Faculty of Medicine

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Author: search.filters.author.Karanfilovikj, Angela

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    ANNUAL CHANGE OF ESTIMATED GLOMERULAR FILTRATION RATE IN HEALTHY INDIVIDUALS
    (Macedonian Association of Anatomists and Morphologists, 2024)
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    Karanfilovikj, Angela
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    Nikolov, Panche
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    Bedzheti, Blerim
    Physiologically, GFR level should be stable up to the end of the fifth decade of life. When measured more frequently, wide dispersion of GFR results have been seen, but, after 5th decade GFR is expected to reduce by 1ml/min/1,73m2 yearly. The aim of this study was to calculate the change of estimated GFR on annual level and its correlations in healthy individuals. This was a retrospective observational study on 62 healthy subjects during 6 years. Demographical characteristics as gender, age, BMI, obesity (defined as BMI above 30kg/m2) and annual creatinine were obtained from medical files at the general practitioner. Serum creatinine level was measured at one biochemical laboratory. eGFR was calculated with CKD EPI formula. Calculation of the mean annual GFR change (δGFR) was done through the method of data smoothing. Statistics: Continuous variables are shown as average and standard deviation and the nominal ones with number and percent. GFR change was correlated with age and BMI. Comparative analyses of δGFR in relation to gender and obesity was done by non-parametric Mann-Whiney U test. P was considered significant if less than 0.05. Mean age of the study group was 39.5 years, dominantly male (78%). Mean BMI was 26,3 ± 3.81 kg/m2, 13% were obese. The mean annual GFR fluctuated (101.8 ± 5.56; 108.0 ± 31.04; 102.8 ± 18.28;103.2 ± 20.49; 99.10 ± 24.28; 103.55 ± 20.74 mL/min/1.73m2, respectively). The δGFR median value was 2.3 mL/min/1.73m2 with range of -23 to +20, and its correlations with age and BMI were insignificant (r= -0.058, p=0.681, r= 0.128, p=0.111, respectively). The δGFR did not differ significantly between genders and obese vs nonobese subjects (p=0.577; p=0.768, respectively). This study demonstrated that annual GFR change wasn’t correlated to age, gender and BMI. It also elucidated the fact of a high variable eGFR levels and its annual decline in presumed healthy persons. This fact emphasizes the need for thorough evaluation of the candidates for kidney donors, especially when applying the expanded criteria.
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    MIXED PULMONARY INFECTION IN A PATIENT WITHSUCCESSFULLY TREATED RECURRENCE OF FOCALSEGMENTAL GLOMERULOSCLEROSIS ON KIDNEYALLOGRAFT
    (Uniunea Medicala Balcanica, 2024-09-24)
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    Suleyman, Sabir
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    Introduction. Recurrence of focal segmental glomerulosclerosis (FSGS) in patients with a kidney transplant (KTx) is a challenging issue. Pulmonary infections can further complicate the clinical course of these patients. Case presentation. A 36-years-old female with kidney failure due to FSGS had KTx from a living-related donor in 2017, with stable graft function during the follow-up. In 2021, the patient presented with proteinuria and increased serum creatinine. Renal biopsy demonstrated recurrence of FSGS in kidney allograft. She was treated with Rituximab combined with plasma exchanges and achieved complete remission. In 2023, the patient was admitted due to 10-days history of weakness, fever and productive cough with hemoptysis. The computed tomography scan of the lungs revealed bilateral ground-glass opacities with cavitary lesion. The bronchoalveolar lavage and immunofluorescence test for detection of atypical pulmonary pathogens were positive for Acinetobacter and human Rhinovirus/Enterovirus. High β-d-glucan fungal antigen suggested a severe fungal infection. To alleviate “cytokine storm” the patient was treated with hemoadsorption (CytoSorb) with transitory hemodynamic stabilization and improved graft function. Despite the therapy with wide-spectrum antibiotics, antiviral and antifungal drugs, the patient developed respiratory failure and need of mechanical ventilation and died on the 15th day of hospitalization. Conclusions. Rituximab and therapeutic plasma exchange are effective for FSGS recurrence following KTx. In these patients, the infections are usually caused by multiple microorganisms, and the diagnosis is challenging, because the clinical presentation is non-specific and the diagnostic tools have limited sensitivity and specificity. The mortality is very high despite the treatment.