Browsing by Author "Djuric, Petar (56979881000)"

A 69-year-old woman presented with severe anemia, proteinuria, microscopic hematuria and rapidly progressive renal failure. She was admitted to the nephrology department due to severe deterioration of renal function with complaints of malaise, fever, dry cough and occasional epistaxis that appeared 2 months prior to admission. Histopathologic examination of a specimen from kidney biopsy and immunologic findings revealed ANCA positive pauci-immune crescentic glomerulonephritis. The patient had a history of ovarian granulosa cell tumor and lung metastases that were treated surgically with postoperative radiotherapy and chemotherapy. Thoracic computed tomography showed tissue neoplasm in the right lung and ultrasound-guided percutaneous transthoracic biopsy confirmed granulosa cell tumor. That was a relapse, thirty-nine years after initial treatment of malignant disease and twenty-four years after surgical resection of metastases from both lungs. Although the association between malignancy and vasculitis has been well known for decades, this is the first described case of ANCA vasculitis associated with any type of gynecological malignancy and glomerulonephritis. © 2023, Cent Eur J Immunol. All Rights Reserved.

Purpose: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. The impact of vascular calcification process on AVF survival remains unclear and results of several studies about this issue are controversial. In the light of the new knowledge about the different susceptibility for calcification process in different blood vessels, the aim of our study was to analyze whether the calcification of AVF-blood vessels may have an impact on AVF longevity. Methods: The study included 90 patients, 49 males and 41 females, all of them Caucasians, with a mean age 62 ± 11 years, on regular hemodialysis for more than 1 year with patent primary AVFs. Vascular calcification in AVF-blood vessels or in the anastomotic region was detected using X-ray examination. Results: Calcification in AVF-blood vessels was found in 62% of patients. Binary logistic regression analysis demonstrated that male gender, presence of diabetes mellitus and longer duration of AVF before calcification determination were associated with calcification of AVF-blood vessels. Using a Cox proportional hazard model adjusted for these standardized predicted values revealed that patients with present AVF-blood vessels calcification had increased risk to develop AVF failure with a hazard rate of 3.42 (95% confidence interval 1.00–11.67; P = 0.049). Conclusions: Calcifications of AVF-blood vessels are found frequently among dialysis patients and may jeopardize the survival of native AVF. We suggested the local X-ray as simple and valid method for detection of patients that are at risk for AVFs failure which should be monitored more closely. © 2017, Springer Science+Business Media Dordrecht.

Postsurgical fat necrosis is a frequent finding in abdominal cross-sectional imaging. Epiploic appendagitis and omental infarction are a result of torsion or vascular occlusion. Surgery or pancreatitis are conditions that can have a traumatic and ischemic effect on fatty tissue. The imaging appearances may raise concerns for recurrent malignancy, but percutaneous biopsy and di-agnostic follow-up assist in the accurate diagnosis of omental infarction. Herein we describe a case of encapsulated omental necrosis temporally related to gastric surgery. Preoperative CT and MRI findings showed the characteristics of encapsulated, postcontrast nonviable tumefaction in the epi-gastrium without clear imaging features of malignancy. Due to the size of the lesion and the pa-tient’s primary disease, tumor recurrence could not be completely ruled out, and the patient under-went surgery. Histopathological analysis confirmed the diagnosis of steatonecrosis of the omentum. © 2021 by the authors. Li-censee MDPI, Basel, Switzerland.

