[Anti-U1RNP antibodies and lupus nephritis]. / Anti-U1RNP antitela i lupusni nefritis.

INTRODUCTION: Systemic Lupus Erythematosus is characterized by production of numerous autoantibodies as an abnormal immune response. The most important antibodies are those aimed at constitutive elements of cell nucleus. METHODS: After antigen typing of antinuclear antibodies in 30 patients with Systemic Lupus Erythematosus we analyzed the correlation between anti-Sm antibodies and anti-U1RNP antibodies and the degree of disease activity, such as correlation of these two antibodies with some clinical manifestations of this disease. This study included patients who fulfilled all revised American Rheumatism Association criteria to diagnose systemic lupus. To determine the degree of disease activity we used Systemic Lupus Erythematosus Disease Activity Index after Bombardier. To detect antinuclear antibodies technique of indirect immunofluorescence and ELISA procedure for antigen typing of these antibodies were used. RESULTS: We registered antinuclear antibodies (ANA) in 100% of our patients, with domination of homogenous pattern of immunofluorescence (70%). Speakled pattern was registered in 16.66% and margin type in 6.66%. Using ELISA procedure of antigen typing of ANA we registered anti-U1RNP antibodies in 26.7% patients, while anti-Sm antibodies were registered in 20%. CONCLUSION: Anti-U1RNP antibodies finding is associated with mild forms of disease and rare appearance of lupus nephritis, while anti-Sm antibodies finding is characteristic for very active forms of disease and often lupus nephritis.

[Systemic necrotizing vasculitis: case report]. / Sistemski nekrotizirajuci vaskulitis: prikaz slucaja.

Systemic vasculitis presents a group of clinically pathologic syndromes with acute inflammatory process in its basis which commonly occurs on small blood vessels destroying their walls with fibrinoid necrosis. It often occurs on several organs and systems depending on the form, size and number of the diseased blood vessels. This paper is a case report on a female patient suffering from a serious systemic necrotizing vasculitis with clinically demonstrated ulceronecrotizing skin changes and purpura together with appearance of coronary ischemia; rhythmic disorders of heart rate and gastrointestinal bleeding and cardiac arrest in one moment. It contains a description of the course of the disease and a good result after application of immunosuppressive therapy with high doses of corticosteroids, cyclosporin A and plasmaphereses.

[Results of a multi-year study of persons with transplanted kidneys]. / Rezultati visegodisnjeg ispitivanja osoba s transplantisanim bubregom.

The authors review their results of five year follow up of renal transplantation. They summarised the results of treatment with three immunosuppressive regimens. There is an analysis of rejection episodes, recurrent glomerulonephritis, infections, surgical complications, a median graft as well as patient survival and other patterns of complications of renal transplantation.

[Urinary infections in patients with transplanted kidneys]. / Urinarne infekcije kod bolesnika s transplantisanim bubregom.

The aim of this study was to evaluate urinary infection frequency in kidney transplanted patients. Infection frequency was assessed in 116 patients (81 males and 35 females; mean age 36.2 years) after renal transplantation. During four year follow-up 41% patients suffered one or more episodes of infection. Bacterial infection caused by Escherichia coli were most frequent. The control group consisted of healthy medical staff and the investigations showed significantly over frequency of infection.

[Clinical and morphologic features in patients with acute nephritis syndrome]. / Klinicke i morfoloske odlike bolesnika s akutnim nefritisnim sindromom.

Acute glomerulonephritis is a distinct clinical entity, more frequently found in younger age. We report 69 patients with AcGN (25 female and 44 male) mean age 26 years (range 15-58). The disease is clinically characterized with hypertension (57%), edema (59%) and oliguria (35%). Urine analysis showed microhaematuria/proteinuria (36%) and micro/macrohaematuria alone in 89%, while azothaemia was observed in 16% pts, and decreased serum complement levels in one third of patients, more often decrease of C3 (33%) than C4 (15%). Initial infection of the upper respiratory tract was seen in 65%, pneumonia in 8%. In 25% of pts. there were no data of previous infection. Cultures of pharyngeal smear revealed. Streptococcus only in 2 pts. Elevated AST titer was found in 32% pts. Eleven kidney biopsies were made, and histological examination showed 2 normal findings, 6 mesangioproliferative GH, 2 endocapillary GN and 1 membranoproliferative GN. Follow ups have showed urinary abnormalities in 25% of pts., without developing renal failure.

[Methylprednisolone pulse therapy in the early phases of lupus nephritis]. / Dejstvo pulsne terapije metilprednozolonom kod ranih faza lupusnog nefritisa.

