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Background: Lupus nephritis (LN) is one of the most severe manifestations of systemic lupus erythematosus (SLE). There are increased studies examining the role of different markers that would facilitate diagnosis, LN activity monitoring, relapse occurrence, and the right time to introduce maintenance therapy. We aimed to examine the importance of determining the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), systemic immuneinflammatory index (SII) and systemic inflammatory response index (SIRI) in LN, comparing their significance with other standard parameters of active disease. Methods: The clinical examination included 66 patients (34 with active and 32 with LN in remission) and 23 healthy controls. The investigated parameters were CRP, CBC, creatinine, albumin, GFR, C3, C4, ANA, anti-ds DNA Ab, in urine: sediment analysis, SLEDAI/r, proteinuria 24h and Up/cre. We determined the derived markers: NLR, PLR, SIRI, and SII and their correlation with other parameters of active disease. Results: Comparing the group with active LN with LN in remission and the control group, a statistically significant difference was obtained for CRP (p=0.004) and RBW and haemoglobin, albumin, C3, ANA and anti-ds DNA Ab (p

Background: Metabolic syndrome (MetS) in patients with systemic lupus erythematosus (SLE) represents an additional burden and a poor prognostic factor for the onset or worsening of atherosclerosis and cardiovascular complications. In many patients with lupus nephritis (LN), MetS is often already manifested initially. Our work aimed to determine the frequency and characteristics of MetS in patients with LN, as well as the relationship components of MetS and characteristics of disease activity. Methods: The clinical study included 67 patients with LN, 54 (80.59%) female and 13 (19.41%) male, with an average age of 42.86±14.46 years. Patients were divided into two groups: with MetS (35.82%) and without MetS (64.18%), active LN had (34 or 50.74%), and LN in remission (33 or 49.25%). We monitored clinical and biochemical parameters of interest. Results: Comparing patients with LN collectively, as well as those with MetS and without MetS, we observed that patients with MetS were older (p=0.001), BMI (p

Background/Aim. Lupus nephritis (LN), as an immuno-inflammatory kidney lesion and the most severe manifestation of systemic lupus erythematosus (SLE), is accompanied by a disorder of nutritional status of patients. The aim of our study was to determine the importance of parameters of nutritional status [nutritional risk index (NRI), prognostic nutritional index (PNI), and Controlling Nutritional Status (CONUT)] and their association with standard parameters of LN activity. Methods. The clinical study included a group of 92 participants: 67 patients with LN (34 patients had LN active disease – the LNa group, and 33 patients were in LN remission – the LNr group) and 25 healthy subjects in the control group. In addition to standard laboratory parameters and LN activity parameters, derived parameters were also determined: PNI = 10 × serum albumin value (g/dL) + 0.005 × total lymphocyte count/mm3; N RI = 1 .519 × serum albumin value (g/dL) + 41.7 × present weight (kg)/usual body weight (defined as stable body weight for last six months) (kg); CONUT score = serum albumin value (g/dL) + total lymphocyte count/mm3 + total cholesterol level (mmol/L). Results. A statistically significant difference between all three groups was observed for the PNI (p = 0.001) and the CONUT score (p = 0.000), while there was no significant difference for NRI. In the LNa group, a statistically significant correlation was found for PNI in relation to albumin, complement C 3 and C 4, and a statistically significant negative correlation with the level of anti-double stranded (ds) DNA antibodies (Abs). NRI had a statistically significant correlation only with proteinuria in the LNa group. CONUT showed significant correlations with most of the parameters of disease activity: negative correlation with albumin and complement C3 (p = 0.000), and positive correlation with anti-dsDNA Abs (p = 0.002), Systemic Lupus Erythematosus Disease Activity Index/renal (SLEDAI/r), and proteinuria g/24 hrs (p = 0.000). Conclusion. A statistically significant difference was observed between the groups for the nutrition score CONUT and the PNI. Their correlation with standard parameters of active disease was significant for most parameters in the group of patients with LNa.

