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Aim: To explore the protective role of hydration, urine alkalization (Na bicarbonate) and high doses of antioxidant (N-acetylcysteine) in the prevention of CIN. Material and methods: In a prospective, randomized, single-blinded study patients were divided into three groups: 1) peroral hydration, 2) Na bicarbonate infusion and 3) N-acetylcysteine (NAC) plus NaHCO3 infusion. Serum creatinine (SCr), blood urea nitrogen (BUN), and neutrophil gelatinase-associated lipocalin (NGAL) were measured before and 48 hours after the angiography. Mehran score was calculated for each patient. Results: The study included 106 patients. Groups were comparable regarding the baseline characteristics. According to Mehran risk score 70 % of patients had a low risk, 24% medium and 6% high risk score for development of CIN. After the procedure renal function was preserved in all patients (SCr 103(87.0-121.5), BUN 5.8 (4.9-7.6), creatinine clearance 74.7(55.3-97.6), NGAL 11.4(5.4-19.9)) regardless of the Mehran risk score. The follow up was completed for 73 patients (68 %). Twenty two patients (32 %) developed chronic kidney disease, mostly classified as G3a and G3b according to KDIGO guidelines. Chronic kidney disease developed in patients with the positive history of diabetes and in patients who had higher Mehran score before the diagnostic procedure. Conclusion: The study showed that patients with preserved renal function are not prone to CIN. Regardless of the protocol used, no case of CIN was observed. Our results indicate that adequate hydration is a key component in maintaining the renal function. Higher Mehran score might be useful in predicting the development of chronic kidney disease., Cilj: Ispitati protektivnu ulogu hidracije, alkalizacije mokraće (natrijevim bikarbonatom) i visokih doza antioksidansa (N-acetilcistein) u prevenciji kontrastne nefropatije. Materijali i metode: U prospektivnom istraživanju pacijenti su bili podijeljeni u tri skupine: 1) peroralna hidracija, 2) infuzija natrijevog bikarbonata i 3) infuzija N-acetilcisteina (NAC) i NaHCO3. Serumska vrijednost kreatinina, ureje i neutrophil gelatinase-associated lipocalin (NGAL) izmjerene su prije i 48 sati nakon angiografije. Svakom pacijentu izračunati su Mehran bodovi koji predstavljaju rizik razvoja kontrastne nefropatije. Rezultati: U istraživanje je uključeno 106 pacijenata. Sve tri skupine pacijenata imale su usporedive osnovne karakteristike. Prema bodovima po Mehranu, 70 % pacijenata imalo je niski rizik, 24 % srednji i 6 % visoki rizik razvoja kontrastne nefropatije. Nakon kontrastne pretrage bubrežna funkcija bila je očuvana u svih pacijenata (serumski kreatinin 103 (87.0 – 121.5), urea 5.8 (4.9 – 7.6), klirens kreatinina 74.7 (55.3 – 97.6), NGAL 11.4 (5.4 – 19.9)) neovisno o riziku procijenjenom bodovima po Mehranu. Praćenje je završeno za 73 pacijenta (68 %). Dvadeset i dva pacijenta (32 %) razvila su kroničnu bubrežnu insuficijenciju, klasificiranu prema KDIGO smjernicama kao G3a i G3b. Kronična bubrežna insuficijencija razvila se u pacijenata sa šećernom bolesti i u pacijenata koji su imali viši broj bodova prema Mehranu prije dijagnostičke pretrage. Zaključak: Istraživanje je pokazalo da pacijenti s normalnom bubrežnom funkcijom imaju mali rizik razvoja kontrastne nefropatije. U ispitivanoj skupini pacijenata nije zabilježen niti jedan slučaj kontrastne nefropatije bez obzira na vrstu protokola koji je korišten za hidraciju. Naši rezultati ukazuju na to da je adekvatna hidracija ključna u prevenciji kontrastne nefropatije. Nadalje, postoji mogućnost da viši broj bodova po Mehranu može poslužiti kao prediktor razvoja kronične bubrežne bolesti.

