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Biomedical subjects

B Stojimirović

Publications and source records attributed to B Stojimirović.

At least 19 recordsLinked to original sources
PubMed2003

Treatment of insulin resistance in uremia.

Insulin resistance is a characteristic feature of uremia. As long as the hyperinsulinemia adequate to overcome the insulin resistance, glucose tolerance remains normal. In patients destined to develop type 2 diabetes, the beta cell compensatory response declines, and relative, or absolute, insulin deficiency develops. At this point glucose intolerance and eventually frank type 2 diabetes occur. Insulin resistance and concomitant hyperinsulinemia are present irrespective of the type of renal disease. Several studies have confirmed that hemodialysis (HD) treatment significantly improves insulin resistance. Both CAPD and CCPD are shown to improve insulin resistance in uremic patients. Comparing the effect of PD and HD treatment, it was found that the CCPD group has significantly higher insulin sensitivity than the HD group with the CAPD group similar to HD. Treatment of calcium and phosphate disturbances, including vitamin D therapy, significantly reduces insulin resistance in uremia. Treatment with recombinant human erythropoietin (EPO) is an efficient way to increase hematocrit, to reverse cardiovascular problems and to improve insulin sensitivity. Angiotensin-converting enzyme inhibitors have been shown to improve insulin resistance, hyperinsulinemia and glucose intolerance in uremic patients. Thiazolidinediones (TZDs), the new insulin-sensitizing drugs, provide the proof that pharmacologic treatment of insulin resistance can be of enormous clinical benefit. The great potential of insulin resistance therapy illuminated by the TZDs will continue to catalyze research in this area directed toward the discovery of new insulin-sensitizing agents that work through other mechanisms.

Anemia↗
PubMed1996

[Radiographic changes in the sella turcica in female patients on chronic hemodialysis].

The bone disease in chronic renal failure patients with secondary hyperparathyroidism is usually termed renal osteodystrophy. Radiographic methods have been applied in renal bone disease mainly to discover lesions on long bones, hands and fee. During the evaluation of hormonal disturbances of hemodialysed chronic renal failure female patients, roentgenograms of sella turcica were taken. Findings that were detected were most probably the consequences of renal osteodystrophy. Osteoporosis of clinoid processes posteriores and dorsum sellae and intrasellar calcifications were confirmed in 25 percent of investigated patients. Lateral view of the sellae turcica demonstrated a "double floor".These pathological findings in sella turcica region could be of practical importance because of well known anatomophysiological position of this sceletal structure.

Adult↗
PubMed1996

[Hemostatic system parameters in patients with chronic renal insufficiency and arteriovenous fistula thrombosis].

Functional disturbances among different tissues and organic systems are associated with chronic renal failure. The most common problems following the disturbances in complex hemostatic changes in uremic patients are prolonged bleeding time ant the increased thrombosis tendency. As the patients vascular access is critical to the treatment of the chronic haemodialysis patient, we performed an investigation of causes of repeated vascular access thrombosis with purpose of detecting any consistent abnormality of the haemostatic system. Research has been conducted on a group of 29 patients (14 males and 15 females), age 21 to 61 (x = 45), on regular haemodialysis from 1 to 6 years (x = 2.2); 23 of them having one episode of thrombosis of vascular access, and 6 having two episodes. Partial thromboplastin time was among the normal ranges in all investigated subjects, three of them had low prothrombine time and thrombine time was prolonged in two cases. The high fibrinogen value was found in 19 patients. Mean value of platelet count was normal, though seven patients had thrombocytopenia. Absence of coagulum retraction was found in three patients. Assessment of blood coagulation in this study could not explain the development of repeated thrombotic events affecting arterio-vein fistula in chronic renal failure patients receiving haemodialysis. That points out the necessity to analyze functional status of natural coagulation inhibitors, fibrinolytic system and platelet function.

Adult↗
PubMed1996

[Transport processes--ultrafiltration in peritoneal dialysis].

