UTJECAJ SEKUNDARNOG HIPERPARATIREOIDIZMA NA EHOKARDIOGRAFSKE POKAZATELJE U HEMODIJALIZIRANIH BOLESNIKA

Cardiovascular diseases are the leading cause of mortality in hemodialysis patients. Patients are exposed to a number of risk factors for cardiovascular complications, which are the result of uremia and dialysis. Aim of our study was to examine the incidence of secondary hyperparathyroidism and left ventricular hypertrophy, the interplay between them as predictors of mortality. This prospective study included 53 patients. All patients had measured echocardiographic parameters of left ventricular hypertrophy and laboratory parameters of bone metabolism. We followed the death rate of patients over two years. Elevated levels of PTH in the serum was present in 79.24% of patients, hypertrophy of the left chamber was recorded in 81.13% of patients. The survivors had lower values of PTH and phosphate levels which were significantly lower (p<0.05) in relation to deceased patients. Patients with poor outcome had higher LV mass index, lower EF and FSLV, larger diameters of interventricular septum and posterior wall (P <0.05). Left ventricular hypertrophy is premature cardiovascular disorder that develops rapidly during the progression of CKD and is based of uremic cardiomyopathy. Left ventricular hypertrophy is a strong indicator of mortality in patients with ESRD.Srčanožilne (SŽ) bolesti su vodeći uzrok smrtnosti u bolesnika na hemodijalizi. Bolesnici su izloženi brojnim čimbenicima rizika za SŽ komplikacije, koje su u prvom redu posljedica uremije i dijalize. Cilj našeg prospektivnog istraživanja jest ispitati učestalost sekundarnog hiperparatireoidizma i hipertrofije lijeve klijetke, i njihovu međuigru kao predskazatelja smrtnosti u bolesnika na hemodijalizi. Istraživanje je uključilo 53 bolesnika. Svim bolesnicima su mjereni ehokardiografski parametri za procjenu hipertrofije lijeve klijetke i laboratorijski parametri koštanog metabolizma. Pratila se smrtnost bolesnika tijekom dvije godine. Povišena razina PTH u serumu bila je prisutna u 79,24% bolesnika, hipertrofiju lijeve klijetke imalo je 81,13% bolesnika. Preživjeli su imali niže vrijednosti PTH i serumskog fosfora (p <0,05) u odnosu na preminule bolesnike. Analizirajući ehokardiografske parametre, bolesnici s lošim ishodom imali su značajno viši indeks mase lijeve klijetke, niže frakcije izbacivanja i frakcijskog skraćivanja lijeve klijetke, veće promjere interventrikularnog septuma i stražnje stijenke lijeve klijetke (P <0,05). Hipertrofija lijeve klijetke je rani SŽ poremećaj koji se razvija brzo tijekom napredovanja kronične bolesti bubrega i u osnovi je uremijske kardiomiopatije. Hipertrofija lijeve klijetke je jak pokazatelj smrtnosti u bolesnika u završnoj fazi kronične bubrežne bolesti

KIDNEY FUNCTION IN A PATIENT WITH THROMBOTIC THROMBOCYTOPENIC PURPURA

Trombotička trombocitopenična purpura (TTP) je multisistemska bolest koja neliječena ima visoku stopu smrtnosti. Prikazujemo slučaj bolesnice od TTP dijagnosticiranog i liječenog u Kliničkom centru Crne Gore, uz prikaz dijagnostike i metodologije liječenja. Opisano je i praćenje bubrežne funkcije bolesnika nakon završenog liječenja i postizanja remisije TTP.Thrombotic thrombocytopenic purpura is a systemic disorder with high mortality rate if not treated with plasma exchange. We present a case of severe thrombotic thrombocytopenic purpura diagnosed and treated at Montenegro Clinical Center, with special reference to the follow-up of renal function

Estimated arterial stiffness and cardiovascular risk in chronic kidney disease – a study protocol

Introduction The prevalence of chronic kidney disease (CKD) in the general population is 9.1%. Cur- rent guidelines recommend a cut-off GFR value of 60 mL/min/1.73 m2 for diagnosis of CKD, without considering the physiological decline of GFR with aging, or the association with cardiovascular (CV), cerebrovascular or renal outcomes. There is also an increase in arterial stiffness with aging, which is es- timated by pulse wave velocity (PWV). Aim The aim of this study is to show how the ePWV predicts CV incidents independently of SCORE chart and traditional risk factors. Materials and Methods This prospective observational study will include 2058 subjects from the Endemic nephropathy in Croatia – epidemiology, diagnosis and etiopathogenesis scientific research project. Conclusion This will be the first study that could show how the estimated arterial stiffness, independently of CKD contributes to overall CV, cerebrovascular and renal risk. We could also, based on the results, propose an age-independent definition of CKD based on the association with CV disease and mortality

