Zavod za Nefrologiju

Zagreb, Croatia

Zavod za Nefrologiju

Zagreb, Croatia
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Belancic A.,Medicinski fakultet Sveucilista u Rijeci | Mikolasevic I.,Odjel za hepatologiju i pankreatologiju | Kukuljan M.,Klinicki zavod za radiologiju | Kupanovac Z.,Zavod za pulmologiju | And 2 more authors.
Medicina Fluminensis | Year: 2017

Introduction: The aim was to present a case of primary hyperparathyroidism due to ectopic parathyroid adenoma localized in thorax. Case report: We report a case of a 64-yearold female patient with hypothyroidism and hypertension in her medical history, presented to us with normocytic anemia, renal insufficiency and dysphagia. Due to swallowing disorder multi-slice computed tomography of thorax was performed and mass in upper-back mediastinum with ossification changes suspicious for metastatic process was found. Within the nephrology examination, hypercalcemia (>3 mmol/L) and elevated parathyroid hormone (PTH) value (200 pmol/L) were noticed, which pointed to the possibility of primary hyperparathyroidism. Consequentially, parathyroid scintigraphy, aspiration biopsy and cytological analysis were performed. Primary hyperparathyroidism was affirmed and ectopic parathyroid adenoma was suggested as possible etiology. The patient has undergone surgical procedure based on thoracotomy with extirpation of the mass. Surgical postoperative course was regular. Postoperative laboratory findings showed hypocalcemia, which was expected due to “hungry bone” syndrome, so medication treatment was necessary. Subsequently, histopathological analysis showed parathyroid tumor with insecure malignant potential. Since metastases were the only satisfied criteria for the malignancy, the diagnosis of parathyroid carcinoma couldn’t be allocated. PTH values after surgery were within the reference range. During a 6-month postoperative follow-up no signs of the disease recurrence were detected. Conclusion: Primary hyperparathyroidism is a very common endocrinology disorder, hence it has to be on a differential diagnosis list in every day clinical practice Except increased parathyroid glands in the typical site in the neck, it is possible to develop ectopic parathyroid glands. © 2017, Croatian Medical Association and School of Medicine. All rights reserved.


Mikolasevic I.,Zavod za Gastroenterologiju | Orlic L.,Zavod za Nefrologiju | Stimac D.,Zavod za Gastroenterologiju | Mavrinac V.,Zavod za Gastroenterologiju | And 4 more authors.
Lijecnicki Vjesnik | Year: 2016

With the increasing incidence of obesity and metabolic syndrome the incidence of nonalcoholic fatty liver disease (NAFLD) is increasing as well. These patients have a significant risk of progression to the end-stage liver disease, but also these patients are at increased risk of developing hepatocellular carcinoma. In recent years there is a growing number of publications that support the idea that NAFLD is not just a disease that is limited to the liver, but is associated with a number of extrahepatic manifestations. For example, NAFLD increases the risk of type 2 diabetes mellitus, cardiovascular diseases and chronic kidney disease. Consequently NAFLD has become a growing public health problem. A number of sub-specialists as well as primary care physicians should be aware of these potential extrahepatic associations, given the availability of numerous methods for screening in clinical practice. The above approach is important in order to recognize potentially modifiable events in the early stages, and thus manage them and at least prevent the progression of certain diseases.


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.


Mustapic Z.,Zavod za Nefrologiju | Basic-Jukic N.,Zavod za Nefrologiju | Lovcic V.,Opca Bolnica Bjelovar | Kes P.,Zavod za Nefrologiju
Acta Medica Croatica | Year: 2011

Post-transplant erythrocytosis is defined as an increase in hematocrit above 55%. It occurs in 10%-15% of renal transplant recipients, most commonly from 8 to 24 months after transplantation. Twenty-five percent of patients experience spontaneous remission within 2 years, while 75% develop symptoms and signs of hyperviscosity (headache, hypertension, plethora). The etiology is multifactorial and includes erythropoietin, renin-angiotensin system (RAS) and IGF-1 as the main factors. RAS inhibition with either ACE inhibitors or angiotensin receptor blockers is efficient therapy which decreases hematocrit in 90% of patients within 2 to 6 weeks, thus decreasing the incidence of fatal complications (like pulmonary embolism and stroke).


