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Development of Acute Peritonitis after Gynecological Procedure in a Peritoneal Dialysis Patient

Abstract

Although the majority of peritonitis cases in peritoneal (PD) dialysis patients are caused by gram-positive cocci, streptococcus agalactiae, a gram-positive group B β haemoliticus streptococcus, may rarely be found in this group of patients. We present a case of acute peritonitis caused by streptococcus agalactiae with bacteriemia and septic shock occurring after a curettage indicated because of gynecologic bleeding. The patient did not receive antimicrobial prophylaxis since the gynecologist considered this case as a "routine" procedure without the need to administer antibiotics. Our case demonstrate that small procedures may cause great problems and therefore one should always give priority to individual approach regardless of the protocol for "routine" surgery, especially if there are no indications for the emergency procedure

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MicroRNA in kidney disease

P. Renal progenitors and childhood: from development to disorders. Pediatr Nephrol 2014; 29: 711-719. 5. Bertram JF, Douglas-Denton RN, Diouf B, et al. Human nephron number: implications for health and disease. Pediatr Nephrol 2011; 26: 1529-1533. 6. Romagnani P, Lasagni L, Remuzzi G. Renal progenitors: an evolutionary conserved strategy for kidney regeneration. Nat Rev Nephrol 2013; 9(3): 137-146. 7. Black MJ, Sutherland MR, Gubhaju L, et al. When birth comes early: effects on nephrogenesis. Nephrology 2013; 18: 180

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Kidney Transplantation Program in Montenegro

century. South Med J 2009; 102: 810-813. 8. World Health Assembly Resolution 57,18. Human organ and tissue transplantation, May 22, 2004, http://www.who.int/gb/ebwha/pdf_files/WHA57/A57_R18-EN.PDF 9. International Summit on Transplant Tourism and Organ Trafficking. The Declaration of Istanbul on Organ Trafficking and Transplant Tourism. Clin J Am Soc Nephrol 2008; 3(5): 1227-1231. 10. Delmonico FL. The development of the Declaration of Istanbul on Organ Trafficking and Transplant Tourism. Nephrol Dial Transplant 2008; 23: 3381-3382. 11

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Preeclampsia: from Pathophysiology to Treatment

, et al. Transcriptionally active syncytial aggregates in the maternal circulation may contribute to circulating soluble fms-like tyrosine kinase 1 in preeclampsia. Hypertension 2012; 59: 256-264. 57. Zhao H, Wong RJ, Kalish FS, et al. Effect of heme oxygenase-1 deficiency on placental development. Placenta 2009;30: 861-868. 58. Lockwood CJ, Toti P, Arcuri F, et al. Thrombin regulates soluble fms-like tyrosine kinase-1 (sFlt-1) expression in first trimester decidua: implications for preeclampsia. Am J Pathol 2007; 170: 1398

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Nephropathology: A Cornerstone for Understanding and Estimation of Recent Advances in Glomerular Diseases

Abstract

The developments in the field of kidney pathology are major objectives for nephrology worldwide, since the histopathologic diagnosis is a cornerstone for all glomerulopathies (either primary or secondary related to systemic diseases-for tubulointerstitial and vascular lesions as well as renal allograft nephropathy). Moreover, the correct interpretation of kidney tissue samples is a challenge for pathologists too. Consequently, a new subspecialty - nephropathology, was accepted by many medical schools in various universities, while dedicated scientific meetings, journals and websites were also created. In the following few pages, a short overview on the history, classic and novel meanings of the renal pathology for the understanding of glomerular pathophysiology will be discussed.

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Contrast Induced Nephropathy in Patients with Acute Coronary Syndrome

Abstract

Introduction. Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality after percutaneous coronary intervention (PCI). On the other hand, CIN is a serious complication in patients with diabetes or renal impairment undergoing percutaneous coronary intervention (PCI). CIN after PCI may be associated with prolonged hospitalization, increased rates of kidney injury, and short- and long-term mortality. Factors that have been associated with CIN include: diabetes mellitus, congestive heart failure, recent acute myfocardial infarction, cardiogenic shock, and pre-existing renal impairment. In this study, we investigated contrast nephropathy development after coronary angiography (CAG) in patients presenting with acute coronary syndrome, who were hospitalized initially in the Coronary Care Unit and subsequenttly referred to the Internal Medicine Clinic in a tertiary care hospital.

Methods. We’ve analyzed 335 patients’ records retrospectively in 1 year that were followed-up with acute coronary syndrome (ACS) in the Coronary Care Unit (CCU) and transferred to the Internal Medicine Clinic (IMC). The following parameters were evaluated: age, gender, chronic disease and drug history, biochemical values evaluated before hospitalization to CCU, ejection fraction (EF) and left atrium diameter (LA), with or without previous CAG; values of serum creatinine (sCr) levels before CAG and after 48 hours. Values of p <0.05 were considered to be significant.

