Malignant tumors in hemodialysis patients.

We reviewed the incidence of malignant tumors among 923 patients with chronic renal failure, treated with hemodialysis (HD) in seven dialysis centers in Serbia between January 1983 and July 1993. Neoplasms were diagnosed in 45 cases (4.9%). The mean age of the cancer patients was 58.7 years. Eighteen cases (40.0%) were diagnosed in the first year after starting HD treatment and 21 (46.7%) cases were detected less than 5 years after induction of HD treatment. Most of the cancer patients (60.0%), especially the patients with Balkan endemic nephropathy (31.1%), developed cancer of the urinary tract. We concluded that HD patients have a several times greater risk of developing malignant tumors than the general population.

[Does renal mycobacteriosis exist?]. / Da li postoji mikobakterioza bubrega?

Urinary mycobacteriosis is rare although nontuberculous mycobacteria (NTM) are frequently isolated from the urine. 63 patients (pts) with NTM isolated from the urine were followed up 1 to 8 years; the most frequent complaint was low back discomfort (91% pts), while the leading laboratory findings were pyuria (72%) and microscopic hematuria (57%). Intermittent proteinuria was present in the minority (35%) showing nonnephrotic range. IVP revealed pathologic findings in 72% of the pts. During follow up none of the pts have had clinical or laboratory progression of the disease. Standard antituberculosis therapy has been applied in 22 pts, only 4 with satisfactory response. -Evidence of NTM does not exclude search for other possible causes of hematuria or pyuria; -renal mycobacteriosis, even if it does exist as an entity, is not as aggressive as tuberculosis; -standard treatment regimen for tuberculosis does not have positive effects in majority and susceptibility testing is necessary.

[Chlamydia urethritis in nephrologic practice]. / Hlamidijski uretritis u nefroloskoj praksi.

Chlamydia trachomatis is an ubiquitous bacterium, strictly intracellular organism. The D-K serovars urethritis, cervicitis, endometritis, salpingitis, periappendicitis and perihepatitis, in women, urethritis, prostatitis, epididymitis and Reiter's syndrome in 1-2% of cases in men. Sterility is the most serious complication in both sexes. Chlamydial infections are sexually transmitted diseases, often asymptomatic, prone to recurrences. Cure occurs only when both sexual partners are treated simultaneously. We treated 40 patients, 24 women and 16 men, from 1991-1994, who presented in nephrologic offices with symptoms of chlamydial urethritis. Detection of Chlamydia trachomatis was performed by direct fluorescent antibody stain. All patients had positive urethral swab, six women had chlamydial cervicitis too, one man had Reiter's syndrome, one man orchiepididymitis, and five men prostatitis. Optimal therapy for Chlamydia trachomatis infections consists of a 10-14 day regimen of quinolone, of tetracycline, and macrolides. We used sulfonamide rarely. Because of very serious sequelae of initial infection with Chlamydia trachomatis, every patient with urethritis should be examined by urethral swab for Chlamydia testing. Both partners should be examined and treated simultaneously.

[Treatment of renal insufficiency in patients with multiple myeloma]. / Terapija insuficijencije bubrega nastale kod bolesnika s multiplim mijelomom.

Multiple myeloma is the most frequent dysproteinaemica causing renal damage. Renal damage can be manifested as acute or chronic renal failure, Tubular disfunction, urinary tract infection, or as proteinuria. The aim of this study is to present our experience in the treatment of renal failure developed during multiple myeloma. Over a ten year period we treated 16 uraemic patients with multiple myeloma and renal failure. Most patients (75% or 12 of them) came to the nephrologic department because of acute renal failure provoked by multiple myeloma. Dialysis was applied to 9 patients. The average survival rate of these patients ranged from 6.2 +/- 9.2 months, while three patients lived for 23-24 months. The combination of chemotherapy and dialysis did not produce recovery of renal function in any case of acute renal failure. All deaths were related to the evolution of multiple myeloma and none to a complication of dialysis. In conclusion, dialysis treatment should be used even in cases of uraemia, if myeloma is not in the terminal phase.

Cytogenetic analyses reveal "atypical cells" in the peritoneal dialysis effluent.

