Janevski, Zoran

Preferred name

Janevski, Zoran

Official Name

Janevski, Zoran

Main Affiliation

zoran.janevski@medf.ukim.edu.mk

dr-zoran-janevski@hotmail.com

Now showing 1 - 10 of 11

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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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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 (Î´GFR) 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 Î´GFR 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 Â± 3.81 kg/m2, 13% were obese. The mean annual GFR fluctuated (101.8 Â± 5.56; 108.0 Â± 31.04; 102.8 Â± 18.28;103.2 Â± 20.49; 99.10 Â± 24.28; 103.55 Â± 20.74 mL/min/1.73m2, respectively). The Î´GFR 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 Î´GFR 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 wasnâ€™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.
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COLLAPSING GLOMERULOPATHY-RARE VARIANT OF FOCAL SEGMENTAL GLOMERULOSCLEROSIS-CASE REPORT
(Македонско лекарско друштво = Macedonian medical association, 2021)
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Focal segmental glomerulosclerosis (FSGS) is classified into five variants, with the collapsing variant being the most rare one. However, the number of idiopathic cases is increasing and the presentation becoming more routine. We report the case of a 77-year-old female patient, with nephrotic syndrome and histopathologic features of glomerular capillary collapse. She presented with chronic renal failure with serum creatinine-126…154…174 μmol/L. Nephrotic syndrome with feet and ankles edema, progressively extended, at first failed to respond to diuretic therapy. The level of total serum protein fraction was 54g/l, albumin-29…24…28g/L. Urinalysis demonstrated proteinuria 7.8 g/l… 6.15g/L and 12.3 g/24 h. Presence of 25-30 erythrocytes and 2-3 leukocytes in urine sediment was also noticed. Renal biopsy was performed to determinate the presence of glomerular disease. The histopathological analysis showed fibrously thickened Bowman’s membrane, with discretely thickened glomerular basal membrane and collapsed vascular lumen on TEM analysis. The treatment of the patient included corticosteroids, angiotensin-converting enzyme inhibitor and lipid lowering agents, which resulted in lowering of the proteinuria, followed by withdrawal of the edema.
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USE OF ULTRASONOGRAPHY FOR CONFORMATION OF CENTRAL VENOUS CATHETER PLACEMENT FOR HEMODIALYSIS - SINGLE CENTER EXPERIENCE
(Faculty of Medicine, Ss Cyril and Methodius University in Skopje, 2022)
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Spasovska-Vasilova, Adrijana
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Milenkova, Mimoza
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Conformation for safe placement of central venous catheter for hemodialysis and exclusion of pneumothorax is done with chest x ray. However, this procedure is time consuming, so in order to shorten this time several attempts have been tried to use bedside ultrasound. To use bedside ultrasonography to confirm tip location of central venous catheter and rule out pneumothorax. The second aim was to compare these results with plain chest x ray. In 50 patients on hemodialysis central venous catheter were inserted in internal jugular vein or subclavian vein under ultrasound guidance. After insertion, a subxiphoid 4 chamber view was obtained looking to detect turbulence or microbubbles shortly after 10ml saline flush through catheter. Then, ultrasound of the patient's chest was performed to exclude pneumothorax. After the exam, a plain chest x raywas performed for the conformation of the findings. From 50 placed hemodialysis catheters, 47 were adequately placed. All catheters were identified with the use of ultrasound. The tip of the 3 misplaced catheters could not be detected with the use of ultrasound. No pneumothorax was observed. The average time for detection of correct catheter placement was much faster with the use of ultrasound compared with chest x ray (11,5min and 80 min, accordingly). The use of bedside ultrasound for conformation of central venous catheter placement and excluding pneumothorax is as accurate as with chest radiography, but it is can be done much faster.
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A Case of Seronegative Pulmonary-renal Syndrome: Diagnostic and Therapeutic Challenge
(Scientific foundation Spiroski, 2021-01-04)
Muharremi, S
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Poposki, A
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Kovaceska, V
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Tozija, L
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BACKGROUND: Pulmonary renal syndrome (PRS) is not a single entity but is caused by varied etiologies, including anti-neutrophil cytoplasmic antibody (ANCA), associated small vessel vasculitis (such as Wegener’s granulomatosis, microscopic polyangiitis, and Churg-Strauss vasculitis), Goodpasture’s syndrome, systemic lupus erythematosus, Henoch-Schonlein purpura, cryoglobulinemia, and rare causes such as druginduced vasculitis and subacute endocarditis. CASE REPORT: We report a case of a 51-year-old man who was referred to our hospital with a 2-month history of breathing difficulties, mild hemoptysis, and deteriorated renal function with a serum creatinine of 269 μmol/L. Serological testing was negative for anti-neutrophil cytoplasmic antibody (ANCA) and anti-glomerular basement membrane (GBM) antibody, and also all cultures, including blood and urine, remained negative. In the renal biopsy, not linear deposition of IgG