RESUMEN
The number of patients on renal replacement therapy has doubled every decade since 1980, and prevalence of chronic kidney disease (CKD) in the early stages is also markedly increased. In addition, CKD is a significant risk factor for cardiovascular morbidity and mortality. The only effective approach to this problem is prevention and early detection of CKD. In recent years, screening studies have been carried out in several countries. The findings have defined the scope of the problem and indicated which population groups are at risk of developing CKD. The most numerous are patients with hypertension and diabetes. Also, these studies have indicated that screening should include measurement of serum creatinine for eGFR as well as urine albumin. Early detection of CKD allows proper management that could slow down CKD progression, prevent cardiovascular and other comorbidities and enable timely initiation of dialysis. Screening for CKD could be best managed by partnership between primary care physicians and nephrologists. It is necessary to educate primary care physicians about CKD, its risk factors and associated co-morbidities. Although multiple benefits of screening for CKD are doubtless, the results obtained by screening should be interpreted with caution, bearing in mind that screening detects only markers of kidney disease but not the disease itself.
Asunto(s)
Insuficiencia Renal Crónica/diagnóstico , Diagnóstico Precoz , Humanos , Tamizaje Masivo , Prevalencia , Insuficiencia Renal Crónica/epidemiologíaRESUMEN
BACKGROUND: It is well known that serum urea concentration is not a good predictor of mortality in hemodialysis patients. On the other hand, urea kinetic modeling has been very successfully used to measure dialysis dose by the Kt/V index, which was found to be a good predictor of mortality. Could there be a relation between urea and mortality, but in some more complex way? METHODS: This is a post-hoc analysis of a single center observation study that included 242 patients and an 11-year observation period. Mortality rates between the quartiles of serum urea levels were examined by a 2 x 4 table with the chi(2) test. Both univariate and multivariate survival analyses were performed with standard and segmented extended Cox regression. RESULTS: The relation between mean urea in the baseline period and mortality showed an irregular U-shaped curve. The lowest mortality was observed in the third quartile (28 to 31 mmol/L). The relation between mean urea in the whole observation period and mortality was a J-shaped curve. The lowest mortality was in the second quartile (25-27 mmol/L). Urea was not a predictor of mortality in the whole cohort, but low-urea (binary) and high-urea (binary) were independent predictors of mortality in the corresponding models using standard or extended Cox regression. CONCLUSION: This study revealed a complex relationship between urea and mortality in hemodialysis patients. Patients with low or high urea levels exhibited higher mortality than those with medium levels, while both low and high levels of urea were independent predictors of all-cause mortality.
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Causas de Muerte , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Diálisis Renal/mortalidad , Urea/sangre , Adulto , Anciano , Análisis de Varianza , Biomarcadores/sangre , Nitrógeno de la Urea Sanguínea , Estudios de Cohortes , Creatinina/sangre , Femenino , Humanos , Fallo Renal Crónico/sangre , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Probabilidad , Pronóstico , Modelos de Riesgos Proporcionales , Diálisis Renal/métodos , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND AND AIMS: Chronic kidney disease mineral- and bone disorder (CKD-MBD) has been studied more often in dialysis than in predialysis CKD patients. The association between efficacy of hyperphosphatemia control and chronic renal failure (CRF) progression, prevalence of bone disease and cardiovascular calcification was the objective of the present investigation. MATERIAL AND METHODS: 42 patients with CKD in Stage 5, regularly monitored for 5 years, were divided into Group 1 of 20 patients with normal serum phosphate (sPO4) levels and Group 2 of 22 patients with hyperphosphatemia registered at the majority of checks. Serum urea, creatinine, calcium (sCa) and sPO4 levels were regularly determined in the retrospective 5-year period. At the end of this period iPTH, bone alkaline phosphatase-BAP and inflammation markers (CRP, fetuin-A) were measured, valvular and arterial calcifications were detected by B mode echocardiogram and soft-tissue native radiograms of the pelvis and the wrist. RESULTS: Progression of CRF (1/sCr over time) was faster in Group 2 than in Group 1 (b = -0.0577 vs. -0.0288, p = 0.003) during the study period. Average BAP and iPTH values were similar in both groups and 23/42 patients had PTH > 300 pg/ml. Arterial and valvular calcifications were found in 5/23 patients from Group 1 and 14/22 patients from Group 2 (p = 0.011). Linear regression analysis revealed sPO4 as a predictor for total calcification number, inflammatory diseases as a predictor for valvular calcifications, while sPO4 and iPTH were predictors for arterial calcifications. CONCLUSIONS: More than half the patients with Stage 5 CKD not yet on dialysis exhibited elevated PTH. Faster CRF progression and frequent arterial and valvular calcifications were seen in patients with poor phosphate control and sPO4 was selected as an independent predictor of total calcification score.
