[The role of slow low efficiency dialysis (sled) in renal replacement therapy].

Slow low efficiency dialysis (SLED) is a hybrid technique of renal replacement therapy. It can be performed with a mobile single-pass batch dialysis system (Genius®) or the multifunctional hemodialysis machines, with reduced dialysate flow and the extended duration of the procedure. The present article reviews the recently published data comparing SLED to continuous renal replacement modalities in critically ill patients with acute kidney injury (AKI). The technical aspects as well as the practical advantages of SLED-Genius®are discussed, and our experience of using SLED for intraoperative renal replacement therapy during liver transplantation is shortly presented.

Autologous peripheral blood stem cell transplantation in dialysis-dependent multiple myeloma patients-DAUTOS Study of the Polish Myeloma Study Group.

INTRODUCTION: Dialysis-dependent (DD) multiple myeloma patients (MM) have a poor prognosis and high tumour burden, thus may benefit from autologous peripheral blood stem cell transplantation (auto-PBSCT), however, these patients have an increased risk of toxicity. AIMS: To evaluate the outcomes (toxicity, PFS, OS) of high dose therapy followed by auto-PBSCT during an observational study and after propensity score matching. PATIENTS AND METHODS: Between 2004-2015, 24 DD patients, (aged 38-67 years), ISS 3, treated with auto-PBSCT, requiring dialysis at diagnosis and auto-PBSCT were evaluated, matched and compared to 55 normal renal function MM patients (NRF) with ISS 3 for outcomes of interest. RESULTS: In DD patients compared to NRF patients risk of mucositis (88% vs 55%), infection (79% vs 51%), parenteral nutrition (50% vs 24%), diarrhoea (71% vs 38%), prolonged duration of hospitalisation (medians: 30 vs 21 days), requirement for RBC transfusion (83% vs 36%) were significantly higher, while no significant differences were found in post-transplant response (ORR; 75% vs 87%), 5-year PFS (36% vs 20%) and OS (39% vs 50%). Subgroup analyses based on toxicity supported these results. CONCLUSIONS: Despite the increased risk of toxicity in DD patients these events do not significantly affect both the PFS and OS.

[Current approaches in the treatment of hyperphosphatemia in chronic kidney disease].

Hyperphosphatemia is a common finding in advanced chronic kidney disease (CKD) and is associated with increased morbidity and mortality. Optimal phosphate control in dialysis patients is a real challenge. In the article, the authors discuss the main phosphate-lowering approaches, such as a change of dietary habits with phosphate restriction and pharmacologic treatment. Several old and new currently available oral phosphate binders are reviewed with their advantages and disadvantages.

[Approach to recurrent urinary tract infections in women].

Recurrent urinary tract infections (rUTI), defined as ≥3 UTI/year or ≥2 UTI/half year, are among the most frequent bacterial infections in women and pose a significant clinical challenge to general practitioner. The main risk factors are: sexual activity with different partners, and - in postmenopausal women - urinary incontinence or incomplete voiding. In the article the current treatment and prevention strategies for rUTI are discussed.

[Metaphylaxis of urolithiasis - a neglected field in medicine?]

Urolithiasis is a common condition linked to lifestyle factors and its prevalence is increasing in Europe and United States. Nevertheless, recurrence of urinary stones can be effectively prevented by dietary and life style changes. The review focuses on general dietary recommendations as well as specific medical therapy for kidney stone formers.

[Advances in the management of renal cell carcinoma].

Renal cell carcinoma accounts for about 3-4% of all malignancies and its incidence is steadily rising. The article presents in short the rationale behind the targeted therapies and provides an update on current therapeutic approaches to metastatic renal cell carcinoma. It also summarizes the most recent developments in the immunotherapy such as immune checkpoint inhibitors, anti-cancer vaccines and chimeric antigen receptors on T cells.

[Renal diseases in malignancies]. / Choroby nerek w przebiegu nowotworów zlosliwych.

Malignancies may be associated with a variety of renal complications. These include: acute kidney injury, chronic tubulointerstitial and vascular pathologies as well as paraneoplastic glomerulonephritis. Membranous nephropathy consists a main paraneoplastic glomerulopathy in solid tumors, and minimal change disease is the most common in haematologic malignancies, especially in Hodgkin lymphoma. Epidemiology, pathogenesis, clinical manifestations and management of these conditions are described in the paper.

[Renal diseases in monoclonal gammopathies]. / Choroby nerek w przebiegu gammapatii monoklonalnych.

Monoclonal gammopathies are a group of diseases caused by proliferation of a single clone of plasmocytes - or lymphoplasmacytic cells producing a monoclonal protein. Renal failure occurs in 20-50% of the patients with multiple myeloma, with myeloma cast nephropathy being its major cause. The other mechanisms of kidney injury include hypercalcemia, AL amyloidosis, light chain deposition disease and others. Patients who develop renal impairment have worse survival than those with normal kidney function. This article discusses the pathogenesis, evaluation and therapy of the renal diseases due to monoclonal gammopathies.

