Effect of COVID-19 on Kidney Graft Function One Year after Onset.

Background and Objectives: Kidney transplant recipients (KTRs) are at a higher risk of severe COVID-19 development. The course of the infection may vary. Long-term consequences for graft function are still being studied. We investigate whether the clinical course of SARS-CoV-2 infection among KTRs had a long-term effect on graft function. Patients and method: 128 KTRs with confirmed SARS-CoV-2 infection were included in the study. They were divided into two groups: mild (without the need for oxygen therapy; n = 91) and severe (with the need for oxygen therapy; n = 21). Baseline characteristics and medical data, especially creatinine level, estimated glomerular filtration rate (eGFR) CKD-EPI, and proteinuria, were analyzed. The main outcomes were the absolute and relative change in eGFR during the one-year follow-up after COVID-19. In the final models, sex, age, smoking, presence of diabetes mellitus (DM), and cardiovascular disease (CVD) were included. Results: KTRs with severe COVID-19 were older, more likely to smoke, and had DM and CVD more frequently. Our analysis reveals that COVID-19 severity was associated with a significantly more pronounced relative eGFR decline one year after recovery only in males [-13.94 (95% CI: -25.13 to -2.76, p = 0.015) percentage points]. One year after the disease onset, males with a severe course of the infection had a higher eGFR decline than those with a mild one. The COVID-19 severity did not affect eGFR loss in females. Conclusions: In KTRs suffering from COVID-19, deterioration of graft function was noticed. The eGFR decline was associated with disease severity and sex. It indicates a need for further research, observation, and preventive actions for KTRs, especially males.

Screening for Polyomavirus Viruria Like Early Detection of Human Polyomavirus Infection and Replication: The Results of a Single-Center Observation.

BACKGROUND: Polyomavirus (PV) infection and PV-associated nephropathy (PVAN) are some of the most important problems in kidney transplantation. PURPOSE: Our objective was to determine the incidence of PV viruria and PV replication in single-center Polish kidney transplant recipients (KTR). METHODS: Urine samples from 155 cadaveric KTR were analyzed for PV viruria using quantitative real-time polymerase chain reaction and the patients were followed prospectively. The PV replication was recognized when the urine level was >107 PV DNA copies/mL of urine. RESULTS: Based on the PV DNA analysis, the patients were divided into 3 groups: Group 1 (n = 87; 56.1%) without viruria, Group 2 (n = 44; 28.4%) with viruria but without PV replication, and Group 3 (n =24; 15.5%) with PV replication. The presence of PV viruria was correlated with the type of immunosuppressive regimen, strongly associated with tacrolimus intake. There was no correlation between viruria and mycophenolate daily dose in the study population. In Group 3 there were 6 patients (3.9%) with high viruria (>1010 copies/mL), and 5 patients from this group had confirmed PVAN in allograft biopsy. CONCLUSIONS: The prevalence of BK virus infection in KTR is similar to that reported in studies from other countries. We confirmed that PV viruria can be both a good screening for PV infection and a good predictor of PVAN. Tacrolimus was the most important predictor of PV viruria and PV replication in KTR.

The relation of fibromyalgia and fibromyalgia symptoms to self-reported seizures.

OBJECTIVE: Several epidemiological and clinical reports associate fibromyalgia (FM) with seizure disorders, and clinical studies associate FM diagnosis with psychogenic non-epileptic seizures. However, these associations rely on self-reports of being diagnosed with FM or unstandardized clinical diagnosis in combination with small samples. We investigated the association of FM and self-reported seizures using a large rheumatic disease databank and the current established self-reported, symptom-based FM diagnostic criteria. METHODS: We selected a random observation from 11,378 subjects with rheumatoid arthritis (RA), 2,390 (21.0%) of whom satisfied 2016 revised criteria for FM. Patients were inquired about the presence of any kind of seizures in the previous 6 months, anti-epileptic medications, and patient-reported symptoms and outcomes. RESULTS: Seizures were reported by 89 RA patients who met FM criteria (FM+) and by 97 patients who did not (FM-), resulting in an age- and sex-adjusted seizure prevalence of 3.74 (95% CI 2.95 to 4.53) per 100 FM+ subjects and 1.08 (95% CI 0.87 to 1.30) in FM- subjects. The seizure odds ratio of FM+ to FM- cases was 3.54 (95% CI 2.65 to 4.74). Seizures were associated to a very similar degree with symptom reporting (somatic symptom count and comorbidity index) as to FM diagnosis variables. RA patients reporting seizures also reported worse pain, quality of life, and functional status. Seizure patients treated with anti-seizure medication had worse outcomes and more comorbidities than seizure patients with no seizure drugs. CONCLUSIONS: We found a significant and similar association of both FM diagnostic variables and FM-related symptom variables, including the number of symptoms and comorbidities, with self-reported seizures in people with RA. The observed association was similar to those found in previous studies of symptoms variables and seizures and does not suggest a unique role for fibromyalgia diagnosis. Rather, it suggests that multi-symptom comorbidity is linked to seizures in a complex and not yet clearly understood way. As the current study relied on self-reported seizures and was not able to distinguish between epileptic and psychogenic nonepileptic seizures, future studies are needed to replicate the findings using both validated FM criteria assessments and clinically verified diagnoses of epileptic and psychogenic seizures.