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Calcinosis/epidemiología , Enfermedades Cardiovasculares/epidemiología , Hiperfosfatemia/prevención & control , Fallo Renal Crónico/complicaciones , Anciano , Estudios de Cohortes , Femenino , Humanos , Hiperfosfatemia/complicaciones , Hiperfosfatemia/patología , Fallo Renal Crónico/patología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Infecciones del Sistema Nervioso Central , Trasplante de Riñón/efectos adversos , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones del Sistema Nervioso Central/diagnóstico , Infecciones del Sistema Nervioso Central/epidemiología , Infecciones del Sistema Nervioso Central/microbiología , Criptococosis/diagnóstico , Criptococosis/epidemiología , Criptococosis/microbiología , Cryptococcus neoformans/aislamiento & purificación , HumanosRESUMEN
UNLABELLED: Over the period 1980-1992 256 kidney transplantations were carried out in the Institute of Urology and Nephrology, Clinical Centre, Belgrade: 105 (41%) from cadaveric and 151 (59%) from alive related donors. The first kidney transplantation was performed in our Institution in 1974; however, in the first decade only 27 kidney transplantations were performed. Since 1987, thanks to an increasing number of living kidney donors, the number of transplantations continually increased, and after that period an average of 30 kidney transplantations are performed annually (Figure 1). The aim of the study was to establish the survival of patients and grafts, and factors influencing this survival, as well as to determine the causes of patients' death and graft loss. All the patients were followed-up in our outpatient department within at least 5 years to maximum 17 years. Drug combination therapies were changed in the observation period. From 1983 cyclosporin A (CyA) was added to azathioprine (Aza) and prednisolone (Pr). An increasing number of patients with high immunological risks necessitated the strongest initial immunosuppressive treatment with ALG in addition to Aza and Pr. CyA in a dose of 8 mg/kg b.w. was introduced when serum creatinine concentration fell below 300 mumol/L. The triple treatment including CyA, Aza and Pr was the most common maintenance immunosuppressive therapy in our patients. RESULTS: One and five years survived 95% and 75% of patients, and 84% and 52% of grafts. In assessing the impact of donor source, the year of transplantation, and age of donors we obtained the following results: Living related grafts survived better than cadaver grafts, especially during the first posttransplantation year (Figure 2). Furthermore, graft survival rates from 1987 to 1992 were significantly better than those from early period i.e. 1980 to 1986 (Figure 3). The significantly worse survival rate for grafts from donors older than 60 was noted than for grafts from younger donors. Searching for factors influencing the survival, non immunological and immunological differences between donors and recipients were analyzed. Our analysis showed that 50 living related donors were older than 60. In addition, the majority of them were 20 years older than their graft recipients. Two and more HLA mismatches were observed in 46% of our transplant patients, and 20 patients were highly sensitized. However, the immunological risks were higher in living related transplantations: different ABO blood groups, historical positive cross match reaction between donors and recipients (Table 1). A multivariate analysis using Cox proportional hazards model was performed to determine the important independent predictors of graft survival, and it revealed the following factors (Table 2): number of acute rejections, graft function at the end of the first month and until the end of the first posttransplant year, donors' age, and age and sex differences between donors and recipients. The