Background: Lupus nephritis (LN) is one of the most serious complications in the development of systemic lupus erythematosus, that can adversely affect the course and prognosis of this autoimmune disease. Therefore, monitoring the effect of applied therapy, achieving remission, or monitoring class IV LN activity is still a great challenge for nephrologists. This study aimed to compare the urinary neutrophile gelatinase associated lipocalin (u/NGAL) with traditionally accepted parameters for LNactivity to indicate the importance of its determination in these patients. Methods: The study group consisted of 40 patients with class IV LN, who were prospectively followed for a period of 4 months within three control visits to 2 months. The first group (20/40) had active disease (Group A), and the second group had diseasein remission (Group B). The parameters we monitored and compared at each visit were standard biochemical parameters and kidney function parameters: C-reactive protein (CRP), blood count (CBC), creatinine, total proteins, albumin, cholesterol, triglycerides, glomerular filtration rate (eGFR). Regarding immune parameters, complement C3 and C4, antinuclear antibodies (ANA), anti-double stranded DNA antibody(anti ds DNA Ab) were monitored. Urine sediment, proteinuria 24h, urine culture, urinary protein/creatinine ratio - Up/Cre, and urinary NGAL (u/NGAL) were monitored in Results: Comparing standard parameters of disease activity and u/NGAL between groups, a statistically significant difference was obtained (p < 0.001). Within Group A, comparing the parameters by visits (0 : 2) for anti-ds-DNA Ab a significance of p< 0.05 was obtained, for albumin/s and C3 a significance of p

Introduction. Kidney failure in multiple myeloma is some-times initial symptomatology and a very serious complication with an unfavorable effect on the course and prognosis of the disease. Multiple myeloma is a disease characterized by the proliferation of plasmocytes in the bone marrow, and in rare cases, it can be extramedullary in various organs and systems. Pulmonary plasmacytoma localization is a rare extramedullary localization, especially when it represents one of the initial manifestations of multiple myeloma. Case report. We present a patient with progressive acute kidney failure who has started hemodialysis treatment. On chest radiography, a homogeneous shadow was observed along the left chest wall, and the multislice computed tomography (MSCT) pointed to the tumor formation in the pulmonary parenchyma in the projection of the left upper pulmonary lobe with signs of pleural infiltration, intercostal muscles, and V rib destruction. Laboratory examination indicated the presence of Bence-Jones proteinuria in the urine sample in addition to anemia syndrome and azotemia with hyperuricemia. After bronchoscopy and needle biopsy, diffuse infiltration of mature plasma cells was demonstrated in the cytological and histopathological findings of the lungs. The histopathological finding of bone marrow biopsy indicated multiple myeloma of Lambda type with infiltration of plasma cells – about 70%. The hematologist determined a diagnosis of multiple myeloma BJ lambda III BCS, with extramedullary lung infiltration and acute kidney failure. Further treatment was continued according to the hematological protocol while performing intermittent hemodialysis. Conclusion. Sometimes, extremely rarely, and in completely asymptomatic patients with massive pulmonary infiltration observed initially, the differential diagnosis may also represent an extramedullary presentation of multiple myeloma, which should be considered.

Background/Aim. Hyperbaric oxygen therapy (HBOT) is a method which increases oxygen solubility in plasma up to 20 times. This effect is very important in the treatment of circulatory disorders, which reduces oxygenation and leads to increased production of inflammatory mediators and free oxygen radicals. The aim of this study was to examine the impact of HBOT on the oxidative stress parameters in the patients with systemic lupus erythematosus (SLE). Methods. This prospective study included 18 females with SLE [American College of Rheumatology (ACR) criteria], average age 52.2 ± 8.82 years, treated with HBOT for 60 min/day, with average partial oxygen pressure of 2.2 atmospheres absolute (ATA), during 10 days, in combination with appropriate medication therapy for SLE. The following parameters were determined in the serum: C-reactive protein (CRP), hemoglobin, creatinine, albumin, complement 3 (C3), antinuclear antibodies (ANA), glomerular filtration rate (GFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. In the urine, parameters of oxidative stress were spectrofotometrically determined: levels of superoxide anion radical (O2 •–), hydrogen peroxide (H2O2), nitrites (NO2-) and concentration of thiobarbituric acid reactive substances (TBARS). In hemolysate, the parameters of antioxidant protection: superoxide dismutase (SOD), catalase (CAT) and reduced gluthatione (GSH), were measured. The samples for the analysis were collected three times: before HBOT (initial values), after 10 days of HBOT and 1 month after beginning the treatment in relation to the initial value. Results. We noticed a statistically significant (p < 0.05) decrease in a level of O2 •–, both after 10 days and after 1 month of HBOT (8.26 ± 13.62; 8.39 ± 4.94; 11.92 ± 6.86 nmol/mL, respectively). Values of other parameters of oxidative stress such as NO2-, TBARS and H2O2- showed no significant difference during the monitored period. Regarding the parameters of antioxidant the protection, we revealed slightly higher value of GSH after treatment (initial value: 66.34 ± 16.31; after 10 days of HBOT 79.43 ± 36.77; after 1 month of HBOT69.72 ± 22.32 μmol/mL red blood cells) which was held after a month, but it was not statistically significant. Activity of SOD and CAT, before and after HBOT, did not change significantly. Conclusion. Our results suggested the potential beneficial effects of HBOT on redox status in the patients with SLE by decreasing the levels of O2•–.

