Cardiovascular surgery after renal transplantation--indications, complications and outcome.

UNLABELLED: Cardiovascular diseases are the major cause of morbidity and mortality in renal transplant recipients. We report our experience in the treatment of patients with renal allograft who required cardiovascular surgery. METHODS: Indications for cardiovascular surgery, postoperative complications, and outcome were recorded in a cohort of renal transplant recipients. RESULTS: Thirteen patients, five female and eight male, aged from 46 to 75 years underwent cardiac surgery after renal transplantation at University Hospital Centre Zagreb. Isolated coronary artery bypass grafting (CABG) was performed in five patients, valve replacement in six patients, reconstruction of ascending aorta, and aortic arch in one patient as well as the extraction of tumor formation from the heart. Three patients had simultaneous CABG and valve replacement. Four patients (31%) required acute hemodialysis after the surgery and two of them continued with dialysis after discharge. Postoperative course was complicated with infections of the lower respiratory tract in two patients, pericardial tamponade, unstable sternum with bleeding from the wound, increased drainage from the chest demanding additional hemostasis, and in-stent restenosis in the previously placed stents, in one patient each. Fatal outcome occurred in two patients who underwent simultaneous valvular replacement and CABG within one month from the surgery. CONCLUSION: In patients with functional renal allograft cardiovascular, surgery procedures are safe, but associated with increased incidence of perioperative complications, with majority of patients maintaining their graft function.

BMP-7 PROTEIN EXPRESSION IS DOWNREGULATED IN HUMAN DIABETIC NEPHROPATHY.

Bone morphogenetic protein-7 (BMP-7) is expressed in all parts of the normal kidney parenchyma, being highest in the epithelium of proximal tubules. It protects kidney against acute and chronic injury, inflammation and fibrosis. Diabetic nephropathy is the leading cause of chronic kidney disease, and is characterized by decreased expression of BMP-7. The aim of our study was to analyze whether the expression of BMP-7 is significantly changed in advanced stages of human diabetic nephropathy. Immunohistochemical analysis of the expression of BMP-7 was performed on archival material of 30 patients that underwent renal biopsy and had confirmed diagnosis of diabetic nephropathy. Results showed that BMP-7 was differently expressed in the cytoplasm of epithelial cells of proximal tubules and podocytes among all stages of diabetic nephropathy. At early stages of diabetic nephropathy, BMP-7 was strongly positive in proximal tubules and podocytes, while low expression was recorded in the majority of samples at advanced stages. In conclusion, increased expression of BMP-7 at initial stages of diabetic nephropathy with subsequent decrease at advanced stage highlights the role of BMP-7 in the protection of kidney structure and function. Further investigations should be focused on disturbances of BMP-7 receptors and signaling pathways in patients with diabetic nephropathy.

The novella about diabetic nephropathy.

Diabetic nephropathy is a common complication in patients with diabetes mellitus and one of the major reasons for renal replacement therapy in Croatia, Europe and the United States. It is characterized by proteinuria, decline in glomerular filtration, hypertension, and high risk of cardiovascular morbidity and mortality. Deterioration of renal function in diabetic nephropathy develops through five clinical stages characterized by the respective histologic description. Genetic susceptibility, hyperglycemia, high blood pressure and duration of diabetes mellitus definitely play a role in the pathogenetic sequence. Early diagnosis, appropriate patient follow up and treatment are essential to improve the outcomes. Interdisciplinary approach and close collaboration of nephrologists and diabetologists are essential for timely detection of disease progression. Tight glycemic control under the supervision of diabetologists, screening of patients, and once a year report of albuminuria and glomerular filtration allow for detection of renal damage in the early stages and timely referral to a nephrologist. The points of interest given in this overview are description of clinical staging in relation to pathologic classification, repetition of basic causal features, and brief analysis of treatment.

Lumboischialgia as the first sign of stomach cancer.

The paper reports on a case of a seventy-three-year-old male patient, whose disease was initially manifested by severe low back pain and lumboischialgia of the right leg as the first and only, and later, the leading symptom of disseminated adenocarcinoma of the stomach. The unusual presentation of stomach cancer confirms the necessity of simultaneous treatment of pain and determination of its etiology. It also indicates the need for re-evaluation of diagnosis when there is no favorable clinical effect of applied therapy.

Acute paroxysmal praecordial pain as a somatosensory elementary partial onset of epileptic seizure.

It presents a 60-year-old female patient with acute paroxysmal intensive pain attacks in the praecordial area that spread to the left hand and were associated with mild transient left hemiparesis, progressing to a myoclonic focal seizure in the region of left abdomen. The diagnostic procedure was interrupted several times by intensive pain attacks, but excluded acute thoracic pathological process, whilst a brain scan found a large, partially necrotic tumour with incipient bleeding and severe oedema subcortically in the right parietal lobe. We are describing a clinical presentation of symptomatic, simple focal, somatosensory epileptic seizure with dominance of intensive pain that progress in myoclonic, somatomotor focal seizure and Todd's Palsy as the first sign of glioblastoma bleeding.

[Treatment anaemia of chronic kidney disease in predialysis patients (stage 1-4)]. / Lijecenje anemije u bolesnika s kronicnom bubreznom bolesti koji jos nisu na dijalizi (stadiji 1.-4.).

Anemia is the most frequent haematological problem of chronic kidney disease (CKD). It begins in early stage of CKD and worsens with disease progression, affecting nearly all of predialysis patients. It is usually asymptomatic, therefore is underdiagnosed and undertreated. Anemia of CKD is predominantly a result of abnormal erythropoietin (EPO) production and iron deficiency. Renal anemia is associated with an increased risk of ischemic heart disease, left ventricular hypertrophy, chronic heart failure and higher cardiovascular morbidity and mortality. Patients et risk for CKD should be more often monitored for early detection of anemia so they could start with treatment on time. Recent studies show that erythropoeisis-stimulating agents (ESAs) are effective in predialysis especially if used with antihypertensive agents and statin. Correcting anemia in early stage kidney disease may delay progression to end-stage kidney disease (ESRD) and prolong time to start dialysis. Improved cardiac function in those patients reduce morbidity and mortality risk and improve quality of life (QoL) in patients with CKD.