Tryptophan is metabolised along the kynurenine pathway under the influence of tryptophan 2,3 dioxygenase and indoleamine 2,3 dioxygenase. Quinolinic acid and kynurenine, two neuroactive metabolites of the kynurenine pathway are, in chronic renal failure patients, considered as uraemic toxins. Related research is generally hampered by the non-availability of relevant analytical techniques. The primary aim of this study was, therefore, to develop and validate suitable methods for the determination of tryptophan, kynurenine and quinolinic acid. The second aim was to quantify the levels of these substances in the blood of chronic renal failure patients on renal replacement therapies and to compare the levels of haemodialysis patients to those on peritoneal dialysis. Patients’ quality of life was investigated relative to disturbances in tryptophan metabolism. Gas chromatography coupled to mass spectrometry (GC-MS) gave the best results for the analysis of tryptophan, kynurenine and quinolinic acid. A Hewlett Packard HP GC 6890 series gas chromatographer was coupled to a MS 5973 series mass spectrometer. Analytes were separated on a DB-5MS column with a nominal length of 30 metres, a diameter of 250.0 µm and film thickness of 0.10 µm. Helium was used as carrier gas, and the chromatographic analysis run time 12.5 minutes. The validation results were within the acceptance criteria for newly developed methods. The linear calibration curves constructed for all of the analytes gave r2 correlation coefficients >0.99. Other validation data such as precision, bias, accuracy and stability all fell within acceptable validation limits. In the study on chronic renal failure patients significant differences were seen between patients and controls. Tryptophan levels were 5.34 SD 5.04 µM for the haemodialysis group, 6.73 SD 3.18 µM for the peritoneal dialysis group and 28.4 SD 4.31 µM for the control group. Kynurenine levels were 4.7 SD 1.9 µM for the haemodialysis group, 2.9 SD 2.0 µM for the peritoneal dialysis group and 2.1 SD 0.6 µM for the control group. Quinolinic acid levels were 4.9 SD 2.0 µM for the haemodialysis group, 2.8 SD 2.0 µM for the peritoneal dialysis group and 0.3 SD 0.1 µM for the control group. Tryptophan was lower for the total patient group than for controls with significantly lower levels for haemodialysis versus control (p<0.05) and peritoneal dialysis versus control (p<0.05). Kynurenine levels were higher in the total patient group with significantly higher levels for the haemodialysis versus control group (p=0.0001). The patient groups had higher quinolinic acid levels with significantly higher levels for the haemodialysis versus control (p<0.05) and peritoneal dialysis versus control (p<0.05) groups. This study was the first to determine the three substances simultaneously in both haemodialysis and peritoneal dialysis patients. The study showed significant tryptophan depletion, as well as kynurenine and quinolinic acid accumulation for both groups. No significant differences were found between the patient groups other than higher kynurenine levels in the haemodialysis group. The quality of life (SF-36) was largely similar in the two patient groups. This decrease in the quality of life strongly correlated with the degree of tryptophan depletion. / Dissertation (MSc)--University of Pretoria, 2008. / Chemical Pathology / unrestricted

