha) 1M level, as well as alkaline RNA-se activity (p<0.0001). A similar relationship was found for residual Kt/V (p<0.0001 for (alpha) 1M and alkaline RNA-se). There was no significant correlation between acid RNA-se activity and any tested parameter of adequacy. When the cutoff points of wClCr = 60 L/week/m2, total Kt/V = 2.0, or RRF=2.0 ml/min were used, we found (alpha)1M level and alkaline RNA-se activity to be significantly lower in patients with higher values of the, Conclusions: RRF plays an important role in elimination of LMWP in PD. The activity of alkaline RNA-se and acid RNA-se behaves differently in these patients.

Aim: This study was carried out to evaluate the pharmacokinetic profile of alpha-dihydroergocryptine (CAS 14271-05-7, DHEC, Almirid) in plasma and urine in patients with moderately to severely impaired renal function (creatinine clearance < 30 ml.min-1.1.73 m-2), following administration of single oral doses., Methods: This was an open, nonrandomized trial. Seven patients with chronic renal disease and six healthy subjects received a single dose of 20 mg DHEC. Blood and urine samples were taken at specified intervals up to 72 h after dosing. Concentrations of unchanged DHEC were determined by radio-immunoassay (RIA) and concentrations of unchanged DHEC plus pooled metabolites by enzyme-immunoassay (EIA), respectively., Results: In patients with impaired renal function, the mean Cmax and AUC(0-infinity) values for unchanged DHEC were 2.1 (95% confidence interval CI: 0.99 to 4.42) and 1.85 (95% CI: 0.72 to 4.77) times larger than in controls. The 24-h urinary excretion was only 0.3 (95% CI: 0.12 to 0.71) times that in healthy subjects. Similar findings were recorded for total DHEC plus metabolites., Conclusions: As treatment with DHEC is in general uptitrated starting with doses as low as 5 mg DHEC, which are then increased while accounting for individual effects both in terms of efficacy and tolerability, the observed range of effects of impaired renal function on DHEC's pharmacokinetics does not suggest the need to revise this policy, although lower end-doses are likely to be achieved.

Scanning probe microscopy (SPM) has recently become the most dynamically developing technique employed in research investigations. Atomic force microscopy (AFM) that uses a digitally-controlled scanner and a cantilever system with a measurement tip shaped as a cone with the apex radius of 2-50 nm and the application force of 10(-10) N, as well as a system of recording detectors, has allowed for identification of numerous biological structures in a nanometer scale. The paper presents a review of measurement methods that employ the atomic force microscopy and are being used in medicine and biology, along with major achievements accomplished owing to this technique by various investigators, including the authors themselves.

Unlabelled: The aim of the study was to estimate mean aluminum concentration in the plasma of Polish healthy subjects., Materials and Methods: The study group consisted of 24 healthy adult volunteers aged 25-65, both genders. The results of the analysis of AI in serum (or plasma) in 128 samples from 107 dialyzed patients assessed during routine checkup, were compared with the group of normal subjects. The AI determinations were performed by means of graphite furnace atomic absorption spectrometry (GF-AAS)., Results: Mean AI concentration in the blood plasma of healthy subjects was 2.25 mcg/L (2.5-97.5 percentile range was 1.10-3.72 mcg/L), while for patients geometric mean was 9.9 mcg/L (2.5-97.5 percentile range was 1.7-124.3 mcg/L)., Conclusion: The plasma AI level of studied group of healthy Polish subjects appeared to be within the low values range compared to that found in other countries.

Background: Rhabdomyolysis is a relatively rare, not always diagnosed cause of acute renal failure (ARF). This fact motivated us to present the results of ARF treatment in the course of this polyetiological clinical syndrome., Material/methods: The analysis was performed on 84 patients (6 F, 78 M) ranging in age from 18 to 82 years (mean 46.5), in whom rhabdomyolysis was diagnosed based on clinical manifestation and laboratory test results (CPK, GTP, GOT, LDH)., Results: The most frequent cause of rhabdomyolysis was alcoholic intoxication (41 patients), often accompanied by hypothermia (15 patients) or trauma (30 patients). Isolated trauma was found in 30 patients, epileptic seizure in 5, and physical exercise in 1 case. In 17 patients, besides alcohol consumption, trauma or epileptic seizure, the use of tranquilizers, anticonvulsants, or narcotic drugs was additionally noted. 78 patients developed ARF requiring dialysis therapy; 49 patients recovered, 5 required maintenance dialysis, and 30 died., Conclusions: During the initial phase of ARF in the course of rhabdomyolysis dynamic increases in serum urea and creatinine were observed, as well as a tendency to hyperkalemia. The treatment results and mortality rate in our study group were primarily influenced by the patients' general condition at admission, as well as the extent of organ damage caused by the primary etiological factor. Favorable treatment results were obtained especially in those patients who were hospitalized in a nephrological center, while the worst outcomes were noted in those patients dialyzed in intensive care units, most with multiple trauma.