occurrence of acute rejection at any time had a significant negative effect on graft survival. Since better HLA matching is likely to mean less early rejection it could be concluded that HLA matching influenced graft function and survival in our patients. Absence of acute rejection and delayed graft function or acute tubular necrosis were associated with an improvement of the graft function based on serum creatinine concentration, indicating that delayed graft function also influenced graft survival. The relative risk of graft loss was 2 times higher for patients receiving graft from donors older than 60. Until December 1997, when our analysis was done, of 256 kidney transplant patients 156 lost their grafts. The major causes of graft loss (Table 3) in the early period from 1980 to 1986 were non immunological such as acute tubular necrosis, vascular thrombosis and patients death with functioning graft. (ABSTRACT TRUNCATED)
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Trasplante de Riñón , Adolescente , Adulto , Niño , Femenino , Supervivencia de Injerto , Humanos , Trasplante de Riñón/mortalidad , Trasplante de Riñón/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tasa de Supervivencia , YugoslaviaRESUMEN
Rapidly progressive glomerulonephritis is a kidney disease leading to sudden and definitive damages of the renal parenchyma and progressive impairment of its function until the complete failure. Histological findings of the changes are characterized with dominant glomerular lesions with crescentic formations. Early and intensive immunosuppressive therapy with pulse doses of steroids (Solumedrol 1.5 to 2.5 g), followed by Prednisolone 1 mg/kg every other day and cytostatic drugs (cyclophosphamide 1-2 mg-kg/every other day) discontinues the processes of specific and non-specific inflammation in the kidney and could enable regeneration of the kidney tissues with favorable outcome of the disease. Immunosuppressive therapy should be gradually lowered after two months, and applied for at least three to six months.
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Glomerulonefritis/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Lesión Renal Aguda/etiología , Adolescente , Adulto , Femenino , Glomerulonefritis/complicaciones , Glomerulonefritis/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The discovery of recombinant human erythropoietin has enabled treatment of anaemia in patients whose anaemia was primarily caused by the lack of erythropoietin. This agent was most widely used in the treatment of anaemia in chronic renal failure patients. Non-regulated hypertension is considered to be the only absolute contraindication for recombinant human erythropoietin application, but thrombocytosis, predisposition to thromboses of arterio-venous fistulae, and convulsions are regarded as relative contraindications. Recombinant human erythropoietin may be administered intravenously, but the subcutaneous route is considered more rational. The treatment is initiated by low doses with gradual dose increase, what enables gradual anaemia correction and prevents the appearance of adverse effects. Haemoglobin level of around 100 g/l is considered the target haemoglobin level. The majority of patients respond well to treatment by human recombinant erythropoietin and the absence of anaemia improvement may be the result of iron deficiency, occult haemorrhages, chronic infection, inadequate dialysis, secondary hyperparathyroidism, aluminium intoxication. Anaemia improvement during the treatment with recombinant erythropoietin leads to the improvement of function of most organs and the quality of life in general as well as avoidance of blood transfusions and their adverse effects. The most frequent adverse effect of recombinant erythropoietin is the development of iron deficiency or hypertension aggravation.