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No. of bitstreams: 1 elaineduartemendesferreira.pdf: 2564205 bytes, checksum: 1b2251e5f6632134b32623071bf5c198 (MD5) Previous issue date: 2015-08-26 / O estudo teve como objeto o Itinerário Terapêutico de Pessoas em Terapia Renal Substitutiva com Doença de Base Hipertensão Arterial e/ou Diabetes Mellitus. Para alcançar o estudo desse objeto os seguintes objetivos foram definidos: Conhecer as percepções de pessoas hipertensas e/ou diabéticas que se encontram em Terapia Renal Substitutiva em relação ao seu próprio processo saúde-adoecimento, e as escolhas de tratamento propostas; identificar o fluxo assistencial às pessoas atendidas em um Centro de Terapia Renal Substitutiva nos três níveis de atenção; analisar o itinerário terapêutico de pessoas hipertensas e/ou diabéticas, portadoras de doença renal crônica, enquanto assistidas pela Terapia Renal de Substituição (TRS) em um serviço de nefrologia. Trata-se de uma pesquisa qualitativa, descritiva, O cenário do estudo foi um serviço de nefrologia localizado em uma cidade do interior da Zona da Mata Mineira, uma entidade que atende a este município e microrregião. Os participantes do estudo foram 20 pessoas em terapia renal substitutiva com doença de base hipertensão e/ou diabetes mellitus, sendo entrevistadas em seu horário de diálise. O período de realização das entrevistas foi de outubro de 2014 à janeiro de 2015. A coleta de dados foi feita utilizando-se de entrevistas semi-estruturadas e para análise dos dados elegeu-se a técnica de análise de conteúdo temático. A partir das narrativas construíram-se as seguintes categorias de discussão: 1) “A Descoberta Do Adoecimento”; 2)”Tecendo Saberes Sobre o Adoecimento” 3)“ O Sentido do Tratamento Renal Substitutivo” e 4)“Caminhos Percorridos em Busca de Tratamento: uma trajetória de (des) cuidado”. Os itinerários apresentados neste estudo descrevem trajetórias e escolhas individuais e singulares, mas que possuem uma forte convergência que expõem de forma clara as fragilidades dos serviços de saúde e profissionais que compõe a rede de assistência à saúde. Possibilitou a compreensão de itinerários que sofrem influências dos contextos de vida de cada pessoa, algo que normalmente vêm escapando aos serviços e profissionais de saúde. Evidencia a necessidade de fortalecer a atenção básica como a porta de entrada desses sujeitos no sentido de reduzir as vulnerabilidades para a Doença Renal Crônica. / The study had as its object the Itinerary Therapeutic of Peoples in Renal Replacement Therapy Based Disease arterial hypertension and / or diabetes mellitus. To achieve the object of this study the following objectives were defined: To know the perceptions of hypertensive and / or diabetic people who are on renal replacement therapy in relation to their own health-illness, and treatment choices proposals; identify the assistance flow to people attending a Renal Replacement Therapy Center in the three levels of care; analyze the therapeutic itinerary of hypertensive patients and / or diabetic, suffering from chronic kidney disease, while assisted by Renal Replacement Therapy (RRT) in a nephrology service. It is a qualitative, descriptive, the study setting was a nephrology service located in a town in Zona da Mata Mineira, an entity that serves this city and micro-region. Study participants were 20 people on renal replacement therapy with underlying disease hypertension and / or diabetes mellitus, being interviewed on his dialysis schedule. The interviews implementation period was from October 2014 to January 2015. Data collection was performed using semi-structured interviews and analysis of data elected to thematic content analysis technique. From the narratives built up the following discussion categories: 1) "The Discovery Of Illness"; 2) "Weaving Knowledge About Illness" 3) "The Renal Treatment Sense Substitute" and 4) "Paths taken in sewage search: a trajectory of (lack of) care." The itineraries presented in this study describe trajectories and individual and individual choices, but have a strong convergence that expose clearly the weaknesses of health and professionals who make up the health care network services. It enabled the understanding of itineraries that are influenced the life contexts of each person, something that usually come escaping services and health professionals. Highlights the need to strengthen primary care as the gateway of these subjects to reduce the vulnerabilities for Chronic Kidney Disease.

