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    COVID 19 Pneumonia and a Rare Form of Fungal Peritonitis in a Patient Survivor on Peritoneal Dialysis
    (Walter de Gruyter GmbH / Macedonian Academy of Sciences and Arts, 2021-12-30)
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    Peritoneal dialysis (PD) related peritonitis is usually caused by bacteria, but viruses and fungi could also affect the peritoneal membrane and cause cloudy effluent with negative bacterial cultures. We present a case of a PD patient who survived fungal peritonitis caused by Geotrichum klebahnii (March 2015) and COVID-19 pneumonia (April 2021) with peritonitis probably caused by the SARS-CoV-2 virus. The fungal peritonitis followed one episode of exit-site infection and two episodes of bacterial peritonitis treated with a wide-spectrum antibiotic. The patient's PD catheter was removed immediately upon the diagnosis of fungal peritonitis, and an antifungal treatment was continued for 3 weeks after catheter removal. The new peritoneal catheter was reinserted 8 weeks after complete resolution of peritonitis, and the patient continued treatment with PD. The patient developed severe Covid-19 pneumonia with a sudden appearance of cloudy peritoneal effluent. There was no bacterial or fungal growth on the effluent culture. A PCR test for SARS-CoV-2 in peritoneal effluent was not performed. The peritoneal effluent became transparent with the resolution of the severe symptoms of Covid-19 pneumonia.
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    KIDNEY FUNCTION DECLINE AND MORTALITY IN DONORS WITH EXPANDED CRITERIA - FIVE YEARS FOLLOW UP STUDY
    (Macedonian Association of Anatomists and Morphologists, 2024)
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    Kidney donors are considered healthy, but with a need for continued medical follow up and encouragement for continued healthy lifestyle, especially when expanded criteria for donation are applied. This study aims to analyse the five years follow up of kidney donors after explanation, encountering risks of kidney function decline and donors’ mortality. In a retrospective study we evaluated a donor cohort with 5 years of follow up. Demographic characteristics as age, gender and the presence comorbidities as diabetes, hypertension, hyperlipidemia and Body Mass Index (BMI) >30kg/m2 were analyzed. Estimated glomerular filtration rate (eGFR) by CKD EPI formula was notified prior donation, and annually afterwards. Consultations with nephrologist or other specialists were notified. In a multivariate regression analysis, the reduction ratio (RR) of eGFR was explored as dependent variable. Cox regression analysis exploited mortality; Kaplan Meier survival curve was applied in respect of BMI. Seventy-five donors with average age above 55 years were predominantly women (69%), nearly every nineth patient had diabetes or obesity (9%). Proportion of donors referred to nephrologist at the 12 months, declined up to 58% at the fifth year, ignoring medical checks showed ascending trend to 16% at the end of second and third year and 12% at the end of observational period. The univariate regression analysis found diabetes, hyperlipidemia and hypertension, the presence of multiple comorbidities, gender and age as insignificant predictors of eGFR 12 months reduction ratio. The nephrologist referral showed borderline significance (β = - 0.103, p=0.076). Only BMI over 30kg/m2 worsened the kidney function (β = 0.600, p=0.001). Five years mortality rate was 6.7%. The diseased donors were significantly older, more frequently had diabetes and obesity also they had significantly lower eGFR pre-donation, at the end of the first year but also and more step decline of it after 12 months. In the multivariate analysis BMI>30kg/m2 emerged as most powerful predictor of mortality (HR 40.02; CI: [4.11-389), p=0.0001). Survival of obese patients was significantly shorter when compared with patients with lower body weight (43.28 ± 7.51 vs. 59.33±0.65, Log rank p=0.000), respectively. Our study demonstrates that the mortality and declination of renal function after donation are associated with nephrologist referral and other potentially modifiable factors, especially obesity. Improved protocols for pre-donation information, education and adequate after-donation follow up is mandatory to achieve better longevity and kidney function survival in these frail and precious individuals.
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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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    Challenging Case of Multisystem Inflammatory Syndrome in a 19- Year Old Female: A Case Report
    (Macedonian Society of Nephrology, Dialysis, Transplantation and Artifical Organs, Department of Nephrology, 2022)
    Spasovska Vasilova, Adrijana
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    Milenkova, Mimoza
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    Introduction. In comparison to older adults, SARSCoV-2, leads to a mild illness in children and young adults typically manifested with fever, cough and gastrointestinal symptoms. However, the multisystem inflammatory syndrome in children and young adults (MISC) emerged during the coronavirus disease in 2019 pandemic. Case report. We report a challenging case of a 19- year old female patient with signs and symptoms of multisystem inflammatory syndrome and SARS-CoV2 infection, most probably as a post infectious disease with onset between 2 to 4 weeks after the infection. Its clinical symptoms may have overlaped with classical Kawasaki disease (systemic vasculitis) or Kawasakilike syndrome (atypical) with fever, gastrointestinal symptoms, rash, conjunctival injection, hypotension, sore throat, mucosal changes with a relative lack of severe respiratory disease, myocarditis, hypoalbuminemia and elevated inflammatory markers. And indeed, the clinical presentation of COVID-19 in young adults resembles Kawasaki disease with gastrointestinal manifestations to severe inflammation with myocarditis. Conclusion. Timely diagnosis and proper treatment of the multisystem inflammatory syndrome and SARSCoV-2 infection are real challenge requiring multidisciplinary approach and tertiary resources.
