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Background: The staging system of chronic kidney disease (CKD) classification plays an important role in patients stratification according to disease activity. The aim of the study was to evaluate the frequency of appearance of consecutive stages of chronic kidney disease based on simplified MDRD formula in patients with diagnosed CKD. Additionally, relationship between eGFR values and selected biochemical parameters and comorbidities were analyzed., Methods: The study was performed retrospectively in the group of 1176 patients (636 males and 540 females) aged between 17-98 years (mean 64.7) with creatinine level > 120 μmol/l and/or creatinine clearance < 90 ml/min/1.73 m2., Results: The highest percentage of patients were designated to the 3rd CKD stage. There were positive correlations between eGFR and Hb, Ht, Fe, LDL-Ch, AspAT, HbA1c and negative correlations between eGFR and age, mean and systolic blood pressure, as well as with P, K, iPTH, and uric acid concentration. Patients with cardiovascular diseases had significaintly lower eGFR values as compare with patients without such complications, respectively: atrial fibrillation, arterial hypertension, chronic heart failure, ischaemic heart disease (p < 0.01), and myocardial infarction (p < 0.04)., Conclusions: The highest percentage of patients with diagnosed CKD belong to the 3rd stage of disease. Patients with cardiovascular complications have significantly lower eGFR as compared with those without such disturbances.

Unlabelled: Hemodialysis (HD) is a dynamic process, which occurs during movement through a semipermeable membrane, water soluble substances of low molecular weight. Transport across the membranes of low-flux (LF) dialyzers is based mainly on diffusion and through the membranes of high-flux (HF) dialyzers, diffusion and convection. The aim of the study was to compare the adequacy of hemodialyses conducted on the basis of the low-flux dialyzers with polysulfone membrane, and the high-flux dialyzers with helixone membrane., Material and Methods: The study included 60 patients (23 women and 37 men) aged 24-84 years (mean 60.73 +/- 15.75) treated with maintenance hemodialysis (three times per week). The study enrolled clinically stable patients after a minimum 3-months period of HD. Blood tests were performed 1 time a month before the middle week dialysis session. For the first six months HD was based on LF dialyzers with polysulfone membrane, and then for an additional 6 months based on HF dialyzers with helixone membrane., Results: The performed study demonstrated a statistically significant higher values of: spKtV and URR% and lower values of the urea before and after HD sessions performed based on HF-HD as compared with LF-HD (spKt/V LF = 1.26 +/- 0.23 vs. spKtV HF = 1.37 +/- 0.17; p < 0.001, URR% LF = 66.74 +/- 5.86 vs. URR% HF = 70.57 +/- 3.71; p < 0.001, urea before LF-HD = 21.57 +/- 4.57 mmol/I vs. HF-HD = 20.57 +/- 4.21 mmol/I; p < 0.01 and the urea after LF. HD = 7.19 +/- 2.25 mmol/l vs. HF-HD = 6.03 +/- 1.55 mmol/l; p < 0.001). Conclusions: The study showed better adequacy of HD treatment performed based on the high-flux dialyzers with helixone membrane as compared with low-flux dialyzers with polysulfone membrane.

Peritoneal dialysis is one of the three available options for renal replacement therapy. This method of treatment of end-stage renal disease gives patients relatively high sense of independence and control over their disease, especially in comparison with hemodialysis, and therefore is often preferable method for young individuals wishing to lead an active lifestyle. We present a case of 22 year old female patient with stage 5 of chronic kidney disease, which is a consequence of multi-agent chemotherapy for endo-dermal sinus tumor of the right ovary (diagnosed at the age of 13). Particularly important in the context of treating our patient with peritoneal dialysis is the fact of confirmed metastases into the peritoneum, which was the reason for the use of chemotherapy reserved for high-risk patients (ifosfamide + etoposide + cisplatin). The selected program of chemotherapy provided effective eradication of cancer, but a side effect of treatment was renal tubular damage. In the period from 03.2006 to 05.2007 our patient required hemodialysis (with gradually reduce dose of dialysis), at a later time to 12.2011 patient did not require renal replacement therapy (stable renal function were observed at the stage 4 of chronic kidney disease), but in 12.2011 resumption of dialysis was necessary and the patient, in accordance with her selection, is receiving peritoneal dialysis. Qualification of our patient for treatment with peritoneal dialysis was associated with reasonable concern about the ability to provide acceptable adequacy of dialysis. Apprehensions proved to be unfounded, the clinical observation of the patient presents proper ratios of dialysis adequacy. Our patient was also qualified for renal transplantation.