Introduction. Renal biopsy represents a diagnostic method that provides an acurrate diagnosis and adequate treatment of different renal diseases. The first biopsy in our Center was done in June 1982, but it has been performing routinely since 1984. The aim of this study was to report the histopathological features of biopsy proven kidney disease during the past 30 years. Methods. During 30 years, a total of 563 biopsies were performed, of which 530(94%) were succesfull. Data about gender, age, clinical syndrome and histopatological finding were collected from the medical records. Results. The mean age of our patients was 48±11 years, 53% were man (No=272). In the first decade (1982-1994) we performed 118(mean age 50±13), in the second (1995-2004) 208 (mean age 46±14), and in the third decade (2005-2014) 189 renal biopsies (mean age 50±16). Mean number of glomeruli per biopsy was 18±11. There were only two serious complications. The most common clinical syndromes as indication for renal biopsy were: nephrotic proteinuria (41%) followed by asymptomatic urinary abnormalities (AUA-14.8%), chronic renal failure (CRF-13.8%), acute kidney injury (AKI-12.8%), nephritic syndrome (7.6%), systemic lupus erytematosus (SLE-4.5%), isolated haematuria (2.7% of the cases) and other (2.9%). The major histological groups identified were: primary glomerulonephritis (GN) (62.3%), secondary GN (21.2%), and other (16.5% of the cases). The most common primary glomerulonephritis (PGN) were focal segmental glomerulosclerosis-FSGS (19.4%) followed by IgA nephropathy-IgAN (18.8%), membranous GNMGN (16.4%) and mesangial proliferation-MesGN (16%). Interstitial changes were present in 55% of biopsy samples in the first, in 66% in the second and in 63% in the third decade. Blood vessel changes were present in 39% of biopsy samples in the first, in 62% in the second and in 72% in the third decade. Conclusions. The most frequent finding among PGN was mesangioproliferative GN (including IgAN, alltogether 34.8%) followed by FSGS and MGN. Apart from succesful biopsies, there are several aspects to be improved in the future including expanding indications and earlier procedure during the course of chronic kidney disease-CKD.

For adequate hemodialysis, functional vascular access is obligatory. Neointimal hyperplasia (NIH) has a central role in stenosis and thrombosis development, which represent the most frequent causes of vascular access failure. Polymorphism of different genes that have a significant role in endothelial function may have an impact on NIH development. Therefore, the aim of our study is to determine the effect of angiotensin-converting enzyme (ACE) I/D and matrix metalloproteinase-3 (MMP3) 5A/6A polymorphism on risk for developing vascular access failure in hemodialysis patients. The study included 200 patients on regular hemodialysis at Nephrology Department, University Medical Center Zvezdara. Retrospective analysis included a collection of general and vascular access data from medical records. Genetic analysis was performed by using polymerase chain reaction-restriction fragment length polymorphism method (PCR-RFLP). Patients were divided into two groups: Group 1 - patients who have never experienced vascular access failure and Group 2 - patients who have at least one spontaneous vascular access failure. There was no difference in age, gender, hemodialysis vintage, main diagnosis, presence of hypertension, and diabetes mellitus between the two groups. There were no statistically significant differences in the frequencies of ACE and MMP3 genotypes between the two groups. Without statistical significance, it was found that homozygotes for I allele had two times higher risk for developing vascular access failure than homozygotes for D allele (OR 2.00; 95%CI: 0.727-5.503; P = 0.180). In addition, patients with 5A allele have 1.7 times higher risk for developing vascular access failure compared with patients without this allele (OR 1.745; 95% CI: 0.868-3.507; P = 0.118). Patients with vascular access failure do not have different genotype distribution regarding ACE gene and MMP3 gene polymorphism as compared with patients without vascular access failure. Still, homozygotes for I allele and homozygotes for 5A allele have higher risk for developing vascular access failure compared with other patients. © 2019 Wolters Kluwer Medknow Publications. All rights reserved.

Background/Aims: Vascular calcifications are frequently found among dialysis patients, and the calcification process may influence the patient's outcome. The aim of the present study was to determine the role that vascular calcifications may have on autologous arteriovenous fistula (AVF) survival. Methods: This study included 90 patients (49 males, mean age 62 ± 11) with a native AVF treated by chronic hemodialysis (HD) for more than one year. The overall vascular calcification scores ranged from 0-11 (Adragao score + vascular access calcification score); patients were categorized into mild (score 0-3; n = 36), moderate (score 4-7; n = 24) and severe (score 8-11; n = 30) calcification groups. AVF survival was then followed for 5 years after calcification measurement or until the patient's death/transplantation. Results: Patients with more pronounced vascular calcifications were more frequently diabetic and male. Multiple linear regression analysis showed a significant relationship between calcification score and male gender, diabetes mellitus, previous duration of AVF, low dialysis flow rate and intact parathormone (iPTH) values. After multivariate adjustment for basal differences, Cox proportional analysis revealed a graded impact of calcification scores on AVF failure: moderate scores (were associated with a hazard rate (HR) of 3.82 (95% confidence interval (CI) 1.10-13.23) and severe scores with an HR of 4.65 (CI 0.97-22.38). Conclusion: Vascular calcifications are associated with worse survival of native arteriovenous hemodialysis fistulas. © 20152015 S. Karger AG, Basel. Copyright: All rights reserved.