Asunto(s)
Anemia/terapia , Eritropoyetina/uso terapéutico , Fallo Renal Crónico/complicaciones , Anemia/etiología , Humanos , Proteínas RecombinantesRESUMEN
Chronic rejection of kidney transplant is a chronic and progressive decline of kidney transplant function related to certain morphologic changes, such as obliterate vasculopathy, interstitial fibrosis, tubular atrophy, and transplant glomerulopathy [1]. The purpose of this study was to investigate the involvement of chronic transplant glomerulopathy in the progression of chronic renal failure. METHOD, PATIENTS: Of 16 transplant patients with histologic diagnosis of chronic kidney transplant rejection in biopsy specimens, 8 patients had chronic transplant glomerulopathy (ChR-1), and in the other 8 patients glomeruli were relatively preserved (ChR-2). Transplant biopsies were performed between the seventh and the 15th month in ChR-1, and between the ninth and the 34th month in ChR-2 group. Morphologic vasculopathy cv2 changes, tubular atrophy ct1 and ct2 in the half of each group, and interstitial fibrosis ci2, were graded according to the BANFF criteria [2]. During the follow up the patients received similar doses of prednisone, as well as of azathioprine and cyclosporine A. IMMUNOHISTOCHEMICAL INVESTIGATION: The expression of MHC I antigen, MHC II antigens, CD3, CD25, CD54 (ICAM-1) was analyzed by indirect immunoperoxidase technique of staining on the frozen sections, (DAKOPATTS). The immunoreactivity score was 0 to 3. BIOCHEMICAL INVESTIGATION: The renal function was expressed as reciprocal serum creatinine values (1/mumol/L) reflecting the mean monthly levels, over the period between the third and the 22nd month following the transplantation. In each patient a decline in kidney functioning was determined in two ways: 1. by the slope of the curve representing the function of regression of the reciprocal serum creatinine over time, started from the third month after the transplantation, 2. by the rate of regression (percent) of the reciprocal serum creatinine values at the sixth, the ninth, the 18th and the 22nd month, compared to the attained serum creatinine level at the third posttransplantation month. RESULTS AND DISCUSSION: Glomeruli with present chronic transplant glomerulopathy (patients of the ChR-1 group) had moderate expression of MHC I antigen [1-2], week expression of ICAM-1 (CD54), whereas DR antigens were almost absent. In cortical tubuli the expression of MHC I antigen was very low. The relatively preserved glomeruli in patients without chronic transplant glomerulopathy (ChR-2 group) showed high expression of MHC I antigen [2], moderate expression of ICAM-1, and low (up to 1) DR expression. The CD25 molecules were not detected in any analyzed glomeruli (62 in total), except a positive cellular crescent formation, seen in 3 patients with chronic transplant glomerulopathy. The regression slopes of reciprocal serum creatinine values according to months, over the third and the 22nd month were similar in both groups of patients, and the speculating mean graft survival time was 44 months, in both groups. However, 4 of 8 patients of the ChR-1 group, and only 1 of 8 patients of the ChR-2 group returned to the haemodialyses because of the graft functioning loss. Besides, the mean percentual rate of the decline in renal functioning, as the rate of decrease of serum reciprocal creatinine values in the chosen growing periods in time after the third month were higher in group ChR-1 with present chronic transplant glomerulopathy in biopsy specimens. The difference was of statistical significance at the end of the 18th month, t = 4.10, p less than 0.01. In this period proteinuria exceeding 3 grams a day was discovered in 6 patients of ChR-1 group, and in 4 patients in ChR-2 group. Our results suggest that the early appearance of chronic transplant glomerulopathy induces a slightly higher loss of function of the kidney transplant with chronic rejection, despite of the absence of the immune activation in the glomeruli with the present chronic transplant glomerulopathy. (ABSTRACT TRUNCATED)
Asunto(s)
Rechazo de Injerto/complicaciones , Fallo Renal Crónico/patología , Glomérulos Renales/patología , Trasplante de Riñón , Enfermedad Crónica , Progresión de la Enfermedad , Rechazo de Injerto/patología , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/fisiopatología , Pruebas de Función Renal , Trasplante de Riñón/patología , Complicaciones Posoperatorias/patologíaRESUMEN
Secondary hyperparathyroidism is a complex pathophysiologic event which we examined in hundred patients Sixteen of them belonged to the control with normal renal function, and the rest of them were categorised into four subgroups according to the actual level of chronic renal failure, determined by GFR a.i. by endogenous creatinine clearance. We determined the serum level of parathormone (C-PTH) and plasma concentration of phosphate and calcium in all of patients. In 43 of them we measured serum level of 1.25 dihydroxycholecalcipherol and ionised calcium. Our results suggested an important parallelism between parathormone hypersecretion (GFR +/- 58.3 ml/min), 1.25 dihydroxycholecalcipherol hypovitaminosis (GFR +/- 50.7 ml/min) and hypocalcemia (GFR +/- 47.7 ml/min) which connect them in very strong relationship. Even if secondary hyperparathyroidism in chronic renal failure is caused by numerous factors, it appears that the hypovitaminosis of 1.25 dihydroxycholecalcipherol with consequent hypocalcemia and phosphate retention acts as a main movement of this complex pathophysiology mechanism.