Cytogenetic analyses were performed on dividing cells from the peritoneal effluent of 26 patients undergoing chronic peritoneal dialysis (CPD). Numerical and structural abnormalities of karyotype served as the diagnostic criteria for "atypical cells." The following cytogenetic abnormalities were observed in 7 patients: hyperdiploidy (in 6 patients), hypodiploidy (in 2 patients), and marker chromosomes (in 2 patients). In 3 patients more than one chromosome abnormality was present. Dividing cells with normal mitoses were observed in 11 patients, while in the remaining 8 patients no dividing cells could be found. There were no differences in age, sex, duration of dialysis, and peritonitis incidence between patients with pathological mitoses and those without it. The question whether this unexpected finding is a consequence of immunosuppressed uremic status, dialysis procedure, or some other factor remains to be elucidated.

[Arterial hypertension in patients with primary glomerulonephritis]. / Arterijska hipertenzija kod bolesnika s primarnim glomerulonefritisom.

Arterial hypertension is a state of blood pressure permanently higher than 160/90 mm Hg (21.3/12.6 kPa). The renal cause of hypertension occurs in about 10% of all cases. The aim of this article was to establish the frequency, the level, and the connection of the hypertension in different types of primary glomerulonephritis. In this study 90 patients with primary glomerulonephritis were observed. Hypertension was present in 45 patients (50%) and different frequency were noticed in different types of glomerulonephritis. The smallest frequency was recorded in the group with minimal changes and IgA nephritis. In the group with mesangioproliferative glomerulonephritis 52% of patients had hypertension and in the group with focal segmental sclerosis 78%. The most frequent hypertension was observed in the group with rapidly progressive glomerulonephritis. Renal failure was more frequent in patients with hypertension. Different frequencies of hypertension was established in different types of glomerulonephritis. It was not severe and was well controlled by remedies. In most cases it suggest a severe glomerular lesions and fast progression of the disease.

Uremic pruritus and skin mast cells.

The number of mast cells in the skin was evaluated in 25 patients with end-stage renal failure on different treatment modality (conservative, hemodialysis and peritoneal dialysis). According to the presence of pruritus, uremic patients were divided into two groups: group A, 13 patients with diffuse pruritus, and group B, 12 patients without pruritus. Controls were 6 age- and sex-matched healthy subjects. In comparison with patients without pruritus, patients with pruritus had mainly degranulated, diffusely spread and more numerous mast cells in the skin; significantly higher levels of plasma middle molecular weight substances, serum histamine and PTH and significantly lower serum iron levels. However, no differences were noted in observed parameters between groups on different treatment modalities. Favorable therapeutic effects in patients with pruritus were achieved either with iron supplementation in those with hypoferremia or with antihistamines, mast cell membrane stabilizers and high-permeability membranes.

[The effect of hyperprolactinemia on biohumoral parameters of bone metabolism in women of reproductive age on chronic hemodialysis]. / Uticaj hiperprolaktinemije na biohumoralne parametre metabolizma kosti kod zena reprodukcionog doba na hronicnoj hemodijalizi.

The study was carried out on a group of 20 women in reproductive age on chronic haemodialysis and on a control group of 11 healthy women. The women on a regular haemodialysis were divided into two subgroups: normoprolactinaemic and hyperprolactinaemic. The following parameters of bone metabolic changes were studied: serum calcium, phosphorus, alkaline phosphatase, pharathormon, osteocalcin, calcitonin, and also LH, FSH, prolactin and estradiol. The values of serum Ca, P, AP, PTH, CTC, OS and of LH and FSH were significantly higher in women on haemodialysis. The hyperprolactinaemic women on haemodialysis had lower values of bone metabolic parameters than normoprolactinaemic women. Hyperprolactinaemia did not significantly contribute to acceleration of bone metabolic changes which were already very accelerated due of secondary hyperparathyroidism.

[Acute kidney failure caused by poisoning]. / Akutna bubrezna insuficijencija kao posledica trovanja.

