[Influence of hemoglobin level and dose of administered recombinant human beta erythropoietin on survival of hemodialysis patients].

BACKGROUND/AIM: In patients with end-stage renal disease, treatment with erythropoietin lowers cardiovascular morbidity, improves quality of life and patient survival. The aim of this study was to determine the difference in survival of hemodialysis patients treated with recombinant human beta erythropoietin and patients without this treatment, and to determine the influence of hemoglobin level and erythropoietin dose on the survival of these patients. METHOD: The study included 291 patients undergoing maintenance hemodialysis, 122 were on erythropoietin therapy, 169 patients formed control group. The study was performed at the Clinic for Nephrology and Clinical Immunology, Clinical Center of Vojvodina, during a 69-month period. We analyzed basic demographic parameters, dialysis duration, underlying disease, comorbidities, death causes, blood-work parameters and erythropoietin dosage. Descriptive statistics, Anova, Manova, discriminant function analysis, Cox regressional model and Kaplan Meier survival curves were used as statistical methods. RESULTS: Average age and dialysis duration in the experimental group were 47.88 +/- 13.32 years, and 45.76 +/- 46.73 months, respectively and in the control group 58.73 +/- 12.67 years and 62.80 +/- 55.23 months, respectively. Average level of hemoglobin and hematocrit in the group in which erythropoietin had been administered was 11.40 +/- 8.39 g/dL and 0.35 +/- 0.04/L, while the control group these values were 8.52 +/- 7.73 g/dL and 0.26 +/- 0.04/L, respectively. Average monthly dosage of erythropoietin was 21 587 +/- 10 183.36 IJ/month. Significant difference in survival was determined (p < 0.05) between the stated patient groups. A significant difference (p < 0.05) was found in survival of the patients in which erythropoietin was administered regarding hemoglobin level (< 100 g/L/100-110 g/L/110-120 g/L/ > 120 g/L), as well as in regard of erythropoietin dose applied (< 20 000 IJ/20 000-40 000 IJ/ > 40 000 IJ/month). CONCLUSION: Best survival was noted in patients with hemoglobin > 120 g/L and erythropoietin dose < 20 000 IJ/month.

Relation between personality dimensions and depressive symptoms in patients on hemodialysis.

The aim of the study was to investigate the relationship between the presence of depressive symptoms and certain dimensions of personality in hemodialysis patients. The study included 93 subjects of both sexes, aged 24-78 years. All subjects were undergoing hemodialysis treatment for terminal stage renal insufficiency. The presence of depressive symptoms was operationally defined by the factor scores for the first principal components on the Beck Depression Inventory. Five personality dimensions were operationally defined by the factor scores for the first principal components on each of the five scales of the Big Five Inventory. The following dimensions of personality were assessed: neuroticism, extraversion, openness, agreeableness, and conscientiousness. The relationship between the five dimensions of personality and the presence of depressive symptoms was analyzed by the multiple regression analysis. The results showed that personality dimensions are significantly connected with the occurrence of depressive symptoms (R = 0.729; R2 = 0.532; F (5,87) = 19.822; p = 0.000). Two partial predictors were significantly connected with depressive symptoms. They were higher degree of neuroticism (beta = 0.082, p = 0.000) and a lower degree of openness (beta = -0.235, p = 0.016).

[Quality of life in patients with chronic renal failure].

INTRODUCTION: Hemodialysis and transplantation are performed not only to replace renal function, but also to improve patients' quality of life. The aim of our investigation was to compare the quality of life in patients with chronic renal failure (CRF) before and after the introduction of active therapy. MATERIAL AND METHODS: We tested 76 patients (pts): 20 pts on conservative therapy (CT), 21 pts on chronic hemodialysis and 35 pts with renal transplantation. A questionnaire (combining two questionnaires) was used to investigate the physical, emotional and social aspects of health. RESULTS: In regard to physical health of transplantation patients (TP) it was established that work capacity and activities were less damaged, whereas physical activity was highest in pts on CT. Social activity was limited in a higher percentage in TP (40%) than in hemodialysis patients (HD) (19%), while family relationships were most damaged in pts on HD (28.57%). Discomforts were most common in pts on HD. The highest percentage of pts estimated their health status as good or average, but their health status improved after transplantation in 82.86% that is in 57.14% after HD. It was similar with the quality of life: 28.57% of kidney transplant patients rated their quality of life as very good, and 54.28% rated it as good: 38.09% of HD patients rated their quality of life as very good, whereas only 5% of CT patients rated it as very good, and 20% as good.

