[Acute papillary necrosis in transplanted kidney]. / Ostra papilarna nekroza v transplantiran bubrek.

After a short literature survey, indicating the rarity of acute papillary necrosis in transplanted kidneys, the authors reported one of their patients, aged 32, with transplanted dead body kidney from a male, aged 30, with blood group compatibility and compatibility of two antigens in locus A. Two hemodialysis were necessiated because of acute tubular necrosis in the transplant. After the second one, performed 10 days after the transplantation, the patient felt very strong pains in the region of the transplant, edema around it and hypovolemic shock. The kidney was explanted and necrosis of the majority of the papillae in it--established, and around it--blood collection. After that incidence, the patients had three severe gastrointestinal hemorrhages with shocks, that necessitated profuse transfusion of blood. Their cause was a small erosion, about a lentil seed, at the pyloric opening, resulting from the cortico-therapy and periodic heparinization for dialysis. The patients was reanimated and returned to programmed chroniodialysis. The possible causes for papillary necrosis are discussed, most acceptable being two of them them--urostasis from 1200 ml urine in the urinary bladder, that required catheterization before the incidence and/or compression and ischemia of the transplanted kidney by the blood collection around it.

[Urea kinetics model of patients on programmed hemodialysis]. / Ureino-kinetichno modelirane pri bolni na programna khemodializa.

Fifty three patients with programmed hemodialysis, in a stable state were studied to the method of urea-kinetic modelling. A high correlation relationship was established between the pre-dialysis values of urea nitrogen in blood and the protein import, calculated from the quantity of the endogenously produced urea nitrogen. The best rehabilitated patients (41,5%) proved to introduce 1,0-1,6 g/kg body weight proteins and maintain a concentration of blood urea nitrogen from 65-95 ng% (32,14-33,8 mmol/1). Furthermore, another three patient groups were formed: with reduced protein introduction, with insufficient clearance and with overnormal protein introduction. The optimal group significantly differ from them, according to the state of nourishment, general rehabilitation, phosphatemia, calcium-phosphorus number and dialysis clearance. Both the stage of anemia and arterial hypertension show only a tendency in similar direction.

[Viral hepatitis associated with prolonged hemodialysis treatment]. / Virusniiat khepatit vuv vruzka s produlzhitelnoto khemodializno lechenie.

Viral hepatitis has a high incidence both among patients on hemodialysis and among the attending personnel. A clinical epidemiological study on hepatitis epidemic was carried out at the department of hemodialysis--Research Institute of Nephrology, Urology, Hemodialysis and Transplantation--for an eight-year period. Twenty two per cent of the patients were affected by hepatitis infection and 27.1 per cent of the personnel. The disease has, more often, a subclinical course in the patients on hemodialysis, manifested not later than one year after the initiation of hemodialysis treatment. The epidemic of viral hepatitis a chain of five epidemic outbreaks with a considerable predomination of HBsAg--positive forms. About 15 per cent of the patients on hemodialysis are chronic carriers of HBsAg, being, very likely, associated with the altered immune reactivity. All those data support the necessity of the introduction of a campaign programme against hepatitis epidemic.

[Acute papillary necrosis in the transplanted kidney]. / Ostra papilarna nekroza v transplantiran bubrek.

After a brief literature survey revealing the rarity of the papillary necrosis in transplanted kidneys, the authors report the case of one of their patients, aged 32, transplanted a corpse kidney of a 30-year old male with blood-group compatibility and with coincidence of the two antigens in locus A. Regardless of the increased diuresis of the patient to 3-4 1 within 24 hours, its nitrogen bodies persisted their elevation, necessitating two dialysis. After the second dialysis performed on the tenth day after the transplantation, the patient had very strong pains in the transplantation region, edema around it and a hypovolemic shock. The kidney was explanted and at the examination--necrosis of all papillae in it was established. Blood collection was found round the kidney. The same patient, after that incidence, suffered three successive severe gastrointestinal hemorrhages with shock that necessitated abundant blood transfusions. The cause was a small erosion, about the size of a millet, at the pyloric lumen, result from corticotherapy and favoured by the periodical heparinization during the following hemodialysis. The patient was reanimated and put again on a programmed chroniodialysis.

[Serum levels of thyroxine (T4), triiodothyronine (T3) and thyrotropic hormone (TSH) in chronic kidney insufficiency]. / Serumno nivo na tiroksina (T4), triiodotironina (T3) i tireotropniia khormon (TTKh) pri khronichna bubrechna nedostatuchnost.

The authors studied the serum level of T3, T4 and TTH in 30 euthyroid patients with chronic renal insufficiency (CRI), distributed in three groups of 10 patients. I group includes patients with CRI II and III stage without dialysis treatment, patients with CRI are included in the II group, being under hemodialysis treatment from 5 to 12 months, and in III group--patients dialized three and more years. Low average values of T3--0.65 mg/ml were established only in the first group; in 8 patients, out of 10 examined, the values were under the lower limit of the norm. Though the T4 values in the first group were within the limits of the norm (5.87 mkg/100 ml), they were under the average normal values (8.5 mkg/100 ml) and lower, with a statistical significance (pt less than 0.025) as compared with those of the other two groups. The values of T3 and T4 in both groups dialyzed patients were within the limits of the norm regardless of the duration of dialysis. In none of the patients from the three groups examined, deviations in TTH level were found. The authors drew the conclusion that biochemical hypothyroidism, manifested with low T3 values, normal TTH level and a tendency of T4 decrease was observed in nondialyzed patients even with CRI II stage (creatine 6.8 mg%). Biochemical hypothyroidism abates with the adequate and effective hemodialysis treatment, suggesting that uremic toxins play and essential role in its development. It was stressed that abatement could be used as a criterion of adequate and effective dialysis programme and a reliable rehabilitation of the patients, under chronodialysis treatment.

[Tuberculosis in patients treated with chronic dialysis]. / Tuberkuloza u bolni, lekuvanni s khroniodializa.

Four cases with tuberculosis, not differentiated clinically and one case with ordinary septic process, falsly diagnosed as tuberculosis are described in patients treated with long-term hemodialysis. The errors admitted are analyzed, the significance of the atypical tuberculosis forms being stressed upon, especially miliary tuberculosis, pulmonary uremic edema, resembling disseminated pulmonary tuberculosis as well as of reduced activity in searching and diagnosis of tuberculosis. A plan and indications for the treatment of those infections in patients with kidney diseases are presented, treated with long-term hemodialysis.