1. The role of vascular lesions in diabetes across a spectrum of clinical kidney diseaseRosa Rodriguez-Rodriguez, Radovan Hojs, Francesco Trevisani, Enrique Morales, Gema Fernández, Sebastjan Bevc, Clara Maria Cases Corona, Josep Maria Cruzado, María Quaro, Maruja Navarro Díaz, Mads Hornum, Beatriz Fernandez-Fernandez, Arianna Bettiga, Federico Di Marco, Marina López Martínez, Francisco J. Moreso, Clara García Garro, Khaled Khazim, Fedaa Ghanem, Manuel Praga, Meritxell Ibernón, Ivo Laranjinha, Luís Mendonça, Miguel Bigotte Vieira, Bo Feldt-Rasmussen, Patricia Fox Concepción, Natalia Negrín Mena, Alberto Ortiz, Esteban L. Porrini, 2021, izvirni znanstveni članek Opis: Introduction: The clinical-histologic correlation in diabetic nephropathy is not completely known.
Methods: We analyzed nephrectomy specimens from 90 patients with diabetes and diverse degrees of proteinuria and glomerular filtration rate (GFR).
Results: Thirty-six (40%) subjects had normoalbuminuria, 33 (37%) microalbuminuria, and 21 (23%) non-nephrotic proteinuria. Mean estimated GFR (eGFR) was 65±23 (40% <60 ml/min per 1.73 m2). About 170 glomeruli per patient were analyzed, and all samples included vascular tissue. Six subjects (7%) were classified in diabetic nephropathy class I, 61 (68%) in class II-a, 13 (14%) in class II-b, 9 (10%) class III, and 1 (1%) in class IV. Eighty percent to 90% of those with normoalbuminuria or microalbuminuria were classified in class II-a or II-b and <10% in class III; 52% of those with proteinuria were in class II-a, 15% in class II-b, and 19% in class III. Nodular sclerosis (57%) and mesangial expansion (15%) were more frequent in cases with proteinuria than in normoalbuminuria (28% and 8%; P = 0.028 and 0.017). About 20% to 30% of all cases, regardless the level of albuminuria or proteinuria or the histologic class had tubular atrophy, interstitial fibrosis, or inflammation in >10% to 20% of the sample. Moderate hyalinosis and arteriolar sclerosis were observed in 80% to 100% of cases with normoalbuminuria, microalbuminuria, proteinuria, as well as in class I, II, or III.
Conclusions: Weak correspondence between analytical parameters and kidney histology was found. Thus, disease may progress undetected from the early clinical stages of the disease. Finally, vascular damage was a very common finding, which highlights the role of ischemic intrarenal disease in diabetes.
Ključne besede: albuminuria, chronic kidney disease, diabetes, diabetic nephropathy, histology, normoalbuminuria
Objavljeno v DKUM: 06.12.2024; Ogledov: 0; Prenosov: 5
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2. Assessment of kidney function : clinical indications for measured GFRNatalie Ebert, Sebastjan Bevc, Arend Bökenkamp, Francois Gaillard, Mads Hornum, Kitty Jager, Christophe Mariat, Bjørn Odvar Eriksen, Runolfur Palsson, Andrew D. Rule, 2021, pregledni znanstveni članek Opis: In the vast majority of cases, glomerular filtration rate (GFR) is estimated using serum creatinine, which is highly influenced by age, sex, muscle mass, body composition, severe chronic illness and many other factors. This often leads to misclassification of patients or potentially puts patients at risk for inappropriate clinical decisions. Possible solutions are the use of cystatin C as an alternative endogenous marker or performing direct measurement of GFR using an exogenous marker such as iohexol. The purpose of this review is to highlight clinical scenarios and conditions such as extreme body composition, Black race, disagreement between creatinine- and cystatin C–based estimated GFR (eGFR), drug dosing, liver cirrhosis, advanced chronic kidney disease and the transition to kidney replacement therapy, non-kidney solid organ transplant recipients and living kidney donors where creatinine-based GFR estimation may be invalid. In contrast to the majority of literature on measured GFR (mGFR), this review does not include aspects of mGFR for research or public health settings but aims to reach practicing clinicians and raise their understanding of the substantial limitations of creatinine. While including cystatin C as a renal biomarker in GFR estimating equations has been shown to increase the accuracy of the GFR estimate, there are also limitations to eGFR based on cystatin C alone or the combination of creatinine and cystatin C in the clinical scenarios described above that can be overcome by measuring GFR with an exogenous marker. We acknowledge that mGFR is not readily available in many centres but hope that this review will highlight and promote the expansion of kidney function diagnostics using standardized mGFR procedures as an important milestone towards more accurate and personalized medicine.
Ključne besede: biomarker, chronic kidney disease, clinical indications, creatinine, cystatin C, kidney function, measured glomerular filtration rate
Objavljeno v DKUM: 12.08.2024; Ogledov: 52; Prenosov: 11
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3. Frailty in community-dwelling older people and nursing home residents : an adaptation and validation studySergej Kmetec, Zvonka Fekonja, Adam Davey, Barbara Kegl, Jernej Mori, Nataša Mlinar Reljić, Brendan McCormack, Mateja Lorber, 2024, izvirni znanstveni članek Opis: Aim: The aim of this was to psychometrically adapt and evaluate the Tilburg Frailty Indicator to assess frailty among older people living in Slovenia's community and nursing home settings.
Design: A cross-cultural adaptation and validation of instruments throughout the cross-sectional study.
Methods: Older people living in the community and nursing homes throughout Slovenia were recruited between March and August 2021. Among 831 participants were 330 people living in nursing homes and 501 people living in the community, and all were older than 65 years.
