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Zagreb, Croatia

Bulum T.,Sveucilisna Klinika za Dijabetes | Duvnjak L.,Sveucilisna Klinika za Dijabetes | Prkacin I.,Zavod za Nefrologiju
Acta Medica Croatica | Year: 2011

Objective: Lipoproteins may contribute to diabetic nephropathy. Although elevated total HDL cholesterol levels have been shown to protect from coronary artery disease and nephropathy in many studies, HDL can be subdivided into at least two major subclasses, which are thought to differ in the ability to protect against atherosclerosis. The objective of this study was to determine the relationship between serum lipids and HDL subclasses with albuminuria in patients with type 1 diabetes. Methods: We analyzed lipid profiles of 259 patients with type 1 diabetes and normal thyroid function. Patients were classified as normoalbuminuric (albumin excretion rate <30 mg/24 h, n=215) and microalbuminuric (albumin excretion rate 30-300 mg/24 h, n=44) in at least two urine collections. None showed signs of adrenal, thyroid, renal or cardiovascular disease, or received drugs, apart from insulin, that could attenuate glucose metabolism, serum lipids or renal function. Total, LDL, HDL, HDL2, HDL3, VLDL cholesterol and triglycerides were measured by an enzymatic colorimetric method and urinary albumin concentration was determined by an immunoturbidimetric assay. Results: Patients with microalbuminuria had higher levels of total cholesterol (5.07 vs. 5.02 mmol/L, Mann Whitney=6874, p=0.666), LDL cholesterol (2.81 vs. 2.80 mmol/L, Mann Whitney=6964, p=0.778), VLDL cholesterol (0.57 vs. 0.48 mmol/L, Mann Whitney=6268, p=0.151) and triglycerides (1.27 vs. 1.08 mmol/L, Mann Whitney=6283, p=0.158), and lower levels of HDL cholesterol (1.68 vs. 1.73 mmol/L, Mann Whitney=6501, p=0.293) and HDL3 cholesterol (1.15 vs. 1.16 mmol/L, Mann Whitney=6991, p=0.812); however, these differences were not statistically significant. In contrast, HDL2 cholesterol levels were significantly lower in those who had microalbuminuria compared with those who had normoalbuminuria (0.50 vs. 0.57 mmol/L, Mann Whitney= 5600, p=0.01). Conclusions: Microalbuminuria is the earliest clinical indicator of diabetic nephropathy. Clustering of coronary artery disease with nephropathy has been shown previously in patients with type 1 diabetes. Specific effects of HDL subclasses on cardiovascular disease have also been observed, i.e. a protective effect of large HDL subfractions (HDL2) and an increased risk for small HDL particles (HDL3). Results of the present study showed that lower levels of HDL2 cholesterol were associated with microalbuminuria in patients with type 1 diabetes. Whether higher HDL2 cholesterol levels may be protective against the development of microalbuminuria in patients with type 1 diabetes can only be determined in long-term studies.

Racki S.,Zavod za nefrologiju i dijalizu | Vujicic B.,Zavod za nefrologiju i dijalizu | Bubic I.,Zavod za nefrologiju i dijalizu | Kes P.,Zavod za Nefrologiju | And 3 more authors.
Medicina Fluminensis | Year: 2010

To evaluate the clinical significance of the Malnutrition-Inflammation- Atherosclerosis (MIA) syndrome as a cardiovascular risk factor in the maintenance hemodialysis patients. Patients and Methods. 208 maintenance hemodialysis patients were assessed at the Nephrology and Dialysis Department of the University Clinical Hospital Rijeka. A total of 168 patients were analyzed. The diagnosis of MIA syndrome was established using the MIA score assessed with appropriate scale and it was present in 66 patients. Two-year mortality and morbidity was followed according to presence of MIA syndrome. Patients with MIA syndrome were randomized into 4 groups and treated with atorvastatin, online hemodiafiltation (OL-HDF), Helixone® membrane, and standard hemodialysis. The MIA syndrome parameters were evaluated after follow-uP of 12 and 24 months. A statistical analysis was performed using the appropriate tests using the statistical software MedCalc 7.5 (Med- Calc, Mariakerke, Belgium). Results. Mean patients age was 63±13 years with equal gender distribution. The most common underlying renal disease was chronic glomerulonephritis (31.0 %). The MIA syndrome was present in 39.3 % of patients. Their mortality was significantly higher (36.4 % vs. 12.7 %, P = 0.0006). Causes of death did not differ according to the presence of MIA syndrome. The most common cause of death was cardiovascular disease (62.2 %). The patients treated with atorvastatin, OL-HDF and Helixone® membrane had better survival than patients treated with standard hemodialysis (P = 0.0032). Independent mortality predictors in the patients with MIA syndrome were not found. Treatment with atorvastatin and OL-HDF significantly reduced serum Creactive protein levels (P = 0.0161; P = 0.0425) and serum interleukin-6 levels (P = 0.0005; P = 0.021) after 12 and 24 months, respectively. Conclusion. Atorvastatin, OL-HDF and use of the new Helixone® membrane was beneficial in the treatment of patients with MIA syndrome.

