Povezanost lipidnog statusa sa 25-hidroksi vitaminom D: studija preseka kod bolesnika sa krajnjim stadijumom bolesti bubrega

Background:Some observational studies indicate an association of 25-hydroxy vitamin D (25(OH)D) insufficiency and atherogenic cholesterol concentrations. The aim of this study was to investigate relationship between 25(OH)D concentrations and lipid parameters in end stage renal disease (ESRD) patients, separately for predialysis, hemodialysis and peritoneal dialysis patients.Methods:We have adjusted 25(OH)D concentrations for seasonal variability with cosinor analysis, and performed all further analysis using these corrected 25(OH)D concentrations. Concentrations of 25(OH)D and the lipid parameters were determined in 214 ESRD patients and 50 control group participants. The analysis included the measurement of 25(OH)D by HPLC, apolipoprotein (Apo) AI, ApoB andLp(a) by nephelometry, total cholesterol (TC), high-densitylipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) by spectrophotometry and manually calculated ApoB/ApoAI and LDL-C/HDL-C ratio.Results:ESRD patients with adjusted 25(OH)D concentrations of ≤ 50 nmol/L had significantly higher TC (P =0.005) and ApoAI (P = 0.049). Significantly higher HDL-C (P = 0.011) and ApoAI (P = 0.020) were found in hemodialysis patients with the 25(OH)D concentrations of ≤ 50 nmol/L. The other analyzed lipid parameters differed significantly between predialysis, hemodialysis and peritoneal dialysis patients with 25(OH)D concentrations of <50 nmol/L. Conclusions:Our study indicate the significant relationship between 25(OH)D repletion and optimal concentrations of lipid parameters in ESRD patients. Further research is necessary to explain whether joint evaluation of vitamin D status and lipid abnormalities could improve cardiovascular outcome in ESRD patients.Uvod: Opservacione studije ukazuju na povezanost nedostatka 25-hidroksi vitamin D (25(OH)D) i koncentracija aterogenog holesterola. Cilj ove studije bio je da se ispita međusobna povezanost 25(OH)D i lipidnih parametara kod bolesnika sa krajnjim stadijumom bolesti bubrega (ESRD) posebno kod predijaliznih, bolesnika na hemodijalizi i peritonalnoj dijalizi. Metode: Podesili smo koncentracije 25(OH)D za sezonsku varijaciju koristeći kosinor analizu, i u daljem ispitivanju smo koristili korigovane koncentracije 25(OH)D. Koncentracije 25(OH)D i lipidnih parametara su određene za 214 ESRD bolesnika i 50 učesnika kontrolne grupe. Analizirali smo koncentracije 25(OH)D metodom HPLC, apolipoproteina (Apo) AI, ApoB i Lp(a) nefelometrijski, ukupnog holesterola (TC), lipoproteina velike gustine (HDL-C), lipoproteina male gustine (LDL-C) i triglicerida (TG) spektro fotometrijski i ručno preračunavali indekse ApoB/ApoAI i LDL-C/HDLC. Rezultati: ESRD bolesnici sa korigovanim 25(OH)D 50 nmol/L su imali značajno viši TC (P = 0,005) i ApoAI (P = 0,049). Značajno više koncentracije HDL-C (P = 0,011) i ApoAI (P = 0,020) smo dobili kod hemodijaliznih bolesnika sa 25(OH)D koncentracijama 50 nmol/L. Ostali analizirani lipidni parametri su bili značajno različiti između analiziranih grupa bolesnika sa 25(OH)D koncentracijama < 50 nmol/L. Zaključak: Naša studija ukazuje na značajnu povezanost dovoljnih nivoa 25(OH)D i optimalnih koncentracija lipidnih parametara kod ESRD bolesnika. Potrebna su dalja istraživanja da bi se objasnilo da li zajednička procena statusa vitamina D i lipidnih abnormalnosti mogu da poboljšaju kardiovaskularni ishod kod ESRD bolesnika