[Nephrological complications in infectious and tropical diseases]. / Powiklania nefrologiczne w chorobach zakaznych i tropikalnych.

Infections cause approximately 1/3 of acute kidney injury (AKI) cases and a substantial number of chronic and end-stage renal failure. Renal disease may also be a side effect of antimicrobial agents. In turn, people suffering from kidney diseases, especially requiring renal replacement therapy are predisposed to severe infections often of atypical clinical course.

[Acute kidney injury in liver transplantation]. / Ostre uszkodzenie nerek u pacjentów poddawanych przeszczepieniu watroby.

Acute kidney injury (AKI) is a common complication in liver transplant recipients. Affecting ~25% of patients preoperatively, and up to 60% postoperatively significantly worsens the prognosis. Etiology differs depending on the time of its onset, from mostly prerenal before the transplantation, ischemic in the early postoperative period to toxic AKI later on. Liver transplantation is a lenghty and complex procedure with a significant risk of hemodynamic instability, metabolic acidosis and electrolyte disturbances. The article discusses the risk of AKI development in patients undergoing liver transplanation and the indications to renal replacement therapy in the perioperative period.

[Anti-cancer agents nephrotoxicity]. / Nefrotoksycznosc leków przeciwnowotworowych.

Nephrotoxicity remains an important complication of chemotherapy. There are many different types of kidney injury that can results from anti-cancer drugs, including: acute and chronic tubular injuries, various podocytopathies, crystal nephropathies, thrombotic microangiopathy, and electrolyte wasting syndromes. All these pathologic changes, their diagnosis and treatment, as well as the preventive measures are shortly summarized in the article.

[Tumor lysis syndrome]. / Zespól lizy guza.

Tumor lysis syndrome (TLS) is a serious adverse event observed in patients treated for hematologic malignancies and solid tumors, particularly those with a high proliferative rate. An abrupt and massive tumor cell lysis with release their contents into the circulation leads to a rapid development of hyperuricemia, hyperkalemia, hyperphosphatemia, followed by hypocalcemia. If not managed appropriately, these metabolic disturbances may result in acute kidney injury and in life-threatening cardiac complications and even death. This short review summarizes current strategies for diagnosis, risk assessment, prophylaxis, and therapy.

[Safe and effective diuretic use in chronic kidney disease]. / Jak skutecznie i bezpiecznie leczyc moczopednie chorego z przewlekla choroba nerek?

Recent epidemiological studies show significant prevalence of chronic kidney disease (CKD) in the general population. Diuretics are critical in therapy ofvolume overload and hypertension commonly encountered in these patients. However, they frequently demonstrate relevant diuretic resistance, and from the other hand diuretic overdose may lead to dehydratation and worsening of kidney function. In this paper the main principles of diuretic treatment in CKD are described, including the diuretic agent and its dose selection, as well as adverse effects of the therapy.

Outcomes of Combined Liver-Kidney Transplantation - Single Center Experience.

BACKGROUND: There is continuous growth of combined liver-kidney transplantation (CLKTx) numbers with remarkable outcomes, especially among patient with liver cirrhosis and end-stage renal disease. The aim was to present a single center experience. METHODS: Twenty patients (9 males) with a mean age of 48 (range: 20-62) years underwent CLKTx from 2005 to 2022. Indications were polycystic liver and kidney diseases (ADPKD) in 12 cases, cirrhosis due to hepatitis (4 patients), and 1 case of amyloidosis, alcoholic liver disease, nonalcoholic steatosis, and congenital hepatic fibrosis with concomitant glomerulonephritis. After hepatectomy, half of the patients had orthotopic liver transplantation with piggy-back technique, and the other had conventional technique. All but 1 recipient had biliary end-to-end anastomosis. 3 patients had preemptive kidney graft transplantation. 4 underwent simultaneous right-side nephrectomy due to volume of the right kidney. Kidney was transplanted from the separate incision after abdominal closure with typical anastomoses. Tacrolimus, mycophenolate mofetile, basiliximab, and steroids were applied for all recipients. RESULTS: Mean follow-up was 57.7 ± 54 months. No primary non-function of the grafts occurred. Delayed kidney graft function (DGF) occurred in 8 patients. Three-month, 1-year, and 5-year cumulative survival rates were: 90%, 80%, and 72% respectively. None of the patients required retransplantation, and 1 recipient returned to hemodialysis 19 months after transplantation. Preemptive kidney transplantation and simultaneous right-side nephrectomy were not significant for DGF and recipient survival. No deaths within the first year occurred in piggy-back technique. CONCLUSIONS: CLKTx is safe and effective in the treatment of both liver and kidney failure.

