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Introduction. Monitoring of graft function by creatinine concentrations in serum and calculated glomerular filtration rate (GFR) is recommended after kidney transplantation. KDIGO recommendations on the treatment of transplant patients advocate usage of one of the existing mathematical equations based on serum creatinine. We compared clinical application of three equations based on serum creatinine in monitoring the function of transplanted kidney. Methods. A total number of 55 adult patients who received their first renal allograft from living donors at our transplant center in between 2011-2014 were included into the study. Renal allograft GFR was estimated by the Cockroft-Gault, Nankivell and MDRD formula, and correlated with clinical parameters of donors and recipients. Results. The mean age of recipients was 35.7±9.5 (range 16-58), and the mean age of donors was 55.5±9.0 (34- 77) years. Out of this group of 55 transplant patients, 50(90.91%) were on hemodialysis (HD) prior to transplantation. HD treatment was shorter than 24 months in 37(74%) transplant patients. The calculated GFR with MDRD equation showed the highest mean value at 6 and 12 months (68.46±21.5; 68.39±24.6, respectively) and the lowest at 48 months (42.79±12.9). According to the Cockroft&Gault equation GFR was the highest at 12 months (88.91±24.9) and the lowest at 48 months (66.53±18.1 ml/min). The highest mean level (80.53±17.7) of the calculated GFR with the Nankivell equation was obtained at 12 months and the lowest (67.81±16.7 ml/min) at 48 months. The values of Pearson’s correlation coefficient between the calculated GFR and the MDRD at 2 years after transplantation according to donor’s age of r=-0.3224, correlation between GFR and the Cockfroft & Gault at 6 and 12 months and donor’s age (r=-0.2735 and r=-0.2818), and correlation between GFR and the Nankivell at 2 years and donor’s age of r=-0.2681, suggested a conclusion that calculated GFR was lower in recipients who had an older donors. Conclusion. Our analysis showed difference in the calculated GFR with different equations at the same time points. Using one mathematical equation during the total post-transplantation period would be a recommended method in order to eliminate the discrepancy in determining the stage of kidney failure.

Introduction. Bone disease is a chronic complication of chronic kidney disease and major clinical problem in hemodialysis (HD) patients. The aim of our study was to assess the influence of treatment longevity on biochemical parameters of mineral and bone metabolism in HD patients, and to identify the most important parameters. Methods. The research was observational and retrospective, involved 70 patients, mean age 58.69±12.54, divided into groups in respect to the duration of dialysis treatment (Group I-5 years, Group II-5-10 years and Group III-over 10 years). Results. Serum phosphorus was increased, but the values tend to increase along with dialysis duration - (Group I: 1.93±0.45; Group II: 1.97±0.50; Group III: 2.01±0.37; p>0,05). Calcium values were also not significantly increased based on the duration of treatment [Group I: 2.3 (2.2-2.41); Group II: 2.46 (2.15-2.6), Group III: 2.35 (2.10-2.52)]. Dialysis and PTH correlated positively in the first group of patients (Rho=0.470, p=0.013). The values of calcium and alkaline phosphatase correlated positively in all patients (Rho=0.351, p=0.003). PTH was significantly higher in the second and third compared to the first group (p=0.009 and p=0.038, respectively), and there was no significant difference between the second and the third group. Interestingly, parathyroidectomized patients had higher PTH values compared to those without parathyroidectomy (557 vs. 359 pg/ml). Conclusion. The most reliable marker for clinical monitoring of bone disease in dialysis patients is PTH. The values of calcium and phosphorus are highly variable and not reliable parameters for bone disease follow-up.

In the last two decades a great progress was observed in understanding of podocytes, their specific structure and function identifying many specific podocyte proteins, such as nephrin and podocalyxin. Podocytes form the final barrier to plasma proteins leakage. Nephrin as a main component of the filtration diaphragm forms a physical barrier while podocalyxin as sialoglycoprotein forms an electrostatic barrier. Podocyte damage, i.e. podocytopathies and their loss through urine-podocyturia, are crucial in pathogenesis and progression of nephropathies with proteinuria as main clinical manifestation. In podocytopathies, nephrin and podocalyxin appear in the urine before proteinuria and microalbuminuria which were previously considered as earliest markers of nephropathies. Nephrinuria and podocalyxuria indicate damage of the podocytes on glomerular level and/or presence of apoptotic and necrotic podocytes in urine. These urinary markers are also important in early diagnosis of secondary nephropathies such as diabetic, lupus and hypertensive nephropathy as the most common causes of end-stage renal failure (ESRF). These markers are also important in the prediction of preeclampsia, which is the most common complication in pregnancy. In this review we elaborate in dept the main structural and functional features of podocytes and their specific proteins, nephrin and podocalyxin, summarizing the recent literature data on their importance in the early diagnosis of the most common secondary nephropathies.

