Hepatitis C virus (HCV) infection has recently become the major cause of chronic liver disease among patients on chronic hemodialysis. The use of erythropoietin for treatment of anemia has reduced the number of blood transfusions, but the frequency of HCV infection has not declined in hemodialysis units. The exact mode of transmission of HCV within dialysis units is as yet incompletely defined, but there is evidence to support nosocomial transmission by sharing dialysis machines in the hemodialysis unit. We performed a study to estimate the prevalence of HCV infection in our hemodialysis unit and to evaluate the effect of patient isolation and use of devoted dialysis machines for HCV-positive patients on the spread of HCV infection. A total of 168 patients on chronic hemodialysis (92 males and 76 females; mean age 54 +/- 12) were screened for HCV-antibodies (HCV-Ab) before their admission to the dialysis unit. Seropositive patients were isolated and confined to dedicated dialysis machines. Aminotransferases were measured monthly and HCV-Ab screening was performed second or third generation ELISA test every two months. Seropositive patients were tested by the PCR for the detection of HCV-RNA. Between March 1992 and August 2000, eight of 168 patients showed seroconversion. Seropositive patients were also found HCV-RNA positive. Four of these patients have become seropositive after they had undergone hemodialysis in other dialysis centers on holiday, two patients had received blood transfusions within the six months preceding seroconversion. The prevalence of HCV positivity in our hemodialysis unit is 4.7%. The low prevalence of HCV infection of our unit suggests that patient isolation and use of dedicated dialysis machines for seropositive patients decrease the transmission of HCV infection in hemodialysis units.

The role of immunosuppressive therapy in the management of IgA nephropathy (IgAN) remains controversial. No consensus has yet emerged on the specific treatment of IgAN and this is mostly related to the lack of complete understanding of the multifactorial pathogenesis of the disease. Choice of appropriate therapeutic agents is further limited by the difficulty in identifying patients who would most likely benefit from therapy. Immunosuppressive therapy has not been recommended in patients with isolated hematuria and well preserved renal function because of their generally favourable prognosis and there are no clinical trials in this area. Considering that mild IgAN may be an early stage of the disease and can be reversed by immunosuppressive agents we have used prednisolone and azathioprine in patients with isolated hematuria in a prospective, randomized, controlled study since 1988. In this prospective study we have evaluated the effect of prednisolone with azathioprine on the clinical course of IgAN and its impact on histologic parameters and prevention of progression in patients with isolated hematuria. We studied 43 biopsy-proven IgAN patients (29 males and 14 females, aged between 13-63 years, mean age 28+/-6) with isolated hematuria and well-preserved renal function (Ccr 89.2+/-10.2 ml/min). The patients were assigned to two groups: 21 patients received prednisolone (40 mg/day) and azathioprine (100 mg/day) orally for four months (group A) and 22 patients received no specific treatment for IgAN and served as a control group (group B). In Group A prednisolone was reduced to 20 mg/day at the end of the second month, then slowly tapered over a two-month period and stopped. The median duration of follow-up was 60 months (range 12-120 months). At the end of the therapy hematuria disappeared in 17 patients. In three patients who did not respond to therapy, microscopic hematuria persisted. Of the 22 patients of group B, three had episodes of gross hematuria and proteinuria >500 mg/day. No significant changes in biochemical profile were observed in either group. Thirteen patients (eight from the treated, five from the untreated group) underwent a repeat biopsy after 12+/-6 months (range 10-25). An improvement of histopathological features was noted in Group A, while deterioration was noted in Group B. We conclude that early treatment with prednisolone and azathioprine appears to be beneficial in preventing the progression of immunologic renal injury and in improving histopathological features in IgAN patients with isolated hematuria.

Primary membranoproliferative glomerulonephritis (MPGN) has a poor long-term prognosis, with 40 per cent of patients reaching end-stage renal failure after 10 years of observation. Approximately 35 per cent of patients die due to complications of the nephrotic syndrome. This study investigates the effect of acetylsalicylic acid (ASA) combined with dipyridamole on proteinuria and renal function in nephrotic MPGN patients with normal/moderately reduced glomerular filtration rate (GFR). Fourteen patients with biopsy-proven type I MPGN received ASA (1000 mg/day) and dipyridamole (300 mg/day) for 24 months. Proteinuria was reduced from 6.8 +/- 2.4 g/day to 1.1 +/- 0.6 g/day (p < 0.001). Serum albumin levels increased from 2.2 +/- 0.5 g/dL to 3.7 +/- 0.4 g/dL (p < 0.001) during the study period after 24 months compared to baseline. Serum creatinine and GFR did not significantly change in patients treated with acetylsaliclylic acid and dipyridamole during the observation period (p < 0.05). Our study suggests that ASA combined with dipyridamole significantly reduces proteinuria without impairing renal function in patients with MPGN.

Preventive effect of a sulfamethizole-sulfaethidole combination on experimental hematogenous pyelonephritis was examined on 120 white rats weighing 200–250 g. Two strains of Staphylococcus aureus, one of which was resistant to the combination and the other sensitive, and a resistant enterococcus strain were used for experimental hematogenous pyelonephritis. As a result, we observed that this kind of sulfonamide combination improved the pathomorphological lesions only in the group in which experimental pyelonephritis was produced by sensitive S. aureus. In the other groups, practically no positive effect could be seen.

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