[Relation between certain parameters of renal function and prognosis in multiple myeloma]. / Povezanost nekih parametara renalne funkcije sa prognozom multipnog mijeloma.

BACKGROUND: Renal involvement is one of the most common manifestations of MM, with different pathogenetic mechanisms, like overproduction of monoclonal light chains and hypercalcemia, those are commonest precipitating factors for renal failure which occurs in nearly 25% of myeloma patients. Some renal pathology is noted in over half. METHODS: We studied retrospectively 16 patients with MM treated at Nephrology and Haemathology Clinic in Sarajevo, in the period from 1996-1999 y (10 females and 6 males). All fulfilled criteria for MM diagnosis: 1. Bone marrow involvement by greater than 20% plasma cells 2. Monoclonal paraprotein in the serum and/or urine 3. Lytic bone lesions. RESULTS: Appearance of high creatinine plasma level, red and white blood cells in urine, and proteinuria are the signs of renal function reduction. Renal failure was noted in 10/16, erythbruria 6/16, pyuria, 7/16 hyperuricemia in 8/16 and 3/16 (19%) were died during hemodialysis programme, and Bence-Jones protein was noted in urine with 7/16 (43%). Severe renal failure with 5/16 was noted and beside high plasma creatinine we found high plasma calcium and Bence Jones in urine. CONCLUSION: High plasma levels of creatinine and calcium and Bence-Jones in urine, are poor prognostic signs of MM.

[Structure of chronic dialysis patients in Bosnia-Herzegovina--a multicenter study]. / Struktura hronicnih dijaliznih bolesnika u BiH--multicentricna studija.

INTRODUCTION: In BiH there are no summary data about chronic dialysis patients (CDP). With this study we tray to make first step to establish B&H system for collecting necessary data. METHODS: This is a retrospective study for 1999 years. We collect data with question form which have been distributed to dialysis centers (DC) in BiH. RESULTS: We got answer from 6 (37.5%) DC: Tuzla, Sarajevo, Bihac, Odzak, Travnik and Tesanj. Totally number of CDP was 533, 256 female (48%) and 277 male (52%), and 79% of them are between 26-65 yrs. Leading primary renal diseases were: glomerulonephritis 22%, pyelonephritis 16%, endemic nephropathy 11%, unknown ESRD 10%, polycystic renal disease 9% and diabetes 9%. Peritoneal dialysis have ben performed in 10 patients only, and bicarbonat HD in 46% of CDP. Half of the patients had serum haemoglobin lower than 7 mmol/1 and only 12% received erythropoietin. 17% of the patients had coronary disease, and 7% peripheral vascular disease. We registered 43 (8%) HBsAg, but 294 (55%) antiHCV positive patients. 52% of the CDP have been vaccinated against B hepatitis. Last year died 76 patients (14.26%), mostly caused by coronary diseases (21%), cardial failure (20%), cerebrovascular accidents (15%) and sepsis (11%). 53% of patients are on dialysis between 1-5 yrs. CONCLUSION: In this study participated 6 DC only, but we think that data we collect are good basis for establishing B&H system for registration and follow-up of the ESRD patients.

[Changes in lymphocyte receptors and their activation markers during hemodialysis using various membranes]. / Promjene limfocitnih receptora i njihovih aktivirajucih markera tokom hemodijaliznog tretmana na razlicitim membranama.

BACKGROUND: It's known that uremia is accompanying with different alteration of immune system. Also, different type of dialysis membranes can affect the immunological competence cells--lymphocytes and their function during hemodialysis (HD). AIM OF STUDY: To establish the effect of single hemodialysis session with polysulfonic and cellulose--acetat membranes on lymphocyte subpopulations and their activation markers. METHODS: In two groups of seven patients with end stage of renal disease (ESRD) on periodic HD we were investigated flow-cytometrical expression the following markers using monoclonal antibodies (BECTON DICKENSON): CD3 (T-Ly), CD19 (B-Ly), CD4 (T helper/inducer), CD8 (T-suppressor/cytotoxic), CD4/CD8 ratio, CD16 (NK cells), CD3/HLA-DR (late activated T-cells), CD4/CD 25 (IL-2R early activated T4), CD4/HLA-DR (late activated T8), CD8/CD25 (early activated T8), CD8/CD71 (late activated CD8). Blood samples were taken before HD, 30 minutes into HD and at the end of a four-hours HD session. RESULTS: Demostrates statistical increased expression T helper cells on both membranes on minute 30 from beginning of HD procedure, but more on cellulose-acetat membranes and the significant falls to normal value at the end of HD: start 46.7% minute 30: 54.9%, minute 240: 42.7%. Significant changes were in expression of NK cells on cellulose-acetat membranes: start 12.7%; minute 30: 6.0; minute 240: 11.1%. No changes were noted in activations of T Ly, T4 and T8 on the both membranes. CONCLUSION: No significant difference was found in expression of lymphocyte subpopulations and their activations during HD with polysulfone membranes. Significant changes of the expression of NK cells during HD with cellulose acetat, indicated that NK cells can be sensitive marker for biocompatibility of HD membranes.

