Now showing 1 - 10 of 73
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    Pharmacotherapeutic options for the prevention of kidney transplant rejection: the evidence to date
    (Informa UK Limited, 2022-08)
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    Although early rejection episodes are successfully controlled, the problem of unrecognized production of de novo anti-HLA antibodies and associated chronic rejection still persists.
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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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    USE OF EVODIAL DIALIZERS FOR HEMODIALYSIS IN PATIENTS WITH HIGH RISK FOR BLEEDING - SINGLE CENTRE EXPERIENCE
    (Macedonian Association of Anatomists, 2023)
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    SHpishikj Pushevska, Anamarija
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    Milenkova, Mimoza
    During hemodialysis exposure of the blood to the dialysis membrane can promote clotting. So, usually anticoagulation is used. In patients with increased risk for bleeding heparin-free regime is mandatory. Evodial dialyzer contains a heparin-grafted membrane in order to reduce patients' bleeding risk. In this study we are showing our experience with the use of Evodial dialyzer. We report 106 dialysis sessions in 59 patients were performed. Reasons for using Evodial: active bleeding, hematological conditions, complications of vascular access. Changes in the dialyzer or additional interventions were examined. Low-dose unfractionated heparin was used in 10 (9,4%) sessions, and was added in 6 (5.7%) more and in another 5 ( 4,7%) saline flushing. In 4 (3,8%) sessions due to coagulation we had to terminate dialysis. Heparin-grafted dialyzers can be safely used in patients with high-risk for bleeding as reasonable alternative when regional citrate anticoagulation is unavailable.
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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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    The Current State of Nuclear Nephrology in Modern Medicine
    (Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2023-12-01)
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    Poposka, Daniela
    Glomerular filtration rate (GFR) is the most reliable parameter of renal function. Regarding the complexity of the gold standard inulin clearance, different estimating equations have been developed with CKD-EPI creatinine equation recommended as the most reliable one. In some clinical situations where creatinine based equations might not be valid, alternative methods are needed. Nuclear medicine methods for measuring GFR with 51Cr EDTA and 99mTc DTPA have been widely used for decades. There are different methodologies for the measurement of kidney function with radiopharmaceuticals: urinary clearance, plasma clearance, multiple plasma sampling, slope intercept, single sample plasma equation, slope only, and the gamma camera-based method. Greater precision of measuring GFR is needed in certain clinical situations. The most common are diagnosis and follow up of chronic kidney disease and definition of the beginning of replacement therapy. The assessment of renal function is also important for potential kidney donors. In recent years, with the introduction of new chemotherapeutic drugs and targeted therapy, oncologic patients treated with nephrotoxic drugs have become more commonly referred for measuring GFR. The monitoring of renal function is important during treatment in order to detect the transformation from reversible acute kidney injury to irreversible chronic kidney disease as well as in the cases of renal insufficiency reduce the dosage and prevent accumulation of the drug and avoid dosage related toxic effects. Assessment of kidney function using measured mGFR will be an important milestone in the creation of more accurate and expanding personalized medicine principle in current onconephrology practice.
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    P1102EVALUATION THE EFFICACY OF MEDIUM CUT- OFF MEMBRANE DIALYZERS AND COMPARISON WITH HIGH FLUX DIALYZERS IN CONVENTIONAL HEMODIALYSIS
    (Oxford University Press (OUP), 2020-06-01)
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    Biljali, Sefedin
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    Hemodialysis (HD) is the most widely used modality of renal replacement therapy. The high-flux dialyzers in standard hemodialysis offer numerous benefits for ESRD patients, such as, increasing the uremic toxins removal and improving patients survival, reduced patients admission and morbidity. A new class of membranes, medium cut-off (MCO) membranes, has been designed to achieve better removal capacities for middle and large middle molecules, as well as to ensure the retention of albumin in hemodialysis (HD) treatments. We evaluated the removal efficacy of Theranova® in standard HD in comparison with standard high- flux HD.</jats:p> </jats:sec> <jats:sec> <jats:title>Method</jats:title> <jats:p>Four stable HD patients (M/F 1/4) were included in 12-weeks small observational pilot study in HD with Theranova® 400 (sup. 1.7 m2) and Theranova® 500 (sup. 2.0 m2) dialyzers. Each patient was assessed four times, T0 with standard high flux dialyzers, T1 at 1 month, T2 at second month and T3 at third month, by measuring pre and post-HD samples of: urea, creatinine, beta2-microglobilin (B2M), myoglobin, albumin and FLC-k, FLC-λ . Data are reported as mean ± standard deviation (SD). The removal rates of uremic toxins are expressed as percentages.