Gastrointestinal Pathologies in Patients After Successful Renal Transplantation.

BACKGROUND: Kidney transplantation (KT) is the most desired and cost-effective modality of renal replacement therapy for patients with chronic kidney failure. KT protects the patient from complications that may develop during chronic dialysis. Unfortunately, evidence also suggests that KT patients are more prone to developing cancer than healthy persons. Many complications after renal transplantation can be prevented if they are detected early. The aim of this study was to evaluate the prevalence of gastrointestinal pathologies in patients after KT. METHODS: Adult patients after KT who are under the care of the Outpatient Department of Nephrology at the Medical University of Gdansk, Poland, received alarm symptom questionnaires and referral for testing for the presence of fecal occult blood. Then, in 58 selected patients (36 men and 22 women), endoscopic examination was performed. Mean age was 57.34 ± 10.1 (range, 35-83) years. RESULTS: Out of 940 patients after KT, resting under supervision of the Outpatient Department, 208 patients completed the questionnaire and 118 gave a stool sample for testing: 40 results were positive. After analyzing the questionnaires and stool results, 100 patients qualified for further investigation. The endoscopic examination had been performed so far in 58 patients and revealed gastritis and/or duodenitis in 49 patients, diverticular colon disease in 26, esophagitis in 8, colon polyps in 16, stomach polyps in 4, inflammatory bowel disease in 12, and cancers in 3. CONCLUSIONS: The preliminary results indicate that patients after KT have significant risk of gastrointestinal pathologies and require detailed diagnostic endoscopy.

Analysis of preoperative blood platelet parameters in terms of diversity of epithelial ovarian cancer.

Smouldering inflammation, thrombocytosis, and platelet hyper-reactivity are linked to malignancy. The relationships between preoperative diagnostic blood morphology parameters and cancer have been the focus of much interest, because some of these parameters are correlated with advanced cancer stages and poor patient survival rates. This study aimed to perform an observational, retrospective analysis of the intradiversity of blood platelet parameters in patients with different International Federation of Gynaecology and Obstetrics (FIGO) stages and different histological types of epithelial ovarian carcinomas (EOC), and also an analysis of the overall survival rate.In all, 94 EOC patients were included in this analysis (23 mucinous, 33 serous, 20 undifferentiated, 14 endometrioid, and 4 clear cell carcinoma cases). Peripheral blood samples were collected and analyzed before drug or surgical treatment.The platelet-to-neutrophil ratio (PNR) was related to the histological type of EOC, particularly mucinous carcinoma. In patients with mucinous cancer, the PNR was significantly lower compared with patients with nonmucinous cancer, and this parameter distinguished between mucinous and nonmucinous groups of patients (area under receiver-operating characteristic [ROC] curve 0.721 ±â€Š.056; sensitivity 82.6%; specificity 61%; P < .001; ROC analysis), regardless of the FIGO stage. Moreover, elevated PNR values were correlated with lower survival rate of EOC patients.The reduced PNR, similar to the lower level of cancer antigen 125, is characteristic for mucinous ovarian carcinoma patients. Moreover, elevated PNR index might correlate with poor survival of patients.

Chronic kidney disease in Polish elderly population aged 75+: results of the WOBASZ Senior Survey.