[Magnesium homeostasis disorders: hypomagnesemia]. / Zaburzenia homeostazy magnezu: hipomagnezemia.

Physiologically, magnesium plays an essential role in bone formation, neuromuscular stability and muscle contraction, and the consequences of its altered homeostasis may be serious. Magnesium deficiency and hypomagnesemia are common and under-recognized problems, which can cause a variety of symptoms and can also affect the other cations metabolism. In this review causes, clinical picture and management of hypomagnesemia and magnesium deficiency are discussed.

[Magnesium homeostasis disorders: hypermagnesemia]. / Zaburzenia homeostazy magnezu: hipermagnezemia mia.

Hypermagnesemia, defined as a plasma total magnesium concentration greater than 1.2 mmol/l, is much less common than hypomagnesemia, however it may be also life-threatening. In this review causes, clinical presentation and treatment of hypermagnesemia is shortly reviewed.

[Alkalosis]. / Zasadowica.

An elevation of arterial blood pH called alkalosis remains an underestimated condition in hospitalized patients. Serious alkalosis can be associated with high risk of death. The disorder can be caused by increased concentration of bicarbonate (metabolic alkalosis) or decreased concentration of carbon dioxide (respiratory alkalosis). In most cases of metabolic alkalosis it is generated by vomiting or diuretic use, whereas respiratory alkalosis is provoked by hyperventilation associated with respiratory or neurological disorder. Maintenance of metabolic alkalosis is possible only in patients with impaired renal base excretion which is most often produced by hypochloremia. In both respiratory and metabolic alkaloses treatment depends on the underlying factor. In hyperventilation syndrome is based on behavioral therapy. In most cases of metabolic alkalosis the administration of sodium and potassium chloride forms a substantial part of therapy.

[Magnesium homeostasis]. / Homeostaza magnezu.

Magnesium is the second most prevalent intracellular cation, which plays a critical role in many cellular processes, essential for life, especially for neuromuscular functioning, cardiovascular health and normal bone formation. Its homeostasis is tightly regulated by a dynamic interplay between intestinal absorption and renal excretion. Additionally, it is controlled through the reservoir in bone tissue. This review summarizes shortly the current knowledge of magnesium homeostasis important for the practitioner to better understand it's disorders.

[Renal amyloidosis]. / Amyloidoza nerek.

Amyloidoses form a group of diseases in which extracellular insoluble fibrils cause organ injury and failure. These aggregates are built of misfolded proteins. Current amyloidosis classification is based on the type of the precursor amyloid protein. Distribution of the amyloid fibrils can be localized or systemic. The two most common systemic diseases are: amyloid light chain (AL) amyloidosis, being a consequence of clonal expansion of plasma cells in the bone marrow, and amyloid A (AA) amyloidosis, secondary to chronic inflammatory disorders. Renal involvement remains a frequent clinical manifestation of both of them with clinical pattern of massive proteinuria and progressive renal failure. Early diagnosis and treatment is essential because of the progressive character of the disease. The goal of current treatment approaches is to decrease the amount of amyloidogenic proteins and depends on its type. Systemic amyloidosis remains a disease with poor prognosis, especially in patients with cardiac involvement.

Simultaneous Liver-Kidney Transplantation and the Use of Intraoperative Dialysis: A Monocenter Study.

BACKGROUND: Simultaneous liver and kidney transplants (SLKT) represent 1.1% of all liver transplants in Poland. Patients undergoing SLKT experience a longer operation time and concurrent kidney dysfunction may aggravate metabolic derangement associated with the procedure. The benefits of intraoperative dialysis (ioHD) in these patients have not been determined. METHODS: A retrospective observational study of all adult patients undergoing SLKT in our center from January 2009 till December 2016. RESULTS: Study group consisted of 10 patients with End-Stage Kidney Disease (0.9% of all liver transplants): 6 patients treated with ioHD during SLKT (group 1) and 4 patients managed conservatively (group 2). All recipients were on chronic dialysis. The mean calculated Model for End-Stage Liver Disease score was 21 ± 0.9 in group 1 and 30 ± 9.5 in group 2 (P = .009). The mean preoperative serum potassium was 4.7 ± 0,6 mmol/L in group 1 and 3.97 ± 1,02 in group 2. Intraoperative serum potassium levels were comparable between the groups, but the maximum lactate and minimum bicarbonate levels were significantly worse in group 2. Postreperfusion syndrome occurred in no patient. Dialysis circuit clotting occurred in 50% of ioHD. Six patients (2 in group 1) required renal replacement therapy after SLKT; no patient was on dialysis on discharge. Three patients died within 1 year after surgery (2 in group 2). CONCLUSIONS: No patient developed intraoperative hyperkalemia or postreperfusion syndrome. We observed a high frequency of circuit system clotting during ioHD. Clinical benefits of intraoperative hemodialysis during SLKT need to be determined in a larger study.