Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with end-stage renal disease present an immunodeficiency that paradoxically coexists with activation of most immunocompetent cells, and the roles of chronic uremia and maintenance dialysis are poorly understood. We determined circulating levels of IL-1 beta and IL-1Ra, TNF-alpha and its soluble receptors (TNF-sR55 and TNF-sR75), and activation markers of T cells (soluble CD25), B cells (soluble CD23), and monocytes (neopterin) in a large cohort of undialyzed patients at various stages of chronic renal failure and in dialyzed patients on maintenance hemodialysis or chronic peritoneal dialysis. The progression of uremia was associated with a gradual increase in soluble CD25, CD23, and especially neopterin levels. Although IL-1 beta could not be detected, IL-1Ra levels were significantly increased from the earliest stage of renal failure. Plasma levels of TNF-alpha, TNF-sR55, and TNF-sR75 progressed with the severity of renal failure and correlated with soluble CD25, CD23, and neopterin levels, whereas IL-1Ra levels correlated exclusively with TNF-sR55 levels. Compared with undialyzed patients, levels of IL-1 beta were higher in patients on maintenance hemodialysis, whereas those of IL-1Ra were lower and decreased further at the end of dialysis sessions. In contrast, both TNF-sR55 and TNF-sR75 levels were significantly higher than in undialyzed patients and increased further at the end of dialysis sessions in the absence of an increase of TNF-alpha. Such an imbalance between cytokines and their inhibitors may play a pivotal role in the multifaceted process of immune dysfunction.
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PMID:Balance between IL-1 beta, TNF-alpha, and their specific inhibitors in chronic renal failure and maintenance dialysis. Relationships with activation markers of T cells, B cells, and monocytes. 781 91

Concomitant immune deficiency and activation of immuno-competent cells, together with a disequilibrium between inflammation-inducing cytokines and their specific natural inhibitors is the basis of our current understanding of immune system dysregulation in patients with chronic uraemia. These anomalies may even be accentuated by dialysis. Clinically, bacterial infections, viral hepatitis and amyloidosis all play important roles. Humoral factors include abnormal immunoglobulin response to specific antibodies and complement activation. The response of T lymphocytes, long sought as the origin of the immunodeficiency associated with chronic uraemia, is also significantly decreased in these patients. The decreased antibody responses to specific stimuli may be related to B cell dysfunction. Monocyte and polymorphonuclear cell reactions are also perturbed. A deficiency in natural killer cells is observed although the mechanisms involved and the consequences are still debated. The factors determining the anomalies leading to immune system dysregulation in chronic uraemia and dialysis and their relationship with the reduction in active nephron mass as well as their metabolic and/or endocrine consequences remain to be fully described. A better understanding of the mechanisms involved should lead to new strategies for immuno-intervention in patients with chronic renal failure and help in optimizing haemodialysis.
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PMID:[Dysregulation of the immune system in chronic uremic and hemodialysed patients]. 789 21

Adult T cell leukaemia-lymphoma (ATL) was first discovered and reported in Japan, where it has a high incidence in the south-west region. The first human retrovirus HTLV-I (human T-cell lymphotropic virus type I) is considered to be related to its aetiology. In ATL endemic areas, HTLV-I carriers form a fairly high percentage of the population, even among healthy individuals. ATL shows diverse clinical features. It can be divided into four subtypes: acute, chronic, smouldering and lymphoma type. ATL cells originate from the CD4-positive subset of peripheral T cells; they show a characteristic notch in the nucleus and a tendency to lobulation. ATL resists chemotherapy, and patients with acute and lymphoma types have a fairly poor prognosis. A definite diagnosis of ATL is made by documenting the presence of HTLV-I proviral DNA in the DNA of tumour cells. HTLV-I infection is caused by transmission of live lymphocytes via three routes (from mother to child, from males to females, and by transfusion). Familial occurrence of ATL is frequently seen. HTLV-I infection is seen in other countries, but its incidence is highest in Japan. Infection with HTLV-I is a direct cause of ATL. Furthermore, infection with this virus can indirectly cause many other diseases via the induction of immunodeficiency, such as chronic lung disease, opportunistic lung infection, cancer of other organs, monoclonal gammopathy, chronic renal failure, strongyloidiasis, non-specific dermatomycosis, HTLV-I-associated lymphadenitis, HTLV-I uveitis and HTLV-I-associated myelopathy-tropical spastic paraparesis (HAM/TSP).
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PMID:Adult T cell leukaemia-lymphoma. 803 96

