Document Detail

Future trends in biocompatibility aspects of hemodialysis and related therapies.
MedLine Citation:
PMID:  3493868     Owner:  NLM     Status:  MEDLINE    
Biocompatibility is redefined as the quality of being mutually tolerant with life. In so far as this represents a quality which is as likely to be achieved as is the alchemist's dream of turning lead into gold, a compromise approach is recommended. It is suggested that all extracorporeal or body invasive procedures stimulate the inflammatory defense mechanism of the body by stimulating the monocyte to produce a family of polypeptides currently known collectively as Interleukin-1 (IL-1). So far two dissimilar gene products have been cloned and there are probably more. The IL-1 group of polypeptides possess hormonal functions which orchestrate nearly every instrument of the body's defense system. Inducers of IL-1 are present in dialysate and include bacterial pyrogen and acetate. In addition bacterial cell wall glycoprotein may be cleaved into muramyl dipeptides by the release of granulocyte lysozyme at the membrane interface. Muramyl dipeptides have been found in CAPD drain fluid and are more potent inducers of IL-1 than endotoxin. Membrane activation of the fifth component of complement with the release of C5a will also induce monocytes to produce IL-1. The consequences of repeated stimulation of the acute phase response are undesirable and may include muscle wasting, osteopenia and bone cysts (Shrinking man syndrome), fibrosis of scapulo-humeral joints and the carpal-tunnel syndrome. These latter lesions are often associated with deposition of amyloid fibrils related to beta 2 microglobulin. Efforts to reduce these complications are urgently required.(ABSTRACT TRUNCATED AT 250 WORDS)
S Shaldon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical nephrology     Volume:  26 Suppl 1     ISSN:  0301-0430     ISO Abbreviation:  Clin. Nephrol.     Publication Date:  1986  
Date Detail:
Created Date:  1987-05-05     Completed Date:  1987-05-05     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  0364441     Medline TA:  Clin Nephrol     Country:  GERMANY, WEST    
Other Details:
Languages:  eng     Pagination:  S13-6     Citation Subset:  IM    
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MeSH Terms
Acetates / metabolism
Acetylmuramyl-Alanyl-Isoglutamine / metabolism
Biocompatible Materials* / adverse effects
Complement C5 / metabolism
Complement C5a
Interleukin-1 / biosynthesis
Kidney Failure, Chronic / therapy*
Peritoneal Dialysis, Continuous Ambulatory / trends
Pyrogens / metabolism
Renal Dialysis / trends*
Reg. No./Substance:
0/Acetates; 0/Biocompatible Materials; 0/Complement C5; 0/Interleukin-1; 0/Pyrogens; 53678-77-6/Acetylmuramyl-Alanyl-Isoglutamine; 80295-54-1/Complement C5a

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