A diálise peritoneal (DP) é uma técnica de reposição renal utilizada mundialmente tanto na medicina como na medicina veterinária. Na medicina veterinária, a pesquisa por técnicas minimamente invasivas para a implantação de cateteres de DP se mostra de grande valia, visto que a indicação de diálise em animais é, principalmente, para casos de injúria renal aguda e agudização da doença renal crônica, e, muitas vezes, o paciente não tem condições de aguardar a cicatrização da ferida cirúrgica para iniciar o procedimento de diálise. O objetivo desta pesquisa foi descrever a técnica de omentectomia e de implantação do cateter de Tenckhoff pelo acesso videolaparoscópico com três portais em coelhos, além de avaliar a funcionalidade do cateter. Foram utilizados oito coelhos adultos, fêmeas, da raça Nova Zelândia para a realização de implantação de cateter de Tenckhoff e omentectomia por videolaparoscopia. As medianas do Tempo Cirúrgico Total (TCT), Tempo para Omentectomia (TOm) e Tempo para implantação do Cateter de Tenckhoff (TICT) foram 65,5, 30, e 5 minutos, respectivamente. As principais complicações apresentadas pela técnica foram hemorragia e herniação pela ferida cirúrgica. Foram realizados oito procedimentos de DP em cada animal, sendo o primeiro iniciado três horas após a implantação do cateter. A principal complicação observada foi o vazamento do dialisato para o espaço subcutâneo, ocorrido em todos os animais. Com base na metodologia utilizada e nos resultados obtidos neste estudo, pode-se concluir que a técnica de omentectomia videolaparoscópica é factível em coelhos, permitindo que o procedimento seja realizado de forma segura e sem intercorrências significativas, além de permitir adequado posicionamento do cateter. / Peritoneal dialysis (PD) is a renal replacement technique used worldwide in both medicine and veterinary medicine. In veterinary medicine, the search for minimally invasive techniques for PD catheters implantation is of great value. The indication of dialysis in animals is mainly for cases of acute renal injury and exacerbation of chronic kidney disease and, the patient is often unable to wait for wound healing to begin the dialysis procedure. The objective of this research was to describe the technique of Tenckhoff catheter implantation and omentectomy by videolaparoscopic access with three portals in rabbits. In addition, to evaluating the catheter functionality. Eight female New Zealand rabbits were used to perform omentectomy and videolaparoscopic Tenckhoff catheter implantation. Median Total Surgical Time (TCT), Time for Omentectomy (TOm) and Time for Tenckhoff Catheter Implantation (TCTI) were 65.5, 30, and 5 minutes, respectively. The main complications presented by the technique were hemorrhage and herniation in the surgical wound. Eight procedures of PD were performed in each animal, the first one being started three hours after catheter implantation. The main complication observed was the leakage of the dialysate into the subcutaneous space, which occurred in all animals. Based on the methodology used and the results obtained in this study, it can be concluded that the videolaparoscopic omentectomy technique is feasible in rabbits, allowing the procedure to be performed safely and without significant intercurrences, besides allowing the adequate catheter positioning.

The presented diploma thesis deals with the study of interactions between humic acids as the main component of soil organic matter with a model organic pollutant presented by cationic surfactant Septonex (which was expected to interact positively with humic acids due to its charge) through unconventional combination of dialysis and diffusion techniques realized in diffusion cells together with isothermal titration calorimetry capable of elucidating the nature of ongoing reactions from a thermodynamic point of view. The experiments were performed with a humic acid isolated by standard isolation procedure from Leonardite (1S104H) purchased from the International Society for Humic Substances, with humic acids isolated from lignite as well as modal chernozem. The aim of the submited diploma thesis is to assess the influence of carboxyl functional groups in the structure of humic acids to interactions with Septonex. For this reason, said samples of humic acids have been modified by selective methylation of their carboxyl functional groups, which can no longer participate in interactions with ionic substances. Results from diffusion cells and isothermal titration calorimetry confirmed the assumption that Septonex interacted with all types of unmodified humic acids more than with their methylated derivatives. Despite the available literature, it was surprising that the differences in the interaction of humic acids with Septonex were not diametrically different when comparing unmodified humic acids with their methylated derivatives. The extent of these interactions was assessed through the apparent equilibrium constant Kapp determined in the diffusion (dialysis) experiments and from the course of enthalpy curves from isothermal titration calorimetry. After the experiments and their evaluation, it can be concluded that humic acids and Septonex in their interactions, due to their structures, probably apply not only electrostatic interactions, especially through available carboxyl functional groups of humic acids and positively charged hydrophilic parts of Septonex molecules, but also a significant role have a hydrophobic effect, hydrogen bonds and Van der Waals forces.

This diploma thesis is concentrated on the interactions between polyelectrolyte (hyaluronan) and cationic surfactant (CTAB). The experiments were performed in an aqueous solution and in an environment of physiological ionic strength (0,15mmoldm-3 NaCl). The determination of the surfactant concentration in solutions was based on the formation of colored complexes of CTAB and picric acid in chloroform. The concentrations of surfactant were measured by UV-VIS spectroscopy. The stability of CTAB+HyA was examined by a dialysis method. The results showed that, regardless of the environment, the presence of HyA in solution reduces the number of free molecules of CTAB which can be determined in the sample. It has been proved that there is an interaction between HyA and surfactant and that CTAB has greater affinity for HyA then for the picric acid. The stability of CTAB+HyA was determined by dialysis of 120 hours. After that time, the concentrations of the retentate and permeate were settled. The results showed that in the membrane remains a certain amount of CTAB bounded to hyaluronan. The system can be suitable for the preparation of targeted carriers of biologically active substances.

