[Reccurent Clostridium difficile infection in patient after kidney transplantation on rituximab therapy due to PTLD (Post-Transplant Lymphoprolipherative Disorder). First experience with Fidaxomicin use--case report]. / Nawracajaca infekcja Clostridium difficile u chorego po przeszczepieniu nerki leczonego rytuksymabem z powodu PTLD (Post- Transplant Lymphoprolipherative Disorder). Pierwsze doswiadczenie ze stosowaniem fidaksomycyny--opis przypadku.

Clostridium difficile infection (CDI) is an increasingly problem in everyday clinical practice. The most important risk factor of this infection is antibiotics use. The incidence of Clostridium difficile associated diarrhea (CDAD) in patients after renal transplantation is estimated to be about 6% in the early postoperative period. Due to the applied immunosuppression and frequent infections requiring intensive, broad spectral antibiotics, the later prevalence of CDAD may remain at a similar level. Massive diarrhea caused by Clostridium difficile may lead to fluctuations in immunosuppressive drugs concentration, in renal transplant patients. The authors present a case study of a 23-year old patient after kidney transplantation from deceased donor, with diagnosed polymorphic PTLD (Post-Transplant Lymphoproliferative Disorder). During biological treatment with rituximab in this patient 4 recurrences of CDI were observed. In this article the clinical manifestation of recurrent CDAD are presented. The authors discuss therapeutic procedure with fidaxomicin use, its results and influence on immunosuppressive drugs concentration.

[Goodpasture's syndrome--disease of many faces]. / Zespól Goodpasture'a - choroba o wielu obliczach.

Pulmonary-renal syndrome (PRS) can originate from several connective tissue diseases. It belongs to the potentially life-threatening conditions. Clinically PRS is a combination of diffuse pulmonary hemorrhage and renal involvement including glomerulonephritis, nephrotic syndrome or acute renal failure. Goodpasture's syndrome accounts for approximately 20% cases of PRS. Until recently diffuse pulmonary hemorrhage connected with rapid progressive glomerulonephritis usually resulted in a very bad prognosis. However now, rapid diagnostic process (antibodies identification, kidney and pulmonary biopsy) can speed up a difficult decision of using intense immunosuppressive therapy including cyclophosphamide and methylprednisolone pulses or plasma exchanges. Simultaneously, the therapy should be supported by artificial ventilation and renal replacement therapy. In some cases such a treatment can be followed by a complete recovery from renal and pulmonary diseases. The combined therapy contributed to considerable reduction in mortality rate that recently has been achieved in PRS patients. In present paper 3 cases of Goodpasture's syndrome with different manifestations of the disease were described.

[Cardiorenal syndrome--alternate challenge for nephrologist]. / Zespól sercowo-nerkowy--kolejne wyzwanie dla nefrologa?

Cardiac diseases are associated independently with a deterioration of renal function and worsening of existing kidney diseases. On the other hand chronic kidney disease is an independent risk factor for increased cardiovascular morbidity and mortality. Cardiorenal syndromes are disorders of the heart and kidneys whereby acute or long-term dysfunction of one organ may induce acute or chronic dysfunction of the other. In these review paper we focused on the pathophysiology and treatment options of five subtypes of the cardiorenal syndrome.

[Relationship between urine volume and long-term prognosis in patients with overcoming acute kidney injury (AKI)]. / Zwiazek pomiedzy wielkoscia diurezy a rokowaniem odleglym u chorych z przebytym ostrym uszkodzeniem nerek (OUN).

Acute kidney injury (AKI) is a multifactorial disease syndrome affecting usually patients in severe states negatively influencing present and long-term prognosis. Between many factors influencing long-term prognosis urine volume at the time of AKI incidence may be a factor that determines the future fate of patients and explains the necessity of its monitoring. The aim of the study was to evaluate the coexistence between present urine volume at the time of AKI and long-term follow-up of 127 patients with AKI treated in our department. It was shown that sustained urine output during the course of AKI incidence significantly influenced long-term prognosis and was a positive factor. Additionally, 300 ml/24 hours urine volume limit as a border of oligoanuria was satisfactory discriminant.

[Acute renal failure during HELLP syndrome--case report]. / Ostra niewydolnosc nerek w przebiegu zespolu HELLP--opis przypadku.

Case report was presented of a 22 year old pregnant patient with diagnosed intrauterine fetal death, who developed HELLP syndrome and acute renal failure. Immediate hemodialysis treatment was initiated that permitted management of pulmonary edema; subsequent plasmapheresis eliminated not only elevated bilirubin and toxins liberated to circulation from the dead intrauterine fetus but also allowed for patient recovery. The HELLP Syndrome requires careful obstetric supervision and if possible treatment in the Intensive Care Unit.

[Insufficiency of arteriovenous fistulas in patients with end-stage renal failure--emergency surgical procedures]. / Niedroznosc przetok tetniczo-zylnych u chorych ze schylkowa niewydolnoscia nerek--dorazne interwencje chirurgiczne.

From 1.07.1994 to 30.06.2001 in the 2-nd Department of Surgery and Department of Nephrology Collegium Medicum Jagiellonian University, in 274 patients with terminal renal failure 341 vascular access for hemo-dialysis have been performed. Acute insufficiency in functioning arteriovenous fistulas occurred in 93 patients. In six of them, an attempt of thrombectomy was done. In 56 patients (group I) we carried out the new fistula on the same vascular level. In the remaining 31 cases (group II) we were forced to perform the procedure at a higher level. To compare late results in both groups of patients the method of Life Table Analysis was used. Cummulated index of patency (Pk) in the time interval 10-12 months in two groups was 0.67. In the time interval 49-54 month in group I, Pk dropped to 0.38, in group II was 0.57. The study we carried out indicates that creation of vascular access on arterialized vessels, being profitable in many aspects, does not provide such long efficient functioning as those created on the new, higher level.

Acute renal failure in patients with rhabdomyolysis.

BACKGROUND: Rhabdomyolysis is a relatively rare, not always diagnosed cause of acute renal failure (ARF). This fact motivated us to present the results of ARF treatment in the course of this polyetiological clinical syndrome. MATERIAL/METHODS: The analysis was performed on 84 patients (6 F, 78 M) ranging in age from 18 to 82 years (mean 46.5), in whom rhabdomyolysis was diagnosed based on clinical manifestation and laboratory test results (CPK, GTP, GOT, LDH). RESULTS: The most frequent cause of rhabdomyolysis was alcoholic intoxication (41 patients), often accompanied by hypothermia (15 patients) or trauma (30 patients). Isolated trauma was found in 30 patients, epileptic seizure in 5, and physical exercise in 1 case. In 17 patients, besides alcohol consumption, trauma or epileptic seizure, the use of tranquilizers, anticonvulsants, or narcotic drugs was additionally noted. 78 patients developed ARF requiring dialysis therapy; 49 patients recovered, 5 required maintenance dialysis, and 30 died. CONCLUSIONS: During the initial phase of ARF in the course of rhabdomyolysis dynamic increases in serum urea and creatinine were observed, as well as a tendency to hyperkalemia. The treatment results and mortality rate in our study group were primarily influenced by the patients' general condition at admission, as well as the extent of organ damage caused by the primary etiological factor. Favorable treatment results were obtained especially in those patients who were hospitalized in a nephrological center, while the worst outcomes were noted in those patients dialyzed in intensive care units, most with multiple trauma.