COMPARISON OF MOLECULAR AND SEROLOGICAL TESTS FOR SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARS-COV-2) IN POST-EXPOSURE EMPLOYEES OF THE NEPHROLOGY DEPARTMENT.

OBJECTIVE: Introduction: A novel coronavirus SARS-CoV-2 RNA, detected by reverse-transcription polymerase chain reaction (RT-PCR) was identified as the cause of a cluster of pneumonia cases in Wuhan, China. It rapidly spread, at first in China, then resulting in an epidemic in other countries throughout the world. One of such controversial topics is the issue of diagnostics and interpretation of test for COVID-19. According to Polish and global guidelines, the basis for diagnosis is molecular testing - real-time reverse transcriptasepolymerase chain reaction (RT-PCR). Taking all these data into consideration, the aim of the study was to compare RT-PCR with serological test in our employees post-exposure. According to Polish and global guidelines, the basis for diagnosis is molecular testing, real-time reverse transcriptase-polymerase chain reaction (RT-PCR). The aim: To compare RT-PCR with serological test in our employees post-exposure. PATIENTS AND METHODS: Material and methods: 79 employees of the Clinic, 19 men and 60 women in the age range 27-69 years were evaluated. Tests were begun four days after information about the positive test in our "Employee 0" and lasted for 7 days. At first, we made RT-PCR tests on the specimen from nasopharyngeal swab. Then, we accomplished rapid antibodies tests. This test is based on the qualitative assessment of the presence of IgM and IgG antibodies by immunochromatography using a sample of capillary blood from the fingertip. RESULTS: Results: All the tests were negative. No employee developed symptoms during the 7-day follow-up after the end of the tests. CONCLUSION: Conclusions: As routine tests for patients have been implemented widely, but similar solutions for employees have not gained popularity. Use of personal protective equipment (PPE) e.g. facemask and shields, transparent screens, disposable medical uniforms, minimalization the contact time, increasing distance from both colleagues and patients (if possible), and strictly follow sanitary procedures largely contributed to the absence of illness in the surveyed group of employees.

, , RHABDOMYOLYSIS - INDUCED ACUTE KIDNEY INJURY - AN UNDERESTIMATED PROBLEM.

Rhabdomyolysis is a condition characterized by muscle damage and the release of intracellular muscle contents into the circulation. It leads to a lot of complications e.g. hyperkalemia, hyperphosphatemia, and calcium disorders. The etiology is multifactorial. Severity ranges from mildly muscle weakness without any systemic complications, to life-threatening multi-organ damage. The most common and serious systemic complication is acute kidney injury (AKI). In the review, we address the epidemiology, causes, and treatment. The ideal would be to predict and prevent rhabdomyolysis at all, but when it is impossible, the key to successful treatment is its rapid implementation. Therapy should be selected individually, adapting to the triggers, and closely monitoring the patient's condition. Early implementation of fluid therapy appears to be crucial. Electrolyte disturbances should always be detected in the early stages and carefully treated. The use of bicarbonates or diuretics may also be helpful, but especially in the latter case, the indications should be well evaluated, remembering to avoid hypovolemia. Renal replacement therapy is often implemented due to water-electrolyte or acid-base disorders. Proper diagnosis and early therapy implementation improve patient outcomes, in particular in the face of new infectious dangers and global underestimating of the disease.

HOME DIALYSIS DURING COVID-19 OUTBREAK - IT IS WORTH TO CONSIDER.

The epidemic with the new SARS-CoV-2 virus poses a serious threat to patients treated with renal replacement therapy. Besides clinical risk factors (such as numerous comorbidities, immune disorders), dialysis patients are additionally exposed to the virus through regular stays for several hours in a dialysis center and ambulance journeys. In such an epidemiological situation, it seems that peritoneal dialysis and home hemodialysis are good alternatives for treatment. Currently available telemedicine and medical technologies allow for effective renal replacement therapy also outside dialysis centers. Thanks to this, it is possible to limit the stay of patients in a medical facility to clinically justified situations. For this reason, increasing the number of patients treated with peritoneal dialysis, which is carried out at home and without contact with medical personnel, seems to be a good solution. Enabling patients to undergo home hemodialysis treatment, nowadays unavailable in Poland and establishing it as a guaranteed benefit in the health care system will enable renal replacement therapy to be adapted to the clinical condition and the need for isolation.

[Common errors in management of urinary tract infections].

Urinary tract infections seems to be simple diseases. However, inappropriate diagnostic and therapeutic procedures may lead to serious complications such as systemic infection, while on the other hand contribute to increasing antimicrobial resistance of uropathogens which is a growing threat to global public health. Due to more frequent occurrence of multidrug resistance bacteria, popularization of guidelines and correct schemes among doctors of all specialities. In the following article the commonest errors made by doctors in their clinical practice that seem to cause a lot of problems are shortly reviewed.

[Diagnostic problems in retroperinoneal fibrosis].

Retroperitoneal fibrosis (RPF) is a uncommon disease characterized by the presence of inflammatory and fibrous retroperitoneal tissue that often encircles the ureters or abdominal organs. The disease may be idiopathic or secondary to infections, malignancies, certain drugs or radiotherapy. Idiopathic form is an immune-mediated entity and a part of the broader spectrum of idiopathic diseases termed chronic periaortitis, characterized by a morphologically similar fibroinflammatory changes in aorta. In the article the most important diagnostic problems of RPF are reviewed.

Hypertension in patients with acute kidney injury.

