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In 30% cases nephrotic syndrome is due to membranous glomerulonephritis (MG). Fifty percent of patients reveal end stage renal disease in 15 years follow-up. The another 50% gain persistent remission. The pathogenesis of disease is not known. Protein accumulation in glomeruli leads to progressive loss of kidney structure and function in MG. Also the role of tissue proteolytic systems and growth factors in this process is not known. We aimed to estimate urine cathepsin B, collagenase activity and urine excretion of TGF-beta 1 and fibronectin in MG. MG patients revealed increased urine cathepsin B activity (10.58 +/- 8.73 pmol AMC/mg creatinine/min. vs. control 7.11 +/- 2.05 pmol AMC/mg creatinine/min. [p < 0.05]), urine collagenase activity (8.59 +/- 4.26 pmol AMC/mg creatinine/min. vs. control 3.84 +/- 2.09 pmol AMC/mg creatinine/min. [p > 0.02]) and increased urine excretion of fibronectin (214 +/- 335 ng/mg creatinine vs. control 12.7 +/- 6.7 ng/mg creatinine [p < 0.05]) and increased urine excretion of TGF-beta 1 (283.55 +/- 248.13 pg/ml vs. control 36.11 +/- 48.01 pg/ml [p < 0.05]). The results indicates on glomerular overproduction of TGF-beta 1 and urinary leak of proteolytic enzymes which may exacerbate glomerular proteolytic activity in MG. This may lead to glomerular protein accumulation and progressive loss of kidney function and structure in MG. Increased urine fibronectin excretion in MG patients seems to confirm the hypothesis.

Multiple myeloma is the most frequent dysproteinemia leading to nephropathy. The aim of the study was to analyse this complication in patients treated in nephrological departments. The study was performed in 83 patients (45 M, 38 F) aged 47-82 years in whom a diagnosis of multiple myeloma was based on clinical manifestation (weakness, subfebrile states, bone aches, loss of body weight, recurrent infections of urinary and respiratory tracts), increased number of plasmocytes in bone-marrow, presence of monoclonal protein in serum and/or urine and lesions in bone system. In a significant number of the studied patients the disease was revealed while diagnosing proteinuria as well as searching for a reason of elevated erythrocyte sedimentation rate or proteinogram abnormalities. The obtained results indicate that signs of nephropathy in the course of multiple myeloma may be the first visible symptoms of the disease. Proteinuria was observed in 79.5% of the studied patients. Bence-Jones protein was found in 41% of individuals and features of renal failure in different stages of development in 67%. Dialysis therapy was started in 3 patients with acute and 7 patients with chronic renal failure.

For ages nephrolithiasis has been a widespread disease and clinical statistics prove that its morbidity index is still increasing, thus it becomes a social problem. Peak morbidity usually occurs at the age between 30 and 40, that is why many patients professionally active and creative have to leave their jobs for a long period. In contrast to earlier years, frequency of the disease occurrence in females is systematically increasing and nowadays it is only slightly lower from that in males. Etiology and pathogenesis of the disease is also not entirely explained. It is generally accepted that urinary stone formation is determined by multiple factors which affect first of all chemical composition and physical features of urine. Individual properties of the kidneys and urinary tract and infections especially with urease producing pathogens as well as environmental factors are also taken into account. The most favourable circumstances for nephrolithiasis occurrence is co-existence of all these factors.

Urolithiasis is a disease with complex and not fully explained etiology and pathogenesis. In its development there play role multiple factors, such as individual features of the kidneys and urinary tract, co-existing infections with urease-producing pathogens and environmental factors. Advance in the field of organ imaging has enabled development of new harmless diagnostic procedures that allowed for fast diagnosis, and current methods of treatment (USR, PCNL and ESWL) have significantly limited the number of surgical procedures performed because of urolithiasis. Introduction of these treatment methods markedly disturbed used for a long time scheme of management and in many cases it limited invasiveness of the treatment and shortened hospitalisation time. Unfortunately, not all urology departments in Poland have access to the newest methods of treatment, thus a percentage of patients treated with traditional methods is still high. Used nowadays methods of diagnosis and treatment have not fully solved a problem of urolithiasis metaphylaxis, and urolithiasis still remains a serious disease that requests close cooperation of the patients, nephrologist and urologist.