Cardiovascular diseases connected with atherosclerosis are the main factor of morbidity and mortality in patients with end-stage renal failure. Hyperhomocysteinemia is a known and independent risk factor of atherosclerosis, occurring in 85-95% patients treated with hemodialysis. The aim of this study was to analyse relation between plasma level of homocysteine and chosen indicators of atherosclerosis development and also examined retrospectively cardiovascular complications in these patients. The study was carried out in 100 patients on hemodialysis who were divided into two groups: 72 patients with mild (20.74 mumol/l +/- 3.75) and 28 patients with moderate hyperhomocysteinemia (38.81 mumol/l +/- 9.81). Ultrasonographic examinations of Carotid Communis Artery Intima-Media Thickness (IMT), Ankle-Arm Blood Pressure Index (AABPI), echocardiographic parameters and biochemical examinations such as: PTH, folic acid and Vitamin B12, total protein, albumin, fibrinogen, glucose, total, LDL and HDL cholesterol, transferring, apolipoprotein B, lipoprotein (a), sodium potassium, calcium, phosphate, magnesium, iron, ferritin, urea, creatinine, uric acid and value of Hb, Ht, total iron binding capacity and transferring saturation, were performed. Patients with hypertension were divided into groups according to the number of taken anti-hypertensive drugs. Hyperhomocysteinemia was confirmed in 96% of patients. Frequency and type of acute cardiovascular complications were not related with the level of hyperhomocysteinemia. Statistically significant difference between IMT and level of hyperhomocysteinemia was observed. In patients with mild hyperhomocysteinemia IMT was 0.68 mm +/- 0.24 whereas in patients with moderate hyperhomocysteinemia 0.80 mm +/- 0.25, p < 0.036). Positive correlation between level of homocysteine and IMT (r = 0.22, p < 0.03) was noted. Based on this study, we concluded, that measurement of intima-media thickness is a good indicator of atherosclerosis development and correlates with hyperhomocysteinemia in patients on maintenance hemodialysis. It clearly confirms the role of hyperhomocysteinemia as significant risk factor of atherosclerosis in those patients.

The main cause of increased morbidity and mortality in patients on maintenance hemodialysis are cardiovascular complications due to accelerated atherosclerosis. Lipid profile disturbances, increased levels of homocysteine (HC), fibrinogen, iPTH as and Ca-P abnormalities seem to be the important factors in atherosclerosis progression. The aim of the study was to evaluate the advancement of atherosclerosis in patients on maintenance hemodialysis and to assess levels of pro-atherosclerotic factors. The study included 50 patients (30 M, 20 F) aged 21-75 years (mean 48.6 y) hemodialyzed three times a week for 12 to 282 months (mean 114.5 m). The homocysteine, fibrinogen, iPTH, calcium, phosphate and indices of lipid metabolism such as total cholesterol, HDL, LDL, triglicerides, Lp (a) and Apo B were measured before hemodialysis. To evaluate the advancement of atherosclerosis, all patients underwent MSCT using Somatom plus 4 apparatus with calcium scoring (CS) calculation and B-mode ultrasound for IMT using Acuson 128 XP 10 apparatus. The above applied methods helped to evaluate changes in central and peripheral arteries. In CS testing, coronary artery calcifications were present in 36 patients (72%). The CS ranged from 0 to 4345, with the mean CS being 584 (SD = 1012). The CS correlated significantly with age (r = 0.39; p < 0.005), P (r = 0.33; p < 0.05), CaxP product (r = 0.39; p < 0.05), iPTH (r = 0.43; p < 0.001) and with IMT (r = 0.56; p < 0.0001). The IMT ranged from 0.5 to 1.5, with mean of 0.89 (SD = 0.28). The IMT correlated significantly with age (r = 0.54; p < 0.0001), time on dialysis (r = 0.40; p < 0.01), fibrinogen (r = 0.43; p < 0.02), LDL (r = 0.30; p < 0.05), P (r = 0.29; p < 0.05), and CaxP product (r = 0.3; p < 0.05). Based on our study, we conclude that age, time on dialysis, increased levels of homocysteine, LDL cholesterol, fibrinogen, P, and iPTH as well as Ca-P disturbances are strong predictors of atherosclerosis in HD patients.

Chronic antiinflammatory treatment is required in autoimmunologic dermatoses. Tacrolimus ointment (Protopic) an inhibitor of calcineurin, is the first topical nonsteroidal immunosuppressant for the last 50 years. Pimecrolimus (ASM 981), a newer calcineurin inhibitor developed for atopic dermatitis treatment has the same mode of action and altered skin penetration profile as takrolimus. Their structure, mechanism of immunosuppressive action, efficacy and safety in atopic dermatitis and other inflammatory dermatitides was described in this article. The attention was paid to systemic and in topical treatment, their intact and injured skin penetration profile, optimal doses, costs and perspectives of broad use of these drugs in dermatology were described.

Unlabelled: Presently, large venous vessel cannulation is the only procedure for attaining immediate dialysis access. As another option, vascular access may be a method for guaranteeing drug administration or parenteral feeding. The aim of the following paper was to evaluate the course of central venous catheter implantation and associated complications. The study included 235 patients (120 male, 115 female) between the ages of 24 and 87 years, treated at the Nephrology Department of the Jagiellonian University in Cracow from January, 1997 to March, 2001. Choice of cannulation location was as follows: subclavian vein--113 cases; internal jugular vein--107 cases; femoral vein--15 cases. In 223 patients, implanted catheters determined temporary access for hemo-dialysis or other extracorporeal circulation, where in 12 cases they determined location for drug administration. The following complications were observed during cannulation: accidental artery puncture--20 cases; inability to implant cannulation probe and puncture location change--16; inability to localize vessel at the first attempt of puncture--12; hematoma at puncture location--8; cephalad probe misplacement--6; bleeding at puncture site--5; catheter occlusion--25; inflammation at catheter exit site--14; catheter bending--10; vessel wall adherence of catheter arterial lumen--8; catheter removal by patient--8; damage of Luer ending--5; bacteremia confirmed by bacterial culture--4 (including 2 cases of sepsis); subcutaneous emphysema--1 case., Conclusion: Cannulation of large venous vessels is a safe method, associated with a small number of complications (23%), where the majority are of mild character (85%). In our material, infectious complications comprised only a low percentage (7.6%) presenting with an asymptomatic or mild course.

