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Tyrimo tikslas. Ištirti ūminio inkstų nepakankamumo priežastis, inkstų funkcijos atsikūrimo dažnį, pacientų išgyvenimą. Tirtųjų kontingentas. Kauno medicinos universiteto klinikose 1995–2006 m. pakaitine inkstų terapija gydyti 1653 pacientai (584 moterys ir 1069 vyrai), sirgę ūminiu inkstų nepakankamumu. Rezultatai ir išvados. Nuo 1995 iki 2007 m. žmonių, kuriems nustatytas ūminis inkstų nepakankamumas, skaičius išaugo devynis kartus. Vyrų sirgo reikšmingai daugiau nei moterų (p

The objective of this study was to examine the factors affecting quality of life in renal transplant patients and to evaluate the association between depression and quality of life. Material and methods. A study was carried out in 61 renal transplant patients. Health-related quality of life was evaluated using the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire. Depression was measured using the Beck’s Depression Inventory (BDI). Results. Twenty percent of the subjects had a BDI score higher than 15. The BDI score correlated inversely with these quality-of-life domains: physical functioning (r=–0.691, P

The aim of the study was to evaluate the causes, prevalence, and grades of chronic renal failure in Lithuanian children and to assess its influence on children's growth. The study was performed in Vilnius University Children's Hospital and Clinic of Children's Diseases, Kaunas University of Medicine. By March 31, 2006, 65 children with chronic renal failure had been registered. The prevalence was 88.3 cases per million children. The mean age was 10.8@4.9 years. The leading causes of chronic renal failure were congenital diseases (37) and obstruction with interstitial nephritis (33.8). At presentation, 23 (35.40) children had mild, 17 (26.15) had moderate, 9 (23.85) had severe renal failure, and 16 (24.6) had end-stage renal disease. Fourteen (21.54) children were below the third percentile in height for their age. Growth failure was observed in one (4.35) child with Grade 1 renal failure. The deterioration of renal function had a significant influence on growth impairment, and 13 (30.95) children with glomerular filtration rate of less than 60 mL/min/1.73 nrand 7 (43.75) with end-stage renal disease had a height below the third percentile. Growth retardation as one of the symptoms of impairment of children's physical development depends on the severity of renal function.

Apsinuodijimų alkoholio surogatais Lietuvoje nemažėja, todėl pabandėme išsiaiškinti tokių apsinuodijimų eigą. Išanalizuotos 1997–2006 m. Kauno medicinos universiteto klinikų Nefrologijos skyriuje gydytų 94 pacientų, apsinuodijusių alkoholio surogatais, ligos istorijos. Nustatyti 53 nepatikslintais etanoliniais surogatais apsinuodijimų atvejai, nesukėlę ūminio inkstų nepakankamumo, kurie išsamiau neanalizuoti, ir 41 neetanoliniais alkoholio surogatais apsinuodijimo atvejis, iš kurių 34 pacientams pasireiškė ūminis inkstų nepakankamumas. Iš 41 paciento, apsinuodijusio neetanoliniais alkoholio surogatais, 31 taikyta detoksikacinė hemodializė. Iš aštuonių pacientų, kurie pradėti gydyti nuo apsinuodijimo pradžios praėjus ne daugiau kaip 12 val., septyniems pacientams (87,50 proc.) ūminis inkstų nepakankamumas nepasireiškė. Kiti 23 pacientai pradėti gydyti po apsinuodijimo praėjus daugiau kaip 12 valandų, visiems pasireiškė ūminis inkstų nepakankamumas. Po hospitalizavimo praėjus ne daugiau kaip 48 val., nuo sunkaus apsinuodijimo mirė trys pacientai. Išvada. Net 82,9 proc. pacientų, apsinuodijusių neetanoliniais alkoholio surogatais, pasireiškė ūminis inkstų nepakankamumas, tačiau, detoksikacines hemodializes pradėjus iki 12 val. po apsinuodijimo, ši komplikacija pasireiškė žymiai rečiau. Intoxications with alcoholic surrogates are still frequent in Lithuania. The aim of this study was to evaluate the frequency, course, and effectiveness of treatment and outcomes of acute renal failure in patients with alcoholic surrogate intoxication. We have analyzed the case histories of 94 patients with alcoholic surrogate poisoning. Patients were treated in the Clinic of Nephrology, Kaunas University of Medicine Hospital, during 1997–2006. Fifty-three cases of poisoning with unspecified ethanolic surrogates, which did not provoke acute renal failure, were identified, and we did not analyze them in detail. Forty-one cases of intoxication with nonethanolic surrogates were identified, and acute renal failure developed in 34 patients. In 31 of the 41 patients, hemodialysis was started for toxin removal. Among eight patients in whom treatment was started within 12 hours of intoxication, seven (87.5%) patients had no acute renal failure. In the 23 remaining patients, treatment was started later than 12 hours after intoxication, and acute renal failure was diagnosed in all of them. Three patients died within 48 hours after hospitalization because of severe intoxication. Conclusion. Acute renal failure developed in 82.9% of patients poisoned with nonethanolic surrogates. In such cases, when hemodialysis for toxin removal was started up to 12 h after poisoning, acute renal failure developed significantly rarely.

