Abdellah Ali, Phalisteen Sultan, Mohamed El-Napoli and Mohamed Fahmy
Lipoprotein Metabolism Abnormalities in Patients with Chronic Renal Insufficiency
Patients with chronic renal insufficiency (CRI) on hemodialysis develop lipoprotein abnormalities that may contribute to increased risk for atherosclerosis. The objective of this study was to assess the atherogenic risk of chronic renal insufficiency patients and dialysis treated patients (DTP) by measuring total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and calculating the risk factor ratio: TC/HDL-C and LDL-C/HDL-C. The examined group consisted of 18 chronic renal insufficiency patients and 60 patients on hemodialysis. The results were compared to a control group of 85 voluntary blood donors. Serum lipid parameters were examined by standard methods. All lipid parameters in hemodialysis patients were statistically different as compared to the control group (p<0.05) while chronic renal insufficiency patients showed significant difference only in triglycerides and HDL-cholesterol. Hypertriglyceridemia was present in both examined groups of patients and HDL-cholesterol was lower within both groups. All calculated atherogenic ratios were higher for patients than the control group. Lipid parameters were compared between chronic renal insufficiency and hemodialysis patients, but statistically significant difference was obtained only for HDL-cholesterol (p<0.05). The increased values of triglycerides and lower HDL-cholesterol in chronic renal insufficiency patients contribute to high incidence of cardiovascular disease. Chronic renal insufficiency patients have impaired reverse cholesterol transport from peripheral cells to lipoproteins, decreased levels of HDL-cholesterol, hypertriglyceridemia prevalence of small, dense LDL and increased levels of potentially atherogenic remnant particles.
Tuba Demirci Yildirim, Mehmet Can Ugur, Utku Erdem Soyaltin and Harun Akar
Bardet Biedl syndrome (BBS) is characterized by obesity, retinitis pigmentosa, hypogonadism, mental retardation and polydactyly. Additionally, renal, cardiac and neurological manifestations may be seen. We report a case of BBS with chronic kidney disease (CKD) at the age of 43.
Nejra Prohic, Halima Resic, Goce Spasovski, Fahrudin Masnic, Amela Beciragic, Jelka Masin Spasovska and Aida Coric
Introduction. BNP plasma levels are significantly increased in heart failure and have an excellent negative predictive value for left ventricular dysfunction. Measurement of BNP level is useful for “screening” in high-risk populations. It is suitable for detection of left ventricular hypertrophy (LVH) and/or dysfunction and risk assessment in the sub-acute phase of acute myocardial infarction in hypertensive patients. The aim of our study was to find whether BNP may correlate with the left ventricular systolic function, i.e. its echocardiographic parameters in chronic kidney disease (CKD) patients.
Methods. In a prospective study performed at the Department of Nephrology and Clinic for hemodialysis at the Clinical Center in Sarajevo we followed-up 80 patients stratified in three separate groups according to CKD stage (Stage III, IV and V) for two years, regardless of their cardiovascular symptoms. We analyzed levels of BNP before and after diuretic therapy or hemodialysis and echocardiographic characteristics of the left ventricle.
Results. There was a strong negative correlation between BNP values and the size of the EF before (rho=−0.692, p<0.0001) and after diuretic therapy (rho=−0.683, p<0.0001) for patients in CKD stage III, stage IV (rho=−0.314, p>0.05) and after diuretic therapy (rho=−495, p<0.05) Similarly, a negative correlation was found for BNP and EF values before (rho=−0.432, p<0.05) and after hemodialysis (rho=−0.556, p<0.01) for stage V CKD.
Conclusions. Our study confirmed that the value of BNP in CKD patients may represent a measure of left ventricular systolic function with a strong negative correlation with ejection fraction. BNP measurement is a reliable parameter for further follow-up and prognosis in patients with established left ventricular dysfunction, acute coronary syndrome and for estimation of the left ventricular dysfunction.
Florentina Radu, Raluca Elena Jipa, Emilia Rusu, Raluca Cursaru, Ramona Drăguţ, Daniela Stegaru, Andra Gabriela Gheorghiţă and Gabriela Radulian
Human Immunodeficiency Virus (HIV) infection and subsequent antiretroviral therapy (ART) are known to be related to different metabolic disorders. Although ART decreased HIV-associated mortality and morbidity, mortality rates in patients with HIV and ART are 3 to 15 higher than those in the general population. More than 50% of the mortality is due to diseases like: diabetes mellitus (DM), hypertension, cardiovascular diseases (CVD), chronic renal disease and complications following bone fractures. In patients with HIV the metabolic disorders are mainly caused by mithocondrial toxicity, a side effect of ART, and they are represented by: dyslipidemia, lipoatrophy, insulin resistance and diabetes mellitus.
The out-patient renal clinic (ORC) represents an important part of the nephrology service in general hospitals. The majority of renal diseases are chronic and patients need a systematic follow-up according to the severity and progression of kidney failure. The most important clinical manifestation is chronic renal failure (CRF) or chronic renal disease (CKD) The management of CKD, apart from medical and nursing services, also involves a number of community structures and financial resources. CRF treatment is costly and is a serious problem for the health systems in the western world. Effective treatment in the early stages aims to decrease the progression of kidney damage and, therefore, to prolong kidney function. Patients with renal failure can be managed as out-patients. The increased number of patients and the complexity of kidney diseases demand the collaboration of other out-patient clinics. The ORC may play an important role in this process. In this article. we present a literature review of the role of ORCs in the management of renal diseases around the world and we also present data based on our experience in our ORC.