The main cause of mortality in patients on renal replacement therapy are disturbances in circulatory system including sudden death. Cardiac hypertrophy, ischemic heart disease, degenerative changes as a consequence of uremic cardiomyopathy and electrolyte disturbances constitute the main cause of cardiac arrhythmia. The differences in duration of QT interval in ECG leads are known as QT dispersion and may indicate on prevalence of cardiac arrhythmia leading to sudden cardiac death. In the paper we described prognostic significance of QT dispersion in patients on maintenance dialysis.

The degree of advancement as well as symptoms of renal osteodystrophy improve significantly in patients after successful kidney transplantation; however bone pathology is still present even after many post-transplant years. The aim of this study was to analyze the bone densitometry in patients during different periods after kidney transplantation and to assess bone metabolism using selected biochemical markers of bone turnover in comparison to healthy controls. Study population consisted of 73 patients of mean age 41.7 +/- 12.6 years (27F, 46M) mean 34 +/- 42 months after kidney transplantation. Mean period of maintenance dialysis prior to surgery was 28.6 +/- 20.3 months. We also analyzed age- and sex-matched control group of 24 subjects. Three-point densitometry was performed with DEXA technique. Serum levels/activity of osteocalcin, C-terminal propeptide of procollagen type I (PCTP), alkaline phosphatase (AP) and its bone-specific isoform (BAP) as well as desoxypiridine (DPD) urine level were analyzed as markers of bone turnover. Serum levels/activity of all mentioned parameters were significantly increased (p < 0.001) and urine DPD--significantly decreased (p < 0.05) in patients as compared to controls. Based on DEXA technique 26% of patients were categorized as having osteoporosis, 32.9%--osteopenia and 41.1% as normal in bone densitometry. Patients with diagnosed osteoporosis spent significantly longer time with functioning graft as compared to those with normal densitometry. In addition, subjects with osteoporosis were characterized by significantly higher serum level of osteocalcin as compared to those with osteopenia and normal DEXA (42.5 +/- 19.9 vs 26.6 +/- 15 ng/ml and 42.5 +/- 19.9 vs 30.2 +/- 104 ng/ml, respectively; p < 0.05). Identical relationship was also observed for serum PTH (128 +/- 42 vs 77.2 +/- 30.4 pg/ml and 128 +/- 42 vs 81.2 +/- 232 pg/ml, respectively; p < 0.001). There was also significant difference in PCTP level in all analyzed groups (203 +/- 85, 171 +/- 69 and 137 +/- 40 ng/ml in subjects with osteoporosis, osteopenia and normal; p < 0.05 for all differences). BAP activity reduction was observed only in the latter group of patients. Results of our study led us to conclude that the prevalence of osteoporosis and osteopenia in three-point densitometry among patients with functioning graft is high. Increased serum levels/activity of osteocalcin, PCTP, AP and BAP with concomitant decrease of urine DPD elimination suggest the predominance of bone formation over the bone resorption process.

Stenting is a modern and progressively developing methods in the treatment of blood vessel stenosis of different localization. Currently it is applied in all medical disciplines. The following article presents general characteristics of stents, methods of their implantation, current therapeutic indications for this procedure and treatment results of renal artery, arterio-venous fistulae and ureteral stenoses.

Multiple clinical trials have been undertaken during last years to assess indications, efficiency and safety of glomerulonephritis treatment with new immunosuppressive drugs as cyclosporine (CsA, Mycophenolate Mophetil (MMF) and Tacrolimus (FK 506). The main indication for cyclosporine is nephrotic syndrome resistance to steroids and cytotoxic agents, steroid-dependent and multi-relapsing cases with serious toxic side effects or with contraindications for steroids and cytotoxic drugs. CsA was administered at the dose of 4-5 mg/kg/day in adults and 5-6 mg/kg/day in children. The best results were achieved with minimal change disease. The durable remission occurred in 70-80% of cases of steroid-sensitive nephrotic syndrome and in 20-30% of steroid-resistant forms. There was a lower rate of remission and a high risk of cyclosporine nephrotoxicity in other types of glomerulonephritis. Therefore CsA, MMF and FK506 remain a late therapeutic option for patients with these types of glomerulonephritis and severe clinical course. As the long-term CsA therapy may be complicated by acceleration of renal fibrosis, a renal biopsy is mandatory before its administration.

