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This report describes data collected by the Croatian Registry of Renal Biopsies (CRRB) for the year 2019. Patients and methods: nine centers (82%) provided data for 255 native kidney biopsies. We assessed the anthropometric data, data on serum creatinine concentration (sCr), 24 h proteinuria, haematuria, serum albumin level, arterial hypertension, histological diagnosis, and complications after renal biopsy. Results: examined group consisted of 58% males, median age 58 y (18-80 y) and 42% women, median age 57 y (20- 86 y). Males had a more impaired renal function at the time of renal biopsy, nephrotic syndrome, and hypertension. The most prevalent clinical presenta tion were urinary abnormalities (34.9%). Among all biopsy cases, primary glomerular diseases were the most often found histology group (41.5%), and IgA nephropathy was the most frequent diagno sis(47.1%). Among secondary glomerular diseases, pauci-immune glomerulonephritis (PIGN) was most often found (30.9%). The highest proteinuria was observed in minimal change disease and dia betic nephropathy (DN). The highest sCR values were found in membranoproliferative glomerulone phritis (MPGN) and necrotizing vasculitis. Patients with MPGN and DN had the highest blood pressure levels. Conclusion: CRRB provides important data on the epidemiology of biopsy-proven kidney diseases from the whole territory of Croatia.

Karcinom bubrega je rijetka komplikacija autosomno dominantne policistične bubrežne bolesti (ADPBB). Prikazujemo 63-godišnjeg pacijenta s ADPBB, karcinomom bubrega i bubrežnom funkcijom koja je bila očuvana sve do nefrektomije. Pacijent je od 2012. g. pod kontrolom urologa pri Klinici za urologiju Kliničkog bolničkog centra Zagreb, jer je radiološkom obradom verifi cirana solidna tvorba desnoga bubrega koja je morfološki izgledala kao onkocitom. Bolesnik je od ranije znao da ima policističnu bolest bubrega i jetre. Od subjektivnih poteškoća navodio je samo povremenu lumbalnu bol. Svi laboratorijski nalazi bili su potpuno uredni. Tijekom kontrola uočen je rast tvorbe u desnom bubregu uz očuvanu bubrežnu funkciju, te je bolesniku predložena nefrektomija za koju se nije odmah odlučio. No, kada je pristao, učinjena je desnostrana radikalna nefrektomija. Radilo se o karcinomu bubrega, tipa svjetlih stanica, koji je klasifi ciran kao pT3aN0MX. U prva tri poslijeoperacijska dana dolazi do porasta kreatinina do 165 μmol/L. U trenutku otpusta iz bolnice kreatinin je bio 132 μmol/L, ureja 9,8 mmol/L. Tri mjeseca nakon kirurškog zahvata kreatinin je stabilan na 135 μmol/L, a kontrolni MSCT toraksa, abdomena, zdjelice, UZV trbuha i rendgenogram srca i pluća su, osim poznatih cističnih promjena na jetri i lijevom bubregu, uredni. Dalje su pacijentu preporučene redovite urološke kontrole, a zbog jasne bubrežne insufi cijencije koja se razvila nakon nefrektomije preporučene su i redovite kontrole nefrologa., Aim: The aim of this case report is to point out the specifi city of clinical, diagnostic and therapeutic approach to the patient with the autosomal dominant polycystic kidney disease (ADPKD), renal cell carcinoma along with preserved kidney function. We used patient medical chart, as well as relevant literature from online medical databases (PubMed, EM-base). Case report: We describe a case of a 63-year-old patient with ADPKD, renal cell carcinoma and preserved kidney function until nephrectomy. ADPKD along with hepatic cysts has been known since 2009. Because of the suspicious renal mass detected by ultrasound, non-contrast computed tomography (CT) was performed in 2009, which did not confi rm the presence of renal tumor. In 2012, the patient suffered right-fl ank pain and therefore underwent contrast CT and magnetic resonance imaging (MRI), which confi rmed renal tumor that morphologically seemed like oncocytoma. For that reason, he has been under urologist supervision ever since 2012. Laboratory blood and urine test results were within the normal range all the time and the patient only complained of right-fl ank pain. Further follow up revealed enlargement of the renal mass on MRI and contrast CT. The patient was informed about his condition from the beginning, but he did not accept nephrectomy. However, in December 2015, he agreed and radical nephrectomy of the right kidney was performed. Histopathologic report showed that it was a clear renal cell carcinoma, 6,5x5x5cm, pT3aN0MX (tumor invaded renal sinus fat). In the fi rst three postoperative days, a decline in kidney function was observed, with serum creatinine up to 165 μmol/L. At patient discharge from the hospital, creatinine was 132 μmol/L and urea 9.8 mmol/L. Three months after the operation, serum creatinine was stable (135 μmol/L) and multi-slice CT of the thorax, abdomen and pelvis was normal. Regarding the histopathologic report, the patient was advised to present for follow up by both urologist and nephrologist because of the evident kidney failure that had begun after nephrectomy. Discussion: Renal cell carcinoma is an infrequent complication of ADPKD. It does not occur with increased frequency when compared to the general population. The diagnosis of renal cell carcinoma is more diffi cult to establish in ADPKD than in the general population since fi ndings such as hematuria, fl ank mass, or complex cysts are common in ADPKD in the absence of malignancy. Malignancy should be suspected if the patient complains of systemic signs and symptoms (fever, anorexia, fatigue, weight loss) or if there is rapid growth of a complex cyst. However, there are several characteristics of renal cell carcinoma in ADPKD, i.e. fever, and tumors are more often bilateral, multicentric and sarcomatoid. CT scanning with contrast and MRI are often able to distinguish malignancy from a complex cyst. MRI is considered to be superior to CT in detecting renal cancers. Considering that clinical, radiological and histologic presentation of renal cell carcinoma in this case report was rather unusual, along with the fact that the patient had refused nephrectomy for several years, we can conclude that the outcome is principally favorable for the patient. Conclusion: We present an instructive case of renal cell carcinoma in a patient with ADPKD. Clinical presentation, radiological and histologic characteristics are different from the usual presentation of renal cell carcinoma in ADPKD. It is necessary to keep in mind an individual approach.