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The average removal rates for the uremic toxins with standard high-flux membranes were 18.4% for B2M, 14.3% for Myoglobin, 19.8 % for FLC-k and 17.4 % for FLC-λ. The data showed a higher average removal rate for all the uremic toxins with Theranova® dialyzers for B2M, Myoglobin, FLC-k and FLC-λ (62.7%, 56.9%, 63.5%, 54.6%, respectively) during the 3 months of follow up. The using of Theranova® dialyzers in standard HD was enough to significantly decrease the pre-dialysis value of Urea (17.72 ± 2.26 vs 13.75 ± 3.75, p=0.001), Creatinine (700.50 ± 315.07 vs 570.00 ± 206.64, p=0.021), B2M (40.90 ± 11.00 vs 29.00 ± 4.64, p=0.005), FLC-k (267.25 ± 113.28 vs 225.25 ± 100.62, p=0.018), FLC-λ (324.25 ± 116.12 vs 215.23 ± 64.44, p=0.011), Myoglobin ( 199.96 ± 124.41 vs 137.00 ± 83.14, p= 0.049). Finally, albumin retention was observed with Theranova® dialyzers, between T0 and T3 it increased significantly (40.50 ± 4.79 vs 42.25 ± 4.50, p=0.0001).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Compared to high-flux dialysis membranes, novel medium cut-off (MCO) membranes show greater permeability for larger middle molecules in mid -term report. But the long term analysis and larger number of patients is necessary to evaluate a clinical significance of this innovative therapy.</jats:p> </jats:sec>
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    Impact of preoperative arterial and venous diameter on achievement of the adequate blood flow in arteriovenous fistula for hemodialysis
    (Wiley, 2020-06)
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    An arteriovenous fistula (AVF) remains the best choice of vascular access (VA) for hemodialysis (HD). The aim of the study was to determine the factors associated with the achievement of adequate blood flow (BF) of AVFs at the 4th week after creation. Created AVFs in 63 patients with chronic kidney disease (CKD) stage 4/5 and CKD stage 5 on hemodialysis (CKD5D) were analyzed in a prospective study. Doppler ultrasound (DUS) was used for measuring the diameter of the radial artery, the brachial artery and the cephalic vein before AVF creation. The BF of AVF was calculated by DUS at the 4th week after creation and adequate BF was defined as ≥ 600 mL/min. The average age of patients was 61.31 ± 12.9 years. An adequate BF of AVF at the 4th week after creation was achieved in 43.54% of patients. The BF of AVF measured in male patients was significantly higher compared to the BF of AVF obtained in females (576.03 mL/min vs 375.12 mL/min, P = 0.004). The diameter of the blood vessels with achieved adequate BF was significantly larger compared to the diameter of the blood vessels without adequate BF (radial artery: 2.45 mm vs 2.03 mm, P = 0.000; brachial artery: 4.78 mm vs 4.06 mm, P = 0.001 and cephalic vein: 3.12 mm vs 2.83 mm P =  0.018). The gender and the diameter of the blood vessels before AVF creation were significantly associated with achievement of adequate BF of AVF at the 4th week of creation.
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    Hypomagnesemia and cause-specific mortality in hemodialysis patients: 5-year follow-up analysis
    (SAGE Publications, 2017-10-13)
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    Tozija, Liljana
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    The aim of this prospective study was to evaluate the association between serum magnesium (Mg) and mortality, in particular the cause-specific mortality of Mg and other risk factors in hemodialysis (HD) patients.
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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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    Enterorrhagia Presented in Patient with Granulomatosis and Polyangitis - A Case Report
    (Macedonian Society of Nephrology, Dialysis, Transplantation and Artifical Organs, Department of Nephrology, 2022)
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    Vesna Ristovska
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    Introduction. ANCA - associated vasculitis (AAV) as a term includes: microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA). GPA is characterised by formation of granulomas and inflammation of small and medium-sized vessels leading to organ dysfunction, with a predilection for respiratory tract and kidneys. Gastrointestinal (GI) involvement happens rarely in GPA but when affected, has a poor prognosis. Case report. We report a case of 50-year-old male with GPA who presents with pulmonary and renal syndrome, along with enterorrhagia due to GI vasculitis. The patient was treated with: hemodialysis, pulse methylprednisolone, cyclophosphamide, and plasmapheresis. Our systematic review of the literature found only a few case reports where gastrointestinal symptoms were one of the first signs of GPA, however, this entity might be more frequent if physicians would think of this possibility more often. Conclusion. In cases of high clinical suspicion of GI involvement in GPA, an early aggressive immunosuppressive therapy and eventual surgical intervention remains the cornerstone of the management.