We present our experience in the treatment of acute renal failure (ARF) as a result of poisoning. The most frequent cause was acetic acid. Oligoanuric ARF was registered in 30 patients. In 34 patients peritoneal dialysis was applied for high values of serum urea and creatinine. The most frequent complications (oesophagitis, bleeding, mediastinitis, pneumonia, acute abdomen) were also the cause of death. After the treatment 31 patients were recovered with the mean creatinine clearance of 65.0 ae 27.7 ml/min. Ten patients died during the first 4 days of hospitalisation because of corrode effect of acid. This mortality of 24.4% is above the mean mortality registered for all ARF in our centre. In our opinion the treatment of ARF due to poisoning requires the team work of many specialists. Peritoneal dialysis is more advisable than haemodialysis because of bleeding tendency and intraabdominal monitoring.

[IgA nephropathy]. / IgA-nefropatija.

A great interest in IgA nephropathy was demonstrated in the last few years. Unfortunately, a complete picture of this chronic disease should not yet been made. The article deals with 7 patients with IgA nephropathy treated in our Institute. The following characteristics were examined during a long period of time (1-17 years): clinical picture, course of the disease, clinical and morphologic correlations. The disease is characterised by micro-and macro-haematuria. In 6 patients a moderate proteinuria and slow progression of the disease were noted. Hypertension, massive proteinuria and azothemia in IgA nephropathy suggested a bad prognosis of the disease. This was confirmed in one patient who developed terminal renal insufficiency within 4 months. The pathological finding by optic microscope revealed a wide spectrum of changes. The role of immunofluorescent microscopy is crucial in the diagnosis of this disease.

[End-stage renal failure due to diabetic nephropathy]. / Terminalna bubrezna insuficijencija kod diabetske nefropatije.

In the treatment of patients with confirmed diabetes mellitus diagnosis and causes of end-stage renal failure represent difficult problems because of their serious systemic complications. There is also disagreement about the advantage of dialysis we have applied. In our Institute over the last five years (until 1986) 20 patients were treated. We analysed the results of 18 patients: 14 on haemodialysis and 4 on intermittent peritoneal dialysis programme at the same time. During haemodialysis treatment the protein condition of the patients was improved and during peritoneal dialysis values of haematocrit and phosphorus. Medical complications were more frequent in the group on peritoneal dialysis. A-V shunt reconstructions were the most common reason of hospitalisation. The most frequent cause of death was hart failure. The survival rate was above the mean values in comparsion to other centres. We are satisfied with the results of treatment of these patients, but we also support the thesis that this is a very risky group of patients. For this moment we cannot adhere to any of these dialysis methods.

Shunt thrombosis prevention in hemodialysis patients--a double-blind, randomized study: pentoxifylline vs placebo.

Previous studies demonstrated a high incidence of local thrombosis in patients in whom external arteriovenous shunts were used for vascular access. This procedure provides, therefore, a useful model for the evaluation of potential antithrombotic agents. The effect of the hemorheologically and hemostasiologically active drug Pentoxifylline on the incidence of thrombosis of arteriovenous shunts (Ramires shunt) was investigated in a long-term, double-blind, placebo-controlled study in 51 patients on chronic hemodialysis. The two treatment groups were comparable in age, sex, concomitant medication, and dialysis program (three times per week for four hours). Drugs known to affect platelet function or coagulation were excluded, with the exception of heparin, during the dialysis procedure. All shunts were placed in the forearm and inserted into the distal part of the radial artery and basilic antebrachial vein. Simultaneously, for medical reasons, in all patients an arteriovenous fistula was performed (proximal part of radial artery and cephalic antebrachial vein). Shunt thrombosis was assumed when the flow in the shunt discontinued under visual and auscultatory control. Thrombi were documented by physical removal from the arterial part of the shunt by use of gentle suction or by complete shunt thrombosis (both arterial and venous part of the shunt). Thereafter, the patients' trial period terminated. The total number of thrombi during the observation period was 44 in the pentoxifylline group (26 patients), compared with 82 in the placebo group (25 patients). The mean number of thrombi per patient was 1.69 +/- 1.29 in the pentoxifylline group, significantly lower than that in the placebo group (3.28 +/- 1.99/p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)