epiglucan and Kidney-Failure--Chronic

(1-3)-β-D glucans (BG) are cellular components of yeasts and fungi. Elevated blood levels may be an adjunct in diagnosing invasive fungal infection, though can be high in dialysis patients without fungaemia. BG can also induce false positive signals in endotoxin detection assays (Limulus Amoebocyte Lysate [LAL] assay). We explored the relationship between BG levels, renal impairment, endotoxaemia and inflammation.. We measured serum BG levels, markers of inflammation and blood endotoxin levels in 20 controls, 20 with stages 1-3 chronic kidney disease (CKD), 20 with stages 4-5 CKD, 15 on peritoneal dialysis (PD) and 60 on haemodialysis (HD). Another 30 patients were studied before and after HD initiation.. BG levels increased with advancing CKD, being highest in HD patients, 22% of whom had elevated levels (> 80 pg/ml). Levels increased significantly following HD initiation. Levels also correlated positively with CRP, TNFα, IL-6 levels, independently of CKD stage. Blood endotoxin was detectable by LAL assays in 10-53% of the CKD cohort, being most prevalent in the HD group, and correlating positively with BG levels. Adding BG blocking agent to the assay reduced endotoxin detection confining it to only 5% of HD patients. Levels of inflammatory markers were higher in those with detectable endotoxin - whether false- or true positives.. BG levels increased with decreasing renal function, being highest in dialysis patients. High BG levels were associated with false positive blood endotoxin signals, and with markers of inflammation, independently of CKD stage. The cause for high BG levels is unknown but could reflect increased gut permeability and altered mononuclear phagocytic system function.

Topics: beta-Glucans; C-Reactive Protein; Correlation of Data; Endotoxins; Female; Humans; Inflammation; Interleukin-6; Invasive Fungal Infections; Kidney Failure, Chronic; Male; Middle Aged; Patient Acuity; Peritoneal Dialysis; Renal Dialysis; Risk Assessment; Severity of Illness Index; Tumor Necrosis Factor-alpha

The aim of this combined in-vitro and in-vivo study was to investigate whether state of the art dialysis modalities produce false positive serum 1,3-ß-d-Glucan (BDG) levels.. Dialysis fluid for simulated dialysis treatments was spiked with BDG from different sources. Samples were taken from the dialysate and dialyzer blood compartments at various time points. In addition, serum samples were obtained in three groups of patients without invasive fungal disease: a.) twelve patients on chronic hemodialysis (HD)/hemodiafiltration (HDF); b.) ten patients on continuous ambulatory peritoneal dialysis (CAPD); and c.) ten patients with stable chronic kidney disease (CKD) but without dialysis.. Median BDG levels in BDG spiked dialysate were 3250.9, 2050.4, and 390.1 pg/ml respectively. All corresponding samples from the blood compartments were BDG negative. In HD/HDF patients no increase of serum BDG levels could be observed over the duration of treatment. 71/72 BDG tests in this group remained negative. BDG tests were also negative in 9/10 CAPD patients, both in in- and outflow dialysates as well as in all ten patients with CKD.. We conclude that state of the art renal replacement therapies using up-to-date treatments are not a cause of falsely elevated serum BDG levels.

Topics: Adult; Aged; beta-Glucans; Cellulose; Female; Hemodialysis Solutions; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Prospective Studies; Renal Dialysis; Renal Replacement Therapy

Ischemia-reperfusion injury is one of the leading causes of acute renal failure which is a common clinical event leading to development of chronic kidney disease and a high mortality; especially in elderly people. β-glucans are glucose polymer groups with free-radical scavenger, macrophage activator, and immune defense inducer functions. We designed this study to determine the possible protective effects of β-glucan against renal ischemia-reperfusion injury comparatively in young and aged rats.. Rats were assigned to the following groups: Young and aged sham, young and aged ischemia-reperfusion, young and aged β-glucan, young and aged ischemia-reperfusion+β-glucan. At the end of the experiment, following collection of blood samples, rats were sacrificed and kidneys were removed for histopathological and biochemical examination.. Mean tissue histopathological damage scores of young β-glucan group was lower than that of young ischemia-reperfusion group, and of aged β-glucan group was lower than that of aged ischemia-reperfusion group. Urea and creatinine levels of young and aged of sham group and β-glucan administered groups were all lower than those of ischemia-reperfusion and β-glucan+ischemia-reperfusion groups. Oxidative stress indexes of ischemia-reperfusion groups were increased however ; oxidative stress indexes of β-glucan administered to young and aged rats were lower than those of ischemia-reperfusion groups.. We conclude that β-glucan is effective to protect kidneys from ischemia-reperfusion-induced oxidative damage, especially in young rats (Fig. 6, Ref. 45).

