[Peritoneal dialysis and kidney transplantation]. / Peritoneumska dijaliza i transplantacija bubrega.

The results of pretransplantation preparation of patients undergoing peritoneal dialysis program before the kidney transplantation at our clinic have been presented. Residual kidney function, and bladder function, respectively, as well as the incidence of the hepatotropic viruses B and C infections and cytotoxic antibodies percentage following blood transfusion have been particularly analyzed. Obtained results have been correlated with those found in 40 patients on hemodialysis and to whom kidneys were transplanted at our clinic. Satisfactory bladder function, the absence of urologic posttransplantation complications, non-existence of hepatotropic viral infections and cytotoxic antibodies resulted in an introduction of a new strategy based on the peritoneal dialysis as the first method of the dialysis treatment prior to kidney transplantation.

[Interleukin-1 beta in patients with primary immunocomplex glomerulonephritis]. / Interleukin-1 beta kod bolesnika sa primarnim imunokompleksnim glomerulonefritisom.

Interleukin-1 is one of the most important pro-inflammatory cytokines whose role in the pathogenesis of glomerulonephritic process was proved in numerous studies. The aim of this study was to determine the urinary level of this cytokine in patients with primary immunocomplex glomerulonephritis and its significance in diagnosis of this disease. This prospective study comprised a total of 96 patients (84 males and 12 females) with primary immunocomplex glomerulonephritis. The elevated urinary IL-1 beta level was noticed in 43 (49.4%) patients with different histological forms of glomerulonephritis. The mean concentration was significantly higher in patient's group (57.7 +/- 120.7 pg/mg creatinine) (range 1.1-731) compared to control group (10.2 +/- 5.96 pg/mg creatinine) (range 1.6-25.4) (p < 0.05). There was no significant difference in the frequency of elevated urinary IL-1 beta concentration in different patients group based on histological type of glomerulonephritis (chi 2 = 6.377, p > 0.05). On the basis of our results we concluded that the elevated concentration of IL-1 beta in majority of patients with primary immunocomplex glomerulonephritis had suggested its role in the pathogenesis of glomerulonephritic process. The urinary level of IL-1 beta represents a novel, non-invasive parameter in the diagnosis of this disease, but its measurement is not useful in predicting the histological type of primary immunocomplex glomerulonephritis. The results of our study suggest the possibility that urinary IL-1 beta level reflects the activity of glomerulonephritic process and it could be useful in non-invasive monitoring of the disease progression.

[Outcome of kidney transplantation in patients on peritoneal dialysis]. / Ishod transplantacije bubrega kod bolesnika na peritoneumskoj dijalizi.

The initial experience suggested that kidney transplantation could be hazardous for patients on peritoneal dialysis due to the high risk of peritonitis and a possible high incidence of acute rejection. In this paper we have presented our experience with kidney transplantation in these patients. During the last four years kidney transplantation was performed in 9 patients on peritoneal dialysis. The average time spent on peritoneal dialysis was 20.6 +/- 7.6 months. In all patients peritoneal catheter was removed during the surgery. During the posttransplantation period a triple immunosuppressive therapy including steroids, cyclosporin and azathioprineor mycophenolate mofetil was administered in all patients. In comparison to patients on hemodialysis no significant difference in the incidence of acute rejection episodes, delayed graft function, graft arterial thrombosis and graft function recovery was observed. Patients on peritoneal dialysis had significantly greater and longer wound drainage in comparison to patients on hemodialysis. It was concluded that peritoneal dialysis had no negative influence on short-term outcome of kidney transplantation.

[A severe form of falciparum malaria associated with staphylococcal endocarditis]. / Teska forma faliciparum malarije udruzene sa stafilokoknim endokarditisom.

A case is presented of a patient, aged 56 years, with severe form of imported malaria caused by Plasmodia falciparum. Hyperparasitemia of erythrocytes > 30% was registered, and during the course of the disease CNS dysfunction, severe anemia, acute renal failure, disseminated intravenous coagulation with manifest hemorrhagic syndrome, icterus, enterocolitis, pneumonia and staphylococcal endocarditis were developed Due to hyperparasitemia and numerous complications, antimalarial drugs such as quinidine (1,200 mg/day) and artemether (160 mg/day) were administered parenterally. Infected erythrocytes were exchanged with 2.5 litres of healthy erythrocytes suspension. Hemodialysis was also performed as well as nine-week antistaphylococcal therapy. During the treatment preparation of deplasmated blood, concentrated thrombocytes, fresh frozen plasma, cryoprecipitates, human albumins and immunoglobulins were applied, along with the correction of electrolytic dysbalance, administration of diuretic, cardiotonic, antiarrhythmic, anxiolytic, antipsychotic and antidepressive drugs. Two months after the admission the patient was released from the Clinic in good condition, with normal clinical-laboratory findings.