Renal involvement i.e. lupus nephritis (LN) in systemic lupus erythematosus (SLE) mainly determines course and outcome of the disease. Recognition of early manifestations of LN makes adequate therapy possible, with very good therapeutic results. We report 7 patients from a group of 150 SLE patients under our permanent control, 4 female and 3 male, mean age 21 years. All of them had signs of LN: proteinuria 7/7 haematuria 4/7 without azotaemia. Renal biopsy was performed in 6 pts, and histological finding was: class II 1 pt, class IV 3 pts and class V in 2 pts. In 4 pts tubulointerstitial changes were noted, while all showed immunofluorescent deposits of immunoglobulins and complement. Methylprednisolone "pulse" therapy (1000 mg, i.v., 3 days) followed by tapering of the steroid dose was given. Reduction of proteinuria and disappearance of haematuria were observed in all patients. During follow up, kidney function remained normal.

[Anti-proteinuria effects of nonsteroidal anti-inflammatory drugs in patients with nephrotic syndrome: an illusion or a read improvement?]. / Antiproteinuricni efekat nesteroidnih antiinflamacionih lekova u bolesnika s nefrotskim sindromom: privid ili stvarno poboljsanje?

In order to examine the antiproteinuric effect of non-steroidal antiinflammatory drugs in patients with nephrotic syndrome, we performed a parallel determination of the daily proteinuria, strength of glomerular filtration and of the effective renal plasmatic flow in basal conditions and after a 7 day ibuprofen therapy at a daily dose of 1200mg (3 x 400mg) in a group of 12 patients with idiopathic glomerulonephritis. In all patients ibuprofen therapy induced a significant decrease of the existing proteinuria, but this decrease was accompanied by the decrease of clearance rate of 99mTc-DTPA and 131J-hipuran clearance, that is by decrease of strength of glomerular filtration (averagely 24.29%) and effective renal plasmatic flow (averagely 18.74%). It can be concluded that the decrease of proteinuria in patients with nephrotic syndrome after ibuprofen therapy (as well as other non-steroidal antiinflammatory drugs) is primarily the result of worsening of hemodynamic conditions in the kidney, that it is caused by the reduction of the renal blood flow and by the strength of glomerular filtration in conditions of cycloxygenetic activity inhibition in the kidney.

[Immunologic characterization of autoreactivity to nuclear antigens in patients with systemic lupus erythematosus]. / Imunoloska karakterizacija autoreaktivnosti prema nuklearnim antigenima u bolesnika sa sistemskim eritemskim lupusom.

Abnormal immune reactivity, with a production of multiple autoantibodies specially against the components of a nucleoplasm is one of the hallmarks of systemic lupus erythematosus (SLE). Our investigations were conducted on 102 patients with SLE, classified according to the criteria of ARA, aiming to better characterize the overall incidence of anti-nuclear antibodies in SLE, to determine the type of immunofluorescent staining of the nuclei, and to characterize the fine specificity of such antibodies using modified ELISA procedure. Results of our investigation show that 95% of patients with SLE have detectable anti-nuclear antibodies. Predominant pattern of nuclear staining is homogeneous, followed by a speckled type, while the rim (peripheral) pattern is relatively infrequent. Anti-nuclear antibodies showed the highest reactivity against native DNA (70% of patients), which was followed by binding to SS-A, eRNP and SS-B antigens. Interestingly, using ELISA procedure we could observe the reactivity against Sm antigen only in 5% of SLE patients. In patients who showed homogeneous or rim pattern of nuclear staining the predominant type of reactivity was against native DNA, while in patients with speckled type most frequent binding to non-histone proteins was observed. The most frequently observed individual pattern of ANA reactivity was of polyreactive type.

[Radionuclide functional tests in transplanted kidneys]. / Radionuklidno funkcijsko ispitivanje transplantiranog bubrega.

Results of 140 combined first-pass and dynamic functional renal studies were clinically evaluated in 50 patients with a transplanted kidney. The renal handling of three different nephroaffine radionuclides, namely the glomerular agent (99m Tc-DTPA), the predominantly tubular agent (99m TcMAG3) and combined glomerulo-tubular agent (99m Tc-PAHIDA) was also analysed in various dysfunctions of renal transplants. It has been concluded, that the clinically most useful information at all levels of the overall renal function has been given by 99m TcMAG3. However, the behaviour of glomerular and tubular agents in postischaemic acute tubular lesion was found to be discordant which in turn could be valuable differential-diagnostic information, and out of this reason their successive application is essential. The combined firstpass and dynamic functional renal studies have been judged as a helpful diagnostic tool in the follow-up of patients who have undergone kidney transplantation, provided that its results are interpreted in the light of clinical and other relevant findings.