In patients with terminal renal failure treated by peritoneal dialysis diffusion and ultrafiltration are used for removal of substances from the blood. Neofiltration is realized via the osmolar gradient, determined by different concentration of glucose and dialysis solutions. Osmotic water transport during peritoneal dialysis is limited. In the course of one exchange of two liters of the dialysate, exponential reduction of glucose levels in the peritoneal fluid ensues against time. Substance of low molecular weight, such as glucose, are resorbed from dialysate reducing the osmotic gradient between blood and dialysis fluid. Two successive phases in the course of exchange lasting for several hours are the main features of ultrafiltration during peritoneal dialysis. The first phase includes positive ultrafiltration, transport of water and soluble substances from the blood into the dialysate. Peritoneal volume increases gradually up to a certain maximum. Time needed to achieve that depends on the glucose concentration in the dialysate and time. The second phase starts when osmotic concentration of peritoneal solution becomes lower than osmotic concentration of the blood due to glucose resorption. It results in negative ultrafiltration, i.e. return of water and soluble substances from dialysis solution back into the blood: The paper reviews the production of concentration haemodialysis solutions at the Department of Pharmacy. Military Medical Academy, Belgrade. The first series of 3400 liters was produced during 1971. It is only 3% of the current production. Ever since, the extent of production and number of new products have increased annually. Today, 2500 lit of five types of solutions for hemodialysis are manufactured weekly at the Institute of Pharmacy. The quality of these solutions is secured by good manufacturing practise, quality control of substances and physico-chemical control of the produced solutions. The Institute of Pharmacy collaborates with the Clinic of Nephrology permanently improving and adjusting the production program.

Ascitic Fluid↗
PubMedDate not supplied

[Peritoneal dialysis in the aged].

INTRODUCTION: Patients older than 65 years represent the group of patients affected by end-stage renal failure characterized by the most rapid growth. The prevalent causes of end-stage renal disease (ESRD) in the elderly are diabetes mellitus and nephrosclerosis due to long-term arterial hypertension. There are a number of physiologic changes which occur with aging that might have an impact on the choice of renal replacement modality for an elderly patient: clinical or subclinical diminished cardiovascular reserve due to atherosclerosis or impaired baroreceptor function, slow deterioration of pulmonary function, impaired immunity, increased susceptibility to infection, metabolic disturbances, bone loss from osteoporosis, altered metabolism of protein and a variety of drugs, high rate of malnutrition, tendency to carbohydrate intolerance. MATERIAL AND METHODS: When choosing a dialysis regimen for an elderly patient, physiologic changes that occur with aging, specific medical conditions that are common in this period of life, medical and psychosocial advantages and disadvantages of the single mode need to be taken into consideration. DISCUSSION: Continuous ambulatory peritoneal dialysis (CAPD) is the predominant mode of therapy for elderly patients. Medical advantages of CAPD in elderly patients are easier control of hypertension and anemia, slower and sustained ultrafiltration, avoidance of cardiac arrhythmias, improvement of nutritional status, better correction of cognitive functions. Psychosocial benefits are home dialysis program, improvement of quality of life and avoidance of co-morbid diseases. There are contraindications to peritoneal dialysis which apply to elderly as well as to younger patients: inadequate peritoneal membrane function, hernias that cannot be repaired, inability to insert a chronic peritoneal access. Relative contraindications include recurrent pancreatitis, chronic back pain, recent aortic prosthesis placement, severe periferal vascular disease and recurrent diverticulitis. Further potential disadvantages of peritoneal dialysis in the elderly are depression and physical and intellectual incapability of self-performing dialysis in the absence of an adequate assistant. Besides, pain, malnutrition and in-hospitalization time associated with peritonitis may be less well tolerated in the elderly than in younger patients. Finally, anorexia, nausea and protein losses in dialysate may aggravate malnutrition. Food intake in the elderly is lower than in younger patients because of the financial situation, loneliness, habits, inertia, depression, bad teeth, impairment of sense of smell and taste, nausea, impeded moving, use of a variety of drugs and many other reasons. Renal failure aggravates malnutrition in the elderly, while peritoneal dialysis is characterized by significant protein losses in the dialysate. It is advisable to make an individual plan of nutrition for elderly patients on peritoneal dialysis in order to provide adequate intake of proteins, energy, vitamins and minerals. Survival rates are the same in patients on peritoneal dialysis and on hemodialysis, but the number of co-morbid conditions is higher in the first group. Age of course is a major death risk factor. Many complications of peritoneal dialysis occur no more frequently in the elderly than in younger patients. The rate of hospitalization is higher and its duration is longer in elderly patients, due to higher incidence of Staphyloccocus epidermidis peritonitis and vascular disease. Urea removal normalized to urea volume of distribution (Kt/Vurea) and weekly creatinine clearance are used as methods of assessing adequacy of peritoneal dialysis in the elderly. Creatinine production declines significantly in older patients and serum creatinine is a poor measure of level of renal function or dialysis adequacy. Assessment of quality of life is quite subjective. Only 15-30% of elderly patients on peritoneal dialysis relate their health worse t

