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Dialysed patients suffering from chronic kidney disease (CKD) show varied levels of concentration of parathyroid hormone (PTH) in the blood. One of the factors in charge of regulating levels of PTH concentration is 1,25-dihydroxycholecalciferol [1,25-(OH)2D3]. Its deficiency in advanced stages of CKD is common. Vitamin D supplementation is not always effective in reaching levels of PTH concentration recommended by KDIGO for the dialysed patients. That suggests, among other things, disturbances in 1,25-(OH)2D3, reaching its place of target effect and having the desired final result. Disturbances of vitamin D target pathway can be genetically conditioned, hence the aim of this paper is to describe the distribution of polymorphic variants of vitamin D-binding protein gene (VDBP), vitamin D receptor gene (VDR) and gene of the calcium-sensing receptor (CaSR) with respect to PTH concentrations in serum and response to cinacalcet treatment in patients with secondary hyperparathyroidism in view of the differences in demographical, clinical and laboratory data of the dialysed patients.


PubMed | Katedra i Klinika Nefrologii and University of Warsaw
Type: Journal Article | Journal: Wiadomosci lekarskie (Warsaw, Poland : 1960) | Year: 2016

Nephrotic syndrome is a group of clinical symptoms and laboratory findings, caused by heavy proteinuria, which may be caused by many glomerular diseases. In the approach to a patient with nephrotic syndrome is important to establish an aetiology of the disease, with excluding its secondary causes and in most cases with renal biopsy. The treatment aims to prevent or slow further kidney damage. It involves addressing the underlying medical condition and the treatment of symptoms such as edema, proteinuria, hyperlipidemia, as well as preventing complications like thromboembolic disease, infections or undernutrition.


PubMed | Katedra i Klinika Nefrologii and University of Warsaw
Type: Journal Article | Journal: Wiadomosci lekarskie (Warsaw, Poland : 1960) | Year: 2016

IgA nephropathy is the most common cause of primary glomerolunephritis. Patients who have isolated hematuria, little or no proteinuria (<0,5 g/d) and present with normal renal function usually have a low risk of progression. In patients with greater proteinuria and/or an elevation in the serum creatinine concentration, different rate of progression to end-stage renal disease has been observed. The approach to the management consists of nephroprotective therapies based on renin-angiotensin-aldosterone system blockade, which aim to slow progression of kidney damage, and, in some patients, immunosuppression.


PubMed | Katedra i Klinika Nefrologii and University of Warsaw
Type: Journal Article | Journal: Wiadomosci lekarskie (Warsaw, Poland : 1960) | Year: 2016

IgA vasculitis (Schnlein-Henoch purpura) is a systemic inflammation of the small vessels associated with the deposition of IgA antibodies in the vascular wall. Typical clinical symptoms are: skin lesions (purpura), joint pain, abdominal discomfort and renal disorder (most common haematuria/proteinuria). The disease affects usually the pediatric population; in those patients its course is benign and usually not associated with permanent complications. However, adults often present severe symptoms of organ damage, and the risk of complications, especially chronic renal failure is high. The diagnosis is based on clinical signs and skin biopsy. In mild cases the treatment is symptomatic. In cases with severe clinical symptoms corticosteroids are the basis of the therapy.


PubMed | Katedra i Klinika Nefrologii and University of Warsaw
Type: Journal Article | Journal: Wiadomosci lekarskie (Warsaw, Poland : 1960) | Year: 2016

Acute tubule-interstitial nephritis is a heterogeneous group of inflammatory diseases which affect renal parenchyma and tubules, mostly as a result of the immune-mediated injury. They are the important cause of acute kidney injury accounting for 5-15% of all its causes. In subsequent years, with the development of pharmacotherapy, the incidence of drug-induced nephrotoxicity has been increasing. The other causes of the acute tubule-interstitial nephritis are autoimmune and inflammatory diseases, infections, neoplasms and electrolyte abnormalities. The diagnostics are complex and treatment of the disease is not always easy. The following overview provides a summary of causes of acute tubule-interstitial nephritis, clinical picture of the disease, the diagnosis and treatment.


PubMed | Katedra i Klinika Nefrologii and University of Warsaw
Type: Journal Article | Journal: Wiadomosci lekarskie (Warsaw, Poland : 1960) | Year: 2016

Systemic scleroderma is a chronic, autoimmune disease of the connective tissue that involves skin, subcutaneous tissue, muscles and joints, as well as the internal organs: kidneys, lungs, heart. Depending on the extent it can occur as limited or diffuse clinical variant. In 60-80 % of patients with diffuse scleroderma, autopsy studies have shown pathologic changes in the kidneys. About half of the patients with renal involvement the clinical manifestation is limited to a moderate increase in serum creatinine, mild proteinuria, and moderate hypertension. The most serious complication remains sclerodermal renal crisis. It develops in 5-20 % of patients and is characterized by severe hypertension, acute kidney injury with oliguria, proteinuria and erythrocyturia, and microangiopathic hemolytic anemia with thrombocytopenia. In this article pathogenesis, risk factors, symptoms and treatment of scleroderma renal crisis have been reviewed.