Unlabelled: Patients on maintenance dialysis have increased heomocystein (Hcy) serum levels. The aim of the study was to evaluate the interdependence between Hcy and folic acid (FA) levels in renal transplant patients (pts) at various time periods during a two year observation period after kidney transplantation (Ktx)., Patients and Methods: The study included 51 pts (17 F, 34 M) aged 15-62 years (median 38.1) after deceased donors Ktx. Before Ktx, 46 pts were treated with maintenance hemodialysis (HD), while 5 by peritoneal dialysis (PD). The mean observation period equaled 21.2 months (6-24 months); while total observation period was 90 person/years. Hcy level was measured using high performance liquid chromatography (HPLC). FA level was measured using chemiluminesence method (standard methods) using the Immulite 2000 analyzer. Patients blood was drawn before Ktx and 3, 6, 9, 12, 15, 18, 21 and 24 months after procedure., Results: An increased Hcy level (>15 micromol/l) - mean 28.5 +/- 17.8 micromol/l (range from 10.2 micromol/l to 116.8 micromol/I) was noted in the blood of 44 pts before Ktx (86.3% of the examined population). In 31 pts after Ktx (60.8% of the examined population), mean Hcy level remained increased above 15 micromol/I (mean Hcy - 19.2 +/- 5.8 micromol/I). A negative correlation was found between the levels of Hcy and FA directly before Ktx (R= -0.28, p<0.05). A statistically significant drop of FA level of 72.6% (mean 220.5 +/- 395.1 ng/ml to 60.3 +/- 129.8 ng/ mi) was noted 3 months after Ktx in the examined group (p<0.001 in the Wilcoxon test). However, in the following period time after Ktx, FA levels did not differ statistically (ANOVA Friedmana p=NS). Mean concentrations of Hcy after Ktx did not correlate significantly with levels of FA (R = -0.12, p = NS). No significant differences between mean levels of FA after Ktx in pts with normal and increased mean levels of Hcy were found; but one must note that presence of hiperhomocysteinemia (HHcy) was associated with a 42% lower concentration of FA in relation to patients who had Hcy >15 micromol/l (36.4 ng/ml vs. 62.5 ng/ml)., Conclusions: Statistically significant decrease of Hcy concentration was observed after Ktx as compare with values before procedure, however not reached normal values. Significant decrease of FA concentration after Ktx is most likely associated with the discontinuation of FA supplementation, as well as due to the restoration of the erythropoietic line.

