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Proteolytic activity in patients with hypercatabolic renal failure
Abstract:
Proteolytic enzymes exist in ultrafiltrated plasma, concentrated dialysates and urine fractions of patients with posttraumatic renal failure. Differences in digestion pattern of phosphorylase kinase suggest the existence of different proteases in patients with hypercatabolic renal failure. Trypsin binding capacity is reduced in RDT patients and markedly lower in patients with posttraumatic ARF. Protein catabolism is inhibited in vitro by alpha 2-macroglobulin. From our in vitro studies we favour the application of fresh frozen plasma instead of the available plasma protein solutions to hypercatabolic patients. Hemodialysis may enhance proteinase inhibitory capacity of the plasma. Hemodialysis therapy induces the increase of plasma E-X1 PI. The continuous release of granulocyte elastase during hemodialysis therapy may enhance the risk for the development of destructive lung disease.
Insights
Proteolytic enzymes in renal failure patients differ, impacting protein breakdown. Fresh frozen plasma is favored over protein solutions for hypercatabolic patients, with hemodialysis potentially increasing protective factors.
Area of Science:
- Nephrology
- Biochemistry
- Enzymology
Background:
- Proteolytic enzymes are present in patients with posttraumatic renal failure.
- Differences in enzyme activity suggest varying proteases in hypercatabolic states.
- Trypsin binding capacity is notably reduced in patients undergoing renal replacement therapy (RRT) and acute renal failure (ARF).
Purpose of the Study:
- To investigate the characteristics of proteolytic enzymes in patients with posttraumatic renal failure.
- To compare enzyme profiles between different types of renal failure.
- To evaluate the efficacy of fresh frozen plasma versus plasma protein solutions and the impact of hemodialysis on protein catabolism.
Main Methods:
- Analysis of ultrafiltrated plasma, dialysates, and urine fractions.
- Assessment of phosphorylase kinase digestion patterns.
- Measurement of trypsin binding capacity.
- In vitro inhibition studies using alpha 2-macroglobulin.
Main Results:
- Distinct proteolytic enzymes were identified in patients with posttraumatic renal failure.
- Reduced trypsin binding capacity was observed in RRT and ARF patients.
- Alpha 2-macroglobulin inhibited protein catabolism in vitro.
- Hemodialysis may increase plasma proteinase inhibitory capacity, including E-X1 PI.
- Continuous release of granulocyte elastase during hemodialysis is noted.
Conclusions:
- Fresh frozen plasma is recommended over plasma protein solutions for hypercatabolic patients.
- Hemodialysis may enhance the plasma's proteinase inhibitory capacity.
- Potential risk for destructive lung disease due to granulocyte elastase release during hemodialysis warrants consideration.