Age Factors↗
PubMedDate not supplied

[Changes in peritoneal mesothelial cells in patients on peritoneal dialysis].

INTRODUCTION: Some thirty years ago peritoneal dialysis (PD) became a respectable modality of renal replacement therapy. That is why peritoneal membrane attracted interest of investigators. Certain changes, known as uremic serositis, appear in morphology of serous membranes in end stage kidney disease (ESKD). The aim of our investigation was to examine the morphology of peritoneal lining cells in control group of healthy persons and morphology of peritoneal lining cells in patients on PD. MATERIAL AND METHODS: Peritoneal biopsies were taken in 10 healthy volunteers during the kidney donation and in 15 patients on PD during clinically indicated extirpation. Biopsy samples were prepared for standard routine HE staining and for plastic embedded fine sections studying. Sections were mounted in an ultramicrotome, stained with Toluidine blue (TB) and studied by light microscope (SM), while fine sections were mounted in an ultramicrotome and studied by transmission electron microscope (TEM). RESULTS: One layer mesothelium of the cuboidal or flattened lining cells were present over the lamina propria connective tissue. Mesothelial cells were overlapped like tiles on the roof. These cells were interconnected with different types of cell junctions (unpermeable, adhesion and communication junctions) positioned on lateral parts of the interdigitated cell membranes. A great number of microvilli were often present on the appical surface, as well as a kinocilia and lamellar bodies. Nuclei were euchromatic with well developed nucleoli. Many ribosomes, mitochondria, cisternae of rough endoplasmic reticulum (RER) and Golgi apparatus, lamellar bodies and lipid inclusions were present in the cytoplasm. Using TEM in analyzing fine sections of biopsies of patients on PD, characteristic ultrastructural changes including epithelial defects with only remaining parts of destroyed cells were established, as well as significantly greater number of rough endoplasmic reticulum (RER) cisternae and immature mesothelial cells in lamina propria indicating intensive regeneration of this epithelium. The cytoplasm of new mesothelial cells were of less electron density on TEM photomicrographs, whereas the nuclei of mesothelial cells in these patients were euchromatic with prominent nucleoli and numerous perichromatic granules and fibrogranular nuclear bodies, indicating cells of great activity. Cytoplasmic protrusions of different shape and content were often recognized on the apical surface of cells. Lamellar bodies were also present in this group of patients within the mesothelial cells, as well as between two mesothelial cells or on their apical surface. Mitochondria were picnotic in many of the mesothelial cells of peritoneum in this patient group. In these mesothelial cells intracytoplasmic paracrystaline inclusions were established. TEM photomicrographs showed basal lamina multiplication in this epithelium. CONCLUSION: Our findings comply with reports of other authors. It should be stressed that TEM examination detects characteristic ultrastructural changes in mesothelial lining cells of peritoneum in patients on PD, which could compromise the function of peritoneum as a membrane for dialysis.

Epithelium↗
PubMedDate not supplied

[The effect of hemodialysis and continuous ambulatory peritoneal dialysis on renal anemia].

