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M Polenaković

Publications and source records attributed to M Polenaković.

At least 19 recordsLinked to original sources
PubMed2005

Membranoproliferative glomerulonephritis complicating diabetic nephropathy.

BACKGROUND: Renal diseases other than diabetic nephropathy can be found in diabetic patients who have undergone renal biopsy. Various forms of primary and secondary glomerular diseases were reported, but membranoproliferative glomerulonephritis was rare. METHODS: Analyzing data at our Department for the past three years, we noted 18 patients with primary membranoproliferative glomerulonephritis and 4 associated with diabetic nephropathy. RESULTS: Nodular glomerulosclerosis with diffuse membranoproliferative glomerulonephritis was registered in two patients and a diffuse form of diabetic nephropathy with a combination of segmental and diffuse changes characteristic of membranoproliferative glomerulonephritis in the other two patients. CONCLUSIONS: Analyzing what can be common for these two diseases we can conclude that they are at least three disorders: 1. hyperperfusion injury, hallmark for the diabetic nephropathy, but also with the highest incidence in membranoproliferative glomerulonephritis than in the other glomerulonephritides; 2. mesangial matrix expansion, and; 3. thickening of all extracellular membranes.

Adult↗
PubMed2005

Recurrent glomerulonephritis in living kidney transplantation.

Glomerulonephritis (GN) is one of the most frequent causes of end-stage renal disease. Recurrent GN can occur very early after transplantation in up to 20% of renal-allograft recipients and should be considered with late graft dysfunction in 2-5%. Importantly, diagnosis of a clinically silent recurrence of the disease will pass undetected unless transplant centers have a policy of protocol biopsies. In addition, the classification of the type of recurrent GN should be done with data on electron microscopy and immunofluorescence, in order to promote prompt treatment and a strategy for long-term graft survival. The aim of our paper was to present a few typical cases of recurrent GN, showing the actuality of the problem in living related kidney transplant recipients and to ascertain the importance of precise and timely diagnosis by protocol biopsy. Recurrent focal segmental glomerular sclerosis (FSGS) in childhood is associated with the highest number of graft loss. The treatment of recurrent FSGN is difficult, so prophylactic plasmapheresis prior to transplantation appeared to be more effective in preventing recurrence than plasmapheresis after transplantation, especially in population of children. Mesangio proliferative GN type II is the second most frequent recurrent GN, followed by type I. Here, it is of paramount importance to classify the type of the disease. The family of the patient at risk for recurrent GN, a candidate for living related kidney transplantation, should be informed for the expected outcome and their voluntary decision whether to proceed with transplantation should be awaited.

Adolescent↗
PubMed2005

Chronic allograft nephropathy (CAN) in early renal protocol biopsies: does treatment of borderline and subclinical acute rejections prevent development and progression of CAN?

Histological markers of chronic allograft nephropathy (CAN) in early protocol biopsies may ultimately result in deterioration of graft function. The aim of our study was to evaluate risk factors of early CAN histology and to determine whether treatment of borderline and subclinical acute rejections (BR/SAR) at 1-month posttransplant, prevents development and/or progression of CAN at 6-month biopsy. Thirty-five paired kidney allograft biopsies at 1 and 6 months after transplantation were blindly reviewed using Banff'97 criteria. The mean CAN score (sum of histological markers for chronicity) increased significantly at 6-month biopsy (1.83 +/- 1.46 vs 4.66 +/- 2.35; p < 0.01). No CAN was present in 27/70 biopsies (38.6%), 71.4% showed progression and 28.6% were with stable CAN at 6-month biopsy. When compared according to the progression, mean histological index (HI) score (sum of acute/chronic changes) in progressed CAN group (pCAN) increased significantly at 6-month biopsy (5.0 +/- 3.0 vs 9.5 +/- 2.8; p < 0.001). At 1-month biopsy, BR/SAR were found in 68% and 70%, in the pCAN and stable (sCAN) groups, respectively. The percentage of treated BR/SAR in sCAN group was significantly higher (57.1 vs 23.5%; p < 0.05), and the score of acute histological lesions lower (1.08 +/- 0.95 vs 0.35 +/- 0.66; p < 0.01) at 6-month biopsy. In conclusion, 1-month protocol biopsy may be valuable to uncover BR/SAR and the presence of early CAN in stable renal allografts. Progression of CAN at 6-month biopsy in our study was found to be associated with a greater number of untreated BR/SAR at 1-month biopsy. This observation may have important implications in the design of clinical trials aimed to prevent the progression of CAN.

Acute Disease↗
PubMed2004

[The role of the von Willebrand factor in renal diseases and haemodialysis patients].

