title: Complement activation and hypersensitivity reactions to dialysis membranes.
abstract: Certain patients receiving hemodialysis experience recurrent chest pain, dyspnea, and hypotension during exposure to new cuprophane-membrane dialyzers (the "first-use syndrome"). Because activation of complement may be involved in these events, we examined in vivo complement activation with new cuprophane membranes and in vitro activation by zymosan in 6 such patients, and compared them with 10 patients who did not have symptoms during dialysis. All patients with the first-use syndrome had maximal complement activation 10 minutes after initiation of dialysis, with C3a des-arginine (desArg), the stable metabolite of C3 activation, equal to 8533 +/- 157 ng per milliliter (mean +/- S.E.M.). In asymptomatic patients the maximal C3a desArg value occurred at 15 minutes and was only 2907 +/- 372 ng per milliliter (P less than or equal to 0.0001). At a concentration of 3.8 x 10(-5) g of zymosan per milliliter, patients with the first-use syndrome had a C3a desArg level of 29.6 +/- 1.4 micrograms per milliliter, whereas it was only 16.6 +/- 2.3 micrograms per milliliter in asymptomatic patients (P less than or equal to 0.0001). Two other patients, who experienced cardiopulmonary collapse during the first two minutes of dialysis, had a C3a desArg level of 18,900 and 7800 ng per milliliter, respectively. We conclude that the occurrence of adverse symptoms associated with new cuprophane-membrane dialyzers correlates with complement activation.
mesh_terms: D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000209:etiology / Q000276:immunology*; D002482:Cellulose / Q000009:adverse effects / Q000031:analogs & derivatives*; D003167:Complement Activation; D003176:Complement C3 / Q000032:analysis; D015926:Complement C3a; D003181:Complement C4 / Q000032:analysis; D015934:Complement C4a; D003182:Complement C5 / Q000032:analysis; D015936:Complement C5a; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D007688:Kidneys, Artificial / Q000009:adverse effects*; D008297:Male; D008567:Membranes, Artificial / Q000009:adverse effects*; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D015054:Zymosan / Q000276:immunology
chemical_list: D003176:Complement C3; D003181:Complement C4; D003182:Complement C5; D008567:Membranes, Artificial; D015926:Complement C3a; D015934:Complement C4a; D015936:Complement C5a; D002482:Cellulose; D015054:Zymosan; C009865:cuprammonium cellulose