T-lymphocyte E-receptor activity, mobility of the surface and deep parts of lymphocytic membrane lipid bilayer and membrane transport function were studied in 47 patients with chronic renal failure (16 had a conservatively curable and 31 terminal stages). A rosette test, polarization of the fluorescent probes I-anilino-naphthaleno-8-sulfonate and pyrene, inclusion of 14C-uridine into immunocompetent cells were employed, respectively. The investigations demonstrate morphofunctional instability of the lymphocytic membranes as indicated by shifts in RFC E-receptor activity, in reduced microviscosity of the lipid bilayer and transport dysfunction. The disturbances progress with deterioration of renal function with their peak at the terminal stage of the disease. It is suggested that morphofunctional damage to the lymphocyte membranes cause, among other factors, lymphocytopenia and secondary immunodeficiency in chronic renal failure.
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PMID:[The morphofunctional instability of the lymphocyte membrane in patients with chronic kidney failure]. 816 Mar 23

A rosette test, fluorescent probing (1-aniline-naphthaline-8-sulfonate and pyrene) and 14C-uridine inclusion into immuno-competent cells were used to investigate T-lymphocyte membrane E-receptor activity, mobility of the surface and deep parts of lymphocytic membrane lipid bilayer, and membrane transport, respectively. A total of 16 patients with conservatively curable and 31 patients with a terminal stage of chronic renal failure (CRF) were examined. The lymphocytic membranes were found unstable: E-receptor activity of RFC changed, microviscosity of the surface and deep lipid bilayer diminished, the transport function got disturbed. These phenomena significantly progress with deterioration of renal function. It is evident that morphofunctional damage to lymphocytic membranes may be a reason of lymphocytopenia and secondary immunodeficiency in CRF patients.
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PMID:[The morphofunctional instability of the lymphocyte membranes in patients with chronic kidney failure]. 839 46

Patients with chronic renal failure often present an immunodeficiency state paradoxically exacerbated by hemodialysis and associated with signs of T cell activation. The presence of circulating monokines suggests that monocytes are also activated. Whether or not this includes B cells is controversial, despite frequently abnormal antibody responses. We thus investigated whether the soluble low-affinity receptor for IgE (Fc epsilon RII/CD23), recently identified as a marker of B cell and monocyte activation and possibly involved in T cell activation, was modulated by chronic renal failure and hemodialysis. Relative to values in healthy individuals (N = 31), plasma concentrations of soluble CD23 were significantly elevated in non-dialyzed chronically uremic patients (N = 44), more elevated in patients on peritoneal dialysis (N = 24), and most elevated in those on regular hemodialysis (N = 132), stabilizing after about six months. Soluble CD23 levels were unmodified by the first dialysis session but rose markedly during regular dialysis with cellulose or polysulfone membranes, but not with polyacrilonitrile AN-69 membranes. Soluble CD23 levels correlated with levels of IgG, and those of tumor necrosis factor alpha and interleukin-6, suggesting that increased sCD23 levels reflect activation of B cells and monocytes, respectively. These findings reinforce the view of soluble CD23 as a multi-functional receptor/cytokine, and provide evidence that it might contribute to the immune dysregulation associated with chronic renal failure and exacerbated by hemodialysis.
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PMID:Soluble CD23 as an effector of immune dysregulation in chronic uremia and dialysis. 847 24

Cytomegalovirus (CMV) colitis is thought to occur almost exclusively in immunosuppressed persons. Colonoscopy in patients with CMV colitis usually shows diffuse or localized ulceration, although mucosal friability, erosions, hemorrhage, and plaque-like pseudomembranes may be observed. We report on a patient with chronic renal failure undergoing hemodialysis therapy who had abdominal symptoms, including bloody diarrhea, along with colonoscopic findings suggestive of carcinoma of the colon. The patient was not infected with the human immunodeficiency virus and had normal lymphocyte subset numbers. He was subsequently found to have invasive CMV disease of the colon. CMV colitis can occur in persons who are not severely immunosuppressed, and its colonoscopic appearance may mimic that of colon cancer.
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PMID:Cytomegalovirus colitis mimicking colon carcinoma in an HIV-negative patient with chronic renal failure. 856 Nov 27

