Clinicopathologic correlations of renal pathology in the adult population of Poland.

BACKGROUND: This is the first report on the epidemiology of biopsy-proven kidney diseases in Poland. METHODS: The Polish Registry of Renal Biopsies has collected information on all (n = 9394) native renal biopsies performed in Poland from 2009 to 2014. Patients' clinical data collected at the time of biopsy, and histopathological diagnoses were used for epidemiological and clinicopathologic analysis. RESULTS: There was a gradual increase in the number of native renal biopsies performed per million people (PMP) per year in Poland in 2009-14, starting from 36 PMP in 2009 to 44 PMP in 2014. A considerable variability between provinces in the mean number of biopsies performed in the period covered was found, ranging from 5 to 77 PMP/year. The most common renal biopsy diagnoses in adults were immunoglobulin A nephropathy (IgAN) (20%), focal segmental glomerulosclerosis (FSGS) (15%) and membranous glomerulonephritis (MGN) (11%), whereas in children, minimal change disease (22%), IgAN (20%) and FSGS (10%) were dominant. Due to insufficient data on the paediatric population, the clinicopathologic analysis was limited to patients ≥18 years of age. At the time of renal biopsy, the majority of adult patients presented nephrotic-range proteinuria (45.2%), followed by urinary abnormalities (38.3%), nephritic syndrome (13.8%) and isolated haematuria (1.7%). Among nephrotic patients, primary glomerulopathies dominated (67.6% in those 18-64 years of age and 62.4% in elderly patients) with leading diagnoses being MGN (17.1%), FSGS (16.2%) and IgAN (13.0%) in the younger cohort and MGN (23.5%), amyloidosis (18.8%) and FSGS (16.8%) in the elderly cohort. Among nephritic patients 18-64 years of age, the majority (55.9%) suffered from primary glomerulopathies, with a predominance of IgAN (31.3%), FSGS (12.7%) and crescentic GN (CGN) (11.1%). Among elderly nephritic patients, primary and secondary glomerulopathies were equally common (41.9% each) and pauci-immune GN (24.7%), CGN (20.4%) and IgAN (14.0%) were predominant. In both adult cohorts, urinary abnormalities were mostly related to primary glomerulopathies (66.8% in younger and 50% in elderly patients) and the leading diagnoses were IgAN (31.4%), FSGS (15.9%), lupus nephritis (10.7%) and FSGS (19.2%), MGN (15.1%) and pauci-immune GN (12.3%), respectively. There were significant differences in clinical characteristics and renal biopsy findings between male and female adult patients. CONCLUSIONS: The registry data focused new light on the epidemiology of kidney diseases in Poland. These data should be used in future follow-up and prospective studies.

Captopril apparently increase and cisplatin apparently decrease human albumin concentration in artificial urinary solutions.

BACKGROUND: Measurement of urinary albumin (HSA) is very important in diagnostic of kidney diseases. Much less is known about the possible impact of substances present in urine together with albumin on the results of measurements. METHODS: We investigated the effect of the presence of captopril and cisplatin in the solution on the result of the determination of HSA by native polyacrylamide gel electrophoresis. Protein conformation in the absence and presence of the drugs was examined using Fourier Transform Infrared Spectroscopy (FTIR). RESULTS: The presence of captopril apparently increases HSA concentration while cisplatin causes an apparent decrease in the HSA concentration. The presence of both drugs also influence the secondary structure forms of HSA albumin investigated by FTIR. CONCLUSION: Both drugs tested in the concentration of human use can have an impact on the results of determination of albumin in urine which can influence clinical decision.

Kidney disease in the elderly: biopsy based data from 14 renal centers in Poland.

