Which level of cytokine production is critical in haemodialysis? (original) (raw)
1998, Nephrology Dialysis Transplantation
Monocyte activation with cytokine produc-Cytokine synthesis modulation tion is a well known event in the course of dialysis treatment but its relation to symptoms of haemodia-Cytokine generation during HD derives from monolysis or long-term pathological changes in chronic cyte activation induced by several agents acting dialysis patients is still under discussion. Cytokine through receptor-related and receptor-independent production depends on the balance between inducers mechanisms, summarized in . Considering and inhibitors while effects rely on the peculiar interleukin-1 ( IL-1) as the pre-eminent cytokine in uraemic environment and cell metabolism. 'Footdialysis, promoting the stimulus, signal transduction, prints' for monocyte activation have been found, but gene transcription into mRNA, mRNA translation no marker for clinical symptoms has been demoninto cytokine protein, post-translational processing strated clearly. In this scenario it is almost impossible from precursors to mature forms and extracellular to link a specific symptom to a definite stimulus such release represent the various intracellular steps needed as dialysate microbial contamination or membrane to reach the final result of extracellular passage. Each complement generation. The topics discussed in this of these steps is induced by specific signals, and they paper include cytokines synthesis modulation factors, have to be differentiated, as some stimuli only start levels in haemodialysis patients, and results of finding the process and produce 'primed' monocytes with markers of clinical relevance. Special attention is paid mRNA not translated into a specific cytokine to microbial contamination of dialysis fluid with . Once IL-1 production has started, it stimuanalysis of cytokine inducing substances in commerlates its own gene expression and synthesis with an cial sterile solutions. Data on cytokine synthesis and amplification loop effect [18]. activity in the aged are also discussed, with special Control of IL-1 production is affected not only by regard to the haemodialysis setting. different cytokines but also by many other variables that produce a modulating effect. Lipopolysaccharide (LPS ) as a pivotal molecule in IL-1 monocyte produc-
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