Batinic D.,Zavod za Nefrologiju | Milosevic D.,Zavod za Nefrologiju
Paediatria Croatica | Year: 2015

Treatment of nephrotic syndrome in children is complex, symptomatic and specific. Symptomatic treatment aims at reducing edemas, treat infections and thromboembolic complications, and maintain an appropriate intake of calories and proteins. Specific treatment starts with corticosteroids with no prior kidney biopsy and histologic checks, based on clinical-laboratory parameters: the child's typical age of 6 months to 12 years of age, lack of hematuria, azotemia and hypertension, normocomplementemia and selective proteinuria. Most children can be successfully treated with corticosteroids, but 20% are resistant to this type of treatment. Children who have responded to corticosteroids have 80-90% chance of one or more relapse of disease; with half having rare relapses, and the rest having frequent relapses or developing an addiction to corticosteroids and toxic side-effects. Treatment of these children poses a real challenge, with different immunomodulatory drugs used. The paper presents up-To-date recommendations and guidelines for treatment of children with nephrotic syndrome.

Kes P.,Zavod za Nefrologiju | Basic-Jukic N.,Zavod za Nefrologiju | Ljutic D.,Odjel za Nefrologiju | Brunetta-Gavranic B.,Zavod za Nefrologiju
Acta Medica Croatica | Year: 2011

The link between the kidney and hypertension has been considered a villain-victim relationship because of the potential two-way causality between high blood pressure (BP ) and chronic kidney disease (CKD). Arterial hypertension (AH) per se, but also together with diabetes mellitus, is the most important cause of CKD and end-stage renal disease (ESRD ) in the developed world. Pathophysiologicaly, the increment in systemic BP leads to the rise in glomerular pressure. Glomerular hypertension results in glomerular capillary wall stretch, endothelial damage and a rise in protein glomerular filtration. These processes, in turn, cause changes of mesangial and proximal tubular cells, ultimately resulting in the replacement of functional by non-functional connective tissue and the development of fibrosis. One of the most important factors in the progression of CKD is activation of the renin-angiotensin system (RAS ). Its effect is not only elevated BP , but also the promotion of cell proliferation, inflammation and matrix accumulation. The terms that clinicians use to identify renal damage associated with hypertension are nephrosclerosis, benign nephrosclerosis, hypertensive kidney disease, or nephroangiosclerosis. Many studies, first in experimental animals and later in humans, have shown that the lowering of BP (and proteinuria) is associated with a slower progression of CKD. It seems that angiotensin-converting enzyme inhibitors (ACEI 's) are more renoprotective than other antihypertensives (the protection beyond the antihypertensive effect), although some studies have also confirmed a comparatively beneficial effect of non-dihydropiridine calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARB s). Moreover, it seems that a combination of antihypertensives (e.g. ACEI , CCB, and ARB ) has a more effective action than either of the drugs alone. The effects depend first on the degree of BP reduction. The strict BP control has been considered the basis of therapy for slowing renal deterioration.

Kes P.,Zavod za Nefrologiju | Basic-Kes V.,Klinika za neurologiju | Basic-Jukic N.,Zavod za Nefrologiju | Juric I.,Zavod za Nefrologiju
Acta Medica Croatica | Year: 2011

Patients with chronic kidney disease (CKD) and specialiy end-stage renal disease (ESRD ) have markedly advanced vascular disease when compared to the general population. In particular, several authors have reported more severe atherosclerotic disease of the carotid arteries among ESRD patients than in subjects with normal renal function. This accelerated disease of the cerebral vasculature could increase the risk of ischemic stroke in these patients. Additionally, ESRD is associated with hypertension, a bleeding diathesis, and the routine administration of heparin during hemodialysis, which could increase the risk of hemorrhagic stroke. Dialytic support, including both hemodialysis (HD) and peritoneal dialysis, have been shown to be risk factors for stroke. No studies have assessed stroke risk in renal transplant recipients. Although there are some epidemiologic data for stroke in patients with CKD, there are fewer data for stroke treatment in patients with CKD. In primary and secondary prevention of stroke even in the CKD patients, it has been well established that improved outcomes occur by correcting reversible risk factors, including treating hypertension, secondary hyperparathyroidisam, anemia, dyslipidemia, coagulation abnormalities, malnutrition, inflammation, controlling diabetes, and cardiac disease.

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