Hüperkaleemia

Hüperkaleemia on üks sagedasemaid elektrolüütide tasakaalu häireid, mis võib põhjustada eluohtlikke arütmiaid ning nõuab kohest meditsiinilist sekkumist. Hüperkaleemia esinemissagedus hospitaliseerimisel varieerub eri uuringutes 1–10%, sõltudes patsientide kohordist ja kaasuvatest haigustest. Hüperkaleemia esineb peamiselt patsientidel, kelle võime kaaliumit väljutada on vähenenud või kes manustavad ravimeid, mis mõjutavad vere kaaliumisisaldust, ning ka neil, kellel koekahjustuse või metaboolse atsidoosi tõttu on kaalium liikunud rakkudest ekstratsellulaarsesse ruumi. Uute suukaudsete ioonivahetajate (naatriumtsirkooniumtsüklosilikaat (ZS-9), patiromeer) kättesaadavaks muutumine Eestis võimaldab nii ägeda kui ka kroonilise hüperkaleemia ravi muuta tõhusamaks ja ohutumaks. Artikli eesmärk on anda ülevaade hüperkaleemia esinemisest, etiopatogeneesist, diagnoosimisest ja ravist

Use of Water Immersion to Ameliorate the Progression of Chronic Experimental Kidney Disease

The possible benefits of aquatic environment to kidney function in renal failure stages not much been investigated.  It is known that water environment could influence renal function positively: plasma renin activity  is reduced, contributing to renal vascular pressure and sodium excretion. Water immersion causes increase  in renal blood flow and contributes to the lowering in renal sympathetic nerve activity, renal vascular pressure  and decrease in plasma renin activity. Non-swimming aerobic aquatic exercises have shown a beneficial  effect to chronic kidney disease patients. We hypothesized that the aquatic environment could improve  renal functioning and even slow the progression rate of chronic kidney disease (CKD). The aim of our study  was to investigate the effects of regular water immersion and voluntary swimming to the rate of progression  of experimental CKD. Wistar rats were divided into matched groups 2 weeks after 5/6 nephrectomy  (5/6NPX) and studied during 18 weeks. One group was subjected to water immersion with water temperature  38o and swimming without exhaustion 30 min daily for 12 weeks. Control groups remained sedentary.  Chronic studies of systolic blood pressure and urinary protein excretion rate (mg/24h) were performed.  Renal morphology was studied and MCP-1 gene expression level was investigated in kidney tissue samples  at the end of the study. The main systolic blood pressure was significantly lower and proteinuria was reduced  significantly in the swimming-immersion group compared to control 5/6NPX animals. The degree  of glomerulosclerosis and interstitial fibrosis was significantly less prominent in the water-therapy group.  Expression of mRNA for chemokine MCP-1 in glomeruli of CKD animals differs significantly between the  water-therapy group and control 5/6NPX group and was closely associated with effects on proteinuria and  systolic blood pressure. These results point to the additional renoprotective properties of long-term water  immersion and daily aquatic therapy in rats with CKD.

Orellaniinimürgistusest põhjustatud neerukahjustus – haigusjuhtude kirjeldus ja kirjanduse ülevaade

2020. aasta augustis diagnoositi Eestis seitse seenemürgistusjuhtu, mille põhjuseks oli orellaniinimürgistus, mis oli tekkinud vöödikute tarvitamisest. Orellaniinimürgistus kulgeb esmalt väheste sümptomitega, kuid põhjustab ägeda neerukahjustuse ning patsiendid satuvad haiglaravile alles nädalate möödudes, kui jääkained on kuhjunud ning esinevad olulised elektrolüütide häired. Tartu Ülikooli Kliinikumi hospitaliseeriti lühikese ajavahemiku jooksul neli patsienti, Põhja-Eesti Regionaalhaiglasse kolm patsienti. Kuus patsienti vajasid hemodialüüsravi ning kolmel patsiendil on krooniline neeruasendusravi vajalik ka 10 kuud pärast mürgistust. Neerukahjustuse kujunemiseks kulub tavaliselt mõni nädal, seetõttu võib mürgistuse algpõhjus jääda märkamata ning käesoleva haigusjuhtude kirjeldamise eesmärk on olla abiks edasiste mürgistusjuhtude diagnoosimisel ja käsitlusel

Neeruasendusravi epidemioloogia Eestis

Neeruasendusravi (NAR) meetodid, nagu dialüüsravi ja transplantatsioon, on arenenud aastakümneid paralleelselt. Kuigi nii dialüüsi kui neeru transplanteerimise katseid tehti 20. sajandi algusaastatel, toimus esimene edukas neeru- siirdamine Brigham & Women’s haiglas USAs 1954. aastal. 50.–60. aastatel muutus neeruasendusravi, sh transplantatsioon, majanduslikult arenenud maades rutiinseks raviks (1, 2)

