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ABSTRACT: Renal functions were investigated in 29 marathon runners and in 20 runners in connection with 16-kilometre long-distance run. Body weight in runners decreased after marathon run in average of 1.3 +/- 0.5 kg and after 16-kilometre long-distance run in average of 1.4 +/- 0.4 kg. Blood pressure decreased after both runs. Total proteinuria and albuminuria significantly increased after both runs. The significant non-glomerular erythrocyturia was found in 9 runners after marathon run and in 3 runners after 16-km long-distance run. Total catalytic activity of serum creatine kinase, and its isoenzyme MB significantly increased after both runs. Increase of isoenzyme MB creatine kinase after runs was lower than 6% of total catalytic activity of creatine kinase. These increases were caused by rhabdomyolysis and were connected with myoglobinuria. Serum myoglobin significantly increased after marathon run and after 16-km run. Serum urea, creatinine, phosphorus and osmolality significantly increased after both runs. Calculated GFR significantly decreased after both runs. FE(Na), FE(Ca), FE(P), FE(OSM) and FE(H2O) significantly decreased after both runs. FE significantly increased after marathon run, but after 16-km run non-significantly decreased. Renal function abnormalities were caused by dehydration, microtraumas in extrarenal urinary tract, protein catabolism, decreased urinary excretion of osmotically active substances, rhabdomyolysis, activation of renin-angiotensin-aldosterone system and other factors. Renal function abnormalities in runners were already not present 2-6 days after marathon run and after 16-kilometre long-distance run and investigated parameters were in normal range or they did not significantly differ from the initial values.
Przegla̧d lekarski 01/2012; 69(1):1-4.
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ABSTRACT: BACKGROUND: Acute intermittent and variegate porphyria are an autosomal dominant hereditary diseases caused by the deficient activity of porphobilinogen deaminase in the haem biosynthesis. Acute intermittent porphyria (AIP) in 11 patients (8 women and 3 men) and variegate porphyria (VP) in one patient were diagnosed and long-term treated during 15-22 years. Eleven patients had in acute attack abdominal pain, they were agitated and restless and suffered from insomnia. Besides they had various neurological signs. Examination of kidney function during remission showed hypertension and tubulointerstitial impairment of the kidneys in 10 patients (hyposthenuria and impairment of tubular excretory phase in isotopic renography). Deficiency of serum erythropoietin in 4 patients, significant deficiency of plasma and erythrocyte vitamin B6, significant hyperoxalaemia and hyperoxaluria in all patients were found. Direct relationship between plasma oxalic acid and effect of pyridoxal-5-phosphate (PLP), (effect of PLP was in indirect relationship with the concentration of erythrocyte vitamin B6), in AIP patients was found. Deficiency of vitamin B6 was probably a cause of hyperoxalaemia and hyperoxaluria in those patients. The effective therapy was repeated i.v. administration of haem-arginate during acute attacks (4-5 days). Besides during remission the patients were treated by pyridoxine (40-60 mg/day), by glucose, sodium chloride and phenothiazines. All patients showed significant improvement and had regular ambulatory check-up every three months. Currently, they are in clinical and laboratory remission.
Przegla̧d lekarski 01/2011; 68(9):610-3.
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ABSTRACT: Vitamin B(6) (VB(6)) is a water-soluble vitamin, which is important for the normal functioning of multiple organ systems. It is metabolized to the active molecule pyridoxal-5-phosphate (PLP). Oxalic acid (OA) is thought to be a uremic toxin that participates in the pathogenesis of the uremic syndrome. The objectives of this study were as follows: (1) to evaluate the plasma and erythrocyte VB(6) (effect of PLP; effect of PLP was in indirect relationship with the concentration of erythrocyte VB(6)), and plasma and urinary OA in marathon runners, in patients with acute intermittent porphyria (AIP) and variegate porphyria, and in patients with stage 1 chronic kidney disease (CKD), chronic glomerulonephritis and nephrotic syndrome (CGNS); (2) to examine the influence of water diuresis in healthy subjects, and the influence of sodium diuresis (high sodium intake) and an intravenous administration of furosemide on the urinary excretion of VB(6) and OA in CKD stage 3-4 patients; and (3) to evaluate the influence of erythropoietin treatment on erythrocyte VB(6) (effect of PLP) in hemodialysis (HD) patients, and the influence of continuous ambulatory peritoneal dialysis (CAPD) therapy on plasma VB(6) and OA and their peritoneal clearance and transfer.
This study was conducted at the Nephrological Clinic of L. Pasteur Faculty Hospital and of Medical School of P. J. Safarik University. A combination of 29 marathon runners, 15 patients with CG and NS, 11 patients with AIP, 1 patient with variegate porphyria, 15 healthy subjects, 27 CKD stage 3-4 patients, 30 HD, and 27 CAPD patients were used in the study.