Aim: To explore the protective role of hydration, urine alkalization (Na bicarbonate) and high doses of antioxidant (N-acetylcysteine) in the prevention of CIN. Material and methods: In a prospective, randomized, single-blinded study patients were divided into three groups: 1) peroral hydration, 2) Na bicarbonate infusion and 3) N-acetylcysteine (NAC) plus NaHCO3 infusion. Serum creatinine (SCr), blood urea nitrogen (BUN), and neutrophil gelatinase-associated lipocalin (NGAL) were measured before and 48 hours after the angiography. Mehran score was calculated for each patient. Results: The study included 106 patients. Groups were comparable regarding the baseline characteristics. According to Mehran risk score 70 % of patients had a low risk, 24% medium and 6% high risk score for development of CIN. After the procedure renal function was preserved in all patients (SCr 103(87.0-121.5), BUN 5.8 (4.9-7.6), creatinine clearance 74.7(55.3-97.6), NGAL 11.4(5.4-19.9)) regardless of the Mehran risk score. The follow up was completed for 73 patients (68 %). Twenty two patients (32 %) developed chronic kidney disease, mostly classified as G3a and G3b according to KDIGO guidelines. Chronic kidney disease developed in patients with the positive history of diabetes and in patients who had higher Mehran score before the diagnostic procedure. Conclusion: The study showed that patients with preserved renal function are not prone to CIN. Regardless of the protocol used, no case of CIN was observed. Our results indicate that adequate hydration is a key component in maintaining the renal function. Higher Mehran score might be useful in predicting the development of chronic kidney disease., Cilj: Ispitati protektivnu ulogu hidracije, alkalizacije mokraće (natrijevim bikarbonatom) i visokih doza antioksidansa (N-acetilcistein) u prevenciji kontrastne nefropatije. Materijali i metode: U prospektivnom istraživanju pacijenti su bili podijeljeni u tri skupine: 1) peroralna hidracija, 2) infuzija natrijevog bikarbonata i 3) infuzija N-acetilcisteina (NAC) i NaHCO3. Serumska vrijednost kreatinina, ureje i neutrophil gelatinase-associated lipocalin (NGAL) izmjerene su prije i 48 sati nakon angiografije. Svakom pacijentu izračunati su Mehran bodovi koji predstavljaju rizik razvoja kontrastne nefropatije. Rezultati: U istraživanje je uključeno 106 pacijenata. Sve tri skupine pacijenata imale su usporedive osnovne karakteristike. Prema bodovima po Mehranu, 70 % pacijenata imalo je niski rizik, 24 % srednji i 6 % visoki rizik razvoja kontrastne nefropatije. Nakon kontrastne pretrage bubrežna funkcija bila je očuvana u svih pacijenata (serumski kreatinin 103 (87.0 – 121.5), urea 5.8 (4.9 – 7.6), klirens kreatinina 74.7 (55.3 – 97.6), NGAL 11.4 (5.4 – 19.9)) neovisno o riziku procijenjenom bodovima po Mehranu. Praćenje je završeno za 73 pacijenta (68 %). Dvadeset i dva pacijenta (32 %) razvila su kroničnu bubrežnu insuficijenciju, klasificiranu prema KDIGO smjernicama kao G3a i G3b. Kronična bubrežna insuficijencija razvila se u pacijenata sa šećernom bolesti i u pacijenata koji su imali viši broj bodova prema Mehranu prije dijagnostičke pretrage. Zaključak: Istraživanje je pokazalo da pacijenti s normalnom bubrežnom funkcijom imaju mali rizik razvoja kontrastne nefropatije. U ispitivanoj skupini pacijenata nije zabilježen niti jedan slučaj kontrastne nefropatije bez obzira na vrstu protokola koji je korišten za hidraciju. Naši rezultati ukazuju na to da je adekvatna hidracija ključna u prevenciji kontrastne nefropatije. Nadalje, postoji mogućnost da viši broj bodova po Mehranu može poslužiti kao prediktor razvoja kronične bubrežne bolesti.