Orientador: André Luis Balbi / Resumo: Introdução: A Doença Renal Crônica (DRC) é uma condição clínica com elevada e crescente prevalência, com repercussão sistêmica, podendo cursar com hipervolemia e consequente congestão de órgãos como os pulmões. O tratamento dialítico também gera uma série de alterações nos sistemas muscular, ósseo, cardiovascular, metabólico e também respiratório. Existem muitos estudos avaliando o sistema respiratório na fase dialítica e poucos avaliam na fase pré-diaítica. Objetivo: Avaliar a função pulmonar e a força muscular respiratória de pacientes com DRC na fase pré-dialítica. Metodologia: Foram assistidos 132 pacientes e 43 avaliados no Ambulatório de Pré-Diálise do Hospital das Clínicas da Faculdade de Medicina de Botucatu, SP (HCFMB), com retornos mensais, em tratamento clínico e programação de diálise. Todos os pacientes estudados foram submetidos inicialmente à avaliação da função pulmonar através da espirometria e logo em seguida avaliação da força muscular respiratória através da manovacuometria, realizadas no laboratório de função pulmonar do HCFMB, pelo mesmo pesquisador em único dia para o mesmo paciente. Resultados: Foram incluídos no estudo 40 pacientes com média de idade de 61 ± 14 anos, sendo 60% do sexo masculino. Com relação à causa, 22 pacientes apresentaram nefropatia diabética (n=13; 32,5%) e nefropatia hipertensiva (n=9; 22,5%).Todos os resultados da espirometria (CVF, VEF1 e VEF1/CVF) foram abaixo do valor predito, com diferença estatística. A maioria dos paciente... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Chronic Kidney Disease (CKD) is a clinical condition with high and increasing prevalence, with systemic repercussions, which can develop with hypervolemia and consequent congestion of organs such as the lungs. The dialysis treatment also generates a series of changes in the muscular, bone, cardiovascular, metabolic and also respiratory systems. There are many studies evaluating the respiratory system in the dialysis phase and few assess it in the pre-dialysis phase. Objective: To evaluate pulmonary function and respiratory muscle strength in patients with pre-dialysis CKD. Methodology: 132 patients were assisted and 43 were evaluated at the Pre-Dialysis Outpatient Clinic of the Hospital das Clínicas, Faculty of Medicine of Botucatu, SP (HCFMB), with monthly returns, in clinical treatment and dialysis schedule. All patients studied were initially submitted to pulmonary function assessment using spirometry and then respiratory muscle strength was assessed using manovacuometry, performed at the HCFMB pulmonary function laboratory, by the same researcher on a single day for the same patient. Results: The study included 40 patients with a mean age of 61 ± 14 years, 60% of whom were male. Regarding the cause, 22 patients had diabetic nephropathy (n = 13; 32.5%) and hypertensive nephropathy (n = 9; 22.5%). All spirometry results (FVC, FEV1 and FEV1 / FVC) were below predicted value, with statistical difference. Most patients (37.5%) had a restrictive ventilatory disord... (Complete abstract click electronic access below) / Mestre

