Protocol for performing nephrological activity in the Republic of Macedonia.

The fast development of nephrology in the world, especially in the second half of the 20 th century demanded protocol (guidelines) for nephrological activity for all levels of medical care, of doctors and specialists. The International Society of Nephrology, the European Renal Association and other national associations created their own protocol (guidelines) for nephrological activity. The Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO) proclaimed the First Protocol for Performing Nephrological Activity in the Republic of Macedonia at the First Congress of the MSNDTAO, held in Ohrid 1993, and it was published in the Macedonian Medical Review, 1994; Supplement 14: 397-406 [1]. The update of the Protocol for Performing Nephrological Activity in the Republic of Macedonia was proclaimed at the Fourth Congress of MSNDTAO, held in Ohrid 2012 and it presented in this text.

[Association of moderate alcohol intake, blood pressure regulation and renal function].

AIM: to determine differences in regulation of blood pressure and renal function in patients with moderate intake of alcohol (1-14 units per week). MATERIAL AND METHODS: Cross-section study performed at the Department of Nephrology. Seventy-six patients admitted for diagnosis and treatment of hypertension were included. Patients with diabetes mellitus, renal failure and other coorbidities were excluded from the study. Medical history, data on alcohol consumption, laboratory analysis, Doppler echosonography of intrarenal blood vessels and 24-hour blood pressure monitoring were performed. The group that consumed alcohol (A+) consisted of 10 patients, while the group that did not (A-) consisted of 66 patients. The two groups were comparable by age, BMI and hypertension history. Two groups were compared by the values of their blood pressure, BMI, hypertension history in months, serum creatinine, uric acid, Doppler duplex index of renal resistence, triglycerides and cholesterol. RESULTS: In group A+ , the serum creatinine was significantly higher, but still within the normal range (86.3+/-15.72 vs 71.75+/-14.77, p=0.005). Serum uric acid followed the same trend (360.3+/-110.18 vs. 284.4+/-95.28, p=0.026. Pulse pressure and mean arterial pressure were higher in the A+ group (71.33+/-19.23 vs. 57.65+/-16.78, p=0.028 and 127.81+/-17.6 vs 111.02+/-21.67, p=0.03 respectively). Serum lipids were unsignificantly higher in the A+ group (9.56+/-1.5 vs 9.02+/-1.59, p=0.38). No changes between groups were registered with Doppler sonography of intrarenal blood vessels. In women, consumption of alcohol was associated with blood pressure control. CONCLUSION: Moderate alcohol consumption is associated with the regulation of the blood pressure.

Decreased nitric oxide in women with essential hypertension in prehypertensive phase.

AIM: To determine the concentrations of nitric oxide (NO) in plasma of women with essential hypertension in prehypertensive phase, its effect on blood pressure, and correlation with other vasoactive substances that regulate systemic and renal vascular tonus. METHODS: The study performed at the Department of Nephrology, Hospital Center in Skopje, Macedonia, included 26 women with essential hypertension in prehypertensive phase and 11 normotensive women as healthy controls. Vasodilating factors NO and 6-keto-prostaglandin F1 alpha (6-keto-PGF1alpha) were determined in plasma. Thromboxane B2 (TXB2) as a vasoconstricting factor and electrolytes Na+, K+, and Ca2+ were determined in urine. Blood pressure was monitored over 24 hours. Systolic, diastolic, mean blood pressure were presented as average 24-hour values. RESULTS: The concentrations of NO and 6-keto-PGF1alpha were significantly lower in women with essential hypertension in prehypertensive phase than in their normotensive controls (NO: median 22, range 11-35 vs median 37.5, range 11-66; 6-keto-PGF1alpha: 64.8+/-14.35 vs 98.21+/-43.45 micromol/L; P<0.001). The index of vascular reactivity (TXB2/6-keto-PGF1alpha ratio) was higher in women in prehypertensive phase than in normotensive women (1.3 vs 0.8, P<0.001). Urinary calcium to creatinine ratio was significantly lower in the prehypertensive group (0.06+/-0.03 vs 0.24+/-0.13, P<0.001). No direct correlations were found between NO, TXB2, and 6-keto-PGF1alpha, or between NO and electrolytes in the urine. Low NO and urinary Ca2+ were significant indicators of increased blood pressure (P=0.013 and P=0.024, respectively; backward stepwise multiple regression analysis). CONCLUSIONS: NO and 6-keto-PGF1alpha were significantly lower in women in prehypertensive phase of essential hypertension. Lower NO correlated with increased systolic blood pressure, but not with on natriuresis and calciuresis. These findings, together with the higher vascular reactivity index, indicate that endothelial dysfunction precedes the establishment of essential hypertension.

Useful biochemical markers for diagnosing renal osteodystrophy in predialysis end-stage renal failure patients.

BACKGROUND: Various biochemical markers have been evaluated in dialysis patients for the diagnosis of renal osteodystrophy (ROD). However, their value in predialysis patients with end-stage renal failure (ESRF) is not yet clear. METHODS: Bone histomorphometric evaluation was performed and biochemical markers of bone turnover were determined in serum of an unselected predialysis ESRF population (N = 84). RESULTS: Significant (P < 0.005) differences between the five groups with ROD (ie, normal bone [N = 32], adynamic bone [ABD; N = 19], hyperparathyroidism [N = 8], osteomalacia [OM; N = 10], and mixed lesion [N = 15]) were noted for intact parathyroid hormone, total (TAP) and bone alkaline phosphatase (BAP), osteocalcin (OC), and serum calcium levels. Serum creatinine and (deoxy)pyridinoline levels did not differ between groups. For the diagnosis of ABD, an OC level of 41 microg/L or less (< or =7.0 nmol/L) had a sensitivity of 83% and specificity of 67%. The positive predictive value (PPV) for the population under study was 47%. The combination of an OC level of 41 ng/L or less (< or =7.0 nmol/L) with a BAP level of 23 U/L or less increased the sensitivity, specificity, and PPV to 72%, 89%, and 77%, respectively. ABD and normal bone taken as one group could be detected best by a BAP level of 25 U/L or less and TAP level of 84 U/L or less, showing sensitivities of 72% and 88% and specificities of 76% and 60%, corresponding with PPVs of 89% and 85%, respectively. In the absence of aluminum or strontium exposure, serum calcium level was found to be a useful index for the diagnosis of OM. CONCLUSION: OC, TAP, BAP, and serum calcium levels are useful in the diagnosis of ABD, normal bone, and OM in predialysis patients with ESRF.