Effect of malnutrition and uremia on impaired cellular host defence

There is a high incidence of infection in hospitalized patients with chronic renal failure. Nutritional and metabolic factors, as well as vitamins and trace elements are involved in impaired host defence and altered PMN function in dialysis patients. A circulating peptide (GIP) could be isolated from uremic serum that inhibits PMN glucose uptake, chemotaxis, oxidative metabolism and intracellular killing of Staphylococcus aureus. In addition to enhanced susceptibility to infection by impaired PMN function, uremic patients show profound defects of specific immune system represented by monocytes, B cells and T cells. T cells show decreased proliferation and Il-2 production on the one hand and enhanced Il-2 receptor expression on the other. Monocytes fail to elicit adequate help for T cell proliferation despite normal production of Il-1 and Il-6, but they produce elevated amounts of TNF alpha. B cells secrete decreased amounts of IgG and respond insufficiently to various vaccines. Malnutrition and uremia induce severe alterations of host defence and specific immune system if a combination of both these diseases occur.