AIM: We analyzed the effects of the angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor type 1 blockers (ARBs) on the evolution of hematocrit (Htc) and hemoglobin (Hgb) levels in stable renal transplant patients (RTRs) with respect to higher and lower initial hemoglobin and hematocrit values. We also wished to determine if these agents have an effect on the evolution of kidney graft function with respect to higher and lower initial hemoglobin and hematocrit values. METHODS: The study group comprised of 270 RTRs (158 male) with stable graft function. Beside other prescribed antihypertensive drugs, 85 of them took ACE-I and 84 ARBs as a part of their antihypertensive therapy. On the other hand, 101 RTRs didn’t have prescribed ACE-I/ARBs. RESULTS: After analyzing the hemoglobin, hematocrit, creatinine and potassium serum levels after initiation of therapy with ACE-I and ARB or no therapy with ACE-I/ARBs trough a 12-month period, we haven’t found any significant difference in hemoglobin, hematocrit, creatinine and potassium levels in those three groups of patients. On the other hand, in patients with initially higher Hgb (Hgb ≥150 g/L) and initially higher Htc (Htc ≥ 45%) levels there was a statistically significant decrease in hemoglobin (p=0.006) and hematocrit (p

Objective Aim of the study is to determine: Toll like receptor 4 (TLR4) expression on monocytes and the level of interleukin 17 (IL 17) in patients’ serum, whether there is correlation between TLR4 expression and IL 17 level, if the type of the used hypertension class influences TLR4 expression and IL 17 level and if hypertension duration contributes to TLR4 expression or IL 17 level. Design and Methods There have been 50 patients included in the study and 33 of them have unregulated hypertension, 17 have regulated hypertension (control group). The blood pressure was measured with Omron M6 Comfort phygmomanometer, on both hands three times. The relevant value was the mean value, measured on the hand which showed higher pressure values. The increased blood pressure was the one over 140/90 mmHg. The patients had their IL 17 serum level determined with ELISA method and the TLR 4 expressions on monocytes from periphery blood applying free flow cytometry. Results Our study did not show differences in TLR4 expression between two patients' group. However, in the patient group with unregulated hypertension inter quartal range was significantly higher than in the control group. There is no significant difference in IL 17 between two groups. The expression of TLR4 is much lower in the patients who were prescribed beta blockers. The level of IL 17 is significantly higher in the patients who use diuretics. In the group of the patients with unregulated hypertension, there was a significant correlation between level of IL 17 and hypertension duration, but in the group with well regulated hypertension there was no correlation. There was no correlation between TLR4 expression and level of IL 17. Conclusion Long term unregulated hypertension leads to the activation of specific immunity response and IL 17 can be a marker of unregulated hypertension duration. The results suggest also that the choice of prescribed anti-hypertension drugs can modify the activity of immunity response.

