Rola biopsji nerek w rozpoznawaniu przewlekłych chorób nerek

Biopsja nerki pełni istotną rolę w diagnostyce zarówno ostrych nefropatii, jak i przewlekłych. Charakter zmian morfologicznych pomaga w ustaleniu i klasyfikacji procesów chorobowych, jest także źródłem informacji przydatnych w podejmowaniu decyzji terapeutycznych i ustalaniu rokowania chorego. W niniejszym artykule przedstawiono wskazania do biopsji nerki, a także podstawowe informacje dotyczące opracowania materiału i rodzaju badań diagnostycznych angażowanych w opracowanie i interpretację zmian mikroskopowych. Należy podkreślić, że rozpoznanie patologii nerkowej w obrazie mikroskopowym jest badaniem interpretacyjnym, wymagającym - poza właściwym warsztatem histopatologicznym - także pełnej charakterystyki klinicznej bioptowanego pacjenta

Slowly progressive chronic kidney disease caused by tubulointerstitial nephritis in a patient with primary biliary cholangitis

Tubulointerstitial nephritis is a rare complication of primary biliary cholangitis. The most typical presentation is progressive renal disease, and a substantial number of patients have renal tubular acidosis and mild proteinuria. Treatment with steroids is effective, but there are no precise recommendations concerning doses and the duration of therapy. This article presents a case of a 41-year-old woman with primary biliary cholangitis and slowly progressive chronic kidney disease. Renal tubular acidosis and very high urinary β2 microglobulin excretion but no albuminuria were observed. A kidney biopsy revealed a diffuse interstitial inflammatory infiltrate in both cortex and medulla, dominated by T lymphocytes and macrophages, less numerous B lymphocytes, neutrophils, and eosinophils. After initiation of steroids, a rapid 10-fold decrease in β2 microglobulin urine excretion and a mild decrease in serum creatinine were observed. This case shows how mildly symptomatic tubulointerstitial nephritis is in a patient with primary biliary cholangitis. The authors emphasize the importance and crucial role of kidney biopsy

Telemedicine in neurology

Introduction Telemedicine in neurology has been developed for the last two decades. However, this concept has only been introduced to the emergency scene recently. In the above review current state and prognosis of development of telemedicine would be described. Material and methods Articles in the EBSCO database have been analyzed using keywords: telemedicine, neurology. The available literature is subjectively selected. Then, the newest version of every paper was searched for. Results Results of researches with applications of telemedicine in neurology in emergency, chronic conditions. Moreover, potential costs and benefits were described. Conclusions The involvement of stroke specialists also facilitated the diagnosis of other neurological emergencies such as intracerebral hemorrhage, subarachnoid hemorrhage, hypoglycemia and seizure. Potential barriers to the use of this technology include the initial costs of equipment and training of personnel. Further development of telemedicine would possibly improve both emergency and long-term care in neurology

Przypadek nefropatii BKV wykrytej w biopsji protokolarnej

Biopsje protokolarne definiuje się jako biopsje wykonywaneu chorych ze stabilną czynnością nerkiw z góry określonych ramach czasowych. Mająone niepodważalne znaczenie w rozwoju wiedzyna temat patofizjologii nerki przeszczepionej. Jednąz patologii opisywanych w bioptatach z biopsjiprotokolarnych nerki przeszczepionej jest nefropatiaBKV (PVAN). Wiąże się ona ze złym rokowaniem:do 50% chorych traci przeszczep nerkowy w ciągu6–60 miesięcy od rozpoznania. W pracy zaprezentowanoprzypadek 23-letniego chorego, u któregowykryto nefropatię BKV w biopsji protokolarnej.Chory J.R., ze schyłkową niewydolnością nerekwłasnych w przebiegu wielotorbielowatego zwyrodnienianerek, został zakwalifikowany do zabiegu przeszczepienia,a następnie otrzymał nerkę od zmarłegodawcy. Przebieg okołooperacyjny był powikłanyepizodem ostrego odrzucania, które było skutecznieleczone wlewami dożylnymi z metylprednizolonu.Stężenie kreatyniny chorego przy wypisie z kliniki wynosiło1,2 mg/dl. W obserwacji ambulatoryjnej stężeniekreatyniny utrzymywało się stabilne. W 180. dniupo przeszczepieniu wykonano biopsję protokolarną.Obraz histopatologiczny pobranych wycinków wykazałcechy nefropatii BKV. Oznaczona we krwi wiremiaBKV wynosiła 995 000 kopii/ml. Postanowionozmniejszyć dawkę mykofenolanu sodu oraz takrolimusa.Włączono również do leczenia ciprofloksacynęjako lek potencjalnie przeciwwirusowy. W wykonanejw 301 dni po transplantacji kolejnej biopsji kontrolnejutrzymuje się obraz PVAN w fazie B1. Wiremiazmniejszyła się do 25 000 kopii/ml. Postanowionodalej redukować dawki immunosupresji. Stężeniekreatyniny chorego pozostaje stabilne — 1,2 mg/dl.Przypadek uzasadnia wykonywanie biopsji protokolarnychnie tylko jako metody przesiewowej, ale równieżjako metody oceny postępów w trakcie leczeniai doboru dalszej metody postępowania

