Ingrid Prkacin
Merkur Teaching Hospital, Emergency Department, Faculty Member
- Born on August 1964.Specialist of internal and emergency medicine. Haed of emergency internal unit, Clinical Hospital Merkur. Zagreb.edit
Merkur Clinical Hospital, Zagreb University School of Medicine, Department of Internal medicine, Zagreb, 1Zadar General Hospital, Department of Nephrology and Dialysis, Zadar, 2Bjelovar General Hospital, Department of Internal medicine,... more
Merkur Clinical Hospital, Zagreb University School of Medicine, Department of Internal medicine, Zagreb, 1Zadar General Hospital, Department of Nephrology and Dialysis, Zadar, 2Bjelovar General Hospital, Department of Internal medicine, Bjelovar, 3Dubrava University Hospital, Department of Nephrology, Zagreb, 4Dubrovnik General Hospital, Department of Internal medicine, Dubrovnik and 5Rijeka University Hospital Center, Department of Nephrology and Dialysis, Rijeka, Croatia.
Research Interests:
Anemia is a very common complication in chronic kidney disease (CKD) patients, resulting in fatigue, reduced quality of life, shortness of breath and decreased exercise capacity (1-3). Multiple factors are involved in the pathogenesis of... more
Anemia is a very common complication in chronic kidney disease (CKD) patients, resulting in fatigue, reduced quality of life, shortness of breath and decreased exercise capacity (1-3). Multiple factors are involved in the pathogenesis of anemia in CKD: iron defi ciency, inadequate production of erythropoietin (Epo), hepcidin and hypoxia-inducible factors (HIFs) (2). Infl ammation and oxidative stress are present in patients with CKD and produce a state of functional iron defi ciency (2). Reduced oxygen delivery activates hypoxia-inducible factors (HIFs) leading to increased transcription of genes, in turn leading to Epo synthesis. Epo binds to the Epo receptor expressed on erythroid progenitor cells, inhibiting apoptosis and enhancOVERVIEW OF ANEMIA TREATMENT IN NON-DIALYSIS CHRONIC KIDNEY DISEASE
Myelodysplastic syndromes (MDS) are a group of clonal disorders arising from hematopoietic stem cells and are generally characterized by inefficient hematopoiesis and dysplasia. The International Prognostic Scoring Sytem (IPSS) is an... more
Myelodysplastic syndromes (MDS) are a group of clonal disorders arising from hematopoietic stem cells and are generally characterized by inefficient hematopoiesis and dysplasia. The International Prognostic Scoring Sytem (IPSS) is an important standard for assessing prognosis of primary untreated adult patients with myelodysplastic syndromes (MDS). Ineffective hematopoiesis leading to anemia is the most common cause of the arrival of patients with MDS in the emergency room . Patients with MDS have a number of associated conditions such as chronic kidney disease and hypertension, and may be present as acute coronary syndrome. We report a case of a 83-year-old female with MDS that was diagnosed in 2014 and had no specific treatment. She presented to the emergency department at the beginning of 2016 because of epigastric and chest pain that began in the morning. Diagnosis of subacute STEMI with a scar formed on front wall and elevated high-sensitivity troponin (hsTnI) which amounted to...
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Protein-energy wasting (PEW) is a frequent problem in patients with end-stage renal disease, which is associated with adverse outcome. Risk factors for development of PEW in dialysis patients include anorexia, limitations in food intake... more
Protein-energy wasting (PEW) is a frequent problem in patients with end-stage renal disease, which is associated with adverse outcome. Risk factors for development of PEW in dialysis patients include anorexia, limitations in food intake due to problems with mineral metabolism (hyperphosphatemia, hyperkalemia). Prevention of PEW in dialysis population demands different therapeutic measures to correct abnormalities and to prevent loss of energy and proteins. Therapeutic approach should be individualized based on the specific problems of each patient in order to correct metabolic problems and to optimize food intake. In patients with inability to maintain nutritional status with standard oral feeding, other measures which include oral nutrition supplements and intradialytic parenteral feeding should be applied. Anabolic steroids, growth hormone and adequate oral nutritional supplements, together with physical activity may prevent further catabolism and correct abnormalities. Appetite s...
Research Interests: Nephrology, Nutrition, Evidence Based Medicine, Dialysis, Medicine, and 10 moreEnergy Metabolism, Humans, Croatia, Dietary Supplements, Nutritional Status, Review of Literature Protein Energy Malnutrition, Renal Dialysis, Nutritional Support, quality assurance in health care, and Medical and Health Sciences
In patients with resistant hypertension (RH) we investigated the importance of urinary neutrophil gelatinase-associated lipocalin (uNGAL- a chemiluminescent microparticle immunoassay (CMIA) method became using (Abbott Diagnostics) for the... more
In patients with resistant hypertension (RH) we investigated the importance of urinary neutrophil gelatinase-associated lipocalin (uNGAL- a chemiluminescent microparticle immunoassay (CMIA) method became using (Abbott Diagnostics) for the measurement of NGAL in urine samples) and incidence of chronic kidney disease using the Modification of Diet in Renal Disease Study (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in estimating glomerular filtration rate (eGFR) based on standardised serum creatinine method traceable to isotope dilution mass spectrometry (IDMS) method. It would have been difficult to predict that levels of these biomarker would perform better organ damage than traditional measurements of kidney function such as standardised serum creatinine, MDRD, or CKD-EPI equations in special population such as RH. Serum creatinine concentrations were measured in 50 patients (24M:26F from RH Registar in Clinical Hospital Merkur) by the kinetic Jaf...
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Anemia is a prevalent finding in patients with type 1 diabetes, particularly in those with albuminuria or reduced renal function. We investigated the relationship between red blood cell count (RBC) and renal function in type 1 diabetic... more
Anemia is a prevalent finding in patients with type 1 diabetes, particularly in those with albuminuria or reduced renal function. We investigated the relationship between red blood cell count (RBC) and renal function in type 1 diabetic patients with normal or mildly impaired renal function and urinary albumin excretion rate (UAE) < 30 mg/24 h. Study included 313 type 1 diabetic patients with estimated glomerular filtration rate (eGFR) > 60 mL min(-1) 1.73 m(-2), and before any interventions with statins, ACE inhibitors or angiotensin II receptor blockers. UAE was measured from at least two 24-h urine samples. Hemoglobin (Hb), hematocrit (Hct), erythrocytes (E), serum iron and ferritin levels were significantly lower in subjects in the highest quartile of serum creatinine compared to those in lowest quartile (132 vs 148 g/L, 0.39 vs 0.42 L/L, 4.5 vs 4.8 x 10(12)/L, 13 vs 18 micromol/L, and 25 vs 103 microg/L, respectively, for all p < 0.001). Hb and Hct levels were significa...