The significance of Goodpasture antigen in hereditary nephritis

INTRODUCTION: Two types of hereditary nephritis, nonprogressive and progressive, clinically present as asymptomatic haematuria, sometimes combined with proteinuria. At the onset, in both types, light microscopic changes are minimal, immunofluorescence findings are negative, and diagnosis can be made only upon electron microscopic findings that are considered to be specific. OBJECTIVE: The aim of this study was to determine the significance of Goodpasture antigen detection in diagnosis of progressive and nonprogressive hereditary nephritis in its early phase. METHOD: Analysis of renal biopsy specimens was done in patients with hereditary nephritis that were followed from 1990 to 2005. Progression of renal disease was examined in 14 patients with Alport's syndrome, 10 patients with thin basement membrane disease, and 6 patients with unclassified hereditary nephritis diagnosed. For all these cases, indirect immunofluorescence study with serum from a patient with high titer of Goodpasture autoantibodies that recognize the antigenic determinants in human glomerular and tubular basement membrane was performed. RESULTS: In 11 out of 14 cases diagnosed as Alport's syndrome, there was negative staining with Goodpasture serum, and in 3 additional cases with Alport's syndrome, expression of Goodpasture antigen in glomerular basement membrane and thin basement membrane was highly reduced. In all 10 patients with thin basement membrane disease, immunofluorescence showed intensive, bright linear staining with Goodpasture serum along glomerular and tubular basement membrane. In 2 out of 6 patients with unclassified hereditary nephritis, Goodpasture antigen expression was very strong, in one patient it was very reduced, and in 3 patients it was negative. CONCLUSION: The results of our study show that Goodpasture antigen detection plays a very important role in differential diagnosis of progressive and nonpregressive hereditary nephritis, particularly in early phases of the disease

Screening for chronic kidney disease in Belgrade Primary Health Care Centers

Introduction. Academy of Medical Science of Serbian Medical Society introduced collaboration between Belgrade nephrologists and general practitioners with the aim of examining the prevalence of chronic kidney disease (CKD) in populations at risk as well as of checking whether collaboration with general practitioners contributed to implementation of regular CKD screening. Methods. The research encompassed two studies carried out in four Belgrade Primary Health Care Centers. The screening study involved 619 patients at risk for CKD (348 with hypertension, 206 with diabetes, 65 persons aged > 60 years without hypertension/diabetes) in whom glomerular filtration rate (eGFR) was estimated by MDRD formula, while urine dipstick test was used for detection of proteinuria and albuminuria (Micral-test® strips).The second study was retrospective analysis of medical records of 450 patients who were examined in the screening study and whose blood pressure and eGFR recording were analyzed during three-year period. Results. In screening study, eGFR below 60 ml/min/1.73m2 was detected in 121 (19.55%) and albuminuria in 242 (39.10%) patients. During three-year retrospective study, percentage of patients whose blood pressure and eGFR were recorded decreased from 42% to 22% and from 42% to 18%, respectively. Multivariate regression analysis selected health center, systolic blood pressure and hypertension as the variables significantly associated with the number of years in which blood pressure was recorded, while male gender, health center, hypertension and basal eGFR as variables associated with the number of years in which eGFR was recorded. Conclusion. Despite collaboration between nephrologists and general practitioners in screening study, the retrospective threeyear study revealed insufficient recording of blood pressure and eGFR in patients’ medical records

Analiza bubrežne funkcije i udaljenih posledica kod žena sa hipertenzivnim poremećajem u trudnoći

Pismo uredniku. Nema apstrakta

Classification of patients at risk for chronic kidney disease by use of eGFR and albuminuria

Introduction. Screening for chronic kidney disease (CKD) has been advisedin high-risk populations. However, data on the prevalence of early asymptomaticstages vary and depend on the definition of CKD. In the present studysubjects at risk for CKD (patients with diabetes mellitus type 2-DM2, withhypertension and older than 60 years without diabetes and hypertension)were classified in categories defined by eGFR and albuminuria staging system.Methods. After regular check-up in primary health center, 285 consecutivepatients at risk for CKD, were selected: 75 patients with well-controlled DM2without hypertension, 130 with hypertension and 80 subjects older than 60years without diabetes or hypertension. Screening included a questionnaire,blood pressure measurement, single albuminuria determined by immunonephelometry,and eGFR estimation using MDRD.Results. Six DM2 patients, 15 withe hyprtension and 12 elderly had eGFR<60(assessed in ml/min/1.73m2) with optimal albuminuria. High albuminuriawas observed in one DM2 and four hypertensive patients, and 28 elderly.When eGFR and albuminuria staging system for predicting risk for majorCKD outcomes was used, 41.2% of the elderly were classified in the moderateand 8.8% in the high risk group, for DM2 patients these percentages were9.3% and 0%, and for hypertensive patients 16.9% and 4.7%, respectively.Conclusion. The majority of examined patients did not have CKD, and in allthree groups most individuals with reduced eGFR did not have albuminuria>30mg/g. Using the classification of CKD based on eGFR and albuminuria