After a marathon run, plasma and erythrocyte VB(6) significantly decreased and plasma OA increased. Plasma (15.5 +/- 3.8 nmol/L) and erythrocyte VB(6) (effect of PLP: 42.1% +/- 7.5%) were decreased and plasma OA (9.8 +/- 2.3 micromol/L) was significantly elevated in patients with CGNS and stage 1 CKD. In patients with AIP, deficiency of plasma (24.3 +/- 5.2 nmol/L) and erythrocyte VB(6) (effect of PLP: 46.2% +/- 7.0%) and hyperoxalemia (9.39 +/- 2.5 micromol/L) were present. The urinary excretion of VB(6) and of OA during maximal water diuresis and after intravenous administration of furosemide increased significantly (P < .01), but was not affected by the high intake of NaCl (P > .05). Erythropoietin treatment in HD patients led to the erythrocyte VB(6) deficiency. This finding is an indirect evidence that erythrocyte VB(6) is consumed by the hemoglobin synthesis much more during EPO treatment. In CAPD patients, plasma value of VB(6) (127.3 +/- 66.9 micromol/L) was in the normal range and plasma OA (23.6 +/- 7.4 micromol/L) was significantly elevated. Mean value of peritoneal clearance of VB(6) was 8.8% and of OA was 76.9% of urea clearance.
Our study indicates that deficiency of VB(6) led to hyperoxalemia and hyperoxaluria in patients with CKD. Deficiency of VB(6) in CKD stage 4-5 patients potentiates the uremic hyperoxalemia and hyperoxaluria.
Journal of Renal Nutrition 09/2010; 20(5 Suppl):S95-102. · 1.57 Impact Factor
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ABSTRACT: Oxalic acid (OA) is thought to be a uremic toxin that participates in the pathogenesis of uremic syndrome. The objectives of this study were to: (1) evaluate the plasma levels of OA in patients with chronic renal disease with various levels of glomerular filtration rate and after renal transplantation; (2) investigate the salivary secretion of OA and ascorbic acid in healthy subjects and in patients with chronic renal failure (CRF); (3) examine the influence of water and sodium diuresis and furosemide administration on the urinary excretion of OA and ascorbic acid in healthy subjects and in CRF patients without dialysis treatment; and (4) evaluate the influence of renal replacement therapy (RRT) on secondary hyperoxalemia in hemodialysis patients.
This study was conducted at the Nephrological Department of P.J. Safárik University. Sixty-one patients with chronic renal disease, 64 CRF patients, 32 continuous ambulatory peritoneal dialysis (CAPD) patients, 15 hemodialysis patients, 21 patients after renal transplantation, and 15 healthy subjects were examined. Maximal water diuresis, diets with low (2 g/day) and high (15 g/day) sodium intake, administration of intravenous furosemide (20 mg), and renal replacement therapy (CAPD, hemodialysis, hemofiltration, and postdilution hemodiafiltration) were utilized in the study.
In patients with chronic renal disease and those after renal transplantation, direct relationships between plasma OA and serum creatinine were found (r = 0.904 and 0.9431, respectively, P < .01). Despite a high level of plasma OA in uremic patients (23.1 +/- 10 micromol/L), there was no significant difference in salivary OA between control subjects (128 +/- 19 micromol/L) and CRF patients (135 +/- 24 micromol/L). The urinary excretion of OA during maximal water diuresis (from 37.5 to 110.3 micromol/4 hours) and after intravenous furosemide (from 34.5 to 66.7 micromol/3 hours) increased significantly, but was not affected by high intake of NaCl. The most significant decrease of plasma OA was observed during postdilution hemodiafiltration (63.3%).
Our study indicates that renal replacement therapy is not effective for a permanent reduction of elevated plasma levels of OA.
