Time filter

Source Type

Filipowicz E.,University of Warsaw | Staszkow M.,Katedra i Klinika Nefrologii
Wiadomosci lekarskie (Warsaw, Poland : 1960) | Year: 2016

Acute kidney injury (AKI) in obstetrics may be caused by the same disorders that are observed in the general population or may be specific for a pregnancy such as: preeclampsia, HELLP syndrome or acute fatty liver of pregnancy. The renal changes may be only temporary, and resolve within a few weeks postpartum, or may become irreversible leading to a progression of chronic kidney disease (CKD). In the article the most important pregnancy related syndromes associated with AKI have been shortly reviewed.

Staszkow M.,University of Warsaw | Mieczkowski M.,Katedra i Klinika Nefrologii
Wiadomosci lekarskie (Warsaw, Poland : 1960) | Year: 2016

Diabetes mellitus is the leading cause of end-stage renal disease in patients beginning renal replacement therapy. The epidemic of type 2 diabetes contributed to a new approach for diabetic kidney disease, one of the most common complications of diabetes type 1 and 2. The current recommendations of the management in diabetic kidney disease developed by an international group of experts based on analysis of clinical trials and expert opinion have been reviewed in this article. The guidelines concern several issues as renal replacement modality selection, glycaemic control, the choice of glycaemia controlling drugs and cardiovascular risk management aiming to improve the quality of life of the patients, as well as to reduce the costs of the medical care.

Matuszkiewicz-Rowinska J.,University of Warsaw | Wieliczko M.,Katedra i Klinika Nefrologii
Wiadomosci lekarskie (Warsaw, Poland : 1960) | Year: 2016

In the developed countries with an access to highly active antiretroviral therapy (HAART), the spectrum of renal complications observed in patients infected with HIV has shifted from HIV-associated kidney diseases to medications-related nephrotoxicities. In this article all types of these disorders, ranging from HIV-associated nephropathy (HIVAN), immune mediated glomerulopathies (HIVICK), and thrombotic microangiopathies to induced by HAART tubulopathies, acute toxic tubular necrosis, acute interstitial nephritis, crystal nephropathy, and chronic kidney disease have are shortly reviewed.

Koscielska M.,University of Warsaw | Mieczkowski M.,Katedra i Klinika Nefrologii
Wiadomosci lekarskie (Warsaw, Poland : 1960) | Year: 2016

Urolithiasis is a common condition linked to lifestyle factors and its prevalence is increasing in Europe and United States. Nevertheless, recurrence of urinary stones can be effectively prevented by dietary and life style changes. The review focuses on general dietary recommendations as well as specific medical therapy for kidney stone formers.

Debowska M.,University of Warsaw | Staszkow M.,Katedra i Klinika Nefrologii
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.

Wieliczko M.,University of Warsaw | Dylewska M.,Katedra i Klinika Nefrologii
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.

Zebrowski P.,University of Warsaw | Mieczkowski M.,Katedra i Klinika Nefrologii
Wiadomosci lekarskie (Warsaw, Poland : 1960) | Year: 2016

Erythropoietin (EPO) deficiency is important complication of chronic kidney disease. It downregulates red cells maturation and production causing renal anemia. It is associated with reduced quality of life, increased risk of blood transfusions and cardiovascular morbidity. It is possible to substitute EPOwith recombinant human EPOor its derivatives - erythropoiesis stimulating agents (ESA). ESA therapy reduces blood transfusions, improves quality of life and can raise hemoglobin to 10-11.5 g/dl. Higher hemoglobin targets bring more harm than benefit - including increased risk for stroke, hypertension and vascular access thrombosis and mortality. Initiation of ESA therapy should be preceded by excluding the other causes of anemia and balancing ESA advantages and disadvantages in every patient. In patients with previous stroke, previous or current malignancy risks of ESA therapy may outweigh the risks of red cell transfusions.

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.

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.

Loading Katedra i Klinika Nefrologii collaborators
Loading Katedra i Klinika Nefrologii collaborators