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Obiectiv. La pacienţii cu diabet zaharat de tip 2, natura progresivă a afectării renale reprezintă un risc crescut de mobiditate şi mortalitate. Scopul studiului nostru a fost acela de a evalua valoarea predictivă a molecului de adeziune intercelulară (ICAM 1) pentru creşterea albuminuriei în stadiile timpurii ale afectării renale la pacienţii cu diabet zaharat de tip 2. Metodă. S-au inclus în studiu pacienţi consecutivi cu diabet zaharat de tip 2, urmăriţi prospectiv timp de 1 an. Progresia bolii renale a fost evaluată prin modificarea în timp a raportului albumină urinară pe creatinină urinară (ΔuACR). Rezultate. 93 de pacienţi cu diabet zaharat tip 2 au fost incluşi în studiu, dintre aceştia 58 fiind normoalbuminurici, iar 35 albuminurici. Media excreţiei urinare de albumină a fost în stadiu microalbuminuric şi au avut a valoare a filtrării glomerulare aproape normală. ΔuACR a prezentat o corelaţie pozitivă cu nivelul seric iniţial al ICAM 1 (p=0.003, r= 0.31) şi cu creatinina serică. În regresie multiplă, ICAM 1 a rămas singurul determinant al ΔuACR (p= 0.002). La pacienţii albuminurici, ΔuACR a prezentat o corelaţie şi mai puternică cu nivelul seric iniţial al ICAM 1 (p=0.0003, r=0.57). Concluzii. La pacienţii noştri cu diabet zaharat tip 2, principalul predictor al creşterii albuminuriei pe parcusul unui an de urmărire a fost nivelul seric iniţial al ICAM 1, în special la pacienţii albuminurici. ICAM 1 ar putea fi un biomarker non-invaziv cu utilitate clinică în prezicerea progresiei albuminuriei la pacienţii cu diabet zaharat tip 2.

Introduction: The life for end-stage renal disease patients has remarkably improved in the last years. Although mineral and bone disorders remain as unsolved complication, in severe secondary hyperparathyroidism (sHPT), the ultimate treatment is parathyroidectomy (PTX). It is an old treatment, but there are still insufficient data regarding survival after PTX. The study goals were to compare 2-year mortality and morbidity after PTX in surgically versus medically treated sHPT and to compare the efficacy and safety in subtotal versus total PTX in a cohort of patients receiving hemodialysis (HD)., Methods: This prospective, longitudinal study was carried out on a cohort of chronic HD patients with severe sHPT (iPTH over 700 pg/ml). Among the overall HD population, 26 patients underwent PTX. This group was compared to a control group treated with specific drugs. Laboratory parameters, specific symptoms and mortality were registered after 24 months of follow-up for each group. The subgroups of subtotal and total PTX patients were also compared., Results: All average values of mineral markers were significantly reduced after PTX, as a proof that surgical treatment was effective. The reduction in mineral markers and the improvement in symptoms and mortality rates were similar after total and subtotal PTX. Bone pain was significantly lower in patients after PTX than in those drug treated (p = 0.0005), but not muscle weakness and itching. Survival at 2 years was better in patients surgically treated (PTX) despite significantly higher mean baseline values of iPTH, Ca and ALP compared to patients medically treated (p = 0.03)., Conclusions: We compared clinical and laboratory outcomes in HD patients with severe sHPT. Mortality, bone pain and mineral markers were improved by PTX. Total and subtotal PTX had similar clinical outcomes.

Background: Currently, less frequent than once-weekly subcutaneous epoetin administration regimens were shown to be equally effective and safe as once-weekly schedules in stable predialysis and peritoneal dialysis patients. Bioequivalency of once-every-2-weeks and once-weekly subcutaneous administration of the same total dose of epoetin beta for the maintenance phase of anemia treatment in stable iron-replete long-term hemodialysis patients therefore was investigated prospectively., Methods: Two hundred seven stable selected hemodialysis patients without diabetes, acute illness, significant inflammation, malnutrition or hyperparathyroidism administered once-weekly subcutaneous epoetin beta and preserving stable hemoglobin levels between 10 and 12 g/dL (100 and 120 g/L; difference between maximum and minimum of 3 subsequent levels

In patients with chronic renal insufficiency (CRI) treated by programmed haemodialysis (HD) were detected, during the last years, amyloid stores at the level of carpal tunnel, of some joints, bones etc., finding which permitted to describe a new type of amyloid, the so-called "dialysis associated amyloid". The immunochemical structure of this amyloid is similar to that of the beta-2-microglobulin (beta-2m). Patients display various clinical manifestations. The variations of serum and urinary beta-2m were studied in 51 uraemic patients chronically dialyzed by means of dialyzers with cuprophan membrane, the average duration of the HD treatment being of 51.5 months. The pre- and postdialysis values of the beta-2-m were determined by Mancini radial immunodiffusion. A considerable increase--about 25 times--of serum beta-2-m was observed, which was more marked in anuric patients and those with a duration of more than 5 years of HD treatment. Among these, 15.7% show various articular manifestations (detected clinically and radiologically): a carpal tunnel syndrome (one patient required surgery) and arthropathies with various sites (scapulohumeral, knee). During a HD sitting with cuprophan membrane dialyzers, an increase of beta-Z-m was recorded, but it was statistically non-significant.(ABSTRACT TRUNCATED AT 250 WORDS)