Dijana Jovanović

Univerzitetski Klinički Centar Srbije

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Milan Stošović

Univerzitetski Klinički Centar Srbije

Ljubica Djukanović

University of Belgrade

Radomir Naumović

Kliničko Bolnički Centar Zvezdara

Sanja Simić‐Ogrizović

University of Banja Luka

J Dimitrijević

University of Sarajevo

M Radović

University of Belgrade

VŽ

Vladan Živaljević

University of Belgrade

Zorana Kovačević

University of Novi Sad

Marija Stanojević

Institut za Reumatologiju

Nevena Kalezić

Univerzitetski Klinički Centar Srbije

Cooperative Institutions

University of Belgrade

102

Univerzitetski Klinički Centar Srbije

Centar za Promociju Nauke

Military Medical Academy

Institut za Reumatologiju

University of Belgrade – Faculty of Medicine

University of Nis

University of Novi Sad

Center for Health, Exercise and Sport Sciences

Clinical Centre of Kragujevac

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[Amyloid tumor in a patient on a regular hemodialysis program].

PubMed (1999)

Žaklina Kovačević Skatarić Dijana Jovanović Predrag Djuran Radoslav Romanović

Amyloidosis is frequent complication in the patients subjected to hemodialysis, and is most frequently manifested in carpal tunnel syndrome, scapulohumeral periarthritis, osseous cysts and exceptionally as solitary tumor. A patient in presented, aged 72 years, who had undergone chronic dialysis for 10 years, in the last 4 years with symptoms and signs of amyloidosis, such as scapulohumeral periarthritis and erosive arthritis of the knee with recurrent effusions. A year ago he had noticed a tumor in the left popliteal cavity that had been progressively increasing and had limited the movements of the knee. After the extirpation, the diagnosis of amyloid tumor was confirmed by histopathologic analysis.

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Serum amyloid a in clinical practice

Srpski arhiv za celokupno lekarstvo (2004)

Dijana Jovanović

Serum amyloid A (SAA) is an acute phase first class protein discovered a quarter of the century ago. Its concentration depends on clinical findings of the patient, illness activity and the therapy applied. SAA increases moderately to markedly (100-1000 mg/l) in bacterial and fungal infections, invasive malignant diseases, tissue injuries in the acute myocardial infarction and autoimmune diseases such as rheumatoid arthritis and vasculitis. Mild elevation (10-100 mg/l) is often seen in viral infections, systemic lupus erythematosus and localized inflammation or tissue injuries in cystitis and cerebral infarction. SAA as sensitive, non-invasive parameter is used in organ transplantation where early and correct diagnosis is needed as well as where prompt therapy is required. Besides acute kidney allograft rejection, SAA is used in the diagnosis of rejection after liver transplantation, simultaneous pancreas and kidney transplantation and also in bone marrow transplantation (acute ?graft vs. host disease"). Simultaneous determination of C-reactive protein (CRP) and SAA may point to acute kidney allograft rejection. Standard immunosuppressive therapy with cyclosporine A and prednisolone significantly suppresses the acute phase CRP reaction both in operation itself and acute rejection, but not in infection. On the other hand, SAA rejection in operation, acute allograft rejection and infection is present in spite of cyclosporine A and steroids therapy. Different reaction of SAA and CRP in transplant patients to cyclosporine A therapy helps in differentiation between the infection and rejection. Although CRP and SAA are sensitive and acute phase reactants, their serum concentrations cannot be valued as prognostic and diagnostic criteria without creatinine serum concentration and clinical findings. In addition, they offer important information for clinical diagnosis as well as the kind of therapy.

Prednisolone

10.2298/sarh0408267j

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[Ten year experience in kidney transplantation in patients undergoing peritoneal dialysis (1996-2006)].

Rabrenović Zorana Kovačević Ljiljana Ignjatović Dijana Jovanović D Maksić

INTRODUCTION Kidney transplantation is nowadays considered the most sophisticated method of treatment of chronic terminal renal insufficiency. The advancement in surgical technique and the use of new immunosuppressive medications provide a longer survival period of both the patient and the graft. MATERIAL AND METHODS The objective of this paper is a retrospective presentation of the ten-year monitoring of kidney transplantation in patients undergoing peritoneal dialysis performed at the Military Medical Academy. RESULTS AND DISCUSSION During that period, 32 patients underwent the transplantation (18 men and 14 women of the average age of 32.48+/-2.1). The total of 34 transplantations were performed, out of which 2 were retransplantations. Patient monitoring period was 7-92 months. The immunosuppressive therapy was quadrupled in 17 (50%) patients and tripled in 17 (50%) of them. The loss of the graft in the early period following the transplantation occurred in 5 (15.6%) patients due to trombosis a. renalis, out of whom two were retransplantation cases. Registered surgical vascular complications included 5 (15.6%) bleeding, 4 (12.5%) hematomes and 6 (18.7%) lymfocells. Delayed graft function occurred in 5 (14.7%) and acute rejection in 7 (20.5%) patients while the disease reccured in 2 patients. As for the complications, rejection without the loss of graft was registered in 4 (12.5%) pts, ureter stenosis in 3 (8.82%) pts, bacterial infections in 4 (12.5%) pts and reactivation of CMV infections in 9 (26.4%) pts. Our patients are observed for the maintenance of stable medium volume of serum creatinine (which is 123.6 +/-10.2 umol/l in the early stage and 133.24+/-11.1 umol/l in the end of the monitoring period as well as the medium volume of clearence creatinine (which is 64.80+/-3.5 ml/min at the early phase of monitoring period and 69.47+/-3.3 ml/min. in the end). CONCLUSION Our group of renal transplantation patients, undergoing peritoneal dialysis was with stable renal function registered through the monitoring period.

