Adrenal Tumors in Young Adults: Case Reports and Literature Review.

The current high detection rate of adrenal tumors (4-10% of general population) is attributable to a widespread use of variety of imaging studies, especially a computed tomography. Most of them represent clinically silent and biologically indolent incidentalomas, but some adrenal tumors may pose a significant clinical challenge. Thus, in every patient with an adrenal tumor, a decision on further management is made after careful hormonal and radiological evaluation. All hormonally active tumors and those with radiological features suggesting malignancy are qualified for surgery. Approximately 80% of adrenal tumors are adrenocortical adenomas, hypertrophy, or nodular adrenocortical hyperplasia. Other histopathological diagnoses include pheochromocytoma, adrenocortical carcinoma, metastases, mesenchymal tumors, lymphomas, cysts, and ganglioneuromas. Adrenal tumors are more commonly diagnosed and better studied in elderly patients. In younger patients, under 40 years old, focal adrenal lesions are relatively rare, and histological distribution of diagnoses differs from that in elderly individuals. Younger patients are more likely to display endocrine symptoms, which raise the suspicion of an adrenal mass. In the current study, we present a case series of seven adrenal tumors occurring in young patients. The cases presented below, along with the literature review, demonstrate that the diagnosis and treatment of adrenal tumors are crucial due to endocrinopathy-derived complications and a potential risk of malignancy.

Novel Markers in Diabetic Kidney Disease-Current State and Perspectives.

Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease. Along with the increasing prevalence of diabetes, DKD is expected to affect a higher number of patients. Despite the major progress in the therapy of DKD and diabetes mellitus (DM), the classic clinical diagnostic tools in DKD remain insufficient, delaying proper diagnosis and therapeutic interventions. We put forward a thesis that there is a need for novel markers that will be early, specific, and non-invasively obtained. The ongoing investigations uncover new molecules that may potentially become new markers of DKD-among those are: soluble α-Klotho and proteases (ADAM10, ADAM17, cathepsin, dipeptidyl peptidase 4, caspase, thrombin, and circulating microRNAs). This review summarizes the current clinical state-of-the-art in the diagnosis of DKD and a selection of potential novel markers, based on up-to-date literature.

Chronic kidney disease in Polish elderly population aged 75+: results of the WOBASZ Senior Survey.

PURPOSE: Kidney filtration decreases with age, which results in an increased frequency of chronic kidney disease (CKD) in the elderly population. The purpose of the study was to assess the prevalence and epidemiology of CKD in the Polish elderly population. METHODS: A representative sample of the Polish elderly population, composed of 918 people (F 452, M 466) in the age of ≥75 years, was chosen. All participants had their history, anthropometric measures and biochemical parameters (creatinine, fasting glucose, complete cholesterol) evaluated. CKD was diagnosed when eGFR was <60 ml/min/1.73 m2. The comorbidities, anthropometric and social factors connected with the onset of CKD were also analyzed. RESULTS: The prevalence of CKD in the analyzed population was 26.9% (F 32.0%, M 15.8%), which gives an estimated number of 495,590 (95% CI 396,363-594,817) patients in the study subpopulation. The majority of these people were in the G3A category-70.1%, while the remaining fell under the G3B-25.7%, G4-3.1% and G5-1.1% categories. Disease awareness among the participants was found to be at 17%. Arterial hypertension (AH) was more frequent in people with CKD (91.0 vs. 80.3%, P < 0.001), whereas diabetes mellitus (DM) prevalence was comparable in both CKD and non-CKD groups (11.7 vs. 11.4%, ns). In the examined group, DM had no influence on the frequency of CKD. In contrast, the presence of cardiovascular diseases substantially increased the chances of developing CKD (OR 1.87, P < 0.05). CONCLUSION: 1. The prevalence of CKD in the Polish elderly population was 26.9%. 2. Awareness of CKD is low. 3. DM, increasing age and AH did not increase the risk of CKD. 4. Coexistence of cardiovascular diseases increased the risk of having CKD.

Gastrointestinal tract involvement in granulomatosis with polyangiitis.

INTRODUCTION: Granulomatosis with polyangiitis (GPA) is a necrotising vasculitis of small arteries and veins. In its classical manifestation GPA affects the upper and lower respiratory tract and kidneys. However, other organs, including those of the gastrointestinal tract, may be affected as well. AIM: To present the clinical manifestations of gastrointestinal tract involvement in patients with GPA. MATERIAL AND METHODS: We analysed case records of 34 patients with GPA treated in the Department of Nephrology, Transplantology, and Internal Medicine of the Medical University of Gdansk from 1991 to 2009. RESULTS: In 9 of 34 patients, 2 men and 7 women, aged 18 to 74 years, gastrointestinal complications were observed in the course of GPA. In two of them a localised and in seven a generalised type of GPA was diagnosed. The main symptoms relating to gastrointestinal tract were: oral mucosa ulcerations, gum mucosa hypertrophy, dyspepsia, vomiting, stomachache, gastrointestinal haemorrhage, diarrhoea, and symptoms of gastrointestinal tract perforation. Two patients required urgent surgical treatment. In 2 of the 5 patients who developed gastrointestinal bleeding, it was the direct cause of death. The histopathological confirmation of specificity of changes in gastrointestinal tract was established only in 2 cases. Tissue samples collected during endoscopy usually revealed only nonspecific inflammation or the presence of ulcers. CONCLUSIONS: Therapeutic strategies accepted for GPA treatment are effective in treating patients with gastrointestinal involvement in the course of the disease. Some complications require surgical intervention.

Prevalence of chronic kidney disease in a representative sample of the Polish population: results of the NATPOL 2011 survey.

BACKGROUND: Chronic kidney disease (CKD) has been proven to be a major risk factor of cardiovascular disease (CVD). Until now, data on the prevalence of CKD among adults in Poland were limited. The NATPOL 2011 survey is a cross-sectional observational study designed to assess the prevalence and control of CVD risk factors in Poland, and the first study capable of evaluating CKD prevalence in adult Polish citizens. METHODS: Serum creatinine concentration and the urine albumin-to-creatinine ratio (ACR) were measured in 2413 randomly selected participants (ages 18-79 years) from a national survey study. CKD was diagnosed if the estimated glomerular filtration rate (eGFR) was <60 mL/min/1.73 m(2) or ≥60 mL/min/1.73 m(2) with coexisting albuminuria (ACR ≥ 30 mg/g). Additionally, comorbidities and anthropometric and social factors related to the prevalence of CKD were analysed. RESULTS: The prevalence of CKD was estimated at 5.8% [95% confidence interval (95% CI) 4.6-7.2] using Chronic Kidney Disease Epidemiology Collaboration formula. The general prevalence was higher when the MDRD was applied [6.2% (95% CI 4.0-7.6)]. An eGFR <60 mL/min/1.73 m(2) was found in 1.9% (95% CI 1.5-2.5) of the studied population. This was accompanied by low awareness of this condition (14.9%). The frequency of albuminuria was estimated at 4.5% (95% CI 3.4-5.9). Diabetes mellitus (DM) and arterial hypertension (AH) were more frequent among respondents with diagnosed CKD compared with those without CKD [18.5 versus 4.5% (P < 0.001) and 67.8 versus 29.0% (P < 0.001) respectively]. DM and AH were, apart from increasing age, the two greatest risk factors of CKD. CONCLUSION: The estimated prevalence of CKD among adults in Poland is 5.8% (∼1 724 960 patients). Its prevalence was lower than expected. CKD is more frequent in older subjects, smokers and people with comorbidities such as AH and DM.