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  • Author: Grigore Aloiziu Dogaru x
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Nicoleta Dora Pop, Anca Bacârea, Ligia Coroș, Grigore Aloiziu Dogaru, Ioan Hosu, Vladimir Bacârea and Attila Nagy

Abstract

In this study, different aspects of anemia in chronic kidney disease have been observed, starting from the fact that the severity of anemia is associated with the degree of kidney dysfunction, the main cause being the erythropoietin deficiency, which is synthesized mostly by the kidneys. 58 persons were included in this study, 19 patients with non-dialysis-dependent chronic kidney disease, 18 patients with chronic kidney disease who received kidney transplantation and 21 apparently healthy persons. We evaluated the serum level of erythropoietin, serum creatinine, proteinuria, the glomerular filtration rate, the erythrocyte parameters and the correlations between them. The prevalence of anemia in patients with chronic kidney disease was of 51.35%. The hemoglobin concentration in patients with kidney transplantation (12.4 ± 2.7 g/dL) and in non-dialysis-dependent patients (11.7 ± 1.4 g/dL) is significantly different compared to the apparently healthy persons (14.6 ± 0.8 g/dL) (p<0.05). In the case of the non-dialysis-dependent patients who were not treated with erythropoiesis- stimulating agents we found positive associations between the glomerular filtration rate and the number of erythocytes (r = 0.71), hemoglobin (r = 0.65) and hematocrit (r = 0.73), as well as negative associations between creatinine and the number of erythrocytes (r = -0.72), hemoglobin (r = -0.86) and hematocrit (r = -0.88). In patients with kidney transplantation and anemia we observed positive correlations between erythropoietin and the number of erythrocytes (r = 0.69), between the glomerular filtration rate and the number of erythrocytes (r = 0.78) and erythropoietin (r = 0.97), as well as negative correlations between proteinuria and the number of erythrocytes (r= -0.89), hemoglobin (r= -0.72), hematocrit (r = -0.72), and erythropoietin (r = -0.67), and between creatinine and the number of erythrocytes (r = -0.75) and erythropoietin (r = -0.86).

Open access

Stoica Ciprian Mihai, Căldăraru Carmen Denise, Vari Camil Eugen, Tarţa Dorin Ionuţ, Dogaru Maria Titica, Caraşca Emilian and Dogaru Grigore Aloiziu

Abstract

Background: Therapeutic drug monitoring (TDM) in patients with Chronic Kidney Disease (CKD) with kidney transplant, represents a major post transplant concern due to the characteristics of this special category of patients, particularities which can generate changes of the pharmacokinetic profile of the administered medication.

Material and methods: The current study is a retrospective pharmacokinetic study, over a period of 50 months, including a group of 36 kidney transplanted patients with CKD. Tacrolimus blood concentration was determined by a validated high-performance liquid chromatography method (HPLC), at a 12 hour time interval from the last administration of the immunosuppressive medication and before the following dose (Residual concentration, Cmin(trough)).

Results: During the monitoring of therapy, based on the pharmacokinetic criteria, 252 measurements of blood concentration were determined, 58 of these being outside the therapeutic window.

Conclusions: The results obtained show that it is mandatory to continue to monitor closely medical therapy based on the pharmacokinetic criteria in view of improving drug administration. The other ways of monitoring therapy: the clinical and biochemical criteria should not be overlooked. In addition, the interindividual variability of patients should be considered, as well as drug interaction which can alter the pharmacokinetics of tacrolimus.

Open access

Vartolomei Mihai Dorin, Chibelean Calin Bogdan, Voidazan Septimiu, Martha Orsolya, Borda Angela, Boja Radu Mihail and Dogaru Grigore Aloiziu

Abstract

Objectives. The purpose of this study was to determine the evolution of patients with unifocal lateral wall MIBC (muscle invasive bladder cancer) after cystectomy with PLND (pelvic lymph node disection) at the Urology Clinic in Tirgu Mures, and to determine tumor stage and lymph node status before and after radical cystectomy with PLND.

Methods. This is a prospective study, conducted between 1 August 2012 to 31 July 2014 at Urology Clinic, with a median follow-up of 14 months (range 7-25). Inclusion criteria were: patients undergone cystectomy with PLND, and unifocal MIBC on the lateral wall of the bladder; exclusion criteria were: multiple bladder tumor, other location and clinical T stage > 3.

Results. Forteen patients met the inclusion criteria, median age was 61 (range 55-72), 85.71 % were male. An increase in T3 patients was noticed from 1 to 5 cases, we noticed a decrease of N0 lymph nodes from 78.6% to 57.1% postoperatively and on the controlateral side the kappa coefficient between the preoperatively and postoperatively negative lymph nodes was 0.63. On the tumor side the most common location for positive lymph nodes was external iliac with 3 nodes (21.4 %) and obturator fossa with 4 nodes (28.6 %) and on the contralateral side 2 positive nodes (14.3 %, obturator fossa, external, internal and common iliac nodes).

Conclusions. In unifocal bladder tumors, located on the lateral wall, PLND could be an alternative with comparable results with extended PLND especially in T1 and T2 patients associated with N0 before and after surgery.