Introduction. Polycystic kidney disease is a hereditary kidney disease characterized by the occurrence of cysts (fluid-filled enlargements) in cortex or medula of the kidney, and is inherited in an autosomal dominant or autosomal recessive manner. In addition to multiple cysts in kidneys, there may be many extra-renal manifestations (cysts of the liver, pancreas, lungs, heart, etc.), among which the most serious one is intracranial aneurysms. Case report. A 57-year-old female patient with polycystic kidney disease and stage IV renal failure was hospitalized at our clinic due to decreased renal function, the development of urinary tract infections, headaches and unregulated blood pressure despite the usual treatment. This patient also had a number of associated diseases: obesity, diabetes mellitus (the insulindependent type), hypothyroidism, and depression syndrome. After better regulation of blood pressure, resolved urinary tract infections and improved renal function, there were still persistent headaches (resulting in the excessive use of analgesics). With adequate preparation, multislice computed tomography (MSCT) angiography of blood vessels of the head was performed. As a result, we diagnosed the saccular intracranial aneurysm (IA) with anterior localization. Regarding the symptoms, age and comorbidity, digital subtraction angiography (DSA) was performed, and showed saccular IA (5.2 mm × 4 mm), with wide neck affecting both middle cerebral artery branches (MCA). During the procedure the stent was placed, which filled the aneurysm with spirals, cutting it off from circulation. After the successful procedure and without further complications, the patient no longer had headaches and blood pressure was maintained within the required limits with stable parameters of chronic renal failure. Conclusion. The case of the patient with polycystic kidney disease, stage IV chronic renal failure, with a number of comorbidities (headache, obesity, hypertension, diabetes mellitus, hypothyroidism) and diagnosed with symptomatic intracranial aneurysm was successfully solved with a multidisciplinary approach, emphasizing the importance of teamwork in daily practice.

Introduction. Oxygen is an essential element of life in aerobic organisms. However, if not controlled, inhalation of oxygen under increased pressure in conditions of hyperbaric oxygen therapy can lead to serious damage and even death. Case report. We presented a 20-year-old male who had begun exhibiting symptoms of epilepsy during diving test in a hyperbaric chamber while inhaling 100% oxygen. He was immediately taken off oxygen mask and started breathing air and began rapid decompression. He lost consciousness, began foaming at the mouth, and had a series of tonic spasms. The patient was previously completely healthy and not on any medications. He was admitted for emergency treatment in our hospital, where he was treated for epilepsy. On admission, he complained of muscle and joint pain, and had erythematous changes on the forehead, neck and chest. All these changes occurred after leaving the hyperbaric chamber. Bloodwork revealed leukocytosis with neutrophil (Leukocytosis 16.0 ´ 109/L (reference values 4.00-11.00 ´ 109/L), Neutrophili 13 ´ 109/L (reference values 1.9-8.0 ´ 109/L), with elevated enzymes aspartate aminotransferase (AST) 56 U/L (reference values 0-37 U/L), alanin aminotransferase (ALT) 59 U /L, (reference values 25-65 U/L), creatine kinase (CK) 649 U/L, (reference values 32-300 U /L), lactate dehydrogenase (LDH) 398 U/L (reference values 85- 227 U/L). Because of pain and his condition we began treatment in a hyperbaric chamber at a pressure of 2.0 ATA for 70 minutes, resulting in a reduction of symptoms and objective recovery of the patient. Within 24 h, repeated laboratory tests showed a reduction of leukocytosis (13 ´ 109/L and neutrophils (7.81 ´ 109/L), and the gradual reduction of the enzymes AST (47 U/L), ALT (50 U/L, CK (409 U/L), LDH (325 U/L). Since head CT and EEG were normal, epilepsy diagnosis was ruled out. This fact, along with medical tests, facilitated the differential diagnosis and confirmed that this was a case of neurotoxic effects of oxygen while the patient was in a hyperbaric chamber, not epileptic seizures. Conclusion. This case report suggests that in patients with symptoms of epileptic seizures while undergoing treatment in a hyperbaric chamber, it is always important to think of neurotoxic effects of pure oxygen which occurs at higher pressures and with a longer inhalation of 100% oxygen. In these patients, reexposure to hyperbaric conditions leads to recovery. This effect is important in daily inhalation of 100% oxygen under hyperbaric conditions which is why the use of pure oxygen is controlled and diving is allowed in shallow depths and for a limited time.

