[Changes in hemodialysis adequacy in Lithuania during 1999-2005]. / Hemodializes proceduros kokybes pokyciai Lietuvoje 1999-2005 m.

Despite the improvement of hemodialysis technique, mortality of chronic hemodialysis patients remains quite high. It considerably depends on dialysis adequacy. The aim of the study was to evaluate the adequacy of hemodialysis procedure and its changes in Lithuania during 1999-2005. Between 1999 and 2005 in December, all hemodialysis centers in Lithuania were annually visited, and data on the type of hemodialysis, duration of hemodialysis (hours per week), single-pool Kt/V were collected from all hemodialysis patients. The percentage of patients on bicarbonate hemodialysis sharply increased from 57.9% in 1999 to 100% in 2001 (P<0.001), and the duration of hemodialysis procedure increased (67.3% of hemodialysis patients were dialyzed 12 and more hours per week in 2005 vs. 41.3% in 1999, P<0.001). The percentage of patients who were dialyzed three times per week increased from 51% in 1999 to 77% in 2005 (P<0.001). The mean Kt/V was 0.81+/-0.53 in 1999, but it increased to 1.21+/-0.27 in 2005 (P<0.001). More than half (54%) of all hemodialysis patients in 2005 had Kt/V > or =1.2 vs. more than one-third (36%) in 1999 (P<0.001). The mean Kt/V of patients who were on dialysis three times per week was 1.25+/-0.6; two times per week, 1.30+/-0.8; and one time per week, 1.27+/-0.26 in 2003. In 2005, the results were 1.21+/-0.27, 1.22+/-0.26, and 1.16+/-0.29, respectively (P>0.05). CONCLUSIONS. 1. The improvement of the quality of hemodialysis was observed in Lithuania during 1999-2005: a) from 2001, patients received only bicarbonate hemodialysis; b) weekly duration of hemodialysis increased; c) Kt/V improved. 2. Despite the improvement of hemodialysis quality, it is not optimal yet and is associated with insufficient duration of hemodialysis.

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.

[Renal failure due to a villous adenoma]. / Viliozines adenomos sukeltas inkstu nepakankamumas.

Villous adenoma comprises 5.6% of colon tumors. Adenomas of the colon could be divided into tubular, villous, and tubulovillous adenomas. Villous adenomas are not as common as tubular neoplasms; however, usually they are larger and could cause a depleting syndrome characterized by dehydration, hyponatremia, hypokalemia, hypochloremia, and metabolic acidosis. In severe cases, shock and renal failure in older patients could cause death. Case of villous adenoma is presented in this article. Seventy-eight-year-old male who suffered permanent diarrhea for few years followed with acute renal failure. Villous adenoma was diagnosed. The conservative treatment had short renal function improvement. Hemodialysis had to be performed. Renal function was completely recovered after radical tumor surgery.