Successful renal transplantation allows to correct most of the abnormalities that lead to cardiovascular system injury in chronic uremia. The aim of the present study was to analyze selected anatomical and functional parameters of the heart using echocardiography. The study was conducted prospectively in two groups of patients: 73 subjects with functioning graft and 53 patients on maintenance hemodialysis. Obtained results were compared between those two groups at the start of the study and later on after 6 and 12 months of follow-up. Post-transplant patients were included into the study 11 +/- 6.4 months after successful transplantation. Mean dialysis period prior to transplantation was 35 +/- 21 months. Patients in the control group were dialyzed for mean 54 +/- 25 months. The prevalence of various diseases of the cardiovascular system was equal in both groups of patients (most frequently diagnosed was hypertension). There was no difference in ejection fraction within groups during the whole study period, however the value of this parameter was higher among patients with functioning graft at the beginning of the study (p < 0.01) as well as after 6 and 12 months (p < 0.001) as compared to patients on dialysis. The prevalence of different morphological abnormalities of the heart, such as concentric hypertrophy, left ventricle dilatation, valve dysfunction as well as calcification of various structures, was equal in both groups of patients at the beginning of the study. In 87.7% of patients with functioning graft, left ventricle hypertrophy was diagnosed at the beginning of the study (mean LVMI value 176.9 +/- 55.5 g/m2) and this percentage decreased to 63% after 6 months (LVMI 155.8 +/- 60.3 g/m2; p < 0.001 vs. baseline) and 53.4% after 12 months (LVMI 141.6 +/- 62.1 g/m2; p < 0.001 vs. baseline). Regression of initial left ventricle hypertrophy, although less pronounced was also present among patients on maintenance dialysis. There was no difference in LVMI value between the studied groups at the beginning of the study, whereas after 6 and 12 months of observation it became significantly lower in patients with functioning graft (155.8 +/- 60.3 vs. 179.5 +/- 50.9 g/m2; p < 0.01 and 141.6 +/- 62.1 vs. 176.2 +/- 50.5 g/m2; p < 0.001). Based on obtained results we conclude that successful renal transplantation promotes the normalization of a number of echocardiographic parameters, especially leads to regression of left ventricle hypertrophy. Renal transplantation seems to be an optimal method of treatment in patients with end-stage renal failure, considering structure and function of the cardiovascular system.

In the paper the authors tried to identify factors influencing prevalence and clinical course of cytomegalovirus (CMV) infection in kidney transplant patients. The study was performed in the group of 100 patients after cadaveric kidney transplant followed up in the Chair and Department of Nephrology, Collegium Medicum, Jagiellonian University in Krakow. CMV infection was demonstrated to occur more frequently and significantly earlier in the patients administered prednisone, cyclosporin A and mycophenolate mofetil, compared to the group treated with standard triple-drug-therapy (prednisone, cyclosporin A, azathioprine) or double-drug-therapy (prednisone, cyclosporin A). Higher serum levels of cyclosporin A did not increase prevalence of the infection but urged its onset. Risk for CMV infection was however higher in the group of patients treated for acute rejection episodes, especially with antilymphocyte preparations. No differences were shown in the immunological matching within HLA-A, -B and -DR antigens between the patients without features of CMV Infection and those treated for its active form. The infection occurred significantly more frequently in the recipients with HLA-A1 antigen than in those with HLA-A9 and -DR7. In patients with delayed transplanted kidney functioning, time of the infection onset and a number of its episodes were similar to the remaining population, however severity of the clinical course positively correlated with the duration of acute tubular necrosis (ATN). CMV infection occurred slightly more frequently in patients requiring transfusions compared to those not administered blood preparations. Among patients with AB blood type, active CMV infection occurred statistically less frequently, whereas in those with other blood types percentage of patients with/without CMV infection were comparable.

Malnutrition is very frequent comorbid factor in chronic renal failure and its prevalence both in the predialysis period as well as on maintenance dialysis is high. The aim of the study was to assess the nutritional status in patients after successful kidney transplantation. 109 patients (47 F, 67 M) of mean age 39.9 +/- 11.5 years were analyzed. Mean time after transplantation surgery was 32.2 +/- 37 months and the maintenance dialysis treatment period prior to transplantation--28.4 +/- 22 months. Nutritional status was assessed with clinical examination based on the SGA scale, anthropometric measurements as well as body composition estimation with bioimpedance. Daily food intake was also monitored with three-day dietary questionnaire. All above analyses were also performed in 25 healthy control subjects with corresponding sex and age distribution. No differences between all analyzed bioimpedance and anthropometry parameters were found between studied patients and controls. 79% of patients were classified as well nourished, 20%--as mildly or moderately malnourished and only 1%--as severely malnourished according to SGA scale. The BMI values less than 21 kg/m2, i.e. suggesting malnutrition were found in 23.3% of patients, whereas values above 25 kg/m2, i.e. suggesting overweight or obesity--in almost 40%. Interestingly, as high as 82.5% of studied patients were characterized by significant weight gain since last "dry weight" assessment on maintenance dialysis up to the time of study (by mean 9.42 +/- 6.9 kg). Obtained results permit us to conclude, that the prevalence of nutritional status abnormalities are relatively frequent among patients with functioning graft. Malnutrition can be demonstrated in more than 20% of the study population, which should be considered however to be markedly lower as compared to most reports regarding dialysis populations. Weight gain during posttransplant period as compared to maintenance dialysis is marked and common; thus the prevalence of obesity is also quite common and reaches 40% of tested patients.

The aim of the study was an analysis of renal transplantation results in the Krakow Transplant Center during 1992-2000. The analysis concerned 94 cadaveric transplant recipients. The study group included 31 females aged 23 to 61 years (mean 40.4 years) and 63 males aged 16 to 60 years (mean 41.8 years). The time of pre-transplant renal replacement therapy ranged from 4 to 120 months (mean 32 months). The mean time of total ischaemia was 22 hours 20 minutes. The majority of the recipients had three identical antigens out of six typed. Most of the recipients were treated with three immunosuppressive drugs including: Cyclosporine A, Azathioprine and steroids. Immediately after kidney transplantation 25.6% of the patients had urine output and did not require dialysis. Acute renal failure (ARF) of the graft was observed in 73.2% recipients. The average number of hemodialysis sessions in patients presenting ARF was 10. Acute rejection was diagnosed in 41.5% of the patients. The most frequent complications were: CMV (cytomegalovirus) infection, UTI (urinary tract infection) and policytemia. In the study group 1-year survival rate of the patients was 97.8% and 1-year graft survival was 93.61%. The 5-year survival rates both in the patients and the grafts were very satisfactory (96.96% and 87.7% respectively).