Cilj: Vankomicin je antibiotik koji se koristi za liječenje infekcija uzrokovanih Gram- -pozitivnim bakterijama, no kod nekih pacijenata uzrokuje ozljedu bubrega. Budući da standardni biomarkeri ozljede bubrega ne pokazuju dovoljnu osjetljivost i specifičnost, potrebno je pronaći nove biomarkere kako bismo mogli ranije detektirati poremećaje bubrežne funkcije te pravovremenim prekidom ili promjenom terapije spriječiti daljnje ozljede bubrega. Cilj je rada bio usporediti proteomske profile urina dviju pacijentica oboljelih od upale pluća koje su primale terapiju vankomicinom sa i bez kliničkih znakova ozljede bubrega uzrokovanih navedenim antibiotikom, kako bismo identificirali nove potencijalne proteinske biomarkere akutne ozljede bubrega uzrokovanog vankomicinom. Prikaz slučaja: Uzorci urina prikupljeni su treći i sedmi dan terapije vankomicinom od pacijentice sa i pacijentice bez kliničkih znakova bubrežne disfunkcije te su analizirani dvodimenzionalnom gel elektroforezom kombiniranom s MALDI-TOF/TOF masenom spektrometrijom. Vidljive razlike u proteomskim profilima urina između dviju pacijentica javljaju se treći, a naročito su izražene sedmi dan terapije. Dvodimenzionalna gel elektroforeza kombinirana s masenom spektrometrijom potvrdila je već ranije dokazanu ulogu proteina neutrofilnog lipokalina povezanog s gelatinazom (NGAL, engl. neutrophil gelatinase-associated lipocalin) kao biomarkera akutne ozljede bubrega, te otkrila ekspresiju citoskeletnog keratina 1 tipa II i retinol-vezujućeg proteina 4 (RBP4, engl. retinol-binding protein 4) samo u urinu pacijentice kod koje je terapija vankomicinom uzrokovala poremećaj bubrežne funkcije. Zaključci: Citoskeletni keratin 1 tipa II i retinol-vezujući protein 4 mogli bi predstavljati nove potencijalne biomarkere ozljede bubrega uzrokovane vankomicinom. Potrebne su daljnje studije na većem broju pacijenata kako bi se validirali dobiveni rezultati i utvrdio njihov potencijalni dijagnostički i klinički značaj., Aim: Vancomycin is an antibiotic used to treat infections caused by Gram-positive bacteria which can induce renal injury in some patients. Since standard biomarkers of kidney injury lack sufficient sensitivity and specificity, there is an unmet need for novel biomarkers that would enable early detection of renal injury and timely cessation or modification of treatment to prevent more severe kidney injury. The goal of this paper was to compare proteomics profiles of urine samples collected from two vancomycin-treated patients suffering from pneumonia with and without clinical symptoms of drug-induced renal dysfunction as to identify novel potential protein biomarkers of vancomycin-induced kidney injury. Case report: Urine samples were collected on the third and seventh day of vancomycin therapy from patients with and without clinical signs of acute kidney injury. Samples were analysed by two-dimensional gel electrophoresis and MALDI-TOF/TOF mass spectrometry. Differences in urinary proteomes between these two patients could be observed on the third and especially on the seventh day of therapy. Two-dimensional gel electrophoresis combined with mass spectrometry confirmed previously established role of neutrophil gelatinase-associated lipocalin (NGAL) as biomarker of renal injury, and revealed the expression of keratin 1 type II cytoskeletal and retinol-binding protein 4 (RBP4) only in urine from the patient with vancomycin- induced renal dysfunction. Conclusions: Keratin 1 type II cytoskeletal and retinol-binding protein 4 could be considered novel potential biomarkers of vancomycin-induced kidney injury. Additional studies with larger patient cohorts are needed to validate these findings and investigate their potential diagnostic and clinical significance.

