[Successful treatment of patients with thrombotic thrombocytopenic purpura]. / Uspesno lecenje bolesnika sa tromboznom trombocitopenijskom purpurom.

The paper presents the case of a 23 years old patient diagnosed with thrombotic thrombocytopenic purpura on the basis of increased body temperature, thrombocytopenia, microangoipathic hemolytic anemia, renal function disorders and a rapid development of coma after the epileptic seizure of Jacsonian type. The treatment included the therapy with antithrombocytic drugs such as lysin acetysalicylate, dipridamol, methylprednisolon, and other symptomatic and substitutional therapies. Fifteen therapeutic plasmaphereses were made with the replacement of 33.150 ml of plasma substituted with albumin and freshly frozen plasma (20.080 ml totally). The applied therapy gradually improved patient's neurologic finding. The patient was discharged from the hospital with normal neurological finding and magnetic resonance of the brain. In the conclusion we emphasize the importance of therapeutic replacement of plasma with the infusion of freshly frozen plasma, antithrombocytic therapy and the application of corticosteroids in the treatment of thrombotic thrombocytopenic purpura.

[Clinical and morphologic features in patients with acute nephritis syndrome]. / Klinicke i morfoloske odlike bolesnika s akutnim nefritisnim sindromom.

Acute glomerulonephritis is a distinct clinical entity, more frequently found in younger age. We report 69 patients with AcGN (25 female and 44 male) mean age 26 years (range 15-58). The disease is clinically characterized with hypertension (57%), edema (59%) and oliguria (35%). Urine analysis showed microhaematuria/proteinuria (36%) and micro/macrohaematuria alone in 89%, while azothaemia was observed in 16% pts, and decreased serum complement levels in one third of patients, more often decrease of C3 (33%) than C4 (15%). Initial infection of the upper respiratory tract was seen in 65%, pneumonia in 8%. In 25% of pts. there were no data of previous infection. Cultures of pharyngeal smear revealed. Streptococcus only in 2 pts. Elevated AST titer was found in 32% pts. Eleven kidney biopsies were made, and histological examination showed 2 normal findings, 6 mesangioproliferative GH, 2 endocapillary GN and 1 membranoproliferative GN. Follow ups have showed urinary abnormalities in 25% of pts., without developing renal failure.

[Methylprednisolone pulse therapy in the early phases of lupus nephritis]. / Dejstvo pulsne terapije metilprednozolonom kod ranih faza lupusnog nefritisa.

Renal involvement i.e. lupus nephritis (LN) in systemic lupus erythematosus (SLE) mainly determines course and outcome of the disease. Recognition of early manifestations of LN makes adequate therapy possible, with very good therapeutic results. We report 7 patients from a group of 150 SLE patients under our permanent control, 4 female and 3 male, mean age 21 years. All of them had signs of LN: proteinuria 7/7 haematuria 4/7 without azotaemia. Renal biopsy was performed in 6 pts, and histological finding was: class II 1 pt, class IV 3 pts and class V in 2 pts. In 4 pts tubulointerstitial changes were noted, while all showed immunofluorescent deposits of immunoglobulins and complement. Methylprednisolone "pulse" therapy (1000 mg, i.v., 3 days) followed by tapering of the steroid dose was given. Reduction of proteinuria and disappearance of haematuria were observed in all patients. During follow up, kidney function remained normal.