POVEZANOST IZMEĐU STAVOVA I NAVIKA U ISHRANI I SERUMSKOG FOSFORA U BOLESNIKA NA HEMODIJALIZI

Nutritional problems in hemodialysis (HD) patients are frequently associated with poor control of serum phosphorus what may lead to chronic kidney disease-metabolic bone disease. Hyperphosphatemia is an important risk factor for extraskeletal and vascular calcifications and is associated with cardiovascular morbidity and mortality. Increased ingestion of phosphorus is an important factor in development of hyperphosphatemia. We investigated nutritional habits and attitudes of HD patients and determined their correlation with serum phosphate levels in 57 patients treated in Clinical centre Montenegro. Twenty-two patients were male (38.6%), with average age 57 (range, 30-73 years). Statistically significant correlation was found between red meat or milk ingestion and serum phosphate, as well as between educational level and serum phosphate. In our population, socioeconomic level was directly correlated with serum phosphate. Conclusion: a serum phosphate level is determined by socioeconomic level, ingestion of red meat and milk, and depends on educational level in HD population of the capital of Montenegro.Poremećaj uhranjenosti bolesnika kojima se bubrežna funkcija nadomješta hemodijalizom (HD) često je povezan s lošom kontrolom serumskog fosfora, što može dovesti do poremećaja metabolizma kosti s posljedičnim razvojem sekundarnog hiperparatireoidizma i poremećajem mineralo-koštanog metabolizma. Hiperfosfatemija je značajan čimbenik rizika za razvoj kalcifikacija mekih tkiva, kao i za pobolijevanje i smrtnost od srčano-žilnih bolesti. Povećan unos hrane bogate fosforom značajan je čimbenik koji dovodi do hiperfosfatemije. Istraživanje ima za cilj ispitati prehrambene navike i stavove bolesnika liječenih HD i utvrditi njihovu povezanost s razinama serumskog fosfora. Istraživanje je provedeno u ožujku 2015. u Centru za hemodijalizu, Kliničkog centra Crne Gore. Istraživanje je provedeno na 57 bolesnika koji su na redovitom programu intermitentne hemodijalize. Muškaraca je bilo 22 (38,6 %). Prosječna dob bolesnika bila je 57 godina (raspon 30-73 godine). Pronađena je statistički značajna povezanost između vrste hrane, osobito crvenog mesa ili konzumiranja mlijeka i mliječnih proizvoda i serumske razine fosfora, kao i između razine obrazovanja ispitanika i razine serumskog fosfora. U našoj je populaciji serumska razina fosfora bila direktno povezana sa socioekonomskim statusom bolesnika. Zaključujemo da je: koncentracija fosfata u serumu određena socijalno–ekonomskom razinom društva, kao i običajem da se u prehrani koriste meso i mlijeko. Nadalje, u konkretnom slučaju vezana je uz prosvjećenost bolesnika koji se dijaliziraju u glavnom gradu Crne Gore

POVEZANOST IZMEĐU STAVOVA I NAVIKA U ISHRANI I SERUMSKOG FOSFORA U BOLESNIKA NA HEMODIJALIZI

Nutritional problems in hemodialysis (HD) patients are frequently associated with poor control of serum phosphorus what may lead to chronic kidney disease-metabolic bone disease. Hyperphosphatemia is an important risk factor for extraskeletal and vascular calcifications and is associated with cardiovascular morbidity and mortality. Increased ingestion of phosphorus is an important factor in development of hyperphosphatemia. We investigated nutritional habits and attitudes of HD patients and determined their correlation with serum phosphate levels in 57 patients treated in Clinical centre Montenegro. Twenty-two patients were male (38.6%), with average age 57 (range, 30-73 years). Statistically significant correlation was found between red meat or milk ingestion and serum phosphate, as well as between educational level and serum phosphate. In our population, socioeconomic level was directly correlated with serum phosphate. Conclusion: a serum phosphate level is determined by socioeconomic level, ingestion of red meat and milk, and depends on educational level in HD population of the capital of Montenegro.Poremećaj uhranjenosti bolesnika kojima se bubrežna funkcija nadomješta hemodijalizom (HD) često je povezan s lošom kontrolom serumskog fosfora, što može dovesti do poremećaja metabolizma kosti s posljedičnim razvojem sekundarnog hiperparatireoidizma i poremećajem mineralo-koštanog metabolizma. Hiperfosfatemija je značajan čimbenik rizika za razvoj kalcifikacija mekih tkiva, kao i za pobolijevanje i smrtnost od srčano-žilnih bolesti. Povećan unos hrane bogate fosforom značajan je čimbenik koji dovodi do hiperfosfatemije. Istraživanje ima za cilj ispitati prehrambene navike i stavove bolesnika liječenih HD i utvrditi njihovu povezanost s razinama serumskog fosfora. Istraživanje je provedeno u ožujku 2015. u Centru za hemodijalizu, Kliničkog centra Crne Gore. Istraživanje je provedeno na 57 bolesnika koji su na redovitom programu intermitentne hemodijalize. Muškaraca je bilo 22 (38,6 %). Prosječna dob bolesnika bila je 57 godina (raspon 30-73 godine). Pronađena je statistički značajna povezanost između vrste hrane, osobito crvenog mesa ili konzumiranja mlijeka i mliječnih proizvoda i serumske razine fosfora, kao i između razine obrazovanja ispitanika i razine serumskog fosfora. U našoj je populaciji serumska razina fosfora bila direktno povezana sa socioekonomskim statusom bolesnika. Zaključujemo da je: koncentracija fosfata u serumu određena socijalno–ekonomskom razinom društva, kao i običajem da se u prehrani koriste meso i mlijeko. Nadalje, u konkretnom slučaju vezana je uz prosvjećenost bolesnika koji se dijaliziraju u glavnom gradu Crne Gore