Cilj: Vankomicin je antibiotik koji se koristi za liječenje infekcija uzrokovanih Gram- -pozitivnim bakterijama, no kod nekih pacijenata uzrokuje ozljedu bubrega. Budući da standardni biomarkeri ozljede bubrega ne pokazuju dovoljnu osjetljivost i specifičnost, potrebno je pronaći nove biomarkere kako bismo mogli ranije detektirati poremećaje bubrežne funkcije te pravovremenim prekidom ili promjenom terapije spriječiti daljnje ozljede bubrega. Cilj je rada bio usporediti proteomske profile urina dviju pacijentica oboljelih od upale pluća koje su primale terapiju vankomicinom sa i bez kliničkih znakova ozljede bubrega uzrokovanih navedenim antibiotikom, kako bismo identificirali nove potencijalne proteinske biomarkere akutne ozljede bubrega uzrokovanog vankomicinom. Prikaz slučaja: Uzorci urina prikupljeni su treći i sedmi dan terapije vankomicinom od pacijentice sa i pacijentice bez kliničkih znakova bubrežne disfunkcije te su analizirani dvodimenzionalnom gel elektroforezom kombiniranom s MALDI-TOF/TOF masenom spektrometrijom. Vidljive razlike u proteomskim profilima urina između dviju pacijentica javljaju se treći, a naročito su izražene sedmi dan terapije. Dvodimenzionalna gel elektroforeza kombinirana s masenom spektrometrijom potvrdila je već ranije dokazanu ulogu proteina neutrofilnog lipokalina povezanog s gelatinazom (NGAL, engl. neutrophil gelatinase-associated lipocalin) kao biomarkera akutne ozljede bubrega, te otkrila ekspresiju citoskeletnog keratina 1 tipa II i retinol-vezujućeg proteina 4 (RBP4, engl. retinol-binding protein 4) samo u urinu pacijentice kod koje je terapija vankomicinom uzrokovala poremećaj bubrežne funkcije. Zaključci: Citoskeletni keratin 1 tipa II i retinol-vezujući protein 4 mogli bi predstavljati nove potencijalne biomarkere ozljede bubrega uzrokovane vankomicinom. Potrebne su daljnje studije na većem broju pacijenata kako bi se validirali dobiveni rezultati i utvrdio njihov potencijalni dijagnostički i klinički značaj., Aim: Vancomycin is an antibiotic used to treat infections caused by Gram-positive bacteria which can induce renal injury in some patients. Since standard biomarkers of kidney injury lack sufficient sensitivity and specificity, there is an unmet need for novel biomarkers that would enable early detection of renal injury and timely cessation or modification of treatment to prevent more severe kidney injury. The goal of this paper was to compare proteomics profiles of urine samples collected from two vancomycin-treated patients suffering from pneumonia with and without clinical symptoms of drug-induced renal dysfunction as to identify novel potential protein biomarkers of vancomycin-induced kidney injury. Case report: Urine samples were collected on the third and seventh day of vancomycin therapy from patients with and without clinical signs of acute kidney injury. Samples were analysed by two-dimensional gel electrophoresis and MALDI-TOF/TOF mass spectrometry. Differences in urinary proteomes between these two patients could be observed on the third and especially on the seventh day of therapy. Two-dimensional gel electrophoresis combined with mass spectrometry confirmed previously established role of neutrophil gelatinase-associated lipocalin (NGAL) as biomarker of renal injury, and revealed the expression of keratin 1 type II cytoskeletal and retinol-binding protein 4 (RBP4) only in urine from the patient with vancomycin- induced renal dysfunction. Conclusions: Keratin 1 type II cytoskeletal and retinol-binding protein 4 could be considered novel potential biomarkers of vancomycin-induced kidney injury. Additional studies with larger patient cohorts are needed to validate these findings and investigate their potential diagnostic and clinical significance.

Hyperviscosity syndrome and cryoblobulinemia associated with lymphoproliferative disorder is a rare but life threatening condition. The delay of diagnosis can lead to severe mutilation and multiple organ damage. The plasma exchange therapy and the targeted treatment of the underlying disorder can lead to significant improvement. We present a patient who developed extensive soft tissue necroses, mimicking the peripheral artery disease. Despite surgical treatment, the skin lesions progressed involving fingers, earlobes and scrotum. Finally, the patient was diagnosed with multiple myeloma and hyperviscosity syndrome. The clinical condition improved after plasma exchange and myeloma treatment with thalidomide and dexamethasone.