along the GBM and crescents at varying stages with extracapillary glomerulonephritis emphasizes the possibility of a double-seronegative pulmonary renal syndrome. Regarding therapeutic dilemmas, on the 3rd day of hospitalization, we initiated immunosuppression with cyclophosphamide and corticosteroids as well as plasma exchange (5 treatments). Under immunosuppressive therapy and plasma exchange, the patient’s status continually improved; there was no pulmonary bleeding, but the serum creatinine remained high and renal function remained in stage 4 chronic kidney disease. Four weeks later, he was hospitalized again, and we faced a new therapeutic dilemma because of the rapid relapse during immunosuppressive therapy and renal function deterioration that required hemodialysis treatment. Despite repeatedly negative results for anti-GBM and ANCA, initial immunosuppressive therapy with plasma exchange (9 treatments) was included again. The patient was discharged 30 days after admission in a stable general condition, with the maintenance immunosuppressive therapy with mycophenolate mofetil and hemodialysis 3 times/week. After 24 months, we have received information from the hemodialysis center that he is on regular hemodialysis and that he is in good condition. CONCLUSION: We think that in this atypical case, intensive plasma exchange and immunosuppressive therapy are crucial in the early stage and maintenance therapy is necessary for vasculitis in remission. This reported case has important clinical implications because pulmonary-renal syndrome with negative ANCAs and anti-GBM antibodies is extremely rare and no treatment recommendations have been established yet.
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ENCOURAGING SELF-ADMINISTRATION OF ERYTHROPOIETIN BY CREATING INFORMATION BROCHURE FOR PREDIALYSIS CKD PATIENTS
(2024-04-04)
Karanfilovikj, A
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Trajcheska, L
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Sulejman, S
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Milenkova Bogojevska, M
ENCOURAGING SELF-ADMINISTRATION OF ERYTHROPOIETIN BY CREATING INFORMATION BROCHURE FOR PREDIALYSIS CKD PATIENTS A. Karanfilovikj, L. Trajcheska, S. Sulejman, A. Canevska Taneska, M. Milenkova Bogojevska, A. Spasovska Vasilova, Z. Shterjova Markovska, J. Usprcov, V. Karanfilovski, A. Stojanoska Severova, Z. Janevski, A. Memeti, S. Filipovski, B. Bedzeti, I. Rambabova Bushljetikj University Department for Nephrology, Faculty of Medicine, University Ss Cyril and Methodius, Skopje, N. Macedonia PP Introduction. Patients with chronic kidney disease have a relatively deficient erythropoietin production, and this is one of the most significant causes of anemia in this group. The disorder starts to develop when the glomerular filtration rate drops below 60 mg/ml. In it’s severe form, anemia decreases quality of life and increases the risk of cardiovascular diseases and mortality in this patients, so the implementation of prevention and control measures is recommended. Methods. In our institution, 54 predialysis CKD patients, with average age 69,44±15, have been regularly followed and treated for anemia with subcutaneous administration of ESA, mostly on weekly basis. Considering the numerous comorbidities of this group of patients, in order to reduce frequent outpatient visits and improving the quality of life, 30 (60%) patients accepted to be educated on self-administration of EPO. Results. We created an information brochure for patients, as an educational training material, with basic information about the medication, how to administer, side effects, contraindications and information about safe storage and disposal. Conclusion. The benefits of education through the information brochure for self-application of EPO among the group of predialysis CKD patients are improved cardiovascular function and a more compliant patient enjoying an improved quality of life.
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THE IMPORTANCE OF RENAL BIOPSY IN PATIENTS WITH DIABETES MELLITUS
(2024-04-04)
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Milenkova Bogojevska M
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Memedi, B
THE IMPORTANCE OF RENAL BIOPSY IN PATIENTS WITH DIABETES MELLITUS V. Ristovska, P. Dzekova-Vidimliski, Z. SterjovaMarkovska, M. Milenkova-Bogojevska, B. Memedi, G. Stefanoska-Taskoska, A. Stojanoska-Severova, Z. Janevski Deparment of Nephrology, Faculty of Medicine, University Sts. Cyril and Methodius Skopje, N. Macedonia PP Introduction. The diagnosis of diabetic kidney disease (DKD) is most often made clinically. However, there is growing awareness of the prevalence of nondiabetic kidney disease (NDKD) with or without concomitant diabetic nephropathy (DN) in patients with diabetes. Proteinuria and renal disfunction is common in patients with diabetes mellitus. In most of the cases diabetic nephropathy is the cause of that disfunction, but some of the cases present other nondiabetic renal disease. Renal biopsy in diabetic patients has presented variety of glomerular changes. Immunosuppresants used for treatment of the glomerular diseases may be associated with complications. Case report. Herein, we review the prevalence and presentation of NDKD in diabetic patients, with a focus on glomerular lesions, and discuss the ways in which diabetes can affect the diagnosis and management of these conditions. Diabetic patients with glomerular disease represent a sizable patient population. We report on 2 cases with diabetes mellitus with nondiabetic kidney disease confirmed with renal biopsy. The first case was a 58-year-old man, admitted to our Department with a history of diabetes, with