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The real prevalence of resistant hypertension (RH) is unknown. Studies suggest that it affects 10%-15% of patients treated for hypertension by primary care physicians. RH is defined as blood pressure (BP) remaining above the goal despite... more
The real prevalence of resistant hypertension (RH) is unknown. Studies suggest that it affects 10%-15% of patients treated for hypertension by primary care physicians. RH is defined as blood pressure (BP) remaining above the goal despite the use of optimal doses of 3 or more medicines of different classes (including a diuretic). It means BP >140/90 mm Hg for the general population and >130/80 mm Hg for patients with diabetes or kidney disease. Prior to diagnosing a patient as having RH, it is important to document medication compliance and exclude white-coat hypertension, inaccurate BP measurement, and secondary causes. The role of aldosterone in RH has gained increasing recognition. There is strong evidence for the use of spironolactone as a highly effective antihypertensive agent. Aldosterone plays a significant role in RH pathogenesis, primarily due to its vasoconstrictive effects and the possibility of altering vascular compliance. In RH, there is a high prevalence of card...
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Stevens-Johnson syndrome mostly involves the skin and mucous membranes. The diagnosis is made when the characteristic rash appears 1 to 3 weeks after exposure to a known stimulus and cannot be explained by some other diagnosis. A... more
Stevens-Johnson syndrome mostly involves the skin and mucous membranes. The diagnosis is made when the characteristic rash appears 1 to 3 weeks after exposure to a known stimulus and cannot be explained by some other diagnosis. A 62-year-old woman was admitted for evaluation of toxo-allergic dermatitis and collagenosis. Ten days prior to admission she was taking a course of azithromycin for upper respiratory tract infection. After a few days she was feeling better but maculopapular, erythematous rash developed over her palms, accompanied by fever and chills as well as reddish discoloration around her eyes. Within the next few days the rash progressed to the feet. Routine hematologic, biochemical and immunologic studies did not confirm the diagnosis of inflammatory rheumatic disease. Corticosteroid therapy with methylprednisolone (1 mg/kg) for the presumed Stevens-Johnson syndrome was started and her condition improved in several days; she became afebrile and her skin lesions gradual...
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It is assumed that retinopathy and nephropathy, as most important microvascular complications in diabetes, occurs at the same time and that retinovascular pathology reflects renal disease. However, several studies demonstrated that... more
It is assumed that retinopathy and nephropathy, as most important microvascular complications in diabetes, occurs at the same time and that retinovascular pathology reflects renal disease. However, several studies demonstrated that albuminuria is not a risk factor for diabetic retinopathy and that retinopathy might be present already in normoalbuminuric state in type 1 diabetic patients (T1DM). The aim of this study was to evaluate the prevalence and predictors of nonproliferative (NPR) and proliferative/laser- treated retinopathy (PR) in normoalbuminuric T1DM.Study included 333 (198 without retinopathy, 114 with NPR and 21 with PR) normoalbuminuric T1DM with normal or mildly decreased renal function (estimated glomerular filtration rate (eGFR) > 60 ml min-1 1.73m-2) and before any interventions with statins, ACE inhibitors or angiotensin II receptor blockers. Patients without retinopathy compared to those with NPR and PR were younger (31 vs 39 vs 45 years, p<0.001), had longe...
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Renal Denervation (RDN), an endovascular catheter- based intervention, is being applied as a novel concomitant treatment of drug-resistant hypertension (rHT). However, with underpowered efficacy and safety data currently available. The... more
Renal Denervation (RDN), an endovascular catheter- based intervention, is being applied as a novel concomitant treatment of drug-resistant hypertension (rHT). However, with underpowered efficacy and safety data currently available. The aim of this study was to evaluate the duration of the blood pressure (BP) lowering effect of RDN and reduction of antihypertensive drug classes needed after intervention. Office BP measurements at 1, 3 and 6 months follow-up visits were compared to baseline values in 7 patients with rHT. Also, the number of antihypertensive drug classes before and 6 months after RDN were evaluated. At baseline, values were 62 ± 6 years for age, 184 ± 21 mmHg and 106 ± 26 mmHg for systolic and diastolic BP, respectively ; and 6.7 1 for number of antihypertensive drug classes. One, 3 and 6 months after RDN, office SBP values were significantly lower (144 ± 13 mmHg, 140 ± 17 mmHg and 141 ± 15 mmHg, respectively ; P < 0.001). However, with no significant reduction in...
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Identification of the determinants of the onset of early diabetic retinopathy is essential for reducing the morbidity and mortality associated with diabetes. Many study have identified poor glycemic control, duration of diabetes and blood... more
Identification of the determinants of the onset of early diabetic retinopathy is essential for reducing the morbidity and mortality associated with diabetes. Many study have identified poor glycemic control, duration of diabetes and blood pressure as most important risk factors for development of retinopathy. The aim of this study was to evaluate the associations of clinical and metabolic parameters with nonproliferative (NPR) and proliferative/laser tretaed retinopathy (PR)in normoalbuminuric T1DM. Study included 333 (198 without retinopathy, 135 with NPR and PR) normoalbuminuric T1DM with normal or mildly decreased renal function (estimated glomerular filtration rate over 60ml/min), before any internevtiions with statins, ACE inhibitors or angiotensin II receptor blockers. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) formula. Microalbumin was measured spectrophotometrically by turbidimetric immuno-inhibition. Diagnosis of retinopathy was...
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Anemia is a common feature in diabetic patients with chronic kidney disease (CKD). Anemia in diabetic patients develops earlier than in subjects with renal disease from other causes and those with reduced hemoglobin have higher risk of... more
Anemia is a common feature in diabetic patients with chronic kidney disease (CKD). Anemia in diabetic patients develops earlier than in subjects with renal disease from other causes and those with reduced hemoglobin have higher risk of progressive renal disease and have a more rapid decline in glomerular filtration rate (GFR). The aim of this study was to investigate relationship between red blood cell count (RBC) and renal function parameters in type 1 diabetic patients (T1DM) with normal or mildly impaired renal function. Study included 313 normoalbuminuric (urinary albumin excretion rate (UAE) <30.0 mg/24h based on median UAE of at least two 24-h urine collections) T1DM with normal or mildly decreased (eGFR > 60 mlmin-1 1.73 m2) renal function and before any interventions with statins, ACE inhibitors or angiotensin II receptor blockers. Estimated GFR was significantly associated with hemoglobin (Hb) (r=0.11), hematocrit (Hct) (r=0.18) and erythrocytes (E=0.17). Hb (133 vs 1...
