Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.21.73 (urokinase-type plasminogen activator)
 10,685 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Relapsing peritonitis is often due to bacterial colonization of the Tenckhoff catheter and may require removal of the catheter in patients on peritoneal dialysis. The efficacy of a Tenckhoff catheter decontamination procedure was examined in 9 pediatric patients aged 1.5-18 years and compared to the outcome of a historical control group. After repeated dialysate cultures had become negative and cell count was normalized (< 100/ul), intraluminal urokinase (5000 IU/ml) and intraluminal high concentrated antibiotics (vancomycin, fosfomycin, cefotaxim) were instilled sequentially for 3 h and 1 h respectively. This procedure was performed once daily for three days. In addition, the connector was exchanged on the last day. This regimen prevented relapsing peritonitis in all study patients, whereas in the control group in 75.8% of events further relapses occurred, necessitating removal of the Tenckhoff catheter in 7/19 (36.8%) episodes. No side effects of intraluminal urokinase were recorded in any of the patients. We conclude that intraluminal urokinase and intraluminal high concentrated antibiotics combined with connector device exchange are highly effective for prevention of further relapses of peritonitis and reduce the need for Tenckhoff catheter exchange.
Adv Perit Dial 1992
PMID:Treatment of relapsing peritonitis in pediatric patients on peritoneal dialysis. 136 12

In patients undergoing CAPD treatment, removal of peritoneal catheters has become a standard practice after two or more episodes of recurrent peritonitis which are refractory to antibiotic treatment. Immediate replacement of peritoneal catheters is not always safe in the presence of active peritonitis. Temporary institution of hemodialysis treatment in some of these patients may also be impossible because of unstable hemodynamic states or loss of vascular access sites. Successful continuation of CAPD treatment in some of these patients has been reported by using intraperitoneal (IP) administration of fibrinolytic agents such as streptokinase or urokinase as an adjunctive therapy to antibiotic treatment and as an outpatient procedure. Although numbers of cases reported are few in the literature and controlled studies in large numbers of patients are lacking, these reports emphasize the safety of IP use of these agents without any major systemic adverse effects. The reports are reviewed here to provide some practical guidelines for safe use of these agents in selected patients with recurrent CAPD-associated peritonitis.
Adv Perit Dial 1991
PMID:Use of streptokinase or urokinase in recurrent CAPD peritonitis. 168 Apr 18

Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients due to S. aureus is associated with an adverse clinical outcome, suggesting impaired clearance of this organism by the host. The ability of peritoneal macrophages (PM0) derived from CAPD patients to take up S. aureus and mount a respiratory burst was investigated. Whilst significant activity was observed in the absence of opsonin, both parameters of phagocytosis were augmented by addition of 20% pooled human serum (PHS), complement-depleted PHS, and fibronectin. When used as sole opsonin, fibronectin resulted in a dose-related increase in chemiluminescent response by both blood neutrophils and PM0. The opsonic activity of dialysis effluent, as judged by neutrophil chemiluminescence, correlated with IgG and fibronectin content, but not with complement as assessed by C3 levels. The addition of urokinase to dialysate improved its opsonic properties whilst having no effect on the activity of PHS-20%; this would suggest that the formation of fibrin in dialysate, promoted by S. aureus, interferes with phagocytosis. This and the low IgG, complement and fibronectin levels in dialysate may explain in part the relatively poor clearance of this organism from the peritoneum.
Perit Dial Int 1990
PMID:Peritoneal defence mechanisms and Staphylococcus aureus in patients treated with continuous ambulatory peritoneal dialysis (CAPD). 208 98

We report a case of membranous lupus nephritis with a previous history of long-standing nephrotic syndrome which developed an acute renal failure due to bilateral renal-vein thrombosis superimposed on a calcified thrombus of the inferior vena cava eight years after the diagnosis. The occurrence of acute renal-vein thrombosis is a possible but rarely described complication of systemic lupus erythematosus. The presence of a calcified thrombus of the inferior vena cava has been described in only one adult patient until now. An aggressive thrombolytic therapy with urokinase permitted the fresh thrombus to be dissolved with a marked improvement in renal function.
Nephrol Dial Transplant 1990
PMID:Acute bilateral renal vein thrombosis superimposed on calcified thrombus of the inferior vena cava in a patient with membranous lupus nephritis. 212 66

A randomised trial, comparing Tenckhoff catheter replacement as a one-stage procedure and i.p. urokinase, was undertaken in the management of recurrent continuous ambulatory peritoneal dialysis (CAPD) peritonitis. In addition to appropriate i.p. antibiotic treatment, 17 patients received i.p. urokinase (5000 i.u.) on the second and fourth days of antibiotic treatment, and 14 patients underwent CAPD catheter replacement. An additional six patients also underwent catheter replacement following the recurrence of peritonitis after urokinase treatment. The subsequent recurrence rate of peritonitis following CAPD catheter replacement (5%) was significantly less than after urokinase (41%) (p less than 0.001). Fourteen patients remained free of peritonitis for at least three months after catheter replacement, and five patients were peritonitis-free following urokinase for this period.
Perit Dial Int 1989
PMID:Tenckhoff catheter replacement or intraperitoneal urokinase: a randomised trial in the management of recurrent continuous ambulatory peritoneal dialysis (CAPD) peritonitis. 248 98

