Glomerulonefriit – märkamatult progresseeruv neerukahjustus

Glomerulonefriidid on põhiliselt immuungeneesiga neeru glomerulaarsed haigused, mille puhul esineb sageli ka põletikuline kahjustus. Glomerulonefriitide diagnostikas on oluline uriini analüüs, kus võib leida erinevas astmes proteinuuriat, hematuuriat, lisaks võib patsiendil esineda hüpertensioon ja neerupuudulikkus. Haiguse algstaadiumis võivad patsiendil igasugused kaebused puududa ning see põhjustab sageli diagnoosi ja ravi hilinemise. Haiguse süvenemise korral ohustavad patsienti nefrootiline sündroom ja selle tüsistused ning terminaalne neerupuudulikkus. Glomerulonefriidi lõpliku diagnoosi, ravitaktika ja prognoosi hindamise aluseks on neerubiopsia. Primaarse glomerulonefriidi eri vormid vajavad erinevat ravi, kuid haiguse progresseerumist ja neerukahjustuse süvenemist lõppstaadiumis neerupuudulikkuseni on sageli võimalik aeglustada. Paljud patsiendid ei vaja pidevat aktiivset ravi, kuid remissioonifaasis on vajalik haigete jälgimine ja regulaarne kontroll (uriini analüüs, vererõhk, neerufunktsioon), sest ägenemine ei pruugi esialgu tekitada vaevusi, mistõttu patsient ei pöördu ise õigel ajal arsti poole ja ravi võib hilineda. Eesti Arst 2009; 88(5):324−32

Kontrastaine kahjulikud toimed, kontrastainenefropaatia

Röntgenkontrastaine kasutamine radioloogilistel protseduuridel võib põhjustada nefropaatiat ja neerupuudulikkust. Kontrastaine(KA)-nefropaatia on neerufunktsiooni kahjustus, mis ilmneb 48–72 tunni jooksul pärast KA manustamist ja väljendub seerumi kreatiniini sisalduse suurenemises vähemalt 25%ni algväärtusest, kui teised neerufunktsiooni halvenemise põhjused on välistatud. Eesti Arst 2007; 86 (9): 659-66

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

The Importance of Early Diagnosis and Intervention in Chronic Kidney Disease: Calls-to-Action from Nephrologists Based Mainly in Central/Eastern Europe

Background: Chronic kidney disease (CKD) has a global prevalence of 9.1–13.4%. Comorbidities are abundant and may cause and affect CKD. Cardiovascular disease strongly correlates with CKD, increasing the burden of both diseases. Summary: As a group of 15 clinical nephrologists primarily practicing in 12 Central/Eastern European countries, as well as Israel and Kazakhstan, herein we review the significant unmet needs for patients with CKD and recommend several key calls-to-action. Early diagnosis and treatment are imperative to ensure optimal outcomes for patients with CKD, with the potential to greatly reduce both morbidity and mortality. Lack of awareness of CKD, substandard indicators of kidney function, suboptimal screening rates, and geographical disparities in reimbursement often hamper access to effective care. Key Messages: Our key calls-to-action to address these unmet needs, thus improving the standard of care for patients with CKD, are the following: increase disease awareness, such as through education; encourage provision of financial support for patients; develop screening algorithms; revisit primary care physician referral practices; and create epidemiological databases that rectify the paucity of data on early-stage disease. By focusing attention on early detection, diagnosis, and treatment of high-risk and early-stage CKD populations, we aim to reduce the burdens, progression, and mortality of CKD

Optical Method for Cardiovascular Risk Marker Uric Acid Removal Assessment during Dialysis

The aim of this study was to estimate the concentration of uric acid (UA) optically by using the original and processed ultraviolet (UV) absorbance spectra of spent dialysate. Also, the effect of using several wavelengths (multi-wavelength algorithms) for estimation was examined. This paper gives an overview of seven studies carried out in Linköping, Sweden, and Tallinn, Estonia. A total of 60 patients were monitored over their 188 dialysis treatment procedures. Dialysate samples were taken and analysed by means of UA concentration in a chemical laboratory and with a double-beam spectrophotometer. The measured UV absorbance spectra were processed. Three models for the original and three for the first derivate of UV absorbance were created; concentrations of UA from the different methods were finally compared in terms of mean values and SD. The mean concentration (micromol/L) of UA was 49.7±23.0 measured in the chemical laboratory, and 48.9±22.4 calculated with the best estimate among all models. The concentrations were not significantly different (P≥0.17). It was found that using a multi-wavelength and processed signal approach leads to more accurate results, and therefore these approaches should be used in future

Is Fluorescence Valid to Monitor Removal of Protein Bound Uremic Solutes in Dialysis?

The aim of this study was to evaluate the contribution and removal dynamics of the main fluorophores during dialysis by analyzing the spent dialysate samples to prove the hypothesis whether the fluorescence of spent dialysate can be utilized for monitoring removal of any of the protein bound uremic solute. A high performance liquid chromatography system was used to separate and quantify fluorophoric solutes in the spent dialysate sampled at the start and the end of 99 dialysis sessions, including 57 hemodialysis and 42 hemodiafiltration treatments. Fluorescence was acquired at excitation 280 nm and emission 360 nm. The main fluorophores found in samples were identified as indole derivatives: tryptophan, indoxyl glucuronide, indoxyl sulfate, 5-hydroxy-indoleacetic acid, indoleacetyl glutamine, and indoleacetic acid. The highest contribution (35 +/- 11%) was found to arise from indoxyl sulfate. Strong correlation between contribution values at the start and end of dialysis (R-2 = 0.90) indicated to the stable contribution during the course of the dialysis. The reduction ratio of indoxyl sulfate was very close to the decrease of the total fluorescence signal of the spent dialysate (49 +/- 14% vs 51 +/- 13% respectively, P = 0.30, N = 99) and there was strong correlation between these reduction ratio values (R-2 = 0.86). On-line fluorescence measurements were carried out to illustrate the technological possibility for real-time dialysis fluorescence monitoring reflecting the removal of the main fluorophores from blood into spent dialysate. In summary, since a predominant part of the fluorescence signal at excitation 280 nm and emission 360 nm in the spent dialysate originates from protein bound derivatives of indoles, metabolites of tryptophan and indole, the fluorescence signal at this wavelength region has high potential to be utilized for monitoring the removal of slowly dialyzed uremic toxin indoxyl sulfate.Funding Agencies|County Council of Ostergotland, Sweden; Estonian Science Foundation [8621]; Estonian targeted financed project [SF0140027s07]; Estonian Ministry of Education and Research [IUT 19-2]; European Union through the European Regional Development Fund</p