Background/Aims: Vascular calcifications are frequently found among dialysis patients, and the calcification process may influence the patient's outcome. The aim of the present study was to determine the role that vascular calcifications may have on autologous arteriovenous fistula (AVF) survival. Methods: This study included 90 patients (49 males, mean age 62 ± 11) with a native AVF treated by chronic hemodialysis (HD) for more than one year. The overall vascular calcification scores ranged from 0-11 (Adragao score + vascular access calcification score); patients were categorized into mild (score 0-3; n = 36), moderate (score 4-7; n = 24) and severe (score 8-11; n = 30) calcification groups. AVF survival was then followed for 5 years after calcification measurement or until the patient's death/transplantation. Results: Patients with more pronounced vascular calcifications were more frequently diabetic and male. Multiple linear regression analysis showed a significant relationship between calcification score and male gender, diabetes mellitus, previous duration of AVF, low dialysis flow rate and intact parathormone (iPTH) values. After multivariate adjustment for basal differences, Cox proportional analysis revealed a graded impact of calcification scores on AVF failure: moderate scores (were associated with a hazard rate (HR) of 3.82 (95% confidence interval (CI) 1.10-13.23) and severe scores with an HR of 4.65 (CI 0.97-22.38). Conclusion: Vascular calcifications are associated with worse survival of native arteriovenous hemodialysis fistulas. © 20152015 S. Karger AG, Basel. Copyright: All rights reserved.

Introduction: Microscopic polyangiitis (MPA) is one of the causes of the pulmonary-renal syndrome associated with elevated non-specific markers of inflammation and antineutrophil cytoplasmic autoantibody (ANCA) positivity in 50-75%. De novo occurrence of the disease in patients on chronic hemodialysis (HD) has not been described. Case presentation: We presented patient who developed MPO-ANCA-associated MPA with lung and musculoskeletal involvement after 4 years on regular HD due to bilateral nephrectomy. After excluding the other causes of MPO-ANCA positivity, diagnosis was confirmed even without renal biopsy. Patient received standard immunosuppression therapy and he is still in remission after 27 months. Conclusion: The onset of immune-mediated disease could be observed even after introduction of renal replacement therapy, which may be a diagnostic problem. Early recognition and traditional immunosuppressive regiment may provide successful outcome. © 2017 Jankovic, Maslarevic-Radovic, Djuric, Tosic-Dragovic, Bulatovic, Simovic, Mitrovic, Stankovic-Popovic, Dopudja-Pantic, Arandjelovic and Dimkovic.

Introduction: Microscopic polyangiitis (MPA) is one of the causes of the pulmonary-renal syndrome associated with elevated non-specific markers of inflammation and antineutrophil cytoplasmic autoantibody (ANCA) positivity in 50-75%. De novo occurrence of the disease in patients on chronic hemodialysis (HD) has not been described. Case presentation: We presented patient who developed MPO-ANCA-associated MPA with lung and musculoskeletal involvement after 4 years on regular HD due to bilateral nephrectomy. After excluding the other causes of MPO-ANCA positivity, diagnosis was confirmed even without renal biopsy. Patient received standard immunosuppression therapy and he is still in remission after 27 months. Conclusion: The onset of immune-mediated disease could be observed even after introduction of renal replacement therapy, which may be a diagnostic problem. Early recognition and traditional immunosuppressive regiment may provide successful outcome. © 2017 Jankovic, Maslarevic-Radovic, Djuric, Tosic-Dragovic, Bulatovic, Simovic, Mitrovic, Stankovic-Popovic, Dopudja-Pantic, Arandjelovic and Dimkovic.

