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Since influenza increases the mortality of chronically ill patients we decided to study the effectiveness of influenza vaccination in hemodialysis (HD) patients. Nineteen HD patients aged from 20 to 60 years, on unrestricted diet and with no febrile episode, were studied. Blood samples were collected before the intramuscular injection of 0.5 mL multivalent influenza vaccine (Inflexal Berna) and every 2 weeks thereafter. At the end of 4th week a second vaccination was done and a dosage of 200 mg of zinc acetate (60 mg elemental zinc) was given daily to each patient for at least 4 weeks. Before vaccination the antibody titers to influenza virus ranged from 1:10 to 1:80 and after vaccination from 1:20 to 1:640. Four weeks after vaccination 6/19 (31.5%), 8/19 (42%), and 10/19 (52.5%) patients showed a fourfold or greater increase at serum antibody titers to antigens A/Singapore, A/Sichuan, and B/Beijing, respectively. The zinc supplementation after the second vaccination induced a similar increase of serum antibody titers to the A/Singapore but some even greater increase of the antibody titers to the A/Sichuan and B/Beijing. Serum immunoglobulins and complement components C3/C4 were not changed during this study. It is suggested that about 50% of uremic patients respond to the influenza vaccination and that zinc treatment does not increase this responsiveness.

In order to evaluate the role of nifedipine in the nephrotoxic effect induced by both ischemia and CyA, 18 healthy mongrel dogs were used. The kidneys were exposed and subjected to 1 h of ischemia by clamping both renal vessels. To the renal artery of the first group of kidneys (n = 9), 300 mL of cold Euro-Collins solution, in which nifedipine (Bay a 1040-10 mg) was diluted, was infused for 15 min (nifedipine group), while 300 mL of cold Euro-Collins solution plus 10 mg of placebo (Bay a 1040-placebo) was infused to the renal artery of the second group (n = 9) of kidneys (placebo group). Venous drainage was effected through a plastic cannula. All animals received through a nasogastric catheter 20 mg/kg cyclosporine A at the beginning of the ischemia. The 1 h of ischemia was divided in a 15-min period of cold ischemia and 45-min of warm ischemia, at the end of which the clamps were removed. During the 2 h (30 min x 4) after reperfusion, 10 mg of nifedipine and placebo was administered additionally by a peripheral vein to the nifedipine and the placebo group, respectively. Then the kidneys were removed for histological study. Urine volume and creatinine and urea clearances of the nifedipine group were significantly higher than the placebo group (p < 0.001) while TxB2 levels were higher in the placebo group in all studied periods (p < 0.001). Urine sodium, FENa, osmolar clearance, and LDH values were significantly different (p < 0.01), but the urine potassium concentration was not different in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

The efficacy and safety of aztreonam for treatment of gram-negative bacterial infections in patients with renal failure were evaluated in an open study. Thirty-nine patients (22-82 years old) with renal failure (chronic, 25; acute, 14) were treated for 40 severe gram-negative bacterial infections. All 41 gram-negative pathogens isolated were sensitive to aztreonam; the pathogens included Escherichia coli (12), Pseudomonas aeruginosa (8), Klebsiella species (7), Proteus species (7), Enterobacter species (5), Serratia marcescens (1), and Acinetobacter species (1). Complete cure (clinical and bacteriologic) was achieved in 31 (77.5%) of 40 infections and improvement (clinical improvement with or without bacteriologic cure) in four (10%). Bacterial eradication of 34 (82.9%) of the infecting pathogens was achieved. The only significant adverse effect noted was a slight, transient elevation in the level of serum transaminases in four patients (10%). Renal function of the patients improved with treatment. Levels of serum creatinine decreased from 3.79 +/- 2.84 to 3.30 +/- 2.52 mg/dL after treatment (P less than .002). It was concluded that aztreonam is effective and safe for the treatment of gram-negative bacterial infections in patients with renal failure.