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    Trend of Kidney Replacement Therapy in North Macedonia from the Years 2015 Through 2020
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2024-11-01)
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    Simjanovska, Simona
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    Rushiti, Emine
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    Cibrev, Dragan
    Kidney replacement therapy (KRT) by dialysis or kidney transplantation represents the main treatment modalities for patients with kidney failure. Here we evaluate the trends in taking care of such patients in North Macedonia from 2015 through 2020.
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    The blood flow rate on the first day after arteriovenous fistula creation is a predictor of successful fistula maturation
    (Wiley, 2022-12-02)
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    Cibrev, Dragan
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    The determination of blood flow rate (BFR) is a useful tool for assessing the function of arteriovenous fistula (AVF).
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    Hypercalcemia and Renal Affection: An Unusual Initial Presentation of Sarcoidosis
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2025-03-01)
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    Sarcoidosis is a chronic, multisystem, inflammatory granulomatous disease that affects multiple organs in the body, but mostly the lungs and the lymph glands. Hypercalcemia and renal affection are rarely initial presenting features, and in the absence of pulmonary symptoms, the diagnosis of sarcoidosis in those patients could be a diagnostic challenge. A case-patient with sarcoidosis presented with elevated serum calcium and creatinine levels. Renal biopsy showed nephrocalcinosis with chronic fibrosing interstitial nephritis. The extensive mediastinal, abdominal, axillar, and neck lymphadenopathy was presented on the computer tomography scan of the patient's chest and abdomen. The neck lymph node surgical biopsy showed confluent, non-caseating, epithelioid granulomas consistent with sarcoidosis. The serum angiotensin-converting enzyme level was elevated. Treatment with oral prednisolone was started, and improvement of renal function and normalization of serum calcium was noted. Sarcoidosis should be considered in the differential diagnoses in patients with renal impairment and non-parathyroid hormone (non-PTH) dependent hypercalcemia.
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    Glomerulopathies with Fibrillary Deposits
    (Walter de Gruyter GmbH, 2023-07-01)
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    The glomerulopathies associated with the deposition of extracellular fibrils in the glomeruli are subdivided into Congo red positive (amyloidosis) and Congo red negative (non-amyloidotic glomerulopathies) based on Congo red staining. The non-amyloidotic glomerulopathies are divided into immunoglobulin-derived and non-immunoglobulin-derived glomerulopathies. The immunoglobulin-derived glomerulopathies: fibrillary glomerulopathy (FGn) and immunotactoid glomerulopathy (ITG) are rare glomerulopathies. The diagnosis of fibrillary-immunotactoid glomerulopathy depends on electron microscopy, which shows the presence of microfibrils in the glomeruli. The microfibrils in FGn are randomly arranged with diameters less than 30 nm. The microfibrils in ITG are larger than 30 nm with a visible lumen (microtubules), focally arranged in parallel bundles. Patients with fibrillary-immunotactoid glomerulopathy present with proteinuria (usually in the nephrotic range), microscopic hematuria, arterial hypertension, and chronic kidney disease that progresses to kidney failure over months to years. Currently, there are no guidelines for the treatment of fibrillary-immunotactoid glomerulopathy, although immunotactoid glomerulopathy could be associated with underlying hematologic disorders with the need for clone-directed therapy.
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    Association Between the Polymorphism of Angiotensin-Converting Enzyme Gene and Interleukin-1 Beta Gene and the Response to Erythropoietin Therapy in Dialysis Patients with Anemia
    (Walter de Gruyter GmbH, 2023-12)
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    Eftimovska-Otovikj, Natasha
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    The polymorphism of the angiotensin-converting enzyme (ACE) gene and interleukin-1 beta (IL-1b) gene could be associated with resistance in the treatment of anemia in dialysis patients with recombinant human erythropoietin (rHuEPO). The aim of the study was to evaluate the association between the polymorphism of the ACE and IL-1b genes and the response to rHuEPO therapy in dialysis patients with anemia.