Terminal Renal Insufficiency Research Articles

HOMOCYSTEINE AS A RISK FACTOR FOR CARDIOVASCULAR DISEASES IN PATIENTS WITH END-STAGE RENAL DISEASE

Cardiovascular diseases (CVD) still remain the main cause of mortality in patients with chronic renal failure in the final stage (chronic terminal renal insufficiency- ESRD), which appears as a consequence of premature atherosclerotic processes (atherosclerosis praecox). In addition to known factors such as: diabetes, arterial hypertension, sedentarity, uremic dyslipidemia, obesity, oxidative stress, MIA syndrome, increased proinflammatory cytokines (interleukin 6, Interleukin 18, Interleukin-1 beta (IL-1β) alpha necrosis factor (alpha tumor necrosis factor (IL-1α) [1] in recent years as an independent non-traditional risk factor for the occurrence of CVD in patients with chronic renal failure and those with ESRD (uraemic) treated with chronic hemodialysis (HD) is also homocysteine (Hcy ) with its high concentrations - hyperhomocysteinemia (HHcy). In recent years, a large number of studies suggest that high levels of Hcy are an important biomarker for the risk of CVD, the increased level of Hcy significantly increases the impact on CVD and mortality in this population (2,3). Therefore, it is necessary to evaluate the level of Hcy in patients with ESRD from the initial stages in order to prevent the occurrence of premature atherosclerotic processes that lead to the risk of CVD.

#2917 Desensitization techniques in ABO-incompatible renal transplantation: efficacy and analysis of complications

Abstract Background and Aims Living donor transplantation is the best optimal choice for the vast majority of patients with terminal renal insufficiency. However, it is limited by the AB0/ HLA incompatibility between donor and receptor. The resolution of this inconvenient relies on desensitization of isoagglutinins (anti-AB0 immunoglobulins depletion); thus transplantation could be performed safely. For desensitization there are two techniques: specific adsorption (S) and non-specific (NS) techniques, including centrifugal therapeutic plasma exchange (cTPE) and membrane-based therapeutic plasma exchange (mTPE). The aims are to evaluate the efficacy of apheresis techniques: specific versus non-specific, and identify their complications. Secondary objectives include analyzing the acute rejection rate (RR), graft survival, and complications of each technique. Method A retrospective cohort study was conducted on AB0-incompatible living donor transplantation patients at our center (Bellvitge's Hospital) from 2014 to 2022. All patients (except 1) received rituximab and induction treatment by Thymoglobulin or Basiliximab, followed by maintenance treatment (Steroids, Mycophenolate, and calcineurin inhibitors). During follow-up, protocol renal biopsies (RB) were taken at one month and between 3-6 months post-transplantation. Complications were defined as significant haematological alterations, bleeding, or major infections requiring hospitalization. According to the technique used, two cohorts were identified: specific (Glycosorb®/Vitrosorb® columns) and non-specific: mTPE (prismaflex TPE2000) and cTPE (Spectra/Optia®). Both were anticoagulated with heparin or citrate randomly. An expert nurse supervised the technique. To calculate the efficacy we considered the percentual reduction of isoagglutinins in the first session. T-student test was used to calculate the percentage of complication and compare the results. Results A total of 50 patients were selected with a mean age (MA) of 49.5 ± 11.8. Four of these did not require apheresis due to lower title isoagglutinins (<1/8). Each cohort included 23 patients: specific with MA 49.5 vs non-specific 48.4, with a mean isoagglutinin titles in specific of 61.65 vs non-specific 11.8 (p = 0.05). Isoagglutinin clearance were higher in specific techniques with 73% vs 59% non-specific (p < 0.03). Due to the dispersion in the number of sessions, results are expressed with the median (4 sessions in specific vs 3 non-specific). Total renal graft survival rate is 93.4%. At one month, it was diagnosed by biopsy an acute renal rejection rate of 16.7% in non-specific vs 18.2% specific (p > 0.05). Considering complications, they are higher with non-specific 41.7% vs specific 18% (p < 0.05). Regarding infectious issues, there are no differences in cytomegalovirus or polyomavirus infections, but there are differences in urinary infections observing in non-specific 79.2% vs specific 63% (p < 0.05). Conclusion Specific techniques are more effective in reducing isoagglutinins, show a lower rate of complications and post-transplant infections, providing greater benefit to the patient.