[Goodpasture's syndrome--case report]. / Goodpastureov sindrom--prikaz slucaja.

INTRODUCTION: Goodpasture's syndrome is a rare, autoimmune disease characterized by pulmonary hemorrhage, glomerulonephritis and production of anti-GBM (glomerular basement membrane) antibodies. The etiology of this syndrome is still unknown. Goodpasture's syndrome usually starts with pulmonary hemorrhage, which is followed by symptoms of kidney disease. Laboratory findings often include: anemia, microhematuria, proteinuria, increased levels of urea and creatinine and anti-GBM antibodies. Diagnosis of this syndrome can be established by presence of pulmonary hemorrhage, pulmonary radiography, kidney biopsy and positive result of circulating anti-GBM antibodies. Treatment of this syndrome should be initiated as soon as possible using a combination of corticosteroids, cytostatics and plasmapheresis. CASE REPORT: The first symptoms in a nineteen-year-old female patient were caused by anemia. Two months later she reported symptoms of pulmonary hemorrhage. At that point of time she already had renal insufficiency and was immediately hospitalized. The same day we started therapy with corticosteroids, endoxan and plasmapheresis was initiated Recovery of pulmonary function was obtained, but kidney function was lost. DISCUSSION AND CONCLUSIONS: The most important thing in regard to Goodpasture's syndrome is quick diagnosis. Because of that, if patients report any kind of pulmonary hemorrhage, this syndrome must be considered At that point of time, kidney function is usually not irreversibly damaged. The second important thing in Goodpasture's syndrome is that treatment must be very aggressive using a combination of immunosuppressives and plasmapheresis. This is the only chance for these patients to avoid hemodialysis or death.

[Radioconstrast nephropathy]. / Radiokontrastna nefropatija.

INTRODUCTION: Hospital-acquired acute renal failure increased in the last years from about 5 to 6.4%, while mortality remained high and according to newest investigations it is about 60% on average. Radiocontrast-induced nephropathy is the third cause of death in hospital-acquired acute renal failure. RISK FACTORS FOR RADIOCONTRAST-INDUCED NEPHROPATHY: Risk factors for radiocontrast-induced nephropathy include: the existing kidney disease, diabetes, dehydratation, multiple myeloma, older age and earlier kidney damage by contrast substances. COURSE OF RADIOCONTRAST-INDUCED NEPHROPATHY: The clinical course of radiocontrast-induced nephropathy may manifest from asymptomatic picture to development of oliguric form of acute renal failure. PREVENTION AND TREATMENT MODALITIES OF RADIOCONTRAST-INDUCED NEPHROPATHY: Modalities of prevention and treatment of radiocontrast-induced nephropathy are as follows: adequate hydration of patients, appropriate application of diuretics, calcium channel blockers nonionizing radiocontrast and preventive haemodialysis. EXPERIMENTAL STUDIES IN PREVENTION AND TREATMENT OF RADIOCONTRAST-INDUCED NEPHROPATHY: Experimental studies indicate application of atrial natriuretic peptide, endothelin, prostaglandin. CASE REVIEW: Two patients treated at the Clinic for Nephrology and Clinical Immunology in Novi Sad, presented with radiocontrast-induced nephropathy. In one patient it appeared after panaortography and in the second after computerized tomography of the abdomen. In both cases aggravation occurred due to already existing renal failure caused by radiocontrast substances. CONCLUSION: The problem is particularly important because there is a large number of patients in whom there is a risk of radiocontrast-induced nephropathy and it is necessary to carry out adequate prophylaxis and accurate assessment of kidney function before application of radiocontrast substances.

[Immunoglobulin A nephropathy and disease prognostic factors]. / Imunoglobulin A nefropatija i faktori prognoze bolesti.

