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      Studies on IL-2 Production and T-Cell Colony Forming Unit in Patients with Chronic Renal Failure

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          Abstract

          To elucidate the nature of altered cellular immunity seen in patients with chronic renal failure, the values of interleukin-2 (IL-2), a kind of lymphokine, and T-cell colony forming units were measured in controls (N=10), predialysis uremic patients (N=14), patients undergoing chronic hemodialysis (HD, N=11) and patients on continuous ambulatory peritoneal dialysis (CAPD, N=9). Dialytic patients were selected as relatively stable cases receiving dialysis for more than 3 months. The duration of dialysis was 25.5±5.5 months in HD and 14.7±3.0 months in CAPD groups. The mean age was 30.3 years in the control, 36.1 years in the predialysis, 32.9 years in the HD and 41.1 years in the CAPD groups; all 4 groups showed male predominance. The serum creatinine concentration of each group was 1.2±0.1 mg/dl in the control, 14.1±0.9 mg/dl in predialysis, 13.5±1.3 mg/dl in HD and 14.7±0.9 mg/dl in CAPD groups. The level of IL-2 in the predialysis group was markedly lower compared to the control, HD and CAPD groups (as 3.1±0.8 unit vs. 8.8±2.2 unit, 11.8±3.0 unit and 14.9±3.4 unit, respectively, p<0.05); the difference between the control and dialytic groups was not statistically significant. The value of the T-cell colony forming unit in the predialysis group was far lower than the other 3 groups (as 427±69 colony/petri dish vs. 998±263 colony/petri dish in control, 1114±273 colony/petri dish in HD and 1369±372 colony/petri dish in CAPD groups, respectively, p<0.05), whereas there was no significant difference between the control and either HD or CAPD groups.

          In conclusion, the lymphokine productivity, as reflected by the level of IL-2 and the T-cell colony forming unit, seemed to be highly suppressed in predialysis uremic patients compared to control and dialytic patients. This result suggests that dialytic treatment tends to improve IL-2 productivity and T-cell colony forming unit, but further evaluations are needed to confirm these finding.

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          Most cited references50

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          Hepatitis B vaccine in patients receiving hemodialysis. Immunogenicity and efficacy.

          We evaluated the immunogenicity and efficacy of hepatitis B vaccine (Heptavax-B) in a randomized, double-blind, placebo-controlled trial involving 1311 patients receiving hemodialysis in the United States. After three doses of vaccine (40 micrograms each) had been administered, 63 per cent of the patients were antibody-positive. After correction for possible passive transfer of antibodies by blood transfusion, only 50 per cent of vaccine recipients were considered vaccine responders. The incidence of hepatitis B viral infection during the 25 months of the trial was much lower than had been anticipated and was virtually the same in the vaccine and placebo recipients (6.4 and 5.4 per cent, respectively). Four cases of hepatitis B occurred in patients who had an apparent antibody response to the vaccine, but in each case either antibody had reached low or undetectable levels before hepatitis B surface antigen was detected or the patient had been receiving immunosuppressive therapy. This study did not demonstrate the efficacy of the vaccine in a population of patients receiving dialysis in whom both the rate of antibody response to hepatitis B vaccine and the viral attack rate were low. Other measures to control transmission of hepatitis B virus in dialysis units, including surveillance for hepatitis B surface antigen and isolation of patients who are positive for the antigen, must be continued.
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            Tuberculosis in patients undergoing maintenance hemodialysis.

            Tuberculosis was diagnosed in eight patients undergoing maintenance hemodialysis and occurred with an incidence 10 times that of the general population. Dialysis-associated tuberculosis is characterized by intermittent fever, anorexia, weight loss and hepatomegaly. Ascites was present in 50 per cent of the patients. A recently converted positive tuberculin skin test was observed in five of eight patients. Tuberculosis was extrapulmonary in seven of eight cases and consequently the diagnosis was frequently delayed. Over-all mortality was 37.5 per cent and correlated with the duration of symptoms prior to initiation of therapy. A trial of antituberculous therapy is warranted in patients undergoing dialysis in whom fever of unknown origin, anorexia, weight loss and/or hepatomegaly develop particularly in areas endemic for tuberculosis.
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              Increased incidence of malignancy during chronic renal failure.

              The incidence of cancer in 646 dialysis/transplant patients before uraemia developed, during the period of progressive uraemia, and post-transplantation was compared. 10 tumours (3 breast, 2 kidney, 1 leukaemia, 1 lung, 1 insulinoma, 1 thyroid, 1 cervix in situ) developed in 9 patients during the period of progressive uraemia, a significant increase over the expected number in the age-matched general population. 6 of these patients have received transplants and have no evidence of recurrent disease 6 months to 4 years post-transplantation. 11 de-novo tumours have developed in 530 transplant recipients (4 cervix in situ, 2 skin, 2 reticulum-cell sarcoma, 1 lip, 1 dysgerminoma, 1 colon)--a significant increase over the age-matched general population. The cancers in the uraemic patients are relatively common types of mesenchymal tumours while the cancers in the transplant recipients are epithelial and lymphoproliferative. This difference may reflect the presence of the graft in the transplant patient or may be due to different patterns of immunosuppression in these two populations.
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                Author and article information

                Journal
                Korean J Intern Med
                Korean J. Intern. Med
                KJIM
                The Korean Journal of Internal Medicine
                Korean Association of Internal Medicine
                1226-3303
                2005-6648
                July 1993
                : 8
                : 2
                : 86-92
                Affiliations
                Department of Internal Medicine, Yonsei University, College of Medicine, Seoul, Korea
                Department of Microbiology
                Author notes
                Address reprint requests to: Sung Kyu Ha, M.D., Department of Internal Medicine, College of Medicine, Yong-Dong, Severance Hospital, 146-92, Dogok-Dong, Kangnam-Ku, Seoul, 135-270, Korea
                Article
                kjim-8-2-86-5
                10.3904/kjim.1993.8.2.86
                4532092
                8031728
                30c9072e-44e1-4491-8a94-ab42f7285622
                Copyright © 1993 The Korean Association of Internal Medicine

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Original Article

                Internal medicine
                interleukin 2,t-cell colony forming unit,chronic renal failure
                Internal medicine
                interleukin 2, t-cell colony forming unit, chronic renal failure

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