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GGT is an independent risk factor for development of hypertension, coronary artery disease, left ventricular diastolic dysfunction and chronic kidney disease. Blood pressure and heart rate (HR) is a strong and independent predictor of... more
GGT is an independent risk factor for development of hypertension, coronary artery disease, left ventricular diastolic dysfunction and chronic kidney disease. Blood pressure and heart rate (HR) is a strong and independent predictor of all-cause death and major cardiovascular complications and increased prevalence and severity of chronic kidney disease. The aim of this study was to explore the relationship between GGT, systolic and diastolic blood pressure and HR in type 1 diabetic patients with normal renal function. Study included 313 normoalbuminuric type 1 diabetic patients (estimated glomerular filtration rate (eGFR over 60 ml/min) with no medical history of liver, renal and cardiovascular diseases and before any interventions with statins, ACE inhibitors or angiotensin II receptor blockers. In this study of normoalbuminuric type 1 diabetic patients we have shown that GGT is positively associated with systolic and diastolic blood pressure and HR. Higher GGT in type 1 diabetic pa...
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Chronic kidney disease (CKD) contributes to the global burden of cardiovascular morbidity (CVM) and mortality. It is documented that blood pressure (BP) control in non-dialysis CKD patients (predominantly CKD stage 3 and 4) plays a key... more
Chronic kidney disease (CKD) contributes to the global burden of cardiovascular morbidity (CVM) and mortality. It is documented that blood pressure (BP) control in non-dialysis CKD patients (predominantly CKD stage 3 and 4) plays a key factor in reducing cardiovascular risk and renal disease progression. Studies suggest that there is a lot of patients with unrecognized resistant hypertension (RH). It affects about 10-15% of patients being treated for hypertension by primary care physicians. We investigated what proportions of patients with CKD have unrecognized RH. In this work we evaluated frequency and prognosis of RH among 58 (M:F=27:31, age 67±15 years) hypertensive non-dialysis CKD patients. RH was defined as BP ≥ 130/80 mmHg despite over 3 drugs at full dose or as BP at goal with ≥4 full-dose drugs. All patients with RH had been screened for secondary forms of hypertension according to current guidelines.At beginning of the study eGFR was 39.2±17.3 ml/min/1.73m², BP 167±23/92±...
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It is known than blood pressure control in non-dialysis chronic kidney disease (CKD) patients (predominantly CKD stage 3. and 4.) plays a key factor in reducing cardiovascular risk and renal disease progression. However, in this study we... more
It is known than blood pressure control in non-dialysis chronic kidney disease (CKD) patients (predominantly CKD stage 3. and 4.) plays a key factor in reducing cardiovascular risk and renal disease progression. However, in this study we observed high prevalence of unrecognized resistant hypertension in non-dialysis CKD patients, which is associated with decreased renal survival.
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The link between the arterial hypertension (AH) and kidney has been considered a villain-victim relationship. AH is one of the two most important causes of chronic kidney disease (CKD) in the developed world. We investigated what... more
The link between the arterial hypertension (AH) and kidney has been considered a villain-victim relationship. AH is one of the two most important causes of chronic kidney disease (CKD) in the developed world. We investigated what proportions of patients with AH have unrecognized CKD (1-4 stage). Prevalence rates of albuminuria (defined as albumin/creatinin ratio over 3.5 mg/mmol) as an early marker of CKD was investigated among 60 ambulatory non-diabetic hypertensive patients (age 65±24 years, M:F=27:33). AH was defined as blood pressure ≥ 140/90 mmHg. The most used antihypertensive were combination of angiotensin-converting enzyme inhibitors (ACEI) with diuretics and calcium channel blockers (CCB) or angiotensin II receptor blockers (ARB) with diuretics and CCB. Estimated glomerular filtration rate (eGFR) was calculated using Cockroft-Gault formula and Modification of Diet in Renal Disease (MDRD) formula. Clinical and laboratory data of 60 patients were included in the analysis. AH...
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Amyloidosis is a clinical entity that results from deposition of an extracellular protein material that causes disruption in normal architecture and impairs function of multiple organs and tissues. Secondary amyloidosis (AA) is a rare but... more
Amyloidosis is a clinical entity that results from deposition of an extracellular protein material that causes disruption in normal architecture and impairs function of multiple organs and tissues. Secondary amyloidosis (AA) is a rare but serious complication that appears in the context of cancer, chronic inflammation, and chronic infectious disease, including rheumatoid arthritis. Renal failure is the most common clinical presentation of AA, ranging from nephrotic syndrome and impaired renal function to renal failure, with a potential for high morbidity. We present a case of a 52-year-old female patient diagnosed with rheumatoid arthritis at age 27. She was hospitalized due to worsening clinical condition. Physical examination revealed marked peripheral edema in both lower extremities. Laboratory tests showed an increase of inflammatory reactants, anemia, electrolyte disbalance, and severe hypoalbuminemia and hypoproteinemia. She had proteinuria 15.4 g/24 h and renal function estim...
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Amyloidosis is a clinical entity that results from deposition of an extracellular protein material that causes disruption in normal architecture and impairs function of multiple organs and tissues. Secondary amyloidosis (AA) is a rare but... more
Amyloidosis is a clinical entity that results from deposition of an extracellular protein material that causes disruption in normal architecture and impairs function of multiple organs and tissues. Secondary amyloidosis (AA) is a rare but serious complication that occurs in the context of cancer, chronic inflammation and chronic infectious diseases, including inflammatory bowel disease, mainly long-standing Crohn's disease. Renal failure is the most common clinical presentation of AA, ranging from nephrotic syndrome and impaired renal function to renal failure, with a potential for high morbidity. The incidence of the association of secondary amyloidosis in patients with Crohn's disease has been reported to be 0.5%-8%. We present a case of a 39-year-old male patient diagnosed with Crohn's disease at age 21 and submitted to right hemicolectomy because of ileus 17 years before. Thereafter, he was treated with corticosteroids for 15 years and with azathioprine for a short p...
