Praca Oryginalna Original Article
Transkrypt
Praca Oryginalna Original Article
Praca Oryginalna Zdr Publ 2011;121(3):272-276 Original Article Partial recovery of renal function dialysis Streszczenie Abstract ! "# !$ $%#&&& &!' ( !( & ! ) !$ ! & $ & ! *+#,&$ -!.) / /$ ) !' &!3!$ /$$ & / 5) & & &&) & $ ! $' 6&! / &$ !$ ' %$&!!! & !/.$ 7898 7898) !) & / +:* /$ ';&& ! $& &&&)! (/' & & & &/&7 & &$$) ($$ !& $ ! & / 5- ! ! / ! ) ! ! & / & !' <!& & & dializoterapii intensywnego leczenia immunosupresyjnego $ ! . . (& =$ ($ & ! ' & & & !! (!' > ) ) !! "# !!%# &)&&>! '5/ extent it depends on primary disease leading to end-stage !&& *+#) & & >& &) / !&& && ! >> ) ! / &' ) ! ) .) . )!' ! >) !&&) >& &) && & &&)/ &' The aim of our study was presentation of three & !7& / !&& *+#) !/ 5'8 &&&> ! &)> &&>!'55&& ! &' The study was performed in three & !7& /!&&'? !&! && &*+#&78987898& > >& &'? ! &*+#&&& & && +:* >> ' ? described cases immunosuppressive therapy was performed !& '? &&&& &! &' 8&& /&&&> ) / ) ! & &/@ > ) enabling us to withdraw them from the renal replacement 5- && & && !& )& &/ !&&' + & !sis and intensive immunosuppressive treatment in patients suffering from vasculitis or systemic lupus erythematosus may lead to renal function recovery and to possibility & /!& '?& !&>! > %# "# &' # 9/)A!;>& : Copyright © 2011 Uniwersytet Medyczny w Lublinie E!%BFGG,GBG3 INTRODUCTION The review of the literature suggests that complete or > & ! !&& "#) !&& %# & > &>! YG73Z' ? & & & && [ & & >&&& 7898) ! 7898 / involvement of violent glomerular nephritis; with primary malignant hypertension; with immunological illnesses like && & && +:*, !7&!! necrosis of the cortex of kidneys; infarction of the kidney ! & & YB)O7IZ' *R ) & rarely been observed in patients dialysed due to polycystic !& !&& F'G\ ! F'O\ YBZ'W!&/3&&) / &&&> ) &/@ > in the renal function was observed and the dialysotherapy & !& !' ? && & systemic vasculitis was the cause of the end-stage renal !&& !> 7898 ! 7898, ! 7 & & !>/ & ' ? !&! && & & !& ) &&&> &!)!B & & &&& & !' 5 ! && G3 && &'? / &) because of considerable worsening of the renal function &!/' The purpose of our study was the description of cases of three patients with kidney failure in the course of the systemic >& &>&&)X/ 5) &&&> ) > of renal function was observed and dialysoptherapy was !& !' #$%&'$#()' * 8BD77!&! ! & :! + BFFI) !/&& & & !) & & 7 H'I/) ! & !& 898 G-IOF ! 7!b !& 7 G-KBF' 8 &)&! &! & / !)!;+N& !& &'6 & / 9> BFFI) & & !' 5 ] > & N9 & > /&^ & & !' +& & && & !/&! +:*' 5 &&& ! >& *!R &! && & ! ' 5 & ! / A ! !& ' 5 7 !&&&GHFF'?#BFFI) reported to Nephrology Department in Lublin with features & / &@- BO'B J 9- BD3 B'H7I'DJ) 3HKJ9-IF7G3FJ) ! & / @ N !/ A## ! G3'O J J G'D3 2) &/@ "/ O'KK J) " F'BB! />& !&&'8& a lowered level of the C 3 fraction of complement was stated KG'3/J!9-Q37GKK/J! O>';+N scan of kidneys revealed their correct size and the preserved & & ' / > !&&) & >!&&*!R'>'!& ! '* &!! '5& > 3D'QJ! HBDJ N! K'IJJG'D32 made the personnel !! // !& ' The earlier immunosuppressive treatment resulted in the > !& !&7#98 > G-OF'?!/R &7898 & !&&S & !)7898) 7 !b) !&898 &! !&'*!R & ! <BFFD) / >& &&' 5 >& 3 ! O & !' #/ ! / > disease accompanied an improvement in the renal function; 7!