Shterjova Markovska, Zhaklina

Preferred name

Official Name

Shterjova Markovska, Zhaklina

Translated Name

Штерјова Марковска, Жаклина

Alternative Name

Zaklina Sterjova Markovska

Zhaklina Shterjova Markovska

Zaklina Sterjova- Markovska

Zhaklina Shterjova- Markovska

Shterjova Markovska, Z.

Sterjova Markovska, Z.

Жаклина Штерјова Марковска

Zaklina S. Markovska

Main Affiliation

Now showing 1 - 10 of 22

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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 donorsâ€™ 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 (Î² = - 0.103, p=0.076). Only BMI over 30kg/m2 worsened the kidney function (Î² = 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 Â± 7.51 vs. 59.33Â±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 (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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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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Association Between Membranoproliferative Glomerulonephritis and Colorectal Cancer - A Case Report
(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2024-06-01)
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Naunovska, Ljupka
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Suleyman, Sabir
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Membranoproliferative glomerulonephritis (MPGN) is a rare glomerular disease characterized by mesangial hypercellularity and thickening of the glomerular basement membrane (GBM). MPGN can be idiopathic or associated with malignancy, systemic immune complex disorders and chronic infections. It has rarely been associated with solid organ tumors, such as lung, gastric, breast or prostate cancer. We report a patient with MPGN and coexisting colorectal carcinoma. A 48-year-old man presented with anemia, loss of weight, hypertension, and nephrotic syndrome. The renal biopsy findings were compatible with type 1 MPGN. The antineutrophilic cytoplasmic antibodies, antinuclear antibodies, anti-GBM, serologic markers of hepatitis B and hepatitis C and tumor markers were negative. After ruling out the secondary causes of MPGN, the patient was treated with pulse doses of methylprednisolone and a single dose of cyclophosphamide. However, due to the worsening anemia and rectal bleeding, a colonoscopy was performed, which established a diagnosis of adenocarcinoma of the descending colon. The patient was treated with left hemicolectomy and oral corticosteroids. Within a year after the cancer treatment, the patient experienced a complete resolution of the proteinuria and improvement of the kidney function. Although rare, MPGN can be associated with hematologic malignancies and solid organ tumors. The most common causes of secondary MPGN should be ruled out before starting specific treatment. In our patient, cancer treatment has led to a subsequent remission of the nephrotic syndrome, which indicated that this association was not coincidental but rather causal. In patients with a tumor and concomitant glomerulopathy which is suspected to be paraneoplastic in etiology, the treatment of the underlying malignancy should be prioritized.
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Focal Segmental Glomerulosclerosis and Collapsing Glomerulopathy after Covid 19 Infection
(Macedonian Society of Nephrology, Dialysis, Transplantation and Artifical Organs, Department of Nephrology, 2021)
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Focal segmental glomerulosclerosis (FSGS) is defined as an increase in the mesangial matrix in some glomeruli with obliteration of capillary lumens, sclerosis, hyalinosis, foam cells, and adhesions to the Bowman’s capsule. Collapsing glomerulopathy is a morphologic variant of focal segmental glomerulosclerosis (FSGS) characterized by segmental and global collapse of the glomerular capillaries, marked hypertrophy and hyperplasia of podocytes, and severe tubulointerstitial disease. Actually secondary collapsing glomerulopathy is a heterogeneous group including numerous causes: viruses, toxins and drugs such as heroin and pamidronate
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Possible relationship between wegener-granulomatosis with polyangitis (vasculitis) and covid-19 infection and their complex treatment- case report
(Macedonian Association of Anatomists and Morphologists (MAAM), 2021)
Janevski Z
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SUCCESSFUL TREATMENT OF ENDOCARDITIS WITH NONSPECIFIC PRESENTATION IN A KIDNEY TRANSPLANTPATIENT-CASE REPORT
(Macedonian Association of Anatomists, 2023-11)
Uspcov, Julijana
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Kabova Karanfilovikj, Angela
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Spasovska, Adrijana
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Infective endocarditis (IE) is a serious complication in patients with transplanted kidney, leading to graft loss and a high mortality rate. We present a case of native valve endocarditis in a 51-year-old male with transplanted kidney that had atypical clinical course. The patient experienced prolonged subfebrile temperature with paroxysmal arrhythmia and development of cardio-pulmonary insufficiency. Transthoracic echocardiography (TTE) set the diagnosis of aortic valve vegetation with severe aortic regurgitation and pulmonary edema. We failed to isolate a microbiological agent, but all blood cultures were taken under antibiotic therapy. The patient was treated with surgical replacement of the native aortic valve with mechanical heart valve with significant clinical improvement. Ten days after the intervention, he was discharged with reduced markers of inflammation and proper function of the kidney graft. Immunosuppressive therapy was gradually reinstated. One year later, the patient was clinically stable and with proper graft function. Early diagnostic and therapeutic intervention, particularly intensive antibiotic therapy and surgical management can preserve the patient and the kidney allograft.
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Rhabdomyolysis Associated with Recent SARS-COV-2 Infection in a Patient with Carnitine Palmitoyltransferase II Deficiency
(Macedonian Academy of Sciences and Arts / Walter de Gruyter GmbH, 2022-11-01)
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Cana, Fadil
Carnitine palmitoyltransferase II deficiency (CPT II) is an autosomal recessive inherited disorder of long-chain fatty acid oxidation in the mitochondrial matrix, resulting in an inability to utilize fat for energy in cells. The most frequent myopathic form occurs in young adults and is associated with recurrent episodes of exercise-induced rhabdomyolysis. The myopathic form is caused by the Ser113Leu mutation of the CPT II gene. Rarely, massive rhabdomyolysis could be complicated by acute kidney injury (AKI), car-diomyopathy, and respiratory insufficiency.We present a case of an 18-year old male with myalgia, muscular weakness, and dark-colored urine after prolonged exercise and a recent mildSARS-CoV-2infection. Massive rhabdomyolysis was diagnosed with markedly increased serum concentrations of myoglobin and creatine kinase, with normal kidney function. The patient experienced two similar episodes in the years 2017 and 2018, with rhabdomyolysis and AKI treated with hemodialysis. After excluding autoimmune and infectious diseases as causes of recurrent rhab-domyolysis, the patient was genetically tested and Ser113Leu mutation of the CPT II gene was confirmed. When a patient presents with myalgia and dark-colored urine triggered by minor physical activities, genetic testing for possible CPT II deficiency should be initiated. TheSARS-CoV-2infection could be a factor that triggers the occurrence of rhabdomyolysis and aggravates the severity of the attack in patients with CPT II deficiency

Shterjova Markovska, Zhaklina

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