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Kidney transplant recipient killer cell immunoglobulin-like receptors (KIR) genotype and HLA-C status of their donors have been separately associated with BK virus-associated nephropathy (BKVAN) and BK virus infection. Our aim was to determine whether different combinations of recipients KIR genes and donor HLA-C ligands influence the risk of BKVAN. Retrospective case-control study included 23 recipients with BKVAN and 46 recipients with persistently negative BK virus. Donor HLA-C*07 positivity was associated with lower odds for BKVAN, recipients bearing KIR haplotype AA or lacking any activating KIR genes were more frequent in BKVAN while recipient/donor combination HLA-C*07 negative/KIR AA positive was significantly associated with BKVAN. Our study complements and confirms results from several previously published studies, suggesting potential clinical usefulness.

Various environmental and endogenous factors (genetic predisposition) influence development of arterial hypertension (AH) and determine clinical course. The role of individual genes and their interactions with external factors is not yet elucidated. The aim of this study is to assess the frequency of the AGT, ACE, AGTR1, ADRB1, UMOD and ADIPOQ genes polymorphisms (SNP) in individuals with prehypertension (PHT) and with optimal blood pressure (BP).

doi: 10.1097/01.hjh.0000571716.53390.4b

Adipokines, cytokines derived from adipose tissue, not only herald and confirm fat tissue as the largest endocrine organ but are also associated with a number of pathological states including obesity, insulin resistance and diabetes. There is a growing body of research on the role of adipokines in blood pressure regulation and development of hypertension. One of these adipokines, adiponectin, is especially interesting, given that it has numerous beneficial effects which include increasing insulin sensitivity and antiatherogenic and anti-inflammatory effects. In recent years, there has been a number of studies examining its possibly protective role in hypertension. In this narrative review we summarize the evidence on the association of adiponectin and polymorphism of the gene which encodes it with blood pressure levels and risk of hypertension, which might provide ideas for future research of adiponectin as a biomarker and potential therapeutic target in this condition.

Objective:Our aim was to determine trends in salt and potassium intake in general rural population during the 7.5 years of follow-up and to analyze differences in results obtained using various equations.Design and method:Out of 1582 subjects (random rural sample) enrolled in ENAH study conducted in

Objective:Our aim was to analyze association of sodium and potassium intake with new onset chronic kidney disease (CKD) in general population during the 7.5 years of follow up.Design and method:Out of 1582 subjects (random rural sample) enrolled in ENAH study conducted in 2008–2010, 739 were invited

Background:A number of blood count parameters are associated with inflammatory and autoimmune diseases. There is discordant evidence whether neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV) might reflect inflammatory response and have prognostic value in SLE patients. However, the studies examining the potential role of these markers in LN are missing.Objectives:To examine NLR, PLR and MPV at the time of biopsy in patients with LN and evaluate their association with prognosis.Methods:In this retrospective study we analyzed the demographic, histologic, laboratory and clinical characteristics of patients with biopsy-proven LN diagnosed between 2011 and 2020. All patients met the 1997 revised American College of Rheumatology classification criteria for SLE. Complete remission was defined as proteinuria Results:We have included 55 patients (80% women) with biopsy-proven LN (age at biopsy 38±13 years). On renal histology, one patient was class I LN, two patients were class II, 7 were class III, 5 were class III+V, 23 were class IV, two were class IV+V, 11 class VI and 4 had other features. Median baseline NLR was 3.64 (IQR: 1.85, 6.93), PLR was 167 (IQR: 116, 300) and MPV was 10.0 (IQR: 9.2, 10.8). There were no differences in any of the three parameters between different classess of LN (all p>0.05). Eighteen patients achieved complete remission (CR), 16 partial remission and 21 did not achieve remission. None progressed to ESRD and two patients died, both from sepsis. There no differences in NLR, PLR and MPV at the time of biopsy between group which achieved CR/PR vs. no remission (all p>0.05; Figure 1). We constructed a thorough multivariate regression model which showed that neither NLR, PLR or MPV are predictors of renal remission in LN.Conclusion:NLR, PLR and MPV are not useful prognostic markers in predicting renal remission in LN.References:[1]Hartmann LT, et al. Open Rheumatol J. 2018 Aug 31;12:129-138.[2]Chen SY, et al. J Res Med Sci. 2018 May 30;23:48.[3]Zhao CN, et al. Rheumatol Int. 2018 Sep;38(9):1635-1641.Disclosure of Interests:None declared