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The focus was on haloperidol (central dopamine antagonist)-stomach lesion, a longly described suitable counterpart of dopamine blocker cysteamine-duodenal lesion. In this, the contribution of blockade of central/peripheral dopamine... more
The focus was on haloperidol (central dopamine antagonist)-stomach lesion, a longly described suitable counterpart of dopamine blocker cysteamine-duodenal lesion. In this, the contribution of blockade of central/peripheral dopamine receptors and prostaglandins synthesis, along with influence of antiulcer agents was evaluated in mice. Male NMRI Hannnover mice were sacrificed 24 h after haloperidol (25 mg/kg b.w. i.p., given alone or with saline (haloperidol+saline) (i) or in combination (ii,iii)). Supporting central dopamine predominance for haloperidol stomach lesion induction, co-administration of peripheral dopamine receptor antagonist domperidone (5 mg/kg i.p.) (haloperidol+ domperidone) (ii), or prostaglandin synthesis inhibitor indomethacin (10 mg/kg s.c.) (haloperidol+ indomethacin) (iii) did not aggravate this lesion. (i) In haloperidol+saline challenged mice the lesions were inhibited by co-administration (/kg i.p.) of a gastric pentadecapeptide BPC 157, GlyGluProProProGlyLysProAlaAspAspAlaGlyLeuVal, M.W. 1419 (10 microg, 10 ng, 10 pg, but not 1 pg, 100 fg, 10 fg), bromocriptine (10 mg), omeprazole (10 mg, 100 mg, but not 1 mg). Atropine (10, 100, 200 mg), pirenzepine (10, 100, 200 mg), misoprostol (10, 100, 200 microg), pantoprazole (1, 10, 100 mg), lansoprazole (0.1, 1, 10 mg), cimetidine (10, 100, 200 mg) and ranitidine (10, 100, 200 mg) were not effective. (ii) Dopamine peripheral blockade influence: in haloperidol+domperidone mice, previously effective bromocriptine, pentadecapeptide BPC 157 (10 microg) or omeprazole (10 mg) did not attenuate stomach lesions. (iii) Prostaglandins synthesis blockade effect: in haloperidol+indomethacin mice, previously effective agents, bromocriptine or omeprazole were not active, while BPC 157 effect was only lessened.
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Research Interests: Physiology, Medicine, Mice, Animals, Male, and 6 moreProteins, Medical Physiology, Rats, Wistar Rats, Alloxan, and Gastric mucosa
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After demonstration that cysteamine induced duodenal lesions in gastrectomized rats, while a number of antiulcer drugs mitigated these lesions, it was shown that one single intrarectal (i.r.) cysteamine application produced severe colon... more
After demonstration that cysteamine induced duodenal lesions in gastrectomized rats, while a number of antiulcer drugs mitigated these lesions, it was shown that one single intrarectal (i.r.) cysteamine application produced severe colon lesions in acute studies in rats. Thus, the further focus was on the protracted effect of cysteamine challenge (400 mg/kg b.w. i.r.) and therapy influence in chronic experiments in female rats. Regularly, cysteamine colon lesions were markedly mitigated by ranitidine (10), omeprazole (10), atropine (10), methylprednisolone (1), sulphasalazine (50; mg/kg), pentadecapeptide BPC 157 (PL-10, PLD-116; 10 microg or 10 ng/kg). Specifically, after 1 or 3 months following initial challenge (cysteamine 400 mg/kg i.r.) in female rat, the therapy [BPC 157 (PL-10, PLD-116 (10.0 microg or 10.0 ng/kg; i.g., i.p., i.r.), ranitidine, omeprazole, atropine, methylprednisolone, sulphasalazine (i.p.)] reversed the protracted cysteamine colon injury: the 1 week-regimen (once daily application) started after 1 month post-cysteamine, as well as the 2 weeks-regimen (once daily application), which started after 3 months. The effect on recidive lesion was also tested. These cysteamine lesions may reappear after stopping therapy (after stopping therapy for 3 weeks at the end of 2-weeks regimen started in 3 months-cysteamine female rats) in sulphasalazine group, while this reappearance is markedly antagonized in pentadecapeptide BPC 157 (PL-10, PLD-116)-rats (cysteamine-colon lesion still substantially low).
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Recently, we showed cysteamine-duodenal lesions without gastric acid, since they were induced also in gastrectomized rats, as in naive rats, and they were inhibited by the novel stomach pentadecapeptide BPC 157 as well as standard... more
Recently, we showed cysteamine-duodenal lesions without gastric acid, since they were induced also in gastrectomized rats, as in naive rats, and they were inhibited by the novel stomach pentadecapeptide BPC 157 as well as standard antiulcer drugs (i.e. cimetidine, ranitidine, omeprazole, bromocriptine, atropine). Therefore, as an advantage of considering cysteamine as a directly acting cytotoxic agent and mentioned agents as direct cytoprotective agents, the present focus was on the ulcerogenic effect of cysteamine and protective effect of gastroduodenal antiulcer agents outside upper gastrointestinal tract (i.e. in colon). Intrarectal administration of the cysteamine (200 or 400 mg/kg b.w) produced severe colon lesions (i.e. transmural inflammation with serosal involvement) in rats (30 min-72 h-experimental period), apparently distinctive from smaller lesions after non-specific irritant enema [diluted HCl solution, pH 3.8 (adjusted to pH of cysteamine solution (pH 3.8)]. All of the tested antiulcer agents were applied simultaneously with cysteamine enema (8 cm from the anus, in a volume of the 1.0 ml/rat) intraperitoneally (i.p.), intragastrically (i.g.) or intrarectally (i.r.). Pentadecapeptide BPC 157 (10 microg or 10 ng/kg b.w.), given in either regimen, previously shown to have, besides others, a particular beneficial activity just in the intestinal mucosa, inhibited these cysteamine colon lesions (assessed after 30 min, 60 min, 180 min, 24 h, 48 h, 72 h following cysteamine in a dose of either 200 or 400 mg/kg i.r.). Cysteamine-colon lesions were also attenuated by standard antiulcer agents (mg/kg b.w.), given i.p., i.g., or i.r., such as ranitidine (10), cimetidine (50), omeprazole (10), atropine (10), together with methylprednisolone (1), and sulphasalazine (50, i.r.), assessed 30 min following application of 200 mg of cysteamine. Finally, standard cysteamine duodenal lesions (assessed 24 h after a subcutaneous application of 400 mg/kg of cysteamine) were also attenuated by these agents application (given in the same doses, i.p., 1 h before cysteamine), with only exception to sulphasalazine. Thus, the extended cysteamine specific ulcerogenic effect, cysteamine colon/duodenum lesion-link and an extenuation of agents protection from upper to lower part of gastrointestinal tract (i.e. stomach pentadecapeptide BPC 157, standard antiulcer agents, cimetidine, ranitidine, atropine, omeprazole) and vice versa (remedies for inflammatory bowel disease) evidenced in the present study may be potentially important for both further experimental and clinical research.