In 25 severely uraemic patients, the relation of serum calcium levels and oral glucose tolerance test (GTT) was studied. Seventeen of the 25 patients, who had a creatinine clearance of 6.16 +/- 1.24 ml . l-1 and a low serum calcium (6.53 +/- 0.35 mg%), had abnormal oral GTT, while from the other 8 patients, who had a creatinine clearance of 6.73 +/- 1.05 ml . l-1 and a normal serum calcium (8.75 +/- 0.60 mg%), only 4 had abnormal oral GTT. In 6 out of 17 patients, the low serum calcium (6.50 +/- 0.34 mg%) was normalized (8.85 +/- 0.54 mg%) by giving calcium gluconate in normal saline intravenously for two days. Subsequently to the calcium treatment, in four of these six patients the oral GTT changed to normal. The insulinogenic index showed increased secretion of insulin in the four patients whose oral GTT was normalized. These findings led us to the conclusion that low serum calcium is one of the contributing factors in the development of abnormal GTT in severely uraemic patients.

In a side-to-side fistula between femoral artery and vein, an external "shunt" was created that simultaneously connected the distal femoral vein and the proximal femoral vein in 14 normal dogs with weight ranging from 14 to 28 kg. Blood flow and pressure alterations of different sites of this experimental model of vascular access were studied. The results showed that the degree of blood flow on these two vascular communications depends on the structural integrity of the femoral artery with adequate blood flow and blood pressure. Also, the correct connection of external shunt with the fistula is of equal importance. It is suggested that the blood pressure as well as the blood flow rate of these two vascular communications were adequate to allow performance of acute and chronic hemodialysis.

The renin-dependent hypertension of uraemic patients on regular dialysis treatment (RDT), resistant to conventional therapy, is a major problem. In these cases, bilateral nephrectomy is effective but carries operative risks and also the possibility of worsening the patients' anaemia. Five uraemic patients on RDT, with severe renin-dependent hypertension resistant to medical therapy were treated with the oral angiotensin converting enzyme inhibitor captopril for 3 to 6 months and the effects of the drug were studied. The pretreatment blood pressure was lowered from 227 +/- 5.7/127 +/- 4.47 mmHg to 146 +/- 13.42/86 +/- 4.18 mmHg within a month of treatment with captopril and that result was maintained throughout the study. A transient loss of taste was seen in two cases, but no other serious side effects of the drug were observed. In conclusion, captopril is a very effective drug in treating the severe renin-dependent hypertensive uraemic patients on RDT.

Two cases of hemorrhagic fever with renal syndrome were diagnosed in woodcutters presumably exposed to wild rodents and their urine in a forest in northern Greece. The disease was characterized by acute renal insufficiency without hemorrhagic manifestations. One patient required hemodialysis, but both recovered without sequelae and developed a fourfold increase in titer of antibody to Hantaan virus, as determined by an immunofluorescence test. These are the first reported cases of hemorrhagic fever with renal syndrome in Greece.

Twelve patients, 8 male and 4 female, aged from 26 to 70 years were studied. They were on hemodialysis (HD) 4 h three times weekly with cuprophan hollow fiber dialyzers (Gambro 120M) and dialysate containing 35 mEq/L of acetate. The study compares two random HD sessions on each patient. Sixty minutes prior to one random session a placebo was administered orally, and prior to another random session piracetam was given at a dose of 8 g. Heparin dosage was not reduced during HD using QB 200 ml, QD 500 ml, and no ultrafiltration. Blood samples for leukocyte and platelet counts, serum C3, arterial paO2 and paCO2, thromboxane-B2 (TxB2), and beta-thromboglobulin (beta-TG) were taken from the arterial line before and at 15, 60, and 240 min during HD. Leukopenia at 15 min of HD was found to be less severe (p less than 0.01) in the piracetam study than in the placebo, whereas platelet count did not change. Serum C3 was slightly increased in both studies. Arterial oxygen was preserved close to the initial levels by piracetam (91.66 mm Hg versus 81.08, p less than 0.01 at 60 min, and 93.08 versus 80.17 mm Hg, p less than 0.01 at 240 min of HD sessions) but paCO2 did not change significantly. TxB2 increased less with piracetam in comparison to placebo (p less than 0.01 or p less than 0.001), but beta-TG was reduced significantly by piracetam at any time during HD (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)