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EN
Multiple myeloma is the second most common neoplastic disease of lymphoid tissue in adults. However, its atypical non secretory form, is quite rare. We present a case of 70 year old male with atypical chest pain and nephrotic range proteinuria fi nally diagnosed as non secretory myeloma who did not present any of characteristic fi ndings when admitted to hospital. Despite the unusual course the diagnosis was established quickly enough to provide a proper treatment. One should remember that occasionally patients do not match typical criteria necessary for diagnosing a disease.
EN
Although preeclampsia affects approximately 3%–8% of pregnancies worldwide and is a major contributor to maternal and neonatal mortality and morbidity, the aetiology of preeclampsia is still not fully understood. This review presents the current knowledge on the aetiology of preeclampsia, with a special emphasis on risk factors and their role, and describes recommendations for the prevention and treatment of preeclampsia.
EN
Background. There is evidence that dyslipidemia is associated with chronic kidney disease (CKD) and it has been implicated in the progression of renal damage. Optimal management of dyslipidemia should therefore lead to renal benefits. A number of experimental models demonstrate a beneficial effect of statins in ameliorating renal damage. However, the exact mechanism by which statins protect against renal damage remains unclear. Methods. In a placebo-controlled, randomized, cross-over study we evaluated the influence of atorvastatin (ATO) 40 mg/day added to the renin-angiotensin-aldosterone systeme (RAAS) blockade on proteinuria and surrogate biomarkers of tubular damage or injury in 14 non-diabetic patients with proteinuria (0.4-1.8 g per 24 h) with normal or declined kidney function (eGFR 55-153 ml/min). In the eight-week run-in period, therapy using angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II subtype 1 receptor antagonists (ARB) was adjusted to achieve a blood pressure below 130/80 mm Hg. Next, patients were randomly assigned to one of two treatment sequences: ATO/washout/placebo or placebo/washout/ATO. Clinical evaluation and laboratory tests were performed at the randomization point and after each period of the study. The primary end point of this study was a change in proteinuria measured as 24-h urine protein excretion (DPE). Secondary end points included urine N-acetyl-β-d-glucosaminidase (NAG) and α1-microglobulin (α1m) excretion. Results. The ATO therapy significantly reduced urine excretion of α1m (p=0.033) and NAG (p=0.038) as compared to placebo. There were no differences in proteinuria, blood pressure, eGFR and serum creatinine between the ATO and placebo groups. Conclusion. Atorvastatin treatment is safe and improves biomarkers of tubular damage or injury in non-diabetic patients with CKD.
EN
Helicobacter pylori (Hp) specific antigens were found deposited in the glomeruli in some kidney diseases. However, the underlying molecular mechanisms remain to be elucidated. The aim of this study was to investigate the effect of cytotoxin associated gene A protein (CagA), a key virulence factor of Hp, on mouse podocytes. Cells were cultured and treated with recombinant CagA protein. The expression of the tight junction protein ZO-1 and p38 MAPK signaling pathway activation were measured with real-time RT-PCR and western blotting. The filtration barrier function of podocytes was evaluated with albumin influx assay. CagA decreased the expression and membrane distribution of ZO-1, impaired the filtration barrier function of podocytes, while activating p38 MAPK signaling pathway in these cells. Selective p38 MAPK inhibition partly prevented CagA-induced filtration barrier dysfunction of podocytes through ameliorating ZO-1 downregulation. Taken together, the results suggested that CagA, at least via p38 MAPK signaling pathway, may induce podocyte injury. Anti-Hp therapy may be beneficial for the treatment of kidney diseases related to Hp antigen deposition.
