Biomedical subjects

P Kes

Publications and source records attributed to P Kes.

At least 19 recordsLinked to original sources

PubMed2005

Does mycophenolate mofetil increase the incidence of cytomegalovirus disease compared with azathioprine after cadaveric kidney transplantation?

Although most of the published papers had not found increase in the incidence of CMV disease in kidney transplant recipients treated with mycophenolate mofetil (MMF), we had feeling from everyday practice that after its introduction number of patients with CMV disease has increased. To test this hypothesis, we performed retrospective analysis of our database, comparing the incidence of CMV disease in patients treated with azathioprine (AZA) and patients treated with MMF. CMV disease was defined as CMV antigenemia (positive CMV pp65 determined by ELISA test) plus any of the following: decrease leucocytes or platelets, increased transaminases, increase in serum creatinine. The azathioprine treated group (AZA group) included 280 patients (132 female) treated for 17,672 months with AZA + Cyclosporine A (CyA) + steroid, or AZA + steroid, while the MMF group included 219 patients (112 female) treated for 5079 months with MMF + CyA + steroid, or MMF + steroid. There was no difference in acute rejection episodes between the AZA and the MMF group. The AZA group had 51 CMV disease episodes (1 episode per 346.5 treatment months), and the MMF group experienced 43 episodes (1 per 118.1 months) (P < .01). Mean onset of CMV disease was 32.65 +/- 47.69 (SD) months after transplantation in the AZA group, and 3.72 +/- 4.43 in the MMF group. There was no difference between two treatment groups regarding the donor-recipient CMV status mismatch. Despite having the increased incidence of CMV disease, MMF group had less severe disease compared to AZA group with decrease in leukocyte count in 11.6% vs 15.7% of episodes, decrease in platelet count in 20.9% vs 21.6%, elevation of transaminases in 18.6% vs 29.4% respectively, and finally increase in serum creatinine greater than 20% in 51.2% in MMF vs 74.5% in AZA group. Five patients from the AZA group experienced CMV pneumonitis with the mortality rate of 80%. Only one patient from the MMF group had CMV pneumonitis, and he survived. According to our results, patients treated with MMF have increased risk for development of CMV disease. However, the disease course is less severe, and less frequently accompanied with deterioration of renal function in comparison to the AZA group.

Adrenal Cortex Hormones↗

PubMed2001

Sudden deaths of Croatian hemodialysis patients in October 2001.

In 2001, there were 2,719 patients with chronic renal failure dialyzed in Croatia. Death rate in this patient group was 10.3%, similar to that in other countries. On October 12, 2001, the Croatian Institute of Public Health received information that four patients unexpectedly died in the dialysis center in Pozega General Hospital in a single day. Within a week, a total of 23 dialysis patients died in Croatia, of whom 5 during hemodialysis, and 18 within several hours after hemodialysis. Those events prompted us to assess the epidemiological situation in all hemodialysis centers in Croatia. We used phone contacts and reports of regional centers to collect the data. Clinical picture of the patients before death was characterized by dyspnea, hypotension, and cardiac arrest; resuscitation was unsuccessful in all cases. Analysis of all possible risk elements associated with hemodialysis revealed that dialysis devices, dialyzate, water, and personnel were different in all cases, and that the only common denominator in all events was dialyzer P-15 or P-18, manufactured by Baxter, USA, and distributed by Pliva, Croatia.

Croatia↗

PubMed2001

Healing of skin necrosis and regression of anticardiolipin antibodies achieved by parathyroidectomy in a dialyzed woman with calcific uremic arteriolopathy.