Background:Optimal prognostic predictors in lupus nephritis (LN) are still not clearly defined. Studies have recently shown that albumin-to-globulin ratio (A/G) is not only a good predictor of outcomes in malignancy, infection and renal disease, but is also a potential marker of increased immunoglobulin synthesis and LN activity and might be useful as a predictor of the development of LN in SLE patients. Studies on the role of A/G in predicting outcomes in LN are, however, lacking.Objectives:To assess a potential prognostic value of A/G at renal biopsy in predicting outcomes in LN.Methods:In this retrospective study we analyzed the demographic, histologic, laboratory and clinical characteristics of patients with biopsy-proven LN diagnosed between 2011 and 2020. All patients met the 1997 revised American College of Rheumatology classification criteria for SLE. Complete remission was defined as proteinuria Results:We have included 55 patients (80% women) with biopsy-proven LN (age at biopsy 38±13 years). On renal histology, one patient was class I LN, two patients were class II, 7 were class III, 5 were class III+V, 23 were class IV, two were class IV+V, 11 class VI and 4 had other features. Median eGFR and proteinuria at biopsy were 69 (IQR: 44, 100) mL/min/1.73 m2 and 3.5 (2.3, 5.6) g/day, respectively. Baseline mean A/G was 1.12±0.29 and did not differ between LN classes (p=0.91). At one-year follow-up eGFR increased non-significantly (69 vs. 82 mL/min/1.73 m2, p=0.13) and proteinuria decreased (3.5 vs. 0.6 g/day, p0.05; Figure 1) and was not a significant predictor of remission in a multivariate regression model (OR 5.9, 95% CI 0.6, 63.2).Conclusion:While being a potential marker for transition of SLE to LN, A/G was not showed to be a predictor of renal remission in LN.References:[1]Liu XR, et al. Lupus. 2021 Jan 6:961203320981139.[2]Kwon OC, et al. Semin Arthritis Rheum. 2018 Dec;48(3):462-466ckDisclosure of Interests:None declared

Balkan endemic nephropathy (BEN), an environmental form of aristolochic acid nephropathy is characterized with later onset and milder forms of hypertension (HT). Thus, we hypothesized that arterial stiffness progresses slower in BEN patients resulting in lower CV mortality. A total of 186 hemodialysed (HD) patients (90 BEN, 96 non-BEN; 67.3 + 13.0 years) were enrolled and followed-up for 25 months. Brachial blood pressure (BP) and pulse wave velocity (PWV) were determined before mid-week dialysis. BEN patients were older (72.1 ± 37.1 vs. 62.8 ± 15.1; p < 0.001), had shorter duration of HT prior commencement of HD than non-BEN patients (36 vs. 84 months; p < 0.001). There were no differences in BP, but BEN patients were treated with less antihypertensive drugs (p < 0.01). BEN patients had lower PWV values at baseline and at the end of follow-up period despite being chronologically older (p < 0.001). Baseline PWV > 10 m/s was associated with higher risk for CV mortality (aHR 1.8 [1.4, 2.4]). In multivariate analyses BEN was predictor of lower PWV. During the follow-up period significantly less CV deaths were observed in BEN vs. on-BEN patients (12 vs. 31; p = 0.001). CV mortality adjusted for other risk factors was significantly lower in BEN group (aHR 0.2 [0.1, 0.5]). Overall BEN patients had longer mean survival time on HD (22.3 vs. 18.2 months; p < 0.001). Observed slower vascular aging (i.e., lower PWV) in BEN patients compared to other ESRD patients is related to the later onset of HT and milder stages of HT during predialytic clinical course and better control of BP and phosphate during HD.