Research Interests: Physiology, Medicine, Inflammatory Bowel Disease, Internal Medicine, Clinical research, and 15 moreIntestinal Mucosa, Female, Animals, Proteins, Medical Physiology, Necrosis, Gastrointestinal Tract, Colon, Ranitidine, Glucocorticoids, Cimetidine, Cysteamine, Duodenum, Methylprednisolone, and Omeprazole
Anti-ulcer agents may likely attenuate lesions outside the gastrointestinal tract, since they had protected gastrectomized rats (a &amp;amp;amp;amp;quot;direct cytoprotective effect&amp;amp;amp;amp;quot;). Therefore, their... more
Anti-ulcer agents may likely attenuate lesions outside the gastrointestinal tract, since they had protected gastrectomized rats (a &amp;amp;amp;amp;quot;direct cytoprotective effect&amp;amp;amp;amp;quot;). Therefore, their therapeutic potential in lung/stomach lesions were shown. Rats received an intratracheal (i.t.) HCl instillation [1.5 ml/kg HCl (pH 1.75)] (lung lesion), and an intragastric (i.g.) instillation of 96% ethanol (gastric lesion; 1 ml/rat, 24 h after i.t. HCl instillation), then sacrificed 1 h after ethanol. Basically, in lung-injured rats, the subsequent ethanol-gastric lesion was markedly aggravated. This aggravation, however, in turn, did not affect the severity of the lung lesions in the further period, at least for 1 h of observation. Taking intratracheal HCl-instillation as time 0, a gastric pentadecapeptide, GEPPPGKPADDAGLV, M.W.1419, coded BPC 157 (10 microg, 10 ng, 10 pg), ranitidine (10 mg), atropine (10 mg), omeprazole (10 mg), were given [/kg, intraperitoneally (i.p.)] (i) once, only prophylactically [as a pre-treatment (at -1h)], or as a co-treatment [at 0)], or only therapeutically (at +18h or +24 h); (ii) repeatedly, combining prophylactic/therapeutic regimens [(-1 h)+(+24 h)] or [(0)+(+24 h)], or therapeutic/therapeutic regimens [(+18 h)+(+24 h)]. For all agents, combining their prophylactic and salutary regimens (at -1 h/+24 h, or at 0/+24 h) attenuated lung lesions; even if effect had been not seen already with a single application, it became prominent after repeated treatment. In single application studies, relative to controls, a co-treatment (except to omeprazole), a pre-treatment (at -1 h) (pentadecapeptide BPC 157 and atropine, but not ranitidine and omeprazole) regularly attenuated, while therapeutically, atropine (at +18 h), pentadecapeptide BPC 157 highest dose and omeprazole (at +24 h), reversed the otherwise more severe lung lesions.
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Up to now, for gastric lesions potentiation or induction, as well as determination of endogenous dopamine significance, dopamine antagonist or dopamine vesicle depletor were given separately. Therefore, without combination studies, the... more
Up to now, for gastric lesions potentiation or induction, as well as determination of endogenous dopamine significance, dopamine antagonist or dopamine vesicle depletor were given separately. Therefore, without combination studies, the evidence for dopamine significance remains split on either blockade of dopamine post-synaptic receptor or inhibition of dopamine storage, essentially contrasting with endogenous circumstances, where both functions could be simultaneously disturbed. For this purpose, a co-administration of reserpine and haloperidol, a dopamine granule depletor combined with a dopamine antagonist with pronounced ulcerogenic effect, was tested, and the rats were sacrificed 24 h after injurious agent(s) administration. Haloperidol (5 mg x kg(-1) b.w. i.p.), given alone, produced the lesions in all rats. Reserpine (5 mg x kg(-1) b.w. i.p.), given separately, also produced lesions. When these agents were given together, the lesions were apparently larger than in the groups injured with separate administration of either haloperidol or reserpine alone. Along with our previous results, when beneficial agents were co-administered, all dopaminomimetics (bromocriptine 10 mg, apomophine 1 mg, amphetamine 20 mg x kg(-1) i.p.) apparently attenuated the otherwise consistent haloperidol-gastric lesions. Likewise, an apparent inhibition of the reserpine-lesions was noted as well. However, if they were given in rats injured with combination of haloperidol and reserpine, their otherwise prominent beneficial effects were absent. Ranitidine (10 mg), omeprazole (10 mg), atropine (10 mg), pentadecapeptide BPC 157 (Gly-Glu-Pro-Pro-Pro-Gly-Lys-Pro-Ala-Asp-Asp-Ala-Gly-Leu-Val) (10 microg or 10 ng x kg(-1) i.p.) evidently prevented both haloperidol-gastric lesions and reserpine-gastric lesions. Confronted with potentiated lesions following a combination of haloperidol and reserpine, these agents maintained their beneficial effects, noted in the rats treated with either haloperidol or reserpine alone. The failure of dopaminomimetics could be most likely due to more extensive inhibition of endogenous dopamine system activity, and need for remained endogenous dopamine for their salutary effect, whereas the beneficial activities of ranitidine, omeprazole, atropine, pentadecapeptide BPC 157 following dopamine system inhibition by haloperidol+reserpine suggest their corresponding systems parallel those of dopamine system, and they may function despite extensive inhibition of endogenous dopamine system activity.