Anaemia is an almost invariable sign of chronic renal failure [1]. Although many factors have been implicated as causes of this anaemia, it seems probable that deficiency of erythropoietin is the main cause for most patients [2]. Institution of chronic dialysis can improve anaemia in end-stage kidney disease, continuous ambulatory peritoneal dialysis being reported as more successful [3]. The aim of this study was to investigate the influence of haemodialysis and continuous ambulatory peritoneal dialysis on anaemia during the first six months of treatment. We examined 21 persons (14 males and 7 females, aged from 18 to 78 years) on haemodialysis treatment and 13 persons (6 males and 7 females aged from 22 to 64 years) on continuous ambulatory peritoneal dialysis (Table 1). Standard procedures were used for measuring biochemical parameters. Urea and creatinine levels were high, almost incompatible with life, in all tested persons before dialysis treatment. During the first three months of both dialysis techniques urea and creatinine were significantly (p < 0.01) corrected, but remained above the normal ranges (Table 2). Patients on continuous ambulatory peritoneal dialysis have shown significantly (p < 0.01) lower urea and creatinine values compared to patients on haemodialysis (Graph 1). These data suggest better preservation of renal function and better control of the internal environment during continuous ambulatory peritoneal dialysis [6]. All tested patients were severely anaemic before the beginning of dialysis. During the first six months of haemodialysis erythrocyte count, haematocrit and haemoglobin levels were unchanged (Table 3). Transfusions and hepatitis episodes only temporary improved anaemia. Patients on continuous ambulatory peritoneal dialysis exhibited significant correction of anaemia already during the first three months of treatment (Graph 2). Though less significantly, haemoglobin values continued to rise even during the next three months. The reached haemoglobin levels were lower than normal, but significantly higher than values in patients on haemodialysis (p < 0.01), suggesting better control of anaemia during continuous ambulatory peritoneal dialysis. Transfusion requirement was irrelevant, and hepatitis was not noticed, so they cannot be held responsible for the improvement of anaemia. Greater iron consumption, illustrated by higher transferrin saturation, also confirmed increased erythopoitesis in patients undergoing continuous ambulatory peritoneal dialysis. They also had lower blood iron level than those on haemodialysis (who had) numerous blood transfusions. The improvement of anaemia during continuous ambulatory peritoneal dialysis may be the result of reduction in plasma volume [7] as well as an increase in red cell mass and a better clearance of middle molecules in comparison to patients on haemodialysis. The main cause is higher erythropoietin level [8]. All tested patients had low folic acid level. Patients who corrected anaemia showed fall in folat level. This was statistically remarkable during the first three months of continuous ambulatory peritoneal dialysis-from 3.64 ng/ml to 2.09 ng/ml. All these data suggest that both dialysis modalities are effective in the control of protein waste products level, but continuous ambulatory peritoneal dialysis has better influence on the improvement of anaemia that haemodialysis. This can be attributed to better removal of uremic toxins, improved protein metabolism, lower parathyroid hormone level and higher erythropoietin value due to peritoneal macrophage production.

Adolescent↗
PubMedDate not supplied

[Effect of various methods of treatment in chronic renal insufficiency on the quality of life in patients].

Interest in measuring the quality of life (QL) in relation to health care has increased enormously in recent years. This is also true for end-stage renal failure where it is important not only to provide a better survival but also the quality of that survival. The aim of this study was to assess the relative influence of different kinds of treatment on end-stage renal disease after the patients' evaluation of their overall QL. We studied 167 patients receiving conservative treatment (45), haemodialysis (44), haemodialysis and erythropoieth (36), and continuous ambulatory peritoneal dialysis (42). The patients completed an original questionnaire consisting of 37 questions divided in five groups and generating 15 QL variables: personal data (name, gender, age, basic kidney disease); sociodemographic data influenced by the illness (family history, working ability, employment status); general health characteristics (fatigue, appetite, wound healing, sleep, resistance to cold); aspects of private life that are mostly influenced by the disease (social interaction, traveling, mood, sports, sexual life), and patients subjective assessment of their condition (self care and happiness). Patients on haemodialysis showed lower levels of QL than that on peritoneal dialysis related to fatigue (p < 0.01), working ability (p < 0.05), wound healing (p < 0.05), and appetite (p < 0.01) compared to the conservative treatment. Peritoneal dialysis had also a statistically significant positive influence on fatigue (p < 0.05) compared to conservative treatment. However, erythropoletin treatment showed better results with regard to traveling (p < 0.05), resistance to cold (p < 0.01), self care (p < 0.05) and mood (p < 0.05) compared to peritoneal dialysis, and working ability (p < 0.05), fatigue (p < 0.05) and mood (p < 0.05) compared to conservative treatment and haemodialysis.

Erythropoietin↗