Changes in the composition of the gut microbiota and content of microbial-derived uremic toxins in patients undergoing hemodialysis

Recent data highlight a significant role of the gut microbiota in the pathogenesis of chronic kidney disease, particularly in its terminal stage. However, little is known about the features of intestinal dysbiosis in people undergoing programed hemodialysis. Changes in the intestinal microbiota and blood levels of uremic toxins of microbial origin in patients with terminal renal insufficiency receiving hemodialysis were analyzed. This cross-sectional study included 80 patients receiving hemodialysis and 20 individuals with normal kidney function. The state of the microbiocenosis of the colon was studied using a polymerase chain reaction with a commercial set Colonoflor 16 (premium) manufactured by Alfalab (Russia). Serum levels of trimethylamine and its metabolite trimethylamine-N-oxide were determined by liquid chromatography/mass spectrometry. The concentrations of indoxyl sulfate and p-cresyl sulfate were evaluated by enzyme immunoassay according to the instructions of a commercial kit. In patients undergoing programed hemodialysis, increased colonization of enterococci was combined with the reduction of lacto and bifidophlora, E. coli, ruminococci, bacteria producing short-chain fatty acids (Faecalibacterium prausnitzii, Eubacterium rectale, Roseburia inulinivorans, and Blautia spp.) and microorganisms involved in maintaining the integrity of the intestinal barrier (Bacteroides thetaomicron and Akkermansia muciniphila). In addition, high titer levels of representatives of opportunistic and even pathogenic flora were often found in this group. Intestinal dysbiosis in patients undergoing programed hemodialysis was accompanied by a significant increase in the concentration of uremic toxins in the blood. Compared with individuals with normal renal function, the trimethylamine level in patients undergoing programed hemodialysis was increased 22 times; trimethylamine-N-oxide, 23 times; indoxyl sulfate, 21 times; and p-cresyl sulfate, 5 times. Thus, patients receiving hemodialysis exhibited pronounced pathological changes in intestinal microbiocenosis, accompanied by a significant increase in serum levels of uremic toxins of microbial origin.

The influence of optimal blood pressure control on the progression of chronic kidney disease

Background/Aim: Chronic kidney disease (CKD) has seen a rapid increase worldwide in recent decades, now recognised as a global health issue of the 21st century. Optimal, continuous control of hypertension represents a crucial part of treatment capable of slowing the progression of CKD. The aim of this study was to demonstrate that optimal regulation blood pressure control in patients with essential and secondary hypertension, along with CKD, slows the progression of CKD. Methods: The research was conducted at the University Clinical Centre of the Republic of Srpska, Banja Luka, Internal Clinic Nephrology Department. A retrospective-prospective study was blind for patients and lasted for 24 months. It included 97 patients, aged 18 and above, of both genders, hypertensive, in the 3rd or 4th stage of CKD (creatinine clearance of 15-59 mL/min). Assess the outcome of CKD, a "complex (undesirable) clinical outcome" was taken - one of three fundamental clinically undesirable events: double increase in serum creatinine values at the end of 24 months, onset of terminal renal insufficiency, or patient death. Patients were classified into three groups: I group - 30 patients with essential hypertension and CKD with optimally regulated blood pressure; II group - 32 patients with secondary hypertension and CKD with optimally regulated blood pressure; III control group - 35 patients with hypertension of various causes and CKD who did not achieve target blood pressure values. Blood pressure control was measured from month 0 to month 24 - once a month. Laboratory tests were taken every 3 months (red blood cells, haemoglobin, glycaemia, cholesterol, urea, creatinine, uric acid, sodium, potassium in serum and urine). Results: There was a highly statistically significant difference in glomerular filtration rate in the first group compared to the third group and in the second group compared to the third group. No statistically significant difference in glomerular filtration rate between the first and second groups was observed, where good blood pressure regulation was achieved. Conclusion: Optimal blood pressure control in the examined groups, regardless of the cause of CKD, was responsible for slowing the progression of CKD compared to the group with unregulated blood pressure.

