Biomedical subjects
Publications and source records attributed to P Tepavcević.
The authors review their results of five year follow up of renal transplantation. They summarised the results of treatment with three immunosuppressive regimens. There is an analysis of rejection episodes, recurrent glomerulonephritis, infections, surgical complications, a median graft as well as patient survival and other patterns of complications of renal transplantation.
Acute glomerulonephritis is a distinct clinical entity, more frequently found in younger age. We report 69 patients with AcGN (25 female and 44 male) mean age 26 years (range 15-58). The disease is clinically characterized with hypertension (57%), edema (59%) and oliguria (35%). Urine analysis showed microhaematuria/proteinuria (36%) and micro/macrohaematuria alone in 89%, while azothaemia was observed in 16% pts, and decreased serum complement levels in one third of patients, more often decrease of C3 (33%) than C4 (15%). Initial infection of the upper respiratory tract was seen in 65%, pneumonia in 8%. In 25% of pts. there were no data of previous infection. Cultures of pharyngeal smear revealed. Streptococcus only in 2 pts. Elevated AST titer was found in 32% pts. Eleven kidney biopsies were made, and histological examination showed 2 normal findings, 6 mesangioproliferative GH, 2 endocapillary GN and 1 membranoproliferative GN. Follow ups have showed urinary abnormalities in 25% of pts., without developing renal failure.
Renal involvement i.e. lupus nephritis (LN) in systemic lupus erythematosus (SLE) mainly determines course and outcome of the disease. Recognition of early manifestations of LN makes adequate therapy possible, with very good therapeutic results. We report 7 patients from a group of 150 SLE patients under our permanent control, 4 female and 3 male, mean age 21 years. All of them had signs of LN: proteinuria 7/7 haematuria 4/7 without azotaemia. Renal biopsy was performed in 6 pts, and histological finding was: class II 1 pt, class IV 3 pts and class V in 2 pts. In 4 pts tubulointerstitial changes were noted, while all showed immunofluorescent deposits of immunoglobulins and complement. Methylprednisolone "pulse" therapy (1000 mg, i.v., 3 days) followed by tapering of the steroid dose was given. Reduction of proteinuria and disappearance of haematuria were observed in all patients. During follow up, kidney function remained normal.
Abnormal immune reactivity, with a production of multiple autoantibodies specially against the components of a nucleoplasm is one of the hallmarks of systemic lupus erythematosus (SLE). Our investigations were conducted on 102 patients with SLE, classified according to the criteria of ARA, aiming to better characterize the overall incidence of anti-nuclear antibodies in SLE, to determine the type of immunofluorescent staining of the nuclei, and to characterize the fine specificity of such antibodies using modified ELISA procedure. Results of our investigation show that 95% of patients with SLE have detectable anti-nuclear antibodies. Predominant pattern of nuclear staining is homogeneous, followed by a speckled type, while the rim (peripheral) pattern is relatively infrequent. Anti-nuclear antibodies showed the highest reactivity against native DNA (70% of patients), which was followed by binding to SS-A, eRNP and SS-B antigens. Interestingly, using ELISA procedure we could observe the reactivity against Sm antigen only in 5% of SLE patients. In patients who showed homogeneous or rim pattern of nuclear staining the predominant type of reactivity was against native DNA, while in patients with speckled type most frequent binding to non-histone proteins was observed. The most frequently observed individual pattern of ANA reactivity was of polyreactive type.
We investigated the effects of NSAIDs (Ibuprofen) on renal plasma flow (RPF) and glomerular filtration rate (GFR) in patients with glomerulonephritis. The study included 98 patients (53 men and 45 women) with idiopathic glomerulonephritis. All of the patients received Ibuprofen 1200 mg (3x400) during 7 days. Before and after the treatment with Ibuprofen ERPF (clearance of 131I-Hippuran) and GFR (clearance of 99mTc-DTPA) were determined. In our patients administration of Ibuprofen was associated with a significant reduction in renal plasma flow and glomerular filtration rate. In patients with reduced renal function the decrease in RPF and GFR after Ibuprofen was significantly greater than in patients with normal renal function.
This paper points out some problems appearing in the selection of candidates for the cadaveric kidney transplantation treats basic issues regarding medical and other references important for making decision in the process of candidate selection, emphasizes the significance of data base for prepared candidates and presents the specific example of the applications of APLLE II C in the practice of the clinic for nephrology. The data for each candidate are grouped in two sections: A. PERSONAL DATA 1. Family name and surname 2. Year of birth 3. Place of residence 4. Address 5. Telephone number 6. Register number of case history 7. Date of enlisting B. BASIC MEDICAL DATA 1. Blood type 2. HLA tipization of tissue: A, B, C, DR 3. Cytotoxic antibodies 4. Urgency priority 5. Date of eventual previous transpl. 6. Special remarks This mode of Candidate selection provides the availability of all relevant data at one place: objectivity and high efficiency. Creation of such data base in every Yugoslav Kidney Transplantation Center would "at the time" mean the formation of YU Information System, thus providing a possibility of choice of the most appropriate cadaveric Kidney recipient on Yugoslav level at any time.
In 38 patients with the positive finding of protein in the urine the determination of beta-2 microglobulin concentration was made in addition to the simultaneous determination of albumin, IgC and transfer in the urine and the calculation of differential protein clearance values for the identification of tubular proteinuria. Only 4 (10.53%) patients had proteinuria of tubular type, 16 patients had proteinuria of glomerular type, while proteinuria of the mixed glomerulo-tubular type was found in 18 (47.37%) patients. The safe separation of tubular proteinuria from that of glomerular type was made possible by the determination of beta-2 microglobulin concentration in the urine in the framework of detailed investigation.
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