Die Bestimmung des Sollgewichts von Dialysepatienten stellt einen Balanceakt zwi-schen Hyper- und Hypovolämie und damit zwischen ischämischen Ereignissen durch Hypotonie und kardiovaskulären Komplikationen dar. Derzeit wird es anhand gering sensitiver bzw. unspezifischer und meist subjektiver klinischer Methoden ermittelt. Die Bioimpedanzanalyse als objektives, nicht invasives und zeitsparendes Verfahren steht zunehmend im Mittelpunkt von Studien, die der Behandlung von Dialysepatienten gewidmet sind. In dieser Arbeit wird die Untersuchung von 40 Patienten mit den Bioimpedanzanalysatoren Body Composition Monitor von Fresenius und Nutriguard-M von Data Input sowie mit klinischen Methoden beschrieben. Der Body Composition Monitor errechnet die Überwässerung des Patienten im Rahmen der Messung. Für die Berechnung der Überwässerung aus vom Nutriguard-M gemessenen Daten wurde eigens eine Formel erstellt. Obgleich hohe absolute Unterschiede zwischen den mittels der Bioimpedanzanalysatoren und der klinisch bestimmten Werte für die Überwässerung beobachtet wurden, waren positive Korrelationen der durch Bioimpedanzsanalyse gemessenen Überwässerung mit klinischen Parametern, wie dem Durchmesser der V. cava inferior, der Ausprägung von Unterschenkelödemen und dem mittleren arteriellen Blutdruck zum Nadir der Dialyse feststellbar. Verglichen wurden die Geräte nicht nur auf der Ebene der gemessenen Überwässerung, sondern auch auf den Ebenen der Rohwerte und der Anteile der Körperkompartimente am Körpergewicht. Dabei zeigten sich in Abhängigkeit des Verarbeitungsgrades der durch die Geräte gemessenen bzw. berechneten Größen sowohl geringe als auch hohe Abweichungen. Diese Erkenntnisse relativieren die Euphorie über die Möglichkeit der Anwendung der BIA in der Dialysetherapie.:1. Einleitung 2. Patienten, Material und Methoden 3. Ergebnisse 4. Diskussion 5. Zusammenfassung

Thesis title: Kinesiophobia in patients on renal dialysis therapy - questionnaire study. The aims of the thesis: To characterise the term kinesiophobia and to evaluate the dependence of the measure of fear of movement on sociodemographic and clinical variables with the use of the Tampa Scale for Kinesiophobia questionnaire (TSK-CZ) in a group of respondents on renal dialysis therapy and a group of healthy respondents. Methods: To determine the dependence of the measure of kinesiophobia on selected variables, the TSK-CZ questionnaire was used in Fresenius Medical Care dialysis centres across towns in the Czech Republic. The reference group of individuals with no renal disease - healthy respondents - was addressed by means of the Survio.cz website. The research comprised a group of respondents on renal dialysis therapy (n = 135) and a group of healthy respondents (n = 135). The collected data was processed using statistical methods - descriptive statistics and data analysis (t-test, Chi-squared test, ANOVA, Spearman's correlation coefficient). After that, the data was transferred to tables and charts and was evaluated. Results: On the basis of the TSK-CZ questionnaire, a significant difference in the measure of fear of movement was found between the respondents on renal dialysis and the healthy ones...

Durch verschiedene Modifizierungen an der Blutkontaktseite von Hohlfasermembranen sollte eine Verbesserung der Bio- und Blutkompatibilität erreicht werden. Zur Modifizierung wurden verschiedene biologisch wirksame Moleküle verwendet. Weiterhin wurden zwei Modifizerungsstrategien verfolgt. Zum einen eine Modifizierung, bei welcher das Material der Hohlfasermembran vor deren Herstellung verändert wird. Und zum anderen eine selektive Modifizierung der Blutkontaktseite nach der Herstellung der Hohlfasermembran.

Vid behandling med Peritonealdialys behöver patienten utföra ett moment där de kopplar samman sin inopererade kateter till en extern dialyspåse. Detta moment innebär stora risker för allvarliga infektioner på grund av kontaminering av känsliga delar. Mitt examensarbete syftar till att göra momentet säkrare och tryggare för patienten genom att minimera den risken. Jag ville skapa ett hjälpmedel som fortfarande engagerar patienten i kopplingsmomentet och håller ner kostnaden genom att designa kring redan befintliga dialysprodukter och undvika avancerad mekanik. Projektet tar avstamp från min tidigare erfarenhet som sjuksköterska och de observationer jag gjort rörande den här behandlingstypen / During treatment with Peritoneal dialysis the patient needs to perform a specific task of connecting their surgically placed catheter to an external bag of dialysis fluids. This specific task implicates big risks of serious infections due to contamination of sensitive parts.  My exam project aims to make this connection safer for the patient by minimizing these risks. I wanted to design a tool that aids the patient and at the same time engage them in the connection process. To keep the costs down I chose to design around already existing dialysis components and to avoid advanced mechanics. This project takes off on my previous experience as a nurse and the observations I made regarding this treatment method.