actual presence of fatigue, inapetence and edema and proteinuria 6 g/24 hours. Renal function was diminished, creatinine values were 226 micromol/l, with GFR 38 ml/min. Second case was a 53 year -old-man with edema, hypertension, atrial fibriloflater and breatlessness, was treated with cardiologic therapy, but the edema was still present. Creatinin value was 126 micromol/l and proteinuria was 4,36 g/l (11,94g/ 24hours). In both cases, renal biopsy was performed and the histopatologic analysis showed membranoproliferaive glomeurlonephritis with presence of diabetic glomerulonephritis. The patients were treated with corticosteroids as pulse therapy, cyclophosphamide, diuretics and after that the clinical signs were stabilized. Conclusion. The authors suggest that the renal biopsy should be performed in diabetic patients with unusual features, such as proteinuria without other signs of diabetic disorders. Renal histology can be of fundamental importance to both treatment and prognosis of the disease
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ASSOCIATION OF AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE AND ABDOMINAL AORTIC ANEURYSM
(2024-04-04)
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ASSOCIATION OF AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE AND ABDOMINAL AORTIC ANEURYSM Z. Shterjova Markovska1, I. Rambabova Bushljetikj1, G. Severova1, L. Trajcevska1, I. Nikolov1, V. Karanfilovski1, S. Sulejman1, J. Usprcov1, Z. Janevski1, A. Canevska1, A. Karanfilovikj1, S. Krstevska Balkanov2, G. Spasovski1 1University clinic of Nephrology, 2University clinic of Hematology, Faculty of Medicine, University Sts. Cyril and Methodius Skopje, N. Macedonia PP Introduction. Autosomal dominant polycystic kidney disease (ADPKD) is a systemic disease with multiple cysts in several organs. Formation of aneurysms of: the aorta, coronary and cerebral arteries are increasingly reported in the literature as extra-renal manifestations. Case report. We report 77-year-old male with ADPKD and long-standing hypertension, admitted to our ward due to extreme weakness, malaise and abdominal pain with severe anemia and elevated serum levels of creatinine and urea. Treatments with hemodialysis and blood substitution were started. Abdomen echo-sonography showed hepatic cysts and polycystic kidneys. The cysts were filled with clear content, in the right kidney toward the upper pole, two larger cysts were notified and next to them а pulsatile cystic lesion was noted with hemorrhagicfilled content which was highly suspicious for an aneurismaticlly dilated abdominal aorta. CT angiography of the aorta showed dilated, tortuous aorta with advanced atherosclerosis along its entire length. The dilatation was evident in the descending part of the aorta, with infrarenal saccular dilatation before the bifurcation, that seemed to be thrombosed and next to it denser content was observed, probably older hemorrhagy, without imaging signs of acute extravasation of the contrast. Cardiovascular surgeon recommended coronography and coronary artery aneurisms were excluded. Unfortunantly the patient started to alternete with his consuosnes and brain CT angiography showed corticoreductive changes, no aneurism, extra-or intra-axial hemorrhage were observed. Due to the severe general condition, clinical assessment and advanced age of the patient, the case was declared as inoperable. Conclusion. Due to hypertension and associated connective tissue disorders patients with ADPKD are prone to develop aortic aneurysms, and should be questioned as a frequent feature in such patients, hence early diagnosis and treatment decisions based on a risk–benefit analysis, remains the cornerstone of management.
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CHRONIC HYPERKALEMIA IN CHRONIC KIDNEY DISEASE
(2024-04-04)
Memeti, A
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Sulejman, S
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Karanfilovik, A
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Stojanoska, A
CHRONIC HYPERKALEMIA IN CHRONIC KIDNEY DISEASE A. Memeti, S. Sulejman, A. Karanfilovik, V. Karanfilovski, A. Stojanoska, Z. Sterjova, M. Milenkova, J. Usprcov, A. Spasovska, Z. Janevski, A. Canevska, L. Trajceska, I. Busletikj University clinic of nephrology, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, N. Macedonia PP Introduction. Our aim was to investigate the need of a dietary intervention in our CKD patients. Methos. 65 ambulatory CKD patients with chronic hyperkalemia were sampled for blood analyses and asked three questions: about knowing the potential harmful effect of high potassium in the blood, secondly about knowing of potassium rich foods and thirdly how they feel about having a leaflet with additional information on the subject. Patients were stratified into groups in respect of potassium level (mild<5,9; moderate 6-6.5 and severe ≥6.5 mmol/l). Results. Mild hyperkalemia was found in 21(32%), moderate in 29(45%) and severe in 15(23%). Out of all, 35(54%) already knew about the harmful effect of high potassium blood. Knowledge about the potassium rich foods claimed 22(34%) of patients but most of them stressed they only knew 2-3 items. The positive response rate on the third question about needing a leaflet with information on this issue was 100%. In order to achieve careful reduction of potassium level without compromising the alkali and fiber intake a leaflet was prepared for the CKD patients. Conclusion. Large proportion of CKD patients with hyperkalemia are in need of dietary intervention with written information in the form of an educational leaflet.

Janevski, Zoran

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