PURPOSE: Kidney filtration decreases with age, which results in an increased frequency of chronic kidney disease (CKD) in the elderly population. The purpose of the study was to assess the prevalence and epidemiology of CKD in the Polish elderly population. METHODS: A representative sample of the Polish elderly population, composed of 918 people (F 452, M 466) in the age of ≥75 years, was chosen. All participants had their history, anthropometric measures and biochemical parameters (creatinine, fasting glucose, complete cholesterol) evaluated. CKD was diagnosed when eGFR was <60 ml/min/1.73 m2. The comorbidities, anthropometric and social factors connected with the onset of CKD were also analyzed. RESULTS: The prevalence of CKD in the analyzed population was 26.9% (F 32.0%, M 15.8%), which gives an estimated number of 495,590 (95% CI 396,363-594,817) patients in the study subpopulation. The majority of these people were in the G3A category-70.1%, while the remaining fell under the G3B-25.7%, G4-3.1% and G5-1.1% categories. Disease awareness among the participants was found to be at 17%. Arterial hypertension (AH) was more frequent in people with CKD (91.0 vs. 80.3%, P < 0.001), whereas diabetes mellitus (DM) prevalence was comparable in both CKD and non-CKD groups (11.7 vs. 11.4%, ns). In the examined group, DM had no influence on the frequency of CKD. In contrast, the presence of cardiovascular diseases substantially increased the chances of developing CKD (OR 1.87, P < 0.05). CONCLUSION: 1. The prevalence of CKD in the Polish elderly population was 26.9%. 2. Awareness of CKD is low. 3. DM, increasing age and AH did not increase the risk of CKD. 4. Coexistence of cardiovascular diseases increased the risk of having CKD.

Abnormal muscle membrane function in fibromyalgia patients and its relationship to the number of tender points.

OBJECTIVES: Fibromyalgia (FM) is a disorder characterised by chronic widespread pain in soft tissues, especially in muscles. Previous research has demonstrated a higher muscle fibre conduction velocity (CV) in painful muscles of FM patients. The primary goal of this study was to investigate whether there is also a difference in CV in non-painful, non-tender point (TP) related muscles between FM patients and controls. The secondary goal was to explore associations between the CV, the number of TPs and the complaints in FM. METHODS: Surface electromyography (sEMG) was performed on the biceps brachii muscle of female FM patients (13) and matched healthy controls (13). Short static contractions were applied with the arm unloaded and loaded at 5% and 10% of maximum voluntary force. The CV was derived by cross-correlation method (CV-cc) and inter-peak latency method (CV-ipl). TP score and Fibromyalgia Impact Questionnaire (FIQ) were performed in all participants. Correlations were calculated between the CVs, TP score and items of the FIQ. RESULTS: In FM patients, the CV was higher than in the controls (CV-cc p=0.005; CV-ipl p=0.022). The CV was correlated with the number of TPs in FM patients (r=0.642 and 0.672 for CV-cc and CV-ipl, respectively). No correlations were found between the CV and any aspect of health status on the FIQ. CONCLUSIONS: The results demonstrate abnormally high muscle membrane conduction velocity in FM, even in non-TP muscles. In addition, a relationship has been found between the high membrane velocity and the number of TPs.

Muscle fiber velocity and electromyographic signs of fatigue in fibromyalgia.

INTRODUCTION: Fibromyalgia (FM) is a disorder of widespread muscular pain. We investigated possible differences in surface electromyography (sEMG) in clinically unaffected muscle between patients with FM and controls. METHODS: sEMG was performed on the biceps brachii muscle of 13 women with FM and 14 matched healthy controls during prolonged dynamic exercises, unloaded, and loaded up to 20% of maximum voluntary contraction. The sEMG parameters were: muscle fiber conduction velocity (CV); skewness of motor unit potential (peak) velocities; peak frequency (PF) (number of peaks per second); and average rectified voltage (ARV). RESULTS: There was significantly higher CV in the FM group. Although the FM group performed the tests equally well, their electromyographic fatigue was significantly less expressed compared with controls (in CV, PF, and ARV). CONCLUSION: In the patients with FM, we clearly showed functional abnormalities of the muscle membrane, which led to high conduction velocity and resistance to fatigue in electromyography.

The prevalence of risk factors for atherosclerosis among middle school students in Sopot, Poland: results of the SOPKARD 15 programme.