OBJECTIVE: Introduction: Hypertension is an overwhelming finding in chronic kidney disease (CKD), but data on hypertension prevalence in acute kidney injury (AKI) are scarce. The aim: The study aimed to assess the prevalence of hypertension in patients with AKI regarding its cause: prerenal, renal, or postrenal.. PATIENTS AND METHODS: Material and Methods: We retrospectively analyzed the medical documentation of 215 patients with AKI. RESULTS: Results: Among them, 35% required acute hemodialysis due to either clinical or biochemical indications. Prevalence of hypertension was 70%, with the highest rate in post-renal AKI (85%), followed by renal AKI (75%) and pre-renal AKI (30%). Dialyzed patients were older, had higher blood pressure, and required more hypotensive drugs. CONCLUSION: Conclusions: Hypertension is prevalent in AKI; however, it depends upon its origin. Uncontrolled hypertension, together with edema and pulmonary congestion are the indications for dialysis initiation. However, caution should be exercised during dialysis to avoid hypotensive episodes.

Chronic Kidney Disease in Patients After Allogeneic Hematopoietic Cell Transplant.

Hematopoietic stem cell transplant (HSCT) is used in advanced hematologic diseases to restart the immune system. Kidney damage remains significant complication of hematopoietic cell transplant (HCT) affecting the mortality of transplant recipients. The aim of the study was to assess the advancement of chronic kidney disease (CKD) in patients after HSCT. We studied 150 patients who underwent allo-HSCT treatment in our center in years 1995 to 2020 because of acute myeloid leukemia in 47% of patients, acute lymphoblastic leukemia in 19%, and lymphoma in 32%. The mean age of patients with acute leukemia is 48 years (including acute myeloid leukemia it is 47 years, and including acute lymphoblastic leukemia it is 32 years). The mean age of lymphoma patients is 34 years. We studied the prevalence and stages of CKD. CKD stage 3a and 3b was found in 24.6%. None of the patients studied had CKD stage 4 or 5. In patients after HSCT because of both acute myeloid leukemia and acute lymphoblastic leukemia, CKD stage 3a was found in 19% and stage 3b in 7.3%. Estimated glomerular filtration rate (eGFR) >90 mL/min/1.73 m2, was found in 36.8% of this population, whereas eGFR between 90 and 60 mL/min/1.73 m2 was observed in 36.8%. In patients with lymphoma who underwent HSCT, CKD stage 3a was found in 18%, while CKD stage 3b was diagnosed in 27% of the patients. An eGFR >90 mL/min/1.73 m2, was found in 27% of this population, whereas eGFR between 90 and 60 mL/min/1.73 m2 was observed in 27% of patients. The categorization of patients according to the underlying disease is important because other drugs are used in therapy of conditioning before HCT. CKD in patients after allogeneic HSCT is common, although advanced stages were not observed, probably because the age of the population studied was not advanced. CKD in these vulnerable patients may be because of prior chemotherapy, conditioning regimen, post-HSCT calcineurin therapy, and other possible nephrotoxic drugs.

Increase Urinary Biomarkers of Kidney Injury in Patients After Allogenic Hematopoietic Stem Cell Transplant Reflect Kidney Damage Even in Normal Kidney Function.

Kidney function in patients undergoing hematopoietic stem cell transplant (HSCT) is frequently worsened by previous chemotherapy and exposure to a variety of nephrotoxic drugs. The aim of the study was to assess biomarkers of kidney injury in patients at least 3 months after HSCT under ambulatory care of the Hematology, Oncology and Internal Medicine Department. We studied 80 prevalent patients after allogeneic HSCT and 32 healthy volunteers to obtain normal ranges for biomarkers. In this cross-sectional study, the following biomarkers of kidney injury in urine were evaluated using commercially available assays: IGFBP7 and TIMP2, netrin-1, and semaphorin A2. All of the biomarkers studied were significantly higher in patients after HSCT compared with the healthy volunteers. When we divided patients according to kidney function (below and over 60 mL/min/1.73m2), we found that only concentration of IGFBP7 was significantly higher in 23 patients with chronic kidney disease (CKD) stage 3 relative to patients with an estimated glomerular filtration rate (eGFR) over 60 mL/min/1.73m2. All biomarkers in both subgroups of patients with eGFRs below and over 60 mL/min/1.73m2 were significantly higher relative to healthy volunteers. In univariate correlations, semaphorin A2 was related to netrin-1 (r = 0.47, P < .001), IGFBP7 (r = 0.35, P < .01), and TIMP2 (r = 0.32, P < .01), whereas IGFBP7 was positively related to serum creatinine (r = 0.38, P < .001) and inversely to eGFR (r = -0.36, P < .001). Patients after allogeneic HSCT, despite normal or near normal kidney function, show evidence of kidney injury.

Post-Contrast Acute Kidney Injury in Patients with Various Stages of Chronic Kidney Disease-Is Fear Justified?

Post-contrast acute kidney injury (PC-AKI) is one of the side effects of iodinated contrast media, including those used in computed tomography. Its incidence seems exaggerated, and thus we decided to try estimate that number and investigate its significance in our clinical practice. We analyzed all computed tomographies performed in our clinic in 2019, including data about the patient and the procedure. In each case, we recorded the parameters of kidney function (serum creatinine concentration and eGFR) in four time intervals: before the test, immediately after the test, 14-28 days after the test, and over 28 days after the test. Patients who did not have a follow-up after computed tomography were excluded. After reviewing 706 CT scans performed in 2019, we included 284 patients undergoing contrast-enhanced CT and 67 non-enhanced CT in the final analysis. On this basis, we created two comparable groups in terms of age, gender, the severity of chronic kidney disease, and the number of comorbidities. We found that AKI was more common in the non-enhanced CT population (25.4% vs. 17.9%). In terms of our experience, it seems that PC-AKI is not a great risk for patients, even those with chronic kidney disease. Consequently, the fear of using contrast agents is not justified.