Onco-nephrology - an approach to patients treatment

Onko-nefrologija je novo, multidisciplinarno področje, ki povezuje predvsem področji onkologije in nefrologije. Število bolnikov z rakom, ki imajo različno stopnjo ledvične okvare, narašča. Cilj celostne obravnave onko-nefrološkega bolnika je večja učinkovitost in varnost zdravljenja. Bolniki z ledvično okvaro višje stopnje so bili izključeni iz prospektivnih randomiziranih raziskav, tako da za njih ni na voljo podatkov z visoko dokazi visoke stopnje o učinkovitosti in varnosti zdravil ter mejnih vrednostih biooznačevalcev, ki so v pomoč pri vodenju zdravljenja. V klinični praksi se zato pri zdravljenju onko-nefrološkega bolnika opiramo na klinične izkušnje, podatke iz retrospektivnih analiz in posameznih objavljenih primerov ter priporočila, ki temeljijo na soglasju strokovnjakov. Pri zdravljenju onko-nefrološkega bolnika je ključno tesno sodelovanje med onkologom in nefrologom, mnogokrat je nujen multidisciplinarni posvet. Zdravnik, ki je odgovoren za načrt zdravljenja, potrebuje osnovno znanje nefrologije in dobro poznavanje omejitev onkološkega zdravljenja. Zaradi vedno večjega števila onko-nefroloških bolnikov in novih možnosti protirakavega zdravljenja je pred desetimi leti na Onkološkem inštitutu Ljubljana začela delovati onko-nefrološka ambulanta, za zahtevnejše bolnike, ki potrebujejo dodatno multidisciplinarno obravnavo, pa deluje onko-nefrološki konzilij. Delovna skupina za onko-nefrologijo v okviru Sekcije za internistično onkologijo vsako leto pripravi onko-nefrološko šolo, kjer svoj pogled na isti klinični problem predstavijo različni strokovnjaki. Ena izmed prioritet onko-nefrologije so raziskave. V prispevku so opisane pomembnejše teme s področja onko-nefrologije skupaj z izzivi iz klinične prakse.Onco-nephrology is a new, multidisciplinary field, which connects the fields of oncology and nephrology. The number of cancer patients with various stages of kidney disease has been increasing. The goal of the holistic management of onco-nephrologic patient is to increase efficacy and safety of treatment. Since patients with renal impairment have been excluded from prospective randomized trials, for these patients there is no available data with high level of evidence about efficacy and safety of treatment and the limit values of biomarkers, which help to guide the treatment. In clinical practice, the management of onco-nephrologic patient is based on clinical experience, data from retrospective analyses and case reports, and recommendations supported by the expert consensus. Close cooperation between an oncologist and nephrologist is crucial and a multidisciplinary consultation is often needed. The physician who is responsible for the treatment plan needs to have a basic knowledge of nephrology and a good knowledge of limitations of oncologic treatment. Due to an increasing number of onco-nephrologic patients and new anti-cancer treatment options, an onco-nephrology outpatient clinic started to operate at the Institute of Oncology Ljubljana ten years ago. A medical council has been established for more complex patients who need additional multidisciplinary care. Every year, The Working Group on Onco-Nephrology of the Section of Medical Oncology organize the Onco-nephrology school, where the views from various experts on a certain clinical problem are presented. One of the priorities of onco-nephrology is research. The paper describes the important topics in the field of onco-nephrology together with challenges from the clinical practice

COVID-19 Pandemic Waves and Mortality Among Patients on Kidney Replacement Therapy

COVID-19; Dialysis; MortalityCOVID-19; Diálisis: MortalidadCOVID-19; Diàlisi; MortalitatThis work was supported with unrestricted grants from European Renal Association (ERA), Nierstichting (Dutch Kidney Foundation), Baxter, and Sandoz unrestricted research grants