&&& !>BFFF' 8 G3 & / 5) > G3B J)!GG'3JN7O3'GJJG'D3 m2) !& & ! & !& ' 8!> !&& GK & !/&&) &!&/ the renal function and the necessity of the patient’s return to !&&/' " 8 HO77! & ! ! 9/# ABFFO'%>&) ! been hospitalized in the medical ward of the regional hospital due to the infection of the upper respiratory tract and &'5) &! & & !- // I'H7GO'K J, BFI7BOI J) 7 !&& GKFF ' % > F'DK/J! & !) & ! && > GDFJGFF "/ ! - "/ H'KG J) " F'BK &&- D'O R GFQJ' ? &&) & ! &@! ! && !'5N > !!/ A##&GK'DJ JG'D32'5 )8+6! W7& / >';+N& !> revealed kidneys of correct echostructure and erased corti&!>& '5 && renal failure in the course of acute glomerulonephritis was >! 9/ # ' N! !> !&&>! 3FIJ) GO'O J &! X/ && &&) && > ! >& !&&'? &! -&/@ ) ! & &!!&&>!' ! BDO N>&/& ! >GH'GJJG'D32' 8 >/ ! ) &>! tient since December 2003 had already suffered from raised )!& !/ )!! ! &' q /&&/ ! !&&)& BO'HJ! GBBQJ)!)!& !& '5N>&O'GJJG'D32 '? !/R &)& >>& 7898 !&! & !&/& /& 7N{A G-GIF& !' ?> & ! 3&&&) & & >& && *!R ! +7A! !& & />'5 !!S >& !&& made to commence for the treatment with peritoneal dialy&& / *!R && ! * !& ' 8 7 !&& GDFF ! ization of the blood pressure were obtained along with the gradual improvement in the renal function: concentration ! BBG J ! GF'D J) & > ! N & BG'Q JJG'D3 2' + A BFFH A BFFD) & & ) &S !&!' ? A BFFD) > &!! &! IGK'KJ, 3O'HJ,"/>!&! HJ!" } F'B3'? & ! & ! && >& GIFJGFF "/' 5 BO7 !&&&!&! DFF7KFF'5N>& !! >I'OJJG'D32'& renal function followed after the episode of an infection of & '?;+N&!& ! &!&&& !'% !&& &&& !'# &6 BFFQ & &! !&&' The next episode of severity of the disease with the massive intra-alveolar bleeding was the cause of death of the patient ABFGF' + 83B77!&! ! 9/#partment due to violent progression of chronic nephropathy & >& & &7898 !&'6!&& ! ) !/&) /&&/&&! &! & '%&/!&&)&/ &/ &)&! )!&7&!& & &!&& !'5BO7 !&&&BFFF)NGF'KGJJG'D32' W & &>! " H'Q3 J) 3'HRGFQJ) ! G'3I/ ! & I'IJ'?;+N&)!&&! & !/ R'6 !>! ! / &) !& & !!! & ' +& >& & 7898& !& Q3'QK;J '*:?+8!/! GF & ! ! ' 5 E!%BFGG,GBG3 && !N>&O3'IJJG'D32)!/ A##'5 & ! && +7A! />A !' 5 &&&!!&&&' ? > / & / !&& > 7898 & !& BF'3F;J) !& &/ &&&> & ! ' & / +7A! *!R ! * & !' 8 3 & a distinct improvement in the general state and the renal & !'5!&& BHFFJ!) & N ! ! > H3 JJG'D3 2' 5 patient didn’t require dialysotherapy any more; he was ! *!R'>'&&!/>* ' ; 3! *!R & && !>! ! & & '8 I &) & N G3'D J JG'D32 !&&GHFFJ! &&>!' &! !&&&!'5 & / & !& & !) / next clinical remission: after 3 months the treatment with haemodialyses was ceased; the renal function was essential>!}N>&! HFJJG'D32) >7898 !&& !/ >GI'G;J'5&& & && & /'5 && ) NXHDJ JG'D3B'5!&&& BHFFJ!'5 is being treated at present with the custom therapeutic meth! 7 in a dose of 2 x 1 g/day and doesn’t need renal replacement 5' RESULTS 8& & & ! >) && /7 &> & ! ) X/ 5) & & !&&&> ) & !&/@ > )/& ! therapy: in two cases of the transitional omission of !& )& &/ !&&' DISCUSSION The authors who analysed a large number of patients treated !& ) > [ & /&G\7B'K\YG73)DZ5G :!! ! 9 YBZ &/ & > B3DDG 8%# ! & ; !+ &&>! BKG & &G'B\'> ' ! & & & YGZ / BOII3 & ! !&&&&>! BH3!>!&G\' '& !&! > & & YKZ' 5 !& ! & & K\ !&! &'+/&&& / '8 & E!%BFGG,GBG3 BDH #,%$*- ./ / 0 . Number of patients treated with peritoneal dialysis 8 & Literature source 1 N ' % #{'GQKI,I-DD7Q DH K\ 2 /<' ' % #? 