Successful Pregnancy with Terminal Renal Failure: Fiction or Reality (on the Example of Clinical Observation)

195 million women on Earth suffer from chronic kidney disease — some of them are planning to become mothers. Even in absolutely healthy women, pregnancy is fraught with risks. These risks increase when it comes to kidney pathology. It is known that pregnancy in women with kidney diseases, even with preserved renal function, is accompanied by serious problems for both the mother and the fetus. We present a clinical observation of a 23-year-old patient with terminal renal insufficiency who successfully carried out the pregnancy. The patient’s polymorbid condition (chronic kidney disease, ulcerative colitis, anemia, etc.) required complex therapy and an interdisciplinary approach, which was implemented from the first days of the woman’s observation. The highly professional work of a team of specialists (nephrologists, resuscitators, obstetricians-gynecologists, gastroenterologists, infectious disease specialists, functional diagnostics doctors, urologists, etc.) determined the successful outcome of this observation. The article focuses on the factors aggravating this observation, as well as determining, on the contrary, a favorable outcome.

Congenital Nephrotic Syndrome: About A Case

Summary: Congenital nephrotic syndrome is a nephrotic syndrome present from birth or in the first three months of life, while infantile nephrotic syndrome is defined by a later onset but in the first year of life. Finnish-type congenital nephrotic syndrome and diffuse mesangial sclerosis represent the two main etiologies. Accurate diagnosis is based on clinical, histological and molecular biology criteria, and antenatal diagnosis is possible in some cases. We report the case of a female newborn, premature 35 WA + 9J, without particular pathological ATCDS admitted on D1 of life for a positive infectious assessment objectifying a bicytopenia made of thrombocytopenia and a neutropenia requested following an infectious anamnesis. positive in the mother, put on ATB, the evolution was marked by the appearance of edema of the two lower limbs on D6 of hospitalization taking the bucket in front generalized with puffiness of the face on D13 of hospitalization, a biological assessment was made and confirmed the nephrotic syndrome: hypoproteinemia at 20.3 g/l + hypoalbuminemia at 10.3 g/l + proteinuria for 24 hours at 3.3 g/24 hours proteinuria/creatinuria ratio 55. Associated symptomatic treatment nephroprotective treatment based on converting enzyme inhibitors was started with regular monitoring of renal function. In conclusion the congenital and infantile nephrotic syndromes are rare and generally have a poor prognosis whose evolution towards terminal renal insufficiency requires a program of dialysis and renal transplantationto the in the intensive Care Department A1 of the Hassan II University Hospital of Fez for the management of CT.

Risk of End-Stage Renal Disease in Patients With Systemic Lupus Erythematosus and Diabetes Mellitus: A Danish Nationwide Cohort Study.

The risk of end-stage renal disease (ESRD) is increased in patients with systemic lupus erythematosus (SLE). This study was undertaken to determine whether diabetes mellitus (DM) increases ESRD risk in a large inception cohort of SLE patients. By means of the Danish National Patient Registry, we identified 3,178 adult patients diagnosed as having SLE between January 1, 1996, and July 31, 2018. DM was defined as the date of first hospital contact for DM or date of a first prescription of an antidiabetic drug. ESRD was defined as first registration of dialysis, renal transplant, or terminal renal insufficiency in the Danish National Patient Registry. ESRD incidence was compared between SLE patients with DM (SLE-DM) and those without DM (SLE-non-DM). Hazard ratios (HRs), adjusted for sex, age, educational level, and occupational status at baseline were calculated for sex, age, educational level, and hypertension (at baseline or during follow-up) strata. The overall hazard ratio (HR) was also adjusted for hypertension. The SLE-DM group included 290 patients, of whom 77% were female, compared with 85% of the 2,859 patients in the SLE-non-DM group. SLE-DM patients had a 3 times higher risk of ESRD compared with SLE-non-DM patients (multivariable-adjusted HR 3.3 [95% confidence interval 1.8-6.1]). In stratified multivariable-adjusted analyses, DM increased the rate of ESRD in women and men, patients ≥50 years old at baseline, those with low educational level at baseline, and those with concomitant hypertension. Our findings indicate that SLE patients with DM have a markedly higher risk of developing ESRD compared with SLE patients without DM.