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Correlation of Bone Alkaline Phosphatase and iPTH with Some Basic Biochemical Markers in Predialysis and Dialysis Patients

Clinical Laboratory (2012)

Neda Milinković Nada Majkić‐Singh Svetlana Ignjatović Višnja Ležaić Svetlana Pejanović

Bone alkaline phosphatase (BALP) is a direct and independent indicator of impaired bone turnover. We intended to find out whether there are any significant changes in BALP and iPTH levels, in comparison to total Ca, total Mg, inorganic P, total alkaline phosphatase (ALP), and tartrate resistant acid phosphatase (TRAP) in predialysis and dialysis patients.Out of 266 patients investigated, 114 were on continuous ambulatory peritoneal dialysis, 112 were on maintenance haemodialysis, while 40 predialysis patients had end stage renal disease. The parameters were analysed according to the manufacturers' instructions.Correlations were established for the bone marker concentrations analysed among the studied groups. The largest ranges were determined for BALP and iPTH. Predialysis and dialysis patients showed very low levels of BALP. Dialysis patients had lower levels of iPTH (p < 0.001), while in predialysis patients the levels were significantly higher (p < 0.05) than recommended for low bone turnover, according to K/DOQI.The observations made in this study identify BALP as a good indicator of decreased bone turnover in predialysis and dialysis patients. However, in order to reveal a difference between bone activity and the level of parathyroid activity and its effect on bone turnover, it is always necessary to observe both BALP and iPTH levels.

Bone remodeling

10.7754/clin.lab.2011.110816

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Slowing down of chronic renal failure progression with captopril in spontaneously hypertensive rats with adriamycin nephropathy

Srpski arhiv za celokupno lekarstvo (2002)

Dijana Jovanović Djurdjica Jovovic Jasmina Varagić J Dimitrijević Z Dragojlović

In SHRs with ADR nephropathy treatment with captopril normalized systemic blood pressure, and slowed down CRF progression in their early stage. These functional changes correlate with significant slowing of glomerular and interstitial changes.

Captopril

Hypertensive Nephropathy

Spontaneously hypertensive rat

10.2298/sarh0204073j

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[Ultrasound guided percutaneous biopsy of the kidney].

PubMed (1996)

Zorana Kovačević M Marić Dijana Jovanović D Maksić R Hrvacević

In the course of 5 years, 582 ultrasound guided percutaneous renal biopsies were performed in 558 patients. Kidney tissue was obtained in 507 patients (90.9%), and in 485 (86.9%) the obtained sample was sufficient to establish the diagnosis. Complications following renal biopsies were observed in 221 patients, or 38% of total biopsies. There were 212 (36.4%) clinically moderate complications. The most frequent ones were asymptomatic hematomae (32.6%), and infrequently lumbar pain (2.4%) and hematuriae lasting less than 12 hours (1.4%). In 9 patients 10 (1.7%) serious clinical complications in the form of hematuria lasting more than 12 h (1%), large perirenal hematomae (0.5%) and urinary infections (0.2%). In the older age group and in patients with pronounced renal failure no significant difference in the incidence of complications was observed. Ultrasound guided percutaneous renal biopsy is a safe diagnostic method, and the associated complications do not seriously curb its use. The therapy of complications is primarily conservative, and only rarely surgical.

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Preoperative preparation of patients with hyperparathyroidism as comorbidity

Acta chirurgica iugoslavica (2011)

Vladan Živaljević Nevena Kalezić Dijana Jovanović Vera Sabljak Aleksandar Diklić

Preoperative preparation of patients with hyperparathyroidism planned to be operated and/or already operated because of some other disease have specific characteristics in function of the type of hyperparathyroidism, primary or secondary. In primary hyperparathyroidism, repercussions of pronounced hypercalcemia on organs and systems are of essential importance. The most important aspect of preoperative preparation of these patients is therefore the treatment of hypercalcemia. In patients with secondary hyperparathyroidism as comorbidity, calcium level is of lesser importance since it stays mostly within reference values. Essential for perioperative preparation of these patients is the fact that they have chronic renal insufficiency and usually are on extrarenal depuration, so that uremic toxic disorders important for the perioperative course should be taken into account. Disorders caused by primary or secondary hyperparathyroidism (and terminal chronic renal insufficiency) must be brough to so-called "stable state" in elective surgical interventions. Preoperative preparation in urgent surgical interventions is focused only on vitally endangering consequences of hyperparathyroidism such as hypercalcemic crisis or extreme hyperkalemia.