Results of one-year dialysis adequacy monitoring in 20 patients treated with continuous ambulatory peritoneal dialysis with Baxter dialysis systems were presented. Relatively low mortality rate (10%), stable, within accepted range, peritonitis rate (1 episode per 16.4 patient-months), and high percentage of patients dialysed adequately (75%), let us to conclude, that CAPD may be a safe renal replacement therapy modality, which may be, in selected cases, an alternative method to hemodialysis.

Between January 1990 and July 1997, in 15 maintenance dialyzed patients and in 3 patients after renal transplantation manifesting hyperparathyroidisms surgical treatment was performed. The diagnosis was based both on the estimation of serum PTH level, total and ionised calcium, phosphates, alkaline phosphatase and imaging procedures: ultrasonography and 99-mTc subtraction scintigraphy. Indications to surgical treatment included ailments like generalized prurigo, bone and joint pains and muscular weakness with no response to pharmacological treatment. The commonly used procedure was subtotal parathyroidectomy (94%), its extent, however, was in each case determined during surgery, depending on the quantity and size of parathyroid glands found. In all cases the immediate intraoperative histopathological examination of the resected tissues was performed. In 10 patients resection of the thyroid gland tissues was carried out because of goiter (56%), among them in 1 case occult papillar carcinoma was found in histopathological examination. In the postoperative period 4 patients (22%) manifested transient hypocalcemia with good response to pharmacological treatment. Good results of surgical treatment reflected by both ailment relief and normalization of serum PTH and phosphates were obtained in 16 patients (89%). In 2 patients (11%) the ailments subsided but did not completely disappear. Surgical treatment of secondary hyperparathyroidism by subtotal parathyroidectomy is efficacious and entails a low risk of complications.

The aim of the study was to evaluate the influence of follow fiber dialyzers reprocessing procedure on urea kinetic modeling parameters, dialysis effectiveness for small molecules and effective clearance/predicted clearance ratio. Fifty patients (27 F, 23 M) aged 18-61 years (mean 47) being on maintenance hemodialysis due to end stage renal failure for 4-136 months were included into the study. Patients were treated 3 times a week with blood flow 160-290 ml/min and dialysate flow 500 ml/min. The dialysis time was calculated individually based on urea kinetic modeling parameters. Reprocessing of dialyzers was performed using Renatron RS 8300 and Renalin as sterilized agent. Dialysers with ppr below 80% were excluded from the use. Mean values of dialysis index Kt/V, TAC and dialysis effectiveness (Ct/C0) for urea, creatinine, uric acid and kalium as well as values of effective/predicted clearance ratio for consecutive reprocessing procedures were compared with the results obtained for the new dialyzers. There was no significant influence of reprocessing procedure on Kt/V, TAC and Ct/C0 for tested substances and studied clearances. The obtained results indicates that dialysers reprocessing procedure performed according to the described protocol was safe and didn't decrease dialysis effectiveness.

An analysis of ethylene glycol acute intoxication treatment results was performed in a group of 36 patients hospitalized within a five year period. Mean serum and urine glycol concentrations in the analyzed population ranged from 0-851 mg/dl (mean = 130 mg/dl) and from 12.4 to 930.0 mg/dl (mean 333 mg/dl), respectively. At the time of admission to the clinic 15 of 36 patients were deeply unconscious and mean acid-base balance values were as follows: pH 6.99, pCO2 16.7 mmHg, pO2 140.1 mmHg, HCO3 6.36 mmol/l, BE -29.6 mmol/l. Because of respiratory failure 21/36 patients (58.3%) required controlled ventilation and 24/36 (66.7%) underwent dialysis. Sixteen patients (44.4%) developed acute renal failure. Mean hospitalization period was 16 days (1-53). Eighteen patients (50%) died. The direct death mechanism in 15 patients (83.3%) was asystolia and in the remaining individuals other circulatory disturbances. The main reasons of high mortality rate were multiple organ damages secondary to severe metabolic acidosis.

