Plasma exchange in elderly patients.

Plasma exchange (PE) is an extracorporeal blood purification technique designed for the removal of large molecular weight substances from plasma. Data regarding the use of PE in elderly patients is lacking, so this study analyzes the database of the Department of Dialysis at the University Hospital Center Zagreb (634 patients, 6237 procedures) for indications and complications in patients aged 65 years or older who were submitted to PE during the period from 1982 to 2007. A total of 50 patients in this age group were submitted to PE; their median age was 69 years (range 65-83).

[The role of nephrologist in treatment of multiple myeloma].

Multiple myeloma (MM) is malignant disease caused by proliferation of malignant clone of terminally differentiated plasma-cells. Clinical features may include symptoms of bone disease, unexplained back-pain, fractures, anaemia, kidney failure, oedema, hypercalcaemia, bacterial infections, impaired hemostasis, peripheral neuropathy and hyperviscosity. Impairment of renal function occurs in 50% of patients with different forms of kidney disease.

[Arterial hypertension in renal transplant recipients].

Arterial hypertension develops in up to 80% of renal transplant recipients. Uncontrolled hypertension induces left ventricular hypertrophy, heart failure and death, but also promotes deterioration of allograft function. Cadaveric transplantation, delayed graft function, renal artery stenosis, presence of native kidneys, increased body weight and therapy with calcineurin inhibitors and steroids have been associated with an increased incidence of hypertension after kidney transplantation.

Treatment of thrombotic microangiopathies with plasma exchange.

Thrombotic microangiopathy (TMA) is a syndrome characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurologic abnormalities, fever and renal dysfunction. This retrospective analysis sought to determine the clinical characteristics and outcome of patients with TMA treated with plasma exchange at the Department of Dialysis, University Hospital Zagreb. From 1982 to July 2005, 17 patients (10 male and 7 female, age ranging from 18 to 74 years) have been diagnosed with TMA.

[Regulation of blood pressure in dialyzed patients].

Up to 90% of chronic haemodialysis patients have blood preasure (BP) greater than 140/90 mmHg. This suggests that only a minor number of the haemodialysis patients have adequate BP control. This is associated with significantly increased morbidity and mortality in haemodialysis population when compared with normal, healthy population.

[Cardiovascular diseases after kidney transplantation].

Cardiovascular complications represent the leading cause of mortality in renal transplant recipients, with ischemic heart disease accounting for more than 50% of deaths. Besides the well known risk factors that affect the general population, risk for development of atherosclerosis in renal transplant patients is further increased by previous uremia and dialysis, as well as by the use of immunosuppressive agents. Diabetes mellitus, arterial hypertension, dyslipidemia, smoking, hyperhomocysteinemia, hyperuricemia, coagulation abnormalities, increased expression of cell adhesion molecules, persistent inflammation, frequent infections and obesity all increase the risk for development of atherosclerosis in transplanted patients.

[Anderson-Fabry disease].

Anderson-Fabry disease is a rare inherited X-linked lysosomal storage disease caused by deficiency of the enzyme alpha-galactosidase A. The deficiency of alpha-galactosidase activity leads to progressive, abnormal accumulation of neutral glycosphingolipids in the lysosome. With increasing age globotriaosylceramide (Gb3) progressively accumulates in different cells, tissues and organs throughout the body.

Complications of therapeutic plasma exchange: experience with 4857 treatments.

Plasma exchange (PE) is a technique of extracorporeal blood purification which removes large molecular weight substances from plasma. The Department of Dialysis, Zagreb University Hospital Center's database, which includes data on 509 patients, or 4857 PE treatments, was retrospectively analyzed to test the safety of PE. A total of 231 adverse reactions were recorded (4.

[Importance of plasmapheresis in the treatment of paraneoplastic cerebellar degeneration].

Paraneoplastic neurologic syndromes are disorders of the nervous system function caused by cancer but not due to metastatic disease, vascular or metabolic deficits, infections, nutritive deficiency, nor side effects of antineoplastic drugs or irradiation. Immunologic factors probably play the crucial role in the pathogenesis of paraneoplastic neurologic syndromes, but nonimmunologic mechanisms that include metabolic abnormalities and competition for substrate are also involved. Paraneoplastic cerebellar degeneration most commonly occurs in the setting of gynecologic cancers, but it accompanies the small-cell lung cancer too.

[Uremic polyneuropathy].

Uremic polyneuropathy is probably the most common complication of chronic renal failure. About 70 percent of dialysis patients regularly have uremic polyneuropathy, in 30 percent the neuropathy is moderate or severe. Coexistence of muscle weakness and atrophy, areflexia, sensory loss and graded distribution of neurologic deficit in a patient with renal disease suggests the presence of uremic polyneuropathy.

[Biological adequacy--what does it mean?].

Appropriate initiation of dialysis is of an outstanding importance in the treatment of patients with end-stage renal disease. It prevents development of irreversible uremic complication and enables selection of the most appropriate dialysis modality for the individual patient. The major causes of morbidity and mortality in dialysis patients are cardiovascular diseases.

[Continuous venovenous hemofiltration as a bridge to heart transplantation in a patient with congestive heart failure and acute renal failure].

Continuous venovenous hemofiltration effectively controls volume overload in cases of severe congestive heart failure accompanied by acute renal failure that could not be medicamentously controlled. A patient with severe ischemic dilated cardiomyopathy who developed acute renal failure while waiting for urgent heart transplantation is described. He was treated with CVVH for three days when the occasion for heart transplantation appeared.

[Indications for continuous renal function replacement therapy].

One of the most important achievements in the contemporary intensive care management is introduction of continuous renal replacement therapy (CRRT). The most common indications for CRRT are acute renal failure complicated with heart failure, volume overload, hypercatabolism, acute or chronic liver failure, and/or brain swelling. Less common indications include systemic inflammatory response (SIRS), sepsis, multiorgan failure (MOF), adult respiratory distress syndrome, crush syndrome, tumor lysis syndrome, lactacidosis, and chronic heart failure.

[Lipoprotein disorders in chronic kidney failure, nephrotic syndrome and dialysis].

Cardiovascular, cerebrovascular and peripheral vascular diseases are the largest cause-specific reason for morbidity and mortality in end-stage renal disease (ESRD) patients. High prevalence of cardio- and cerebrovascular death may be explained by multiple factors present in patients with progressive renal disease, including hypertension, hyprelipidemia, hyperhomocysteinemia, diabetes mellitus, and hyperparathyroidism. Experimental studies have provided in vivo and in vitro data to support the notion that lipid abnormalities contribute to glomerular and interstitial injury of the renal parenchyma.

[Should anemia be completely corrected in patients with chronic renal failure?].

The optimal target hemoglobin (Hb) for the correction of renal anemia by recombinant human erythropoietin therapy is discussed controversially. Normalization of Hb that could lead to a further improvement of the patient's status is often rejected, because of possible effects as a result of an increase in blood viscosity. However, recent studies demonstrated that the higher the Hb level, the better the quality of life and the lower the incidence of cardiovascular morbidity and mortality, as well as hospitalisation.