INTRODUCTION: Immunoglobilin A nephropathy (IgAN) is a clinicopathological entity characterized by diffuse glomerular mesangial deposition of IgA as the predominant immunoglobulin. Renal biopsy reveals a spectrum of changes in glomerula, tubulointerstitium and blood vessels. 20-50% of all patients develop end-stage renal failure 20 years after onset of disease. The aim of this study was to investigate the incidence of IgAN and to analyze clinicopathological changes and prognosis of IgAN. MATERIAL AND METHODS: The study included 60 patients with biopsy-proved IgAN without some other systemic diseases or Henoch-Schonlein purpura. We analyzed clinical features of the disease, laboratory findings, findings of immunofluorescence and light microscopy and prognosis of IgAN. The study is partly retrospective and partly prospective. RESULTS AND DISCUSSION: Incidence of the disease in the period 1981-1997 was 9.78%. At the moment of renal biopsy 63.16% of patients had normal renal function, 31.58% had stage I and 5.25% had stage II chronic renal failure. At the end of study 21.05% of investigated patients were included into the worse stage of renal failure in regard to the initial stage. Progression of renal damage correlated with special tubulointerstitial damage and heavy proteinuria. CONCLUSIONS: In this study we found severe histopathological changes in the group with already impaired renal function and these changes correlated with laboratory findings, clinical features and prognosis. Normal renal function at the moment of renal biopsy pointed to risk for further damage. Changes in the tubulointerstitium and mesangium, heavy proteinuria and hypertension affect the disease prognosis. Evolution to the higher stage of renal failure was 1.24% per year and this requires long-term follow-up of patients with IgAN.

[Major characteristics of immunoglobulin A nephropathy]. / Glavne karakteristike imunoglobulin A nefropatije.

INTRODUCTION: Immunoglobulin A nephropathy (IgAN) is one of the most common forms of primary glomerulonephritis in many countries. Most clinical features of IgAN point to a renal problem, such as recurrent macroscopic hematuria or asymptomatic microscopic hematuria and proteinuria. Pathologic features of IgAN present with different types and different degrees of glomerular, tubulointerstitial and vascular lesions. The aim of this study was detailed analysis of clinical and laboratory findings, as well as findings of immunofluorescence and light microscopy. We also investigated associations between these factors. MATERIAL AND METHODS: We investigated 60 patients who underwent renal biopsy. The study was partly retrospective and partly prospective. RESULTS: The average age of patients was 34.19 years. Male female ratio was 2.33:1. IgAN was most frequently asymptomatic (83.33%) as microhematuria and proteinuria, while gross hematuria was found in 16.667%. Renal biopsy material was analyzed by light microscopy revealing changes in all glomerular structures. Immunofluorescence microscopy demonstrated dominant IgA deposits. This study established association of glomerulosclerosis with clinical features of disease. DISCUSSION AND CONCLUSIONS: IgAN frequently develops in the 4th decade of life, mostly in males and presents as asymptomatic (83.33%). Pathohistological changes include all glomerular structures. There is no specific serological test for IgAN, but pathological changes affect clinical features of the disease, as proteinuria and increase of creatinine concentration.

Tubulointerstitial dysfunction in early post-transplant period.

Dysfunction of a transplanted kidney may develop at any time in the post-transplant period. The aim of this study was to differentiate levels of early dysfunction of a transplanted kidney. The study included 45 examinees undergoing kidney transplantation. They were divided into four groups, in regard to length of hospitalization and post-transplant complications: group I (up to 15 days, complication-free); group II (up to 15 days, with complications); group III (up to 30 days); group IV (up to 60 days). The control group included patients undergoing abdominal surgery, without uropoetic system disorders. The following parameters were examined on a daily basis a month after transplantation on average: creatinine clearance, creatinine and urea. Statistical analysis of these parameters revealed the following levels of renal dysfunction: control group--circulatory tubular dysfunction without azotemia; group I--polyuric acute tubular necrosis; group II and group III--severe or moderately severe polyuric acute tubular necrosis and group IV--polyuric acute tubular necrosis.

[Long term survival of patients with lupus nephritis]. / Dugogodisnje prezivljavanje bolesnika s lupusnim nefritisom.

Lupus nephritis is a clinical manifestation of Systemic Lupus Erythematosus with most prominent influence on the course of the disease. The most predictive parameters for development of renal failure are: type of hystological changes, degree of interstitial inflammation, serum creatinine concentration at the time of diagnosis and therapeutical protocols used in the treatment. Single center experience in a group of 220 lupus patients is presented in this paper. In 130 patients (59%) lupus nephritis was diagnosed by clinical and laboratory tests, while 74 kidney biopsies were performed. Proliferative type of lupus nephritis (class IV in 54% of cases and class III in 18.9%) was more frequent than the other histological types. During a long term follow up (range 1-17 years, mean 7.6 years) renal failure developed in 17 patients (24%), while 11% of patients developed uremia and required dialysis. Development of renal failure was influenced by histological changes with predominance of class IV lupus nephropathy, disseminated disease with more ARA criteria for systemic lupus erythematosus classification present at the time of kidney biopsy, more frequent lupus flares, persistence of low complement levels during the first year of follow-up and even earlier.