Problems of replacement therapy with special attention (regards) to renal transplantation and selected aspects of other organ transplantation were presented. Introduced during the lecture information was updated based on enclosed literature.

This study is the preliminary review of the above 2 year period of treatment of patients with chronic renal failure being on CAPD in our center. The study was performed in 14 patients during the cumulative period of 192 patient-months. The analysis of infectious and non-infectious complications was conducted, and patients were also monitored in terms of quantitive measurements of dialysis adequacy and nutritional status using such parameters like total Kt/V (urea), total Weekly Creatinine Clearance (tWCC), normalized protein catabolic rate (npcr) and serum albumin level. We also analysed the influence of residual renal function (RRF) on these parameters and relationships between them. During the study period we observed 7 episodes of peritonitis with the medium rate of 1 episode per 24.7 patient-months. Six of them were treated succesfully conservatively, but in one case catheter removal was necessary because of uneffective farmacological therapy. We also observed two episodes of exist site infection (ESI), one treated finally by catheter replacement. Two technical problems also occurred: leakage into abdominal wall and through the catheter tunnel. During the observation period all patients remained alive, although one was transfered to HD after 14 months of CAPD (earlier 4 months on manual IPD) because of lack of adequacy and severe peritonitis. Obtained results of nutritional status indicate, that 50% of patients were malnourished in terms of npcr and 35.7% in terms of serum albumin level. Seven of 14 patients were adequately dialysed acording to Kt/V, 9 according to tWCC.

Our aim was to estimate the effect of having a functioning cadaveric renal transplant on the risk of cardiovascular and total mortality in patients on renal replacement therapy (RRT). We retrospectively studied (by the Cox proportional hazards regression model) 195 subjects who began RRT with maintenance dialysis in our centre from 1 January 1978 to 31 December 1991. Out of this number, 76 patients received a cadaveric kidney transplant. Cardiovascular abnormalities at the onset of RRT were the principal independent determinant of both total and cardiovascular mortality risk. As compared to patients on dialysis with the same duration of RRT, patients with a functioning renal transplant for more than 1 year had a significantly lower total mortality risk (mean relative risk (RR): 0.48 (0.25-0.91) (95% confidence limits in parentheses), P = 0.03), an effect whose significance disappeared after adjustment for pretreatment conditions (RR = 0.62 (0.30-1.30), P > 0.3). However, the beneficial effect of a functioning renal transplant for more than 1 year on cardiovascular mortality risk was significant, both before (RR = 0.21 (0.06-0.74), P = 0.02) and after the adjustment for pretreatment conditions (RR = 0.32 (0.11-0.90), P = 0.035). During the first year after a successful transplantation the beneficial effect of having a functioning transplant on cardiovascular mortality risk was only weakly attenuated. During RRT a functioning cadaveric renal transplant decreases cardiovascular mortality risk partially independently of the better pretreatment status of the patients selected for transplantation.

The effect of urea kinetic modeling (u.k.m.) application on dialysis efficiency and metabolic status was evaluated in 50 maintenance dialyzed patients. U.k.m. sessions were performed once a month based on the self-developed computer program to control dialysis. The dialysis index (Kt/V), the time averaged concentration (TAC), protein catabolic rate (pcr) and dialysis effectiveness (Ct/Co) were evaluated and the results obtained at the beginning and after 2, 4, and 8 months of the study were compared. Kt/V had risen significantly in the modeled patients from 1.04 to 1.24 and was accompanied by 12% Ct/Co increase of urea removal after 8 months. The tendency of the moderate (non significant) decrease of TAC from 54.57 to 52.48 mg% BUN was observed during the study. According to the NCDS criteria the percentage of adequately dialyzed patients increased from 42% at the beginning to 64% after 80 months; underdialyzed patients decreased from 16% to 6% and malnourished also from 16% to 6%, respectively, after u.k.m. application. Dialysis effectiveness for creatinine and uric acid described by Ct/Co for the above after 4 and 8 months was significantly increased when compared with the results obtained at the beginning of the study. These results indicate that u.k.m. application allowed to take control over uremic toxemia and improved dialysis adequacy in patients on maintenance dialysis. Protein catabolic rate in studied patients increased from 1.18 to 1.24 g/kg/per day during the study and it was accompanied by a total blood protein and serum albumin increase. This could indicate improvement of the nutritional status of dialyzed subjects.