Xerostomia in Dialysis Patients—Oral Care to Reduce Hyposalivation, Dental Biofilms and Gingivitis in Patients with Terminal Renal Insufficiency: A Randomized Clinical Study

Objectives: Dialysis patients suffer from xerostomia based on hyposalivation even in stimulated saliva testing. Therefore, the aim of this study was (i) to evaluate an optimized oral hygiene system with an oral care gel reducing oral dryness, supporting dental plaque control and reducing the number of gingivitis affected teeth; (ii) to document the efficacy in a randomized controlled trial with dental indices; and (iii) to record the individual’s oral health related quality of life. Methods: After ethical approval (EC-UWH 103/2019), 44 dialysis patients provided signed informed consent and were divided into two groups followed up for four weeks. Subjects of the verum group (A) received daily oral care gel OROFAN® based on biopolymers with a mild antibacterial and saliva stimulating action. They were compared to the control group (B) who executed routine oral hygiene with conventional dentifrice and toothbrushes. At baseline (T0), the medical report and all dental indices (sialometry, DMF/S, plaque index, periodontal index, tongue coating and denture hygiene index) were assessed. After 2 weeks and 4 weeks, T1 and T2 dry mouth frequency and all dental indices were assessed. An Oral Health Impact Profile was documented at baseline (T0) and at the end of the study (T2). Results: Twenty-two subjects were allocated to group A and to group B. At baseline, there were no statistical differences concerning renal insufficiency (years on dialysis and complications), systemic diseases and dental background (caries experience, periodontal diseases, plaque index and number of gingivitis affected teeth). All subjects exhibited hyposalivation (<0.7–1.0 mL/min). The control group (B) showed no statistical differences from baseline (T0) to the end of the study (T2) in dry mouth parameters, in all dental plaque and inflammation indices and in their Oral Health Impact Profile. In contrast, the verum group (A) exhibited a highly significant (p < 0.001) decrease in xerostomia frequency, in the number of gingivitis affected teeth and in their plaque index. Furthermore, their Oral Health Impact Profile improved considerably (p < 0.01). Significance of Results: Terminally ill patients may gain better oral health and, consequently, an improved quality of life by rather simple oral care using long-lasting, edible anti-inflammatory oral hygiene gel and a dentist’s devotion.

Antithrombotic therapy in patients with diabetes mellitus

The study discussed various possibilities of antithrombotic therapy in patients with diabetes mellitus. Patients with diabetes mellitus, regardless of whether they have cardiovascular diseases, have a high risk of thrombosis. A feature of the response to antiplatelet therapy is the higher resistance to acetylsalicylic acid and clopidogrel of patients with diabetes mellitus than patients without diabetes mellitus, which can reach 71.4% and 57.1%, respectively. With a decrease in the functional ability of the kidneys in patients with diabetic nephropathy, acetylsalicylic acid is a safe antiplatelet drug; the use of clopidogrel in these patients leads to an increase in the risk of general and cardiovascular mortality. In the absence of contraindications, acetylsalicylic acid is recommended for patients with diabetes mellitus for the secondary prevention of cardiovascular diseases and may be recommended for primary prevention in patients with high and very high cardiovascular risk. Clopidogrel is recommended for patients with diabetes mellitus only for the secondary prevention of intolerance to acetylsalicylic acid. With the development of acute coronary syndrome, patients with diabetes mellitus received double antiplatelet therapy using acetylsalicylic acid and any P2Y12 receptor blocker. In patients who received percutaneous coronary intervention, prasugrel or ticagrelor is recommended as the second component. Double antiplatelet therapy extended for 12 months is indicated for patients with diabetes mellitus with a very high cardiovascular risk and good tolerability. In non-valvular atrial fibrillation, direct oral anticoagulants, in the absence of contraindications, are the drugs of choice in patients with diabetes and creatinine clearance 30 mL/min for dabigatran and 15 mL/min for rivaroxaban and apixaban. With the development of terminal renal insufficiency, only warfarin has proven effectiveness. Combined antiplatelet and anticoagulant therapy is indicated for diabetes mellitus with coexisting atherosclerotic diseases with a high risk of thrombotic and low risk of hemorrhagic complications.

