[Chlamydia urethritis in nephrologic practice]. / Hlamidijski uretritis u nefroloskoj praksi.

Chlamydia trachomatis is an ubiquitous bacterium, strictly intracellular organism. The D-K serovars urethritis, cervicitis, endometritis, salpingitis, periappendicitis and perihepatitis, in women, urethritis, prostatitis, epididymitis and Reiter's syndrome in 1-2% of cases in men. Sterility is the most serious complication in both sexes. Chlamydial infections are sexually transmitted diseases, often asymptomatic, prone to recurrences. Cure occurs only when both sexual partners are treated simultaneously. We treated 40 patients, 24 women and 16 men, from 1991-1994, who presented in nephrologic offices with symptoms of chlamydial urethritis. Detection of Chlamydia trachomatis was performed by direct fluorescent antibody stain. All patients had positive urethral swab, six women had chlamydial cervicitis too, one man had Reiter's syndrome, one man orchiepididymitis, and five men prostatitis. Optimal therapy for Chlamydia trachomatis infections consists of a 10-14 day regimen of quinolone, of tetracycline, and macrolides. We used sulfonamide rarely. Because of very serious sequelae of initial infection with Chlamydia trachomatis, every patient with urethritis should be examined by urethral swab for Chlamydia testing. Both partners should be examined and treated simultaneously.

[Renal mycobacteriosis]. / Mikrobakterioza bubrega.

There is a number of specific infections due to opportunistic mycobacteria which normally exist as environmental saprophytes. Among them, renal mycobacteriosis is a disease similar to renal tuberculosis. The obvious causative agents are some mycobacteria: Mycobacterium chelonei, Mycobacterium fortuitum, Mycobacterium xenopi, Mycobacterium kansasii, Mycobacterium avium complex, and Mycobacterium simiae. It is not easy to prove that a renal disease is of mycobacterial origin. We suggest some criteria as revision of Davidson's sign that help establish the diagnosis of renal mycobacteriosis. The aim of this paper was to review clinical features, diagnosis and treatment of renal mycobacteriosis, illustrated by presentation of a case of pyelonephritis and cystitis caused by Mycobacterium chelonei. Successful chemotherapeutic regimen was largely based upon our own experience as well as on the limited information in the medical literature.

[Acute pancreatitis in a patient treated with hemodialysis]. / Akutni pankreatitis kod bolesnika lecenih hemodijalizom.

Acute pancreatitis presents about 1% of all acute abdominal diseases. Its mortality is about 20-50%. The main etiological causes are diseases of the biliary tract and alcoholism. In 10-20% of cases the cause is still unknown. Chronic renal failure is also mentioned as a possible cause of acute pancreatitis. The purpose of this article was to show the frequency and course of acute pancreatitis in patients on haemodialysis during the last 15 years with a case report. From 1976, to 1991, in our Centre about 600 patients have been observed. The diagnosis of acute pancreatitis has been posed in 5 patients (0.8%). In 2 of them the course was easy, 2 died and 1 survived despite a number of complications and two surgical operations. Acute pancreatitis is a rare disease in patients on dialysis, but it is more frequent in them than in persons with healthy kidneys. The mortality in those patients is also high. With adequate care and treatment there is a possibility to survive even heavy type of acute pancreatitis.

[Treatment of renal insufficiency in patients with multiple myeloma]. / Terapija insuficijencije bubrega nastale kod bolesnika s multiplim mijelomom.

Multiple myeloma is the most frequent dysproteinaemica causing renal damage. Renal damage can be manifested as acute or chronic renal failure, Tubular disfunction, urinary tract infection, or as proteinuria. The aim of this study is to present our experience in the treatment of renal failure developed during multiple myeloma. Over a ten year period we treated 16 uraemic patients with multiple myeloma and renal failure. Most patients (75% or 12 of them) came to the nephrologic department because of acute renal failure provoked by multiple myeloma. Dialysis was applied to 9 patients. The average survival rate of these patients ranged from 6.2 +/- 9.2 months, while three patients lived for 23-24 months. The combination of chemotherapy and dialysis did not produce recovery of renal function in any case of acute renal failure. All deaths were related to the evolution of multiple myeloma and none to a complication of dialysis. In conclusion, dialysis treatment should be used even in cases of uraemia, if myeloma is not in the terminal phase.

Malignant tumors in hemodialysis patients.

We reviewed the incidence of malignant tumors among 923 patients with chronic renal failure, treated with hemodialysis (HD) in seven dialysis centers in Serbia between January 1983 and July 1993. Neoplasms were diagnosed in 45 cases (4.9%). The mean age of the cancer patients was 58.7 years. Eighteen cases (40.0%) were diagnosed in the first year after starting HD treatment and 21 (46.7%) cases were detected less than 5 years after induction of HD treatment. Most of the cancer patients (60.0%), especially the patients with Balkan endemic nephropathy (31.1%), developed cancer of the urinary tract. We concluded that HD patients have a several times greater risk of developing malignant tumors than the general population.