engleski

Chronic renal failure deranges non-specific cellular immunity

To find out if frequent infections in chronic renal failure patients are accompanied by defects in non-specific immunity, particularly of monocyte and polymorphonuclear phagocytic function and large granular lymphocyte number. Monocite and neutrophil phagocytosis of non-opsonized yeast cells, production of cytokines TNF-&#945; and Il-1&#945; by endotoxin stimulated monocyte cultures, and number of LGL in the peripheral blood were analysed in 15 uremic patients on conservative treatment (U), 18 hemodialysis patients (HD), and 9 patients treated by continuous ambulatory peritoneal dialysis (CAPD). Uremia decreased monocyte ingestion (0.78 vs. 1.07 yeast cells retained per phagocyte ; p = 0.003), neutrophil ingestion (2.46 vs. 3.15 ; p = 0.003), neutrophil digestion (5 vs. 9% of killed among ingested yeast cells ; p<0.001), and LGL number (46 vs. 164 x 106/L ; p<0.036), while increase in TNF-&#945; (2.0 vs. 1.3 ng/mL) and Il-1&#945; (1.7 vs. 1.4 ng/mL) synthesis was not significant. HD ameliorate all parameters, the only significant reductions left were neutrophil digestion (5.5 vs. 9% ; p = 0.002), and LGL number (109 vs. 164 x 106/L ; p = 0.0001). Values for CAPD group were not statistically different from uremia. Renal insufficiency causes the failure of non-specific cellular immunity that is not completely corrected by dialytic treatment and, together with increased exposure, contributes to increased infection frequency.

phagocytosis; monocytes; neutrophils; TNF-&#945;; Il-1&#945;; large granular lymphocytes; uremia; hemodialysis; CAPD

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