SARCOPENIC OBESITY IN PATIENTS RECEIVING TREATMENT WITH PROGRAMMED HEMODIALYSIS

BACKGROUND . The term "sarcopenic obesity" has been used not so long ago. The epidemiology of this phenomenon during renal replacement therapy in the Russian Federation has not been studied. THE AIM : to assess the prevalence of sarcopenic obesity in patients on hemodialysis (HD). PATIENTS AND METHODS . 140 patients receiving treatment with programmed bicarbonate HD in 2 dialysis centers of St. Petersburg were examined, among them 68 women and 72 men, the average age was 56.8±12.8 years. The main cause of the development of terminal renal insufficiency was chronic glomerulonephritis – in 43, autosomal dominant polycystic kidney disease – in 14, chronic pyelonephritis – in 9, hypertension – in 15, chronic tubulointerstitial nephritis – in 6 and other diseases – in 53 people. The prevalence of these pathological conditions in men and women did not differ. To assess the component composition of the patient's body, we used: 8–point tactile tetrapolar multi–frequency bioimpedance (BIM) on the InBody device (South Korea) with a frequency range of 1 – 1000 kHz, 10 measurements for each of 6 frequencies for each of 5 body segments (right and left arm, right and left leg, torso), followed by the calculation of the index of appendicular skeletal muscles. The criteria of RN. Baumgartner (2000) were used to diagnose sarcopenic obesity. RESULTS . Sarcopenic obesity was detected in 62 patients (44.3 %). There was no correlation with the underlying pathology. Patients with sarcopenic obesity were distinguished by a longer period of renal replacement therapy, the lowest concentration of serum creatinine and the number of points of the physical component of the SF-36 scale, higher levels of C-reactive protein, parathyroid hormone, HOMA-IR index, Charleson index. Also in this group, the lowest score on the IPAQ scale of motor activity and the worst results in the 6-minute walking test were noted. CONCLUSION . Currently, it is not entirely clear what is the primary link in the development of sarcopenic obesity and whether it is realistic to isolate it in a particular patient. We believe that the main cause of the development of this syndrome is obesity, which causes the expression of pro-inflammatory cytokines and insulin resistance. The most important modifiable risk factor for obesity is considered to be the hypercaloric intake of patients, which is due to the lack of nutritionists with experience in the field of nephrology and indexing the amount of calories indicated in clinical recommendations to the real, and not to the recommended body weight.

Ураження нирок при деяких ревматичних хворобах

Ревматичні хвороби з вісцеральними проявами, зокрема з ураженням нирок, або формування ниркових ускладнень в разі ізольованих кісткових, м’язових або суглобових проявів ревматичної хвороби становлять потенційну загрозу як перебігу хвороби, так і її прогнозу. Гломерулярні імунозапальні хвороби виникають у випадках, коли ревматична хвороба наближається за своїм перебігом до системного запального процесу; АА-амілоїдоз — у випадках тривалого активного суглобового процесу; тубулоінтерстиціальні ураження — при лікуванні нестероїдними протизапальними препаратами та аналгетиками. Прогресуючий характер уражень нирок при ревматичних хворобах у напрямку ниркової недостатності та розвиток термінальної її стадії становлять проблему для індивідуума щодо життєдіяльності в умовах замісної ниркової терапії.

Impact of Body Mass Index on Outcome in Patients with Chronic Myeloid Leukemia in Chronic Phase Treated with Imatinib in First-Line