Šlapimo takų infekcijos (uroinfekcijos) pasitaiko 40–60 proc. visų ligoninėje įgytų infekcijų. Didėjantis ligonių amžius bei gretutinės ligos sudaro palankias sąlygas šioms infekcijoms rastis. Be to, maždaug 80 proc. hospitalinių uroinfekcijų yra susijusios su šlapimo pūslės kateteriais ir tik 5–10 proc. ligonių jos randasi po invazinių procedūrų šlapimo takuose. Hospitalines infekcijas sukeliantys mikroorganizmai dažnai pasižymi atsparumu antibakteriniams vaistams bei virulentiškumo faktoriais, todėl antibakterinis gydymas gali būti sėkmingas tik pašalinus infekciją sukeliančius veiksnius ar atkūrus normalią urodinaminę funkciją. Antimikrobiniai vaistai komplikuotoms hospitalinėms uroinfekcijoms gydyti turi pasižymėti adekvačiomis farmakodinaminėmis ir farmakokinetinėmis savybėmis: didele vaisto koncentracija šlapime bei antimikrobiniu aktyvumu tiek rūgščiame, tiek ir šarminiame šlapime. Empirinis hospitalinių uroinfekcijų antibakterinis gydymas skiriamas atsižvelgiant į infekcijos lokalizaciją ir sunkumą, įtariamą sukėlėją, skyriaus mikrobiologinę situaciją. Geriausias pasirinkimas gydymo pradžiai – pigiausias siauriausio veikimo veiksmingas uroinfekcijoms gydyti antimikrobinis vaistas, kol bus gauti bent preliminarūs šlapimo pasėlių mikrobiologinių tyrimų duomenys, pagal kuriuos gydymą galima koreguoti. Adekvatus uroinfekcijų gydymas mažina komplikacijų dažnį, antimikrobinių vaistų poreikį ir kartu mikroorganizmų atsparumą jiems, taip pat ekonomiškai naudingas. Urinary tract infections are responsible for 40–60% of all hospital-acquired infections. Increased age of patients and comorbid diseases render hospitalized patients more susceptible to infection. Almost 80% of hospital-acquired urinary tract infections are associated with urinary catheters, and only 5–10% of urinary infections are caused by invasive manipulations in the urogenital tract. Pathogens of hospital-acquired urinary tract infections are frequently multi-resistant, and antibiotic therapy can only be successful when the complicating factors are eliminated or urodynamic function is restored. For treatment of complicated hospital-acquired urinary tract infections, the antibiotics must exhibit adequate pharmacodynamic and pharmacokinetic properties: high renal clearance of unmetabolized form with good antimicrobial activity in both acidic and alkaline urine. For selection of empirical treatment of hospital-acquired urinary tract infections, it is necessary to evaluate localization of infection, its severity, possible isolates, and the most frequent pathogens in the department where patient is treated. The best choice for the starting the antimicrobial therapy is the cheapest narrow-spectrum effective antibiotic in the treatment of urinary tract infection until microbiological evaluation of pathogens will be received. Adequate management of urinary tract infections lowers the rate of complications, requirements for antibacterial treatment, selection of multi-resistant... [to full text]

Objectives. To determine the incidence and variety of microorganisms of positive urine culture in patients of intensive care units of Kaunas University of Medicine Hospital and to estimate the risk factors for colonization, development of urinary tract infection, and outcome during the period of 2003–2004. Material and methods. We retrospectively reviewed patients with a positive urine culture with or without clinical symptoms of urinary tract infection admitted to an intensive care unit. Results. The growth of microorganisms was determined in urine of 82 (3.9%) patients: urinary tract infection in 64 (78%) and colonization in 18 (22%) patients. Among pathogens of urinary tract infection rods predominated significantly (p0.05). E. coli in urine culture was obtained exclusively in cases of urinary tract infection. All patients with a positive urine culture had catheterized urinary bladder (p0.05). In cases of the same sex, age, and underlying disease of the patients, the risk of urinary tract infection with every day of catheterization significantly increased by 21.7% (p0.05). In cases of the same sex, age, underlying disease, and duration of catheterization, the development of urinary tract infection significantly increased the risk of lethal outcome by 5.5 times (p

Darbo tikslas. Įvertinti hemodialize gydomų pacientų kalcio ir fosforo apykaitos sutrikimų dažnio ir jų korekcijos Lietuvos hemodializės centruose pokyčius 1996–2003 m. Visuose Lietuvos hemodializės centruose lankytasi 1996–2003 m. pabaigoje (gruodžio mėnesiais) ir surinkta informacija apie hemodializėmis gydomų pacientų kalcio ir fosforo apykaitos reguliavimą. 51,8 proc. pacientų 1999 m. ir 44,6 proc. 2003 m. nustatyta hiperfosfatemija (>1,8 mmol/l) (p1.8 mmol/l) (p

The aim of the research was to determine causes of acute renal failure in children, their outcome and to define risk factors associated with mortality. 75 children with acute renal failure, who were treated at the Clinic of Children’s Diseases of Kaunas University of Medicine between 1998–2003 years, were included in the study. The age range of patients was 1 month to 16 years. They were divided into two groups. Acute renal failure was diagnosed in 42 (56%) patients (the first study group) and in 33 (44%) patients acute renal failure was together with multiple organ failure (the second study group). In the first study group 69% of cases of acute renal failure were found to be due to renal diseases and in the second study group 97% were because of extrarenal diseases. Sepsis was the most frequent cause of acute renal failure in the second group (p

The aim of the study was to identify risk factors for secondary hyperparathyroidism at the start and during the first year of hemodialysis. Retrospective analysis of medical records of all patients with end-stage renal disease, dialyzed at the hemodialysis center of Kaunas University of Medicine Hospital on December 2004, was performed. Biochemical data at the start, during the first year and at the end of follow-up (December 2004) were analyzed. At the start of hemodialysis elevated level of parathyroid hormone (PTH) was observed in 46 of 69 patients (67.6%), at the end of the first year – in 27 of 69 patients (39.1%). In 22 of 46 patients (47.8%), who started hemodialysis with elevated PTH levels, the level of PTH decreased to