Asunto(s)
Hiperparatiroidismo Secundario/etiología , Fallo Renal Crónico/complicaciones , Adulto , Femenino , Humanos , Hiperparatiroidismo Secundario/fisiopatología , Fallo Renal Crónico/metabolismo , Masculino , Persona de Mediana EdadRESUMEN
According to the aim of our research to find a regulatory of changes of the serum levels of 1.25 dihydroxyvitamin D3 and 25 OH D vitamin, we examined their serum concentration in 43 among 100 pts. with normal and impaired renal function with different stages of chronic renal failure (CRF). In all of 100 pts. we measured plasma phosphate and calcium concentration and endogenous creatinine clearance. The results of our research showed homeostasis abnormalities in all of parameters we examined. We found out that the serum 1.25 (OH)2 D3 levels decreased in early course of CRF, hypovitaminosis occurred when glomerular filtration rate reaches values equal or less than 50.7 ml/min. Hypovitaminosis of 25 OH D expressed in end-stage of CRF, while hyperphosphatemia was commonly seen in moderate CRF, when GFR became less than 28.6 ml/min. Hypocalcemia obtained when GFR was equal or less than 47.7 ml/min.
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Calcifediol/sangre , Calcitriol/sangre , Fallo Renal Crónico/sangre , Adulto , Femenino , Tasa de Filtración Glomerular , Humanos , Fallo Renal Crónico/fisiopatología , Masculino , Persona de Mediana EdadRESUMEN
Hepatitis C virus infection is a very important problem among patients on maintenance hemodialysis. To determine incidence and clinical manifestations of hepatitis C virus infection, we tested blood samples of patients on hemodialysis in 1992 and 1994 using ELISA a HCV test of second generation. In 1992 46 out of 119 patients (38%), and in 1994 36 out of 122 (29%) patients on hemodialysis were aHCV positive. Duration of dialysis program and level of serum aminotransferases were significantly higher in the group of aHCV positive patients had received more blood transfusions per year, but not significantly higher than HCV negative patients. These results with knowledge about common routes of HCV transmission, demand strict preventive measures in dialysis units, routine and regular HCV testing of patients' blood samples and serum aminotransferases level, and isolation of HCV positive patients and machines.
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Hepatitis C/epidemiología , Diálisis Renal , Adulto , Ensayo de Inmunoadsorción Enzimática , Femenino , Hepatitis C/diagnóstico , Hepatitis C/etiología , Anticuerpos contra la Hepatitis C/análisis , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Reacción a la TransfusiónRESUMEN
In order to monitor changes of the nutritive status of hemodialyzed patients, antropometric and laboratory parameters of the population of hemodialyzed patients in 1988 vs. 1994 have been compared. Antropometric parameters were measured by the same investigator. The results show absence of significant difference between antropometric parameters (body weight after hemodialysis, body mass index, triceps fold, circumference of upper arm and percentage of fat) in the patients hemodialyzed in 1988. The laboratory parameters (albumin and transferrin), however, show significant increase in the 1994 group. In the group of patients subjected to hemodialysis in 1988 as well, albumin was significantly elevated. Nevertheless, no differences in laboratory parameters in healthy populations of 1988 and 1994 were noted (controls). It was concluded that no significant changes in the nutritive status were present among either the population or the same patients, while elevation of laboratory parameters necessitate further investigation.