To summarize and define the most appropriate diagnostic methods and therapeutic options for ruptured renal artery aneurysms in pregnancy based on rarely published data.MethodsLiterature searches of English-, German-, Spanish-, and Italian-language articles were performed in PubMed (1946-2018), PubMed Central (1900-2018) and Google Scholar. The search terms included renal artery aneurysm, renal artery rupture, pregnancy, puerperium, nierenarterienaneurysma, schwangerschaft, wochenbett, aneurisma de la arteria renal, el embarazo, puerperio, aneurisma dell'arteria renale and gravidanza. Additional studies were identified by reviewing reference lists of retrieved studies.ResultsFifty-three cases were collected. The average maternal age was 316years ; 71.4% were multiparous and significantly older than primiparas. The majority presented in the third trimester (62.3%), followed by second (20.7%) and the first (5.7%), while 11.3% presented postpartum. All postpartum patients presented during the first week postpartum and 50% during the first 24h postpartum. Parity was not associated with the trimester of presentation. The left renal artery was affected slightly more frequently (58.5% vs. 41.5%). There were no differences in the affected side according to trimester of presentation, including postpartum. 25 out of 53 cases underwent ipsilateral nephrectomy (47.1%) and 18 underwent aneurysm repair or coil embolization (34.0%). There was no difference in maternal (25.8%) vs. 4 (18.1%) and fetal mortality according to the side of rupture. There were no differences in the distribution of maternal or fetal mortality frequency according to the trimester of presentation.Conclusions p id=Par4 The clinical presentation is easily confused with more common conditions and time to diagnosis is often delayed. Diagnostic delay is associated with high maternal and fetal mortality. Ruptured renal artery aneurysm should be included in the differential diagnosis for pregnant or peripartum patients presenting with acute and severe flank pain, especially if followed by a drop in blood pressure. Early diagnosis and immediate intervention are important for achieving better maternal and fetal outcomes. There are several methods of managing asymptomatic or ruptured renal artery aneurysm during pregnancy although no established guidelines exist.

Laparoscopic appendectomy is the method of choice of many professional societies owing to its many advantages. The question arises whether surgeons urge more easily to laparoscopic exploration due to its less invasiveness, faster recovery and adequate exploration of the entire abdominal cavity than to observation in unequivocal cases. This retrospective analysis (2009-2016) included 1899 patients undergoing laparoscopic (lap) or gridiron intra-abdominal approach treated at Zagreb University Hospital Centre. The analysis included total negative appendectomy, negative-negative appendectomy (normal appendix and no other pathology found), and negative-positive appendectomy (normal appendix but another pathology found) in children (≤16 years) and adults. There was no statistically significant difference in the rates of negative appendectomy (children) – lap vs. open (p=0.24); negative appendectomy (adults) – lap vs. open (p=0.15); negative-negative appendectomy (children) – lap vs. open (p=0.36); negative-negative appendectomy (adults) – lap vs. open (p=0.21); negative-positive appendectomy (children) – lap vs. open (p=0.53); negative-positive appendectomy (adults) – lap vs. open (p=0.56); and laparoscopy group negative appendectomy in children vs. adults (p=0.56). There was a statistically significantly higher perforation rate with the open approach in total (p, Laparoskopska apendektomija metoda je izbora većine stručnih društava zbog dokazanih mnogobrojnih prednosti. Pitanje je da li se u slučajevima nejasne dijagnoze kirurzi ranije odlučuju na laparoskopsku eksploraciju u odnosu na opservaciju zbog manje invazivnosti i bržeg oporavka i eksploracije cijelog abdomena. Na KBC Zagreb retrospektivno je analizirano 1899 bolesnika u razdoblju od 2009. do 2016. godine kod kojih su operacije započete izmjeničnim rezom ili laparoskopskim pristupom (lap) kod sumnje na akutni appendicitis kod djece i odraslih (stariji od 16 godina). Analizirane su: 1) ukupno negativne apendektomije, 2) negativno-negativne apendektomije (uredan apendiks i nije nađena druga patologija) i 3) negativno-pozitivne apendektomije (uredan apendiks, ali je nađena druga patologija). Nije bilo statistički značajne razlike u stopama negativne apendektomije (djeca) – lap prema izmjeničnom rezu (p=0,24); negativne apendektomije (odrasli) – lap prema izmjeničnom rezu (p=0,15); negativno-negativne apendektomije (djeca) – lap prema izmjeničnom rezu (p=0,36); negativno-negativne apendektomije (odrasli) – lap prema izmjeničnom rezu (p=0,21); negativno-pozitivne apendektomije (djeca) – lap prema izmjeničnom rezu (p=0,53); negativno-pozitivne apendektomije (odrasli) – lap prema izmjeničnom rezu (p=0,56); negativne laparoskopske apendektomije – djeca prema odraslima (p=0,56). Utvrđena je statistički značajno viša stopa perforacija izmjeničnim rezom ukupno (p