BackgroundImatinib mesylate (IM) 400 mg daily still represents the gold standard for chronic phase chronic myelogenous leukemia (CP-CML). Currently, the initiation dose of IM is adapted to the body weight only in childhood. There are some concerns regarding the adaptation of IM prescription in overweighted patients that may respond poorly to this tyrosine kinase inhibitor (TKI). However, this has not been extensively studied in the first-line setting. In addition, it is known that IM is able to promote weight gain and further, obesity has been identified as a possible risk factor in several solid cancers and leukemias.AimsIn a retrospective observational monocentric study, we evaluated the impact of the weight and the body mass index (BMI) measured at diagnosis on CP CML patients outcomes, on IM first-line, in terms of survival, responses and kinetics.MethodsWe retrospectively enrolled in this study, newly diagnosed CP CML patients, treated with IM in first-line between 2000 and 2017. Overall survival (OS), progression-free survival (PFS), failure-free survival (FFS, defined as progression to advanced phases death, loss of CHR, CCyR, or MMR, discontinuation of IM for toxicity, primary cytogenetic resistance) were analysed since IM initiation in intention-to-treat. Responses (hematologic, cytogenetic, molecular) were analysed according to standard methods. Molecular results were standardised according to the ELN/Eutos programs since 2003, and were expressed as BCR-ABL (IS) in %. Clinical data were extracted from medical files, weight and height measured for all patients at diagnosis, and later nearly all patients being weighted at each time point. The BMI was categorized into 4 stages according to the OMS classification: underweight (BMI < 18.5), normal weight (18.5 ≤ BMI ≤ 24.9), overweight (25 ≤ BMI ≤ 29.9), and obesity (BMI ≥ 30). Serum Albumin (g/l) was regularly assessed, and the nutritional risk index (NRI) was also calculated.ResultsWe enrolled 107 patients in this study, 62 (58%) males, with a median age at diagnosis of 55.36 (17-83) years. Sokal risk and Hasford scores were low for 32% and 39%, Intermediate for 48% and 52%, and high for 20% and 9% respectively, (2 patients unknown). Eutos score was low for 95% of patients. The median BMI at diagnosis was 24.61 (17-44.3) Kg/m2. The median weight at diagnosis was 69 (48-128) Kg. We analysed the patients in 2 groups: A: low + normal BMI (<24.9) and B: overweighted + obese (>25). The median follow-up was 97.3 (3-17) months. Age at diagnosis, Sex ratio, duration on IM, Sokal, Euro, Eutos risk scores, presence of ACA at diagnosis, menopauses women, IM duration were not different between groups A & B. There was significantly more diabetic patients in group B (3 vs 11, p=0.018). The rates of CCyR at 6 months, MMR at 12 months were not different between the 2 groups (38% in group A vs 48.9% in group B, p=0.388; and 48.94% in group A vs 66.67% in group B, p=0.133). The rate of MR4 (56 [44.09-71.91]% group A vs 67.7 [52.60-80.74]% group B, p=0.817), MR4.5 (48 [33.95-62.05]% group A vs 48.9 [34.05-63.73]% group B, p=0.97) at 5 years were not significantly different.Five patients died, all in group B, from a lymphoid blast crisis in 1 patient, secondary tumours in 3 (lung, colon, prostate cancer + cholangiocarcinoma) and terminal renal insufficiency in 1. The OS rate at last follow-up was significantly better in low/normal BMI 100% months (A) versus 84.7 [71.5-100] % months (B, p=0.022) (Fig 1A), as well as the PFS 100% months versus 86.5 [75.-99.7] % months (p=0.027) (Fig 1B).The FFS rate was not different (p=0.794). Interestingly, 25 (23.4%) patients fulfilling the STIM criteria for Treatment-Free Remission, were 17 in arm A and 8 in arm B. Of note, the BMI regularly increases over time with an increase of 0.045 [0.006-0.084] Kg/m2 per month, and patients may become overweighted over time (42% at diagnosis, 45.8% at latest follow-up).ConclusionThis retrospective analysis on an homogeneous population demonstrates that being overweighted at diagnosis of CP CML, and undergoing IM treatment first-line, selectively impacts on survival. However, the rates of responses do not seem to be altered, and the majority of such patients died from CML unrelated causes, mostly from other cancers. The mechanisms responsible for that are probably complex, multifactorial, and confounding factors may interfere, and finally remain to be deciphered. [Display omitted] DisclosuresLabussiere-Wallet:Novartis: Speakers Bureau. Nicolini:Novartis: Consultancy, Honoraria, Research Funding, Speakers Bureau; Incyte Biosciences: Honoraria, Speakers Bureau; BMS: Consultancy, Honoraria, Speakers Bureau; ARIAD: Honoraria, Speakers Bureau.

Differential Diagnosis of Pulmonary Hypertension Using the Example of Collagenosis-associated PAH in the Context of Chronic Lung and Left Heart Disease

Pulmonary hypertension (PH) can be diagnosed in the context of connective tissue diseases (CTD) as well as in elderly patients with multiple comorbidities. A correct clinical differential diagnosis and classification is essential before adequate therapeutic decisions can be made. Differential diagnosis of PH in CTD comprises associated pulmonary arterial hypertension (APAH), group 2 or 3 PH (PH arising from left heart or chronic lung disease), chronic thromboembolic PH (PH) and group 5 (e. g. in the context of terminal renal insufficiency). This is also true of elderly patients in whom the decision has to be made if the increasing number of coincident diseases lead to PH or have to be interpreted as comorbidities. In this manuscript, the differential diagnosis of PH is elucidated, focusing on CTD, in the context of left heart disease and chronic lung disease. Furthermore, criteria are presented facilitating an objective approach in this context.

