No abstract

Aim:Cardiovascular diseases are leading cause of death in patients with chronic renal failure. The aim of our study was to establish connection between levels of homocysteine and traditional and nontraditional risk factors for developing cardiovascular diseases in dialysis and pre dialysis patients.Methods:We included 33 pre dialysis (23 in stage three and 10 in stage four of chronic kidney disease) and 43 patients receiving hemodialysis longer than six months. Besides standard laboratory parameters, levels of homocysteine and blood pressure were measured in all patients. Glomerular filtration rate was measured in pre dialysis patients and dialysis quality parameters in dialysis patients.Results:Homocysteine levels were elevated in all patients (19±5.42mmol/l). The connection between homocysteine levels and other cardiovascular diseases risk factors was not established in pre dialysis patients. In patients treated with hemodialysis we found negative correlation between homocysteine levels and patients’ age (p<0.05) and positive correlation between homocysteine levels and length of dialysis (p<0.01) as well as between homocysteine and anemia parameters (erythrocytes, hemoglobin), (p<0.01). Homocysteine and LDL (and total cholesterol) were in negative correlation (p<0.01).Conclusion:Homocysteine, as one of nontraditional cardiovascular diseases risk factors, is elevated in all patients with chronic renal failure and it’s positive correlation with some other risk factors was found.

Introduction. Renal osteodystrophy is a severe complication of chronic kidney disease (CKD) that increases morbidity and mortality in these patients. Mineral and bone disorder starts early in CKD and affects the incidence of bone fractures. The aim of this study was to observe the frequency of diverse bone fractures in patients with CKD not on dialysis.Methods. This cohort study included 68 patients that were followed during the two-year period. The patients were divided into two cohorts: one that developed bone fractures and the other that did not. There were 35 (51.5%) men and 33 (48.5%) women. The mean age of patients ranged 62.88±11.60 years. During follow-up serum values of chronic kidney disease -mineral and bone indicators were measured. The methods of descriptive and analytical statistics were used in order to analyze obtained data.Results. During this two-year follow-up seven patients developed bone fractures. Among them, females dominated (6 patients) compared to males (only 1 patient). The most common were fractures of forearm. The mean level of parathyroid hormone (PTH) at the beginning of the monitoring was higher in the group of patients with bone fractures (165.25 ± 47.69 pg/mL) in regard to another group (103.96 ± 81.55 pg/mL). After two-year follow-up, this difference became statistically significant at the level p < 0.05. Patients that developed bone fractures had higher FRAX (Fracture Risk Assessment) score compared to another group.Conclusion. In our study, about 10% of patients had bone fractures in the two-year follow-up period. Patients who developed fractures had a higher PTH level and FRAX score.

Systemic lupus erythematosus (SLE) is a disease of unknown etiology in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes. About ninety percent of patients with lupus are women between the ages of 20 and 40. The disease may affect only one organ system, and it also can be a multisystem and affect the skin, joints, kidneys, lungs, nervous system, and serous membrane. In the case report is presented a 38 year old patient with severe systemic lupus erythematosus, which adequately reacted to the treatment of mycophenolate mofetil.

Contrast-induced nephropathy (CIN) is characterized as an acute renal injury after the administration of intravascular iodinated radio-contrast medium in the absence of any other etiology. There is a small number of studies that analyze the occurrence and impact of CIN in traumatized patients who require whole-body CT according to the polytrauma protocol. In the period from January 2021 to May 2022, patients in the University Clinical Center of the Republic of Srpska who underwent CT according to the protocol for polytrauma were retrospectively analyzed. The study included 51 patients. CIN was defined as a 25% rise from baseline creatinine, or an absolute increase in creatinine of  ≥ 44 µmol/l 24–48 h after administration of contrast. Of the total number of patients, 12% (n = 6) met the criteria for CIN. Age, sex, comorbidity, severity of injury based on ISS (injury severity score) were analyzed. Hemoglobin and fibrinogen levels, length of hospitalization, stay in the intensive care unit, mortality were monitored. A value of p 0.01 was considered statistically significant. CIN is common in traumatized patients, but it is not an independent risk factor for length of hospitalization or mortality.