Purpose: Cardiovascular calcifications (CVC) are present in up to 70% of non-diabetic dialysis patients. Sparse data are available on predictors of very long-term outcomes of such patients. The Belgrade Aachen Study on Calcification in Hemodialysis patients (BASCH study) aimed to study this using a comprehensive CVC assessment. Methods: We prospectively analyzed 220 hemodialysis patients followed for a mean of 76 months (median 73 months, range 6–160 months). We compared patients deceased from cardiovascular diseases (CVD) and survivors. Analyses included composite calcification scores (determined by combining ultrasound and X-ray analyses), demographic, clinical and laboratory data and pulse wave velocity (PWV). For survival analysis, patients were divided into group according to quartiles (Q). Results: Compared to survivors, deceased patients from CVD were significantly older, more frequently hypertensive, had shorter dialysis times per week and lower Kt/V values, and they exhibited lower serum fetuin A, osteoprotegerin and hemoglobin as well as higher CRP levels. Composite calcification and Adragao scores were significantly higher in deceased patients from CVD as was PWV. Mean survival was 101 ± 47 months (Q1), 87 ± 51 month (Q2), 66 ± 48 (Q3) and 54 ± 45 months (Q4), p = 0.000. Cox multivariate regression analysis showed that independent predictors for cardiovascular mortality were composite calcification score in the range of third and fourth quartiles. Conclusion: Composite calcification score emerged as significant predictors of long-term survival in our group of largely non-diabetic dialysis patient population, finding that should be confirmed by intervention studies. © 2018, Springer Science+Business Media B.V., part of Springer Nature.

Background: Sodium thiosulphate (NaTS) is mostly used in haemodialysis (HD) patients with calcific uraemic arteriolopathy. This double-blind, randomized, placebo-controlled study assessed the effect of NaTS on progression of cardiovascular calcifications in HD patients. Methods: From 65 screened patients, we recruited 60 patients with an abdominal aorta Agatston calcification score ≥100. Thirty patients were randomized to receive NaTS 25 g/1.73 m2 and 30 patients to receive 100 mL of 0.9% sodium chloride intravenously during the last 15 min of HD over a period of 6 months. The primary endpoint was the absolute change of the abdominal aortic calcification score. Results: The abdominal aortic calcification score and calcification volume of the abdominal aorta increased similarly in both treatment groups during the trial. As compared with the saline group, patients receiving NaTS exhibited a reduction of their iliac artery calcification score (-137 ± 641 versus 245 ± 755; P = 0.049), reduced pulse wave velocity (9.6 ± 2.7 versus 11.4 ± 3.6; P = 0.000) and a lower carotid intima-media thickness (0.77 ± 0.1 versus 0.83 ± 00.17; P = 0.033) and had better preservation of echocardiographic parameters of left ventricular hypertrophy. No patient of the NaTS group developed new cardiac valve calcifications during the trial as compared with 8 of 29 patients in the saline group. By univariate analysis, NaTS therapy was the only predictor of not developing new valvular calcifications. No adverse events possibly related to NaTS infusion were noted. Conclusions: While NaTS failed to retard abdominal aortic calcification progress, it positively affected calcification progress in iliac arteries and heart valves as well as several other cardiovascular functional parameters. © 2019 The Author(s). Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

[No abstract available]