Pregnancy in women with end-stage renal failure on maintenance dialysis is rare, and the chance of successful delivery is relatively low. In this paper we present two cases of women who conceived just prior to initiation of renal replacement therapy and the pregnancy was terminated successfully already on chronic dialysis treatment. The special attention was paid on the necessity of multi-disciplinary collaboration and the need for changes in regular dialysis schedule as the conditions crucial for successful delivery. In summary, the review of current literature dealing with mentioned problem was done.

The most common metastatic tumour of the thyroid gland which is clinically revealed is renal clear cell carcinoma (RCCC). Our clinical experience in cases of RCCC metastases into thyroid gland is reviewed in terms of the history of the disease, obligatory diagnostic procedures, surgical management and outcome prognosis. We believe that all the patients with even a remote RCCC history require systematic follow-up including thyroid gland as metachronic metastatic disease can occur many years after primary surgery. Clinical diagnosis and ultrasound of the thyroid gland is essential in selection for surgical treatment. Confirmation of malignancy in FNA (fine needle aspiration) in often difficult regarding concomitant multinodular goitre. Enlargement of a single thyroid nodule except L-thyroxin therapy for 3-6 months is a sufficient indication for surgical treatment, not depending on FNA result, particularly when a suspected nodule becomes bigger than 30 mm in diameter.

The aim of the study was to analyze the response of autonomic nervous system to dialysis related systemic volume reduction using heart rate variability (HRV) analysis. The possible relationship between changes in serum levels of calcium-phosphate balance parameters and HRV measurements results was also analyzed. The study was performed in 32 patients (20 men, 12 women) aged between 27 and 71 years (mean 44 years) treated with maintenance dialysis due to end-stage renal disease from 3 months to 15 years (mean 4.4 years). All parameters mentioned above were analyzed during 4-hour dialysis session. Mean value of LF/HF ratio at the beginning of the procedure was 5.36, with continuous increase in consecutive measurements performed 30-minute intervals to the maximal value 8.2 in 120th minute of HD session (p < 0.05). In the next measurements continuous decrease in the mentioned parameter was noticed, to the mean value 6.99 in minute 240. The values of LF/HF ratio were also lower for the whole HD session in the group of patients with initial predialytic concentration of calcium lower than 2.35 mmol/l as compared to those with initial calcium concentration higher than 2.35 mmol/l. Higher values of LF/HF ratio and bigger oscillation amplitude of this parameter were also noted in those patients, in whom the percentage reduction of magnesium level during dialysis exceeded 20%. In addition, statistically significant relationship between percentage reduction in magnesium ion concentration and LF/HF ratio during HD was found. Obtained results let us to conclude, that hemodialysis leads to important change in the activity of both components of autonomic nervous system. The factors which may adversely influence the quality of this response may be, among others, low total calcium ion concentration as well as low percentage reduction in magnesium level during hemodialysis session.

The aim of the study was the microscopic evaluation of internal structure of cuprophane and polysulfone membrane and their surface analysis before and after reprocessing. The investigations were performed using an optical measurement system (Digital Instruments), a scanning electron microscope (SEM) and an atomic force microscope (AFM). We confirmed by SEM that reprocessing completely removed biofilm from both membranes surface. The analysis based on AFM visualized channels in the examined membrane. The diameter of the channels varied from 150 nm for cuprophane to 380 nm for polysulfone. The roughness expressed as root mean square (RMS) was higher for cuprophane than for polysulfone membrane. The physical differences between nanostrucure of the examined membranes might be responsible for lower biocompatibility of cuprophane.

Spontaneous intracranial hematoma is not rare, but with bad prognosis, complication in patients on maintenance hemodialysis (HD). Diagnostic difficulties result from a fact that symptoms of acute hematoma such as headaches,, nausea, vomitis, apathy, sleepiness, parestesia and seizures may also suggest dysequilibrium syndrome, dialytic dementia as well as hypertensive encephalopathy. We describe a case of female patient with 20-year interview data of hypertension on HD since 1981 because of end-stage renal failure in a course of chronic glomerulonephritis, who developed spontaneous epi- and subdural hematoma four year ago in 47 age of life. Performed CT examination confirmed diagnosis and on the same day the patient underwent right frontoparietotemporal craniotomy and the hematoma was removed. During postoperative period, HD sessions were performed without heparin. After surgery the patient developed transcient hypertonia, epileptic sizures and left-sided paresis. Currently, 48 months after craniotomy the patient is fully rehabilitated, with normal blood pressure, without epileptic sizures or palsy. Gradually we discontinued anticonvulsans and antihypertensives.

