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Φαινοτυπικές μεταβολές λεμφοκυττάρων στη χρόνια νεφρική νόσο (Bachelor thesis)

Πασαδάκης, Σταύρος

Impairment of renal function is directly related to immune response disorders, which mainly concern specific immunity, and have a direct impact on the morbidity and mortality of patients with chronic kidney disease (CKD). The causes of immune system disorders in CKD are multifactorial, and they include the accumulation of metabolic products, the uremic environment, the chronic inflammatory response, while the extra renal clearance methods seems to have an important role in patients with end-stage CKD. In this diploma thesis, immuno-phenotypic changes of T and B lymphocytes, in patients with CKD, were evaluated. This is a detailed cross-sectional study that concerns adult patients with stage 5 CKD, patients before initiation extra-renal dialysis (group A, predialysis), in chronic hemodialysis with artificial kidney (group B, hemodialysis), or continuous ambulatory peritoneal dialysis (CAPD, Peritoneal Dialysis) and healthy controls of similar age and sex. A method of flow cytometry was applied to determine specific subpopulations of lymphocytes, while the monoclonal antibodies used to standardize subpopulations of T lymphocytes are anti-CD45, CD3, CD4, CD8, CD28, CD16, CD56, CD25 and FoxP3 and for the standardization of subpopulations of B lymphocytes anti-CD19, lgD, CD27. There was also detection of morphometric and immunofluorescence parameters per cell and computer analysis for the standardization of cell populations. Based on the above subpopulations CD4 and CD8 of T lymphocytes, it was observed that between healthy controls and the above study groups, there is a statistically significant difference (p < 0.05) in the total number of lymphocytes and the percentage (%) of CD4 and CD8. Regarding to CD4CD28null T cells, active memory cells, and CD8CD28null cells, the comparison showed that there is a statistically significant difference (p < 0.05) between all study groups only in the percentage of CD4CD28null cells. The comparison of healthy and patients before hemodialysis showed no statistically significant difference in the number of CD4CD28null and CD8CD28null T cells, with patients on dialysis showed a significant difference (p < 0.05), only in the percentages of CD4CD28null and CD8CD28null cells while there was no statistical difference between healthy and PD patients. The association between hemodialysis patients (HD + HDF) with weak peritoneal dialysis was a significant difference only in the number and rate of CD4CD28null. Regarding Natural Killer Cells and T Regulatory Cells/Tregs, the CD19 B cells and CD19+CD27+ B memory cells, it was observed that there is a statistically significant difference (p < 0.05) between all study groups. It seems that in patients with Chronic Kidney Disease there are significant disorders in the subpopulations of T lymphocytes and B lymphocytes, which is of particular importance for the balance in the functioning of the immune system, which moves between protection against exogenous factors, such as pathogenic microorganisms (responsible for infections) and excessive activation, which can turn the immune system against familiar antigens, and creation of autoimmune diseases.