Vasculitis associated with IgA (Henoch-Schönlein purpura) and kidney

Zapalenie naczyń związane z IgA (plamica Henocha-Schönleina; HSP, Henoch-Schönlein purpura) to zapalenie drobnych naczyń o zmiennej symptomatologii z częstym zapaleniem kłębuszków nerkowych. Zajęcie nerek przejawia się stwierdzanymi w badaniu moczu: krwinkomoczem i/lub białkomoczem, a czasem również wzrostem stężenia kreatyniny. Choroba ta może prowadzić do rozwoju schyłkowej niewydolności nerek i konieczności wdrożenia leczenia nerkozastępczego, w tym transplantacji nerki. W niniejszej pracy przedstawiono obszernie obraz kliniczny choroby, ze szczególnym uwzględnieniem diagnostyki i leczenia chorych z zajęciemnerek, w tym pacjentów z nawrotem HSP w nerce przeszczepionej.Vasculitis associated with IgA (HSP, Henoch-Schönlein purpura) is the inflammation of the small vessels of varying symptomatology with quite often glomerulonephritis. Renal involvement is manifested by hematuria and/or proteinuria, and sometimes an increase in serum creatinine level. This disease can lead to the development of end-stage renal failure and the need for implementation of renal replacement therapy, including kidney transplantation. This paper presents the broad clinical picture of the disease, with particular emphasis on the diagnosis and treatment of patients with renal disease, including patients with recurrent HSP in the kidney transplant

Physical activity in healthy, older people. How many drops of sweat away from gain the health benefit?

Kujawska Agnieszka, Perkowski Radosław, Androsiuk-Perkowska Joanna, Skierkowska Natalia, Gajos Małgorzata, Topka Weronika, Kujawski Sławomir, Kędziora-Kornatowska Kornelia. Physical activity in healthy, older people. How many drops of sweat away from gain the health benefit?. Journal of Education, Health and Sport. 2017;7(7):412-422. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.833881 http://ojs.ukw.edu.pl/index.php/johs/article/view/4640 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26.01.2017). 1223 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Authors 2017; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 01.07.2017. Revised: 02.07.2017. Accepted: 23.07.2017. Physical activity in healthy, older people. How many drops of sweat away from gain the health benefit? Agnieszka Kujawska1, Radosław Perkowski1, Joanna Androsiuk-Perkowska1, Natalia Skierkowska1, Małgorzata Gajos1, Weronika Topka1, Sławomir Kujawski2, Kornelia Kędziora-Kornatowska1 1. Faculty of Health Sciences, Department and Clinic of Geriatrics, Nicolaus Copernicus University 2. Faculty of Health Sciences, Department of Hygiene, Epidemiology and Ergonomics, Division of Ergonomics and Exercise Physiology, Nicolaus Copernicus University Abstract Introduction: Aging process leads to increased risk of functional impairments and diseases occurrence. Sedentary lifestyle is one of the main risk factors the occurrence of chronic disease such a diabetes and cardiovascular disease. On the other hand, results of many studies showed that regular physical activity (PA) and physical exercise (PE) could decrease the risk of these hazards. Last decades were fruitful in developing evidence-based recommendations for physical activity and exercise in older people, therefore it is worth to examine dynamics of development and the similarities between different recommendations. Material and methods: Articles in the EBSCO database have been analyzed using keywords: older people, physical exercise, physical activity, recommendations, aerobic training, resistance training. Results: Studies showed that people who were more active during lifetime, have greater self-efficacy, better physical and mental health status and in general higher satisfaction on the autumn of their life. Every analyzed recommendation underlies the negative consequences of sedentary activity, however, there is no evidence-based “cut-off” point. Similarly, there is not clear optimal “dose” of PA or PE to prescribe for older patients. Conclusions: It seems that undertaking light level of PA activity is more beneficial than none PA or sedentary lifestyle. The newest recommendations underlie the possibility of the existence of positive linear relationship between the level of PA and health benefits: every additional amount of time spent on PA during week could be related with additional health benefit Key words: Older people, physical exercise, physical activity, recommendations, aerobic exercise training, resistance exercise trainin

