Filipovski, Stefan
Preferred name
Filipovski, Stefan
Official Name
Filipovski, Stefan
Alternative Name
S. Filipovski
Filipovski, S.
Filipovski Stefan
Email
stefanfilipot@gmail.com
5 results
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Item type:Publication, KIDNEY FUNCTION DECLINE AND MORTALITY IN DONORS WITH EXPANDED CRITERIA - FIVE YEARS FOLLOW UP STUDY(Macedonian Association of Anatomists and Morphologists, 2024); ; ; ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ANNUAL CHANGE OF ESTIMATED GLOMERULAR FILTRATION RATE IN HEALTHY INDIVIDUALS(Macedonian Association of Anatomists and Morphologists, 2024); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, MIXED PULMONARY INFECTION IN A PATIENT WITHSUCCESSFULLY TREATED RECURRENCE OF FOCALSEGMENTAL GLOMERULOSCLEROSIS ON KIDNEYALLOGRAFT(Uniunea Medicala Balcanica, 2024-09-24); ; ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ENCOURAGING SELF-ADMINISTRATION OF ERYTHROPOIETIN BY CREATING INFORMATION BROCHURE FOR PREDIALYSIS CKD PATIENTS(2024-04-04); Milenkova Bogojevska, MENCOURAGING 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Association of Autosomal Dominant Polycystic Kidney Disease and Abdominal Aortic Aneurysm - A Case Report(Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2023); ; ; ; 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 a 77-year-old male with ADPKD and long-standing hypertension, admitted to our ward due to an extreme weakness, malaise and abdominal pain with severe anemia and elevated serum levels of creatinine and urea. The treatment with hemodialysis and blood substitution was initiated. Abdominal echo-sonography showed hepatic cysts and polycystic kidneys. The cysts were filled with a clear content, in the right kidney toward the upper pole, two larger cysts were noted and an adjacent pulsatile cystic lesion with a hemorrhagically-filled content, highly suspicious for an aneurismatically 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 an infrarenal saccular dilatation before the bifurcation, that seemed to be thrombosed and a denser content was observed next to it, probably an older hemorrhagy, without imaging signs of acute extravasation of the contrast. Cardiovascular surgeon recommended coronography and coronary artery aneurisms were excluded. Unfortunately, the patient started to alternate with his consciousness and brain CT angiography showed corticoreductive changes, without any aneurism, or extra-or intra-axial hemorrhage. Due to the severe general condition, clinical assessment and advanced age of the patient, the case was declared as inoperable. Conclusion. Due to a hypertension and associated connective tissue disorders patients with ADPKD are prone to develop aortic aneurysms, that should be questioned as a frequent feature in such patients. Hence, an early diagnosis and treatment decision based on a risk-benefit analysis, remain the cornerstone of management.