During a period of twenty years, the von Willebrand factor (VWf) biological activity was evaluated in 805 patients with vein thrombosis, diabetes mellitus, chronic renal failure and ischemic heart disease. The examined patients were 168 with vein thrombosis, 129 with diabetes mellitus, 412 with chronic renal failure (CRF), and 96 with ischemic heart disease. The biological activity was also determined in 104 haemodialysis patients using four different haemodialytic membranes: 30 on cuprophan membrane, 30 on polymethylmetacrylate membrane (PMMA), 24 on hemophane and 20 patients on polysulphone (PS) membrane. In 42 patients with arterio-venous fistula prone to thrombosis, the biological activity of the von Willebrand Factor was 178% in comparison to 106% in the control group. The biological activity of VWF was increased in patients with vein thrombosis (p < 0.02), in patients with diabetes mellitus (p < 0.01), CRF (p < 0.05), and in patients with ischemic heart disease (p < 0.01). The highest biological activity was found in patients on PMMA (p < 0.001), then cuprophan (p < 0.05) and hemophane membrane (p < 0.01), while the lowest increase of its concentration was noticed in patients on PS without statistical significance. In arteriovenous fistula prone to thrombosis patients biological activity of the von Willebrand Factor was significantly increased (p < 0.01). Our investigations show the importance of VWF as a marker of endothelial disfunction, a possible predictor of A-V fistula thrombosis, and a possible marker of haemodialysis membranes biocompatibility.

Diabetes Mellitus↗
PubMed2000

Accelerated growth and improved nutritional status after recombinant human growth hormone (rhGH) therapy in uremic children.

The effect of recombinant human growth hormone (Norditropin, Novonordisk) was studied in 6 children (4 boys and 2 girls) on maintenance hemodialysis, age 13.8 (range 11-17) years. The recombinant human growth hormone (rhGH) was given in a dose of 4 IU/m2/day s.c. Height velocity was followed 6 months before therapy (washout period) and 6 and 12 months later. Growth was estimated by use of Holtain stadiometer in the same conditions and by the same investigator. Nutritional status was assessed by anthropometric measurements including triceps skinfold thickness (TST), midarm muscle circumference (MAMC), and lean body mass (LBM), as well as serum albumin concentration. The mean height velocity increased from 1.67 +/- 0.98, before therapy to 3.33 +/- 1.25 and 6.70 +/- 0.9 cm 6 and 12 months after therapy, respectively (p < 0.001). Body weight also increased during the treatment period from 29.45 +/- 5.24 to 30.96 +/- 6.4 and 31.68 +/- 6.42 kg (p < 0.02) and so did body surface area from 1.01 +/- 0.12 to 1.07 +/- 0.13 and 1.15 +/- 0.1 m2 (p < 0.001). LBM increased from 26.8 +/- 5.4 to 29.85 +/- 6.42 and 31.1 +/- 7.01 kg 6 and 12 months after therapy (p < 0.001). There was a decrease in TST from 7.35 +/- 1.8 to 6.8 +/- 2.18 and 6.8 +/- 2.4 mm (p < 0.3, NS), and an increase in MAMC from 15.15 +/- 2.42 to 16.1 +/- 2.4 and 17.63 +/- 2.6 cm 6 and 12 months after therapy (p < 0.001). Serum albumin concentration increased from 33.5 +/- 1.22 to 36.0 +/- 2.4 and 38.66 +/- 1.03 g/L (p < 0.001). Nutrition parameters confirmed the beneficial effect of rhGH therapy. The authors recommend rhGH therapy in uremic children with growth retardation as well as in any case of malnutrition in these patients.

Adolescent↗
PubMed1999

Bioelectric impedance in the estimation of hemodynamic and fluid status in dialysis patients.