Neeruasendusravi Eestis aastatel 1996–2004

Eestis jt maades on neeruasendusravi vajavate kroonilise neerupuudulikkusega haigete arv aasta- aastalt kasvanud. Peamiseks neerupuudulikkuse sagenemise põhjuseks paljudes maades on diabeetilise ja kõrgvererõhktõve tagajärjel tekkinud nefropaatia sagenemine. Probleemiks on ka neerupuudulikkuse esinemine eakatel patsientidel. Et aeglustada kroonilise neeruhaiguse progresseerumist ja edasi lükata neeruasendusravi alustamist, on oluline võimalikult varases staadiumis avastada krooniline neerupuudulikkus. Artiklis on analüüsitud neeruasendusravi vajavate haigete kliinilisi ja epidemioloogilisi andmeid Eestis aastatel 1996–2004 ning võrreldud neid teiste maade andmetega. Eesti Arst 2005; 84 (10): 714–71

Improvements in Renal Replacement Therapy Practice Patterns in Estonia

Background: The clinical performance indicators (CPI) are important tools to assess and improve the quality of renal replacement therapy (RRT). The aim of the current study was to compare the results of a longitudinal set of CPI in RRT patients and to determine the extent to which the guidelines for anaemia, calcium phosphate management and other CPI are met in Estonian renal centres. Methods: A long-term retrospective, observational, cross-sectional CPI analysis was undertaken in RRT patients from 2007 to 2011. The following CPI set of well-designed measures based on good evidence was analysed: anaemia management variables, laboratory analyses of mineral metabolism, nutritional status variables and dialysis adequacy variables. Results: Relatively small changes in the analysed mean CPI values were noticed during the study period. In the course of the study, we noticed an improvement in anaemia control, but not all centres achieved the standard of >80% of the dialysis patients with a haemoglobin (Hb) level >100 g/l. There was a trend of decreasing Hb concentrations below 125 g/l in both haemodialysis (HD) and peritoneal dialysis (PD) patients. In 2011, hyperphosphataemia was present in 58% of the HD and 47% of the PD patients, whereas centre differences varied between 50 and 60% of both the HD and PD patients. HD adequacy was achieved in 77% of the HD patients. Conclusion: An improvement in the data collection was noticed, and the analysis of CPI allows renal centres to assess and compare their practices with others. The collection and evaluation of CPI of RRT patients is an important improvement and significantly increases the awareness of nephrologists

IgA nephropathy clinicopathologic study following the Oxford classification: Progression peculiarities and gender-related differences

Background and aim: Immunoglobulin A nephropathy (IgAN) is the most frequent glomerular disease worldwide and one of the main causes of chronic kidney disease. We aimed to investigate clinicopathological correlations in IgAN patients by gender. Materials and methods: The study was based on a retrospective analysis of renal biopsy data and clinical manifestations of the disease. Consecutive 73 biopsy-proven IgAN cases of male (62%) and female (38%) patients were investigated. Renal biopsies were reviewed using the new Oxford classification assessing the MEST (mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis/adhesion, tubular atrophy/interstitial fibrosis) score. The most powerful IgAN prognostic risk factors, morphological (segmental glomerulosclerosis and tubular atrophy/interstitial fibrosis) as well as clinical (proteinuria and hypertension) were taken into account in the correlation analysis. The mean rate of renal function decline was expressed as a slope of eGFR during the follow-up (FU) dividing delta GFR with the FU years. Results: The mean age of the patients was 33.7 years (range, 16–76). Follow-up data were available for 64 patients with the mean follow-up of 4.1 years. The mean proteinuria at biopsy was 0.79 g/24 h. The mean arterial pressure (MAP) was 94.5 ± 16.7 mmHg and 7% of the patients were hypertensive. The initial mean estimated glomerular filtration rate (eGFR) was 94.9 ± 30.7 mL/min, at the end of the follow-up it was 86.2 ± 27.1 mL/min. The mean rate of renal function decline was −3.4 ± 11.9 mL/min/1.73 m2 per year in males (P < 0.05) and −0.7 ± 5.3 mL/min/1.73 m2 per year in females. The Spearman correlation analysis confirmed a higher MEST score in the whole cohort and in males correlated with disease progression. In patients with proteinuria below 1.0 g/24 h, disease progression was faster in males. Conclusions: According to the correlation analysis of the main prognostic risk factors, affecting the progression of IgAN, we can conclude that IgA nephropathy in males progresses more rapidly compared to females