The aim of a study was to estimate the renal osteodystrophy status using bone densitometry in relation to selected biochemical parameters of calcium-phosphate metabolism. The study population consisted of 123 patients with end-stage renal disease, including 24 patients treated with continuous ambulatory peritoneal dialysis (CAPD), aged between 22 and 73 years (mean 49.9 years), on dialysis program for mean period of 14.9 months and 99 patients on maintenance hemodialysis for mean period of 58.8 months, aged between 19 and 72 years (mean 46.6 years). Densitometric measurements using DEXA technique were performed in three different skeletal points: distal ends of both radial bones, lumbar spinal region and femoral neck. Concomitantly, serum concentrations of total and ionized calcium, phosphates and parathormone as well as alkaline phosphatase serum activity were measured. Among male patients treated with CAPD significantly higher BMD values in right forearm were found as compared to women treated with this method (0.769 vs. 0.616; p < 0.001). Higher values of BMD were also found in both forearms in whole CAPD population as compared to those on hemodialysis. However, there was no difference in densitometry results between CAPD and HD patients as well as between men and women within these groups, when measured in femoral neck and lumbar spinal region. Among hemodialysis patients higher levels of phosphates and PTH were found as compared to CAPD, doses of drugs used for treatment of osteodystrophy--calcium carbonate, aluminum hydroxide and active vitamin D were also higher in individuals on HD. In addition, in CAPD patients statistically significant, positive correlations were found between BMD value in lumbar spinal area as well as in femoral neck and amount of ingested calcium carbonate, between BMD in lumbar spinal area and aluminum hydroxide dose taken by patients and between BMD in both forearms and dose of active vitamin D. We failed to demonstrate any relationship between obtained densitometric results as well as biochemical markers of calcium-phosphate metabolism and quantitative parameters of dialysis adequacy in both treatment modes. Obtained results let us to conclude that renal osteodystrophy is less advanced in patients treated with peritoneal dialysis, however this may be related only to markedly shorter renal replacement therapy period in this group. Lack of significant abnormalities in densitometry measurements taken in lumbar spinal area and femoral neck, while they are present in forearms, may suggest that the latter point of skeleton may be most useful for identification of bone mass deficiency in dialyzed patients.

Cardiovascular disease constitute the main cause of death in chronic renal failure patients on maintenance dialysis. During the last years one of the suspected cause promoting atherosclerotic lesions in this group of patients has been increased plasma homocystein level. The following article presents selected causes of hyperhomocysteinemia in chronic renal failure patients, mechanism of their toxic effect on cardiovascular system and methods of treatment of these disturbances.

The aim of a study was to evaluate the usefulness of bioelectric impedance as a method of body composition analysis in patients treated with CAPD, with the special attention paid on hydration status and lean body mass. The values of parameters obtained by bioelectric impedance and other methods were compared. The impact of peritoneal dialysis fluid in peritoneal cavity on bioimpedance measurement results were also analyzed. The study was performed in 33 patients dialyzed with CAPD for mean period of 12.3 months, aged between 23 and 72 years (mean 50.9 years). Bioimpedance measurements were also performed in 10 healthy volunteers. The significant impact of 2-liters dialysate volume on measurement results was found. The percentage water contain as well as LBM are under this condition higher (59.2% vs. 58.3%; p < 0.005 and 80.73 vs. 79.6; p < 0.01, respectively), and body fat--lower (19.07 vs. 20.39%; p < 0.005) as compared to empty peritoneal cavity. We also found, that the values of body water obtained from BEI measurements are higher as compared to those calculated from Watson formulas and lean body mass values obtained from BEI analysis are higher as compared to those derived from creatinine kinetics (39.4 vs. 36.96 I.; p < 0.05 and 53.7 vs. 51.1 kg; p < 0.01, respectively). Total and lean body mass did not differ from the values predicted in the treatment group, however the percentage contain of body water was significantly higher (58.34 vs. 51.39%; p < 0.0001). No significant differences were found between body composition of CAPD patients and control individuals.

Background: Elevated plasma endothelin-1 (ET-1) was found in end-stage renal failure (ESRF). However, there are discordant reports on the influence of hypertension on plasma ET-1 in ESRF and on the effect of hemodialysis on ET-1 concentrations., Aim: To compare the time course of plasma ET-1 during hemodialysis in hypertensive (HT) and normotensive (NT) ESRF patients., Methods: Plasma ET-1 and mean blood pressure (MP) were measured in 12 HT patients and 11 matched NT patients on maintenance hemodialysis at baseline (B), after a 2.5-3.5 h hemodialysis with ultrafiltration (P1) and after a subsequent 1 h isovolumic dialysis (P2)., Results: In HT patients, plasma ET-1 increased at P1 with no further change after P2 (B vs. P1 and P2, p < 0.05). In NT patients, ET-1 levels were similar at B, P1 and P2. In HT, but not in NT subjects, volume loss correlated with change of ET-1 at P1. In HT patients, MP fell during P1 and tended to return towards baseline at P2. In NT patients, MP dropped after P1 and remained lower also at P2., Conclusion: Hypertensive ESRF subjects exhibit potentiated ET-1 release on hemodialysis, possibly stimulated by volume depletion with sympathetic activation, which may attenuate hypotensive hemodialysis effects thus contributing to hypertension in ESRF.

Non-steroid anti-inflammatory drugs are easily available and commonly used. Mechanism of their action is based on inhibiting prostaglandin synthesis. Prostaglandins are arachidonic acid derivatives that are responsible, among others, for regulation of renal blood flow. In some kidney disorders as well as in hemodynamic disturbances, their increased release aims at balancing substances causing kidney ischemia. Blocking prostaglandin synthesis in such conditions may result in development of nephrotoxic effect, manifesting in water-electrolyte imbalance, acute tubulo-interstitial nephropathy, nephrotic syndrome, acute and chronic renal papillary necrosis as well as acute or chronic renal failure. Analgesic nephropathy with papillary necrosis is a particular form of the nephrotoxic effect of non-steroid anti-inflammatory drugs. Development of this complication has been described in patients abusing phenacetin or other analgesic drugs and especially their combination.