Screening for chronic kidney disease in Belgrade Primary Health Care Centers

Introduction. Academy of Medical Science of Serbian Medical Societyintroduced collaboration between Belgrade nephrologistsand general practitioners with the aim of examining the prevalenceof chronic kidney disease (CKD) in populations at risk as well as ofchecking whether collaboration with general practitioners contributedto implementation of regular CKD screening.Methods. The research encompassed two studies carried out infour Belgrade Primary Health Care Centers. The screening study involved619 patients at risk for CKD (348 with hypertension, 206 withdiabetes, 65 persons aged > 60 years without hypertension/diabetes)in whom glomerular filtration rate (eGFR) was estimated byMDRD formula, while urine dipstick test was used for detection ofproteinuria and albuminuria (Micral-test® strips).The second studywas retrospective analysis of medical records of 450 patients whowere examined in the screening study and whose blood pressureand eGFR recording were analyzed during three-year period.Results. In screening study, eGFR below 60 ml/min/1.73m2 wasdetected in 121 (19.55%) and albuminuria in 242 (39.10%) patients.During three-year retrospective study, percentage of patientswhose blood pressure and eGFR were recorded decreasedfrom 42% to 22% and from 42% to 18%, respectively. Multivariateregression analysis selected health center, systolic blood pressureand hypertension as the variables significantly associated with thenumber of years in which blood pressure was recorded, while malegender, health center, hypertension and basal eGFR as variablesassociated with the number of years in which eGFR was recorded.Conclusion. Despite collaboration between nephrologists andgeneral practitioners in screening study, the retrospective threeyearstudy revealed insufficient recording of blood pressure andeGFR in patients’ medical records

Sex-specific differences in the epidemiology, progression, and outcomes of chronic kidney disease

Higher prevalence of chronic kidney disease (CKD) in women than in men was reported all over the world. This difference could be partly explained by longer life expectancy and slower CKD progression rate in women. Potential factors associated with sex differences in CKD progression are as follows: difference in glomerular hemodynamic and the response to angiotensin II; sex hormones – estrogen has protective and testosterone deleterious effects on CKD progression; lifestyle. In most countries, the percentage of men is higher than that of women among incident and prevalent patients on hemodialysis (HD). In HD patients, the Kt/V index overestimates HD adequacy, secondary hyperparathyroidism is more common in women, and women require higher doses of erythropoiesis-stimulating agents for achieving and maintaining the hemoglobin target level. The survival of HD patients is equal for both sexes. In earlier years, an equal percentage of women and men started peritoneal dialysis, but in recent years, a higher percentage of women, especially at younger ages, start peritoneal dialysis. Initial peritoneal transport properties differ between men and women. A smaller percentage of women than men receive deceased donor kidneys, but women are more likely to be living kidney donors. Kidney allograft outcome depends on the sex and age of both the recipient and the donor. Cardiovascular diseases are the most common cause of death for renal replacement therapy patients of both sexes. Although sex-specific differences have been described in CKD patients, the inequality of patients in access to medical care has not been found in most regions of the world

