[Evaluation of the renal excretory function using estimated GFR in patients coming to Voivoidship St. Lukas Hospital in Tarnow in the years 2007-2010]. / Ocena funkcji wydalniczej nerek w oparciu o eGFR u pacjentów zglaszajacych sie do Szpitala Wojewódzkiego im. sw. Lukasza w Tarnowie w latach 2007-2010.

BACKGROUND: Studies concerning chronic kidney disease frequency are becoming of more and more interest. This is connected with an increased morbidity and diagnosis of chronic kidney disease. The aim of this study was an analysis of glomerular filtration rate results in patients coming to Emergency Department (ED) of Voivodship St. Lucas Hospital in Tarnów for various medical reasons. MATERIAL AND METHODS: We analyzed patients admitted to ED between 30th March 2007 and 31st December 2010. In that period 121116 patients were seen in ER (52660 females and 68456 males). A creatinine level test was performed using the kinetic Jaffe method with alkaline picrate. Glomerular filtration rate (eGFR) was automatically calculated using the abbreviated MDRD formula. eGFR was evaluated in 26176 persons aged 18-104 years (average 59 years) which constituted 21.6% of all people coming to the hospital. Due to lack of some data and some mistakes the final analysis was performed on 23845 patients (12472 females (52.3%) and 11373 males (47.4%)). The whole study population was divided according to sex and age range; 18-34 years, 35-64 years and above 65 years. Stratification of kidney failure was done using the classification of stages of chronic kidney disease according to NKF KDOQI. RESULTS: Patients with chronic kidney disease stages 3 to 5 comprised 25.2% of the study population. Patients above 65 years constituted 45.9%. That group had also the greatest number of patients with eGFR below 60 ml/min (stages 3, 4 and 5 respectively 79.6%, 83.2% and 60.3%), mostly females. Patients who had a creatinine test performed and eGFR evaluated were more frequently hospitalized than patients without creatinine and eGFR checking. CONCLUSIONS: Among patients admitted to ED 21.6% had eGFR evaluated which allowed classification of those patients to an appropriate stage of chronic kidney disease. 25.2% patients in that group had renal insufficiency. The majority of patients with renal insufficiency were above 65 years of age and mostly women. People who had eGFR evaluated were more frequently hospitalized. Evaluating eGFR in ED can help in diagnosing chronic kidney disease.

[Roux-en-Y gastric bypass in a candidate for kidney transplant]. / Zabieg wylaczenia zoladkowego z zespoleniem omijajacym typu Roux-en-Y u chorego hemodializowanego przed planowanym przeszczepieniem nerki.

Obesity is a factor limiting access to kidney transplantation because of the high risk of perioperative complications, worse graft function and patients' survival. We present a case of an obese patient (BMI-38 kg/m2) with hypertension, diabetes and end-stage kidney disease caused by chronic glomerulonephritis treated with hemodialysis, who was excluded from transplantation because of obesity. The patient underwent Roux-en-Y gastric by-pass surgery as a preparation for kidney transplantation.

[Outcome of patients with acute kidney injury in the course of neoplastic diseases]. / Rokowanie u chorych z ostrym uszkodzeniem nerek w przebiegu nowotworów zlosliwych.

Patients with malignancies are a group of increased risk of acute kidney injury (AKI). The aim of this study was to evaluate selected parameters characterizing acute kidney injury in patients with malignancies such as the cause ofAKI, previous kidney function, diuresis, duration of oligoanuria, the number of dialysis sessions, mortality and normalization of renal function in the course of AKI. We analyzed data of 387 patients with AKI (155 women, 232 men) aged 26-96 years treated in hospital wards of nephrological profile in the most requiring dialysis. Among the female the most frequent neoplasm were cervical cancer (26.4%), multiple myeloma (14.8%) and colorectal carcinoma (7.7%). In men the most common cancers localization was: the urinary bladder (25.4%), prostate (23.7%), colon (7.7%), and multiple myeloma (6.9%). In 14 patients 2 tumors were reported while in one 3 different cancers. In total, patients in the study group had 403 cancers, including 162 women and 241 men. Average serum creatinine was 752.1 micromol/l, and diuresis at the start of observation 483 ml/24h. Oligoanuria (less than 500 ml/24h) occurred in 64.9% of patients and lasted from 1 to 117 days, an average of 6.8 days. Because of severe AKI, most of patients (357-92.2%) were dialyzed, an average 4.6 of sessions. Mean hospital stay was 15.4 days. Some patients (20.1%) had impaired renal function, even before the AKI episode which indicate coexistence of chronic kidney disease in the study population. The most common cause of AKI was urine flow disorders seen in 53.2% of patients, especially ureteral obstruction. A numerous AKI episodes (26.1%) were caused by the loss of body fluids. In 21.2% of patients multifactorial causes of AKI were found. The mortality rate in the studied group was 33.9%.