Introduction. Assessment of renal function is a crucial component of donor evaluation. The higher measured donor GFR is independently associated with a better allograft outcomes in living donor kidney transplantation (LDKT). Monitoring graft function and estimation of GFR is a recommended method for patients’ follow-up in posttransplantation period. The aim of our study was to investigate the correlation of directly measured GFR of donated kidney with estimated GFR through creatininebased formulas and to detect impact factors on the graft function at 12 months posttransplantation. Methods. Fifty LDKT patients (related and nonrelated donors) with stable renal function in a period of 12 months after transplantation were included in our study. The mean recipient age was 30.7±9.6 years, and donor age 55.45±9.41 years. The mean directly measured donated kidney GFR was 47.61±5.72 ml/min. Graft function was estimated at 3, 6 and 12 months by 3 formulas: Cockcroft- Gault (C-G), MDRD 6 variables and Nankivell. Direct correlation of estimated with measured radiolabeled 99mTc DTPA GFR was performed. Various impact factors such as donor age, dialysis vintage and different calcineurin inhibitors as a part of immunosupression were evaluated. Results. Estimated GFR at 12 months with MDRD, Cockroft Gault, and Nankivell formulas was 72.65±22.6, 94.25±36.42, and 81.78±17.89 ml/min, respectively. The highest estimated GFR was obtained with C-G formula at all three time points. The estimated allograft GFR did not correlate with directly measured GFR of donated kidney. Donor age well correlated with the graft function at 12 months. Allografts from standard criteria donors-SCD (60 years). The highest GFR was estimated with C-G equation (106.08±39.26 ml/min), while GFR estimated with Nankivell was 86.86±15.30 ml/min, and with MDRD 79.67±20.28 ml/min, presenting patients in stage 2 of chronic kidney disease. Duration of hemodialysis treatment under 24 months showed better graft function estimated by C-G at 12 months (102.23±38.86 ml/min), compared to that above 24 months of HD (77.84±18.11 ml/ min). Different type of calcineurin inhibitors did not influence on the graft function at any time point. Conclusion. Creatinine-based formulas for estimation of the graft function did not correlate with directly measured function of the donated kidney with radiolabeled isotopes, nor between each other. Hence, the monitoring of the graft function should be done by a single formula in the posttransplantation period. Expectedly, a better graft function was observed in young donors (standard criteria) and in patients with shorter hemodialysis treatment.

Introduction. Nowadays, obesity has emerged as one of the most independent risk factors for chronic kidney disease (CKD) in both economically developed and undeveloped countries. The number of patients requiring dialysis as a consequence of obesity-related renal diseases, such as diabetes mellitus and hypertension, is increasing worldwide. Moreover, obesity has been shown to favorize the risk of cardiovascular diseases (CVD) with premature death due to CKD and/or end-stage renal disease (ESRD). The aim of the study was to investigate the association between obesity [e.g. body mass index (BMI)], kidney function [e.g. glomerular filtration rate (GFR)] and renal anemia in CKD patients. Methods. Retrospectively, data from the register of 315 pre-dialysis patients with different stages of CKD not on erythropoiesis stimulation agents (ESAs) during the period between 1 Jan 2013-30 June 2013 were used to assess the association between the degree of CKD impairment with the degree of obesity and anemia. The stage and/or progression of CKD was calculated by GFR, while the degree of obesity by the body mass index (BMI). CKD was defined as a glomerular filtration rate (GFR) 2. Data analysis was performed by means of the simple Microsoft excel program. Results. Within the study population of 315 CKD patients, 123 were males with mean age of 63.4±1.33 years and 192 females of 57.3±1.2 years. The GFR reduced with the increased BMI in both genders, and majority of patients (n=243) were in CKD stage 3, with a mean GFR of 44.5 ml/min/1.73 m2. The BMI values in female patients with first and second degree of obesity negatively correlated with GFR (r=−0.46, p2) had a positive correlation between the decreased renal function and reduced Hb levels. Conclusions. Our study provided an unconditional evidence not only for the presence of an association between the degree of obesity (BMI) and the degree of renal function impairment (GFR), but also an association between the higher BMI and the higher degree of kidney anemia seen in women with second degree of obesity. Further larger scale trials and interventional studies are required to see the effect of body weight reduction on renal function and especially anemia.

