Faculty of Medicine
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Item type:Publication, Living donor kidney transplantation in a patient with inherited skin fragility disorder in a resource-limited setting: a case report(Oxford University Press (OUP), 2025-11-29) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Percutaneous Nephrostomy in the Treatment of Hydronephrosis in Renal Transplant Patients - Case Report(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2022-11-01); ; ; ; Percutaneous nephrostomy is a first-line minimal invasive treatment option for ureteral obstruction following kidney transplantation, with high effectiveness and a low complication rate. Percutaneous nephrostomy might be used as a temporary salvage therapy, providing acute decompression of the kidney collecting system and preventing graft loss. It can also function as a permanent and sometimes only possible option in transplant patients with frequent recurrences of ureteral stenosis who either fail an open surgical reconstruction or who are not good candidates for these procedures. We present two patients with acute decline in urine output after renal transplantation with radiologically verified hydroureteronephrosis of the transplanted kidney (graft) caused by stenosis of distal ureter. In both cases, nephrostomy was placed within 48 hours as a temporary salvage treatment that ameliorates renal function and prevents graft loss. The permanent nephrostomy was the only possible solution for the preservation of the graft's function in the first case because of the recurrences of ureteral stenosis after several percutaneous interventions and open-surgery ureteral reconstruction. A few episodes of nephrostomy tube-related infections were resolved with antibiotics in the first case. The second case was treated with open ureteroneocystostomy with resection of stenotic segment and reinsertion of the ureter into the bladder (ureterocystoneostomy) because of the length of the involved ureteral segment. Both patients had stable graft function in the follow-up period. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, АHNAK2 ELISA-based urinary test for bladder cancer detection and monitoring: a pilot study(Springer, 2021-08); ; ; ; Dohchev, SashoBackground & objectives: Non-invasive bladder cancer (BC) detection markers are urgently needed. Recent studies demonstrated that AHNAK nucleoprotein2, (AHNAK2) differentiates between cystitis and BC. We aimed to perform an ELISA urine test to compare AHNAK2 levels in BC patients with the control’s levels. Methods: Voided urine specimens were collected from 27 patients with histologically proven BC and 28 healthy controls. AHNAK2 concentrations were measured using a quantitative sandwich ELISA test, according to the manufacturer’s protocol. Associations between groups and the diagnostic performance of the assay were evaluated with the Student t-test, Spearman’s Rank correlation, MannWhitney U Test, and Receiver Operating Curve (ROC) curve analysis. Results: Mean AHNAK2 urine levels were higher in BC patients (80.7pg/ml; Median 13.87), compared to the controls (5.19pg/ml; Median 2.25) (p<0.05). In the BC group, we found a statistically significant difference in AHNAK2 urine values between non-invasive and invasive BC patients (p<0.01). We noted a moderate positive correlation between AHNAK2 urine levels and pT status (r=0.69; p<0.05), but no correlations were found with gender, age, and histologic grade. With a cut-off value of 11.84pg/ml (Mean+SD of the control group), the sensitivity and specificity of the assay were 51.85% and 85.71%, respectively. Alternatively, in a proposed cut–off value of 5.19pg/ml, the sensitivity increased to 62.96%, but the specificity declined to 67.86%. Conclusion: The measurement of AHNAK2 urine concentrations could represent an inexpensive, adjunct tool in the diagnostic evaluation of patients suspected of having BC. Future research should refine and validate these findings, which might ultimately reduce the number of unnecessary cystoscopies. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Percutaneous Nephrostomy as a Procedure in the Treatment of Urinary Tract Obstruction - Experiences in the University Clinic of Urology in Skopje(Macedonian Academy of Sciences and Arts, 2024-04); ; Obstructive uropathy encompasses various urinary tract obstructions, leading to changes in urine flow, kidney pressure, and impaired kidney function. Predicting renal recovery from obstructive uropathy, can be challenging and necessitates treatment, as in percutaneous nephrostomy (PNS) drainage. The choice of drainage method depends on patient-specific factors and local expertise. According to the data for the Republic of North Macedonia, in the register of the European Renal Association, in the last few years, there has been an increase in the percentage of patients with obstructive nephropathy from 7.6% to 8.9% who end up on a chronic hemodialysis program. Prompt relief from urinary tract obstruction is essential to preserve renal function and prevent complications. The aim of this study is to present our initial data analysis of recent experience in the use of nephrostomies as a method for temporary or long-term resolution of obstructive nephropathy, in terms of safety and success in preserving kidney function and reducing the number of patients on hemodialysis. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, CORRELATION OF PD-L1 GENE EXPRESSION WITH GRADE OF THE URINARY BLADDER CANCER(Македонско лекарско друштво = Macedonian medical association, 2023-12); ; ; Abstract Introduction. Bladder cancer (BC) ranks fourth in the prevalence of malignancies in developed countries and is the eighth leading cause of cancer-related mortality in men. PD-L1, known for its role in inhibiting immune responses against malignant cells, has garnered significant attention in BC research. Methods. This study, comprising 45 patients with histopathologically confirmed urothelial carcinoma of the urinary bladder, analyzed the connection between histological grade and PD-L1 gene expression. The patient cohort was divided into 31 classified as low-grade and 14 as high-grade, with gender and age distribution well-balanced across the groups. PD-L1 expression was notably higher in the high-grade group (p=0.005), showing its potential clinical relevance as a biomarker. Results. Univariate logistic analysis revealed a robust correlation between histological grade and PDL1 expression, with high-grade patients exhibiting a 7.227-fold higher likelihood of increased PD-L1 expression. A predictive model for grade determination demonstrated commendable performance, boasting an area under the curve (AUC) of 0.788. Conclusion. These findings provide compelling evidence of a strong association between PD-L1 gene expression and the histological grade of bladder cancer. PD-L1 emerges as a potential biomarker, shedding light on a disease pathological grade, offering a significant clinical value for precise prognosis, and guiding tailored treatment strategies. These insights hold promise for improved disease management and patient outcomes. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Laparoscopic Donor Nephrectomy in the Republic of North Macedonia(Macedonian Academy of Sciences and Arts, 2023-07); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Covid infection as devastating post-transplant complication(Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs, 2020); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Lindsay's Nails and Terry's Nails in End Stage Renal Disease - Case Series(Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2021-02); ; ; ; Introduction. Nail changes occur as part of a single organ disease, multisystemic diseases or because of the intake of some medications. Chronic kidney disease (CKD) is associated with various nail abnormalities. Тo identify Lindsay’s nails and Terry’s nails in patients with end stage renal disease (ESRD) on maintenance he-modialysis (HD) and to determine the common anam-nestic, clinical and/or laboratory parameters that would help elucidate the etiopathogenesis of these nail pathology. Methods. Twenty patients with ESRD on hemodialysis were included into the study. Dermatological examina-tion took place during the dialysis session. Lindsay’s nails were identified when the distal part of the nail bed is red/rose-brown, clearly separated from the proxi-mal part of the nail bed, occupying 20-60% of the entire length of the nail bed. The proximal part of the nail bed is whitish, resembling grounded glass. When pressing the nail, the discoloration of the distal part of the nail bad does not fade completely. Terry’s nails were identified by a 0.5-3.0 mm wide distal band, pink-brown in color, with a proximal part of the nail bed that is white and occupies 80% of the entire nail bed. Data on demographic characteristics, history of the disease and the laboratory values were noted for each patient. Results. Out of 20 patients, all males, we diagnosed Half-and-Half nails, also called Lindsay’s nails, and Terry’s nails in 6(30%) patients [5 Half-and-Half nails (25%), and 1 with Terry’s nails (5%)]. All patients had sideropenic-free anemia, elevated urea and creatinine values and elevated parathyroid hormone (PTH) values (>190 pg/L, range 190.3-387.5 pg/L). Conclusion. After searching the relevant literature (MEDLINE, PubMed), we found this is the first study to link elevated PTH values and Half-and-Half nails (also called Lindsay’s nails), and Terry's nails in patients with ESRD on HD. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, LONGSTANDING, REPETITIVELY MISDIAGNOSED KYRLE’S DISEASE IN A PATIENT WITH END-STAGE RENAL DISEASE: A CASE REPORT(University Ss. Cyril and Methodius in Skopje, 2023); ; ; Kyrle’s disease (KD) is a rare variant of acquired perforating dermatosis (APD), associated with systemic diseases in adults, particularly chronic kidney disease (CKD) and diabetes mellitus (DM). Hyperkeratotic papules of KD are clinically important as a sign of a systemic disorder that are often misdiagnosed, so clinicopathological correlation is needed to establish the diagnosis. We report a rare case with longstanding KD, associated with end-stage renal disease (ESRD) on hemodialysis for 25 years that was repetitively misdiagnosed as folliculitis, excoriations and prurigo nodularis. The KD skin changes started to develop during earlier stages of CKD, before the kidney disease was suspected, and continued to appear in flares with extensive lesions when the systemic disease in the background was not under control. Dermoscopy revealed a 3-zonal concentric pattern, characterized by bright whitish scales in the centre, a structureless whitish-grey area surrounding the central crusts, and a peripheral, rose/brown pigmentation. Histopathological examination revealed moderately acantathotic epidermal invagination filled with a keratotic plug admixed with cellular debris and neutrophils, and a modest parakeratosis. Our goal is to emphasize that the accurate and timely diagnosis is vital to be able to monitor patients for a life threating, systemic disease such as kidney failure, and attaining better management of the dermatological status which can become longstanding and hindering, as well as to outline the importance of the multidisciplinary approach to improve outcomes in patients affected by KD. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Evaluation of changes in serum concentration of sodium in a transurethral resection of the prostate(Macedonian Academy of Sciences and Arts, 2015); ; ; Spirovska, TThe purpose of this study was to evaluate changes in serum electrolytes during Transurethral resection of the prostate (TURP) and to evaluate the degree of correlation of hyponatremia and the factors that affect the incidence of TURP syndrome and to show the impact of the duration of the procedure on the severity of hyponatremia due to absorption of irrigation fluid in the systemic circulation.