BACKGROUND: Longer life expectancy is associated with an increasing prevalence of kidney disease. Aging itself may cause renal damage, but the spectrum of kidney disorders that affect elderly patients is diverse. Few studies, mostly form US, Asia and West Europe found differences in the prevalence of some types of kidney diseases between elderly and younger patients based on renal biopsy findings, with varied proportion between glomerulopathies and arterionephrosclerosis as a dominant injury found. Here, for the first time in Eastern Europe we analyzed native kidney biopsy findings and their relationship to clinical characteristics at the time of biopsy in elderly individuals (aged ≥65) in comparison to younger adults (aged 18-64). METHODS: Biopsy and clinical data from 352 patients aged ≥65 were retrospectively identified, analyzed and compared with a control group of 2214 individuals aged 18-64. All kidney biopsies studied were examined at Medical University of Warsaw in years 2009-14. RESULTS: In elderly patients the leading indication for biopsy was nephrotic range proteinuria without hematuria (34.2%) and the most prevalent pathologic diagnoses were: membranous glomerulonephritis (MGN) (18.2%), focal segmental glomerulosclerosis (FSGS) (17.3%) amyloidosis (13.9%) and pauci immune glomerulonephritis (12.8%). Hypertension and age-related lesions very rarely were found an exclusive or dominant finding in a kidney biopsy (1.7%) and a cause of proteinuria (1.1%) in elderly individuals. There were 18.2% diabetics among elderly individuals, and as much as 75% of them had no morphologic signs of diabetic kidney disease in the renal biopsy. Amyloidosis, MGN, pauci immune GN, crescentic GN and light and/or heavy chain deposition disease (LCDD/HCDD) were more frequent whereas IgA nephropathy (IgAN), lupus nephritis (LN) and thin basement membrane disease (TBMD) were less common among elderly than in younger patients. CONCLUSIONS: Proteinuria, a dominating manifestation in elderly patients subjected to kidney biopsy was most commonly related to glomerulopathies. The relatively high prevalence of potentially curative kidney diseases in elderly individuals implicates the importance of renal biopsy in these patients.

[Expert's opinion on recommendations for water and other beverages consumption in elderly?]. / Stanowisko Grupy Ekspertów w sprawie zalecen dotyczacych spozycia wody i innych napojów przez osoby w wieku podeszlym.

The article encloses definition of water role and its body requirement, review of water balance and management in older persons regarding characteristic of this age group and concomitant disorders. Based on current literature and expert's opinion the recommendations for water consumption were expressed with estimation of insufficient apply and oversupply, evaluation of hydration state, domestic water sources in diet with accent on influence of proper hydration on comfort and good health.

[Polish physicians'opinions concerning morally controversial medical practices]. / Opinie lekarzy polskich o kontrowersyjnych moralnie procedurach medycznych.

OBJECTIVES: Some lawful procedures are morally controversial and this situation can sometimes provoke conflicts between patients and physicians (conscience clause problem). The aim of our survey was to collect opinions about medical procedures that are accepted by Polish law and unaccepted by the Catholic Church--dominating denomination in Poland, and analyzing conditions determining these opinions. MATERIAL AND METHODS: Cross sectional study. An anonymous survey was distributed among 528 physicians who work in public hospitals in eastern Poland (turn = 61%). The sample consist of: 51% women, 49% men; 52% work AT surgical wards, 48% at non-surgical wards; average work period: 17.03 years (SD = 10.73; min. = 1, max. = 45); 93% Catholics; average religiosity (measured by the Scale of Religious Attitudes): M = 5.47 (SD = 1.01; min. = 1.60, max. = 6.80). The questionnaire contained questions about: hormonal contraceptives, artificial fertilization, abortion in the case of rape and fetus defect. RESULTS: The majority of respondents accepts artificial fertilization (70%), about half accepts abortion in case of fetus defect (50%), almost half accepts abortion in case of rape (41%) and contraception for minors (43%). There was statistically significant differences between physicians with different religiosit--the lack of approval for above procedures correlates with increasing religiosity. CONCLUSIONS: Individual religiosity (regardless of denomination) is the most important condition influencing Polish physician's opinions and attitudes concerning contraception, abortion and artificial fertilization. Physicians with higher religiosity (about 25%) in the situation of divergence between their moral beliefs and patient's demands will choose for their beliefs, which can cause conflicts. Physician-patient relationship's models should take into account physicians'cultural beliefs and not only the cultural beliefs of the patients.

