KINETICS OF TUMOR-NECROSIS-FACTOR-ALPHA S UBSTITUTE RENAL THERAPY IN PATIENTS WITH SEPSIS AND POLYORGANIC INSUFFICIENCY

Peptide TNF-alpha (tumor necrosis factor alpha) secreted by monocytes and resident macrophages is a key proinflammatory mediator. It can gen erate response systemic inflammation leading to shock and polyorganic insufficiency. Elimination of circulating TNF-alpha is pathogeneticall y perspective in respect to therapy of septic shock. Plasma level of T NF-alpha and its elimination with the filter/dialysate was traced in 2 3 patients with sepsis and polyorganic insufficiency receiving substit ute renal therapy (continuous hemodiafiltration, intermittent hemodial ysis) for acute renal failure. Sepsis and polyorganic insufficiency wa s associated with elevated plasma levels of TNF-alpha correlating in m any cases with the disease severity. TNF-alpha was for the most part e liminated with the filter/dialysate. The degree of this elimination wa s related to the technique of blood perfusion and characteristics of t he procedure.