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Primary prevention of nephropathy in obese type 2 diabetic patient

100%
Yovchevski P., Boneva Z.
Open Medicine
|
2009
|
vol. 4
|
issue 3
379-381
EN
We report a case of a 36-year-old obese man who presented with newly onset diabetes mellitus type 2 and hypertension. The estimated value of glomerular filtration rate - 203.7 ml/min was associated with the patient being at high risk of developing progressive renal disease. In this case, in order to prevent nephropathy, the preferred therapy was a gradual bodyweight reduction. A low-calorie diet providing an 800 kcal/day deficit was recommended to the patient, as well as an increase in physical activity. After a total weight reduction of 50 kg (33% of initial bodyweight), the patient’s glomerular filtration, body mass index, and blood pressure normalized without any drug therapy. Glucose, blood pressure and lipid target levels can only be simultaneously achieved through body-weight reduction. In the presented case, we show the beneficial effects of bodyweight reduction, and dietary and physical activity changes on high glomerular filtration rate. Bodyweight reduction stops the cascade of events that are caused by glomerular hyperfiltration and the progression toward irreversible renal damage.
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Tuberculous spondylitis in patients with end-stage renal disease undergoing chronic hemodialysis therapy - Report of two cases

81%
Kostov K., Yovchevski P., Petrov I.
Open Medicine
|
2010
|
vol. 5
|
issue 4
475-477
EN
Tuberculous spondylitis is more common in patients with chronic renal failure who receive hemodialysis because of their abnormal T-cell-mediated immunity. It frequently poses both diagnostic and therapeutic challenges. We describe two cases of tuberculous spondylitis in patients undergoing chronic hemodialysis therapy. They are IFN-γ assay diagnosed (QuantiFERON-TB Gold) and conservatively treated. Our cases suggest that IFN-γ assays equip clinicians with more accurate tools for tuberculosis control. A combination of T-SPOT.TB testing and MRI assessment may be the accurate method to diagnose tuberculous spondylitis in patients with end-stage renal disease.
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