Phaeochromocytoma in a 86-year-old patient presenting with reversible myocardial dysfunction.

BACKGROUND. Phaeochromocytomas and paragangliomas are rare, mostly benign catecholamine-producing tumours of chromaffin cells of the adrenal medulla or of extra-adrenal paraganglia. Phaeochromocytoma may occur at any age, the greatest frequency being in the fourth and fifth decades. Only on extremely rare occasions does the tumour develop in the very old patients. METHODS. We are describing an 86-year-old patient with phaeochromocytoma, presenting with reversible myocardial dysfunction. RESULTS. This very old patient with phaeochromocytoma had hypertension characterized by labile blood pressure values and increased daytime blood pressure variability. This patient exhibited reversible myocardial dysfunction suggestive for "catecholaminergic cardiomyopathy", as the complication of phaeochromocytoma. After surgical removal of the tumour, recovery of left ventricular function was documented by echocardiography showing normalization of systolic function and improvement of diastolic function. CONCLUSION. Phaeochromocytomas are rare forms of secondary hypertension, but should be considered in the differential diagnosis, regardless of age, even in very old patients.

The analysis of the ethical, organizational and legal aspects of Polish biobanks activity.

BACKGROUND: Biobanks create new opportunities for the public health (Public Health Genomics) but need some regulations. Polish biobanks are in the phase of dynamic transformations aiming at integrating their activity and adjusting them to the international standards. The aim of this article is to present the current standards held in the most important Polish institutions collecting biological samples. METHODS: A survey was conducted by the questionnaire filled by managers and directors of 24 Polish biobanks. Questions concerned obtaining patient informed consent (also a consent to some future researches and access to dates by other organizations), protection of privacy, storage of the samples and the relevant information, the opinion related to the need of establishing Polish national DNA data bank and possibilities of the scientific international cooperation. RESULTS: The written consent to carry out research on the samples is obtained almost everywhere, but 29% of biabanks does not acquire the consent for the future usage of the samples. Almost all inquired banks (93%, n = 22) declare the willingness to start an international cooperation. Most of respondents support the idea of establishing the Polish national DNA bank by the fusion of the already existing banks. CONCLUSION: The inquiry findings point that the current biobanks procedures do not differ to any relevant degree from procedures applied in the West European countries. Many of Polish biobanking organizations are willing to cooperate with foreign sites. It may enhance the European biobanking network and gene-environmental research.

Sepsis caused by Chromobacterium violaceum - probably the first case in Europe, or Macbeth read anew.

Rare diseases, almost by definition, present us with diagnostic as well as therapeutic difficulties as. They also include infectious diseases outside endemic areas. Without expecting them, we are not preparing to fight them. Like Macbeth, we feel safe, convinced that tropical diseases do not reach us, like Birnam forest towards his castle. Nevertheless, the forest moved according to the prophecy of the three witches, and in a similar way tropical flora is moving towards us according to the predictions of environmentalists. This is illustrated by the history of the presented patient, who was admitted to hospital because of sepsis caused by Chromobacterium violaceum (CV), a Gram-negative facultatively anaerobic, oxidase-positive bacterium producing a dark violet antioxidant pigment called violacein. This is probably the first documented case report of sepsis in this part of the world. To the best of the authors' knowledge, the patient is the first to require dialysis after Chromobacterium violaceum infection.

[Diagnostic and treatment processes and the requirement of patient's consent in doctors' opinions]. / Procesy diagnostyczno-lecznicze a potrzeba udzielenia zgody przez pacjenta w opinii lekarzy.