AIM: To present the impact of parathyroidectomy on the spontaneous healing of necrotic lesions of the skin of the lower leg and on anticardiolipin antibodies regression in a 68-year-old female dialyzed patient with hyperparathyroidism and calcific-uremic arteriolopathy (CUA). METHODS: After the occurrence of initial lesions of the lower leg skin, the intact parathyroid (iPTH) level, calcium (Ca) and phosphorus (P) product were measured, and on two occasions at 6-week intervals, the titer of anticardiolipin antibodies was determined, followed by a clinical monitoring of the progress of necrotic skin lesions. Two months after the occurrence of the skin lesions, the patient's right leg was amputated below the knee due to gangrene, and a histopathological analysis of the skin tissue sample of the amputated lower leg was made. After parathyroidectomy, iPTH, Ca x P product were measured, and on two occasions at 6 weeks' intervals, anticardiolipin antibodies titer was determined, followed by a clinical monitoring of lesions of the left lower leg skin. RESULTS: Before parathyroidectomy, iPTH level and Ca x P product were increased, as well as IgG anticardiolipin antibody titer measured on two occasions 6 weeks apart. The histopathological analysis of the skin tissue sample of the amputated right lower leg showed mural calcification of artery walls and thrombotic occlusions of small arteries, arterioles, and dermal capillaries, in addition to epidermolysis. A week after parathyroidectomy, iPTH level and Ca x P product were within normal range. Two measurements 6 weeks apart revealed no anticardiolipin antibodies. Eight weeks after parathyroidectomy, spontaneous healing of necrotic skin lesions of the left lower leg was observed. CONCLUSION: Regression of anticardiolipin antibodies, normalization of Ca x P product, and healing of the skin lesions after parathyroidectomy all pointed to the elevated PTH level as a crucial factor in the pathogenesis of CUA.

Aged↗

PubMed2001

Myeloma kidney: pathogenesis and treatment.

Renal failure frequently complicates the course of multiple myeloma. Factors that determine the development of myeloma kidney include a high rate of light chain excretion, biochemical characteristics of light chain, and concurrent volume depletion. There are two main pathogenetic mechanisms; i.e. direct tubular toxicity and intratubular cast formation. Therapeutic measures include chemotherapy, bone marrow or peripheral blood stem cell transplantation, hyperhydration, plasmapheresis, dialysis, solving of hypercalcemia, treatment of anemia with erythropoietin, and avoidance of nephrotoxic drugs and radiocontrast agents. Experimental approach includes administration of colchicines and alkalinization of the urine.

Humans↗

PubMed2001

Lipid abnormalities in chronic renal failure, nephrotic syndrome and dialysis.

Cardiovascular, cerebrovascular and peripheral vascular development are the largest cause-specific reason for morbidity and mortality in end-stage renal disease (ESRD) patients. The high prevalence of cardio- and cerebrovascular death may be explained by multiple factors present in patients with progressive renal disease, including hypertension, hyperlipidemia, hyperhomocysteinemia, diabetes mellitus, and hyperparathyroidism. Experimental studies have provided in vivo and in vitro data to support the notion that lipid abnormalities contribute to glomerular and interstitial injury of the renal parenchyma. Hyperchlolesterolemia and increased low-density lipoprotein (LDL) cholesterol are prevalent in patients with the nephrotic syndrome. Plasma high-density lipoprotein (HDL) cholesterol is decreased, and reverse cholesterol transport is impaired in hemodialysis (HD) and pre-ESRD patients. Chronic renal failure patients treated with HD have an increased prevalence of intermediate-density lipoprotein (IDL), and lipoprotein(a). The findings in diabetic patients corresponded with those in nondiabetic patients with renal failure, but diabetic patients have higher apoliprotein C-III and apoliprotein E concentrations. Impaired lipid metabolism is common in patients receiving peritoneal dialysis (PD). In most ESRD patients treated with peritoneal dialysis hypercholesterolemia and hyperglyceridemia are found. Wide panels of therapeutic interventions aimed at correcting the lipid abnormalities that may develop in chronic renal patients as well as in ESRD patients are currently available. Although some novel pharmacological agents are remarkably effective in returning the lipid abnormalities to normal, there is still no convincing evidence based on long-term prospective studies, that would clearly demonstrate a significant reduction of cardiovascular morbidity and mortality of ESRD patients. The therapeutic approaches, which may be considered, include mainly dietary and life-style modifications, selective use of some technical components of dialysis systems, and the judicious prescriptions of lipid-lowering drugs.

Humans↗

PubMed2000

Effects of renal transplantation on hearing and ocular changes in a monozygotic twin with Alport's syndrome: comparison with other twin on hemodialysis.

