Impaired Neutrophil Response to Acute Bacterial Infection in Dialyzed Patients

Acute Renal Failure Complicating Aortic Aneurysm Surgery

“…The diagnosis of infections is always difficult. Both WBC count and fever are unreliable signs of infection in patients with uremia [22,23], In our patients it took 2-3 weeks for these signs to separate survivors from those patients who died. The new radiological methods such as sonography, indium and gallium scanning, as well as computerized axial tomography and diagnostic peritoneal lavage ought to be employed frequently.…”

Mesenteric Ischemia in Chronic Dialysis Patients

“…Although the leukocytic and febrile responses to sepsis are diminished in renal failure [16,17], leukocytosis remains a valuable early diagnostic clue for mesenteric ischemia. Admission leukocyte counts of 12.000 -40,000 were seen in all of our patients and in the patient described by Cryer and Kissane [14], Acidemia devel- oped only late and was usually present only after an abdominal catastrophe was clinically apparent [18].…”

Host Immune Status in Uraemia

“…In a recent report [14], it was suggested that the re duced neutrophil response found in dialyzed patients makes peripheral blood leucocyte examination unreli able in the diagnosis of bacterial infection in these pa tients. It was also stated that there are significant differ ences between experimental models of chronic renal failure and the clinical situation.…”

“…The effect of uraemia on neutrophil and phagocytic cell func tion has been investigated in some detail, but with vary ing results [1,2,5,6,11]. Recently, an interesting study reported on the effect of acute infection on the neutrophil response in patients on regular dialysis [14], Most of the patients did not show the expected rise in leucocyte count, suggesting that the blunted response might be another facet of the uraemic patient's compromised re sponse to infection. There are many variables associated with individual uraemic patients and, as a result, the contribution of uraemia perse to the observed reduction in immune function would have been difficult to assess.…”

“…We have recently used a carefully characterized model of chronic uraemia [13] to define the effect of uraemia on immune mechanisms [4,9,11,12,15], In the present exper iment, the effect of uraemia on the leucocytic response of the host to infection, as suggested by the study of Peresecenschi et al [14], has been examined using this experi mental model.…”