Introduction. Patients on hemodialysis (HD) are proven to have impaired Health Related Quality of Life (HRQoL) compared to the general population. Recovery from the hemodialysis session is a permanent problem among majority of patients receiving HD treatment. A partial explanation may be the osmotic imbalance between different compartments of the body due to the fluid and electrolyte movement across the cell membrane which is a part of the HD process itself. The aim of our study was to see whether the length of recovery time (RT) is associated with different clinically relevant variables and dialysis treatment features in our HD population. Methods. We performed a cross-sectional study on patients receiving trice weekly HD in a single hemodialysis center. The recovery time was defined by posing a single question "How long does it take you to recover after a hemodialysis session?" and was calculated in hours (up to 2, 2-6, 6-12, and 12-24 hours) / minutes. Various demographic and clinical characteristics were analyzed for association with the RT. Results. The mean RT was 364.62±339.24 minutes. From all of the analyzed variables a significant statistical correlation was obtained with the level of albumin, urea, interdialytic weight gain (IDWG), protein catabolic rate (PCR), body mass index (BMI) and the level of hemoglobin (p Conclusions. RT in our study was associated with IDWG, albumin, urea, BMI, and PCR, while the level of hemoglobin was also shown to have a significant impact on the RT and on patients’ overall health status. Hence, we could conclude that maintaining Hb levels in dialysis patients within reference values among the other benefits, may improve the recovery time and HRQoL of our patients.

Introduction. Kidney disease is associated with many abnormalities in the oral health status as well as with alterations in salivary flow and composition. The aim of this study was to evaluate and to correlate oral clinical findings, salivary flow (SF) and salivary pH values in patients with chronic kidney disease (CKD) not yet on hemodyalisis treatment, those undergoing hemodialysis and in kidney transplant recipients. Methods. In a cross-sectional study 90 patients were included. The cohort was composed of three groups: 30 patients with CKD (serum creatinine values under 120 μmol/L-group 1), 30 patients with CKD on hemodialysis (group 2) and 30 kidney transplanted patients (group 3). The control group consisted of 20 healthy individuals. Oral symptoms, signs and lesions: salivary volume, salivary pH and SF of stimulated and unstimulated saliva were evaluated. Results. Among patients with CKD without dialysis treatment inverse relationship was found between uremic fetor, unpleasant taste and unstimulated SF and also between xerostomia and stimulated SF. Negative correlation between thirst and unstimulated salivary flow was found in both groups, patients with CKD on dialysis and kidney transplant group. Furthermore, in kidney-transplant patients a negative correlation was found between petechiae and SF, while in group of patients with CKD on hemodialysis the same negative correlation was registered between uremic fetor and stimulated SF. Conclusions. Salivary flow was significantly lower in hemodialysis patients, while the highest was in the kidney-transplant recipients accompanied with improvement in the other oral clinical findings observed in our study.

Introduction. BNP plasma levels are significantly increased in heart failure and have an excellent negative predictive value for left ventricular dysfunction. Measurement of BNP level is useful for “screening” in high-risk populations. It is suitable for detection of left ventricular hypertrophy (LVH) and/or dysfunction and risk assessment in the sub-acute phase of acute myocardial infarction in hypertensive patients. The aim of our study was to find whether BNP may correlate with the left ventricular systolic function, i.e. its echocardiographic parameters in chronic kidney disease (CKD) patients. Methods. In a prospective study performed at the Department of Nephrology and Clinic for hemodialysis at the Clinical Center in Sarajevo we followed-up 80 patients stratified in three separate groups according to CKD stage (Stage III, IV and V) for two years, regardless of their cardiovascular symptoms. We analyzed levels of BNP before and after diuretic therapy or hemodialysis and echocardiographic characteristics of the left ventricle. Results. There was a strong negative correlation between BNP values and the size of the EF before (rho=−0.692, p0.05) and after diuretic therapy (rho=−495, p Conclusions. Our study confirmed that the value of BNP in CKD patients may represent a measure of left ventricular systolic function with a strong negative correlation with ejection fraction. BNP measurement is a reliable parameter for further follow-up and prognosis in patients with established left ventricular dysfunction, acute coronary syndrome and for estimation of the left ventricular dysfunction.