Results. 126 of 335 patients were female and 209 were male. The average age of patients was 64.2 years. 122 patients used angiotensin converting enzyme inhibitor (ACEI), 54 patients used furosemide. CIN development rate of CAG patients was 22.8% (n=54). There was no significant relationship with age, gender and chronic disease history in CIN patients. When laboratory findings were compared, there was no significant relationship except for potassium value before CAG. However, potassium values were significantly higher in CIN patients (p=0.001). When drug usage of patients was compared, 48.1% (n=26) of CIN patients used ACEI and there was a significant relationship between ACEI use and CIN development (p=0.026).

Conclusions. CIN development rate was 22.8% and it was relatively high when compared with literature data. Awareness about contrast nephropathy develepment risk and assessment of risk factors before the procedure should be increased in our Center.

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Five Years of Renal Transplantations in Montenegro: Results and Challenges

Abstract

First renal transplantation in Montenegro was performed on September 25th, 2012. Since then, 32 transplantations have been performed. Only one was from deceased donor, the remaining were from living donors. 40.4% of all patients with end-stage renal disease currently live with the functioning renal allograft (190 patients on dialysis, 129 transplanted patients). There are 32 patients on the waiting list. Further efforts will be focused on development of the deceased donor program and introduction of the AB0 incompatible renal transplantations.

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Aspergillus Peritonitis in Chronic Peritoneal Dialysis Patients: Review of the Literature and Report of Two Cases

Abstract

Although gram positive bacteriae are the most common causative microorganisms of chronic peritoneal dialysis (CPD) peritonitis, fungi are responsible for 1-15% of all cases. On the other hand, fungal peritonitis episodes may potentially cause serious consequences such as resistance to treatment, extended hospital stay and also a higher probability of death. Fungal peritonitis due to Aspergillus spp is relatively uncommon, but its mortality rate and severity is known to be even higher. It was our aim to conduct a review of the medical literature regarding the treatment and clinical outcome of Aspergillus related CPD peritonitis and to present two cases with Aspergillus related CPD events. Our current knowledge and the outcome of our two cases suggest that, despite the use of recommended therapeutic measures, Aspergi-llus induced fungal peritonitis in CPD patients may still be fatal. Therefore, there is a need for development of more efficient therapeutic approaches including the type, dose and route of antifungal therapy.

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Clinical Course of Children and Adolescents with Primary Vesicoureteral Reflux: A retrospective study of 958 patients

Abstract

Introduction. Vesicoureteral reflux (VUR) is the most common pediatric urologic abnormality and since it can predispose to urinary tract infection and resultant kidney scar it is an important issue in pediatric nephrourology. Methods. A retrospective chart review and follow-up of 958 patients with primary VUR was performed in the Children’s Medical Center, Tehran, Iran. Children with primary vesicoureteral reflux were included in the study and these parameters were studied: age, sex, clinical presentation, VUR grade, sonographic findings, DMSA changes, treatment modality (medical, surgical or endoscopic) and response to treatment, hypertension (presence/absence), urinary tract infection recurrence and development of new kidney scars in patients under medical treatment. Results. VUR was more prevalent in girls. Sonography was unable to detect VUR in many cases. Presence of renal scars was strongly associated with degree of reflux. Medical management was effective in a substantial percentage of patients and they experienced full resolution of reflux. This was especially true for lower degrees of VUR. 17.6% of patients developed new kidney scars on followup which was associated with higher degrees of VUR. Hypertension and breakthrough urinary tract infection was an uncommon finding in our patients. Conclusion. Medical management, which means using prophylactic antibiotics for prevention of urinary tract infection, is effective in many cases of VUR especially in cases with lower degrees of VUR. Surgical and endoscopic procedures must be reserved for patients with higher degrees of VUR unresponsive to conservative management or in whom new scars may develop.

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Kidney Complications Due to Hematopoietic Stem Cell Transplantation-A Disorder of an Increasing Incidence?

Abstract

Hematopoietic stem cell transplantation (HSCT) is becoming an increasingly popular treatment considering that it is the only curative option for many malignant and non-malignant diseases. Many patients treated in this way have been followed for two or three decades post-transplant and are presumed to be cured. But, on the other hand, a great proportion of these patients are experiencing long-term side effects after HSCT, including non-malignant organ or tissue dysfunction, changes in quality of life, infections and secondary malignancy. Renal complications caused by HSCT are high and are associated with the development of both acute and chronic kidney failure. So, considering the increasing numbers of HSCT survivors many years after the transplantation, chronic kidney disease due to HSCT is becoming a growing problem and represents a new population of patients who are presented to nephrologists. The three most common forms of chronic kidney disease related to HSCT are: chronic calcineurin nephrotoxicity, glomerular disease after HSCT and HSCT associated thrombotic microangiopathy.

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