Nephrology

Textbook in Internal medicine consists of 37 chapters. This textbook is made up of text material and enough illustrations, including clinical findings and schematic figures. The textbook is intended for English-speaking students of medical and pharmaceutical faculties of higher educational establishments of Ukraine.

Підручник з внутрішньої медицини складається з 37 розділів. Містить текстові матеріали та достатньо ілюстрацій, у тому числі клінічні матеріали та схематичні рисунки. Підручник призначений для англомовних студентів медичних та фармацевтичних факультетів вищих навчальних закладів України.

This study investigates why the illegal traffic of kidneys exists and remains resilient in the Philippines. It also evaluates the efficacy of the legal and regulatory framework for kidney (and organ) transplantation, and the corresponding implications for health policy. The experiences of comparable countries are noted.Three surveys were employed in this study: 1) a review of related literature on kidney black markets; 2) questionnaire-based interviews of a multi-stage probability sample of 131 kidney vendors from the two largest supplier regions in the Philippines; and 3) a comparative content analysis of pertinent legal and regulatory measures to address the underground kidney trade.Survey results, based on a 4.0 percent statistical margin of error, indicate that kidney vendors are typically males (98.4 percent) who belong to the lower income classes/groups D and E (88.5 percent). The vast majority of vendors (89.2 percent) were unrelated to kidney recipients, many of whom were of foreign descent (60.3 percent). The study finds that certain key elements underpin the kidney black market in the Philippines: an open, brokered and compensation-based contractual system between unrelated donors and sellers. These elements are sustained and reinforced by a robust supply-and-demand interface anchored on brokerage pricing, government incapacity, policy contradictions and public tolerance or indifference.The study suggests that the relative ambiguity of, and continuity between, the legal and underground kidney transplant systems be carefully addressed prior to enacting more specific reforms. The study also calls attention to the unintended consequences of various reform efforts, which are often neglected in formulating health policy and evaluating its costs and benefits.

Renal anemia is the result of chronic kidney disease (CKD) and deteriorates with disease progression. Anemia may be the first sign of kidney disease. In all patients with anemia and CKD, diagnostic evaluation is required. Prior to diagnosing renal anemia, it is necessary to eliminate the other possible causes. Direct correlation between the concentration of hemoglobin and the stage of renal failure is well known. Early development of anemia is common in diabetic patients. Correction of anemia may slow the progression of CKD. Anemia is an independent risk factor for developing cardiovascular disease in patients with CKD. Treatment of anemia in patients with CKD is based on current guidelines. Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) group has produced comprehensive clinical practice guidelines for the management of anemia in CKD patients and ERBP (European Renal Best Practice) group its position statement and comments on the KDIGO guidelines. The Croatian Socie...

Placental blood flow was measured with the aid of radioactive microspheres, in normal (N) and manifest diabetic (MD) rats, and related to fetal body growth and incidence of congenital malformations. The total blood flow in the placentae of the MD rats was decreased to about one-half of the normal flow on gestational days 20 and 22. The placentae of the MD offspring were enlarged, whereas the fetuses in this group were smaller than normal. Thus, the placental blood flow per placental weight was drastically decreased in the MD fetuses on both days 20 and 22. In contrast, the placental blood flow per fetal weight was not different in the N and MD groups on gestational day 20 whereas it was decreased in the MD offspring on gestational day 22. Placental blood flow in the malformed fetuses of the MD group did not differ significantly from that in the nonmalformed MD fetuses.

Objective: While treating anaemia in end stage renal disease (ESRD) patients, recombinant human erythropoietin (EpO) is the therapy of choice. However, it is rarely used in developing countries because of the financial constrains to the healthcare as well as the patient. Keeping the point of view in mind, the objective of this research was to identify the use of Epo, its frequency, and dosage in the patients of ESRD receiving continuous haemodialysis in Quetta city, Pakistan. Methods: This was a retrospective, single cantered study. The selected population was subject with ESRD and on dialysis with prolonged anaemia. All recipients of dialysis in the past one year were targeted for the study. Data of the patients regarding anaemia and the use of erythropoietin was collected through a data collection sheet. Evaluation of the biochemical parameters of ESRD patients on haemodialysis was also be taken into consideration. Demographics of the selected patients were recorded carefully for the evaluation and analysis. SPSS 20.0 was used for data analysis and based on the objectives; both descriptive and inferential statistics were used for data elaboration. Results: A total of 97 ESRD patients that fulfilled the inclusion criteria were enrolled. Out of the 97, (52.6%) had age of more than 47 years and the cohort was dominated by males (63, 64.9%). Seventy two patients were on EPo use with majority on dose of 10000 IU with once a week frequency. The Man Whitney U test was used to compare erythropoietin use / non use and biochemical parameters. Haemoglobin percentage was significantly associated with erythropoietin use (p<0.05). The mean rank interpretation revealed erythropoietin users significantly associated with improved haemoglobin percentage. The Kruskal Wallis test was used to compare erythropoietin usage frequency and biochemical parameters. Haemoglobin percentage was again significantly associated with erythropoietin use frequency. The Bonferroni correction revealed erythropoietin frequency of twice a week was significantly associated with improved haemoglobin percentage. Conclusion: Although the use of EPO among ESRD was reasonable, few patients were not prescribed EPo for anaemia associated with ESRD. We do understand that availability and affordability can be a major reason here; policy makers should make sure about the use of EPo because of its evidence-based advantages over other procedures.

This is the first case of documented treatment failure of JCV nephritis, despite a reduction of immunosuppressive agents and the use of antiviral therapy. We consistently detected high levels of JCV viremia, which correlated with the progressive deterioration of the graft and caused the final loss of the kidney, suggesting that JCV plays an etiological role in the onset of severe nephropathy in kidney transplant patients.

Summary: To initiate an investigation into the biochemistry and mechanism of group B [beta]-hemolytic Streptococcus virulence, bacterial cultures grown in suspension were centrifuged, and the bacteria and media were subjected to extensive fractionation. Each ...

Thrombosis is the most common complication of hemodialysis access. Few reports are available concerning the use of recombinant tissue plasminogen activator (rt-PA) to declot an arterio-venous (A-V) access. This report describes the use of rt-PA for this purpose in 17 A-V accesses. The rt-PV was infused manually using a small catheter directly into the A-V access in 10-mg doses at 1-2 hour intervals, to a maximum dose of 40 mg. The procedure was followed by angiography, through the same catheter. One fistula could not be cannulated, and in three the lysis of the clot failed. The other 13 cases (3 fistulas, and 10 grafts 81%) had successful lysis with return of bruit and thrill. Most patients had dialysis the next day using the declotted A-V access. Angiogram detected stenosis in six patients and surgical revision was done 1-8 days after the treatment. In the other seven patients no organic lesions were found, and six of them have a functioning A-V access 50-395 days after the lysis. ...

Objective: To determine frequencies of various acute complications in patients undergoing hemodialysis. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Nephrology Military Hospital (MH) Rawalpindi, from Jan 2016 till Mar 2016. Material and Methods: A total of 150 patients who underwent haemodialysis at MH were enrolled in the study after informed consent on justification of inclusion and exclusion criteria. The patients were evaluated for the frequency of various intra-dialytic complications and data were analysed using SPSS version 19. Results: Out of the 150 enrolled patients, males were 125 (83.33%) and females were 25 (16.67%). A total of 2520 haemodialysis session were performed. Hypotension was the most frequently observed complication during 318 (12.62%) dialysis sessions, followed by hypertension in 208 (8.25%) and fever in 193 (7.66%) sessions. Other complications were muscle cramps in 116 (4.60%), shivering in 94 (3.73%), headach...