BACKGROUND: SOPKARD 15 is a comprehensive programme to assess the health status of a population of teenagers. The aspects assessed in the study are: physical development, nutritional status, arterial blood pressure, lipid and carbohydrate metabolism, oral hygiene, and psychological parameters. AIM: To assess the prevalence of cardiovascular risk factors in the study population. METHODS: We examined 372 children (185 girls) at the age of 14. The cut-off values for normal lipid blood levels were based on the NCEP-Peds guidelines. Body mass index was assessed on the basis of the Polish centile charts. Blood pressure values assessed against the centile charts were the mean values calculated on the basis of the second and third measurements. RESULTS: Systolic and diastolic blood pressure values were elevated in 15.81% and 10.90% of the subjects, respectively. Abnormal blood glucose was detected in fewer than 6% of the children. Total cholesterol was elevated in 8% and borderline in 24% of the subjects; 8.5% of children were overweight and 7.4% were obese; 5.0% of the subjects took very little physical exercise; 16.4% of boys and 23.4% of girls admitted smoking. Dental examination revealed inflamed gums in 77.6% of the subjects. The diagnosis of a depressive episode was confirmed in 4.2% of the teenagers. CONCLUSIONS: 1. Due to the high prevalence of the risk factors there is a need to launch a comprehensive cardiovascular prevention programme among the teenagers. 2. A considerable proportion of children with lipid abnormalities indicate the need for more frequent lipid profile testing in children.

Aging or comorbid conditions - what is the main cause of kidney damage?

BACKGROUND: Chronic kidney disease (CKD) is widespread in the general population. It is generally accepted that worsening renal function is common with aging. However, the question still remains whether it is caused by the natural process of aging or whether coexisting chronic diseases and comorbid conditions contribute to deteriorating renal function. METHODS: The frequency of albuminuria-the marker of early kidney damage-was evaluated according to different coexisting conditions in younger (18/64 years old, n=2,074) and elderly (=65 years old, n=395) participants of the Polish study PolNef on early detection of CKD. Multivariate logistic regression was performed to identify associations between elevated levels of albuminuria, age and coexisting conditions. RESULTS: 12% of the younger group demonstrated albuminuria compared to 18% of the elderly. Independent predictors of detecting an elevated level of albuminuria for the whole examined population were male gender (2.48, 1.59-3.88), hypertension ineffectively treated (1.8, 1.34-2.4), diabetes (1.67, 1.11-2.49), and age (1.56, 0.97-2.52) at border levels of significance. Moreover, elevated levels of albuminuria occurred more frequently in the obese elderly group (1.89, 0.98-3.63, p=0.058). The following predictors were found based on gender: for men, hypertension regardless of efficacy of treatment, diabetes, smoking, and age at border level of significance, in contrast to women who had the sole predictor of ineffectively treated hypertension. CONCLUSIONS: The influence of aging alone on kidney damage is not evident. Moreover, it is different in males and females. Hypertension is the only coexisting comorbid condition contributing to kidney damage in both males and females. Advanced age together with comorbid conditions is more harmful to the kidney in males.

Early detection of chronic kidney disease: results of the PolNef study.

BACKGROUND: Continuous increase in the number of patients with end-stage renal disease demands early detection of chronic kidney disease (CKD). The aim of the present study was to diagnose CKD in its earliest stages in a randomly selected population using a diagnostic algorithm developed by the working group. METHODS: An algorithm for the diagnostic procedure was created to identify patients with CKD requiring further nephrological care. Randomly chosen adult inhabitants of a city with a population of 60,000 were invited to participate in this study. Screening procedures included a microalbuminuria dipstick test accompanied by blood pressure measurement and medical questionnaire. In further diagnosis of CKD, estimated glomerular filtration rate (eGFR), albumin concentration in urine, urinalysis and ultrasound examination were used according to the algorithm. Multivariate logistic regression was performed to identify associations between participants' characteristics and albuminuria. RESULTS: Out of 9,700 invited subjects, 2,471 individuals participated in the PolNef study. Albuminuria was detected in 15.6% of the investigated population using the dipstick test and thereafter confirmed in 11.9% by the turbidimetric method. The modeling of multivariate logistic regression indicated the following independent predictors of albuminuria: male sex, diabetes, nocturia and hypertension. For people without diabetes and without hypertension, nocturia independently predicted detection of albuminuria. 481 people received a consultation with a nephrologist, and 96% of them were recognized as having CKD. At least 9% of patients with CKD had eGFR by MDRD <60 ml/min/1.73 m(2). Six persons were referred for further treatment because of newly diagnosed kidney tumor. CONCLUSIONS: CKD in early stages occurs frequently in the studied population. The proposed diagnostic algorithm seems to be a powerful tool to identify subjects at risk of CKD. The role of nocturia as an independent predictor of albuminuria, both in the general population and in people without diabetes or hypertension, should be further examined.