Journal of Renal Nutrition 01/2008; 18(1):33-9. · 1.57 Impact Factor
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ABSTRACT: Atherosclerotic cardiovascular disease is the most frequent cause of death in patients with end-stage renal disease who have undergone dialysis treatment. Oxidative stress, increased lipid peroxidation, and impaired function of antioxidant systems may contribute to the accelerated development of atherosclerosis in chronic renal failure patients during renal replacement therapy. The aim of this study was to investigate the influence of a vitamin E-coated dialyzer on antioxidant defense parameters in hemodialysis (HD) patients. In 14 HD patients, hemodialysis was performed using a vitamin E-coated dialyzer (Terumo CL-E15NL; Terumo Corporation, Tokyo, Japan) during a 3-month study. In these patients, erythrocyte (ER) antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GPX), glutathione reductase (GR) and catalase (CAT), plasma total antioxidant capacity (TAC), RBC glutathione (GSH), plasma malondialdehyde (MDA), plasma, and RBC vitamin E were investigated. Each parameter was measured at the beginning of the study, after the 1st, 2nd, and 3rd month of the study, and 10 weeks after the interruption of the use of vitamin E-coated dialyzer. All HD patients were treated by erythropoietin (EPO) and received vitamin C 50 mg/d, pyridoxine 20 mg/d, and folic acid 5 mg/wk during the entire study. The 3-month treatment with the vitamin E-coated dialyzer led to a significant decrease of plasma MDA level (from 2.85 +/- 0.44 to 2.25 +/- 0.37 micromol/L) and to an increase of plasma TAC, RBC, GSH, and the vitamin E levels both in plasma (from 25.9 +/- 2.8 to 33.6 +/- 3.8 micromol/L) and in the RBCs (from 6.7 +/- 0.8 to 7.4 +/- 0.7 micromol/L) by 30% and 10.5%, respectively. Ten-week interruption of the use of the vitamin E-coated dialyzer led to near initial values of MDA (2.90 +/- 0.28 micromol/L), plasma (28.6 +/- 3.5 micromol/L), and RBC (6.9 +/- 0.7 micromol/L) vitamin E and of other investigated parameters. Statistical analysis of results was performed by conventional methods and analysis of variance. The findings of the current study confirm the beneficial effect of the vitamin E-coated dialyzer against oxidative stress in HD patients.
Seminars in Nephrology 10/2004; 24(5):525-31. · 2.12 Impact Factor
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ABSTRACT: To investigate if oral use of Sorbifer Durules (EGIS Pharmaceutical Ltd, Budapest, Hungary) (1 tablet/d) is adequate for the maintenance of serum iron and vitamin C in normal range during recombinant human erythropoietin treatment in hemodialyzed patients. One tablet of Sorbifer Durules contains 100 mg of Fe(2+) and 60 mg of vitamin C.
Short-term, open-label clinical trial.
Hemodialysis units.
Twenty-four adult patients with end-stage renal disease on hemodialysis.
Four-week treatment period of Sorbifer Durules, preceded and followed by iron and vitamin C washout periods.
Fasting predialysis serum samples were collected on days 0, 28, 56, and 84 to determine hematocrit, blood hemoglobin, serum iron, total iron-binding capacity, transferrin saturation, ferritin, vitamin C, and plasma oxalate.
Four-week treatment in hemodialyzed patients by Sorbifer Durules led to significant increase of hematocrit, blood hemoglobin, serum iron and vitamin C. This treatment did not influence the level of plasma oxalate.
Oral dose of one tablet of Sorbifer Durules per day is adequate for the maintenance of serum iron in normal range during recombinant human erythropoietin treatment in hemodialyzed patients. This treatment simultaneously prevented the development of serum vitamin C deficiency and did not lead to further increase of plasma oxalate in these patients.
Journal of Renal Nutrition 02/2003; 13(1):47-51. · 1.57 Impact Factor
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ABSTRACT: The authors present the development of clinical nephrology from 1954 to 2004 at the Louis Pasteur Faculty Hospital and the Medical Faculty of P.J. Safárik University in Kosice (Slovak Republic), recounting its role in the delivery of preventive and therapeutic care, teaching and research. On October 24, 1997 a Nephrology Clinic was established, the first in the Slovak Republic. This led to the further qualitative development of nephrology not only in Kosice but in the whole Slovak Republic.
Journal of nephrology 19 Suppl 10:S173-7. · 1.65 Impact Factor
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Miroslav Mydlík
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ABSTRACT: The author of this paper was one of the postgraduate medical students of Prof. Jan Brod, MD, DSc, FRCP, from the former Czechoslovakia. The manuscript includes a short biography and his complicated curriculum vitae. Professor Brod was one of the greatest well-known nephrologists and cardiologists, who worked in Europe and elsewhere in the 20th century. He exerted a significant influence on the development of nephrology in Slovakia during his productive scientific and research activities in Prague.
Journal of nephrology 24 Suppl 17:S73-7. · 1.65 Impact Factor
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ABSTRACT: The authors present a brief history of the activities of 7 important and well-known foreign nephrologists in Kosice and in the region of Eastern Slovakia who were awarded the honorary title Doctor Honoris Causa by P. J. Safárik University in Kosice. The above-mentioned professors presented their papers as guest professors to the students of the Medical Faculty of P. J. Safárik University and in meetings of medical societies and at many symposia and congresses with international participation in the region of Eastern Slovakia. All of the awarded nephrologists have visited the Faculty Hospital of L. Pasteur, the Fourth Internal Clinic and the Nephrological Clinic. During their stays, they stimulated the thinking of researchers in other metabolic studies within clinical nephrology and toxicology. In addition they contributed to the establishment in 1997 of the Nephrological Clinic of the Medical Faculty of P. J. Safárik University and the Faculty Hospital of L. Pasteur, the first one of its kind in the Slovak Republic.
Journal of nephrology 22 Suppl 14:143-8. · 1.65 Impact Factor