Contemporary medicine, together with the increase in invasiveness into the patient's body, exerts mounting pressure on state institutions and medical chambers aiming at the development of suitable regulations protecting patients against excessive interference with their bodies and psyche, and also allowing for their full autonomy. A gradual shift in the doctors' behaviour from a paternalistic approach towards partnership becomes more apparent. Its purpose is to take shared decisions concerning diagnostic methods and treatment. This process is best noticed when it comes to the issue of taking medical measures after obtaining patient's conscious agreement. The term 'conscious agreement' emerged in the legal terminology fairly late, in 1957, during the lawsuit Salgo vs. Leland Stanford Junior University Board of Trustees. Much later it found its place in the legal regulations concerning everyday medical routines. The fundamental factor of the patient's autonomy and simultaneously a remedy to the risk of patients acting against their own good is the process of obtaining the sick person's conscious agreement prior to anticipated medical measures, both therapeutic and diagnostic. The patient's informed conscious agreement to diagnostic process and treatment is not only the crucial prerequisite of doctor's lawful behaviour but also a significant evaluation criterion with regard to doctor's deeds and intentions. We requested doctors to share their opinion, in the form of an anonymous feedback form, on the issue of obtaining from patients their conscious agreement to diagnostic and therapeutic measures. The survey was carried out among 231 physicians of different specialisations from the Lublin Province and Podkarpackie Province employed both in hospitals, outpatient clinics and in health centres for basic medical care. Almost all the respondents declared the knowledgw of the regulations on the protection of patients' rights; however, only half of the surveyed persons expressed the opinion that the regulations concerning patient's rights refer also to diagnostic examination. Doctors clearly differed with regard to the meaning of the notion of 'giving conscious consent by the patient' and tended to associate such a patient's declaration only with invasive procedures. The survey results allowed us to outline the level of knowledge and the degree of compliance with patient's rights related to the necessity of obtaining conscious consent to medical treatment.

[Anaemia from religious reasons as a distant effect of husband's alcoholism]. / Niedokrwistosc z przyczyn religijnych jako odlegly skutek alkoholizmu meza.

Chronic nutrition deficiencies, economic or cultural in their nature are one of the most often reason ofanaemia. From the other hand various diet restrictions may lead to different nutrition deficiencies. The occurrence of anaemia caused by diet restrictions is relatively rare among Catholics in Poland. We present a case of 51 years old woman with severe anaemia (Hgb 2.48 mmol/l), occasionally diagnosed. Anaemia occurred 20 years after she took a pledge never to eat meat. The aim of her oath was the begging for grace and quitting alcoholism by her husband, a habitual alcoholic. The iron and vitamin B12 supplementation led to quick improvement of hematological parameters.

[Nephrology of love]. / Nefrologia milosci.

The article presents different aspects of the connection between human heart and kidneys. This connection is evident in the symbolism of the Old Testament of the Bible, organ donation as the manifestation of the love of our neighbor, endocrinological and sexual dysfunction, and finally in searching for biological determinants of finer feelings. In the Old Testament tradition kidneys were thought to be human spirit's dwelling. Moreover, the simultaneous studying of kidneys and heart meant profound understanding of the matter. Nowadays, it is also possible to find the Biblical love of our neighbor, for instance among kidney donors. What is more, every nephrologist should treat his patients with love and dedication, which makes it easier for him to understand their problems, especially these concerning sexual dysfunction. Sexual dysfunction occurs among men and women equally and specialists, apart from using many different methods, have to deal with the consequences of renal failure mainly by means of transplantation.

[Multivessel coronary angioplasty in chronically haemodialysed patient]. / Wielonaczyniowa angioplastyka wiencowa u osoby przewlekle dializowanej.

Unstable angina in chronically haemodialysed patients has poor clinical outcome. Surgical treatment of these patients is a procedure of high risk. According to guidelines left main coronary artery stenosis is the indication for by-pass grafting. In some cases the alternative to surgical treatment could become percutaneous coronary intervention. We present the case of the patient in which we have perform multivessel percutaneous coronary angioplasties including left main coronary artery.

[Caroli's disease--if so rare clinical problem?]. / Choroba Caroliego--czy tak rzadki problem kliniczny?

