Browsing by Author "Mitrovic, Milos (56979859800)"

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.

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.

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.

Introduction. Patients on dialysis have a high rate of death, mainly of cardiovascular cause. Nephrologists are actively looking for ways to improve patients’ outcomes, and alternative dialysis strategies, such as long conventional hemodialysis and hemodiafiltration, are currently being investigated. The aim of this study was to compare anemia, nutrition, inflammation, mineral metabolism, and 3-year survival rates between patients treated with hemodiafiltration and prolonged high-flux hemodialysis (HFH). Materials and Methods. A total of 58 dialysis patients were divided into 2 groups to undergo hemodiafiltration 3 times weekly, 12 hours in total per week, or prolonged duration of HFH (≥ 15 h/w). One-year biochemical parameters were collected retrospectively, together with 36 months patients’ survival (prospectively). Results. Patients in the HFH group had longer dialysis vintage; significantly higher levels of hemoglobin (despite less frequent use of erythropoietin-stimulating agents), serum albumin, serum calcium, and serum bicarbonate; and a lower intact parathyroid hormone level. Survival rates were comparable between the two groups. The Cox proportional hazard model showed that patients treated with longer HFH had a 32% relative risk reduction of mortality compared to patients treated with hemodiafiltration, but without statistical significance (hazard ratio, 0.68; 95% confidence interval, 0.21 to 2.20; adjusted for diabetes mellitus). Conclusions. Longer duration of hemodialysis with high-flux membranes had beneficial effects on anemia indexes, mineral metabolism, nutrition parameters, and acidosis in comparison with hemodiafiltration. However, hemodiafiltration did not offer a 36-months survival benefit over prolonged HFH. © 2016, Iranian Society of Nephrology. All rights reserved.