AIM: To present a unique case of Alport's syndrome in monozygotic twins with two different treatment modalities - renal transplantation and hemodialysis, and to evaluate the effects of therapy on hearing and ophthalmological findings. METHODS: Pure-tone audiogram and ophthalmologic examinations were performed in both twins at the age of 30. At the age of 46, 4 years after renal transplantation in the first twin and after 6 years of hemodialysis in the second twin, both twins underwent control audiometric and ophthalmologic examinations. RESULTS: Control audiometric measurements showed the progression of bilateral sensorineural hearing loss in the high-frequency range (>2,000 Hz) in both twins. The hearing threshold progressed from initial 50 dB in both twins at the time of the diagnosis to 55 dB in the twin on hemodialysis, and 85 dB in the twin with a transplanted kidney. Retinal blurry hyperpigmentations disappeared in the twin with a transplanted kidney. CONCLUSION: In comparison with hemodialysis, renal transplantation in Alport's syndrome may have deleterious effect on hearing, when associated with plasma hyperviscosity and hyperlipidemia, but may lead to regression of retinal hyperpigmentation.

Adolescent↗

PubMed2000

Acute acalculous cholecystitis in patients with surgical acute renal failure.

Acute acalculous cholecystitis (AAC) developed in 11 (7.7%) of 143 patients with surgical acute renal failure (ARF) who had no prior biliary tract disease. The cause of this potentially fatal complication is multifactorial and include trauma, previous surgery, sepsis, intermittent positive pressure ventilation, total parenteral nutrition, multiple transfusions, hypotension, and opiate sedation. The diagnosis of AAC was based on clinical suspicion, ultrasound scanning, and laboratory tests (leukocyte count, liver enzymes, bilirubin and C-reactive protein). All our ARF patients with AAC were receiving antibiotics at the time of diagnosis. Five patients were treated conservatively and six underwent cholecystectomy. The mortality rate in our ARF patients with AAC was 45.5%, and was not significantly different from than in ARF patients without AAC. The diagnosis of AAC should be made early, and judicious management (conservative or surgical) decreases its role as a contributory factor to the mortality in ARF patients.

Acute Disease↗

PubMed2000

Slow continuous renal replacement therapies: an update.

Continuous renal replacement therapies (CRRT) are now being used by nephrologists, intensivists, and anesthesiologists. The various CRRT modalities differ in the kind of vascular access, the application of diffusive or convective clearances (or a combination of both), and in the location where the replacement fluid enters the circuit. CRRTs have certainly made the management of critically ill patients with acute renal failure (ARF) combined with cardiovascular instability, severe fluid overload, hypercatabolism, cerebral edema, adult respiratory distress syndrome, lactic acidosis, sepsis or other inflammatory syndromes, crush syndrome, congestive heart failure, and cardiopulmonary bypass easier. Continuous therapies incorporate several advantages including improved hemodynamic stability, optimal fluid balance, gradual urea removal, elimination of septic mediators, and the possibility of unlimited parenteral nutrition. Major difficulties and unsolved problems of CRRT are the ongoing necessity of continuous anticoagulation, considerable loss of amino acids, vitamins, trace elements, potassium, phosphate, and some drugs, as well as immobilization of the patient. The advantages of CRRT should theoretically translate into improved outcomes of critically ill ARF patients, but the superiority of continuous modalities in terms of outcome is still controversial, despite encouraging results in some clinical trials. Currently used CRRT with sophisticated treatment devices has become more expensive than hemodialysis, but the cost cannot be used as an argument against the continuous treatment modalities.

Acute Kidney Injury↗

PubMed2000

Hepatorenal syndrome: new perspectives in pathophysiology and management.