Jacques Caroli for the first time described in the year 1958, cavernous dilatation of the hepatic bile ducts. It's the rare abnormality; there have been reported less than 200 cases until now. The disease is caused by defects in the genetic program which are transmitted in an autosomal recessive way. There are two basic types of the disease: focal (so called. "simple type") and diffuse, embracing entire bile tree. Both types maybe associated with congenital hepatic fibrosis and then the abnormality is usually called "Grumbach disease". There is an excessive risk of cancer (cholangiocarcinoma) in patients with Caroli's disease. Dominant symptoms are due to recurrent cholangitis, sometimes with signs of portal hypertension. Basic treatment is hepatic resection (focal form) and internal bypass of the biliary tree (diffuse form). The prognosis of the disease is reserved one.

[Is dehydration an ethical problem?]. / Czy odwodnienie moze byc problemem w kategoriach etycznych?

In the paper, issues connected with chronic dehydration were discussed from the point of view of medical ethics. Rudimentary definitions concerning the issues were mentioned. An attempt was made at analysing critically the views on chronic voluntary dehydration as a possible form of causing death. Some pathophysiological and psychopathological aspects were discussed. "The pyramid" of physician doubts were presented.

[Discitis caused by Kingella kingae--case report]. / Opis przypadku zapalenia krazka miedzykregowego z wychodowaniem Kingela kingae

The patient with acute infection and the presence of bacterium Kingella kingae cultured from cerebrospinal fluid is presented. The analysis of clinical picture and the results of all performed tests did not allow to diagnose cerebrospinal meningitis. Despite of being not sure if Kingella kingae was an etiopathogenetic factor in the described subject, we decided to discuss this interesting case.

Physicians' religiosity and attitudes towards patients.

BACKGROUND: Many religions underline the value of merciful acts, especially the care of the sick. The aim of the survey was to verify the hypothesis that a higher religiosity correlates with a more desirable ethical attitude towards patients. METHOD: An anonymous questionnaire consisting of standardized tools: Scale of Attitudes towards the Patient (SAtP) (four dimensions: respect for autonomy, altruism, empathy and holistic approach to a patient), the Scale of Religious Attitudes (SReAt) evaluating the religiosity, and some questions related to the role of religious beliefs in respondents' professional lives. The research was carried out on a group of 528 Polish physicians, 324 of whom returned the questionnaire (return = 61%); 51% women, 49% men; average work experience: 17.03 years; 93% Catholics. RESULTS: Religiosity correlates positively with altruism (r=0.12; p<0.05), holistic approach (r=0.18; p<0.01) and empathy (r=0.20; p<0.01), but not with respect for autonomy. For the majority of physicians, religious faith is an important supportive factor, especially in making difficult decisions. Surgeons are less religious (M=5.32; SD=1.06) than non-surgeons (M=5.61; SD=0.93); (t= -2.59, p<0.05). CONCLUSION: Physicians' religiosity is an essential factor shaping their attitude towards patients. The majority of physicians declared that their religious faith influences their professional decisions, especially in difficult situations. The religiosity variable explains physicians' moral attitude better than the denomination (religious affiliation) variable. Physician-patient relation frameworks should take into account not only patients' but also physicians' cultural and religious beliefs.

Evaluation of the effectiveness of therapeutic massage in patients with neck pain.

BACKGROUND: Neck pain is one of the most common musculoskeletal ailments. The aim of this study was to evaluate the effectiveness and impact of therapeutic massage on the range of motion in patients with neck pain. MATERIAL AND METHODS: The study involved 60 patients aged 37-82 years (mean age: 62.8 ± 9.86 years) treated for neck pain at the Rehabilitation Department of Zamosc University of Management and Administration. The patients were divided into two groups: one (30 persons) received kinesiotherapy and physiotherapy, and the other group (30 persons) additionally received therapeutic massage. The effectiveness of rehabilitation was assessed with a Saunders digital inclinometer, the Neck Disability Index (NDI) and a Visual Analogue Scale (VAS). RESULTS: Both groups did not differ significantly in terms of NDI and VAS scores at baseline (NDI: p = 0.56, VAS: P = 0.231) and after rehabilitation (NDI: p = 0.203; VAS: P = 0.401). The NDI questionnaire and VAS revealed a significant pain reduction (p <0.001), and improved performance and function (p <0.001) after rehabilitation in both groups. Patients who had received massage demonstrated a statistically significant improvement in the range of flexion (p = 0.022), lateral bend to the right (p = 0.018), and lateral bend to the left (p = 0.003). CONCLUSIONS: 1. Therapeutic massage increases ranges of motion. 2. The effectiveness of therapeutic massage is comparable to the effectiveness of rehabilitation based only on physical therapy and kinesiotherapy.