Pulmonary embolism as the first sign of the nephrotic syndrome

Introduction. Pulmonary embolism (PE) is a serious complication of deep venous thrombosis, with a significant morbidity and mortality. More often, PE complicates the course of the nephrotic syndrome (NS), in particular when the disease is active, but it may occur as the first sign of illness when the diagnosis of the NS is being delayed as a result. Membranous nephropathy is, generally speaking, the most commonly reported glomerulonephritis associated with the increased risk of thrombosis. Case outline. This report summarizes our experience with three young male patients (a 26-year-old, a 22-year-old, and a 45-year-old), in which PE was the first presenting feature of the NS. All of them were admitted to the hospital experiencing chest pains, dry cough, and shortness of breath. One of them had high temperature and the other two swelling of the lower parts of legs. Computed tomography of the thorax showed pulmonary artery thrombosis in all three patients. Diagnosis of the NS was confirmed by laboratory analysis, while renal biopsy showed membranous nephropathy. The treatment was based on the pulse of methylprednisolone (1.5 g over a period of three days), with alternating therapy of oral corticosteroids and cyclophosphamide on a monthly basis during six months. After six months, two patients reached incomplete remission, while the third one still has the NS and normal renal function. Conclusion. Not so rare occurrence of thromboembolic events in the NS suggests that one should always suspect the NS in all patients with deep venous thrombosis or PE

Evaluation of methods for rapid microalbuminuria screening in kidney diseased patients

Introduction. One of the criteria for chronic kidney disease detection is determination of microalbuminuria. Objective. This analysis was performed to evaluate accuracy of three useful methods for microalbuminuria detection in 24h urine collection and in the morning urine specimen calculated from urine albumin creatinine ratio, or with a dipstick in patients with different kidney diseases or kidney function. Methods. Microalbuminuria was detected in 74 patients referred to the Outpatient Nephrology Department for kidney function determination or regular nephrology checking. Albumin concentration determined using immunonephelometry was lower than 300 mg/day. Discriminates cutoff values for spot urine test strip and albumin creatinin ratio in predicting 24 h protein ‘threshold’ excretion were determined using ROC analysis. Results. Mean value of 24 h microalbuminuria was 80.3 mg/24 h, and value &gt;30 mg/24 h was present in 71.8% of patient. Correlation coefficients between dipstick microalbuminuria or albumin/creatinine ratio in a spot urine specimen and 24 h microalbuminuria were 0.709 and 0.598 (p&lt;0.0001). For pathological value of 24 h microalbuminuria &gt;30 mg/24 h, the coresponding dipstick microalbuminuria value was ≥20 mg/L (AUC 0.849, specificity 95%, positive predictive value 97.3%), and ≥3.55 mg albumin/mmol creatinine ratio (AUC 0.914, specificity 90% and positive predictive value 95.5%). No difference was found between dipstick mikroalbuminuria and albumin/creatinine ratio value. In addition, albumin/creatinine ratio value from 24 h urine was similar to the value obtained from the spot urine sample. Conclusion. Obtained results indicated that albuminuria could be determined accurately in spot urine either with the Micral test strip or with albumin creatinine ratio

Risk factors for the development of diabetic nephropathy

Introduction. Results of epidemiological analysis show that one third of patients with diabetes mellitus develop diabetic nephropathy (DN). Strategies used until now to slow down the progression of DN were initiated when the symptoms of DN were already present. Objective. Our objective was to analyze the prevalence and characteristics of DN and to determine the factors leading to DN. Methods. Fifty-two patients with diabetes mellitus (DM) - 32 with type 1 aged 32 years and 20 with type 2 aged 59 years - were referred from the Institute of Endocrinology, Diabetes and Metabolic Diseases to the Department of Nephrology for kidney function evaluation. Apart from routine laboratory analyses, glomerular filtration rate was calculated using the MDRD formula (modification of diet in renal disease), the size of the kidney was measured by ultrasound, and kidney volume was calculated using the ellipsoid formula. Results Thirty percent of the patients revealed normal (eight patients with DM type 1) or satisfactory kidney function (eight patients with DM type 1) with physiological proteinuria. Micro-albuminuria (MAU) or pathological proteinuria (PRT) were found in 10 and 9 patients, respectively, with DM type 1, while decreased kidney function was found in one patient without proteinuria. MAU or PRT were found in four and eight patients, respectively, with DM type 2 and decreased kidney function in four patients without proteinuria. Kidney function was significantly lower in patients with DM type 2 in comparison to DM type 1, while the patients with decreased kidney function had a higher PRT. Compared to DM type 2, in DM type 1 patients, the kidney was longer, and parenchymal artery resistance index was lower in DM type 1 patients compared to DM type 2. Factors associated with DN were patient's age, duration of diabetes, systolic blood pressure, HbA1c and kidney volume. Conclusion. The prevalence of DN among the studied patients was 70%. Treatable factors associated with the development of DN are strict control of blood pressure and glycaemia control