Introduction. Immunoglobulin D (IgD) myeloma is a rare disease, about 2% of all myelomas, even rarer when accompanied with another multiple myeloma in biclonal gammopathy. We presented a case of biclonal gammopathy - associated manifestation of IgD myeloma and light chain disease in a patient who initially had renal failure. Case report. 37-year-old male approximately one month before hospitalization began to feel malaise and fatigue along with decreased urination. Laboratory analysis revealed azotemia. A dialysis catheter was placed and hemodialysis started. The patient was then admitted to our hospital for further tests and during admission, objective examination revealed pronounced paleness with hepatosplenomegaly and hypertension (170/95 mmHg). Laboratory analysis showed erythrocyte sedimentation rate 122 mm/h, expressed anemic syndrome (Hb 71 g/L) and renal failure dialysis rank: creatinine 1,408 μmol/L, urea31.7 mmol/L. There was two M components in serum protein electrophoresis: IgD lambda and free light chain lambda. Proteinuria was nephrotic rank (5.4 g/24 h), whose electrophoresis revealed 2 M components - massive in α 2 fraction of 71%; 7% in the discrete β fraction, beta 2M /serum 110 mg/L, in urine 1.8 mg/L - extremely high; IgL kappa / lambda index 1 : 13 (reference value ratio 2 : 1). The findings pointed to double myeloma disease: IgD myeloma and Bence Jones lambda myeloma. Bone biopsy confirmed IgD myeloma lambda 100% infiltration medulla predominantly plasmablasts. The treatment continued with hemodialysis 3 times per week with chemotherapy protocol bortezomib, doxorubicin, dexamethasone. After 4 cycles of chemotherapy, there was a decrease of IgD, λ - light chains, reduction in proteinuria (1.03 g/24 h), so hemodialysis was reduced to once per week. Six months after treatment initiation the patient underwent autologous bone marrow transplantation. In a 2-year follow-up period double myeloma disease showed complete remission. Conclusion. The presented rare form of double myeloma disease with initial renal insufficiency underscores the importance of careful observation and team-work that can alter the course of this serious disease.

Background. Systemic lupus erithematodes (SLE) is chronic, often febrile, multisystemic disease unknown origin and relapsing course which affects connective tissue of the skin, joints, kidney and serous membranes. Gastrointestinal manifestations are rarely the first sign of systemic lupus erythematosus. Case report. We presented a female patient, 35 years old, whose first symptoms of SLE were paralitic ileus (chronic intestinal pseudo-obstruction) and polyserositis (pleural effusion and ascites). Except for high parameters of inflammation, leucopenia and thrombocytopenia, all immunological and laboratory tests for SLE were negative in the onset of the disease. During next six months the patient had clinical signs of paralitic ileus several times and was twice operated with progressive malabsorptive syndrome. The full picture of SLE was manifested seven months later associated with lupus nephritis. Treatment with cyclophosphamide, corticosteroids and total parenteral nutrition (30 days) induced stable remission of the disease. Conclusion. The SLE can be initially manifested with gastroenterological symptoms without any other clinical and immunologic parameters of the disease. If in patients with SLE and gastrointestinal tract involvement malabsorption syndrom is developed, a treatment success depends on both immunosupressive therapy and total parenteral nutrition.