10.2298/aci1102109z

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Effects of Rapamycin on Active Heymann Nephritis

American Journal of Nephrology (2007)

Radomir Naumović Djurdjica Jovović Gordana Basta-Jovanović Zoran Miloradović Nevena Mihailovic‐Stanojevic

The effects of rapamycin (RAPA) were examined in active Heymann nephritis (HN), an experimental model of human membranous nephropathy (MN). Current opinion on the therapy of MN is controversial, and medications used for its treatment have not yielded the expected results.In a two-part study, we examined the effects of RAPA (1.5 mg/kg/day) during the induction phase of HN and on the evolving disease. In both parts, control groups of immunized rats not treated with RAPA and control groups of unimmunized rats were observed and sacrificed concurrently with the treated groups.During the induction phase no significant changes in proteinuria were observed in the group treated with RAPA, in comparison to those in the untreated group (p < 0.001). During the evolving disease RAPA significantly lowered proteinuria (p < 0.001). The characteristic pathohistologic changes and IgG depositions along the glomerular basement membrane were considerably diminished, and infiltration of CD8+ cells completely prevented.RAPA demonstrated beneficial effects on disease progression, given either in the induction phase or during evolving HN. It would be desirable to investigate the effect of RAPA on patients with MN.

Membranous Nephropathy

Nephritis

Minimal change disease

10.1159/000103918

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Analysis of Factors Influencing Chronic Renal Failure Progression

Renal Failure (1999)

Dijana Jovanović Ljubica Djukanović

AbstractOne of the most important characteristics of chronic renal failure (CRF) is its progression to end stage renal disease. CRF progression depends of many factors indicated in numerous experimental and clinical studies. The present study was undertaken with the aim to examine the role of sex, etiology of CRF, renal function at the beginning of the study, hypertension and protein intake on CRF progression. Ninety-two patients (47 female and 45 male) aged between 17 and 70, with various underlying kidney diseases and various degrees of CRF were followed for 8 years. CRF progression was expressed as Creatinine clearance (CCr) and reciprocal values of serum Creatinine (SCr) against time. CRF progression was slower in women than in men, but not significantly. Patients with diabetic nephropathy (b = 0,00006) and glomerulonephritis (b = 0,00005) had faster progression of CRF than patients with nephrosclero-sis (b = 0,00002), tubulointerstitial nephritis (b - 0,00003) and polycys-tic kidney disease (b = 0,00003). The fastest progression of CRF was in patients with the lowest SCr values at the beginning of the study. Proper regulation of blood pressure was the most important factor in slowing down CRF progression, independently of kind of antihypertensive drugs. Neither angiotensin converting enzyme inhibitors (b = -0,00001) nor calcium channel Mockers (b = -0,00002) showed better effects on CRF progression slowing down in comparison with other antihypertensive drugs (b = -0,00001). Low protein die t slowed down CRF progression, but not significantly.In conclusion, our retrospective study confirms that CRF progression depends on sex, underlying renal diseases and serum Creatinine levels at the beginning of the study. Good regulation of blood pressure and low protein diet can slow down CRF progression.Key Words: CRF progressionRateUnderlying renal diseaseAntihypertensive therapyLow protein diet

Nephrosclerosis

10.3109/08860229909066982

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Depression and quality of sleep in maintenance hemodialysis patients

Srpski arhiv za celokupno lekarstvo (2014)

Jasna Trbojević‐Stanković Biljana Stojimirović Zoran Bukumirić Edvin Hadžibulić Branislav Andrić

Sleep disorders and psychological disturbances are common in end-stage renal disease (ESRD) patients. However, despite their frequency and importance, such conditions often go unnoticed, since all patients do not clearly manifest fully expressed symptoms.This study aimed to determine the prevalence of depression and poor sleep quality and to examine the association between these disorders and demographic, clinical and treatment-related characteristics of ESRD patients on hemodialysis (HD).The study included 222 patients (132 men and 90 women), mean age 57.3 +/- 11.9 years, from 3 HD centers in Central Serbia, which provided us with biochemical parameters and demographic data. Sleep quality and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI), respectively.The average BDI was 16.1 +/- 11.3. Depressed patients were significantly older (p=0.041), had a significantly lower dialysis adequacy (p=0.027) and a significantly worse quality of sleep (p < 0.001), while they did not show significant difference as regarding sex, employment, marital status, comorbidities, dialysis type, dialysis vintage, shift and laboratory parameters.The average PSQI was 7.8 +/- 4.5 and 64.2% of patients were poor sleepers. Poor sleepers were significantly older (p = 0.002), they were more often females (p = 0.027) and had a significantly higher BDI (p < 0.001), while other investigated variables were. not correlated with sleep quality. A statistically significant positive correlation was found between BDI and PSQI (r = 0.604; p < 0.001).Depression and poor sleep quality are frequent and interrelated among HD patients.

Depression

Sleep

Marital status

10.2298/sarh1408437t

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