Vascular Access Failure - Cause or Complication of Central Venous Catheterization: Case Report

Abstract The quality of life and patient survival rate in terminal chronic renal insufficiency depends on the duration of vascular approaches. Dialysis catheters are used to establish an adequate vascular approach when emergency hemodialysis is indicated and when all approaches are exhausted. Complications of CVC can be classified into three categories: mechanical (hematoma, arterial puncture, pneumothorax, hemothorax, catheter misplacement, and stenosis), infectious (insertion site infection, CVC colonization, and bloodstream infection) and thrombotic (deep vein thrombosis). Despite the increasing prevalence of haemodialysis patients with complex access issues, there remains no consensus on the definition of vascular access failure or end-stage vascular access. The dilema in these cases remains whether the generalized vascular insufficiency is the cause or a complication of exhausted vascular accesses. This case report is one of the examples of combined complications with generalized vascular access insufficiency. During the year and a half of the chronic dialysis program, the patient had several changes of vascular approaches, and each approach became dysfunctional in certain time due to various causes. After six months of successful hemodialysis, the patient was admitted with signs of infection and during hospitalization was again subjected to multiple changes of the vascular approach due to infection, thrombosis, and vascular access failure.

Evaluation of the frequency of kidney disease in patients with type 2 diabetes and hypertension

Kidney disease is the primary cause of terminal renal insufficiency and dialysis in diabetics. An early diagnosis may allow to slow down and even to avoid its progression. The aim of our study is to determine the frequency of kidney disease in patients with type 2 diabetes (T2D) and hypertension. A descriptive cross-sectional study was carried out in the exploration unit of internal medicine department, throughout a period of two years. Patients included were adults with T2D and hypertension. The Chronic Kidney Disease (CKD) was defined by the glomerular filtration rate (GFR) ≤ 60 ml/min. Estimation of GFR was calculated with the CKD-EPI formula. The presence of an albuminuria detected by test strips defined the diagnosis of diabetic nephropathy. The level of microalbuminuria was performed with the immune nephelometry technique. Our study included 115 patients T2D hypertensive patients, 83 women, 32 men. Average age was 59 years old. Mean duration of diabetes was 10 years. Average Hb1c was 8%. CKD was present in 22% of patients, macroalbuminuria was detected in 6 from 69 performed tests (9%) and microalbuminuria was positive in 10 patients out of 31 performed dosages (32%). In our series of patients, chronic kidney disease was frequent in patients with type 2 diabetes and hypertension.

Cutis laxa associated with monoclonal gammopathy: 14 new cases and review of the literature

Cutis laxa associated with monoclonal gammopathy: 14 new cases and review of the literature

The pathogenetic mechanisms of acute kidney injury and chronic kidney disease (a literature review)

А im – compilation of scientific data on the pathogenetic mechanisms of acute kidney injury and chronic kidney disease. Although the general pathophysiological picture and the main clinical and laboratory signs of renal damage or comorbid conditions causing CKD have been established, the research of the gradual nephron death mechanisms are still very actual. To date it is unknown why kidney injury initially causes reversible changes, but with the passing of time irreversible acute renal insufficiency occurs or chronic process develops. Broadening pathogenesis knowledge is an important step toward improving early diagnosis and treatment of acute and chronic kidney injury for the maximal postponement of end-stage renal disease. We have analyzed available scientific literature for the past 5 years that allows formulating the modern concept of the general pattern and the key links in the mechanisms of kidney dysfunction and loss of nephrons homeostatic functions. The results, shown in our own experiments, demonstrate the influence of ATP-dependent potassium (KATP) channel activator flocalin on renal. Defined nephroprotective effects of flocalin on tubular and glomerular parts indicate the pathogenetic role of KATP channels and importance of their pharmacological activation during acute and chronic kidney injury. Conclusions. Regardless of its etiology acute injury of the nephrocytes proceeds through several mechanisms. The initial compensatory effects of these mechanisms can change to irreversible destructive influence that finally results in reduction in the number of the functioning nephrocytes, chronic kidney disease formation and terminal renal insufficiency. Despite intensive research of pathogenesis and continuous search for the new markers of acute and chronic kidney injury the causes of kidney pathology progression have not been fully disclosed yet. The important medical, social and economic aspects of renal diseases substantiate perspective of the key links further study that form a universal pathophysiological picture and facilitate the pathogenetic directions of pharmacological nephroprotection improvement.