Začetak transplantacije bubrega u jugoistočnoj Europi

Organ transplantation is one of the most important medical achievements of the 20th century. Kidney transplantation is the most efficient method of renal replacement therapy. The first successful kidney transplantation in human was performed in 1954 in Boston, USA. In former Yugoslavia, the first kidney transplantation was performed on April 16, 1970 in Ljubljana, Slovenia, and second one on January 30, 1971 in Rijeka, Croatia. In both cases, the mother donated kidney to the son. In the article, we describe the prerequisite conditions for this operation, the characteristics of first patients, and the impact of transplantation program on the development of the hospitals and medical schools.Transplantacija organa zasigurno predstavlja jedno od najvećih dostignuća 20. stoljeća. Transplantacija bubrega je najučinkovitija metoda od svih oblika nadomještanja bubrežne funkcije. Prva uspješna transplantacija bubrega u ljudi je učinjena u Bostonu, SAD, 1954. godine. U bivšoj Jugoslaviji prva transplantacija bubrega je učinjena 16. travnja 1970. u Ljubljani, Slovenija, a potom 30. siječnja 1971. u Rijeci, Hrvatska. Darivatelj je kod oba bolesnika bila majka, a primatelj sin. U članku ćemo prikazati što je prethodilo ovim operacijama, značajke prvih bolesnika te utjecaj transplantacijskog programa na razvoj matičnih bolnica i fakulteta

Temporal trends in the quality of deceased donor kidneys and kidney transplant outcomes in Europe:an analysis by the ERA-EDTA Registry

BACKGROUND: We investigated 10-year trends in deceased donor kidney quality expressed as the kidney donor risk index (KDRI) and subsequent effects on survival outcomes in a European transplant population. METHODS: Time trends in the crude and standardized KDRI between 2005 and 2015 by recipient age, sex, diabetic status and country were examined in 24 177 adult kidney transplant recipients in seven European countries. We determined 5-year patient and graft survival probabilities and the risk of death and graft loss by transplant cohort (Cohort 1: 2005–06, Cohort 2: 2007–08, Cohort 3: 2009–10) and KDRI quintile. RESULTS: The median crude KDRI increased by 1.3% annually, from 1.31 [interquartile range (IQR) 1.08–1.63] in 2005 to 1.47 (IQR 1.16–1.90) in 2015. This increase, i.e. lower kidney quality, was driven predominantly by increases in donor age, hypertension and donation after circulatory death. With time, the gap between the median standardized KDRI in the youngest (18–44 years) and oldest (>65 years) recipients widened. There was no difference in the median standardized KDRI by recipient sex. The median standardized KDRI was highest in Austria, the Netherlands and the Basque Country (Spain). Within each transplant cohort, the 5-year patient and graft survival probability were higher for the lowest KDRIs. There was no difference in the patient and graft survival outcomes across transplant cohorts, however, over time the survival probabilities for the highest KDRIs improved. CONCLUSIONS: The overall quality of deceased donor kidneys transplanted between 2005 and 2015 has decreased and varies between age groups and countries. Overall patient and graft outcomes remain unchanged

Video1_Use of absorbable hemostat bolster for prevention of donor renal artery kinking in kidney transplant.mov

Transplant renal artery stenosis due to mechanical kinking is a rare but significant complication in kidney transplantation that can lead to graft dysfunction due to graft hypoperfusion, delayed graft function, or even global kidney infarction. When detected during surgery, re-anastomosis is usually performed after re-clamping, which inevitably prolongs the warm ischemia time, and increases the possibility of primary graft non-function. In this report, we describe a novel, noninvasive surgical technique whereby the donor renal artery is padded with absorbable hemostatic material (i.e., Surgicel) bolster, placed below the middle third of the renal artery in recipients who were found to have mechanical kinking during the implantation procedure. The bolster technique was used in 12 kidney transplant recipients who were found to have kinking of the donor artery during the primary surgery. After pillowing the renal artery with absorbable hemostatic bolster, no residual kinking was observed intra-operatively, and good allograft perfusion was confirmed with no Doppler ultrasound evidence of renal artery stenosis confirmed at 1 week, 1 month, and 1 year after transplantation.</p