Loredana Hanzu-Pazara, L. Muflic, Daniela Dusa, Camelia Pana, Monica Tudorache, Maria Suta and Liliana Tuta
The use of biological therapies may have positive impact on chronic renal disease associated with rheumatoid arthritis.
The study evaluates retrospectively renal function in 57 patients with rheumatoid arthritis treated with different types of biological therapy, comparative with 62 RA patients treated conservatively with DMARDs.
Patients treated with biological therapies presented a lower mean value for serum creatinine measured both at baseline and after 6 months of treatment, statistically significant compared with the subgroup treated with DMARDs (0.69 ± 0.17 mg/dL vs. 1.18 ± 1.01 mg/dL, p = 0.003). Results for estimated filtration rate were significantly increased in biologically treated cohort (100.36 ± 16.76 mL/min/1.73 m2 vs. 63.49 ± 21.60 mL/min/1.73 m2, p < 0.00001). Rituximab presented a better estimated filtration rate compared with other biological tharapies (eGFR 97.037 mL/min/1.73 m2 vs. 90.933 mL/min/1.73 m2).
The positive effect of potent biological anti-inflammatory therapies sustains the need of further exploring the risk of reduced kidney function in immune-mediated diseases, including rheumatoid arthritis.
Danijela Ristovski-Kornic, Aleksandra Stefanović, Jelena Kotur-Stevuljević, Aleksandra Zeljković, Vesna Spasojević-Kalimanovska, Jelena Vekić, Milica Miljković, Dušan Paripović, Amira Peco-Antić and Zorana Jelić-Ivanović
Background: The aim of this study was to explore oxidative stress status, especially the enzyme myeloperoxidase in children with end-stage renal disease. Also, we investigated possible associations between the atherogenic index of plasma and these parameters.
Methods: Lipid status parameters, oxidative stress status parameters, and myeloperoxidase concentration were measured in the sera of 20 children in the last stage of chronic renal disease (ESRD) and 35 healthy children of matching age and sex. The Atherogenic Index of Plasma (AIP) was calculated according to the appropriate equation.
Results: We did not find any significant differences in myeloperoxidase concentrations between the investigated groups (p=0.394). Oxidative stress parameters were, however, significantly higher in the patient group (p<0.001), as well as the atherogenic index of plasma (p<0.001). Myeloperoxidase concentration and advanced oxidation protein product (AOPP) concentration were independently associated with increased AIP in the patient group (p<0.05).
Conclusions: Changes in AIP in children with ERSD are associated with the oxidative stress status and myeloperoxidase concentration.
Aurelia Enescu, F. Petrescu, P. Mitruţ, Ileana Octavia Petrescu, V. Pădureanu and Anca Ştefania Enescu
Hepatorenal syndrome (HRS) is defined as renal failure that occurs in the presence of severe acute or chronic liver disease in the absence of underlying renal pathology. Due to the functional nature of the disease and the absence of specific diagnostic markers, HRS diagnosis is determined based on positive criteria associated with excluding other causes of renal failure in patients with liver cirrhosis and ascites. Differentiation from other types of acute or chronic renal disease is extremely difficult and therapeutic options are limited, prophylactic behavior is most appropriate in patients with severe hepatic disease and risk factors for the installation of hepatorenal syndrome.
Highlighting all precipitating factors of acute renal insufficiency and therapeutic modalities in order to minimize adverse events is an important step in improving the follow-up of the patients with liver cirrhosis. The prognosis is reserved especially for type 1 HRS. Liver transplantation is the best option for patients without contraindications. The therapies introduced in recent years, such as vasoconstrictor drugs or transjugular intrahepatic portosystemic shunt are effective methods in the renal function improvement.
Anca Găitan, Cristian Stătescu, Radu Sascau, Mircea Balasanian and Cătălina Arsenescu Georgescu
Background: In just a few years, cardiac resynchronization therapy (CRT) has emerged as a key player in the treatment of advanced heart failure (HF). However, approximately 30% of patients with CRT device implantation do not achieve a favorable response. The purpose of the present study was to identify clinical, electrocardiographic, and echocardiographic predictors of a positive response to biventricular pacing in patients with advanced decompensated HF.
Methods: This prospective, observational study involved 42 consecutive patients admitted in emergency settings in our clinic with HF in New York Heart Association (NYHA) functional class III/IV, with QRS duration ≥120 ms and left ventricle ejection fraction (LVEF) ≤35%, who underwent cardiac resynchronization therapy (CRT-P or CRT-D) between January 2010 and July 2014. Statistical analysis was performed using IBM SPSS statistical software.
Results: The clinical response (improvement in NYHA class) was recorded in 6 patients (14.3%), while echocardiographic response (change in ejection fraction and/or in endsystolic or end-diastolic volumes) was recorded in 10 patients (23.8%). The most frequently observed type of response to CRT was the double (clinical plus echocardiographic) response, recorded in 23 out of 42 patients (54.8%). ROC analysis identified the absence of chronic renal disease and the duration from onset of symptoms to CRT implantation as good predictors for clinical improvement after CRT (AUC = 0.625, 95% CI: 0.400–0.850 for absence of renal failure and AUC = 0.516, 95% CI: 0.369–0.853 for symptoms duration). However, gender, age, duration from symptom onset, and comorbidities were not good predictors for the echocardiographic response (AUC <0.600).
Conclusions: CRT represents an important therapeutic option for selected patents with advanced decompensated HF and prolonged QRS interval; however, only some of the commonly used criteria can predict a favorable outcome in patients undergoing CRT.
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