Two cases of unusual rupture of aortic aneurysm with extravasation in the bronchus and duodenum are described. The clinical evolution of such aneurysm ruptures is associated with considerable diagnostic difficulties due to the absence of pathognomonic typical features and the short survival time after onset of pain symptoms.

The results of the treatment of patients with acute renal failure (ARF) in dialysis units of Kraków, Nowy Sacz and Tarnów were estimated on the basis of prepared questionnaire. The increased number of patients treated because of ARF was demonstrated in the successive years of the study. The mortality rate in the tested group of patients remained about 27%. It depended on the cause of ARF and equalled to 26.7% in medical, 36.7% in surgical, 8% in obstetrical and 6.7 in urological patients, respectively.

The effect of recombinant human erythropoietin (rHu-EPO) on anaemia and some biochemical parameters was investigated in 7 predialysis patients. A statistically significant increase in erythrocyte, haematocrit and haemoglobin levels was observed after 3 weeks of treatment and such changes were constant during the 6 month maintenance therapy. The mean urea and creatinine levels were comparable during the tested period in 4 of the studied patients. The other 3 patients did not completed the planed period and started the dialytic therapy because of progression of renal insufficiency. The latter group had more advanced renal failure and higher blood pressure prior to rHu-EPO treatment as compared with the patients who completed the study.

The influence of recombinant human erythropoietin (rHu-EPO) on anaemia and bone marrow cells was investigated in 7 patients with terminal renal failure on maintenance haemodialysis. The examination was performed immediately prior to rHu-EPO treatment (mean hematocrit 20.3%) and after increase of hematocrit to 33%. An increased number of cells from the erythroblastic series and rejuvenation of this population were observed during the treatment. There was no significant influence of the treatment on the myeloblastic cells series. An increase in megakaryocyte activity was observed in 2 studied patients.

The prevalence of anti-HCV antibodies, HBs antigenemia and transaminase level were examined in the 136 patients with chronic renal failure on maintenance hemodialysis, treated in dialytic centers of South Poland. In this group anti-HBs and anti-HBc antibodies were also investigated in 60 and 42 patients respectively. Anti-HCV antibodies were present in 16.7-60.0% (mean = 44.1%) of patients depending on the center. These values considerably exceed the percentage of antigen HBs positive patients but they are lower that the percentage of anti-HBs and anti-HBc positive patients.

Acid phosphatase (AcP), beta-glucuronidase (GR) and N-acetyl-beta-D-glucosaminidase (NAG) activity was determined, using semiquantitative cytochemical methods, in the peritoneal fluid lymphocytes obtained from 50 patients with terminal renal failure treated by intermittent peritoneal dialysis. The control group included 30 subjects with normal renal function. The percentage of AcP and NAG-positive lymphocytes was significantly lower and that of the GR-positive cells significantly higher in dialysed patients than in the control group. A group of 22 dialysed patients with bacterial peritonitis showed a significant increase of the percentage of NAG-positive lymphocytes as compared with both the subjects in the control group and the peritonitis-free dialysed ones. Changes of the lymphocytes enzymatic activities were distinct in cells exhibiting the granular reaction type, and to a much lesser extent in those showing granular diffuse reaction.

The peroxidase, alkaline phosphatase, acid phosphatase, beta-glucuronidase and N-acetyl-beta-D-glucosaminidase activity was assessed using a semiquantitative cytochemical methods in peripheral blood neutrophils from 10 maintenance haemodialysed patients treated with recombinant human erythropoietin (rHu EPO) due to severe anaemia. The examination was performed immediately prior to rHu EPO treatment, after 10 weeks and 32 weeks of therapy. A statistically significant increase in the beta-glucuronidase and N-acetyl-beta-D-glucosaminidase activity was observed after 10 weeks, while all the enzymes studied except peroxidase showed a significant elevation of their activity after 32 weeks of the treatment as compared with the values obtained prior to therapy.