Hyperviscosity syndrome and cryoblobulinemia associated with lymphoproliferative disorder is a rare but life threatening condition. The delay of diagnosis can lead to severe mutilation and multiple organ damage. The plasma exchange therapy and the targeted treatment of the underlying disorder can lead to significant improvement. We present a patient who developed extensive soft tissue necroses, mimicking the peripheral artery disease. Despite surgical treatment, the skin lesions progressed involving fingers, earlobes and scrotum. Finally, the patient was diagnosed with multiple myeloma and hyperviscosity syndrome. The clinical condition improved after plasma exchange and myeloma treatment with thalidomide and dexamethasone.

Prikazan je bolesnik u dobi od 59 godina s dugotrajnim febrilitetom i kašljem koji je razvio oštećenje jetre. Biopsijom jetre je dokazana nekazeozna granulomatozna upala. Vrijednost angiotenzin konvertirajućeg enzima je bila povišena (85 U/L). Opetovano uzimane hemokultura, kultura urina i kultura likvora su bile sterilne. U iskašljaju nije detektiran mikobakterij. Obzirom na navedeno, postavljena je sumnja na sarkoidozu te je započeta terapija kortikosteroidom. Usprkos terapiji, stanje bolesnika se pogoršavalo. Razvilo se akutno zatajenje bubrega do potrebe za hemodijalizom te parcijalna respiratorna insuficijencija. MSCT toraksa je pokazao sitnonodularni intersticijski infiltrat, pretežno u gornjim režnjevima pluća, uz povećane medijastinalne limfne čvorove, te konglomerat uvećanih mjestimično kolikviranih limfnih čvorova subkarinarno. Direktni preparat bronhoalveolarnog lavata u dva navrata i transbronhalna aspiracija iglom bili su negativni na bacil tuberkuloze. Nakon pregleda očne pozadine postavljena je sumnja na diseminiranu tuberkulozu. Mycobacterium tuberculosis, osjetljiv na streptomicin, izonijazid, etambutol, rifampicin, pirazinamid, naknadno je porastao u kulturi koštane srži. Uz antituberkulotsku terapiju bolesnik je trajno bio febrilan 21 dan. Nakon pet mjeseci terapije bolesnik se potpuno oporavio, uključujući i potpuni oporavak bubrežne funkcije., We present a previously healthly 59-year-old patient with fever, cough and liver disease. Liver biopsy showed non-necrotizing ("non-caseating") granulomas. The level of angiotensin-converting enzyme was above the reference range (85 U/L). Blood, urine and cerebrospinal fluid cultures were repeatedly sterile. No mycobacteria were detected in the sputum. Given the above findings, sarcoidosis was suspected and corticosteroid therapy was initiated. However, the patient was getting worse and developed acute kidney injury together with partial respiratory insufficiency. The chest CT showed interstitial infiltrate, mainly in the upper lobes of the lung, mediastinal lymph node enlargement with partial colliquation. Bronchoscopic aspiration and bronchoalveolar lavage was performed two times; no Mycobacterium was detected. Transbronchial needle aspiration also found no Mycobacterium. Ophthalmologic examination revealed choroiditis and antituberculosis therapy was initiated. Mycobacterium tuberculosis was later detected in culture of bone marrow. After five months of antituberculosis therapy the patient completely recovered, his liver tests were normal as well as renal function.

A case series of 12 obese patients admitted to medical intensive care unit (ICU) due to life-threatening diseases and the influence of weight loss on cardiovascular parameters is presented. We assessed body weight, body mass index (BMI), blood pressure, pulse, and laboratory values on admission. At discharge from ICU patients were counseled on how to lose weight. They were examined one and six months later. Statistically significant (p<0.05) decrease of body weight (median at the beginning of a treatment 134 kg, after six months 127.5 kg), BMI (median 41.5 kg/m2 at the beginning of a treatment; 38.9 kg/m2 after six months), systolic blood pressure (medians 145 mmHg and 130 mmHg), diastolic blood pressure (medians 95 mmHg and 85 mmHg) and pulse (medians 104 beats per minute, 78 beats per minute) was found. The reduction of the waist circumference was not significant. One patient died due to severe acute pancreatitis. Patients reported feeling much better after losing weight.