Human recombinant erythropoietin has been approved by the Food and Drug Administration for treatment of anemia due to chronic renal failure or malignancy and in zidovudine-treated patients with the human immunodeficiency virus. It is highly effective in reducing the anemia commonly seen in these patients, with minimal adverse effects. Approximately 20% of patients undergoing elective orthopedic procedures are not able to donate adequate amounts of autologous blood prior to surgery. Additionally, patients who cannot donate 3 or more units of blood prior to large procedures are at increased risk for receiving a homologous transfusion despite the use of intraoperative and postoperative blood conservation techniques. Investigational use of this drug as an adjuvant to autologous blood donation has been shown to increase the amount of blood donated by patients prior to surgery and, therefore, will decrease homologous blood transfusions after surgery. Perioperative use of this drug, dosage, route of administration, and clinical indications are currently being evaluated in multicenter clinical trials.
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PMID:The potential use of human recombinant erythropoietin in orthopedic surgery. 878 23

The immunodeficiency of patients with chronic renal failure (CRF) is related to multiple and complex alterations of the cytokine network and of its target cells such as T or B lymphocytes, monocytes, fibroblasts or endothelial cells. Chronic activation of monocytic functions is recognized as a key factor in these immunological disorders. Since macrophage colony stimulating factor (M-CSF) is essential for the activation of several functions of monocytes and macrophages and their production of cytokines such as interleukin-1, interleukin-6, and tumor necrosis factor alpha, we investigated its involvement in patients with CRF. When measured by ELISA, M-CSF serum levels were significantly higher in patients with progressive CRF and those on hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) than in controls. M-CSF serum levels did not correlate with the degree of renal insufficiency and were probably related to complex alterations in its production and/or degradation by the specific M-CSF receptors of macrophages. In HD patients the M-CSF serum concentrations inversely correlated with the number of circulating lymphocytes and were significantly higher in anemic patients requiring treatment with erythropoietin. Our results suggest that M-CSF may play a role in altering the immune system in uremic patients by maintaining in the circulation and tissues permanently primed monocytes and/or macrophages that can then be triggered to an activated state by secondary stimuli such as endotoxins, complement components, other cytokines or contact with foreign surfaces.
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PMID:Macrophage colony stimulating factor involvement in uremic patients. 887 77

Chronic infections contribute significantly to morbidity and mortality in dialysis patients. These infections are acquired either before or after initiation of dialysis, and the latter may be via nosocomial modes of transmission. Consequently, policies that deal with infection control in dialysis units have assumed increasing importance. The incidence and prevalence of hepatitis C virus (HCV) infection among patients on dialysis is steadily declining. Nonetheless, the 0.4% to 15% incidence of anti-HCV in hemodialysis (HD) units continues to be a cause for concern. Although nosocomial transmission of HCV infection in HD units has been demonstrated, the Centers for Disease Control and Prevention (CDC), Atlanta, GA, does not recommend dedicated machines, patient isolation, or a ban on reuse in HD patients with HCV infection. Conventional cleansing and sterilization procedures for reprocessing the dialyzers appear to be adequate to inactivate the virus. Over the years, there has been a steady increase in the number of human immunodeficiency virus (HIV)-infected patients entering end-stage renal disease (ESRD) programs. Transmission of HIV infection is extremely unlikely in dialysis units that conform to the standard practice guidelines. Dedicated machines or isolation from other patients are not recommended for patients with HIV infection. Risk of acquiring HIV infection after an occupational exposure is approximately 0.32%. Nonetheless, a combination of zidovudine and lamuvidine for most parenteral exposures, and the addition of a protease inhibitor in high-risk exposures, is recommended. The wide range of immunological derangements in chronic renal failure have been postulated to be the cause for the increased susceptibility of dialysis patients to tuberculosis (TB). The high incidence of extrapulmonary disease may be a significant factor in the delay in diagnosis of TB in these patients. In view of their high-risk for exposure to TB, the purified protein derivative (PPD) skin test is recommended on an annual basis in the staff of dialysis units.
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PMID:A 1990s perspective of hepatitis C, human immunodeficiency virus, and tuberculosis infections in dialysis patients. 924 19


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