Unlabelled: The aim of the study was to evaluate the influence of the type of prescribed immunosuppression: cyclosporine A (CsA) vs. tacrolimus (Tac) on remote homocystein levels in patients (pts) after kidney transplantation (Ktx)., Patients and Methods: The study included 51 pts (17 F, 34 M) aged 15 to 62 years (mean 38.1) after cadaver Ktx. The mean observation period equaled 21.2 months (6 -24); while total observation period was 90 personlyears. Before Ktx, 46 pts were treated with maintenance hemodialysis (HD), while 5 by peritoneal dialysis (PD). After Ktx, patients had immunosuppression prescribed according to the following schemes: prednisone (P) + CsA + azathioprine (AZA) - 12 pts; P + CsA + mycophenolate mofetil (MMF) -26 pts; P + Tac + MMF - 11 pts; and P + Tac + AZA - 2 pts. Hcy level was measured using high performance liquid chromatography (HPLC). Serum creatinine level was measured by standard method using the Hitachi 917 analyzer. Creatinine clearance was calculated based on the Cockcroft-Gault formula. Patient's blood was drawn before Ktx and 3, 6, 9, 12,15, 18, 21 and 24 months post procedure., Results: Delayed graft function (DGF) after Ktx was diagnosed in 29 pts (56.9%) and this group required from 4 to 28 HD sessions (mean 14 sessions). Hcy level did not significantly differ between pts requiring (29 pts) and not requiring (22 pts) HD treatment after Ktx. It was also noted that the number of performed HD sessions did not significantly correlate with Hcy levels 24 months after Ktx (R =0.04, p=0.81). No relationship was found (non-parametric Spearman test) between the drop in Hcy level 3 months after Ktx as compare with value before Ktx and ischemia time (R=0.09, p=0.49), number of compatible HLA A and B (R=0.07, p=0.63), and DR antigens (R=0.09, p=0.51). Decrease in Hcy level (before Ktx and 24 months after Ktx) did not significantly correlate with the above parameters, respectively: R=-0.14, p=0.40; R=0.06, p=0.73; R=0.12, p=0.45; R=0.11, p=0.50. Decrease in Hcy level (before Ktx and 3 months after) did not differ significantly when compared to pts receiving immunosuppressive therapy CsA vs. Tac (p=0.18). Even though notable differences were observed in the drop in Hcy level (immunosuppressive treatment scheme CsA vs. Tac) in measurements before Ktx and 24 months post (respectively: 27% and 57.6%), no statistical significance was noted (p=0.13). Using the Mann-Whitneys' Test, no statistical significance was noted (p=0.13) when comparing differences in creatinine clearance between the group of pts receiving CsA and Tac 24 months after Ktx. Patients treated with Tac achieved a higher creatinine clearance by 16.5% when compared with those receiving CsA. No significant differences were observed between these two groups (p=0.65) when serum creatinine levels were evaluated., Conclusions: Incidence of DGF, as well as prescribed immunosuppressive therapy does not have an influence on remote Hey levels in pts after Ktx. Graft function seems to be the main predictor that influences Hcy levels after Ktx in this group of pts.

Unlabelled: The aim of the study was to evaluate the influence of elevated homocystein (Hcy) level and selected lipid parameters on the progression of atherosclerotic changes in patients after kidney transplantation (KTx)., Patients and Methods: The study included 51 pts (17 F, 34 M) aged 15-62 years (median 38.1) after cadaver KTx. The mean observation period equaled 21.2 months (6-24 months); while total observation period was 90 patients/ years. Hcy levels was measured using HPLC, Lp(a) and Apo-B levels using the nephelometric method and total cholesterol with its' HDL and LDL fractions, triglycerides and creatinine based on the Hitachi 917 analyzer. Patients' blood was drawn before renal transplantation and 3, 6, 9, 12, 15, 18, 21 and 24 months after KTx. Common carotid artery intima media thickness (CCA-IMT) was evaluated by ultrasound on 14 days, 12 and 24 months after KTx., Results: CCA-IMT correlated significantly with Hcy levels after 12 months (R=0.53; p=0.0009) and 24 months (R=0.38; p=0.0356) after KTx. Significant differences were found 12 and 24 months after KTx in CCA-IMT between patients with normal (<15 micromol/l) and increased (>15 micromol/ l) mean Hcy concentrations: p=0.0035 and p= 0.015, respectively. Analyzing changes in CCA-IMT, significant differences were noted when comparing the CCA-IMT increment after 12 and 24 months post KTx in patients with normal (< or =15 micromol/l) and increased (>15 micromol/l) homocystein concentrations: p=0.049 and p=0.0039, respectively. Increment of CCA-IMT 12 months after KTx, significantly correlated with mean total cholesterol level (R=0.35; p=0.0333), whereas 24 months after procedure correlated significantly with 0.0315)., Conclusions: Hcy level is an independent risk factor for atherosclerosis development in patients after KTx. Elevated Hcy level as well as increased cholesterol and Lp(a) levels enhance the progression of atherosclerotic changes evaluated by CCA-IMT in KTx patients.

