RESUMEN
Serum lipase and amylase isoenzymes were measured in 44 chronic hemodialysis patients, 16 CAPD patients and 22 normal volunteers. The enzyme levels of the two patient groups were similar and were significantly higher than those of the volunteer group. The ratio of pancreatic to salivary amylase was similar in all three groups. Anuric patients in both dialysis groups had higher enzyme levels than those with residual urine output. Linear regression analysis was done to attempt to identify factors which were good predictors of enzyme levels. Although no such factors were found in the hemodialysis group, in the CAPD group there were significant correlations between the degree of azotemia and the magnitude of enzyme elevations. Further studies are needed to determine the relative importance of oversecretion and underexcretion in the genesis of the amylase and lipase elevations found in dialysis patients.
Asunto(s)
Amilasas/sangre , Lipasa/sangre , Diálisis Renal , Anuria/enzimología , Anuria/terapia , Humanos , Isoenzimas/sangre , Fallo Renal Crónico/enzimología , Fallo Renal Crónico/terapia , Diálisis Peritoneal Ambulatoria ContinuaRESUMEN
In the plasma and/or serum ultrafiltrates of a 20-year-old patient with tourniquet shock and post-traumatic acute renal failure it was possible to identify free proteolytic activity during the oligoanuric phase. Plasma alpha 2-macroglobulin values were significantly lowered, whereas the plasma concentrations of antithrombin III were unchanged. alpha 1-Antitrypsin values, however, were markedly enhanced. In contrast, urinary excretion of alpha 1-antitrypsin and antithrombin III were enhanced during the oligoanuric phase. Addition of kallikrein and/or trypsin resulted in strong inhibition of urinary proteolytic activity. These effects were not seen during the polyuric and recovery phase. From our results it can be concluded that proteolytic enzymes may be involved in protein catabolism of patients with tourniquet shock and hypercatabolic acute renal failure.
Asunto(s)
Fracturas Abiertas/cirugía , Péptido Hidrolasas/metabolismo , Choque/etiología , Fracturas de la Tibia/cirugía , Torniquetes/efectos adversos , Lesión Renal Aguda/etiología , Lesión Renal Aguda/orina , Adulto , Antitrombinas/orina , Anuria/enzimología , Anuria/metabolismo , Inhibidores Enzimáticos , Fijación Interna de Fracturas , Humanos , Calicreínas/metabolismo , Masculino , Péptido Hidrolasas/sangre , Choque/metabolismo , Tripsina/metabolismo , alfa 1-Antitripsina/orina , alfa-Macroglobulinas/metabolismoRESUMEN
With the help of the haemofiltration on the capillary dialysator CDAK 4 the behaviour of lysozyme (muramidase) was investigated in 20 dialysis patients. In 6 of 55 cases a measurable lysozyme concentration in the haemofiltrate was found. A relation to the size of the serum lysozyme level could not be established. The influence of defective capillaries is discussed. Despite the in most cases not measurable lysozyme concentrations in the haemofiltrate a decrease of the serum lysozyme level taking place parallel to creatinine could be proved during dialysis. Examinations of the influence of the renal rest function in dialysis patients with a rest diuresis resulted in a lower lysozyme concentration in the serum than in patients with complete anuria. These findings allow conclusions to the behaviour of low-molecular proteins in the kidney of dialysis patients and to their losses on the dialysis membrane.