'GQKQ,Q-I37I 300 3'3\ 3 A' ' 9#5& 'GQKQ,O-OQQ7HFF GQK O'H\ O A' ' 9/'GQKQ,GF-&'H37H OFF 3'Q\ H +A8 ' 8<!#&'GQQF,GH-IG7H DKIF B'K\ I :!!8+)9# % #? 'GQQB,GB-O37D B3DDG G'B\ D N!& ' % #? 'BFF3,B3-GHG7I 1200 B'O\ K 8A+'> ' % #? 'BFFD,BD-GKO7QG BOII3 G\ included in this group 2 patients with diagnosed acute / &) ! ' !!& /R &&!/ !7& /!&&'5&&& >& &) / / / !&) malignant hypertension and other more rarely appearing &'? &)!&& >& & ! 7898 7898 !&&' 8& & ! &&&> !/ &&&) &/@ > & !' 5 ! !& >& & 898 !& & ! 898 && ! / &^'8 & />/ &&@ [ & & ! && ? &&& ! GQQO "' !&& & !! [ & && ! !> 898 !& ! / !&- W/S& / &&) & / & A%8) /7 + && &! + ! 7 & / / &' { / &&&> ) & & !! & & & &/ !/&& YQZ' 5 && [ & & & /& !'5 & >/!! > & &' ">) & !! & !!& / ! ! &! YGFZ' The cyclophosphamide is also an essential element of therapy associated with other immunosuppressive agents ) &) ' ? & !@ && >& &) / /& ! !&) &&&> & ! &&&YGG7GOZ'" 'YGFZ!& ! the improvement in the renal function and the withdrawal !& & &) & !) > /& & !'8 > changes more often appear in patients with the presence of A%678987898 !&! % 378987898' +& )&&& [ 78987898&!& & !& YGHZ' ? !/&! & ) A ! !& > * ! &! ]&&^ ! &&&)!/ Partial renal function recovery && & !' 5 !& & & ! ! !&& !GK &'8 this period the relapse of the activity of disease caused the && !&& %#' A & &! !@ appeared in PD-treated patients as compared with those ! "#YG)D)KZ' This peculiarly concerns the patients in whom malignant hypertension coexists with the increase in the rennin activity &) / &??!!& ' #/"# )&& & !! ! &!&&) & & & > '? &&& !&&&! !'?& ! &&>! the improvement in the renal function in patients treated with !&&' CONCLUSIONS The diagnosis of advanced kidney failure in the course of the >&& >& &&& & &&) points to continuing of the intensive immunosuppressive treatment at the same time commencing the treatment of 5' + !/& /@ > ! && &&) / ) !&&' 6 improvement we propose to include such patients in the / !&&' REFERENCES G' > 8A) " A) A#! +%' ' %! & >8& !9E!!7& / & ! !&&'% #? 'BFFD,BD-GKO7QG' B' :!! 8+) 9 #' > & !&&-& !9 8%#/& ! ' % #? 'GQQB,GBG-O37D' 3' +A8)% )W8' '>!7& / !&&'8<!#&'GQQF,GHG-IG7H' O' +&?<'% > +:* & !&!&&'9EA!<'GQKD,GFFK3H-IQI' H' / <) ?&&! {) 8 A) <& ' > & !8%#'8!>% #'GQKQ,H-I37I' I' ! :! > W/! 8) " "8) W ' ' & > !&&7!! 8987&& ! / &'<8+9'BFFD,GKD-BGKQ7QD' D' N!& 8) / 8+) & 6' > and the discontinuation of dialysis in patients treated with continuous !&&'% #? 'BFF3,B3B-GHG7I' BDI K' N) { N) ' ' > ! &!!&&8%#!!&&'% #? 'GQKI,IB-DD7Q' Q' + A) 5> <W) && A' ' &>> ! /& & & %37898 && ! >& & >> '!? 'BFF3,I3-IDF7D' GF'" "8) { ?A) "/ "' ' # & 8987&& !/ &-& >7 & /&&QI &'!? 'BFFB,IBH-GD3B7 OB' GG'{ 8#)8!A){&8' '6 8987&& ! >& &- H7 & > & !' 8 < ! #&' BFF3,OGO-DDI7KO' GB'!:!>W/!8)""8)W ' ' ! "& / # & 6 89878&& ! & &- %& > 8&& GFF % & +> ?>> '<8+9'BFFI,GD-BBIO7DO' G3'9?))/"' '"& /!! & ! 8987&& !>& &'9 #5& 'BFFH,BFG-QI7GFO' GO'W!+)N&&+)"7 +' '8987&& !>& & >> - &&'9#5& ' BFFO,GQI-GOF37GG' GH'8 %)+N) '?&&&> !&& &'9#5& 'BFFB,GD-B7Q' E!%BFGG,GBG3 /1 %' ! ' !' /8&<1$ -$1,&.$ 7 ! , ! ' !'$*1,(6=.$ 0*5=(%$/6.$ } ! , ! ' !' ,:21$ %$5$12:,&=*Ą6=&=<. – ! , ' !' :2-&,(&+ 3,.723,(7.,(:,&= } ! , ' ! ' ' !' $1'5=(- .6,Ąĩ(. } ) ! 9/) ;& A!:' 1 8/&A'N& !9/);& A!: <&/K)BF7QHO: -FKGDBOODFO 7-/& '