ABSTRACT
BACKGROUND: Pregnancy in patients with advanced chronic kidney disease (CKD) is associated with a high risk of adverse outcomes for the mother and the fetus, but data on the characteristics of the course of pregnancy in these women is limited. AIM: To analyse of the course and outcomes of pregnancy in patients with CKD stages 3a4. MATERIALS AND METHODS: Thirty five pregnant women with CKD stages 34 were included: 3a 12 (34.3%) patients, stage 3b 10 (28.6%), stage 4 13 (37.1%). RESULTS: Proteinuria, serum creatinine, blood pressure in dynamics, the presence of a physiological response were investigated. Pregnancy management included blood pressure correction, antianemic, antiplatelet, anticoagulant therapy, prevention and treatment of urinary infection, correction of metabolic disorders. All pregnant women had proteinuria of varying severity, which increased towards the end of pregnancy. Seventeen (51.5%) patients had hypertension, successfully corrected with antihypertensive drugs. The average delivery term was 34.6 weeks. Preeclampsia developed in 14 (42.4%) cases, an inverse relationship was found between the presence of a physiological response and preeclampsia (p=0.009; rs=-0.463). All children were born alive and viable. After delivery in patients with CKD 3a creatinine values returned to the pre-gestational level, in patients with grade 3b and 4 progression of CKD was noted. CONCLUSION: A favorable pregnancy outcome in women with late stages of CKD is possible with constant monitoring by a multidisciplinary team of doctors with mandatory monitoring of renal function, proteinuria, blood pressure, coagulation, markers of preeclampsia and indicators of fetal health. It was proposed to consider the physiological response of the kidneys to pregnancy as a predictor of a favorable outcome.
Subject(s)
Pre-Eclampsia , Pregnancy Complications , Renal Insufficiency, Chronic , Child , Pregnancy , Humans , Female , Pre-Eclampsia/diagnosis , Creatinine , Pregnancy Complications/diagnosis , Pregnancy Complications/drug therapy , Antihypertensive Agents , Pregnancy Outcome , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/diagnosis , Proteinuria/diagnosis , Proteinuria/etiology , AnticoagulantsABSTRACT
Atrial fibrillation (AF) is the commonest heart arrhythmia with the estimated incidence of 1-2%. It affects over 6 mln persons in Europe, its prevalence is expected to be twice the current level within the next 50 years. AF is known to increase the risk of ischemic stroke by five times and be the cause of each fifth stroke. Ischemic stroke in AF patients as a rule has a fatal outcome and leads to more severe disability than stroke of different nature; also, it recurs more frequently. Modern approaches to the treatment of this pathology by antiarrhythmic medicines, defibrillation, and new antithrombotic agents as recommended by international societies of cardiologies.
Subject(s)
Atrial Fibrillation , Atrial Fibrillation/diagnosis , Atrial Fibrillation/drug therapy , Atrial Fibrillation/surgery , HumansABSTRACT
AIM: To analyse the results of treatment of children and adolescents with acute promyelocytic leukemia (APL) including polychemotherapy and ATRA (protocols APL 93, 98 and 2003). MATERIAL AND METHODS: The course of the disease, modification of the treatment protocols with reduction of anthracyclines and ATRA doses, results of molecular monitoring of PML/RARalpha transcript have been analysed for 107 APL patients. RESULTS: For prognosis of the disease important are initial characteristics of the patient and the time of the tumor regress assessed by molecular methods--establishment of molecular remission and molecular recurrence. CONCLUSIONS: In APL it is necessary to conduct molecular monitoring especially in patients at high risk and with poor prognosis in a decrease of treatment intensity for toxicity relief. Detection of molecular recurrence is indication for treatment. To raise efficacy of APL recurrence therapy it is necessary to design a special updated protocol.