[Treatment of chronic viral hepatitis B in secondary membranoproliferative glomerulonephritis using recombinant alfa-2 interferon]. / Lecenje hronicnog virusnog hepatitisa B u sekundarnog membranoproliferativnog glomerulonefritisa rekombinantnim alfa-2 interferonom.

A patient suffering from viral hepatitis B and secondary membranoproliferative glomerulonephritis was presented. He was treated with recombinant alfa-2 interferon. The therapy led to clinical and biochemical remission of the liver and kidney lesions. The example of our patient justifies the use of recombinant alfa-2 interferon in the patients with chronic viral hepatitis B and secondary glomerulonephritis.

[Analysis of a 4-year follow-up of the results of kidney transplantation from living related donors]. / Analiza cetvorogodiznjeg pracenja rezultata transplantacije bubrega od zivog srodnog davaoca.

The aim was to present a four-year experience in living related kidney transplantation. A total of 43 patients (9 females and 34 males) were enrolled in this study. The standard triple immunosuppressive therapy (steroids, azathioprine and cyclosporine) was administered in 19 (44.1%) patients, and in 20 (46.5%) mycophenolate mophetil in daily dose of 2 g instead of azathioprine. In 5 (14.2%) patients with high immunological risk and delayed graft function was administered antithymocite globulin in duration of 7-14 days, prophylactically. In 3 (6.97%) patients graft loss was caused by vascular complications and in 1 (2.32%) by infection as the complication. During the first post-transplantation year acute rejection was noticed in 8 (34.7%) patients and in 3 (37.5%) it was steroid resistant. The graft loss was never caused by acute rejection. Six-months graft survival was noticed in 91.1% patients and one-year graft survival in 88.4% patients. One-year patient survival was 100%. Short term results in living related kidney transplantation are excellent and nowadays, due to improvement in immunosuppressive therapy, the success in this type of kidney transplantation is mainly limited by surgical and infective complications.

[Pathologic changes in the interstitium in IgA nephropathy]. / Patohistoloske promene intersticijuma u IgA-nefropatiji.

Some of tubulointerstitial changes are frequently found in glomerular disorders. A wide range of interstitial lesions have also been observed in patients with IgA nephropathy. Percutaneous biopsy specimens taken from 74 kidneys of IgA nephropathy patients have been analysed. Obtained tissues were examined by LM, If and EM. Light microscopy, immunofluorescence and electron microscopy Morphologic changes have been classified into 5 groups according to WHO classification. Interstitial changes, cellular infiltrations, fibrosis and other lesions from all renal tissues have been analysed and according to their intensity semiquantitatively graded into 4 groups. Histopathologic analysis has most frequently revealed interstitial fibrosis and less frequently mononuclear cellular infiltration particularly in patients with more prominent glomerular changes. Therefore, we have as well as other authors, confirmed that interstitial changes represent an important prognostic factor in the IgA nephropathy development. However, analysis of repeated biopsy specimens to confirm this hypothesis is necessary.

[Serum and urinary interleukin-6 levels in patients with primary glomerulonephritis]. / Nivo interleukina sest u serumu i urinu bolesnika s primarnim glomerulonefritisom.

Several studies have suggested that the measurement of urinary interleukin-6 (IL-6) is a helpful tool for diagnosis and monitoring the progression of glomerulonephritis. The aim of this study was to determine if IL-6 level might reflect the histological type of glomerular lesions. We performed a prospective study of 43 patients who underwent renal biopsy in our hospital. There were 35 male and 8 female patients with median age of 30.5 years (range 19-50). Included among these were 13 cases of IgA nephropathy, 11 cases of membranoproliferative glomerulonephritis, 6 cases of poststreptococcal glomerulonephritis, 6 cases of mesangial proliferative glomerulonephritis, 5 cases of membranous nephropathy and 2 cases of C3 nephritis. IL-6 was measured by ELISA (Lucernachem, Switzerland). IL-6 was not detected in the serum and rine of 15 healthy controls. IL-6 was elevated in the urine of 30 patients with different histological types of glomerular lesions (range 3.7 to 433.3 pg/ml) but was not detected in the urine of remaining 13 patients. The presence of IL-6 in the urine in absence of raised serum IL-6 suggests that urinary IL-6 was produced by the kidney. We have concluded that urinary IL-6 level can be considered as a marker of glomerulonephritis but not one that is very specific for any particular histological type of primary glomerulonephritis. Thus, the urinary IL-6 level is not a useful tool in the differential diagnosis of primary glomerulonephritis. We need further studies to determine whether urinary IL-6 level could by considered for monitoring of disease activity and therapy.