[Chronic graft-versus-host disease presenting as nephrotic syndrome after allogenic hematopoietic stem cell transplantation]. / Letines ligos 'transplantatas pries seimininka" pasireiskimas nefroziniu sindromu po kraujo kamieniniu lasteliu persodinimo.

Complications of allogenic hematopoietic stem cell transplantation that occur in the first 100 days are considered early and those that begin 100 days after are considered late complications. Chronic graft-versus-host disease is the most common late complication of allogenic hematopoietic cell transplantation, which occurs in 60-80% of long-term survivors and causes significant morbidity and mortality. It is well known that it affects primarily the skin, mucous membranes, cells in the gastrointestinal tract and liver. The kidneys are not considered a target organ for chronic graft-versus-host disease in humans, although renal involvement in patients with chronic graft-versus-host disease, presenting as nephrotic syndrome, has been reported in patients who underwent allogenic transplantation. We present a case of chronic graft-versus-host disease that manifested as nephrotic syndrome after hematopoietic cell transplantation performed 3 years ago. Kidney biopsy revealed membrane nephropathy. Treatment with cyclosporine and methylprednisolone significantly reduced albuminuria.

[Surgical treatment of secondary hyperparathyroidism (The first experience in Klaipeda region)]. / Antrines hiperparatirozes chirurginis gydymas (pirmoji patirtis Klaipedos kraste).

UNLABELLED: The aim of the study was to analyze criteria for selection of patients for parathyroidectomy, results of surgery and the need for such surgeries in patients undergoing dialysis in Klaipeda region. RESULTS: 201 chronic patients were hemodialyzed in Klaipeda region in January 2005. 4 of them underwent parathyroidectomy. Before surgery parathyroid hormone of all patients was greater than 1000 pg/ml; during sonoscopy enlarged parathyroid glands were identified; increased levels of alkaline phosphatase and bone lesions, hyperphosphatemia hardly corrected with drugs were detected; one patient had tissue calcification. After surgery clinical state of all the patients improved noticeably and amounts of parathyroid hormone, calcium and phosphorus in blood decreased. No postoperative complications were observed. After review of medical records of 201 chronic patients undergoing hemodialysis, it was discovered that 9.4 % of patients had secondary hyperparathyroidism resistant to treatment. CONCLUSIONS: The first parathyroidectomies in Klaipeda region were successful; previous disorders of metabolism of calcium, parathyroid hormone and phosphorus were corrected. On average 9.4% of patients on hemodialysis in Klaipeda region were recommended to undergo parathyroidectomy.

Nationwide renal biopsy data in Lithuania 1994-2012.

BACKGROUND: Our aim was to evaluate the incidence of biopsy-proven kidney diseases in Lithuania and to compare their changes in three different time intervals. All Lithuanian kidney biopsies were performed in the National Center of Pathology, enabling analysis at the national level. METHODS: The native kidney biopsy data were reviewed, and incidence of renal disorders and patient demographics were compared during three time intervals: 1994-1999, 2000-2006, and 2007-2012. RESULTS: A total of 5,368 kidney biopsies were performed, including 3,640 native kidney and 1,728 kidney transplant biopsies; 59.5% (2,165) of the native kidney biopsies were classified as primary glomerulopathies. The most common entity was IgA nephropathy (737; 34.0%), followed by focal segmental glomerulosclerosis (285; 13.2%) and membranoproliferative glomerulonephritis (256; 11.8%). Prominent decrease in incidence of membranoproliferative glomerulonephritis (16.8 to 8.7% from the first to third time interval) and increase in (mainly, pauci-immune) crescentic glomerulonephritis (6.2 to 15.3%) were noted over the study period. In a subgroup of 427 pediatric native kidney biopsies, IgAN accounted for 24.9% of biopsies. The incidence of MCNS increased dramatically from the first to third time interval (6.3 to 25.4%), while the number of MPGN increased in the second time interval (from 7.2 to 8.9%) but decreased in the third one (to 4.4%). CONCLUSIONS: Decrease in relative incidence of membranoproliferative glomerulonephritis, most likely, reflects improvement in socioeconomic conditions, while relative increase in crescentic glomerulonephritis is interpreted as improved diagnostics of the disease.

[Potential causes of antigenemia in the patients with an immune complex-mediated membranoproliferative glomerulonephritis in Lithuania]. / Galimos imunokompleksinio membranoproliferacinio glomerulonefrito antigenemijos priezastys Lietuvoje.

UNLABELLED: The pathogenesis of an immune complex-mediated membranoproliferative glomerulonephritis (IMPGN) involves persistent deposition of circulating immune complexes in the glomeruli caused by persistent antigenemia. We have previously reported relatively high incidence of IMPGN in Lithuania. The objective of our study was to evaluate potential causes of persistent antigenemia in the patients with IMPGN. MATERIAL AND METHODS: Forty-five patients with IMPGN diagnosed on renal biopsy during 2000-2002 were retrospectively evaluated for the presence of persistent bacterial or viral infections, autoimmune diseases and other associated medical conditions. Patients with established diagnosis of systemic lupus erythematosus (SLE) before the biopsy were not included in the study. RESULTS: A great majority (20; 44%) of the patients were found to have persistent bacterial infections of various localization. Four patients (9%) were infected with hepatitis B virus (HBV). Three (7%) patients were eventually diagnosed with SLE and another 3 (7%) had other associated pathology. In the remaining 15 (33%) patients, IMPGN remained idiopathic. Testing for hepatitis C virus (HCV) antibody was performed in 36 patients (12 of them with idiopathic IMPGN) and was negative in all patients. Testing for HCV RNA was not performed. Patients with bacterial infections were significantly younger compared to the group of idiopathic IMPGN (36.5+/-19.1 and 53.8+/-16.4, respectively, p=0.01). We conclude that persistent bacterial infection was a major potential source of antigenemia in our patients with IMPGN, particularly in the younger patients, while HBV and HCV infection was rarely detected.