In several renal diseases such as nephrotic syndrome or terminal renal insufficiency changes in lipids metabolism may lead to increase of cholesterol level or changes in its fractions proportions. There are many clinical and experimental observations demonstrating direct toxic effect of lipids on endothelium leading to impairment of endothelial function what can increase damage of glomeruli. It is associated with passive filtration of lipoprotein to mesangium and active fagocytosis by mesangial cells and infiltrating macrophages, which release cytokines and growth factors increasing mesangial proliferation. There are first publications suggesting possibility of application LDL-apheresis-radical cholesterol removing procedure in renal disease. Periodical cholesterol lowering in the blood reduces proteinuria in patients with resistant for pharmacotherapy nephrotic syndrome, especially with focal glomerulonephritis.

The aim of this study was to evaluate if there were any differences in clinical outcome as well as in values of quantitative adequacy/nutritional parameters in ESRD patients treated with continuous ambulatory peritoneal dialysis, depending on their sex. Nutritional and adequacy parameters: NPCR, Kt/V, weekly creatinine clearance (wClCr), dialysis index (DI), serum albumin concentration, as well as clinical parameters such as hospitalization rate, admission rate, peritonitis rate, exit-site infection rate and co-morbidity score were evaluated in 31 CAPD patients (12 F and 19 M). Lower comorbidity score (0.583 vs. 1.58 points; p < 0.05) and higher Kt/V total and residual (2.25 vs. 1.57; p < 0.01 and 1.7 vs. 1.42; p < 0.01, respectively) were found in women as compared to men. The value of the quantitative nutritional parameter--NPCR--was also higher in women (0.842 vs. 0.73 g/kg b.w./24 hours; p < 0.05). Despite these differences, only a small difference was found in the clinical outcome and survival between men and women. The obtained data may suggest that women can achieve better treatment results with the CAPD method as compared to men.

In 30% of cases nephrotic syndrome is caused by membranous glomerulonephritis (MG). Protein accumulation in glomeruli leads to progressive loss of kidney function and damage of structure in MG. The role of tissue proteolytic systems and growth factors in this process is not known. The purpose of the study was to estimate urine cathepsin B, collagenase activity and urine excretion of TGF-beta 1 and fibronectin in MG. Cathepsin B activity was greater in the urine of MG patients than in the control group (10.58 +/- 8.73 pmol AMC/mg creatinine per min-1 vs control 7.11 +/- 2.05 pmol AMC/mg creatinine per min-1; P < 0.05). Urine collagenase activity was higher in the group of patients than in the control group (8.59 +/- 4.26 pmol AMC/mg creatinine per min-1 vs control 3.84 +/- 2.09 pmol AMC/mg creatinine per min-1 P < 0.02). Urine excretion of fibronectin (45.60 ng/mg creatinine vs control 10.30 ng/mg creatinine; P < 0.04) and TGF-beta 1 levels in the urine were higher than in controls (283.55 +/- 248.13 pg/ml vs 36.11 +/- 48.01 pg/ml; P < 0.01). Results suggest glomerular overproduction of TGF-beta 1 and urinary leak of proteolytic enzymes (PE). This may result in decreased glomerular PE activity in MG and, with time, may lead to protein accumulation in renal glomeruli and to progressive loss of kidney function and damage of structures as the course of MG progresses. PE urine composition as well as ECM protein and cytokine urine excretion may allow noninvasive glomerulopathy course monitoring in humans in the future.

Cytomegalovirus (CMV) infection is an important cause of morbidity and mortality after solid organ transplantation. CMV infection after kidney transplantation was confirmed in 19 (54.3%) out of 35 patients. 16 of these (84.2%) developed CMV disease. CMV infection was diagnosed based on a fourfold or greater increase of anti-CMV IgG antibody titre, detection of CMV-IgM antibodies and/or virus isolation. Primary infection was observed in 3 patients, reactivation in 9 and an undefined type of infection in 7. In most patients (63%), infection was diagnosed in the first 2 months, and in 3 patients, after 3, 5 and 9 years following kidney transplantation. The most frequent symptoms of CMV disease were fever (58%), pneumonitis (26.3%) and enterocolitis (15.8%). In 53% of the patients, CMV infection co-occurred with other pathogens such as Candida albicans. Cryptococcus neoformans, bacteria or viruses (HBV, HCV, HSV). Treatment with polyvalent globulin (Sandoglobin) or hyperimmune globulin (Cytotect), in combination with ganciclovir in 7 patients, resulted in a regression of CMV disease.

The paper presents 2 cases of metastases of clear cell carcinoma of kidney into thyroid gland in patients on renal replacement therapy. In one patient after bilateral nephrectomy due to renal clear cell carcinoma (in 15 years time interval) and in second patient after left-side nephrectomy performed 16 years earlier and terminal right kidney insufficiency due to nephropathy with nephrotic syndrome for a year. In diagnosis essentials were: physical signs--palpable single node within the thyroid gland, earlier neoplastic anamnesis, cold node in scintigraphy, hypoechogenic node in ultrasonography of the thyroid gland, particularly with a rich vascular net within the node in power-doppler examination and, at last cytology of material from ultrasound-guided fine needle biopsy of the node. The diagnosis had been confirmed in intraoperative histopathological examination before the total thyroidectomy was performed.

