Nefroloogia

Eesti Arst 2013; 92(7):408–41

Nefroloogia

Eesti Arst 2011; 90(6):29

Glomerulaarhaiguste uus ravijuhend

Eesti Arst 2022; 101(2):117–12

Krooniline neeruhaigus – üleilmne tervishoiuprobleem

Krooniline neeruhaigus (KNH) on üleilmne tervishoiuprobleem, sest KNH esineb tänapäeval sagedasti ja ravikulud on väga suured. KNH on n-ö varjatud ja vaikne haigus ning võib kulgeda märkamatult, sest seda haigust haige sageli ei tunne. Selline haiguse kulg on ka KNH aladiagnoosimise ja alaravimise põhjuseks. Suurtes rahvastiku-uuringutes on kindlaks tehtud, et erinevates staadiumides krooniline neerukahjustus võib olla ligikaudu igal kümnendal inimesel (1, 2). Eesti Arst 2009; 88(5):319−32

Urotrakti infektsioonid naistel

Urotrakti infektsioonid (UTI) on enamasti bakteriaalse päritoluga. Infektsiooni põhjustajaks on 80–95%-l juhtudest Escherchia coli. UTId esinevad sagedamini naistel ja võivad retsidiveeruda. Kliiniliselt võivad UTId kulgeda erineva raskusastmega: nii asümptomaatilise bakterineemia, ägeda tsüstiidi kui kapüelonefriidina. Enamikul juhtudel vajavad haiged antibakteriaalset ravi. Selle kestus sõltub infektsiooni kulust ja urotrakti erinevate osade haaratusest. Sagedaste infektsiooni retsidiveerumiste või ravile allumatuse korral on vajalikud täpsustavad uuringud võimaliku urotrakti obstruktsiooni või anomaaliate väljaselgitamiseks. Eesti Arst 2008; 87(2):132−13

Mikroalbuminuuria – südame- ja veresoonkonnahaiguse riski näitaja

Mikroalbuminuuria on diabeetilise nefropaatia varajane riski näitaja. Essentsiaalse hüpertensiooniga haigetel on mikroalbuminuuria ilmumine märgiks, et veresoonkonna olukord halveneb progresseeruvalt ning võib areneda nefroskleroos. Hiljuti tehtud uuringutel on leitud, et mikroalbuminuuria on sage ka üldrahvastikus. Seetõttu on soovitatav suure kardiovaskulaarse riskiga inimestel mikroalbuminuuria sõeluurimine ja vasoprotektiivse ravi määramine. Eesti Arst 2007; 86 (7): 470–47

Nutritional research and intensive nutritional counselling of the chronic kidney disease patients after kidney transplantation

Background: Dietology treatment is the one of the foundation stones in the complex treatment of the chronic kidney disease (CKD) patients together with all other treatments. The dietary intervention plays an important role to determine the effects to a decrease of metabolic abnormalities.Aim: The aim of the long-term study was to monitor nutritional parameters in the post-transplant period.Subjects and methods: We studied 28 clinically stable consecutive nondiabetic kidney transplant patients: 12 males at the age of 42.8 ± 16.1 years, and 16 females at the age of 47.0 ± 14.9 years. Intensive nutritional counselling and dietary consultation by a dietitian were carried out for all the studied patients during one and a half years after the kidney transplantation. Initial data were compared with the results obtained at the end of the study. During the 3-days dietary records analysis and counselling of CKD patients, giving answers to their questions about their food and portion sizes, the dietitian used the standards portion book with many photographs.Results: The consumption of vegetables and fruit was modest compared to Estonian food and nutrition recommendations. The food frequency questionnaire revealed that the patients consumed different foodstuffs at different frequencies, but there was a tendency to excessive consumption of foodstuffs rich in proteins and carbohydrates. To consumption of fat-rich foodstuffs a tendency of decrease was found.Conclusion: An intensive nutritional counselling and healthy diet, avoiding excessive amounts of alcohol as well as regular exercise can help to reduce the chance of developing of chronic transplant nephropathy

Peritoneal Dialysis Penetration and Peritonitis Rate at a Single Centre during Last Decade

Peritoneal dialysis (PD) has been intensively offered at our centre to patients (pts) with end-stage renal disease (ESRD) from 2000, and the number of PD pts was noticed to raise. We aimed to analyse the PD population from the aspect of penetration and peritonitis rate during eleven years. Cumulative number of new RRT pts was 378 during the study period. We found high PD penetration rate: 53% (range 32–72%). The rate of peritonitis was as high as 9.8 during first study years, but it has declined progressively last year being 29.1 by September 2010 and 21.7 by December 2010. Most cases of peritonitis were due to gram-positive pathogens. We have demonstrated steady high single-centre PD penetration rate and improvement of management of patients during last decade probably because of the result of better pts education and a continued dedication of the staff

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.