الفهرس 
Naturall IImmune SystemOnly 14 pages are availabe for public view
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Abstract
years (Stenvinkel et al., 2005).
Uremia is associated with immune dysfunction characterized by immunodepression leading to infections, as well as immunoactivation resulting in inflammation and CVD (Sawako et al., 2008). This disturbance is a result of alterations in the two major branches of the immune system innate and adaptive (Janeway and Medzhitov, 2002) on one hand, hypercytokinemia, on the other hand, Variety of disorders exerted on immunocompetent cells (Stenvinkel et al., 2005).
Uremic monocytes display decreased endocytosis and impaired maturation (Lim et al., 2007). Bactericidal capabilities of neutrophils are reduced in HD (Anding et al., 2003).This might be the result of uremic toxins (Glorieux et al., 2003).
The increased rate of infections, impaired response to vaccination and a common failure of tuberculin skin test to diagnose latent tuberculosis indicate that the adaptive immunity is weakened in the ESRD population (Eleftheriadis et al., 2007). ESRD and (Ando et al., 2006) HD patients, Expresses a low TLR4 expression (Kuroki et al., 2007).
Predisposing factors to immune dysfunction in uremia include, Accumulation of uremic toxins exerting an adverse biologic impact on different organs (Raymond et al., 2007), Comorbidities e.g. DM, ISHDS, CHF Hypoalbuminemia (vanholder et al., 1996), Iron overload (Powe et al., 1999), Invasive vascular procedures whose infection incidence varies with site and duration of the vascular access, Infections are common with vascular graft than with AV fistula, Also are higher with femoral and internal jagular than subclavian (Powe et al., 1999), Deficient mucocutaneous barrier (Kause and Pahari, 2004), Dialyser membrane bio-incompatibility (Hakim., 1993,.Vitamins and trace element deficiencies (vanholder et al.,1996) and use of immunosuppressives and antibiotics (vanholder et al., 1996).
Different modalities have different effect on immune dysfunction. High-flux membranes have a better survival for cardiac deaths compared to low flux (Cheung et al., 2003). and PD (Evenepoel et al., 2006), hemodiafiltration showed better survival than high flux(Canaud et al., 2006).
PD and HD patients had similar overall rates of infection, but they have different types of infections. Among PD patients, peritonitis accounted for a significant portion, and no episodes of bacteremia were observed. Among HD patients, bacteremia accounted for a significant portion (Aslam et al., 2006).
Different strategies must be done to improve immune function e.g. Prophylaxis (vaccinations); Among HD and PD (Gilbertson et al., 2003). Normalization of hemoglobin level as cutaneous reactivity was better at a normal hemoglobin (Yoshimoto et al., 2000). High-flux dialysis is associated with better clinical outcomes (Cheung et al., 2006). Several lines of evidence have suggested a potential antiinflammatory activity of vitamin D (Mizobuchi et al., 2007).
Sevelamer is associated with less inflammation, increased levels of the circulating inhibitor of vascular calcification fetuin-A, and an improvement of endothelial function (Kayser et al., 2008). Treatment of patients on HD with verapamil, nifedipine, or amlodipine is associated with an improvement in metabolism and phagocytosis of PMNLs in humans (Shaul and Miroslaw, 2001).