Biomedical subjects
J Butorajac
Publications and source records attributed to J Butorajac.
[Analysis of a 4-year follow-up of the results of kidney transplantation from living related donors].
The aim was to present a four-year experience in living related kidney transplantation. A total of 43 patients (9 females and 34 males) were enrolled in this study. The standard triple immunosuppressive therapy (steroids, azathioprine and cyclosporine) was administered in 19 (44.1%) patients, and in 20 (46.5%) mycophenolate mophetil in daily dose of 2 g instead of azathioprine. In 5 (14.2%) patients with high immunological risk and delayed graft function was administered antithymocite globulin in duration of 7-14 days, prophylactically. In 3 (6.97%) patients graft loss was caused by vascular complications and in 1 (2.32%) by infection as the complication. During the first post-transplantation year acute rejection was noticed in 8 (34.7%) patients and in 3 (37.5%) it was steroid resistant. The graft loss was never caused by acute rejection. Six-months graft survival was noticed in 91.1% patients and one-year graft survival in 88.4% patients. One-year patient survival was 100%. Short term results in living related kidney transplantation are excellent and nowadays, due to improvement in immunosuppressive therapy, the success in this type of kidney transplantation is mainly limited by surgical and infective complications.
[Tuberous sclerosis].
Tuberous sclerosis is a rare hereditary disease which appears immediately after birth of during the second and third year of life. It is a multiorgan disorder characterized by convulsions, mental retardation and focal angiofibromyoma. The main findings are brain lesions including tuberous and astrocytes hamarthomas by which this disease was named. Renal alterations are angiofibromyolipoma and cysts, which are present in 40-80% of patients. The diagnosis is based on clinical, radiological and histological findings. This disease has a progressive course and fatal outcome. The therapy is symptomatic and surgical. The aim of this paper was to present this rare disease, which occurred in this patient during fourth year of life. Besides brain changes the patient also has extensive morphological renal alterations and renal failure. She died in 40th year of life due to multiorgan dysfunction.
[Replacement of mycophenolate mofetil with azathioprine in patients with renal transplants].
Numerous clinical studies demonstrated that mycophenolate mofetil (MMF) was significantly more effective in prevention of acute rejection episodes than azathioprine. Since the data supporting the long-term benefits of MMF therapy are not available, and considering the high cost of this therapy, we examined the safety of conversion from MMF to azathioprine in renal transplant patients. In 12 renal transplant patients (4 cadaveric and 8 living related donors) on triple immunosuppressive therapy (prednisone/MMF/cyclosporine) conversion from MMF to azathioprine was done after the first six to twelve post-transplant months. The majority of patients were in the low immunological risk of transplantation, and 7 (58.3%) received antithymocite globulin due to the delayed graft function. The mean follow-up period after the conversion to azathioprine was 6.4 months (range 3-12 months). Acute rejection episode was noticed only in one patient 8 months after the conversion following acute graft pyelonephritis. In all other patients graft function remained unchanged. We have concluded that the conversion from MMF to azathioprine in renal transplant patients on triple immunosuppressive therapy is safe and without detrimental effects on short-term allograft function. Long-term follow-up studies on larger number of patients are needed to confirm these observations.
[Dynamic scintigraphy of the kidney using 99m-Tc-DTPA before and after extracorporeal shock wave lithotripsy].
The results of dynamic scintigraphy of the kidneys using 99mTc-DTPA that is glomerular radiopharmaceutic in patients before and after ESWL (extracorporeal shock wave lithotripsy) are presented. Investigation was performed in 22 patients--in 8 patients immediately before ESWL, 7 days and 3 months later, and in 14 patients before and 7 days after ESWL. The time alteration of the achievement of the maximal values of radiorenographic curve obtained by dynamic scintigraphy (Tmax), as the alteration of separate clearance (SCI) counted as an integral below the other phase of renographic curve. No significant differences were observed in the values of separate clearance before and after ESWL, while Tmax was significantly reduced 3 months after ESWL (p < 0.05). Our results indicated the improvement of glomerular filtration of the kidneys 3 months after ESWL (faster passing of DTPA through the treated kidney).
[Hemostatic changes during hemodialysis of patients with chronic kidney insufficiency].
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[Acute renal insufficiency in patients after surgical treatment of dissecting aortic aneurysm].
The retrospective analysis was performed of 26 patients (5 women and 21 men), mean age of 47.04 years, surgically treated for aortic dissecting aneurysm (ADA) at the Clinic of Cardiosurgery of the M.M.A. in the period 1988-1990. In the postoperative course acute renal insufficiency (ARI) has developed in 13 (50%) patients: of milder form in 5 (38.4%), medium in 6 (46.1%) and advanced form in 2 (15.3%) patients. The most common precipitating factor in development of ARI has been arterial hypotension (92.3%). In all patients including the patients treated by hemodialysis, it has come to complete recovery of renal function.
