Great figures of Polish Nephrology - Participants of the Warsaw Uprising 1944.

In 1944, during the World War II, many doctors and many medical students participated in the Warsaw Uprising. This group also comprised future nephrologists, professors of medicine, founders of Polish nephrology, dialysis and transplantology centers. We presented 3 of great polish nephrologists who participated in medical services in the Warsaw Uprising: Zygmunt Hanicki, Andrzej Manitius and Tadeusz Orlowski.

[A case of acute renal failure in pregnancy complicated by Henoch-Schoenlein purpura requiring hemodialysis therapy]. / Przypadek ostrej niewydolnosci nerek w ciazy w przebiegu zespolu Schoenleina-Henocha wymagajacy dializoterapii.

The secondary kidney's diseases may be a cause of the acute renal failure in pregnancy. Pregnancy may be a factor which reveal earlier existence of the disease. We reported the case of 18-year-old woman (gravida 1) in whom the first symptoms of the Henoch-Schoenlein purpura occurred in 23rd week of pregnancy. In 32nd week of pregnancy appeared hypertension, anasarca, oliguria and acute renal failure. In this case hemodialysis appeared as an effective procedure which saved mother's and child's life.

[Prevalence of response to anti-HBV infection in patients on maintenance hemodialysis infected with hepatitis C virus (HCV)]. / Wystepowanie odpowiedzi na szczepienie przeciwko HBV u chorych przewlekle hemodializowanych i zakazonych wirusem C (HCV).

We have studied the antibody response to hepatitis B vaccine in 42 hemodialysis patients; 8 of them were diagnosed as having HCV infection before vaccination. Hemodialysis patients received four doses of recombinant HB vaccine (Engerix-B, SKB, 40 micrograms per dose). Seroconversion occurred in 71.4% of all hemodialysis patients; in 79.4% of HCV-negative and in 37.5% of HCV-positive patients. Effective immunity (anti-HBs titer higher than 100 m IU/ml) was observed in 12.5% of HCV positive and in 35.3% of HCV-negative patients. We conclude that HCV infection may modify or postpone the response to hepatitis B vaccine.

[A case of hemolytic-uremic syndrome after normal pregnancy and delivery. Two year follow-up observations]. / Przypadek zespolu hemolityczno-mocznicowego po prawidlowej ciazy i porodzie. Dwuletnia obserwacja.

Hemolytic-uremic syndrome is a very rare complication in the postpartum period, starting a few days or few months after usually spontaneous labour, which concludes a normal pregnancy. We report a case in which treatment with early hemodialysis, heparin, corticoids, and blood transfusions appeared to cure the acute hemolytic anaemia and the thrombocytopenia, normalise kidney function and prevent kidney damage.

Anemia treatment with darbepoetin alpha in pregnant female with chronic renal failure: report of two cases.

Pregnancy is a rare finding in females with CRF. It is well known that in these cases pregnancy worsens the renal function and accelerates the beginning of dialysis therapy. Pregnancies in uremic females are complicated by a worsening of anemia as well as hypertension, fluid imbalance, electrolyte difficulties, malnutrition, polyhydramnios and preterm labor or sudden intrauterine death. The use of erythropoiesis stimulating agents (ESA) allows a better hematocrit control. Data concerning anemia treatment in pregnants with CRF and data regarding the use of ESA in these patients is scarce. We report two cases of anemia treatment with darbepoetin alpha in pregnant women with CRF in predialysis period and during the hemodialysis therapy. Both patients during the darbepoetin treatment did not require any blood transfusions and at 32nd and 37th weeks of pregnancy delivered healthy infants. The high darbepoetin doses did not cause any side effects, were well tolerated and safe for both gravida and fetus. The effective anemia treatment in pregnants with CRF improves the prognosis for a successful pregnancy.

Increased serum levels of troponin I and lesions in coronary angiography in hemodialysed patients.