Amyloidoza nerek

Kidney amyloid deposition is one of the most common and most severe manifestations of systemic amyloidosis. Since kidney involvement occurs in almost each type of amyloidosis, proteinuria and GFR (glomerular filtration rate) decrease are often among the first symptoms of this disease. Kidney involvement is, beside heart failure, a major prognostic factor. The most typical presentation is isolated nephrotic syndrome, especially in two most common types of the disease: AA and AL amyloidoses. The less common manifestation is chronic renal failure, which typically occurs in the acquired types of amyloidosis (ALECT2, AApoAIV), but also in several hereditary genetic forms. In the case of renal involvement, kidney biopsy is of major significance: it allows not only for amyloidosis recognition, but also for further specification of its type. Currently there are methods allowing for reduction in the amyloidogenic protein release and amyloid deposition, also in kidney tissue. Due to the effective treatment, proteinuria reduction and slowdown of kidney failure progression became possible. In the case of the successful control of amyloid production, patients with end-stage renal failure can be qualified for kidney transplantation.Amyloidoza nerek jest jedną z najczęstszych i najcięższych manifestacji amyloidozy układowej. Do odkładania amyloidu w nerkach dochodzi prawie w każdej postaci amyloidozy, dlatego często pierwszym objawem choroby jest białkomocz lub obniżenie filtracji kłębuszkowej. Zajęcie nerek, obok amyloidozy serca, decyduje o rokowaniu chorego. Najbardziej typową manifestacją amyloidozy nerek jest izolowany zespół nerczycowy, co dotyczy w szczególności dwóch najczęstszych postaci — AA i AL. Rzadziej dominującą manifestacją jest postępująca niewydolność nerek dotycząca zarówno postaci nabytych (ALECT2, AApoAIV), jak i kilku rzadkich postaci uwarunkowanych genetycznie. Podstawą diagnostyki jest zawsze badanie histopatologiczne, dlatego histopatologicznaocena bioptatu gruboigłowego nerki jest jednym z najczęstszych narzędzi rozpoznawania amyloidozy i określania jej typu. Współcześnie są dostępne metody skutecznego ograniczania tworzenia białek amyloidogennych, a dzięki temu powstrzymania dalszego odkładania się amyloidu w tkankach, w tym także w nerkach. Dzięki skutecznemu leczeniu możliwe jest uzyskanie zmniejszenia lub ustąpienia białkomoczu i powstrzymanie postępu niewydolności nerek. Pacjenci ze schyłkową niewydolnością nerek w przebiegu amyloidozy mogą być kwalifikowani do przeszczepienia nerki pod warunkiem uzyskania remisji lub skutecznej kontroli procesu będącego przyczyną amyloidozy

Torque Teno virus — potencjalny biomarker w monitorowaniu kompetencji immunologicznej

Infectious complications and rejection processes constitute two major types of post-transplant complications. The gold standard of post-transplant pa­tients’ management is to keep recipient’s immune system at such optimal level of competence that is low enough to prevent rejection being the same time high enough to protect them from serious infectious complications. Unfortunately, at present, there are no tools that would allow for the precise defining the optimal immunosuppression in individual recipients. The development of biomarkers that would help de­termine the state of immunosuppression remains the holy grail of current transplantology. Torque Teno virus (TTV) is a highly prevalent, nonpathogenic DNA virus emerging as a promising marker since its levels seem to reflect the level of immune competence of the host. Data collected so far implicate, that TTV may be clini­cally useful in predicting the risk of both rejection and infectious complications in grafts’ recipients.Infectious complications and rejection processes constitute two major types of post-transplant complications. The gold standard of post-transplant pa­tients’ management is to keep recipient’s immune system at such optimal level of competence that is low enough to prevent rejection being the same time high enough to protect them from serious infectious complications. Unfortunately, at present, there are no tools that would allow for the precise defining the optimal immunosuppression in individual recipients. The development of biomarkers that would help de­termine the state of immunosuppression remains the holy grail of current transplantology. Torque Teno virus (TTV) is a highly prevalent, nonpathogenic DNA virus emerging as a promising marker since its levels seem to reflect the level of immune competence of the host. Data collected so far implicate, that TTV may be clini­cally useful in predicting the risk of both rejection and infectious complications in grafts’ recipients

The influence of non-pharmacological methods in osteoporosis treatment

Introduction Osteoporosis is a systemic skeletal disorder which results from an imbalance in bone remodeling. The disease can occur because of failure to achieve peak bone mass and/or excessive bone resorption and/or decreased bone formation during remodelling. Multiple pathogenetic and regulatory mechanisms are responsible for these changes. In the above review, selected non-pharmacological therapies in osteoporosis are described. Material and methods Articles in the EBSCO database have been analyzed using keywords: osteoporosis, osteopenia, treatment. The available literature is subjectively selected. Then, the newest version of every paper was searched for. Results Results of researches on osteoporosis pathomechanism, quality of life in patients, comorbidities, non-pharmacological methods for treatment of osteoporosis, the impact of physical exercise, role of diet as adjunctive therapy in osteoporosis were described. Conclusions Osteoporosis and treatment influence on the patient's functioning and subjective assessment of the quality of life. Medical doctors need to take into account high occurrence of multimorbidity in adults with osteoporosis to be able to propose comprehensive treatment. The treatment of the affected patients should be improved to offer early or even preventive care for other diseases that coexist with osteoporosis. Non-pharmacological interventions, such as diet, seem to be effective in osteoporosis. Effects of physical exercise could be beneficial in osteoporosis patients, however further studies are needed to determine specifics of the most effective program