Biobank research and ethics: the problem of informed consent in Polish biobanks.

INTRODUCTION: The dynamic development of biobanks causes some ethical, social, and legal problems. The most discussed problems are obtaining informed consent, especially for future research, from minors and from deceased people. The aim of this article is to present the current standards held by Polish biobanks concerning obtaining a participant's informed consent in some aspects. MATERIAL AND METHODS: Survey was carried out by anonymous questionnaire among 59 institutions which deal with the collecting and storage of human cells and tissues in the year 2008. Twenty four filled-in copies of the questionnaires were sent back (return=41%). RESULTS: Almost every institution (92%) obtains written consent, but a third of the surveyed institutions (29%) do not obtain consent for the future use of the samples. The majority of the respondents (83%) support the idea of using biological materials for research purposes of a donor who died if he did not leave any written objection to such practices and 46% of respondents stated that biobanks should obtain the consent from the already mature donor who gave their samples as a child. CONCLUSIONS: The practice and rules for obtaining informed consent for the scientific research require improvement. The possibility to use the human materials in the future, conditions for getting access to the data, the possibility of their withdrawal from the database and using the materials and data after the death of the donor should be clearly determined when the informed consent to collect the material is obtained.

Evaluation of the effectiveness of short-term rehabilitation of women with chronic low back pain using the Oswestry and Roland-Morris Disability Scales.

BACKGROUND: 60-80% of the population experience chronic low back pain at some point in their lives [1], with women suffering more frequently [2]. Low back pain-related ailments lead to long-term or recurrent disability [3, 4]. Rehabilitation based on physiotherapy provides a viable alternative and is rightly regarded as safer for patients. However, finding an effective method of rehabilitation is a difficult task [5, 6]. The aim of this study was to compare the outcomes of rehabilitation in women with chronic low back pain using the Oswestry and Roland-Morris Disability Scales and to identify factors influencing the degree of functional disability in patients with chronic low back pain. MATERIAL AND METHODS: The study involved 319 women aged 18-75 years (mean age = 45 years, SD ± 16. 3). The participants were undergoing treatment at the Rehabilitation Centre of Zamosc University of Management and Administration on account of chronic low back pain, following two or more episodes lasting longer than three months. The outcomes of rehabilitation were assessed with ODI and RMDQ. RESULTS: We obtained comparable results with the ODI and RMDQ and found statistically significant improvement in functional status after rehabilitation (ODI: p <0.001, RMDQ: p <0.001). In both cases there was a statistically significant relationship between the degree of functional disability and age (ODI: p <0.001, RMDQ: p <0.001), education (ODI: p <0.004, RMDQ: p <0.004), BMI (ODI: p <0.001, RMDQ : p <0.001), WHR (ODI: p <0.001, RMDQ: p <0.001), and hypertension (ODI: p <0.001, RMDQ: p <0.001). There were no statically significant differences between the degree of disability vs. place of residence (ODI: p <0.5, RMDQ: p <0.867) or the presence of type 2 diabetes (ODI: p <0.321, RMDQ: p <0.06). CONCLUSIONS: 1.The programme for rehabilitation of patients with low back pain proved effective in reducing the degree of disability, as demonstrated both by the Oswestry Disability Index and the Roland-Morris Disability Questionnaire. 2. The relationship between the degree of functional disability and age, BMI, WHR, and hypertension was also confirmed by both questionnaires.