The aim of this study is to present in the chronological order evolution of opinions about the etiopathogenesis of Autosomal Dominant Polycystic Kidney Disease (ADPKD), with the special regard to the newest genetic investigations. Prevalence of this disease is estimated at 1:1000, and patients with ADPKD compose up to 10% patients, who need renal replacement therapy. Since 1957, when inheritance was defined by Daalgard as autosomal dominant, a rapid progression in investigations of genetic aspects of this disease has been done. Actually three genes responsible for the development of the disease are known: PKD1 gene located on the short arm of the chromosome 16 (isolated and described in 1994-1995), PKD2 gene, which is located on the long arm of the chromosome 4 (isolated in 1996) and exceptionally occurs PKD3 gene which is not mapped by linkage analysis neither on the PKD1 nor the PKD2. Loci for PKD3 gene is unknown up to now. Investigations, which have been done indicate dependence between genetic type of ADPKD and clinical picture of the disease. Majority of authors consider ADPKD1 as the severe form of the disease, although it is not a rule. The biggest emphasis has been also lay on the influence of other factors. Pathomechanisms of cyst formation in kidneys, the presence of which is pathognomonic for this disease has been better and better understood. Employment of modern diagnostic methods with combinations of the genetic analysis (especially linkage analysis) afford possibilities for early diagnosis of the disease among persons, who are kindreds of ADPKD family members and are at risk of the disease.

Malnutrition is a serious and common problem among patients dialyzed with peritoneal dialysis. Simple and reproducible methods of nutritional status assessment are needed for early problem identification to prevent and treat this complication. The aim of the present study was to evaluate the usefulness of albumin serum concentration and normalized protein catabolic rate (NPCR) derived from urea kinetic modeling session to assess the clinical status of ESRD patients treated with Continuous Ambulatory Peritoneal Dialysis (CAPD). Statistically significant, negative correlations between NPCR and hospitalization rate (r = -0.307; p < 0.05) and co-morbidity score (r = -0.429; p < 0.001) as well as statistically higher NPCR in the group of patients who survived the whole study period (0.82 vs. 0.74 in Non-Survivors; p < 0.01) support the value of this marker as an indicator of clinical status of peritoneal dialysis patients. Significant, negative correlations between serum albumin level and co-morbidity score (r = -0.379; p < 0.05), peritonitis rate (r = -0.359; p < 0.05) and hospitalization rate (r = -0.601; p < 0.005) were also found. Low absolute values of NPCR for the whole population as well as significant, positive correlations of this marker with dialysis adequacy parameters with concomitant lack of such correlations for albumin indicate, that NPCR as a nutritional marker should be interpreted with caution, and always regarded to the calculation method.

In the first part of this paper achievements in the genetic investigations of ADPKD and pathomechanism of cyst formation have been presented. Majority of authors acknowledge that first type of the disease (ADPKD1) in comparison with the second (ADPKD2) has more severe clinical course. On the basis of clinical analysis of selected affected families the larger and larger emphasis has been put on the influence of such factors like: presence of arterial hypertension, especially role of RAA system, sex, diet, hyperlipoproteinemia, environmental factors, toxic and infectious agents. It seems that genetic analysis of the RAA system and ADPKD will partially explain differences in the clinical course of the disease in different families. Persons with DD genotype in RAA system have statistically significant, more severe clinical course in comparison with their relatives with DI or II genotype. Decidedly worse course of the disease is observed in patients with positive family history of arterial hypertension and in persons with increased blood pressure. Patients sex play a major role. Men have more severe renal manifestations, when in women symptoms and complications associated with liver cysts are more frequent than in men. Frequency of intracranial aneurysms (ICA) in the population of patients with ADPKD have been presented. CT, MRA and classical angiography are in order screening tests for detection of ICA, especially in persons with family history of their prevalence. Prevalence of liver cysts and selected clinical symptoms and complications associated with extrarenal manifestations have been discussed. Problems associated with infections of the urinary tract and cysts, their etiology, pathomechanisms and treatment have been presented. Ultrasonography seems to be the best diagnostic tool because of it's accessibility, high sensitivity and low cost. It is accepted, that presence of 3 cysts in both kidneys in ADPKD kindreds in significant for diagnosis. Modified Ravine's criteria for diagnosis of ADPKD have also been presented. Employment of modern diagnostic methods in combination with genetic analysis (especially linkage analysis) enable early diagnosis in persons who are at risk of ADPKD.

Rhabdomyolysis is a condition affecting body homeostasis that results from impaired supply of muscles with energy, nutritional factors and blood. Complex pathophysiological mechanism causes that extended myolysis may complicate different clinical conditions, such as: crush syndrome, excessive physical effort (work, seizures), toxic effect of drugs and toxins, water-electrolyte disturbances, congenital enzymatic deficiencies etc. It seems that on the cellular level, essential role is played by excessively high intracytoplasmatic calcium level, which affects metabolic processes. So high calcium level is a consequence of muscular cell injury irrespective to its reason. It manifests clinically as muscular weakness, pal and oedema and laboratory tests reveal elevated CK, GOT, GPT, aldolase and LDH levels as well as dark brown urine colour. Demonstration of elevated serum myoglobin level or its presence in urine directly confirms development of rhabdomyolysis. In unfavorable conditions, rhabdomyolysis may result in acute renal failure. Appropriately early and adequate water supply and alkalization plays an essential role in prevention of impairment in renal function. In advanced phase of renal failure, hemodialysis is a standard treatment.