Four consecutive patients with relapsing peritonitis due to coagulase-negative staphylococci have been successfully treated by the addition of urokinase to their treatment regime, having failed to respond to appropriate antibiotic therapy alone. The organisms isolated from each episode of peritonitis in an individual patient were shown to be identical by antibiotic sensitivity, phage typing, slime production and immunoblot analysis. The action of urokinase is unknown but it may act by fibrinolysis, allowing antibiotics access to a source of infection previously protected by fibrin. The technique described is a simple, safe and effective treatment of relapsing peritonitis due to coagulase-negative staphylococci, and its use can markedly reduce the morbidity associated with this infection.
Nephrol Dial Transplant 1989
PMID:Urokinase: a treatment for relapsing peritonitis due to coagulase-negative staphylococci. 249

We compared peritoneal dialysis effluents from 18 CAPD patients who had not suffered from peritonitis during the last 6 months (group 1) with the effluents from five patients with acute peritonitis (group 2), measuring activation markers of coagulation and fibrinolysis. These markers included prothrombin fragment F1 + 2 (F1 + 2), thrombin-antithrombin III complex (TAT), fibrin monomer (FM), and fibrin degradation products (FbDP). In the dialysate of group 1 we found remarkably high levels of F1 + 2, TAT and FM concomitant with a high concentration of FbDP, indicating a high rate of intraperitoneal fibrin turnover. The balance between peritoneal generation and degradation of fibrin was disturbed in untreated patients of group 2, who had significantly higher levels of coagulation markers and a higher ratio between FM and FbDP. Seven days after treatment with intraperitoneal administration of antibiotics and heparin, F1 + 2, TAT, FM and FbDP decreased significantly. To evaluate the role of mesothelial cells (MC) in the high peritoneal fibrin turnover we investigated the expression of tissue-type plasminogen activator (t-PA), urokinase-type plasminogen activator (u-PA), plasminogen activator inhibitor type-1 (PAI-1), and tissue factor in cultured human peritoneal MC under basal conditions and after exposure to tumour necrosis factor alpha (TNF alpha), interleukin-1 alpha (IL-1 alpha), or bacterial lipopolysaccharide (LPS). The exposure of MC to TNF alpha or to a lesser extent IL-1 alpha or LPS reduced their fibrinolytic activity by decreasing t-PA production and increasing PAI-1 synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephrol Dial Transplant 1995
PMID:Imbalance between intraperitoneal coagulation and fibrinolysis during peritonitis of CAPD patients: the role of mesothelial cells. 756 82

Resistant peritonitis in continuous ambulatory peritoneal dialysis (CAPD) is an indication for catheter removal, followed by interim haemodialysis and subsequent catheter replacement. This involves two surgical procedures using general anaesthetic and the availability of adequate hospital haemodialysis facilities. Urokinase is an alternative therapy but evidence of its effect is anecdotal and it has not been studied in a double-blind manner. Patients with resistant peritonitis (either no resolution of peritonitis within 4 days of appropriate antibiotic therapy or a third episode of peritonitis within 6 months) were randomized to receive intraperitoneal urokinase or placebo (saline) followed by 14 days of antibiotics in this double-blind prospective study. Treatment success was resolution of peritonitis within 4 days of giving urokinase/placebo (persistent infection) and no recurrence with the same organism for 6 months (recurrent infection). Twelve patients received urokinase and 12 placebo. Treatment was successful in 8/12 in the urokinase group and 1/12 in the placebo group (Fisher's exact test; P = 0.0047). Urokinase was successful in 8/12 patients with resistant peritonitis and significantly better than placebo. Urokinase is an effective and simple treatment that may avoid the need for catheter removal and interim haemodialysis in patients with resistant CAPD peritonitis.
Nephrol Dial Transplant 1994
PMID:Treatment of resistant peritonitis in continuous ambulatory peritoneal dialysis with intraperitoneal urokinase: a double-blind clinical trial. 797 Jan 21

The authors report three cases of peritoneal dialysis catheter obstruction in children. The catheters were successfully cleared by a combination of urokinase and Fogarty catheter manipulation. This technique can be used to clear fibrin and omentum from obstructed peritoneal dialysis catheters.
Adv Perit Dial 1995
PMID:Unblocking peritoneal dialysis catheters with a combination of urokinase and Fogarty catheter manipulation. 853 5

Catheter obstruction by a fibrin clot is one of the early complications after catheter implantation in continuous ambulatory peritoneal dialysis (CAPD) patients. manual compression of the dialysis solution container is usually the initial method used in an attempt to dislodge clots formed in the catheter. However, it is usually difficult to achieve and maintain sufficient pressure to open the obstructed catheter by this method. Alternatively, forceful irrigation using a syringe with heparin or urokinase, or clot removal using a corkscrew clot remover can be tried. These conventional maneuvers may potentiate the chances for bacterial contamination. In addition, these procedures require hospital visits by the patient. To solve this problem, we developed a new infusion accelerator for CAPD. Recanalization was attempted using the infusion accelerator in six cases of complete catheter obstruction. The bag was pressurized to 450 mm Hg. In all six cases, catheter patency was completely recovered without any complications. After appropriate training of patients, this method may be performed by patients themselves. Given the ease and efficiency of this procedure utilizing the improved equipment, we think that in cases with complete catheter obstruction this method should be considered before initiating more invasive procedures.
Adv Perit Dial 1996
PMID:A simple method for opening an obstructed peritoneal catheter using an infusion accelerator. 886 9


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