Hepatorenal syndrome (HRS) is a unique form of acute renal failure occurring in patients with advanced liver disease. Despite the severe derangement of renal function and ominous prognosis, minimal pathologic abnormalities of the kidneys are found at autopsy. The kidneys, if transplanted, are capable of normal function, which supports the concept that renal failure is functional and potentially reversible. The pathogenesis of HRS is not completely known, but it is probably the result of an extreme underfilling of the arterial circulation secondary to an arterial vasodilation located in splanchnic circulation. Besides the renal circulation, all other extrasplanchnic vascular beds also appear to be vasoconstricted. The diagnosis of HRS is currently based on several widely accepted diagnostic criteria aimed at excluding nonfunctional causes of renal failure. Recently initiated therapeutic approaches lend a note of optimism to the future management of HRS. These include liver transplantation as definitive treatment for patients with end-stage liver disease, and introduction of new vasoconstrictor drugs with the preferential effect on the splanchnic circulation. The development of HRS after spontaneous bacterial peritonitis may be effectively prevented by the administration of albumin together with antibiotic therapy.

Hepatorenal Syndrome↗

PubMed2000

Hyperhomocysteinemia in end-stage renal failure.

The end-stage renal disease (ESRD) population experiences an excess morbidity and mortality due to arteriosclerotic cardiovascular disease (CVD) outcomes. Specifically, event rates for myocardial infarction and stroke are 5- to 10-fold in ESRD patients on maintenance dialysis than in the general population. Recently, there is controlled evidence that hyperhomocysteinemia occurs more commonly than any of the traditional CVD risk factors in ESRD patients. Prolonged exposure of endothelial cells to homocysteine impairs the production of nitric oxide and endothelium-dependent vasodilatation, they combine with low-density lipoprotein cholesterol to produce aggregates that are taken up by vascular macrophages in the arterial intima (foam cells), produce aggregatory effects on the platelets, and decrease endothelial antithrombotic activity due to changes in the thrombomodulin function. Current treatment regimens for ESRD hyperhomocysteinemia, which are based on the pharmacological doses of folic acid (5 to 15 mg/day), frequently result in suboptimal lowering of Hcy concentrations. Other potential therapeutic approaches (such as oral N-acetylcysteine at 1.2 g/day) merit controlled investigation.

Arteriosclerosis↗

PubMed1999

Biocompatibility of dialysis membrane.

During the last years, the progress in membrane development has contributed to the improvement of hemodialysis (HD) treatment. The performance of a dialyzer membrane is determined by its structure, overall mass transfer properties, and biocompatibility. Membrane biocompatibility, however, is not exclusively influenced by the membrane structure but also by the medication taken during dialysis and patient's underlying disease. The contact of dialyzer membranes with blood may stimulate an alternative pathway of the complement system, activation of the kinin system, activation of the coagulation system, generation of the fibrinolytic activity, as well as activation of the plasma immune system. Although the cell biological and biochemical consequences of bioincompatibility during HD have been extensively studied, the clinical significance of these changes still remains controversial. Recent data suggest that in acute and chronic HD patients, the biocompatibility of the dialysis membrane is an important predictor of morbidity and mortality.

Acute Kidney Injury↗

PubMed1999

Extracorporeal treatment for refractory hyperlipidemia.

Radical, non-pharmacological, methods of treatment should never be used until it has first been shown that conventional therapy either fails to control hyperlipidemia or cannot be tolerated by the patient. In general, the use of extracorporeal techniques will be restricted to patients with severe familial hypercholesterolemia, although occasionally they may be resorted to in other categories of hyperlipidemia. Seven different procedures are available today for routine clinical practice: unselective plasma exchange, semi-selective double filtration and its modifications as well as the highly selective procedures of immunoadsorption, chemo-adsorption onto dextran sulfate, heparin induced LDL precipitation lipoprotein(a) column, and LDL hemoperfusion (direct adsorption of lipids--DALI). Large-scale regression studies were performed with five highly selective treatment modalities. Control coronary angiograms obtained after about two years of treatment showed that atherosclerotic plaques on coronary arteries had not enlarged or had even been reduced in 80% to 90% of patients.

Adsorption↗

PubMed1999

Therapeutic plasma exchange.

Therapeutic plasma exchange is a treatment modality used for over two decades in a variety of diseases. The purpose of this review is to outline the general principles of, including its rationale, current indications, prescription, and complications. The treatment of complications and methods to reduce the risk of their occurrence are outlined. Apheresis technology developments offer new hopes and promises for the clinician team.