Increasing interest in home dialysis treatments are driven by better outcomes, less complications, patients desire and economic reasons. We compared 26 prevalent home hemodialysis (HHD) patients with 52 matched institutional hemodialysis patients (IHD) in survival and morbidity. Median age for HHD and IHD patients was 55,7 and 56 years respectively, and 77% were men. HHD patients had significantly better anemia control (Hgb level 12.2 ± 1.7 vs. 10.8 ± 1.3gr/dl; p = 0,001 respectively), and significantly higher albumin and cholesterol levels than IHD (42.5 ± 2 vs. 39 ± 3 g/l, p = 0.001; 5.1 ± 1 vs.4.7 ± 0.8 mmol/l, p = 0.05, respectively). During the nine years of follow up, there was no difference between groups in overall number of hospitalization (3.7 ± 3.3 vs. 3.9 ± 2.8; p = 0.47), nor in annual admission rate for everyone cause (0.5 ± 0.4 vs. 0.6 ± 0.4, p = 0.28), but IHD patients stayed longer in hospital (7.4 ± 9.8 days vs. 9.3 ± 8.7 days; p = 0.05). Cause-specific morbidity showed that IHD patients had more frequent annual admission rate for cardiovascular diseases (CVD) than HHD (0.4 ± 0.3 vs. 0.2 ± 0.1 respectively, p = 0.05), while there were no differences for infections (0.3 ± 0.3 vs. 0.3 ± 0.2 respectively, p = 0.9) nor vascular access (VA) dysfunction (0.4 ± 0.3 vs. 0.3 ± 0.3 respectively, p = 0.3). Also annual in-hospital stay for CVD (3.0 ± 3.1 vs. 4.0 ± 4.5 days; p = 0.5), infection (6,4 ± 7,5 vs. 5,7 ± 7,6 days; p = 0,6) and VA dysfunction (6.0 ± 7.0 vs. 7.7 ± 7.8 days; p = 0,5) did not differ between HHD and IHD group. As revealed by Kaplan Meier curve, survival in HHD and IHD patients were 92.3% vs. 90.4% at 3 years, 84.6% vs. 70.2% at 5 years, and 55.7% vs. 50% at 9 years (log-rank test p = 0,5). HHD provides better anemia and nutrition control; shorter hospitalizations and less frequent hospitalizations for CVD. © The Author(s), under exclusive licence to the Japanese Society for Artificial Organs 2025.

Increasing interest in home dialysis treatments are driven by better outcomes, less complications, patients desire and economic reasons. We compared 26 prevalent home hemodialysis (HHD) patients with 52 matched institutional hemodialysis patients (IHD) in survival and morbidity. Median age for HHD and IHD patients was 55,7 and 56 years respectively, and 77% were men. HHD patients had significantly better anemia control (Hgb level 12.2 ± 1.7 vs. 10.8 ± 1.3gr/dl; p = 0,001 respectively), and significantly higher albumin and cholesterol levels than IHD (42.5 ± 2 vs. 39 ± 3 g/l, p = 0.001; 5.1 ± 1 vs.4.7 ± 0.8 mmol/l, p = 0.05, respectively). During the nine years of follow up, there was no difference between groups in overall number of hospitalization (3.7 ± 3.3 vs. 3.9 ± 2.8; p = 0.47), nor in annual admission rate for everyone cause (0.5 ± 0.4 vs. 0.6 ± 0.4, p = 0.28), but IHD patients stayed longer in hospital (7.4 ± 9.8 days vs. 9.3 ± 8.7 days; p = 0.05). Cause-specific morbidity showed that IHD patients had more frequent annual admission rate for cardiovascular diseases (CVD) than HHD (0.4 ± 0.3 vs. 0.2 ± 0.1 respectively, p = 0.05), while there were no differences for infections (0.3 ± 0.3 vs. 0.3 ± 0.2 respectively, p = 0.9) nor vascular access (VA) dysfunction (0.4 ± 0.3 vs. 0.3 ± 0.3 respectively, p = 0.3). Also annual in-hospital stay for CVD (3.0 ± 3.1 vs. 4.0 ± 4.5 days; p = 0.5), infection (6,4 ± 7,5 vs. 5,7 ± 7,6 days; p = 0,6) and VA dysfunction (6.0 ± 7.0 vs. 7.7 ± 7.8 days; p = 0,5) did not differ between HHD and IHD group. As revealed by Kaplan Meier curve, survival in HHD and IHD patients were 92.3% vs. 90.4% at 3 years, 84.6% vs. 70.2% at 5 years, and 55.7% vs. 50% at 9 years (log-rank test p = 0,5). HHD provides better anemia and nutrition control; shorter hospitalizations and less frequent hospitalizations for CVD. © The Author(s), under exclusive licence to the Japanese Society for Artificial Organs 2025.