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Decrease of Arterial Hypertension After Adrenalectomy in Patients Without Confirmation of Adrenal Tumour Hyperfunction

100%
Ziaja J., Chudek J., Król R., Cierniak T., Adamczak M., Więcek A., Cierpka L.
Polish Journal of Surgery
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2007
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vol. 79
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issue 4
273-279
EN
Adrenal tumours incidentally found in patients with arterial hypertension pose a severe clinical problem when no endocrine hyperactivity is confirmed and their features in diagnostic imaging do not suggest malignancy.The aim of the study was to evaluate the clinical consequences of unilateral adrenalectomy in a long term follow up period for patients that have adrenal tumours without confirmed endocrine hyperactivity.Material and methods. We evaluated the clinical consequences of unilateral adrenalectomy in a long term follow up of 48 hypertensive patients with a unilateral adrenal tumour lacking biochemical confirmation of adrenal hyperactivity. The mean duration of hypertension was 87 months; observation time ranged from 6 to 62 months.Results. Normalisation of blood pressure was observed in 8.3% of patients. In addition, better blood pressure control was documented in 35.4% of patients. There were no significant differences between group of patients with normalization or improvement of blood pressure control and those with no improvement with respect to age, BMI, duration of hypertension, tumour size, renin activity, aldosterone to plasma renin activity ratio, or the preoperative plasma concentration of potassium, aldosterone, or cortisol. The maximum values of systolic, but not diastolic, blood pressure before surgery were lower in patients with normalization or improvement of blood pressure control.Conclusions. Improvement of blood pressure control after unilateral adrenalectomy in 43.7% of patients may suggest tumour endocrine hyperactivity which remains unconfirmed by laboratory tests. It is not possible to predict improvement of blood pressure control after adrenalectomy in this group of patients according to tumour size and routine biochemical examination.
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Analysis of relationship between UMOD polymorphisms rs13335818, rs4293393 and rs13333226 and risk of chronic kidney disease caused by chronic glomerulonephritis

100%
Żywiec J., Piecha G., Gola M., Kiliś-Pstrusińska K., Więcek A., Gumprecht J., Grzeszczak W.
Annales Academiae Medicae Silesiensis
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2017
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vol. 71
193-203
EN
INTRODUCTION: Chronic glomerulonephritis is one of the common causes of chronic kidney disease that can lead to end-stage renal failure and the need for renal replacement therapy. Understanding the aetiology of this disease and its risk factors can help develop new methods of early diagnosis and effective therapy. Uromodulin is a protein with a broad spectrum of activity, and is involved in the key pathways that regulate kidney homeostasis. AIM OF THE STUDY: The aim of the study was to analyse the relationship between three selected polymorphisms (rs13335818, rs4293393 and rs13333226) of the uromodulin gene (UMOD) and the risk of chronic kidney disease caused by chronic glomerulonephritis. MATERIAL AND METHODS: 113 patients with chronic glomerulonephritis and eGFR < 60 ml/min/1.73 m2 (experimental group) and 196 patients from the General Outpatient Clinic without a history of renal disease and eGFR > 60 ml/min/1.73 m2 (control group) were recruited for the study. The study protocol assumed a one-time blood collection for genetic testing and serum creatinine level determination. Genetic material was isolated from the peripheral blood lymphocytes of the subjects. Genotyping of the analysed polymorphisms was performed using TaqMan SNP Genotyping Assay kits. The results were processed with statistical methods using Statistica 10 and Microsoft Office Exel 2003 software, the Mann-Whitney U test and the χ2 test. Statistical significance was adopted at p < 0.05. RESULTS: No statistically significant differences in the distribution of genotypes between the experimental and control groups were found for any of the three analysed UMOD variants. CONCLUSIONS: UMOD polymorphisms rs13335818, rs4293393 and rs13333226 are not associated with the risk of chronic kidney disease caused by chronic glomerulonephritis.
PL
WSTĘP: Przewlekłe kłębuszkowe zapalenie nerek jest jedną z częstych przyczyn przewlekłej choroby nerek mogącej prowadzić do ich schyłkowej niewydolności i konieczności stosowania terapii nerkozastępczej. Poznanie etiologii tej choroby oraz czynników ryzyka daje nadzieję na wdrożenie nowych metod wczesnej diagnostyki i skutecznej terapii. Uromodulina jest białkiem prezentującym szerokie spektrum działań, włączonym w kluczowe szlaki warunkujące homeostazę nerek. CEL PRACY: Celem pracy była ocena związku wybranych trzech polimorfizmów (rs13335818, rs4293393 i rs13333226) genu uromoduliny (UMOD) z występowaniem przewlekłej choroby nerek na tle przewlekłego kłębuszkowego zapalenia nerek. MATERIAŁ I METODY: Do badania zrekrutowano 113 chorych z przewlekłym kłębuszkowym zapaleniem nerek i eGFR < 60 ml/min/1,73 m2 (grupa badana) oraz 196 pacjentów Poradni Ogólnej POZ bez chorób układu moczowego w wywiadzie, z eGFR > 60 ml/min/1,73 m2 (grupa kontrolna). Protokół badania przewidywał jednorazowe pobranie krwi do wykonania badań genetycznych oraz w celu oznaczenia stężenia kreatyniny w surowicy. Materiał genetyczny wyizolowano z limfocytów krwi obwodowej badanych. Genotypowanie badanych polimorfizmów przeprowadzono z wykorzystaniem zestawów TaqMan SNP Genotyping Assay. Uzyskane wyniki opracowano statystycznie na podstawie programów Statistica 10 i Microsoft Office Exel 2003 z wykorzystaniem: testu Manna-Whitneya i testu χ2. Za granice istotności statystycznej przyjęto wartości p < 0,05. WYNIKI: W zakresie żadnego z trzech badanych polimorfizmów UMOD nie stwierdzono znamiennych statystycznie różnic w rozkładzie genotypów pomiędzy grupami badaną a kontrolną. WNIOSKI: Nie wykazano związku polimorfizmów rs13335818, rs4293393 i rs13333226 genu UMOD z występowaniem przewlekłej choroby nerek na tle przewlekłego kłębuszkowego zapalenia nerek.
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Expression of Genes Encoding Aldosterone Synthesis Pathway Enzymatic Proteins in Adrenocortical Adenomas in Patients With Conn Syndrome