Background. Multiple myeloma is a plasmaproliferative disease characterized by the uncontrolled proliferation of a pathogenic plasma cell clone engaged in the production of monoclonal immunoglobulin. This condition affects the bone marrow, but it can be manifested in any other organ or tissue. The urinary bladder involvement is extremely rare. Case report. We reported a 70-year-old male with the history of multiple myeloma, receiving chemotherapy containing melphalan and prednisone (MP). Two years after the treatment, there was a renal failure associated with oligoanuria, hematuria and bilateral hydronephrosis. The urine cytology tests revealed the atypical cells, so was suspected obstructive uropathy to be caused by urothelium cancer. However, only upon the cystoscopy and biopsy performed on the urinary bladder mass, plasmacytoid infiltration diagnosis was confirmed. This extremely rare variant was presented throughout the illness period and proved to be resistant to the administered chemotherapy. Conclusion. When renal failure associated with hematuria and bilateral hydronephrosis is presented in a patient with multiple myeloma, this unusual and rare extramedular localization should be also considered.

Background. Systemic lupus erithematodes (SLE) is chronic, often febrile, multisystemic disease unknown origin and relapsing course which affects connective tissue of the skin, joints, kidney and serous membranes. Gastrointestinal manifestations are rarely the first sign of systemic lupus erythematosus. Case report. We presented a female patient, 35 years old, whose first symptoms of SLE were paralitic ileus (chronic intestinal pseudo-obstruction) and polyserositis (pleural effusion and ascites). Except for high parameters of inflammation, leucopenia and thrombocytopenia, all immunological and laboratory tests for SLE were negative in the onset of the disease. During next six months the patient had clinical signs of paralitic ileus several times and was twice operated with progressive malabsorptive syndrome. The full picture of SLE was manifested seven months later associated with lupus nephritis. Treatment with cyclophosphamide, corticosteroids and total parenteral nutrition (30 days) induced stable remission of the disease. Conclusion. The SLE can be initially manifested with gastroenterological symptoms without any other clinical and immunologic parameters of the disease. If in patients with SLE and gastrointestinal tract involvement malabsorption syndrom is developed, a treatment success depends on both immunosupressive therapy and total parenteral nutrition. [ABSTRACT FROM AUTHOR]

Background. Multiple myeloma is a plasmaproliferative disease characterized by the uncontrolled proliferation of a pathogenic plasma cell clone engaged in the production of monoclonal immunoglobulin. This condition affects the bone marrow, but it can be manifested in any other organ or tissue. The urinary bladder involvement is extremely rare. Case report. We reported a 70-year-old male with the history of multiple myeloma, receiving chemotherapy containing melphalan and prednisone (MP). Two years after the treatment, there was a renal failure associated with oligoanuria, hematuria and bilateral hydronephrosis. The urine cytology tests revealed the atypical cells, so was suspected obstructive uropathy to be caused by urothelium cancer. However, only upon the cystoscopy and biopsy performed on the urinary bladder mass, plasmacytoid infiltration diagnosis was confirmed. This extremely rare variant was presented throughout the illness period and proved to be resistant to the administered chemotherapy. Conclusion. When renal failure associated with hematuria and bilateral hydronephrosis is presented in a patient with multiple myeloma, this unusual and rare extramedular localization should be also considered. [ABSTRACT FROM AUTHOR]

Diagnostics in patients with the acute coronary syndromes (ACS) is becoming even more complex with the increase of number of available options. In addition, the number of treatment options accessible to patients with ACS keeps on growing rapidly. Physicians must now choose from a wide variety of antiplatelet and antithrombotic therapies and also determine what patients would benefit from an invasive management approach. These decisions have become more difficult with the introduction of recent drugs such as low molecular weight heparins, direct-acting antithrombins, thienopyridines, and glycoprotein IIb/IIIa inhibitors. Simple tools, which can often be applied at the patient's bedside, can help physicians to choose the intensity of antiplatelet and antithrombotic therapy, and decide whether to use invasive coronary procedures. Cardiac biomarkers have proven to be particularly effective for these purposes. Moreover, cardiac biomarkers play an important role in risk stratification in ACS, and the results of cardiac biomarker tests can be used to help us choose between alternative therapies. In addition to biomarkers of myocyte necrosis, markers of neurohormonal activation, such as B-type natriuretic peptide (BNP), provide important prognostic information in ACS. However, the increase of number of elevated biomarkers, although simple to implement in practice, does not allow for full employment of value of information provided by these biomarkers. In the future, multimarker strategies that incorporate panels of cardiac biomarkers are likely to be used for risk stratification and for pathophysiology guided treatment in patients with ACS.