PURPOSE: Calcium-phosphate disorders are a frequent finding in HD patients, and, in some cases, may cause an abnormal coronary calcification. Some of the HD patients have increased serum cTnI level without evidence of acute coronary syndrome. The aim of this study was to determine if there is a correlance between increased cTnI levels and presence of stenotic changes in coronary arteries in asymptomatic HD patients. MATERIAL AND METHODS: In 13 of 119 HD patients (M:F 10:3) a coronary angiography was performed. The mean age of the patients was 53 years (33-76) and the mean HD duration was 55 months (3-156). cTnI was analyzed by AxSYM system and, subsequently, by VIDAS system. RESULTS: A constant or intermittent elevation of cTnI was detected in 5 of 13 patients. In 10 of 13 pts a critical stenosis of at least 1 coronary artery was found. A critical stenosis was found in 4 of 5 cTnI (+) patients and in 6 of 8 cTnI (-) patients. An excess calcification of coronaries was observed in 7 patients, including 1 cTnI positive patient with no evidence of coronary stenosis. CONCLUSIONS: 1. The elevation of cTnI in asymptomatic HD patients is observed when there is: (I) excess calcification accompanied by a critical stenosis of at least 1 coronary artery, (II) a critical stenosis of 2 or more coronaries with no evidence of calcification. 2. We suggest that excess cardiovascular calcification in HD patients may be one of the major factors responsible for the troponin release.

[Treatment of multiple myeloma associated anemia with human recombinant erythropoietin in a hemodialysis patient]. / Leczenie niedokrwistosci w szpiczaku mnogim rekombinowana ludzka erytropoetyna u pacjenta dializowanego.

Recombinant human erythropoietin (rHuEPO) was used to treat the anaemia in a hemodialyzed 60 year old man with multiple myeloma requiring chemotherapy; the type of serum M component was IgA kappa. During the 5 months before rHuEPO treatment the patient was given multiple blood transfusions. rHuEPO was started 125 U/kg/week subcutaneously in divided doses after dialysis. After introduction of rHuEPO, blood transfusions were no longer required and haemoglobin concentration increased from 5.2 mmol/l to 6.9 mmol/l after 8 weeks of treatment. We conclude that rHuEPO treatment in haemodialysed patients with multiple myeloma may be safe, well tolerated and clinically effective.

[Evaluation of acceptance rate and outcome of renal replacement therapy in patients with diabetic nephropathy--multicenter study]. / Ocena dostepnosci i wyników leczenia nerkozastepczego u chorych z nefropatia cukrzycowa--obserwacje wieloosrodkowe.

Development of dialysis methods and progress in kidney and pancreas transplantation allowed to treat an increasing number of patients suffering from diabetic nephropathy (D.N.). This report evaluates availability and results of treatment in these patients. 31.12.93 in Gdansk and Bydgoszcz area there were treated 519 patients, including 43 (8.2%) with D.N. It is impossible to evaluate the demand for renal replacement therapy in patients with D.N., because there is no exact data concerning diabetic patients with progressing renal failure. Up to now 88 patients with D.M. (68 with IDDM, 20 with NIDDM) were treat in this area. Most of them (92%) were treated with hemodialysis is and only a few with CAPD, 13 patients received a kidney graft. The average patient survival on dialysis treatment in NIDDM patients was 15 months and in IDDM patients was 11 months. Deaths were mainly caused by cardiovascular complications. The results of renal replacement therapy in these patients cannot be compared with data from other re ports, because the treatment was introduced at advanced stage of D.N. in patients with systemic complications (serum creatinine in IDDM was 9.7 md% and in NIDDM was 6.2% mg%). Following conclusions can be drawn from our observations: 1. There is a need for close cooperation between diabetologist and nephrologist in repeat of evaluation of the demand for renal replacement therapy and time for its institution in a particular patient. 2. The choice of method of renal replacement therapy depends on clinical findings in a particular patient but also on methods available in a particular center. 3. Improvement of therapy outcome can be achieved primarily by earlier institution of dialysis (serum creatinine below 5 m5%).

[Evaluation of prophylaxis and actual prevalence of HBV infection in twelve hemodialysis centers of Northern Poland]. / Ocena profilaktyki i aktualnej sytuacji epidemiologicznej zakazenia HBV w dwunastu osrodkach hemodializy Polski pólnocnej.

The aim of the study was to estimate the HBV infection preventive measures used in the twelve dialysis centres in north Poland. In all of the centres hepatitis B vaccination and segregation of HBV infected patients (dedicated machines or separate rooms), which are the two basic HBV infection control methods, were introduced. Our results point out that in some of the centres certain modification of these methods would be possible, including universal predialysis vaccination programme, changes in hepatitis B vaccination schedules with most effective routes of vaccination only and dedication for HBV infected patients not only separate rooms but separate dialysis staff as well.