Effect of intravenously administered recombinant human erythropoietin (rHu EPO) on haemoglobin (Hb) level, haematocrit (Ht), reticulocyte count and foetal haemoglobin (HbF) concentration was assessed in 10 patients with anaemia, treated by repeated haemodialysis due to end-stage kidney. As compared to the initial values, erythropoietin treatment brought about a significant increase in all the parameters examined. During the subsequent therapy with lower, supporting doses of erythropoietin, the elevated HbF values fell back to normal, whereas the higher level of total Hb and Ht were maintained.

In 10 patients (8 men and 2 women) aged 28 to 58 years (mean 44.4 years) treated by repeated haemodialysis due to end-stage renal failure, the bleeding time, whole-blood coagulation time, one-stage prothrombin time, thrombin time of plasma, activated partial thromboplastin time (APTT), fibrinogen level and euglobulin lysis time have been determined (1) during a 4-hour haemodialysis using heparin as an antithrombotic agent, and (2) one week later in the course of another haemodialysis using prostacyclin-heparin. The values for any of the above parameters with both anticoagulant treatment types did not differ. Plasma fibrinogen level after haemodialysis was significantly lower after administration of heparin alone as compared with the group treated by prostacyclin-heparin infusion. During haemodialysis performed with prostacyclin-heparin infusion, activation of the blood fibrinolytic system was manifested by a significant shortening of euglobulin lysis time, observed after 1.5 hours and after the end of haemodialysis. The above phenomenon did not occur when haemodialysis was performed with heparin alone.

Peritoneal macrophages obtained from 30 patients with end-stage kidney treated by intermittent peritoneal dialysis and from 30 subjects with normal renal function (relative control) were investigated by light microscopy, transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Two populations of peritoneal macrophages were distinguished in both dialysed and control patients. In the former group, the main population consisted of macrophages similar to monocytes from peripheral blood, while the majority of macrophages in control patients showed larger size, more prominent vacuolization of the cytoplasm and stronger spreading on glass surface.

Peroxidase activity was assessed cytochemically in the peritoneal dialysate neutrophils of 50 patients with terminal renal failure treated by intermittent peritoneal dialysis. In 22 patients cells were harvested for the second time after they developed peritonitis as a complication of the treatment. The results obtained were compared with those in the control group consisting of 30 patients with normal renal function. The patients treated by peritoneal dialysis showed both in the complication-free period and in the course of peritonitis significantly higher peroxidase activity in the neutrophils, as revealed by the semiquantitative score test. In the course of peritonitis, the neutrophils peroxidase activity was significantly lower than in the complication-free period.

Acid phoshatase (AcP), beta-glucuronidase (GR) and N-acetyl-beta-D-glucosaminidase (NAG) activity in neutrophils obtained from the peritoneal fluid of 50 patients with terminal renal failure treated by intermittent peritoneal dialysis, and of 30 control subjects with normal renal function was semiquantitatively scored using a cytochemical method. This study was repeated in 22 dialyzed patients during the course of bacterial peritonitis. A significant decrease in the AcP score and an increase in the GR score were found in the neutrophils from dialyzed patients. In dialyzed patients with peritonitis, the GR and NAG scores were higher that in those without this complication.

Peroxidase activity was assessed cytochemically in macrophages from peritoneal dialysate of 50 patients with terminal renal failure treated by intermittent peritoneal dialysis. In 22 patients cells were harvested for the second time after development of peritonitis as the complication of the treatment. The obtained results were compared with those of the control group consisting of 30 patients with normal renal function. Patients treated with peritoneal dialysis showed both in complication-free period and during the course of peritonitis significantly higher peroxidase activity in macrophages as revealed by the semiquantitative score test. In the course of peritonitis, peroxidase activity in macrophages was significantly lower than in complication-free period. Electron-microscopic cytochemistry demonstrated that in macrophages obtained from both control and dialyzed patients the peroxidase activity was located exclusively in cytoplasmic granules, suggesting a similarity of the studied cells and exudative macrophages.