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Liver lesions and portal hypertension in rats, following chronic alcohol administration, are a particular target for therapy. Portal hypertension (mm Hg) assessed directly into the portal vein, and liver lesions induced by 7.28 g/kg b.w.... more
Liver lesions and portal hypertension in rats, following chronic alcohol administration, are a particular target for therapy. Portal hypertension (mm Hg) assessed directly into the portal vein, and liver lesions induced by 7.28 g/kg b.w. of alcohol given in drinking water for 3 months, were counteracted by a stable gastric pentadecapeptide BPC 157, GEPPPGKPADDAGLV, M.W. 1419, known to have a beneficial effect in a variety of models of gastrointestinal or liver lesions (10 microg or 10 ng/kg b.w. i.p. or i.g.) and propranolol (10 mg/kg b.w. i.g.), but not ranitidine (10 mg/kg b.w. i.g.) or saline (5 ml/kg b.w. i.p./i.g.; control). The medication (once daily) was throughout either the whole 3 months period (1) or the last month only (2) (last application 24 h before sacrifice). In the background of 7.28 g/kg/daily alcohol regimen similar lesions values were assessed in control rats following alcohol consumption, after 2 or 3 months of drinking. Both prophylactic and therapeutic effects were shown. After a period of 2 or 3 months, in all control saline [intragastrically (i.g.) or intraperitoneally (i.p.)] treated rats, the applied alcohol regimen consistently induced a significant rise of portal blood pressure values over values noted in healthy rats. In rats that received gastric pentadecapeptide BPC 157 or propranolol the otherwise raised portal pressure was reduced to the values noted in healthy rats. Besides, a raised surface area (microm(2)) and increased circumference (microm) of hepatocyte or hepatocyte nucleus [HE staining, measured using PC-compatible program ISSA (VAMS, Zagreb, Croatia)] and an advanced steatosis [scored (0-4), Oil Red staining] (on 100 randomly assigned hepatocytes per each liver), an increased liver weight, all together parallel a raised portal pressure in controls. Some of them were completely eliminated (not different from healthy rats, i.e. portal pressure, the circumference and area of hepatocytes, liver weight), while others were markedly attenuated (values less than in drinking controls, still higher than in healthy rats, i.e. circumference and area of hepatocytes nucleus). On the other hand, ranitidine application attenuated only steatosis development. In summary, despite continuous chronic alcohol drinking, pentadecapeptide BPC 157, and propranolol may prevent portal hypertension as well as reverse already established portal hypertension along with related liver disturbances.
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A gastric pentadecapeptide, BPC 157, with the amino acid sequence, Gly-Glu-Pro-Pro-Pro-Gly-Lys-Pro-Ala-Asp-Asp-Ala-Gly-Leu-Val, MW 1419, known to have a variety of protective effects in gastrointestinal tract and other organs, was... more
A gastric pentadecapeptide, BPC 157, with the amino acid sequence, Gly-Glu-Pro-Pro-Pro-Gly-Lys-Pro-Ala-Asp-Asp-Ala-Gly-Leu-Val, MW 1419, known to have a variety of protective effects in gastrointestinal tract and other organs, was recently shown to particularly affect dopamine systems. For instance, it blocks the stereotypy produced acutely by amphetamine in rats, and the development of haloperidol-induced supersensitivity to amphetamine in mice. Consequently, whether pentadecapeptide BPC 157, that by itself has no cataleptogenic effect in normal animals, may attenuate the immediate effects of neuroleptics application, particularly catalepsy, was the focus of the present report. Prominent catalepsy, otherwise consistently seen in the mice treated with haloperidol (0.625, 1.25, 2.5, 5.0 and 10.0 mg/kg b.w., i.p.) and fluphenazine (0.3125, 0.625, 1.25, 2.5 and 5.0 mg/kg b.w., i.p.) after 1.5, 3, 4.5, 6 and 7.5 h following administration, was markedly attenuated when pentadecapeptide BPC 157 (10 microg or 10 ng/kg b.w., i.p.) was coadministered with the neuroleptic. The number of cataleptic mice was markedly lower throughout most of the experimental period. Moreover, on challenge with lower doses of neuroleptics, catalepsy appearance was postponed and the mice, otherwise cataleptic since the earliest period, became cataleptic later, not before 3 or 4.5 h after neuroleptic administration, especially if protected with higher pentadecapeptide dose. Besides catalepsy, coadministration of the pentadecapeptide BPC 157, given in the above mentioned doses, reduced not only catalepsy but somatosensory disorientation (for 7.5 h after administration of a neuroleptic, assessed at intervals of 1.5 h, by a simple scoring system [0-5]) in haloperidol- or fluphenazine-challenged mice as it did in mice treated with sulpiride (20, 40, 80 and 160 mg/kg b.w., i.p.) or with clozapine (25, 50 and 100 mg/kg b.w., i.p.), in which case catalepsy was absent. In other experiments, considering the gastric origin of this pentadecapeptide, the focus was shifted to the evidence that a dose of haloperidol, cataleptogenic due to dopamine receptors blockade, induces gastric ulcers in rats. Coadministration of pentadecapeptide BPC 157 (10 microg, 10 ng, 1.0 ng, 100 pg/kg b.w., i.p.) to rats completely inhibited the lesions otherwise regularly evident 24 h after haloperidol (5.0 mg/kg b.w., i.p.) in control rats (18 of 20 rats had gastric lesions). This activity accompanied the antagonism of the haloperidol catalepsy in rats (assessed at 60-min intervals from I to 5 h after haloperidol), when 10-microg- or 10-ng regimens were given (lower doses could not influence catalepsy). Together, these findings indicate that pentadecapeptide BPC 157 fully interacts with the dopamine system, both centrally and peripherally, or at least, that BPC 157 interferes with some steps involved in catalepsy and/or ulcer formation.
Research Interests: Drug interactions, Medicine, Dopamine, Mice, Orientation, and 15 moreAnimals, Male, Proteins, Haloperidol, European, Rat, Gastrointestinal Tract, Amino Acid Sequence, Gastric Ulcer, Peptic Ulcer, Clozapine, Dopamine antagonists, Antipsychotic agents, Catalepsy, and Pharmacology and pharmaceutical sciences
Various antidepressants have antiulcer activity. Likewise, the models currently used in ulcers and depression disorders research have a considerable degree of similarity. Therefore, the possibility that depression disorders could be... more
Various antidepressants have antiulcer activity. Likewise, the models currently used in ulcers and depression disorders research have a considerable degree of similarity. Therefore, the possibility that depression disorders could be effectively influenced by a primary antiulcer agent with a cyto/organoprotective activity, such as the novel stomach pentadecapeptide BPC 157, was investigated in two rat depression assays. First, a forced swimming test (a Porsolt&amp;amp;amp;amp;#39;s procedure) was used. As a more severe procedure, chronic unpredictable stress (after 5 d of unpredictable stress protocol, once daily drug application during stress procedure, open field-immobility test assessment at fourth or sixth day of medication) was used. In a forced swimming test, a reduction of the immobility time in BPC 157 (10 microg, 10 ng x kg(-1) i.p.) treated rats corresponds to the activity of the 15 mg or 40 mg (i.p.) of conventional antidepressants, imipramine or nialamide, respectively, given according to the original Porsolt&amp;amp;amp;amp;#39;s protocol. In chronic unpredictable stress procedure, particular aggravation of experimental conditions markedly affected the conventional antidepressant activity, whereas BPC 157 effectiveness was continuously present. The effect of daily imipramine (30 mg) medication could be seen only after a more prolonged period, but not after a shorter period (i.e., 4-d protocol). In these conditions, no delay in the effectiveness was noted in BPC 157 medication and a reduction of the immobility of chronically stressed rats was noted after both 4 and 6 d of BPC 157 (10 microg, 10 ng) medication.