[Program of early diagnosis of chronic renal disease in children--SopKard 15 nephrological project]. / Zalozenia programu wczesnego wykrywania przewleklej choroby nerek u mlodziezy--SopKard 15 modul nefrologiczny.

The Sopot Program of Cardiac Infarct and Stroke Prevention--SopKard 1999-2009 was established for health promotion to decrease cardio-vascular diseases mortality. To serve these purposes a new project SopKard 15 for adolescents was created. The main aim of SopKard 15 is evaluation of health status with particular attention to risk factors of civilization diseases, with chronic kidney disease (CKD) among them. In population of 14-year-old students a complex nephrological examination including medical history, blood pressure measurements, ultrasound examination, and laboratory tests with e.g. albuminuria, urinalysis, and serum creatinine and cystatin C levels was performed. Nephrology part of Program SopKard 15 aspired to early detection of CKD and verifies normal value for this age group.

Current diagnostic evaluation of autosomal dominant polycystic kidney disease.

Despite changing epidemiology of chronic kidney disease, autosomal dominant polycystic kidney disease (ADPKD) is one of the most prevalent causes of end stage renal disease. The first symptoms of the disease occur usually in the 3rd or 4th decade of life, however, it can often be diagnosed much earlier. Advances in the understanding of the disease may lead, in the near future, to slowing the progression of ADPKD in asymptomatic individuals. ADPKD is diagnosed on the basis of family history (autosomal dominant inheritance) and radiological imaging. Ultrasound examination (US) of the kidneys is the most important imaging diagnostic method. US is highly sensitive and specific in patients >30 years of age. In US, Ravine criteria are applied and their modifications with other imaging techniques (computed tomography [CT], magnetic resonance [MR]). In all cases, however, there are multiple cysts in both kidneys and, importantly, concomitant renal enlargement can be observed, which is typical of ADPKD. High expectations for early ADPKD diagnosis are risen by genetics and proteomics. However, these methods are not used routinely. The most sensitive parameter in the evaluation of the disease progression is total renal volume. This parameter is presently used in clinical studies, but its utility in monitoring an individual patient has not been fully proven. Unfortunately, MR and CT are expensive and in case of significantly enlarged kidneys US does not yield accurate assessment of their size and is not sensitive enough for monitoring the disease progression. The rate of glomerular filtration rate (GFR) decline is usually constant. Therefore, it is important to monitor GFR in individuals who have developed renal insufficiency. Other tests, including markers of kidney injury, e.g. albuminuria, or vascular flow parameters, are used mainly in clinical studies. Thus, before more efficient therapeutic approaches have been developed, an early diagnosis and prevention of the disease complications are most essential.

Effectiveness of antihypertensive treatment in patients with chronic kidney disease.

OBJECTIVE: Hypertension is closely associated with chronic kidney disease (CKD) and is one of the main factors of progression of CKD. Early detection of CKD allows introducing a therapy that slows the progression of CKD. SETTING: A prevalence of hypertension and effectiveness of its treatment were assessed during the accomplishment of the Program for Early Detection of CKD in Poland (PolNef). RESULTS: In 456 of a total of 2476 participants of PolNef program (269 females, 187 males), CKD was recognized. Diagnosis of CKD was made according to classification proposed by K/DOQI and KDIGO. Estimated glomerular filtration rate (eGFR) from serum creatinine, albuminuria and ultrasound examination were the main diagnostic tools. Hypertension was defined on the basis of actual antihypertensive treatment or on the basis of medium value (> or = 140 and/or > or = 90) of three separate measurements of blood pressure. Frequency of hypertension and effectiveness of its treatment, frequency of overweight and obesity, microalbuminuria, and abnormalities in ultrasound examination of urinary system were studied. CONCLUSION: Of the CKD population, 68% were hypertensive, 21% remained without antihypertensive medication, and 22% on medication were effectively treated. Kidney insufficiency with eGFR below 60 ml/min/1.73 m2 was recognized in 9% of CKD population. Also, 63% of women and 39% of men without hypertension had normal body mass compared to 19% of people with CKD and hypertension. Microalbuminuria was found in 51% of women and 66% of men with CKD and hypertension. Increased echogenicity of kidney and simple cysts were detected significantly more often in hypertensive patients.

[Prevalence of congenitial kidney and urinary tract anomalies in neonates and infants with congenital heart disease]. / Wystepowanie wrodzonych anomalii ukladu moczowego u noworodków i niemowlat z wrodzona wada serca.