Acid phosphatase, beta-D-Glucuronidase and N-acetyl-beta-D-glucosaminidase were assessed cytochemically in peritoneal macrophages obtained from 50 patients with end-stage renal failure treated by intermittent peritoneal dialysis and from 30 control subjects with normal renal function. A statistically significant increase in beta-D-glucuronidase activity accompanied by a decrease in acid phosphatase activity were observed in peritoneal macrophages of dialysed patients, as compared with the control group. In patients with dialysis-associated peritonitis, the activity of N-acetyl-beta-D-glucosaminidase was significantly higher than that observed in the same patients during the complication-free period of the treatment.

The phagocytic activity of peritoneal neutrophils was assessed using Bacto-Latex in 50 patients with chronic renal failure treated with intermittent peritoneal dialysis, and in 30 control patients with normal renal function. In the group of patients treated with peritoneal dialysis 20 were additionally investigated while developing peritonitis. A significant decrease in the phagocytic activity of neutrophils was observed in the both dialysed groups, as compared with control subjects. Moreover, the phagocytic activity was significantly lower in patients with peritonitis as compared with dialysed patients without this complication.

In ten patients treated by maintenance hemodialysis due to end-stage renal failure evaluation of dialysis efficiency was performed during the treatment with heparin alone as well as in the course of prostacyclin -heparin infusion. Statistically significant lower level of urea at the end of dialysis and significantly higher urea clearance were found during hemodialysis with prostacyclin -heparin infusion in comparison with infusion of heparin alone.

The number of circulating platelet aggregates determined according to the method of Wu and Hoak and the platelet morphology revealed by scanning electron microscopy were investigated in 10 patients (8 males, 2 females) age 28-58 years) with end-stage renal failure treated by repeated hemodialysis. The examination was carried out twice: during a 4-hour hemodialysis session with the use of heparin alone and 1 week later during the course of another dialysis in the presence of both heparin and prostacyclin. During each dialysis session the platelet system was examined three times: prior to, after 90 min, and at the end of the procedure. As compared with the situation prior to dialysis, the number of platelet aggregates assessed after 90 min of dialysis and after its termination insignificantly rose following the treatment with heparin, but significantly fell after the use of the prostacyclin/heparin combination. The differences were also significant when the effects of both treatment types were compared. As revealed by scanning electron microscopy, during the course of hemodialysis with the use of heparin alone, the platelets showed signs of activation manifested by increases in number and length of cytoplasmic processes and by a tendency to aggregate. When both prostacyclin and heparin were used during dialysis, platelet activation was minimal or absent. Thus, the combined treatment with prostacyclin and heparin protects platelets from activation induced by their contact with artificial surfaces and may lower the risk of microthrombosis, making thereby hemodialysis safer and more effective.

The quantitative and qualitative characteristics of cells in the peritoneal dialysate from 12 patients were examined. The number of cells in each subsequent fraction of dialysate decreased, while the differential cell count remained relatively constant for each individual patient. Macrophages, lymphocytes, granulocytes and occasionally mesothelial cells were observed. In 1 patient, plasmocytes were also found. Evident differences in cellularity and cell composition were noticed in dialysate obtained from different patients, especially in 2 patients with bacterial peritonitis there was a rise in cellularity with neutrophilia. Cytochemical (peroxidase, nonspecific esterase activity) and functional (phagocytosis, receptor expression) tests revealed that macrophages form a heterogeneous population of cells.

Patients with various malignancies are characterized by decreased numbers of intact acid phosphatase-positive lysosomes within the peripheral blood lymphocytes as compared to the control groups of healthy subjects.

To investigate further the biologic activity of solutes in the middle-molecular-weight range, we studied the influence of these compounds on the migration of unseparated white blood cells and separated granulocytes and lymphocytes. Middle molecules (MM) inhibit the migration of unseparated leukocytes, but this effect on lymphocytes was seldom observed. With scanning electron microscopy, unseparated leukocytes were shown to adhere to one another, forming cellular clumps. This phenomenon could not be seen when separated cells were used. These results give some insight into the mechanism of inhibition exerted by MM and into the changes, observed in earlier experiments, of cellular composition of skin exudate obtained from untreated patients with uremia.