Humans↗

PubMed1999

Acute renal failure after open heart surgery: prevention and management.

The frequency of acute renal failure (ARF) in the setting of open heart surgery is high, because the patients are frequently elderly, may have atherosclerosis, diabetes mellitus, hypertension, or previous renal disease. The appropriate preoperative patient preparation might be the first step treatment. The choice of renal support used in the care of ARF patients may influence the ultimate outcome, and therefore dialysis treatment must be tailored to each individual patient.

Acute Kidney Injury↗

PubMed1999

Acute carbon monoxide poisoning as the cause of rhabdomyolysis and acute renal failure.

Acute renal failure (ARF) is a severe complication of acute CO poisoning which, combined with other organ lesions, may result in lethal outcome. In all vague cases of ARF with nontraumatic rhabdomyolysis, CO poisoning should be considered as a possible etiologic factor. The diagnosis is made on the basis of several simple laboratory tests: determination of carboxyhemoglobin concentration, demonstration of myoglobin in urine or pigment granulated cylindres in urinary sediment, positive orthotoluidine test, and high CPK values originating from skeletal musculature. Many authors report on excellent prognosis in ARF due to nontraumatic rhabdomyolysis of various causes. Our case report shows that the prognosis of CO poisoned patient greatly depends on timely and appropriate treatment, severity of damage to other organs, and success of the treatment of complications such as hospital infections.

Acute Disease↗

PubMed1998

Efficacy of therapeutic plasma exchange in specific renal disease.

Therapeutic plasma exchange (TPE) is a treatment modality used in a variety of disease states, some of which are characterized by renal involvement (i.e., primary and secondary rapidly progressive glomerulonephritis, myeloma nephropathy, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome). The aim of this review was to summarize the results of clinical studies that evaluated TPE efficacy in some renal diseases, and to give general guidelines for treatment strategies in specific renal diseases.

Humans↗

PubMed1998

Beta-2-microglobulin kinetics during paired filtration dialysis.

Although the accumulation of beta-2-microglobulin (beta2M) occurs in end-stage renal disease (ESRD) patients prior to the initiation of dialysis, there is increasing evidence that the mode of dialysis treatment plays an important role in the development of amyloidosis. In the present study, a hemofiltration technique that uses both convection and diffusion, with a double chamber hemodialyzer composed of high-flux polysulphone and hemophan (paired filtration dialysis--PFD) was evaluated with regard to the beta2M removal capacity during PFD in 8 stable ESRD patients. PFD resulted in a significant (P < 0.001) beta2M removal during a 210-min dialysis session. The sieving coefficient was calculated to be 0.6 +/- 0.07 at 60 min after the start of PFD. The mean beta2M concentration in the ultrafiltrate was 13.4 +/- 1.6 mg/L, and total quantity cleared by convection alone was 135.9 +/- 12.6 mg/session. These data demonstrate that PFD is a highly efficient, variable convection-diffusion rate mixed depuration technique, that can remove beta2M with a minimal back-filtration risk and without the need of great amounts of special reinfusion solutes.

Adult↗

PubMed1998

Therapeutic plasma exchange in severe sepsis or septic shock.

Endotoxic shock with multiorgan dysfunction syndrome (MODS) is fatal in more than 80% of cases and is the leading cause of death in patients admitted to intensive care units. The incidence has increased to more then 100% in the last 10 years and there has been no significant decreases in its morbidity and mortality. The systemic inflammatory response to infection, e.g. sepsis, develops when the endotoxins activate various cascade systems. The activation of the cascade systems triggers further release of various active substances and cytokines. The progress may result in consumption coagulopathy, which may further generate an acute septic shock, disseminated intravascular coagulation, and MODS. When more than 3 organs are involved, the risk of fatal outcome exceeds 80%. The use of plasma exchange may be a beneficial adjunct to therapy during a progressive septic shock with MODS, when the patient does not respond to classical intensive care unit therapy. The beneficial effect, recently reported for plasma exchange procedures in patients with sepsis, may be due to the removal of various toxins and waste products from the blood, and administration of plasma from healthy subjects.

Humans↗