[Acute kidney injury in cancer patients]. / Ostre uszkodzenie nerek u chorych z nowotworami zlosliwymi.

Acute kidney injury is a common and serious complication of cancer. We analyzed medical records of 335 cancer patients who were treated in Internal Diseases and Nephrology Department with Dialysis Center at St. Lucas Hospital in Tarnow in years 2009 and 2010. AKI was diagnosed according to the RIFLE classification in 91 cases (43 woman and 48 men). The average age was 68.7 years (from 18 to 93 years). 54 patients were classified as category F, 23 as category I and 14 as category R of the RIFLE classification. 60.4% of the patients were diagnosed with metastatic cancer, 12.1% with a regionally developed disease, 18.7% with cancer limited to one organ and in 8.8% the stage of the disease could not be established. The highest incidence of AKI was observed in patients with cancer of the cervix, ovary, prostate, breast, stomach and of unknown primary site. The most common risk factor of AKI was hypovolemia diagnosed in 35% of cases. Obstruction of the urinary tract, the second most frequent risk factor was observed in 26% of cases. 14.5% of the patients required hemodialysis. In the group of dialysed patients 38.5% of them died, 61.5% were discharged from hospital after improvement of renal function. In the group of non-dialysed patients mortality rate was 25.6%; survivors in that group presented improvement in renal function. Evaluation of the renal function in patients with cancer is essential.

[Multiple myeloma--analysis of patients diagnosed in Internal Diseases and Nephrology Department and Dialysis Center St. Lukas Hospital in Tarnow in years 1999-2009]. / Szpiczak mnogi--analiza przypadków rozpoznanych w I Oddziale Chorób Wewnetrznych i Nefrologii z Osrodkiem Dializ Szpitala Wojewódzkiego im. Sw. Lukasza w Tarnowie w latach 1999-2009.

We analyzed 25 patients with multiple myeloma. All the patients fullfilled diagnostic criteria of International Myeloma Working Group (2003): presence of monoclonical protein in serum or/ and in urine (IgG 64%), IgA -16%, free light chains - 16%, in one patient (4%) biclonal typ plasmocytoma was diagnosed), at least 10% plasmocytes in the bone marrow and at list one evidence of end-organ damage such as anemia (92%), bone lesions (65%), hypercalcemia (36%) and renal insufficiency (92%). Acute renal failure was diagnosed in 60% of patients and 32% with chronic renal failure. Only 2 patients had normal renal function. 36% of patients required hemodialysis. Our analysis showed that almost all patients were admitted to hospital at a very advanced stage of the disease and renal failure was dominant, mostly at advanced stadium.

[Withdrawal of maintenance dialysis in a patient with diagnosed multiple myeloma and renal failure as a consequence of effective anti-tumor treatment]. / Zaprzestanie przewleklej dializoterapii u chorej ze szpiczakiem mnogim i niewydolnoscia nerek jako wynik skutecznego leczenia przeciwnowotworowego.

Renal failure is a common complication in the course of multiple myeloma (MM). It is being observed in 20-40% of patients at the moment of disease diagnosis and in 10-36% of the cases dialysis treatment is required. Kidney damage is mainly caused by the toxic effect of monoclonal light chains, also known as Bence-Jones proteins produced by the pathological plasma cells. Light chains coaggregate with Tamm-Horsfall glycoprotein leading to casts formation in the distal nephron (cast nephropathy). Additional factors causing renal damage in MM may be dehydration, hypercalcemia, hyperuricemia as well as drug nephrotoxicity. We have described a 49 year-old woman diagnosed with IgA multiple myeloma at IIIB advance stage according to Durie and Salmona classification. The disease course was complicated by renal failure. Myeloma treatment (cyclophosphamide + talidomid + dexamethasone) was initiated simultaneously with hemodialysis therapy. Treatment with this was successful even though disease course was very severe and required longer-term hemodialysotherapy. Complete hematological remission was obtained and after 17 months of renal replacement therapy--hemodialysis treatment was ceased due to improvement of renal function. The presented case confirms the necessity of dialysis therapy initiation in every case of acute renal failure in the course of multiple myeloma--even when symptoms indicates an advanced stage of the disease. Initiation of dialysis therapy allows to initiate and continue the effective multiple myeloma treatment. This is the chance for recovery of renal function to such a level that dialysis treatment could be ceased, even after many months of dialysis therapy.