Suchergebnisse

Abstract
Acute kidney injury (AKI) is a serious complication in the perioperative period and is consistently associated with increased morbidity and case fatality rate. This has been best studied in the cardiac surgery setting where it has been shown that up to 11.5–86.0% of patients exposed to cardiopulmonary bypass (CPB) will develop AKI, with 2.0–18.9% requiring renal replacement therapy (RRT). A prospective uncontrolled cohort study was conducted between 2011 and 2015, in which 93 children with various congenital heart lesions undergoing CPB were enrolled. Serum creatinine (SCr) level was determined by Jaffé's method (Cobas 6000 analyser, Roche). Postoperative fluid balance was estimated as the difference between fluid intake and output. Data for further processing were retrieved from anaesthesia and intensive care data management system flowsheets (IntelliView, Philips). AKI developed in 42 patients (45.6%) by meeting at least KDIGO (Kidney Disease: Improving Global Outcomes) stage I criteria (with SCr rise by more than 50% from the baseline). Thirty eight patients complied with the 1st stage of AKI, three with 2nd stage and two with 3rd stage, according the KDIGO classification and staging system. One patient having severity stage II and two patients having severity stage III of AKI required initiation of RRT using peritoneal dialysis. Two patients from the RRT group survived, one died. The median intraoperative urine output was 2.32 ml/kg/h, (range from 0.42–5.87 ml/kg/h). Median CPB time was 163 min., median aortic cross-clamping time was 97.9 min., cooling during CPB to 29.5 °C. The diagnosis of AKI using SCr was delayed by 48 hours after CPB. Median fluid balance (FB) on the first postoperative day in non-AKI patients was 13.58 ml/kg (IQR 0–37.02) vs 49.38 ml/kg (IQR 13.20–69.32) in AKI patients, p < 0.001. AKI is a frequent complication after open heart surgery in children with congenital heart lesions. From 93 patients included in the study, 42 (45.2%) met at least KDIGO Stage I criteria for AKI. FB is a sensitive marker of kidney dysfunction. Median FB in the 1st postoperative day significantly differed between AKI patients: 49.38 ml/kg (13.20–69.32) versus 13.58 ml/kg in patients with intact kidney function (AUC = 0.84; p = 0.001). Thus it can be used as a marker of AKI.

Renal anaemia: the role of haemoglobin control in patients with chronic kidney disease
Chronic kidney disease (CKD) is a significant and prevalent health problem in the world. Anaemia is one of the most common manifestations in patients with CKD. The correction of anaemia with erythropoietin normalises haemoglobin level and improves quality of life. Many aspects of the impact of anaemia treatment with erythropoiesis-stimulating agents on the progression of CKD remain unresolved and disputable. The present study is a retrospective chart review of 1654 outpatients with CKD. The data were collected from the Centre of Nephrology between 1 January 2002 and 31 December 2006. The aims of the study were to assess the causes of CKD; the prevalence of anaemia based on the current guidelines for anaemia management in CKD (Kidney Disease Dialysis Outcomes Quality Initiative; K/DOQI); to evaluate haemoglobin (Hb), systolic and diastolic blood pressure (SBP and DBP), glomerular filtration rate (GFR) at the first referral to a nephrologist and at the start of renal replacement therapy (RRT). The most common causes of CKD were arterial hypertension (17.2%), chronic glomerulonephritis (17.2%), chronic intersticial nephritis (13.3%), and diabetes (12.8%). Twenty-three percent of end-stage renal disease (ESRD) patients had diabetes mellitus. At the first visit in the renal department, 16% of the patients had an advanced degree of CKD (GFR <30 ml/min). The proportion of patients under an observation in the kidney centre for a period of six months and more was only 34% (554 of 1654). Hypertension was recorded in 72% of study subjects. The blood pressure (BP) values in patients at the first visit (n = 1633) vs. at the start of RRT (n = 154) were: mean SBP 147.4 ± 24.8 mm Hg vs. 152.2 ± 23.0 mm Hg (P < 0.05); mean DBP 88.8 ± 13.6 mm Hg vs. 88.4 ± 12.0 mm Hg (P 0.05). Anaemia was recorded in 41% of study subjects, estimated using K/DOQI recommendations. The prevalence of anaemia was increased from 30.2% to 44.8% of study patients with a rise of BP (from normal BP to hypertension; P < 0.05). The mean Hb level at the start of RRT was 9.8 ± 2.1 g/dl. Only 18% of patients with renal anaemia had used erythropoiesis-stimulating agents before RRT (28 of 155). Anaemia is the prevalent condition at moderate degrees of CKD. The severity of anaemia in the CKD population is determined by evidence of diabetes, cardiovascular disease, and renal function. Anaemia may often be unrecognised or untreated.

Abstract
Immunoglobulin A nephropathy (IgAN) is the most common chronic glomerulopathy with variable clinical manifestations. IgAN diagnostics became possible in Latvia in 2013. The study aim was to describe IgAN manifestations in the Latvian population by analysing epidemiological, clinical, histological data, and reveal factors that might determine the course of the disease. The retrospective, one-centre study included biopsy-proven IgAN patients over a five-year period in the Nephrology Centre at Pauls Stradiņš Clinical University Hospital. Data from inpatient and outpatient medical records were collected. The study included 69 patients with histologically confirmed IgAN (23% of all renal biopsies): 52% men with mean age of 37. More than a half of them had hypertension, changes in urinalysis and kidney structure, and GFR < ml/min before the biopsy. Pathology data stratified by MEST-C score were: M1 (93%), E1 (5%), S1 (81%), T1 and T2 (24%), C1 (18%). 20% started renal replacement therapy (RRT). Proteinuria, obesity, hyperuricemia, high total MEST-C score, and low serum C3 were associated with a worse prognosis. As a significant part of patients start RRT in the five-year period after the biopsy, the disease course is not benign. IgAN in the study population was diagnosed with clinical and histological signs of advanced disease.

Abstract
Our study was focused on identification and correction of early hyperglycaemia, with the aim to reduce the risk of developing post-transplant diabetes mellitus (PTDM) and its associated complications. In a single centre, the prospective study included adult kidney transplant recipients without diabetes mellitus whose pre-transplant glucometabolic data did not show signs of diabetes mellitus. Starting from the first day after kidney transplantation, patients were closely monitored for hyperglycaemia; glucose level measurements were started to obtain pre-prandial levels. If the blood glucose level exceeded 11.1 mmol/l, hyperglycaemia was corrected with short-acting insulin. A total of 14 patients completed a three-month follow-up. During the first post-transplant week, the blood glucose level exceeded 11.1 mmol/l in nine patients (63.9%). From those patients five (55.5%) did not develop PTDM. None of the patients who did not need insulin treatment developed PTDM. Higher pre-lunch glucose levels increased the risk of developing PTDM (p = 0.006). Patients with diabetes required a two times higher insulin dosage than other patients during the first post-transplantation week. We found that hyperglycaemia is a common problem in the early post-transplant period. Early recognition and correction of inpatient hyperglycaemia was associated with reduction of the prevalence of PTDM in more than a half of the patients in the studied group at three months post transplant.