Arterial stiffness is an independent cardiovascular risk factor. Aging, high blood pressure and increased renin-angiotensin system activity contribute to increased arterial stiffness in patients with atherosclerotic renovascular hypertension (aRVH). A literature search failed to identify any study related to this topic. Therefore, our aim was to determine the arterial stiffness in patients with aRVH and analyze whether stenting in addition to multifactorial drug therapy has beneficial effects on markers of stiffness and the clinical course. In this 6-month longitudinal study, 37 patients with refractory hypertension and unilateral aRVH were enrolled. After stenting, all patients received multifactorial dug therapy including 80 mg of telmisartan. Arterial stiffness indices were determined using Arteriograph. The control group consisted of 44 patients with essential hypertension. There were no differences in brachial blood pressure values between the two groups (P > 0.05). At baseline, adjusted pulse wave velocity (PWV) was higher in aRVH patients than that of essential hypertensive patients (12.8 ± 0.4 vs. 11.6 ± 0.3 m/s ; P = 0.029). In the aRVH group, at the end of the follow-up, a significant decrease in the aortic augmentation index (37.7 ± 9.9 vs. 33.7 ± 11.4 ; P = 0.02) without changes in PWV was observed (P > 0.05). This study is the first to show that arterial stiffness is higher in patients with refractory aRVH than in those with essential hypertension. Multifactorial therapy based on stenting and intensive medical treatment reduced central blood pressure and augmentation index. Failure to obtain PWV reduction is likely a consequence of the present irreversible structural vessel changes. Longer follow-up might enable us to resolve whether arterial stiffness indices have better predictive ability in patients with aRVH than brachial blood pressure.

Objective:Our aim was to analyze characteristics of subjects with new onset hypertension (NOHT) and impact of sodium and potassium intake on development of NOHT.Design and method:Out of 1582 subjects (random rural sample) enrolled in ENAH study conducted in 2008–2010, 739 were invited for the second

Objective:The aim of this study was to assess the association of chronic kidney disease (CKD) with all-cause and cardiovascular (CV) mortality in patients surviving their first ischemic stroke and enrolled in the Croatian part of the ESH Stroke Survey.Design and method:The cohort consisted of 292 co

Background/Aims: Delayed graft function (DGF) is associated with adverse outcomes after renal transplantation. Bone morphogenetic protein-2 (BMP-2) is involved in both endothelial function and immunological events. We compared expression of BMP-2 in epigastric artery of renal transplant recipients with immediate graft function (IGF) and DGF. Methods: 79 patients were included in this prospective study. Patients were divided in IGF group (64 patients) and DGF group (15 patients). BMP-2 expression in intima media (BMP2m) and endothelium (BMP2e) of epigastric artery was assessed by immunohistochemistry. Results: Lower intensity of BMP2e staining was recorded in DGF compared to IGF. In DGF patients, 93% had no expression of BMP2e and 7% had 1st grade expression, compared to 45% and 41% in IGF group, respectively (P=0.001) (Pst grade expression). Patients who had BMP2e staining positive had lower odds for DGF (OR 0.059 [0.007, 0.477]) and this remained significant even after adjustment for donor and recipient variables, cold ischemia time, and immunological matching (OR 0.038 [0.003, 0.492]). Conclusions: Our results demonstrate that BMP-2 expression in endothelial cells of epigastric arteries may predict development of DGF.