Clinical research and sampling in the scientific: Research work

The survey is used to verify existing knowledge, to extend or discover a previously unknown knowledge, with the aim to come to the knowledge in the most efficient manner. Scientific research is systematic, planned testing of a problem to certain methodological rules. The aim of this study is that nurses and health workers informed on the methodology of scientific research. According to the purpose of the study vary basic and applied study by. Basic research increases our knowledge of a particular field without a goal that the results are directly applied in medical practice. On the other hand, applied research with direct practical valuable asset and usability. Results of clinical research should be directly applied in the prevention, detection and treatment of disease

DISSEMINATED INTRAVASCULAR COAGULATION AND ACUTE KIDNEY INJURY REQUIRING RENAL REPLACEMENT THERAPY AFTER DIAGNOSTIC AMNIOCENTESIS

Diseminirana intravaskularna koagulacija (DIK) je vrlo rijetka komplikacija amniocenteze. Opisujemo slučaj 33-godišnje bolesnice koja je nakon dijagnostičke amniocenteze razvila DIK s posljedičnom akutnom ozljedom bubrega. Bubrežna funkcija je nadomještana kontinuiranom veno-venskom hemodijafiltracijom tijekom osam dana, a nakon toga intermitentnom hemodijalizom. Stanje je bilo dodatno komplicirano razvojem intracerebralnog hematoma i akutnim respiratornim distres sindromom. Nakon 67 dana hospitalizacije bolesnica je otpuštena na kućnu njegu sa serumskim kreatininom 337 umol/L. Bolesnica se uspješno oporavila i ostvarila uspješnu trudnoću koja je u tijeku.Disseminated intravascular coagulation (DIC) is a very rare complication of amniocentesis. We present a case of a 33-year-old patient who developed DIC with acute respiratory distress syndrome and acute kidney injury after diagnostic amniocentesis. The patient required replacement of renal function for 59 days with continuous venovenous hemodiafiltration and later with hemodialysis. She was treated with heparin, fresh frozen plasma, platelets and cryoprecipitate. Her condition was further complicated with the development of intracranial hematoma. After 67 days of hospitalization, she was discharged from the hospital with serum creatinine 337 μmol/L. Three years later, her serum creatinine was 102 μmol/L, and she is currently in the 7th month of pregnancy

Cutaneous manifestations of tuberous sclerosis

No abstract availabl

DISSEMINATED INTRAVASCULAR COAGULATION AND ACUTE KIDNEY INJURY REQUIRING RENAL REPLACEMENT THERAPY AFTER DIAGNOSTIC AMNIOCENTESIS

Diseminirana intravaskularna koagulacija (DIK) je vrlo rijetka komplikacija amniocenteze. Opisujemo slučaj 33-godišnje bolesnice koja je nakon dijagnostičke amniocenteze razvila DIK s posljedičnom akutnom ozljedom bubrega. Bubrežna funkcija je nadomještana kontinuiranom veno-venskom hemodijafiltracijom tijekom osam dana, a nakon toga intermitentnom hemodijalizom. Stanje je bilo dodatno komplicirano razvojem intracerebralnog hematoma i akutnim respiratornim distres sindromom. Nakon 67 dana hospitalizacije bolesnica je otpuštena na kućnu njegu sa serumskim kreatininom 337 umol/L. Bolesnica se uspješno oporavila i ostvarila uspješnu trudnoću koja je u tijeku.Disseminated intravascular coagulation (DIC) is a very rare complication of amniocentesis. We present a case of a 33-year-old patient who developed DIC with acute respiratory distress syndrome and acute kidney injury after diagnostic amniocentesis. The patient required replacement of renal function for 59 days with continuous venovenous hemodiafiltration and later with hemodialysis. She was treated with heparin, fresh frozen plasma, platelets and cryoprecipitate. Her condition was further complicated with the development of intracranial hematoma. After 67 days of hospitalization, she was discharged from the hospital with serum creatinine 337 μmol/L. Three years later, her serum creatinine was 102 μmol/L, and she is currently in the 7th month of pregnancy

Cutaneous manifestations of tuberous sclerosis

No abstract availabl