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Open access

Carmen Denise Caldararu, Dorin Tarta, Raluca Pop, Mirela Gliga, Emilian Carasca and Grigore Dogaru

Abstract

Obesity and chronic kidney disease are epidemic size. Chronic kidney disease (CKD) appears to be more common in obese, although interrelation is not supported by all authors.

Aim: The aim of the study was to investigate the effects of overweight and obesity on glomerular filtration rate (GFR) and the relationship between body mass index (BMI) and other risk factors for CKD.

Methods: This is a cross-sectional study on 627 patients admitted in a Nephrology Department between January 2007 - December 2011. Patients were divided according to eGFR in a CKD group and a non-CKD group. Patients were divided based on BMI in: normal (<25 kg/m2), overweight (≥ 25 kg/m2 and ≤30 kg/m2) and obese (>30 kg/m2). Demographical, clinical and laboratory data (serum creatinine, lipid parameters, etc) were used for the statistical analysis. The relationship between BMI (as a marker of obesity and overweight), glomerular filtration rate and other possible risk factors for chronic kidney disease was studied.

Results: 43.70% patients were obese and 33.17% overweight. CKD prevalence was 58.69%. Logistic regression analysis showed that systolic blood pressure was the main determinant of CKD in our patients.

Conclusion: Lack of association between BMI and CKD was demonstrated in our study.

Open access

Carmen Denise Căldăraru, Dorin Ionuţ Tarta, Mirela Liana Gliga, Cristina Tarta, Emilian Caraşca, Sorin Albu, Adina Huţanu, Maria Dogaru and Grigore Dogaru

Abstract

Introduction: Hepcidin is a regulatory protein in iron metabolism; we do not know the role in chronic kidney disease anemia. Methods: 22 patients with CKD anemia and 15 patients with CKD without anemia were investigated. CKD anemia-inclusion criteria: over 18 years, hemoglobin ≤12 g/dl for women and ≤13 g/dl for men, no treatment for anemia 6 months before enrollment, glomerular filtration rate (eGFR) <60 ml/min/1.73m2 and stable creatinine three months before enrollment. Exclusion criteria: infection, bleeding, malignancy, systemic or liver disease, immunosuppression, renal replacement therapy. CKD without anemia-inclusion criteria: over 18 years, no anemia or treatment for anemia, CKD with stable creatinine values three months before enrollment. Exclusion criteria: medical conditions known to have a role in the development of polycythemia. Hepcidin-25 and ferritin were measured by ELISA method. Erythropoietin (EPO), tumor necrosis factor (TNF)-α, interleukin (IL)-6 were evaluated using chemiluminescent enzyme immunometric assays. Unpaired T test, Pearson correlation and multiple regression were used for statistical analysis. Results: Hemoglobin values were significantly lower in anemia group. There were no differences in terms of eGFR, age, body mass index, serum hepcidin, erythropoietin, fibrinogen, IL-6, and TNF-α between CKD patients with and without anemia. Serum hepcidin correlated positively with ferritin (r=0.45 p<0.05), TNF-α (r=0.54, p<0.05) and negatively with erythropoietin (r=-0.51, p<0.05). Multiple linear regression analysis demonstrated that TNF-α is an independent predictor of serum hepcidin in our patients (p=0.003, R=0.71). Conclusion: We found no differences in serum hepcidin, erythropoietin and inflammatory markers in non-dialysis CKD patients with and without anemia.

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

Sala Nicoleta, Bancu Ligia, Ureche Corina, Botoman Maria, Simon Ionela, Ciorba Marius and Dogaru Grigore

Abstract

Introduction. Renal disease plays an important role in the prognosis and evolution of chronic liver disease, in particular in its advanced stages. The aim of our study is to analyze the prevalence of chronic liver disease (hepatitis and cirrhosis of different etiologies) and to assess possible correlations between these and impaired renal function.

Material and methods. We conducted a retrospective observational study based on data collected from observation charts of patients admitted to the 2nd Medical Clinic, Emergency County Hospital Tirgu-Mures between January 1st 2012-December 31 2013. In this study we included, based on informed consent, 401 patients with documented liver pathology, with preserved or modified renal function.

Results. Age distribution shows that 41.1% of cases occured between 51 and 60 years of age. Sex distribution shows that 65.3% of cases were male. Toxic cirrhosis was found in 40.8% of males and viral C cirrhosis in 15.1% of women. Toxic cirrhosis associated the following complications: ascites (35.7%), encephalopathy (75%), PAH (68.6%), esophageal varices and upper GI bleed (35.7%). Analyzing the risk factors of renal failure we found that increased mean values of creatinine are associated with viral B cirrhosis (p = 0.02), portal vein diameter (OR 1.37), portal hypertension (OR 1.24), male gender (OR 1.84) and the age group 61-70 yo (OR 1.04).

Conclusions. The current study demonstrated that renal function in chronic liver disease correlates with viral etiology of liver disease, its advanced stage, presence of portal hypertension, older age and male gender.

Open access

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

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.