A reduction in population salt intake is one of the most cost-effective measures to prevent cardiovascular disease [1, 2]. Two recent articles by O’Donnell et al. in the New England Journal of Medicine attempt to cast doubt on this important public health policy by claiming that a salt intake below 7.5 g/day was not associated with lower blood pressure and related to a higher cardiovascular events or total mortality based on the Prospective Urban Rural Epidemiology study [3, 4]. However, this claim is invalid because of methodological problems as well as errors in using a mathematical formula to estimate daily salt intake from spot urinary sodium.

Cardiovascular (CV) complications are the most important cause of morbidity and mortality in patients with advanced chronic kidney disease (CKD). Arterial stiffness (AS) has been recognized as a strong and independent predictor for CV events in CKD. Our aim was to assess indices of AS in a group of Endemic (Balkan) Nephropathy (EN) patients undergoing haemodialysis (HD). Hypertenison was not considered an importnat feauture in earlier stages of the disease, and therefore we presumed that those patients would have lower AS. Interestingly, we found AS to be even higher in this group of EN patients. This result should be confirmed in a larger cohort of EN patients.

Endemic (Balkan) nephropathy (EN) is a chronic tubulointerstitial nephropathy frequently associated with upper urothelial cancer exclusively affecting farming villagers [1–3]. Based on our results, EN is considered to be an environmental form of aristolochic acid nephropathy (AAN) [1–3]. AAN was first reported in 1993 in Belgium and subsequently more AAN cases were reported worldwide as AA has been an integral part of traditional herbal medicines [4]. The extent of this problem was recently documented in Taiwan where precise data on prescriptions of herbal products containing AA is available [5]. Aristolochia spp. has been used for more than 2,000 years in the practice of traditional medicine and European physicians were familiar with the use of this plant as well. After its intrinsic toxicity became known, importing Aristolochia herbs was banned in many countries, including Croatia. Nevertheless, products containing AA remain a part of traditional medicine and are sold in many countries that do not have strict control protocols. Recently we reported that AA DNA adducts were present in 95 % of patients with EN who underwent surgery for upper urothelial cancers [2] and affirmed the idea that bread contaminated with AA might be the cause of EN [6, 7]. However, the causative relationship between AA and EN again raised the question whether bread intake is the only route of ingestion or whether AA was ingested also in EN as a part of folkloric medicine. Gluhovschi et al. [8] reported that although therapeutic remedies based on AA products are used in the EN affected area in Romania, no relationship between these remedies and the development of EN or of tumors was observed. However, they used HPLC for detection of AA in plasma, which is less sensitive than the mass spectrometry we recently used in tissue samples [1, 2]. In addition, when re-analyzing their data, it does appear that AA was used more frequently in the endemic area. In our opinion, this leaves the question whether herbal tea may play a role in EN still unanswered. In our preliminary study we failed to find any evidence in the group of 1,041 Croatian farmers that herbal tea or traditional medicine use is related to EN [9]. The observed differences between

Objective:Data on prevalence of metabolic syndrome (MS) in rural regions are still inconclusive and several reports showed it to be higher in urban than in rural areas. The aim of this study was to determine the prevalence of MS in a rural, continental Croatian part comparing 3 most widely used defi

Objective:Chronic kidney disease(CKD) is established CV risk factor, and already early renal impairment(RI) increases risk for hypertension(HT) and loss of renal function. It was reported that blood pressure (BP) and metabolic derangements are associated with glomerular hyperfiltration(GHF), and GHF