Mihovilovic K.,Zavod za Nefrologiju | Maksimovic B.,Zavod za Nefrologiju | Knotek M.,Zavod za Nefrologiju | Knotek M.,University of Zagreb
Acta Medica Croatica | Year: 2011

INTRODUCTION : Tunneled dialysis catheters are one of the methods for vascular access in hemodialysis patients. In the Clinical Hospital Merkur placement of tunneled dialysis catheters was started in 2007. The aim of this study was to analyze results of that program. MET HODS : We analyzed survival of tunneled dialysis catheters placed in our Division of nephrology from January 2009. to April 2011. First site of choice for placement of catheter was right jugular vein. Catheters were placed de novo or as over the wire exchange of a previous catheter. Catheters were placed under fluoroscopy guidance. Survival was analyzed using Kaplan-Meier analysis. Difference between survivals was tested by the log-rank test. RESULTS : 88 catheters have been placed in 70 patients. Cumulative 1- year catheter survival, censored for patient death was 58%. 1- year catheter survival analyzed by the location of placement was as follows: jugular veins 70 %, right subclavian vein 58 %, left subclavian vein 43 % and femoral veins 33 %. Left jugular vein and femoral veins had lower survival rate in comparison with jugular veins (p=0,057). There was no statistical difference in catheter survival with respect to placement de novo or after over the wire exchange (p=0,516). CONCLUSION : Jugular veins are best location for placement of tunneled dialysis catheter. There is no statistical difference of catheter survival after placement de novo or after over the wire exchange in the presence of previous catheter.


Kes P.,Zavod za Nefrologiju | Mesar I.,Zavod za Nefrologiju | Basic-Jukic N.,Zavod za Nefrologiju | Racki S.,University of Rijeka
Acta Medica Croatica | Year: 2014

Biological drug is a drug containing one or more active substances produced or secreted from a biological source. Some of them may be previously present in the human body, and examples include proteins such as insulin, growth hormone or erythropoetin. Biosimilar drug is a medical product that is a copy of the original approved drug whose patent has expired. Strict rules apply to similar biological medicines: 1) it is unable to support extrapolation of data on safety and efficacy between individual indications, except in the case of appropriate, science-based evidence; 2) biosimilar drugs must meet the requirements associated with testing the immunogenicity and safety monitoring after the introduction of the drug in clinical practice, including the risk management program; 3) each biosimilar drug has to be labeled under its own name in order to allow clear traceability of all medications; and 4) the principle of automatic substitution cannot apply to biosimilar drugs because they are not interchangeable.


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.


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.


Atherosclerosis is a systemic disease that is the leading cause of death in the developed world and leads to coronary artery, carotid artery, and peripheral arterial atherosclerotic syndromes. The pathophysiology of atherosclerosis is known to be dependent on multiple hereditary and environmental factors. Loss of normal endothelial function is a fundamental step in the atherosclerotic disease process. A consistent body of evidence from large clinical trails suggests that qualitative changes in plaques contribute importantly to the striking reduction in clinical events produced by lipid lowering. Calcium mineral deposits that frequently accompany atherosclerosis are readily quantifiable radiographically, serve as a surrogate marker for the disease, and predict a higher risk of myocardial infarction and death. Coronary artery calcification is a common observation in chronic kidney disease and end-stage renal disease and is mainly related to age, duration on dialysis, and dyslipidemia. The annual progression of coronary artery calcification can be reduced from 30 % to 6 % with LDL cholesterol reduction caused by statins and possibly sevelamer. At treated LDL cholesterol levels somewhere below 2.59 mmol/l, several sources of data suggest that the anatomic burden of coronary artery disease, including coronary artery calcification, regresses. Additional supportive studies indicate that carotid intima media thickness and the volume of coronary atheroma can also be reduced by LDL cholesterol reduction in concert with elevation of HDL cholesterol.


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.

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