Unlabelled: The aim of the study was to assess the relationship between the advancement of secondary hyperparathyroidism and the concentrations of selected calcification markers, i.e. osteopontin (OPN), osteoprotegerin (OPG), osteocalcin (OC), fetuin-A as well as fibroblast growth factor-23 (FGF-23) in peritoneal dialysis patients (PD)., Material and Methods: The study included 67 patients (36 male and 31 females) aged 52.9 years (19-75 years) with chronic kidney disease (CKD) on peritoneal dialysis therapy 30.4 +/- 24.2 months. BMI was calculated using Quetelet formula. Serum Pi, Ca, albumin, fibrinogen, iPTH were performed using standard laboratory methods, while the selected bone metabolism parameters: fetuin-A, OC, OPG, OPN and FGF-23 were measured based on commercially available ELISA kits., Results: Patients with high iPTH levels (> 300 pg/ml) had higher OC levels (median 68.5 ng/mL) comparing to patients with target iPTH, i.e. 100-300 pg/ mi (57.3 ng/mL; p = 0.003) and patients with low iPTH < 100 pg/ml (17.3 ng/mL; p < 0.0001). Also, OPN and FGF-23 concentrations were significantly higher in patients with high iPTH comparing to patients with target iPTH (1535 vs. 1001 ng/mL; p = 0.04 and 4952 vs. 702 RU/ mL; p = 0.02, respectively). Patients with increased Ca x P values (> 45 mg2/dl2) as compared with patients having lower Ca x P had higher FGF-23 (4308 vs. 678 RUlmL; p < 0.0001), higher OC (67.0 vs. 60.2 ng/mL; p = 0.049) and lower OPG concentrations (8.97 vs. 11.97 pmol/L; p = 0.02). OC strongly correlated with iPTH concentration (R = 0.78; p < 0.0001) and FGF-23 strongly correlated with Ca x P value (R = 0.74; p < 0.0001)., Conclusions: In peritoneal dialysis patients along with increment of IPTH concentrations and enchancement of calcium-phosphate imbalance, significantly rise concentrations of calcification markers such as: osteocalcin (OC), osteopontin (OPN), as well as fibroblast growth factor-23 (FGF-23).

Unlabelled: The type of vascular access is an important determinant of complications in the dialysis population. The aim of the study was to evaluate types of hemodialysis vascular access at hemodialysis start, in the course of treatment and complications during a one year observation period. The study group consisted of 213 patients [126 (59%) males; 87 (41%) females] treated for 54 months (range from 2 to 384 months) by maintenance hemodialysis at the Nephrology Department of the University Hospital. Mean age of the patients equaled 57.4 years and ranged from 21 to 91 years. The observation period began on June 1st, 2009 and finished on May 31st, 2010. At the start of the dialysis therapy - 99 (46.5%) patients had arterio-venous fistula (AVF), 81 (38.0%) temporary catheters (TC), and 33 (15.5%) permanent catheters (PC). At the beginning of the one-year observation period, 161 (75.6%) of the patients were treated using an AVF, 37 (17.4%) using a CP, 11 (5.1%) CT, and 4 (1.9%) using an artificial graft (AVG). At the end of the one year observation period - 179 (84%) patients were dialyzed using AVF, while 30 (14.1%) patients on PC, and 4 (1.9%) using a AVG. Statistically significant differences in possessing AVF were noted between start of renal replacement therapy and the start and finish of the one year observation period (p < 0.0001), as well as beginning and finish of the observation period (p < 0.002). During the observation period - 37 (20.7%) patients with an AVF required intervention due to complications associated with vascular access; where 4 from 11 (36.4%) patients in this group had AVF located on the arm and 33 from 150 (22.0%) on the forearm. The most common complications associated with AVF were thrombosis (23 = 14.3%), narrowing of the fistula (9 = 5.6%), too high output flow (HOF) 2 = 1.2% and the steal syndrome (SS) 3 (1.9%). Infectious complications were noted in 4 from 37 patients with PC (10.8%), and significantly less with AVF-4 from 161 (2.5%) (p < 0.0001). AVG infection occurred in 2 (50%) individuals of this group., Conclusions: AVF created using patients' own vessels of the forearm is characterized with decreased risk of complications in comparison to fistulas made of artificial materials or permanent catheters. However, fistula thrombosis of the AVF is still the most common complication requiring surgical intervention.