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Unlike severe gastric damage acutely induced by ethanol administration in rat, the ulcerogenic effect of chronic alcohol administration (3.03 g/kg b.w. or 7.28 g/kg b.w.) given in drinking water, producing liver lesions and portal... more
Unlike severe gastric damage acutely induced by ethanol administration in rat, the ulcerogenic effect of chronic alcohol administration (3.03 g/kg b.w. or 7.28 g/kg b.w.) given in drinking water, producing liver lesions and portal hypertension, is far less investigated. Therefore, focus was on the antiulcer effect of the gastric pentadecapeptide BPC 157, GEPPPGKPADDAGLV, M.W. 1419, known to have a beneficial effect in variety of gastrointestinal lesions models (10 microg or 10 ng/kg b.w. i.p. or i.g.), ranitidine (10 mg/kg b.w. i.g.) and propranol (10 mg/kg b.w. i.g.) or saline (5 ml/kg b.w. i.p./i.g.; control). They were given once daily (1) throughout 10 days preceding alcohol consumption, (2) since beginning of alcohol drinking till the end of the study, (3) throughout the last month of alcohol consumption, 2 months after alcohol drinking had been initiated. Gastric lesions were assessed, at the end of 3 months drinking [(1), (2)] or with respect to therapeutic effect of medication before medication or at the end of therapy. Pentadecapeptide BPC 157, ranitidine and propranolol may prevent gastric lesion development if given prophylactically, before alcohol drinking. Likewise, they attenuate the lesion appearance given once daily throughout the drinking period. Importantly, when given therapeutically, they may antagonize otherwise pertinent lesion presence in stomach mucosa of the drinking rats. Thus, these results demonstrate that pentadecapeptide BPC 157, ranitidine and propranol may prevent, attenuate or reverse the gastric lesions appearance in chronically alcohol drinking rats, and may be used for further therapy, while the other studies showed that their effect (except to ranitidine) is parallel with their beneficial effect on liver lesion and portal hypertension.
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Studies have generally suggested a positive association between dyslipidemia and chronic kidney disease, but sparse data are available on the relation of lipids and glomerular filtration rate in patients with normal renal function. We... more
Studies have generally suggested a positive association between dyslipidemia and chronic kidney disease, but sparse data are available on the relation of lipids and glomerular filtration rate in patients with normal renal function. We investigated the associations of serum lipids, including total, LDL, HDL, VLDL cholesterol, and triglyceride levels with estimated glomerular filtration rate (eGFR) in type 1 diabetic patients. Study included 313 normoalbuminuric type 1 diabetic patients with normal or mild decrease (eGFR > 60 mL/min per 1.73 m2) renal function and before any interventions with statins, ACE inhibitors or angiotensin II receptor blockers. eGFR was significantly associated with total, LDL, and HDL cholesterol (r = -0.21, -0.18, and -0.17, respectively, for all p < 0.05). Stratifying serum lipids for degree of eGFR, levels of total, LDL, and HDL cholesterol were inversely related to eGFR, but trends were significant only for total (5.1 vs 5.0 and 4.6 mmol/L) and LDL...
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Research Interests:
Studies have documented independent contribution of sympathetic activation to the cardiovascular disease continuum. Hypertension is one of the leading modifiable factors. Most if not all the benefit of antihypertensive treatment depends... more
Studies have documented independent contribution of sympathetic activation to the cardiovascular disease continuum. Hypertension is one of the leading modifiable factors. Most if not all the benefit of antihypertensive treatment depends on blood pressure lowering, regardless how it is obtained. Resistant hypertension is defined as blood pressure that remains uncontrolled in spite of the concurrent use of three antihypertensive drugs of different classes. Ideally, one of the three drugs should be a diuretic, and all drugs should be prescribed at optimal dose amounts. Poor adherence to antihypertensive therapy, undiscovered secondary causes (e.g. obstructive sleep apnea, primary aldosteronism, renal artery stenosis), and lifestyle factors (e.g. obesity, excessive sodium intake, heavy alcohol intake, various drug interactions) are the most common causes of resistant hypertension. Cardio(reno)vascular morbidity and mortality are significantly higher in resistant hypertensive than in gen...
Several studies investigated the association between the estimated glomerular filtration rate (eGFR) and the concentration of high-density lipoproteins (HDL) in patients without severely damaged kidney function. As results of those... more
Several studies investigated the association between the estimated glomerular filtration rate (eGFR) and the concentration of high-density lipoproteins (HDL) in patients without severely damaged kidney function. As results of those studies were inconclusive and contradictory, we wanted to investigate this association in multiple cardiovascular disease (CVD) risk patients without severe kidney disease or renal failure. We enrolled a cohort of 187 patients with intermediate and high CVD risk without severe renal disease. We grouped them based on their eGFR into: group 1 (≥ 30 < 60 ml/min/1.73 m), group 2 (≥ 60 < 90 ml/min/1.73 m) and group 3 (≥ 90 ml/min/1.73 m). We analyzed the difference between their HDL levels and assessed the association of HDL and eGFR in three regression models with the following predictors: model 1 (age and gender), model 2 (model 1 plus smoking status, hs-CRP and diabetes mellitus) and model 3 (model 2 plus excessive weight and obesity, hypertension, hy...
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Research Interests:
Clinical and laboratory findings of kidney disease in an adult may find an explanation in kidney functional and/or structural abnormalities that already existed during infancy and childhood, but that may have been missed or... more
Clinical and laboratory findings of kidney disease in an adult may find an explanation in kidney functional and/or structural abnormalities that already existed during infancy and childhood, but that may have been missed or underdiagnosed. All the cardiovascular abnormalities that occur in adults with chronic kidney disease are also present in children with chronic kidney disease. Complications in childhood chronic kidney disease will have consequences well beyond pediatric age and influence outcomes of affected young adults with disease. Kidney dysfunction appears early in the course of kidney disease and has been observed in children and adults with chronic kidney disease, condition characterised with kidney fibrosis. Transforming growth factor beta is recognized as a major mediator of kidney fibrosis. New evidence illustrates the relationship between transforming growth factor beta signaling and microRNAs expression during kidney diseases development. MicroRNAs play important rol...
