Platelet surface receptors for von Willebrand factor and for fibrinogen (glycoproteins GPIb and GPIIb/IIIa) were studied with monoclonal antibodies CD42 and CD41 and cytofluorometry in 31 healthy subjects, 10 hemodialysis patients with no A-V fistula obstruction (patent original fistula), 10 hemodialysis patients with frequent A-V fistula obstruction (more than twice), 12 patients with mild chronic renal failure (creatinine 1.75 +/- 0.40 mg/100 ml), 11 patients with advanced chronic renal failure (creatinine 5.62 +/- 1.22 mg/100 ml), and 10 patients with end-stage renal disease (ESRD) treated with peritoneal dialysis. There was a significant increase of platelet surface glycoproteins GPIb and GPIIb/IIIa in the population of hemodialysis patients with frequent A-V fistula obstruction. The expression of these platelet receptors might be related to the prothrombotic tendency of a group of patients with ESRD, who suffer more occlusive and thrombotic events of the A-V fistula. This group of patients may also have a higher frequency of systemic thrombotic and atherosclerotic complications.

Dear Sir, In a recent article by Nomura et al.[1] a reduction of platelet glycoprotein GPIb ex pression in the uremic patient was con firmed. just as reported by Sloand ct al. [2], We agree with these data, that clarify the important role of a defect in primary hemo stasis in the pathogenesis of uremic bleeding. We investigated the abnormalities of platelet surface glycoproteins GPIb, the receptor for von Willebrand factor, and GPIIb/llla. the receptor for fibrinogen, since the early stages of renal failure and we correlated them with the degree of uremia and plasma creatinine. We studied four groups of patients: group A (n = 18 healthy controls) creatinine = 0.8 ± 0.3 mg%; group B (n = 10) creatinine = 1.8 ± 0.5 mg%; group C (n = 8) creatinine = 5.4 ± 2.1 mg%; group D (n = 10) creatinine = 9.6 ± 3. In all the patients we investigated platelet glycoproteins GPIb and GPIIb/llla with monoclonal antibodies CD42b and CD41 (Biorad, Italy) and flow cytometric analysis (Bryte cytometer: Biorad). Mean values of GPIb glycoproteins (mean flow ± SD): group A = 43.09 ± 11.19; group B = 37.84 ± 5.57: group C = 34.82 ± 9.54 (p < 0.05); group D = 33.02 ± 7.6 (p < 0.05). Mean values of GPIIb/llla: group A = 312.40 ± 108.3: group B = 410.63 ± 34.65 (p < 0.05); group C = 434.89 ± 50.86 (p < 0.025); group D = 415.31 ± 70.5 (p< 0.05). Our data suggest: (1) that platelet surface gly coprotein abnormalities are present since the early stages of renal failure and are well cor related with the degree of uremia; (2) that also glycoprotein GPIIb/llla is altered in uremia (these further data are different from the data reported by other authors), and (3) that the defect is not corrected by dialytic procedure. Finally, we want to stress in ure mic patients the main importance of platelet glycoprotein abnormalities that also have an important role in the abnormal procoagulant response to treatment with recombinant hu man erythropoietin, as just reported [3].

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POSTER Microbiologia M e d i c a 211quanto verrebbero sottovalutate le cariche batteriche basse, espressione dell'attività inibente presente nell'urina e non del processo infettivo in atto. Inoltre nei pazienti con carica batterica significativamente elevata (> 80 4 UFC/ml) e PARtest positivo (11.3% nella nostra casistica) il PAR test può essere utile nel valutare l'efficacia della terapia antibiotica. La ricerca delle sostanze antibatteriche nell'urina rappresenta quindi un doveroso completamento dell'esame colturale, affinché questo risulti attendibile e con un fondato riscontro clinico. Tabella

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