Neeruhaige õigeaegne avastamine

Diabeedi, arteriaalse hüpertensiooni, kroonilise glomerulonefriidi ja teiste krooniliste neeruhaiguste korral võib aegamööda progresseeruda neerukahjustus. Haiguse varajases staadiumis võib kliiniline leid olla tagasihoidlik ja seetõttu ei osuta arstid sellele vajalikku tähelepanu. Neerukahjustuse avastamiseks ja progresseeruva neerukahjustuse hindamiseks on uriinianalüüs lihtne, käepärane, mitteinvasiivne ja informatiivne esmane meetod. Eesti Arst 2006; 85 (1): 49–5

Kroonilise neerupuudulikkusega haigete kompleksse taastusravi võimalusi

Taastusravi kroonilise neeruhaiguse korral hõlmab lisaks medikamentoossele renoprotekteerivale ravile kindlasti ka dieedisoovitusi, kehakaalu langetamise planeerimist, suitsetamisest loobumist ning mõõdukalt doseeritud ja regulaarset kehalist aktiivsust (liikumisravi). Kehalise aktiivsuse intensiivsus, regulaarsus ja maht tuleb valida individuaalselt igale patsiendile sõltuvalt neeruhaiguse staadiumist. Eesti Arst 2003; 82 (1): 16–2

Predialüüsiprogramm Tartu Ülikooli sisekliinikus

Krooniline neerupuudulikkus (KNP) tekib glomerulaarse filtratsiooni vähenemisel ja areneb neeruhaiguse tagajärjel neeru parenhüümi kahjustuse tõttu tavaliselt aastate või aastakümnete jooksul. Peamised neeruhaigused, mis progresseeruvad lõppstaadiumi neerupuudulikkuseni, on järgmised: diabeetiline nefropaatia, hüpertensioon, glomerulonefriit, polütsüstiline neeruhaigus, tubulointerstitsiaalne nefriit, pärilikud nefropaatiad jt. Iga kroonilise neeruhaiguse progresseerumise iseärasused ja kiirus olenevad haiguse varajasest diagnoosimisest ning põhihaiguse ja neeruhaiguse progresseerumist ennetavast optimaalsest ravist

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

Cell proliferation and apoptosis in wistar rat kidney after renal mass ablation and low-dose irradiation

Cell proliferation and apoptosis in the remnant rat kidney after treatment with lowdose irradiation was investigated. Material and methods. In the first group (n=9), adult male Wistar rats underwent 5/6 nephrectomy (NPX); in the second group (n=9), NPX was combined with low-dose irradiation. Rats without surgery and irradiation formed the control group (n=9). Results. Hypertension and proteinuria induced by NPX were decreased by 3-Gy irradiation. The 5/6 NPX rats showed a dramatic increase in proliferating and apoptotic cells in the glomeruli and in the distal tubules at week 2, which was significantly decreased by low-dose irradiation. Conclusion. The data demonstrate that low-dose irradiation is a factor slowing the process of chronic renal injury.publishersversionPeer reviewe

Südame- ja veresoonkonnahaiguse riskitegurid neeruasendusravi haigetel

Südame- ja veresoonkonnahaigusest (SVH) põhjustatud tüsistused on kroonilise neerupuudulikkuse haigete (KNP) peamisteks surmapõhjusteks nii predialüüsi staadiumis kui ka haigetel, kes on juba dialüüsravil või kellele on siiratud neer (1). Võrreldes üldpopulatsiooniga on kroonilise neerupuudulikkuse haigetel 10–20 korda suurem risk aterosklerootilise SVH tekkeks (2) ja selle riskitegurid sarnanevad üldpopulatsioonis esinevate ateroskleroosi progresseerumise riskiteguritega nagu hüpertensioon, adipoossus, diabeet, hüperlipideemia, suitsetamine, füüsiline inaktiivsus ja muud

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

Impact of Anthropometric Measurements in Clinical Practice

Anthropometry helps to assess nutritional status which is an important determinant of clinical outcome in many patients, including the number of those suffering from chronic kidney disease (CKD). Weight gain after successful kidney transplantation is a well-known phenomenon, therefore we hypothesized that intensive counseling, based of menu analysis by a dietitian of CKD patients with a kidney transplant, can prevent the significant body weight (BW) gain after the transplant operation. The aim of the investigation was to study long-term anthropometrical, biochemical and dual-energy densitometry changes in the kidney transplant patients, to study correlations between the studied parameters and to compare those with the follow-up data. The prospective long-term study was carried out in 28 clinically stable renal transplant patients. Control groups consisted both transplant patients (47 patients), receiving ordinary nutritional counseling, and of healthy population subjects (342). Anthropometry and biochemistry were studied in patients twice: the first follow-up (FU1) data were collected 1.3±0.2 years, and the second follow-up (FU2) data were collected 2.7±0.3 years after the transplant. Significant BW gain was found only in renal transplant male patients (FU1 vs. FU2, p<0.001) but not in females. The mean weight gain in control group patients was significant both in the male and female groups. In males, the mean C-reactive protein was significantly correlated with different body circumferences. But, in females, no clear associations were found. In females, significant correlation was found between mean body weight, body mass index and triglycerides. We conclude that the use of anthropometry in clinical practice, together with intensive and individual counseling by a dietitian, should be regular in the kidney transplant patients’ population to prevent overweight. Monitoring of the dynamics of anthropometrical and biochemical parameters are clinically relevant in the post-transplant period together with densitometry

Peritoniit peritoneaaldialüüsi tüsistusena

Terminaalse neerupuudulikkuse ehk lõppstaadiumi neerupuudulikkuse (ingl end-stage renal disease, ESRD) korral on neerufunktsioon eluohtlikult vähene ning on vaja rakendada neeruasendusravi (NAR): kroonilist hemodialüüsi, ambulatoorset peritoneaaldialüüsi (ingl chronic ambulatory peritoneal dialysis, CAPD) või neeru transplantatsiooni. CAPD on kliinilisse praktikasse juurutatud 70. aastatel: 1976. a kirjeldas seda Popovich ja 1978. a Oreopoulus (1). Tartus on CAPD kasutusel alates 1994. aastast. Peritoneaaldialüüsi (PD) korral infundeeritakse dialüüsivedelik peritoneaalõõnde ja dreenitakse välja kindla ajavahemiku järel