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Evaluación Nutricional , Diálisis Renal , Antropometría , Femenino , Humanos , Masculino , Albúmina Sérica/análisis , Transferrina/análisisRESUMEN
Septic complication in patients (pts) with ARF are among the most important causes of mortality, especially in pts with polytrauma and multiple-organ failure. Prevention procedures, early and accurate diagnosis and persistent treatment in time are necessary to avoid septic shock. During the period od 27 months (1992-1994), 25 pts with wounds inflicted in war and AFT were treated by haemodialysis. Eighteen (72%) pts had septic complication. Eleven (71%) of them recovered from ARF, while 7 (39%) pts died despite the undertaken procedures. Nine pts (81%) with septic complication and ARF who improved their renal function were treated by one or more nephrotoxic antibiotics. Haemodialysis was initiated when average BUN concentration was 35.7 mmol/l and plasma creatinine level about 0.8 mmol/l. Simultaneously with symptomatic and substituting therapy, and surgical correction of polytrauma, approximately 9 haemodialysis in the period of 21 day were necessary for ARF recovery. In the group of pts who had no improvement of renal function, 6 (85%) received 1 or more nephrotoxic drugs. Approximately 5 haemodialysis were done in these pts, in a shorter period of time. In polytraumatized pts with ARF with septic complication, factors which potentiate hypercatabolism aggravate the prognosis of ARF, increase mortality, require a greater number of haemodialysis and significantly prolong the recovery time of ARF.
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Lesión Renal Aguda/mortalidad , Traumatismo Múltiple/complicaciones , Sepsis/complicaciones , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Adulto , Femenino , Humanos , Masculino , Insuficiencia Multiorgánica/etiología , PronósticoRESUMEN
We analysed 27 patients (15 women and 12 men) on CAPD treatment longer than 6 months at the Clinic of Nephrology, CCS, in Belgrade. Pts were between 22 and 72 years old (57.77 +/- 12.21 years). These pts had 47 episodes of peritonitis: 6 pts (22.22%) were without peritonitis, but 21 pts (78.22%) had between 1 and 5 episodes of peritonitis. We found 1 peritonitis /pts/year. Causes of peritonitis were mostly unknown (27/47) because treatment had began before taking culture of the peritoneal dyalisate. The most common causes of peritonitis were coagulase negative staphylococci: Staphylococcus aureus (8) and Staphylococci epidermidis (8). Laboratory showed: leucocytosis, hyperfibrinogenaemia, hypoproteinaemia and accelerated ESR. There was no connection between causes of chronic renal failure and frequency or peritonitis. During treatment of peritonitis in 2 pts we had to replace the peritoneal catheter and 5 pts went on haemodialyses. The other were recovered and continued CAPD treatment.
Asunto(s)
Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Peritonitis/etiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Peritonitis/microbiología , Peritonitis/terapiaRESUMEN
We analysed 27 patients (15 women and 12 men) on CAPD treatment, between 6 months and 7 years at the Clinic of Nephrology, Clinical Center of Serbia, in Belgrade. Patients were between 22 and 72 years old. The main causes of pulmonary abnormalities were infections (5), hypervolaemia, hypoproteinaemia and heart failure (13). We had 11 patients (40.74%) with 18 pulmonary abnormalities: bronchopneumonia (2 pts), pleuritis sicca (1 pt), pleural effusion (10 pts): unilateral (4) and bilateral (7). Three patients had recurrent pulmonary infections and pulmonary abnormalities. All patients recovered and continued treatment with CAPD.
