[Renal transplantations in the Centre for Nephrology in Szombathely, 1976-2016]. / Veseátültetések a szombathelyi nefrológiai centrumban, 1976­2016.

INTRODUCTION: The organized nephrological care in Szombathely commenced its activities in 1976. AIM: Follow-up of our patients who has undergone a kidney transplantation. METHOD: We used the local and national databases. RESULTS: 213 patients (7 preemptive, 206 dialyzed) had 240 renal transplantations. Only 11 of them were living organ donation. Between 69 transplantations (Tx) were carried out between 1976-1995, and 163 Tx were done in the second 20 years. 122 patients (57%) are still alive (the average survival of these patients in renal replacement therapy - RRT - are 11.4 years), and 7 of them had transplantation between 1976-1995. The longest survival time was 35.1 years. Prevalence of patients on RRT at the end of 2016 was 1367 pmp in our county (32.5% living with functioning graft). CONCLUSIONS: Number of transplanted patients has grown in the last decade. Proportion of living organ donation was minimal. Orv Hetil. 2017; 158(25): 984-991.

Modeling long-term diabetes and related complications in rats.

INTRODUCTION: Accurate preclinical modeling of diabetic complications such as retinopathy, nephropathy and neuropathy is crucial to enable the development of novel preventative therapies. The aims of this study were to establish a model of long-term diabetes with sustained medium scale hyperglycemia and characterize the pathological changes detectable after 4months, with particular respect to dependence on the degree of hyperglycemia. METHODS: Streptozotocin-induced diabetic CFY rats were subjected to four different insulin substitution protocols to achieve different levels of glycemic control (Diabetic 1-4 groups). Eyes were investigated by ophthalmoscopy, kidney function by urine analysis, and neuropathy by functional tests. Retinal and renal morphological evaluations were performed by histology, immuno-histochemistry and electron microscopy. RESULTS: Rats of the Diabetic 3 group showed massive hyperglycemia-dependent anterior segment neovascularization, enhanced total retinal score and retinal apoptotic cell number, degeneration of dopaminergic amacrine cells, increased glomerular PAS-positivity, altered excreted total protein/creatinine ratio and cold allodynia, parallel with medium scale hyperglycemia (blood glucose level between 22 and 25mmol/L) and satisfying state of health. DISCUSSION: We established a treatment protocol in rats enabling complex investigation of diabetic retinopathy, nephropathy and neuropathy on a long-term period. Clearly hyperglycemic dependent parameters of these complications serve as good outcome measures for preclinical trials. Our results provide a useful basis for designing studies for testing preventative treatments as well as other translational medical research in this field.

[Anemia and iron metabolism in patients with type-2 diabetes mellitus]. / Anaemia es vasanyagcsere 2-es típusú diabetes mellitusban szenvedo betegekben.

INTRODUCTION: Nowadays the iron status in chronic illnesses can be judged by non-invasive methods, too. The soluble transferrin receptor, that is also measurable in most laboratories, means a leap forward among the new markers. AIMS: The authors examined the prevalence of anemia and the iron status of type-2 diabetic patients with markers of the iron metabolism. They studied the clinical applicability of these laboratory procedures. METHODS: Concentration of iron, transferrin, ferritin and soluble transferrin receptor levels of healthy and diabetic patients were compared with a Mann-Whitney U-test. They examined the incidence and the type of anemia, the cause of the elevation in soluble transferrin receptor levels, and the effect of inflammation and nephropathy on the iron status. Relationship of the transferrin saturation, the concentration of ferritin and soluble transferrin receptor levels were depicted by graphic representations. RESULTS: The authors have found difference between the transferrin levels of women and men in contrast to the literature (z = 3.56; p < 0.05). The reference intervals of the ferritin levels of the control and patient groups also showed a significant difference between women and men (z = 7.59; z = 5.69; p < 0.05). 7% of the patients have suffered from anemia. 23% of the patient group had nephropathy, 10% of this subgroup was anemic, and further 8% of this subgroup had iron distribution disorder. 6% of the patients had elevated soluble transferrin receptor levels. Anemia or iron metabolism alteration was found only in 14% of the cases with elevated C-reactive protein levels. CONCLUSIONS: According to these findings ferritin reference levels of healthy people can not be used in diabetes mellitus similarly to other chronic illnesses. It seems that anemia is not frequent in diabetes mellitus. There is no connection between nephropathy and anemia, and not all of the inflammatory conditions are accompanied with iron metabolism disturbance. The soluble transferrin receptor can be interpreted only together with the other markers. In the opinion of the authors, the iron status of an individual can be judged with the collective use of all markers in chronic diseases, too.

[Macro-creatine kinase: an interesting occurrence that can cause diagnostic mistake]. / Makro-kreatinkináz: egy érdekes, diagnosztikus tévedésre alkalmat adó jelenség.

INTRODUCTION: Macroenzymes have been known for a long time. Macro-creatine kinase is important among them, because it can cause serious diagnostic misunderstanding. OBJECTIVE: The authors describe a case in which creatine kinase MB isoenzyme activity measured by immunoinhibition was much higher than total creatine kinase activity. METHOD: The presence and type of possible macro-creatine kinase was examined by the authors with heat-stability test and electrophoresis. RESULTS: Total creatine kinase and creatine kinase MB isoenzyme activity measured by immunoinhibition of macro-creatine kinase sample remained still unchanged, while activity of control samples decreased significantly. Macro-creatine kinase remained on the carrying point, while isoenzymes migrated accordingly in the other samples during electrophoresis. CONCLUSION: Two types of macro-creatine kinase are known. In the first the BB isoenzyme of enzyme joint to immunoglobulin (mostly immunoglobulin G) and its presence may refer to autoimmune factors. The second type is a polymer of mitochondrial creatine kinase and appears in malignant tumours mainly. The presented case the clinic of the patient, the heat-stability test and the typical electrophoretic migration proved the presence of the second type.