In order to estimate the hemodynamic and fluid changes, "dry body weight" and intradialytic stability, electric bioimpedance cardiography was performed in 37 dialysis patients during dialysis procedure, i.e. before, at 2 h and after dialysis. The following parameters were estimated: systemic vascular resistance index-fl. Ohm/m2 (SVRI), mean arterial pressure-Torr (MAP), thoracic fluid conductivity/Ohm (TFC), cardiac index-L/min/m2 (CI), left cardiac work index-kg m/m2 (LCWI) and ejection fraction % (EF). Results were compared with changes in total body water estimated by the urea kinetic model (UKM). The patients were divided into three groups: normotensive (n = 12), hypertensive (n = 15) and hypotensive (n = 10). EF was increased in all the three groups, but only in hypotensives this change was significant (from 40.5 +/- 9.1 to 50.2 +/- 5.41, p < 0.01). The changes in other hemodynamic parameters (CI, LCWI, SVRI) did not reach statistical significance. TFC decreased significantly in all the three groups: normotensive from 0.056 +/- 0.009 to 0.048 +/- 0.009 (p < 0.001), hypotensive from 0.043 +/- 0.009 to 0.035 +/- 0.058 (p < 0.001) and hypertensive from 0.054 +/- 0.016 to 0.045 +/- 0.014 (p < 0.001). These changes were accompanied by a significant decrease in total body water (TBW): from 34.05 +/- 4.19 to 32.72 +/- 4.51 in the hypotensive group, from 34.06 +/- 7.18 to 32.91 +/- 7.27 in the normotensive group, and from 38.92 +/- 7.06 to 37.59 +/- 7.04 in the hypertensive group. The technique was found to be simple, noninvasive and helpful for the estimation of individual hemodynamic changes during dialysis procedure.

Blood Pressure↗
PubMed1998

Plasmapheresis in treatment of acute oligoanuria in crescentic glomerulonephritis.

Plasmapheresis therapy can provide an approach in the treatment of crescentic glomerulonephritis by mechanically removing nephritogenic factors from the circulation, both antiglomerular basement membrane antibodies and circulating immune complexes as well as antineutrophil cytoplasmic antibodies (ANCAs). We present our experience with plasmapheresis treatment in patients with acute oligoanuria caused by crescentic glomerulonephritis. We used membrane plasmapheresis to treat 11 patients with crescentic glomerulonephritis with more than 80% crescent formation on biopsy and with acute onset of the disease and acute oligoanuria. The immune complex form of the disease was documented in 7, the antiglomerular basement membrane antibodies mediated (anti-GBM) form in 2, the ANCA-associated form in 1 case, and the recurrent anti-GBM form in 1 patient. Plasmapheresis was performed 2-3 times weekly using Bellco BL 500 and Gambro 2000 PF plasma filters. The total number of plasma exchanges (2,000-2,200 ml each) for each patient was 5-9. The treatment was associated with steroids and cyclophosphamide. The improvement of renal function with the start of diuresis and significant decrease of creatinine from the range of 786-1,301 microM at the start of the treatment was noted in 5 of the 11 patients. The duration of remission without hemodialysis was 6-12 months. Treatment with plasmapheresis in cases with recurrent anuria was without benefit. We can conclude that plasmapheresis can delay end-stage renal failure in cases with acute onset of crescentic glomerulonephritis.

Acute Disease↗
PubMed1997

Acute renal failure with severe tubulointerstitial changes in a patient with minimal change nephrotic syndrome treated with enalapril.

A 35-year-old nephrotic man developed acute renal failure with serum creatinine to 1543 micromol/l after a month of therapy with enalapril. Renal biopsy demonstrated minimal glomerular changes with fusion of podocytes, tubular necrosis with regeneration of tubular epithelial cells, interstitial edema with focal interstitial fibrosis, and interstitial infiltration with neutrophils, eosinophils, plasma cells and mononuclear cells. Three hemodialyses were performed in the patient during the oliguric phase of the disease. Renal function was restored after withdrawal of enalapril and initiation of steroid therapy. Steroids also contributed to the improvement of the nephrotic syndrome and proteinuria decreased from maximal ranges of 27 g/l to 2.2 g/l after six months of the follow-up. Similar cases were previously described associated with captopril treatment, but not with enalapril.

Acute Kidney Injury↗
PubMed1996

[Membranous glomerulonephritis].

We report on 59 patients with membranous nephropathy, 37 male and 22 female, aged between 15 and 72 years (33.2 +/- 11.5). Light microscopy was performed in all cases, immunofluorescent in 53 and electron microscopy in 10 cases. Clinical data (renal function, nephrotic syndrome and hypertension) were taken into consideration. Follow-up period was 6 months to 16 years. The outcome of the disease was on 5 ways: I (17 patients)-long remission without proteinuria or with a presence of non-nephrotic proteinuria, II (11 patients)-relapsing disease, III (22 patients)-persistent nephrotic syndrome with slow progressive renal failure, IV (3 patients) rapid development of chronic renal failure and V (5 cases) remission after long period of occurrence of nephrotic syndrome and elevated serum levels of urea and creatinine. Predictors for the poor prognosis were male sex, elevated serum creatinine and hypertension at biopsy (clinical) and tubulo-interstitial changes (morphologic).

Adolescent↗
PubMed1996

[Disorders of renal function in patients with minimal change glomerulopathy].

