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      Immune System Dysregulation in Uremia: Role of Oxidative Stress

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          Immune system dysregulation in end-stage renal disease patients is a multifactorial process combining profound immunodeficiency with a state of cellular activation. While at the origin of the deficiency uremic toxins are thought to play a prominent role, the dialysis procedure is the main factor for the genesis of a recurrent cellular activation process leading to a chronic inflammation state dominated by oxidative stress and its related severe complications, e.g. β<sub>2</sub>-microglobulin amyloid arthropathy and accelerated atherosclerosis. The recent identification of advanced oxidation protein products (AOPPs) in the plasma of uremic patients and the following demonstration that AOPPs act as both potential uremic toxins and proinflammatory mediators, have opened novel areas of research on these novel molecular bases of oxidative stress and on therapeutic strategies aimed at reducing its most deleterious effects in hemodialysis patients.

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          Chronic Inflammation in Hemodialysis: The Role of Contaminated Dialysate

          Routine sodium bicarbonate-buffered dialysate is contaminated with predominantly gram-negative micro-organisms. These bacteria release pyrogenic substances such as endotoxins, peptidoglycans, exotoxins and fragments thereof. Pyrogens derived from contaminated dialysate either alone or in costimulation with activated complement components are the most important activators of circulating mononuclear cells in patients on chronic intermittent hemodialysis. Activated mononuclear cells release proinflammatory cytokines which are key mediators in acute and chronic inflammatory diseases associated with long-term hemodialysis therapy. Recent experimental and clinical data suggest that the use of pyrogen-free dialysate prevents activation of mononuclear cells and improves the state of chronic inflammation, as indicated by decreased plasma levels of C-reactive protein in chronic hemodialysis patients. Future clinical studies have to prove whether the use of pyrogen-free dialysate in combination with biocompatible dialyzer membranes and tubings reduces the incidence and severity of chronic inflammatory diseases (β 2 -microglobulin amyloidosis, muscle protein wasting, atherosclerosis) in long-term hemodialysis patients.
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            Malnutrition and Chronic Inflammation as Risk Factors for Cardiovascular Disease in Chronic Renal Failure

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              Tuberculosis in children undergoing continuous ambulatory peritoneal dialysis.

              The incidence of tuberculosis (TB) is increasing worldwide. Due to an impairment of cellular immunity, patients with chronic renal failure are susceptible to reactivation of TB. Seventy patients were treated by continuous ambulatory peritoneal dialysis (CAPD) in our pediatric nephrology department during the years 1989-1997. TB was diagnosed in 4 patients, representing 5.7% of all CAPD patients in our department. One patient had extrapulmonary (TB osteomyelitis) and the others had pulmonary TB. All patients were treated with antituberculous drugs. Two patients with pulmonary TB were cured. Symptoms improved in the other 2 patients but they died at home for unknown reasons. We recommend that all children in regions of high prevalence of TB should be investigated for TB, especially if they have a cough or fever of unknown etiology.

                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                30 August 2002
                : 20
                : 5
                : 481-484
                INSERM U507 and Department of Nephrology, Necker Hospital, Paris, France
                63558 Blood Purif 2002;20:481–484
                © 2002 S. Karger AG, Basel

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                Tables: 1, References: 22, Pages: 4
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