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Ziaja J., Cholewa K., Chudek J., Król R., Kajor M., Więcek A., Mazurek U., Cierpka L.
Polish Journal of Surgery
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2010
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vol. 82
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issue 1
47-52
EN
One of the possibilities of explanation of persistent hypertension after adrenocortical adenoma excision in patients with Conn syndrome could be analysis of transcriptional activity of genes encoding aldosterone synthesis pathway enzymatic proteins within these tumours.The aim of the study was to analyze the expression of mentioned genes in adrenocortical adenomas in patients with primary hiperaldosteronism and to analyse correlations between their expression and results of hormonal tests of blood serum before surgery as well as maximal values of blood pressure before surgery and their decrease after operation.Material and methods. Thirteen patients with Conn syndrome subjected to surgical excision of adrenocortical tumour were analyzed. Expression of CYP 11A1, CYP 21A2, CYP 11B2 and HSD 3B2 genes in tissue of removed tumours was analyzed using RT real-time PCR method. GAPDH was used as reference gene. The results analysis was based on amplification threshold values CT. Analysis of clinical consequences of adrenalectomy was performed after a period of minimum 12 months after surgery.Results. Expression of mRNA, presented as 2-ΔΔCT, of CYP 11A1 gene was 1.58 (1.01-2.48), CYP 21A2-2.74 (1.78-4.24), CYP 11B2- 19.15 (11.28-32.50) and HSD 3B2-2.57 (1.47-4.50). Correlation analysis revealed only negative correlation between CYP 11A1 gene expression and plasma renin activity in upright position (r=-0.604; p=0.049) and positive correlation between HSD 3B2 gene expression and decrease of maximal values of systolic blood pressure in long term follow up (r=0.763; p=0.010).Conclusions. High expression of genes encoding aldosterone synthesis pathway enzymatic proteins is observed in adrenocortical adenomas in patients with Conn syndrome. The transcriptional activity of the genes does not correlate with results of preoperative hormonal tests and is not a prognostic factor of persistent hypertension after adrenal tumour excision.
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Introduction of Liver Transplant Programme in Upper Silesia

60%
Król R., Jaworska K., Karkoszka H., Chudek J., Ziaja J., Badura J., Pawlicki J., Oczkowicz G., Caban A., Marcinkowski W., Sekta S., Wilk J., Gabriel A., Gonciarz Z., Kunsdorf-Wnuk A., Kokot F., Więcek A., Cierpka L.
Polish Journal of Surgery
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2007
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vol. 79
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issue 10
656-662
EN
Liver transplantation is the only method of treatment of patients with end stage liver insufficiency. Inadequate number of transplantations in Poland in relation to demands causes a need of new liver transplantation centres formation.The aim of the study was to present process of introduction of liver transplantation programme and results of the first 12 transplantations.Material and methods. Preparations to transplantation were based on training of surgical, anaesthetics and nephrological teams in transplant centres in Paris, Birmingham and Warsaw. Own protocols of organ harvesting, recipients' qualification, transplantation and postoperative treatment were worked out; they were a result of experience acquired in teaching centres. From October 16, 2005 to October 2006, 12 liver transplantations were performed in patients with end stage liver insufficiency of different origin. Patients' age varied from 21 to 67 years. The stage of liver failure according to Child-Pough was 8.6±2.8, and MELD 18.6±7.2. All elective operations were performed using Piggyback technique. Immunosuppression regimen was uniform and consisted of tacrolimus and prednisolone.Results. One patient died due to post reperfusion syndrome with no respond to catecholamine treatment. In 1 patient developed primary lack of the liver graft function that required re-transplantation, which was successfully performed on 2nd postoperative day. Among 10 patients who were discharged from the hospital on mean 31 postoperative day all are alive, and 7 of them returned to full live activity.Conclusion. Training in famous liver transplant centres and own experience in kidney and pancreas transplantation allowed for successful introduction of liver transplantation programme.
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