INTRODUCTION: Congenital heart diseases are the most frequent anomalies and one of the most important reasons of mortality and morbidity in neonates and infants. Coincidence of additional malformation aggravates prognosis. The frequency of incidence of other anomalies accompanying congenital hart diseases is defined as 11 to 45%. AIM: Estimation of the frequency of a coincidence of congenital kidney anomalies on the basis of the ultrasound examination (US) in children with congenital heart disease in first year of life. MATERIAL AND METHODS: Abdominal US were done in 350 neonates and infants hospitalized in Department of Pediatric Cardiology Medical University of Gdansk in the first twenty-four hours after diagnosis of congenital heart disease. Examinations were performed in 187 male (53%) and 163 female (47%) in average age 54.9 days (range from 1 to 349 days). RESULTS: In examined population congenital kidney anomalies were found in 4.9% of children from which 18% represent hipoplasia, and another 18% dysplasia. 15.3% of examined patients were diagnosed by dilatation of collecting system, whereof 3% mild, 7% moderate, and 5% severe degree. CONCLUSIONS: 1. The frequency of incidence of kidney anomalies and collecting system dilatation in the examined population of neonates and infants with congenital heart disease accounts for 20.2%. 2. Abdominal ultrasound screening with carefully examination of urinary tract should be performed in neonates and infants with congenital heart disease.

Remarks on surgical strategy in creating vascular access for hemodialysis: 18 years of one center's experience.

The aim of the study is to evaluate surgical methods for creating vascular access for hemodialysis (HD) in patients with chronic renal failure. Over the last 18 years, 1,827 surgical procedures were performed in 722 patients (399 men and 323 women, mean age 43.7 +/- 17 years) in order to provide and maintain permanent vascular access for HD. Among all the surgical procedures, 992 were based on the construction of arteriovenous fistulas (AVF) and 835 were undertaken as secondary reparative surgical procedures. A total of 992 vascular accesses have been performed, including 904 AVF on upper and 14 on lower extremities as well as insertion of 74 permanent catheters. Radiocephalic AVF (RCAVF) was the principal type of AVF (58.8%). While constructing secondary angio-access after using RCAVF on the other extremity, fistulas with usage of brachial vessels were preferred. A total of 228 AVF of this type were created, including 143 brachiocephalic (BCAVF) and 85 brachiobasilic (BBAVF) AVF. Lately, synthetic grafts (arteriovenous graft, AVG) have been used more frequently, in 90 AVF. A brachial straight graft was the main type procedure performed, with polytetrafluoroethylene (95.6%). The patency of the fistulas has been evaluated. Kaplan-Meier survival curves were calculated to determine primary, primary-assisted, and secondary patency. Log-rank analysis was used to determine differences between curves. Primary, primary-assisted, and secondary patency at 12 months and 24 months were calculated. Comparing AVF patency in two patients' age periods (18-65 years, >65 years), it may be concluded that in the elderly group AVG provides better treatment for AVF. Finally, we conclude that a multidisciplinary approach to vascular access strategy offers the best option to achieve good functional AVF. Autogenous arteriovenous access should be regarded as the most suitable type in creating VA. However, individual conditions should be taken into consideration.

[Early diagnosis of renal diseases--preliminary results from the pilot study PolNef]. / Wczesne wykrywanie chorób nerek--wstepne wyniki programu pilotazowego PolNef.

Continuous increase of the number of patients with chronic kidney failure which require renal replacement therapy, in Poland as all as over the world, demands the analysis of epidemiological situation concerning renal diseases. Early diagnosis of nephropathy permits not only an adequate treatment, but also facilitates the introduction of the therapy that slows the progression of kidney failure. The aim of the pilot study PolNef was an attempt to evaluate the epidemiology of renal diseases in Poland on the basis of a randomly selected population from a city numbering 60 thousand people. As a screening test, allowing to distinguish patients requiring further diagnostic of nephropathy, the microalbuminuria dipstick test accompanied by blood pressure measurement and questionnaire was accepted. Microalbuminuria was detected in more than 18% of the population investigated up till now. It was more frequent in male, in obese, and in smokers. More than 33% of all participants consulted by the nephrologist required permanent nephrological care and for the next 32% another nephrological consultation in 6 to 12 month should be ordered. Decreased clearance of creatinine was found in above 17% participants and 6 patients were referred for further treatment because of new diagnosis of renal tumor. Identification in investigated population patients with of an early stage of kidney disease needs further nephrological diagnosis and treatment is especially important from the point of view of every single patient and also may bring substantial economic benefits for health protection system as well.