Renal sympathetic denervation (RSD) could be an effective antihypertensive treatment of resistant hypertension that triggers additional positive effects on glucose metabolism and insulin sensitivity in type 2 diabetes mellitus. We report... more
Renal sympathetic denervation (RSD) could be an effective antihypertensive treatment of resistant hypertension that triggers additional positive effects on glucose metabolism and insulin sensitivity in type 2 diabetes mellitus. We report the effects of RSD in a patient with chronic kidney disease, type 2 diabetes mellitus and resistant hypertension, manifesting as blood pressure reduction with dipping pattern restoration, followed by nephrotic proteinuria alleviation. The non-dipping blood pressure pattern and proteinuria increase the risk of cardiovascular complications and accelerate kidney disease progression. Thus, further research documenting the frequency and investigating the mechanisms of these effects reported after RSD in chronic kidney disease patients with type 2 diabetes mellitus and resistant hypertension is necessary for the benefit of this high-risk patient population.
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We present a case of a 50-year-old man with advanced liver cirrhosis and native valve infective endocarditis caused by methicillin-resistant Staphylococcus epidermidis. Bacterial infections are one of the most common complications of... more
We present a case of a 50-year-old man with advanced liver cirrhosis and native valve infective endocarditis caused by methicillin-resistant Staphylococcus epidermidis. Bacterial infections are one of the most common complications of liver cirrhosis, but reports of infective endocarditis in patients with liver cirrhosis are relatively rare. Because of vulnerability of patients with advanced cirrhosis for developing infections, it is necessary to pay attention to the pathogens that are sometimes considered contamination and actively seek for the seat of infection, even in less expected areas (e.g., native heart valves without a history of heart disease).
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The primary glomerular disease in patients with diabetes mellitus is rare. Several reports have shown that primary glomerular diseases can be superimposed on diabetic nephropathy. The recognition of nondiabetic glomerular diseases in... more
The primary glomerular disease in patients with diabetes mellitus is rare. Several reports have shown that primary glomerular diseases can be superimposed on diabetic nephropathy. The recognition of nondiabetic glomerular diseases in diabetic patients is of utmost importance since they might be successfully treated. This would positively affect the otherwise poor prognosis of renal disease in diabetic patients. The suspicion on nondiabetic renal disease is raised by the appearance of urinary abnormalities such as hematuria, massive nephrotic proteinuria or deterioration in renal function in patients with diabetes mellitus but without coexisting diabetic retinopathy. We report on diabetic patients who underwent renal biopsy because of the massive nephrotic proteinuria and non-nephrotic proteinuria without diabetic retinopathy, hematuria, and because of the deterioration of renal function. On pathohistological examination different types of primary glomerular diseases were found. The diagnosis and the treatement of glomerular diseases improved the renal prognosis in some of these patients.
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A 31-year-old woman suffering from diabetes type1 and terminal kidney disease, with simultaneously transplanted kidney and pancreas, developed an episode of acute organ rejection caused by antibodies. The management of organ rejection was... more
A 31-year-old woman suffering from diabetes type1 and terminal kidney disease, with simultaneously transplanted kidney and pancreas, developed an episode of acute organ rejection caused by antibodies. The management of organ rejection was complicated by cytomegalovirus viremia, with accompanying leukopenia and neutropenia. The patient also developed invasive aspergillosis of the lungs, which progressed and disseminated hematogenously to the thyroid gland and the skin. Due to resistance to classical antimycotic therapy, the patient was treated with a combination of caspofungin and variconazole. In the beginning of treatment, the effects of this combined therapy were not evident due to strong immunosuppression caused by antimycotic immunoglobulin, which the patient had been administered on her previous hospital stay to treat acute kidney transplant rejection caused by antibodies, as well as due to immunosuppression caused by tacrolimus, mycophenolate mofetil and prednisone. On combined therapy with antimycotic drugs and supportive therapy, the patient was completely cured.
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To evaluate efficacy and safety of CERA (continuous erythropoietin receptor activator) administration for correcting anemia in the patients with chronic kidney disease (CKD), not on dialysis. We performed observational study on 27 CKD... more
To evaluate efficacy and safety of CERA (continuous erythropoietin receptor activator) administration for correcting anemia in the patients with chronic kidney disease (CKD), not on dialysis. We performed observational study on 27 CKD patients in stage 4 or 5 with renal anemia requiring use of erythropoiesis-stimulating agents (ESA). All patients received CERA (Mircera; Roche, Basel, Switzerland) subcutaneously in dose of 0.6 microg per kg every two weeks during the correction phase of anemia treatment or once monthly during the maintenance treatment. Dose of CERA was modified according to manufacturer instructions. Iron supplementation was administrated orally or intravenously in order to achieve serum ferritin 200-500 microg/L. Patients were followed up to 1 year (from 3-12 months). Response criteria for CERA were Hb increase &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10 g/L above baseline or Hb &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 110 g/L. Hb statistically significant (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), increased during the observation period. The median at baseline was 94 g/L and after 6 months and one year were 108 g/L and 114.5 g/L respectively. Furthermore, the range of the lowest and highest values of Hb gradually decreased indicating less Hb fluctuation. After one year, all patients had Hb range 100 g/L to 120 g/L. There were no statistically significant differences between Hb between groups of patients stratified according to the primary kidney disease and age. During the study period two patients died due to myocardial infarction, probably not associated with CERA administration according to observed Hb levels (103 and 110 g/L). Only registered side effect was slight increase in arterial pressure, controlled with antihypertensive drugs. The majority of patients had reported better exercise tolerance and sleep and less irritability. The results of this observational study suggest that the use of CERA is effective and safe and leads to a successful correction of anemia in CKD patients who have not yet started renal replacement therapy.
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Hyperhemolysis syndrome usually occurs in patients with sickle cell disease and possibly thalassemia who receive multiple transfusions. There are only few clinical reports on patients without hemoglobinopathies as in this report. Our... more
Hyperhemolysis syndrome usually occurs in patients with sickle cell disease and possibly thalassemia who receive multiple transfusions. There are only few clinical reports on patients without hemoglobinopathies as in this report. Our patient was diagnosed with hyperhemolytic reaction and was infused with IVIG and methylprednisolone for several days. Signs of tissue hypoxia developed along with increased cardiac enzymes, hepatocellular and cerebrovascular injury, and finally death. On autopsy, there was no evidence for hemolytic uremic syndrome or thrombotic thrombocytopenic purpura.