[The vertigo syndrome, magnetic resonance and magnetic angiography of the head in patients on a chronic hemodialysis program]. / Vertiginozni sindrom, magnetna rezonanca, magnetna angiografija glave kod bolesnika na hronicnom programu hemodijalize.

BACKGROUND: Vertiginous syndrome appears in more then 100 diseases, therefore subject of intensive investigation. Insufficient research has been done on vertiginous syndrome in patients on chronic program of haemodialisis. The aim of this study is to search anatomical and structural changes on blood vessels of the brain by neuroimaging techniques, as well as increased circulatory resistance on TCD, in patients on chronic program of haemodialysis. METHODS: The research has been done on 30 patients with vertiginous syndrome, 22 males and 8 females, average age 45.9 years, average duration of haemodialysis 5.83 +/- 4.5. In all patients relevant diagnostic procedures had been done (EEG, TCD, audio vestibulogram, X-ray of cervical spine), and in 14 patients with increased circulatory resistance TCD we have done MRI and MRA of the brain. Pathological EEG has been found in 10%, 40% of the patients have had normal EEG finding, while 50% had slowing (non-specific disfunction) in EEG record. RESULTS: MRI and MRA had been done in 14 patients of average age 51.21 +/- 10.82. In 13 patients we had a pathological finding of MRI and MRA, while in one patient only we had normal finding of MRA, and another one patient with normal MRI scan. In 64.2% of the sample we have had cortical cerebral atrophy, in 57.1% cortical atrophy of cerebellum, while in 35.8% apart from the mentioned changes atrophy of cerebellar vermis had been found. In 71.4% of all patients cerebrovascular disease (stroke) could be identified. Atherosclerosis changes in blood vessels of anterior or posterior circulatory segment were found in 78.5% of the patients, while spasm of arteries had been registered in 21.4% of the sample. CONCLUSION: MRI and MRA of the brain brought light on aethiological aspect of vertigo in these patients. Results of our research indicate vascular aethiology of vertiginous syndrome in patients on chronic program of haemodialysis.

[Echocardiographic changes in patients with chronic renal insufficiency on hemodialysis]. / Ehokardiografske promjene kod pacijenata sa hronicnom bubreznom insuficijencijom na hemodijalizi.

Cardiovascular diseases cause death in 40% patients on the chronic haemodialysis program. Our aim was to assess the heart changes in these patients by echocardiography. We have tested 40 patients, but 34 of them accomplished criteria for this study. There were 19 (55.88%) females and 15 (44.12%) males. The average age was 44 years and average duration of haemodialysis treatment was 4.72 years. The research was made with ultrasound device TOSHIBA SSH 65 A SONOLAYER and transducers 3.5 and 2.75 MHz. Twenty patients (58.82%) have had pathological echocardiogram. Ten patients (29.42%) have had conditionally normal echocardiogram while four patients (11.76%) have had completely normal echocardiogram. In patients with pathological echocardiogram, some of the left ventricle hypertrophy forms dominated. Echocardiography is a useful method in morphologic and functional cardiac assessment at the last stage renal disease patients on the chronic haemodialysis program. Using the aforementioned method we are able to select the patients who need intensive cardiac care.

[Clinical and histologic findings in patients with renal amyloidosis]. / Klinicki i histoloski nalazi u pacijenata sa renalnom amiloidozom.

Renal amyloidosis is a rare disease when compared to other kidney diseases. During the period of last fifteen years, at the Institute of Nephrology and Immunology in Sarajevo renal amyloidosis was diagnosed with 15 patients. The disease occurred more often with men than with women. Only during 1988, renal amyloidosis was revealed and followed up with five patients. The most common clinical manifestations of renal amyloidosis are nephrotic syndrome and chronic renal failure, with respective laboratory findings. Using immunofluorescent analysis of the kidney biopsy material, we discovered deposits of immunoglobulins of different intensity and deposits of lambda and kappa light chains of immunoglobulins. The intensity of lambda light chains is greater than that of kappa chains. The analysis of light microscopy showed nodular mesangial deposits and deposits along GBM without proliferation. The diagnosis of amyloidosis was confirmed by staining of amyloid. Application of therapy for amyloidosis was without any effect. Although renal amyloidosis is a rare disease, we want to point out disease as being an etiologic factor in nephrotic syndrome.

[Detection of glomerular basement membrane antibodies using the ELISA enzyme assay]. / Dokazivanje antitijela protiv GBM enzimatskim esejom--ELISA.

The intention of this work is to show the usefulness of use of enzymatic essay in the anti-body detection against GBM in the serum of the Patient with linear deposits of IgG. Full success was obtained. Maximal sensibility of test sensibility and reproduction, as well as the advantage that tests are simply enough for the empiric application in everyday clinical practice was achieved through multiplied vibration of anti-bodies. Test were done 30 patients in the Immunology Laboratory of the Institute for Nephrology in Sarajevo.