Polymorphism of Kibra gene in patients with terminal renal insufficiency

Polymorphism of Kibra gene in patients with terminal renal insufficiency

Iron homeostasis in inflammation: a single centre prospective observational study in medical inpatients.

We aimed to assess a potential association of iron status with mortality and morbidity of inpatients with systemic inflammation. This was a single centre prospective observational study. From April 2014 to October 2014, all consecutive medical inpatients aged >=18 years with a C-reactive protein value >5 mg/l on hospital admission were eligible for the study. We excluded pregnant women and patients with terminal renal insufficiency or past allogeneic stem cell transplantation. For all patients, a complete set of serum iron parameters was obtained on hospital admission. In the final analysis, the in-hospital all-cause mortality and several morbidity measures (length of stay, number of secondary diagnoses and Charlson Comorbidity Index) were compared between four distinct iron status groups: patients having iron deficiency anaemia, iron deficiency without anaemia, anaemia without iron deficiency, and normal iron status. Iron deficiency was quantifies as the serum transferrin receptor / ferritin index, with a cut-off level of 1.5. A total of 438 patients were included in the final analysis. Patients with iron deficiency had a higher in-hospital mortality than patients with iron deficiency anaemia, anaemia without iron deficiency, or normal iron status (6% vs 1%, 5%, and 1%, respectively; p = 0.042). Patients with iron deficiency anaemia had a higher number of secondary diagnoses (mean 8.4; standard deviation 4.2) and a higher Charlson Comorbidity Index (mean 1.8; standard deviation 1.9) than patients with iron deficiency, anaemia without iron deficiency, or normal iron status (p <0.001 and p <0.001, respectively). The median length of stay did not differ significantly between the iron status groups (p = 0.080). In our study population, iron status was significantly associated with mortality and morbidity. Further studies are required to assess the pathophysiological and clinical effects of an altered iron metabolism and iron substitution therapies in inflammation.

Immunological pecularities of recipients of renal transplant

Objective. To study immunopathological disorders in renal allograft recipients with terminal stage of chronic kidney disease. Material and Methods. There were studied 119 medical cases of patients with terminal renal insufficiency (tCKD). The amount of leucocyte subpopulation CD19+, CD3+, CD3-CD16+CD56+, CD3+CD16+CD56+, CD3+CD4+, CD3+CD8+, and as well as of lymphocytes expressing activation receptors of CD3+HLA-DR+, CD3+CD38+, CD3+CD8+HLA-DR+, immunoglobulins G, A, С3- and С4-components of the complement were assessed within the patients. Results. There was detected a decrease of the main subpopulations of T lymphocytes CD3+ lymphocytes (рabs=0,033), T helper CD3+CD4+ (рrel=0,002 and pabs=0,001) and T-cytotoxic lymphocytes CD3+CD8+ (рrel=0,006 and рabs=0,001), CD3-CD16+CD56+ lymphocytes (рabs=0,045) within the patients with terminal stage of chronic kidney disease who were on renal replacement therapy; an increase of the subpopulation of TNK-lymphocytes (CD3+CD16+CD56+) (рrel=0,015) was also detected; an increase in the concentration of C4 component of the complement was detected (p=0,014). There was detected positive level correlation of C3-component of the complement (rs=+0,49; р=0,007), C4-component of the complement (rs=+0,37; р=0,049) and CIC (rs=+0,4; р=0,029) with the duration of the hemodialysis, and C3-component of the complement (rs=+0,79; р=0,034), CIC (rs=+0,39; р=0,0334), IgG (rs=+0,845; р=0,008) and IgA (rs=+0,732; р=0,039) with the duration of peritoneal dialysis. Conclusion. Thus, the immune system dysfunction within the patients with terminal kidney disease on renal replacement therapy in the form of hemodialysis or peritoneal dialysis is associated with a change in the quantitative composition, functional activity and cooperation between immunocompetent cells.