RESUMEN
Complement receptor type 1 (C3b/C4b receptor, CR1) is known to be present in human glomerular epithelial cells (GEC) in vivo. The presence of CR1 has not been documented in rat glomeruli, although cultured rat GEC appear to express CR1 based upon their ability to rosette with complement-coated erythrocytes. In this study, we establish that CR1 is present in cultured rat GEC: (1) by isolating a 200 kDa protein from detergent-solubilized cultured rat GEC through the use of C3b affinity chromatography; (2) by Western blotting studies demonstrating reactivity of anti-human CR1 antibodies with this protein from cultured GEC; and (3) by demonstrating that C3b binding to GEC monolayers exhibits low affinity and that an estimate of the number of binding sites is 6700 per cell, both of which are comparable to that seen for CR1 in human blood cells. Furthermore, we show that CR1 is also present in rat glomeruli by Western blotting studies with anti-human CR1. Anti-human CR1 also identifies a 70 kDa protein from cultured GEC and isolated glomeruli. This 70 kDa protein is likely to be the CR1-like protein, designated Crry, which was initially identified in the mouse and has significant homology to human CR1. Crry may be present in rat GEC instead of decay accelerating factor, which is present in human GEC.
Asunto(s)
Glomérulos Renales/inmunología , Receptores de Complemento 3b/aislamiento & purificación , Animales , Anticuerpos , Western Blotting , Células Cultivadas , Complemento C3b/metabolismo , Epitelio/inmunología , Epitelio/metabolismo , Humanos , Glomérulos Renales/metabolismo , Masculino , Peso Molecular , Ratas , Ratas Sprague-Dawley , Receptores de Complemento 3b/química , Receptores de Complemento 3b/inmunologíaRESUMEN
OBJECTIVE: To evaluate the effectiveness of continuous arteriovenous hemodiafiltration (CAVHD) using citrate as the anticoagulant for the treatment of lactic acidosis in patients with renal failure. DESIGN: Case series with careful monitoring of the clinical course of patients being treated in a medical or surgical ICU. SETTING: University hospital ICU. PATIENTS: Two patients with lactic acidosis are described, along with our experience using CAVHD and citrate in other clinical settings. INTERVENTIONS: CAVHD was used to manage renal failure, while a continuous infusion of citrate was administered to maintain patency of the extracorporeal circuit. MEASUREMENTS: Total and ionized serum calcium concentrations and citrate concentrations were monitored. MAIN RESULTS: CAVHD with citrate as the anticoagulant proved to be a convenient means of managing vascular volume, serum electrolyte concentrations, acid-base balance, and replacement renal function requirements in the setting of severe lactic acidosis, oliguric renal failure, and hemorrhagic diathesis. CONCLUSIONS: CAVHD with citrate as the anticoagulant can be recommended as effective therapy for selected patients, but careful monitoring is needed to avoid serious complications.