The aim of the study was to assess the frequency of SNP896A/G in the Toll-like receptor (TLR) 4 gene and SNP1350T/C in the TLR2 gene in patients with acute myocardial infarction (AMI) and to analyse the association of these SNPs with risk factors for atherosclerosis and clinical aspects of AMI in a sample of the Croatian population. We included 240 participants in the study: 120 AMI patients and 120 sex- and age-matched healthy blood donor controls. The SNP1350T/C variant in the TLR2 gene showed a lower frequency in the AMI patient group than in the control group (P = 0.033). The frequency of SNP896A/G variants in the TLR4 gene between the patients and the controls did not differ (P = 0.286). Significantly, fewer people had SNP1350T/C in the TLR2 gene (P = 0.003) among the participants with arterial hypertension than those without it. The frequency of SNP896A/G in TLR4 was the same in hypertensive patients compared with normotensive subjects (P = 0.088). SNP1350T/C in TLR2 was less frequent in the AMI patients and in those with hypertension. Thus, SNP1350T/C in TLR2 might play a protective role against AMI and arterial hypertension. The frequency of SNP896A/G in the TLR4 gene was not associated with AMI and arterial hypertension. Other risk factors for atherosclerosis and clinical aspects of myocardial infarction were not associated with the genotype distribution of the examined genes.

Pojava aPL antitijela moguća je u sklopu različitih netrombotskih manifestacija živčanog sustava. Neadekvatno reagiranje na terapiju u liječenju tih manifestacija ili pojava atipičnih oblika manifestacija, treba pobuditi sumnju kako se radi o APS.

The aim of the study was to show the differences in BPV regarding gender, age and body mass index (BMI) in normotensive patients. The study included 40 normotensive patients (22 women and 18 men. Ambulatory blood pressure monitoring (ABPM) was performed using Spacelab 90217 monitor. From these measurements we obtained data on overall (o), wake (w) and sleep (s) systolic (SBP) and diastolic (DBP) blood pressure, mean arterial pressure (MAP) heart rate (HR) and percentage of time when SBP, DBP and MAP were above limits (%TAL). Patients were divided into groups regarding gender, BMI < or > 25 kg/m2 and age < or > 40. Three ABPMs were not technically acceptable, and three cases of hypertension were detected (2 men and 1 woman). Thirty-four ABPMs were statistically analyzed (21 female, 13 male). There were no significant differences in age or BMI between men and women or within groups. oSBP (p = 0.028), oPP and oPP variability (p = 0.023, p = 0.005, respectively), o%TAL of SBP (p = 0.048), wSBP and BPV of wSBP (p = 0.031 and p = 0.005, respectively) were significantly higher in group of patients with BMI > 25 kg/m2. BPV of wDBP correlated to BMI in women (p = 0.008). Men had significantly higher oSBP compared to women (p = 0.029) as well as BPV of oSBP (p = 0.01). They had significantly greater o%TAL of SBP (p = 0.02) and o%TAL of DBP (p = 0.018) as well as wSBP (p = 0.02). oSBP and o%TAL of SBP correlated to BMI in women (p = 0.012, p = 0.02, respectively), but not in men. Both absolute blood pressure values and BPV of systolic blood pressure during the daytime correlated with BMI in all patients. This study showed connection between BPV of diastolic blood pressure during the nighttime and BMI of female patients. No difference in BPV was detected regarding the age of patients. Men have higher SBP and BPV of SBP then women during the 24 hour period as well as longer period of time with values above limits.