Koscielska M.,Katedra i Klinika Nefrologii
Przegla̧d lekarski | Year: 2013

Amyloidoses form a group of diseases in which extracellular insoluble fibrils cause organ injury and failure. These aggregates are built of misfolded proteins. Current amyloidosis classification is based on the type of the precursor amyloid protein. Distribution of the amyloid fibrils can be localized or systemic. The two most common systemic diseases are: amyloid light chain (AL) amyloidosis, being a consequence of clonal expansion of plasma cells in the bone marrow, and amyloid A (AA) amyloidosis, secondary to chronic inflammatory disorders. Renal involvement remains a frequent clinical manifestation of both of them with clinical pattern of massive proteinuria and progressive renal failure. Early diagnosis and treatment is essential because of the progressive character of the disease. The goal of current treatment approaches is to decrease the amount of amyloidogenic proteins and depends on its type. Systemic amyloidosis remains a disease with poor prognosis, especially in patients with cardiac involvement.


The type of vascular access is an important determinant of complications in the dialysis population. The aim of the study was to evaluate types of hemodialysis vascular access at hemodialysis start, in the course of treatment and complications during a one year observation period. The study group consisted of 213 patients [126 (59%) males; 87 (41%) females] treated for 54 months (range from 2 to 384 months) by maintenance hemodialysis at the Nephrology Department of the University Hospital. Mean age of the patients equaled 57.4 years and ranged from 21 to 91 years. The observation period began on June 1st, 2009 and finished on May 31st, 2010. At the start of the dialysis therapy - 99 (46.5%) patients had arterio-venous fistula (AVF), 81 (38.0%) temporary catheters (TC), and 33 (15.5%) permanent catheters (PC). At the beginning of the one-year observation period, 161 (75.6%) of the patients were treated using an AVF, 37 (17.4%) using a CP, 11 (5.1%) CT, and 4 (1.9%) using an artificial graft (AVG). At the end of the one year observation period - 179 (84%) patients were dialyzed using AVF, while 30 (14.1%) patients on PC, and 4 (1.9%) using a AVG. Statistically significant differences in possessing AVF were noted between start of renal replacement therapy and the start and finish of the one year observation period (p < 0.0001), as well as beginning and finish of the observation period (p < 0.002). During the observation period - 37 (20.7%) patients with an AVF required intervention due to complications associated with vascular access; where 4 from 11 (36.4%) patients in this group had AVF located on the arm and 33 from 150 (22.0%) on the forearm. The most common complications associated with AVF were thrombosis (23 = 14.3%), narrowing of the fistula (9 = 5.6%), too high output flow (HOF) 2 = 1.2% and the steal syndrome (SS) 3 (1.9%). Infectious complications were noted in 4 from 37 patients with PC (10.8%), and significantly less with AVF-4 from 161 (2.5%) (p < 0.0001). AVG infection occurred in 2 (50%) individuals of this group. Conclusions: AVF created using patients' own vessels of the forearm is characterized with decreased risk of complications in comparison to fistulas made of artificial materials or permanent catheters. However, fistula thrombosis of the AVF is still the most common complication requiring surgical intervention.


Pure red-cell aplasia (PRCA) is a serious, life threatening rare condition of multifactorial causes manifested as severe anemia with absence of erythroid precursors in the bone marrow. PRCA may be a consequence of antibody production against applied recombinant human erythropoietin (EPO). The first description of PRCA in the course of EPO therapy was performed in a patient receiving subcutaneously Eprex and in the next years after therapy with other erythropoiesis stimulating agents like erythropoietin beta, omega or darbepoetin. In the paper we describe epidemiology and diagnostic criteria of PRCA. The current treatment possibilities of this complication were described with special attention dedicated to different immunosuppressive agents and effectiveness of kidney transplantation with subsequent immunosuppression.


PubMed | Katedra i Klinika Nefrologii
Type: Journal Article | Journal: Wiadomosci lekarskie (Warsaw, Poland : 1960) | Year: 2016

HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) is a relatively rare complication of pregnancy. It usually develops in the IIId trimester or after delivery. HELLP syndrome is associated with increased maternal (placental abruption, disseminated intravascular coagulation, hepatic hematomas and rupture, and acute kidney injury) and neonatal (prematurity, low birth weight) risk complications. In this article the diagnosis, clinical picture and treatment of this disease have been shortly reviewed.

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