Topics: Acute Kidney Injury; Age Factors; Animals; beta-Glucans; Free Radical Scavengers; Ischemia; Kidney; Kidney Failure, Chronic; Male; Oxidative Stress; Rats; Rats, Sprague-Dawley; Reperfusion Injury

Beta-glucan is a major component of fungal cell walls and shows various immunopharmacological activities including antitumor activity. Previously, we detected anti-beta-glucan antibody in human sera. Anti-beta-glucan antibody participates in the immune response to fungal cell wall beta-glucan. Patients on dialysis are at high risk of infection including fungal infections. We examined the plasma beta-glucan level and the titer of anti-beta-glucan antibody in dialysis patients. We measured plasma beta-1,3-glucan concentrations with the limulus G test and anti-beta-glucan antibody titers by ELISA with Candida beta-glucan-coated plates. We also examined the influence of the period of dialysis and the kind of dialysis membrane. The patients were positive for beta-1,3-glucan in their plasma. The anti-beta-glucan antibody titer was lower in the dialysis patients than in healthy volunteers. Long-term dialysis patients showed lower anti-beta-glucan antibody titers than short-term dialysis patients. No significant difference was found between the kinds of dialysis membrane. The titer of anti-beta-glucan antibody as recognition molecule of beta-glucan was low in dialysis patients compared with healthy volunteers. This is likely to be one factor explaining the sensitivity to infection of the dialysis patients. An appropriate application of culinary-medicinal mushroom such as Agaricus brasiliensis has potential for the prevention of fungal infection in dialysis patients.

Topics: Agaricus; Aged; Antibodies, Fungal; Aspergillus niger; beta-Glucans; Candida; Candida albicans; Cell Wall; Female; Humans; Kidney Failure, Chronic; Limulus Test; Male; Middle Aged; Mycoses; Renal Dialysis

Determination of the blood (1-->3)-beta-D-glucan (beta-DG) concentration is a sensitive marker to detect the presence of deep mycosis and fungal infections. Although cellulose material is known to contain beta-DG, the influence of a cellulose dialyzer membrane on the blood beta-DG level remains to be elucidated. In this study, we determined the plasma beta-DG levels in dialysis outpatients using either a modified regenerated cellulose (MRC) or a synthetic polysulfone (PS) membrane for more than 3 months. Plasma beta-DG levels were extremely high in patients using the MRC (2,778 +/- 549 pg/ml, n = 9) but not the PS membrane (18.8 +/- 3.7 pg/ml, n = 8) compared to normal ranges (<20 pg/ml). A single dialysis session using the MRC membrane further increased blood beta-DG values to 5,561 +/- 722 pg/ml (p < 0.01). After changing the membranes from MRC to PS, the blood beta-DG levels gradually decreased and reached 29.6 +/- 6.0 pg/ml at 6 months. In contrast, the PS membrane did not affect plasma beta-DG levels after a single dialysis session (16.0 +/- 3.9 pg/ml) or 4 months later (24.0 +/- 4.9 pg/ml). These findings suggested that a cellulose membrane could influence the measurement of blood beta-DG concentrations in the long-term. Careful assessment is required to diagnose the presence of fungal infection in HD patients using a cellulose membrane.

Topics: Aged; beta-Glucans; Biocompatible Materials; Cellulose; False Positive Reactions; Glucans; Humans; Kidney Failure, Chronic; Membranes, Artificial; Middle Aged; Mycoses; Polymers; Renal Dialysis; Sulfones