[Glomerulonephritis and infected ventriculoatrial shunt in hydrocephalus (shunt nephritis)].
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[Pseudoporphyria in patients with kidney disease on hemodialysis].
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[Perirenal hematoma as a complication caused by extracorporeal lithotripsy].
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[Posttraumatic acute renal insufficiency].
Acute renal insufficiency is a severe, but most frequent reversible illness followed by sudden onset, oliguria or anuria of indefinite duration, by rapid increase in decomposition products of protein catabolism in serum, by acidosis and fluid balance and electrolytes disorder. The aetiologic factors of acute renal insufficiency are various. A very significant aetiological factor in the appearance of acute renal insufficiency is a trauma caused by any kind or type of weapons, arms or instruments [1-5, 6, 9-13, 15]. Of a total number of injured persons who were treated in our institution (4,086 injured persons), 251 (6.14 percent) were with acute renal insufficiency, and of that number with all signs and symptoms of acute renal insufficiency 37 (0.9 percent) were treated with haemodialysis. Of the number of dialysed patients 30 (80 percent) patients had oliguric form of acute renal insufficiency and 7 (19 percent) were with non oliguric form of acute renal insufficiency. The most frequent injuries were to abdomen and then to extremities, liver, chest and kidneys. The smallest percentage concerned isolated injuries in extremities. According to a pathogenic mortality mechanism, the highest mortality was in patients with haemorrhagic syndrome and in septic condition, and the minimal in patients with other syndromes, such as crush syndrome, etc. In 25 (68 percent) patients acute renal insufficiency was associated with haemorrhagic syndrome, in 7 (18.9 percent) with crush syndrome and in 5 (13.5 percent) with septic condition. In 36 (97 percent) patients haemodialysis was performed and in 1 (3 percent) subject peritoneal dialysis. The reason for such a small number of peritoneal dialysis are severe injuries to abdomen and chest, since this type of dialysis could not be performed for technical reasons. In 27 (73 percent) patients haemodialysis was performed as a type of intermittent heparinization. In 5 (14 percent) patients heparinization was a type of continual heparinization. Thanks to prompt haemodialysis together with medical therapy and surgical treatment, the mortality rate in our patients was lower in comparison to mortality rate in other centres (Table 3). The main causes of acute renal insufficiency in our patients were: Acute tubular nercosis, peripheral blood flow insufficiency (hypovolaemia, cardiovascular failure), and postrenal insufficiency (excretory obstruction, intrarenal obstruction, urinary organ ruptures, haemorrhagic shock) and the underlaying kidney disease. Acute renal insufficiency can be divided into acute renal insufficiency, primary parenchymal renal insufficiency and postrenal azotaemia [1-6, 9, 12, 13]. During the therapy of these patients it is important to evaluate the dehydration degree of patients by clinical and laboratory parameters. In case of hypovolaemia the complete compensation of fluid should consist of infusion together with administration of diuretics. The central venous pressure should be maintained at the values in a range from 6 to 8 cm H2O. In case of oliguric acute renal insufficiency the fluid intake should be equal to diuresis plus every other loss of fluids. Diet should be high-caloric with carbohydrates in the amount of 100 mg, and that amount should be given three to four times daily (both parenterally and orally) together with restriction of potassium intake due to a well known effect of potassium on myocardium function. Dosage of drugs which are eliminated via kidney should be managed promptly by parenteral administration of antibiotic agents [7, 8, 13-16]. Haemodialysis should be started at the very beginning of the patients admission to the hospital and should be associated with anticoagulant therapy for avoiding haemorrhages. Thanks to haemodialysis performed in time, the mortality rate in our patients was reduced in comparison to health centres where haemodialysis was delayed. Thanks to such treatment of patients with many severe injuries in whom the mortality rate is usuall
[Histopathologic changes in the kidneys in patients with asymtomatic pathologic findings in urine].
The authors had analyzed histopathologic changes in the kidneys of patients with asymptomatic abnormalities of urine analyzing if they were correlated with the type of pathologic finding in urine. Retrospective study comprised a total of 76 patients with asymptomatic urine abnormalities. In all three groups of patients, formed upon the type of pathologic finding in urine, were determined heterogeneous histopathologic changes, and different types of glomerulonephritis, respectively. The most frequent histopathologic finding was IgA nephropathy, observed in 16.7% patients with isolated proteinuria, in 50% patients with isolated microscopic hematuria and in 55.9% patients with associated urine abnormalities. In distinction from the other two groups of patients, in the group of patients with isolated proteinuria normal histologic finding was very frequently found (25% patients), and in group of patients with associated urine abnormalities were observed more severe histopathologic forms of glomerulonephritis, such as membranoproliferative glomerulonephritis. It was concluded that different types of glomerulonephritis most frequently caused asymptomatic abnormalities of urine in younger patients.