EN
Background: Inhibition of the renin-angiotensin-aldosterone system (RAAS) with angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II subtype 1 receptor antagonists (ARB) is a common strategy used in the management of patients with chronic kidney disease (CKD). However, there is no universal therapy that can stop progression of CKD. Pentoxifylline (PTE) is a non-specific phosphodiesterase inhibitor with anti-inflammatory properties. It has been reported to have promising effects in CKD treatment. Methods: In a placebo-controlled, randomized, cross-over study we evaluated the influence of PTE (1200 mg/day) added to RAAS blockade on proteinuria, surrogate markers of tubular injury and oxidative stress-dependent products in 22 non-diabetic patients with proteinuria (0.4-4.3 g per 24h) with normal or declined kidney function [eGFR 37-178 mL/min]. In an eight-week run-in period, therapy using ACEI and/or ARB was adjusted to achieve a blood pressure below 130/80 mm Hg. Next, patients were randomly assigned to one of two treatment sequences: PTE/washout/placebo or placebo/washout/PTE. Clinical evaluation and laboratory tests were performed at the randomization point and after each period of the study. Results: The PTE therapy reduced proteinuria (by 26%) as compared to placebo. There were no differences in α1-microglobulin, urine excretion of N-acetyl-β-d-glucosaminidase (NAG), hsCRP, the urinary excretion of 15-F2t-isoprostane, blood pressure (BP), eGFR and serum creatinine between the PTE and placebo groups. Conclusion: Pentoxifylline may decrease proteinuria in non-diabetic patients with CKD.
EN
Chronic Kidney Disease (CKD) in children could be initially maintained on conservative treatment but at the end it leads unavoidably to renal replacement therapy application. Disease progression in children not exclusively aff ects renal function but also causes systemic complications (proteinuria consequences, cardiovascular complications, anemia, calcium-phosphate metabolism disorders, metabolic acidosis, hypostature, hypertension, chronic systemic infl ammation and malnutrition). Psychological aspect of CKD should not be forgotten because as other chronic illnesses, it aff ects both the quality of life of a child and the whole family. Early diagnosis of CKD gives a chance for the eff ective control of disease symptoms and for the prolongation of the period on conservative treatment. During the predialytic period the child and the family could be better prepared for renal replacement therapy or pre-emptive transplantation. In conclusion, diagnostic and treatment procedures require an achievement of good cooperation and close contact with the child and its family by the specialized team (pediatrician, nephrologist, dialysis nurse, psychologist, dietetician and social worker) at each treatment stage. Predialytic period is the time when child and his family inevitably experience the harmful consequences of CKD. The important task for the medical staff is the optimalization of the methods of treatment.
PL
Przewlekła choroba nerek (PChN) u dzieci, początkowo leczona zachowawczo w konsekwencji prowadzi do rozpoczęcia leczenia nerkozastępczego. Zaawansowanie procesu chorobowego wpływa nie tylko na czynność nerek, ale ma także u dzieci skutki ogólnoustrojowe, m.in. następstwa białkomoczu, powikłania w układzie sercowo - naczyniowym, niedokrwistość, zaburzenia gospodarki wapniowo - fosforanowej, kwasicę metaboliczną, niedobór wzrostu, nadciśnienie tętnicze, stan zapalny oraz zaburzenia odżywiania. Nie można także pominąć aspektu psychologicznego, gdyż jak każda choroba przewlekła wpływa zarówno na życie dziecka, jak i pozostałych członków rodziny. Wczesne wykrycie choroby to szansa na jej skuteczniejszą kontrolę, wydłużenie czasu leczenia zachowawczego a w okresie predializy lepsze przygotowanie młodego pacjenta i jego rodziny do podjęcia terapii nerkozastępczej lub przeprowadzenia przeszczepu wyprzedzającego nerki. Cały proces diagnostyczno - leczniczy wymaga dobrej współpracy z dzieckiem i jego rodziną na poszczególnych etapach leczenia poczynając od lekarza pierwszego kontaktu – pediatry poprzez specjalistę nefrologa, pielęgniarkę nefrologiczną, psychologa, dietetyka oraz pracownika socjalnego. Okres predializy to czas, w którym dziecko wraz z rodziną doświadcza nieuchronności następstw PChN, a zadaniem personelu medycznego jest konsolidacja działań w celu optymalizacji sposobu leczenia.
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