Unlabelled: Infectious complications associated with vascular access are a well known cause of increased morbidity and mortality in hemodialysis patients. The aim of the study was to evaluate the incidence of hemodialysis vascular access infections and patients survival in the group of maintenance hemodialysis patients during a one year observation period. The study group consisted of 213 patients (126 male, 87 female; aged 57.4 +/- 14.9 years being on renal replacement therapy for 54 months; range: 2 to 384 months) treated by maintenance hemodialysis at the Nephrology Department of the University Hospital. From the study group 181 patients (84.9%) had created arterio-venous fistulas (AVF); 28 (13.2%) permanent central venous catheters (CVC) implanted and 4 (1.9%) arterio-venous grafts (AVG). Vascular access infectious complications were monitored during a one year observation period. Infections of CVC were observed in 4 (14.3%) of the patients with CVC; 4 (2.2%) of patients with AVF and 2 (50%) of AVG. In the group of patients with signs of AVF infection the following pathogens were found: S. epidermidis 50%, S. aureus 25% and negative culture in 25%. The common pathogens in the group of patients with AVG were as follows: S. aureus and S. hemoliticus. Patients that had infections of implanted CVCin 75% were found to have Gram-positive bacteria (50% S. aureus, 25% S. coagulazo-negative), while 25% had Gram-negative infections (E. coli). In the analyzed period 30 deaths (14.1%) were noted; 23 (12.7%) in patients with AVF and 7 (25%) with CVC. Mortality due to cardio-vascular events in dialyzed patients using permanent catheters came to 43%; death due to catheter infections 14%. In the group of patients with AVF from 23 deaths 83% were of cardio-vascular origin, and 4% due to infections. No deaths were occurred during the observation period in the group of patients with AVG. One should note that only 4 patients with AVG during the study period were evaluated., Conclusions: 1. Types of vascular access has some influence on infectious complications and survival in the group of hemodialized patients. 2. High rate of CVC infections and associated increased mortality and better patients outcome with AVF, indicate that fistula should be constructed in all cases where it is possible.

Unlabelled: HCV and HGV were recognized as highly prevalent in maintenance dialysis population and variable from country to country and unit to unit. The introduction of serologic tests, for detecting antibodies to HCV (anti-HCV) and HGV (anti-HGV) antigens, has facilitated the study of the epidemiology as well as clinical significance of HCV and HGV infections in patients on maintenance dialysis. The implementation of molecular biology techniques (polymerase chain reaction) for detecting HCV and HGV viremia (HCV-RNA, HGV-RNA) facilitate diagnosis and transmission routes of the infection. The aim of the study was to evaluate the coincidence of HCV and HGV infections in dialysis population and relationship between current and overcome infections and markers of liver damage. The study was performed in the group of 215 patients aged 26-81 years (mean 53.2) on 3 x week maintenance hemodialysis from 33 to 301 months (mean 101.8 months) in the Department of Nephrology, University Hospital, Cracow. Anti-HCV and anti-HGV antibodies were determined based on immunoenzymatic, IIIrd generation, methods. HCV-RNA and HGV-RNA were estimated using polymerase chain reaction (PCR). The anti-HCV antibodies were present (+) in 40 (18.6%) of patients. From the group of patients with anti-HCV (+) antibodies 42.5% were also HCV-RNA (+) whereas from the patients with anti-HCV (-) antibodies 10.4% were HCV-RNA (+). Anti-HGV antibodies tested in the group of 93 patients: 32 anti-HCV (+) and 61 anti-HCV (-) were positive in 20 (62.5%) and 22 (36.1%) patients, respectively. In the group of patients with anti-HGV (+) antibodies HGV-RNA (+) were detected in 63.6%. Anti-HCV (+) and anti-HGV (+) patients were dialysed longer as compared with negative ones: 144.5 vs. 83.5 months, p < 0.001 and 119 vs. 96.4 months, p-NS, respectively., Conclusions: 1. The prevalence of HCV and HGV infections in the dialysis population is very high. 2. The coincidence of HCV and HGV infections is frequent. 3. Our results showed that even anti-HCV (-) and anti-HGV (-) patients carry the risk of viral infection due to detected HCV-RNA and HGV-RNA in some patients.

Pure red-cell aplasia (PRCA) is a serious, life threatening rare condition of multifactorial causes manifested as severe anemia with absence of erythroid precursors in the bone marrow. PRCA may be a consequence of antibody production against applied recombinant human erythropoietin (EPO). The first description of PRCA in the course of EPO therapy was performed in a patient receiving subcutaneously Eprex and in the next years after therapy with other erythropoiesis stimulating agents like erythropoietin beta, omega or darbepoetin. In the paper we describe epidemiology and diagnostic criteria of PRCA. The current treatment possibilities of this complication were described with special attention dedicated to different immunosuppressive agents and effectiveness of kidney transplantation with subsequent immunosuppression.

