[The comparison of selected parameters of structure and function of the cardiovascular system in patients with functioning graft on maintenance hemodialysis during a one year period]. / Porównanie wybranych wskazników opisujacych strukture i funkcje ukladu krazenia u pacjentów po przeszczepieniu nerki oraz chorych hemodializowanych w okresie jednego roku.

Successful renal transplantation allows to correct most of the abnormalities that lead to cardiovascular system injury in chronic uremia. The aim of the present study was to analyze selected anatomical and functional parameters of the heart using echocardiography. The study was conducted prospectively in two groups of patients: 73 subjects with functioning graft and 53 patients on maintenance hemodialysis. Obtained results were compared between those two groups at the start of the study and later on after 6 and 12 months of follow-up. Post-transplant patients were included into the study 11 +/- 6.4 months after successful transplantation. Mean dialysis period prior to transplantation was 35 +/- 21 months. Patients in the control group were dialyzed for mean 54 +/- 25 months. The prevalence of various diseases of the cardiovascular system was equal in both groups of patients (most frequently diagnosed was hypertension). There was no difference in ejection fraction within groups during the whole study period, however the value of this parameter was higher among patients with functioning graft at the beginning of the study (p < 0.01) as well as after 6 and 12 months (p < 0.001) as compared to patients on dialysis. The prevalence of different morphological abnormalities of the heart, such as concentric hypertrophy, left ventricle dilatation, valve dysfunction as well as calcification of various structures, was equal in both groups of patients at the beginning of the study. In 87.7% of patients with functioning graft, left ventricle hypertrophy was diagnosed at the beginning of the study (mean LVMI value 176.9 +/- 55.5 g/m2) and this percentage decreased to 63% after 6 months (LVMI 155.8 +/- 60.3 g/m2; p < 0.001 vs. baseline) and 53.4% after 12 months (LVMI 141.6 +/- 62.1 g/m2; p < 0.001 vs. baseline). Regression of initial left ventricle hypertrophy, although less pronounced was also present among patients on maintenance dialysis. There was no difference in LVMI value between the studied groups at the beginning of the study, whereas after 6 and 12 months of observation it became significantly lower in patients with functioning graft (155.8 +/- 60.3 vs. 179.5 +/- 50.9 g/m2; p < 0.01 and 141.6 +/- 62.1 vs. 176.2 +/- 50.5 g/m2; p < 0.001). Based on obtained results we conclude that successful renal transplantation promotes the normalization of a number of echocardiographic parameters, especially leads to regression of left ventricle hypertrophy. Renal transplantation seems to be an optimal method of treatment in patients with end-stage renal failure, considering structure and function of the cardiovascular system.

[Selected renal complications during the course of multiple myeloma]. / Wybrane powiklania nerkowe w przebiegu szpiczaka mnogiego.

Multiple myeloma is the most frequent dysproteinemia leading to nephropathy. The aim of the study was to analyse this complication in patients treated in nephrological departments. The study was performed in 83 patients (45 M, 38 F) aged 47-82 years in whom a diagnosis of multiple myeloma was based on clinical manifestation (weakness, subfebrile states, bone aches, loss of body weight, recurrent infections of urinary and respiratory tracts), increased number of plasmocytes in bone-marrow, presence of monoclonal protein in serum and/or urine and lesions in bone system. In a significant number of the studied patients the disease was revealed while diagnosing proteinuria as well as searching for a reason of elevated erythrocyte sedimentation rate or proteinogram abnormalities. The obtained results indicate that signs of nephropathy in the course of multiple myeloma may be the first visible symptoms of the disease. Proteinuria was observed in 79.5% of the studied patients. Bence-Jones protein was found in 41% of individuals and features of renal failure in different stages of development in 67%. Dialysis therapy was started in 3 patients with acute and 7 patients with chronic renal failure.