We report a group of 27 patients with minimal-change nephrotic syndrome who experienced complete recovery from the nephrotic syndrome and the other clinical signs during follow-up. At the start of the examination elevated serum urea was found in 10 (37%) and serum creatinine in 4 (15%) patients. Creatinine clearance was decreased in 10 (37%), systolic blood pressure was elevated in 8 (29%) and diastolic in 11 (41%). Interstitial oedema was found in 3, tubular parenchymal degeneration in 4, slight interstitial mononuclear infiltration in 6 and slight interstitial fibrosis in one patient. Complete recovery of renal function was seen in all patients.

Adolescent↗
PubMed1995

Hantaan virus infection with acute renal failure.

We report on 10 patients with acute renal involvement in Hantaan virus infection observed at the Department of Nephrology, Faculty of Medicine, Skopje, Republic of Macedonia, during a period of 3 years (October 1987-July 1990). Eight patients were male and 2 were female, aged 37.5 +/- 4.8 years. The diagnosis of Hantaan virus infection was proven by an indirect immunofluorescent and ELISA test with a significant increase of the titer after a week to ranges from 1:512 to 1:2,048. Percutaneous renal biopsy was performed in 3 cases using standard procedures for optical and immunofluorescent microscopy. Fever, weakness, headache, conjunctival injection, hematuria, and lumbar pain were clinical features all patients had in common. Complete anuria was noted in 7 out of 10 and oliguria in the other 3 of the 10 cases with serum levels of creatinine 967 +/- 152.6 mumol/L. Other following laboratory findings were leukocytosis in 10 out of 10 patients, with neutrophylia, and reduction of serum sodium and potassium in 8 out of 10, and a decrease in serum complement C3 in 3 out of 10 patients. Percutaneous renal biopsy confirmed interstitionephritis in 2 out of 3 biopsied patients and acute diffuse proliferative glomerulonephritis in the third. Interstitial mononuclear infiltration with dominant T cells proven with monoclonal antisera (direct immunoperoxidase method) was present in all 3 cases. The outcome of the disease was good in 8 of the 10 patients with a development of polyuric phase and complete recovery of renal function later. One patient with interstitial lesions on biopsy developed chronic renal failure, and the other with a concomitant brucellosis died during the polyuric phase of the disease.

Acute Kidney Injury↗
PubMed1994

Development of renal failure in IgA nephropathy: the importance of interstitial infiltration and deposition of fibrinogen.

We analyzed renal biopsy specimens of 60 patients with IgA nephropathy, 34 male and 26 female, aged 32, 8 +/- 9, 1. Patients were divided into 5 classes according to the morphological classification proposed on the basis of WHO criteria: 1, minimal lesions; 2, minor changes; 3, focal and segmental glomerulonephritis; 4, diffuse mesangial proliferation; and 5, sclerotic changes. Interstitial infiltration on optical microscopy and fibrinogen deposition on immunofluorescent microscopy were graded using a semiquantitative score. Clinical features (hypertension, proteinuria, erythruria/hematuria, renal function) were taken into consideration. The Mann-Whitney test was used for comparison of results between different classes. Classes 1 and 2 were younger (p < 0.01) and had significantly better renal function than classes 3 and 4. Proteinuria was significantly higher in classes 2 and 3 (p < 0.001) than the others. Macroscopic hematuria was more frequent in classes 1 and 2. Hypertension was absent in class 1 and correlated with the severity of histologic changes. Interstitial infiltration was absent in class 1 and also correlated with the degree of histological changes, but in contrast, fibrinogen deposits were more severe in earlier histological classes.

Adult↗
PubMed1994

The importance of the clinico-pathological presentations in the evaluation of the survival of patients with IgA nephropathy.

The authors analyzed renal biopsy specimens, clinical data (erythruria/hematuria, severity of proteinuria, occurrence of hypertension and renal failure) and survival (using the original method by Cutler and Ederer) in 60 patients with IgA nephropathy, 34 were male and 26 female aged between 15 and 56 years (32.8 +/- 9.1). The authors divided all cases in 5 classes taking into consideration glomerular changes: class 1 disease-minimal lesions, class 2-minor changes, classes 3-focal and segmental lesions, class 4-diffuse proliferation and class 5 disease-diffuse sclerotic changes. The authors found that: class 1 was younger than the others; macroscopic hematuria was more frequent in classes 1 and 2; proteinuria was significantly higher in classes and 3; and hypertension was absent in class 1 correlating with the severity of glomerular changes. Development of chronic renal failure and occurrence of kidney death also correlated directly with the severity of histologic glomerular classes.

Adolescent↗