Circumferential Strain as a Marker of Vessel Reactivity in Patients with Intradialytic Hypotension.

Background and Objectives: Intradialytic hypotension (IDH) complicates 4 to 39.9% of hemodialysis (HD) sessions. Vessels' reactivity disturbances may be responsible for this complication. Two-dimensional speckle tracking is used to assess arterial circumferential strain (CS) as a marker of the effectiveness of the cardiovascular response to the reduction of circulating plasma. Materials and Methods: The common carotid artery (CCA) and common iliac artery (CIA) CSs were recorded using ultrasonography in 68 chronically dialyzed patients before and after one HD session. Results: In patients with IDH episodes (n = 26), the CCA-CS was significantly lower both before (6.28 ± 2.34 vs. 4.63 ± 1.74 p = 0.003) and after HD (5.00 (3.53-6.78) vs. 3.79 ± 1.47 p = 0.010) than it was in patients without this complication. No relationship was observed between CIA-CS and IDH. IDH patients had a significantly higher UF rate; however, they did not differ compared to complication-free patients either in anthropometric or laboratory parameters. Conclusions: Patients with IDH were characterized by lower pre- and post-HD circumferential strain of the common carotid artery. The lower CCA-CS showed that impaired vascular reactivity is one of the most important risk factors for this complication's occurrence.

Multiple Post-SARS-COV2 Infectious Complications in Kidney Transplant Recipient.

A forty-seven-year-old recipient in late period after kidney transplantation with chronic estimated glomerular filtration rate (eGFR) 30 mL/min/1.73 m2, fully vaccinated against COVID-19 was diagnosed with SARS-CoV-2 infection in November 2021. After an initially mild course of the disease, he developed multiorgan failure requiring periodic respiratory and dialysis therapy. Covid-19 disease was complicated by multiple infections such Clostridioides difficile infection, Streptococcus epidermidis bacteriemia, Klebsiella pneumoniae and Candida glabrata urinary tract disease, cytomegalovirus infection and oral candidiasis. In a short period, he was readmitted to the hospital twice with recurrent Klebsiella pneumoniae urosepsis. One of those hospitalizations was also complicated by another COVID-19 infection that was confirmed with non-reactive neutralizing antibody. Due to severe infections the patient required individualized modification of immunotherapy; however, due to their recurrence it was finally decided to be discontinued. The patient was also reintroduced to hemodialysis therapy and no infections occurred since then.

Acute Kidney Injury Following Exposure to Calcineurin Inhibitors in a Patient with Idiopathic Membranous Nephropathy.

Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in non-diabetic adult patients; 75% of adult patients with MN suffer from primary idiopathic membranous nephropathy (IMN). The treatment of choice is immunosuppressive therapy, with a combination of steroids and cyclophosphamide (CYF) or chlorambucil or, as second-line treatment, calcineurin inhibitors (CNIs). One of the main concerns associated with the usage of CNIs is their potential to induce nephrotoxicity. We report a case of acute kidney injury that developed on two separate occasions within days of the administration of CNIs in a 57-year-old male patient treated for MN. The patient was qualified for first-line treatment with prednisone and CYF. Due to insufficient response and bad tolerance of CYF infusions, the immunosuppressive regimen was modified and CNIs were introduced, starting with cyclosporine A (CsA). On the third day of treatment, a severe decrease in diuresis and kidney function occurred and CsA was discontinued, resulting in a return to baseline kidney function. After 2 months, the situation repeated after attempting to introduce tacrolimus.

[Hypoglycemia--a new view on the problem of classification and clinical diagnostic]. / Hipoglikemia--nowe spojrzenie na problem klasyfikacji i diagnostyki klinicznej.

The commonly applied division of hypoglycemia into reactive and non-reactive one is too general and often times insufficient in clinical practice. The authors of this study presented a classification based on the clinical profile of patients with hypoglycemia. They also recommended patterns allowing proper diagnostic procedure in each classified group.