Asunto(s)
Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Enfermedades Respiratorias/etiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The paper presents results of renal transplantation from a living unrelated donor in Bombay. Within the past three years 15 patients reported themselves at our Clinic immediately upon renal transplantation from a living unrelated donor, 7 of whom were women and 8 men, 17 to 52 years of age. There were no data on previous pretransplantation processing for the majority of patients, and treatment by repeated hemodialyses in 46.7% of patients lasted less than a year, which increased the risk of transplantation. On admission at our clinic, nine patients had satisfactory renal function, four patients moderate insufficiency and two advanced insufficiency. The most frequent complications occurring in these patients were various forms of infections. A three-year follow-up of these patients showed at the results of renal transplantation in Bombay were unsatisfactory, and the survival rate of the patients and the graft was far too worse that the one in Europe, that is at our Centre.
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Trasplante de Riñón/efectos adversos , Donadores Vivos , Adolescente , Adulto , Femenino , Humanos , India , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana EdadRESUMEN
At the nephrologic offices of the Clinical Centre of Serbia Polyclinic 2,451 patients (975 males and 1,476 females) were examined over a period of four years (1987-1990). Out of these 647 (26.40%) were suffering from chronic renal failure. Hypertension as the principal diseases was diagnosed in 432 patients (17.62%), being somewhat more frequent in women. Two hundred patients were suffering from glomerulonephritis. Pyelonephritis was diagnosed in nearly the same number of patients (199). Out of the 129 patients suffering from urinary tract infections 112 (86.82%) were women. Women appeared in large numbers in other diagnostic groups as well. Quite a number of patients (14.08%) reported only once for functional examination of the kidneys. It may be concluded that among the examined patients the most numerous were those with chronic renal failure, while many were suffering from chronic nephropathy which points to the comparatively late diagnosing of nephrological disorders.
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Enfermedades Renales/diagnóstico , Femenino , Humanos , Enfermedades Renales/epidemiología , Masculino , Yugoslavia/epidemiologíaRESUMEN
99mTc MAG3 is the radiopharmaceutical agent that provides simultaneous investigation of renal perfusion, functional parenchyma and collecting system. Clearance of MAG3 which is equal to its tubular extraction rate (TER) and other quantitative parameters of renal function can be determined at the same time. The aim of the study was to analyze importance of TER, clearance index (CI) and renal accumulation rate (RA) of MAG3 in the assessment of the functional status of renal transplants. 31 kidney transplant recipients and 14 healthy donors were investigated. Dynamic renal scintigraphy was carried out 20 min. after i.v. injection of 150-220 MBq MAG3. Clearance was determined by single sample volume distribution method. For the calculation of CI and RA counts from transplant region acquired during the second minute of study were used. Results of TER, CI and RA were correlated with blood urea (Pu), serum creatinine (Pcr) and creatinine clearance (Ccr). The sensitivity of TER, CI and RA in well functioning kidney graft as well as in chronic rejection were analyzed. We concluded that: TER, CI and RA are more sensitive in comparison with Pu, Pcr and Ccr in quantitative assessment of renal transplant function; sensitivity of TER is greater than the sensitivity of CI and RA.
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Trasplante de Riñón/diagnóstico por imagen , Riñón/diagnóstico por imagen , Tecnecio Tc 99m Mertiatida , Humanos , CintigrafíaRESUMEN
The effects of captopril on morphologic changes and clinical course of adriamycin (ADR) nephropathy in spontaneously hypertensive rats (SHR) were examined. After ADR infections rats were divided into two groups: ADR-C group (n = 20) given captopril (60 mg/kg per day) and ADR group (n = 19) receiving no antihypertensive treatment. SHR were examined every 6 weeks. Captopril normalized systemic blood pressure, but failed to prevent proteinuria. It slowed down renal function deterioration in the early stage of ADR nephropathy (weeks 6 and 12), but at the end of the study both groups had the same degree of renal failure irrespectively of whether blood pressure was well controlled with captopril or hypertension persisted. Captopril slowed down mesangial expansion in the early stages of ADR nephropathy, but at the end of the study there was no statistically significant difference between these two groups. Treatment with captopril also reduced the development of glomerular sclerosis.