Relapsing polychondritis is a rare autoimmune disease, which is due to sporadic occurrence, unexplained etiology and wide range of symptoms resulting in the difficulties in diagnosis. Recurrent inflammation leads to destruction of cartilaginous tissues, such as ear, nasal septum, larynx, trachea and bronchi, peripheral joints and vertebral structures. Blood vessels, the central nervous system, eyes, and the urinary tract can be involved as well. Clinical course of relapsing polychondritis is often modified by co-existing systemic diseases and remains misdiagnosed. In case of inappropriate or delayed treatment, serious and life-thretening complications may develop. In this article we present the most characteristic clinical features of the disease, differential diagnosis, focusing on current approaches to treatment.

Lyme disease is a multi-system inflammatory disease caused by spirochetes of the Borrelia burgdorferi. Among multiplicity manifestations of Lyme disease, musculoskeletal symptoms also occur. In the following article authors present epidemiology of Lyme disease, pathogenesis of antibiotic-refractory Lyme arthritis, symptoms, diagnosis and management of Lyme arthritis based on recent guidelines prepared by an expert panel of the infectious Diseases Society of America.

Chronic inflammation is an inherent feature of chronic renal failure. Successful renal transplantation (RTx) is the only known renal replacement therapy sufficient to reverse most of the metabolic disturbances of chronic uremia, although still some of these abnormalities may be present or even new problems may occur (mostly as the side effects of immunosuppressive drugs). The aim of this study was to evaluate the level of inflammation in 20 patients (9 F, 11 M, aged mean 44.0 +/- 11.8 years) with well-preserved renal function 36 months after kidney transplantation, using serum levels of selected cytokines (IL-6, IL-18, TNFalpha and soluble receptor for TNF - sTNFRII), acute phase proteins (CRP, fetuin A) and hepatocyte growth factor (HGF). Procalcitonin was also assessed as the sensitive indicator of active infection. Obtained results were compared with the control group of healthy subjects in a respective age. Serum levels of IL-6, TNF-R and IL-18 were significantly higher, and HGF and fetuin A--significantly lower in patients vs. controls (p < 0.05 for all differences). Significant negative correlations were noted between glomerular filtration rate (GFR) and serum TNF, sTNFRII and IL-18 in RTx patients, whereas strong positive relationship between GFR and fetuin A was observed. Serum creatinine correlated with IL-6, IL-18, TNFalpha, sTNFRII and hsCRP levels and serum urea-with TNFalpha, sTNFRII, IL-6 and IL-18. Significant negative associations were also noticed between serum fetuin A and most of the tested inflammatory markers: sTNFRII (r = -0.77; p = 0.0005), IL-6 (r = -0.63; p = 0.009), hsCRP (r = -0.62; p = 0.009) and IL-18 (r = -0.60; p = 0.01). Obtained results permit us to conclude that the increased activity of inflammation can still be noticed in RTx patients 36 months after successful engraftment. This process is inversely associated with the level of kidney function. The role of fetuin A as the 'negative' acute phase protein was also demonstrated in this group of patients.

Sjögren's Syndrome (SS) is the second most common autoimmune disorder after rheumatoid arthritis (RA). It can be found as a lone condition (primary Sjögren's Syndrome) or may accompany other autoimmune rheumatic diseases (secondary Sjögren's Syndrome). Despite such frequent occurrence, accurate diagnosis of Sjögren Syndrome is difficult. These difficulties result from highly variable symptoms of SS as well as from common presence of other autoimmune disorders. In the following article authors present current knowledge concerning clinical symptoms, diagnostic methods and latest clinical guidelines on the diagnosis of SS. Differential diagnosis of SS and systemic lupus erythematosus (SLE) is also discussed.

Kidney transplant recipients, comparing to general population, have an increase risk of cancer development. The most frequent lesions, observed in this population, are skin cancers, especially NMSCs (nonmelanoma skin cancers) which make up to 50% of all malignant lesions. The incidence of neoplasm is influenced by demographic characteristics and the highest prevalence achieve in Australia where 52.5% of kidney recipients develop skin cancer after 10 years after transplantation and 82.1% after 20 years. Authors in the following article describe the most common cutaneous premalignant and malignant lesions in patients after kidney transplantation, types of their treatment, and potential risk factor responsible for its development.