Results: All items were translated into the Slovene language, and a slight cultural adjustment was made to improve the clarity of the meaning of all items. The average scale validity index of the scale was rated as good, which indicates satisfactory content validity. Cronbach's α was acceptable for the total items and subitems.
Conclusions: The Slovenian questionnaire version demonstrated adequate internal consistency, reliability, and construct and criterion validity. The questionnaire is suitable for investigating frailty in nursing homes, community dwelling and other settings where older people live.
Impact:The Slovenian questionnaire version can be used to measure and evaluate frailty among older adults. We have found that careful translation and adaptation processes have maintained the instrument's strong reliability and validity for use in a new cultural context. The instrument can foster international collaboration to identify and manage frailty among older people in nursing homes and community-dwelling homes.
Reporting Method: The Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting cross-sectional studies was used.
No Patient or Public Contribution: No patient or public involvement in the design or conduct of the study. Head nurses from nursing homes and community nurses helped recruit older adults. Older adults only contributed to the data collection and were collected from nursing homes and community dwelling.
Ključne besede: aged, chronic disease, frailty, instrument validation
Objavljeno v DKUM: 17.07.2024; Ogledov: 106; Prenosov: 26
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4. Kakovost oskrbe v odnosu na oceno kakovosti vodenja kronične bolezni bolnikov s koronarno boleznijoKsenija Tušek-Bunc, Marija Petek Šter, Davorina Petek, 2018, izvirni znanstveni članek Opis: Purpose: Patient-centered assessment of chronic illness care is replacing the assessment of satisfaction, which does not cover all dimensions of care. Pa- tient assessments reflect both the qual- ity of chronic illness care and provide feedback to healthcare workers about their work. The study aim was to inves- tigate the patient-centered assessment of coronary heart disease (CHD) pa- tients and its correlation with the care that was delivered. Methods: This cross-sectional study evaluated data obtained from the patient medical records and surveyed patients using the Patient Assessment of Chronic Illness Care (PACIC) ques- tionnaire. A descriptive analysis of the overall and domain-specific responses to the PACIC questionnaire was con- ducted and the association of the results with delivery of care data in the patient records was determined by Pearson's correlation coefficient. Results: The study sample included 768 of 1080 CHD patients (71,1%) at 36 family medicine practices who com- pleted the PACIC questionnaire. The mean age of the re- spondents was 68.3 +- 10.7 years and the overall PACIC score was 3.3 +- 0.9. The highest PACIC scores were deliv- ery system design (3.7), patient activation (3.7), and prob- lem solving (3.6). Follow-up received the lowest score (2.8). Quality of delivered care and PACIC scores were correlated (r = 0.10, p = 0.009). Conclusions: CHD patients highly rated all aspects of chronic care included in the PACIC questionnaire. They were least satisfied with the follow-up and coordination as- pects of chronic care. The process indicators of care were positively correlate with patient assessment of care.
Ključne besede: coronary heart disease patients, patient's assessment of chronic illness care, quality of care
Objavljeno v DKUM: 05.04.2024; Ogledov: 199; Prenosov: 9
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5. The role of oxidative stress in kidney injuryNejc Piko, Sebastjan Bevc, Radovan Hojs, Robert Ekart, 2023, pregledni znanstveni članek Opis: Acute kidney injury and chronic kidney disease are among the most common non-communicable diseases in the developed world, with increasing prevalence. Patients with acute kidney injury are at an increased risk of developing chronic kidney disease. One of kidney injury’s most common clinical sequelae is increased cardiovascular morbidity and mortality. In recent years, new insights into the pathophysiology of renal damage have been made. Oxidative stress is the imbalance favoring the increased generation of ROS and/or reduced body’s innate antioxidant defense mechanisms and is of pivotal importance, not only in the development and progression of kidney disease but also in understanding the enhanced cardiovascular risk in these patients. This article summarizes and emphasizes the role of oxidative stress in acute kidney injury, various forms of chronic kidney disease, and also in patients on renal replacement therapy (hemodialysis, peritoneal dialysis, and after kidney transplant). Additionally, the role of oxidative stress in the development of drug-related nephrotoxicity and also in the development after exposure to various environmental and occupational pollutants is presented.
Ključne besede: acute kidney injury, acute tubular necrosis, chronic kidney disease, oxidative stress, reactive oxygen species
Objavljeno v DKUM: 19.03.2024; Ogledov: 210; Prenosov: 45
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6. SGLT2i for evidence based cardiorenal protection in diabetic and non-diabetic chronic kidney disease : a comprehensive review by EURECA-m and ERBP working groups of ERAPatrick B. Mark, Pantelis Sarafidis, Robert Ekart, Charles J. Ferro, Olga Balafa, Beatriz Fernandez-Fernandez, William G. Herrington, Patrick Rossignol, Lucia Del Vecchio, Jose M. Valdivielso, 2023, pregledni znanstveni članek Opis: Chronic kidney disease (CKD) is a major public health issue affecting an estimated 850 million people globally. The leading causes of CKD is diabetes and hypertension, which together account for >50% of patients with end-stage kidney disease. Progressive CKD leads to the requirement for kidney replacement therapy with transplantation or dialysis. In addition, CKD, is a risk factor for premature cardiovascular disease, particularly from structural heart disease and heart failure (HF). Until 2015, the mainstay of treatment to slow progression of both diabetic and many non-diabetic kidney diseases was blood pressure control and renin-angiotensin system inhibition; however, neither angiotensin-converting enzyme inhibitors (ACEIs) nor angiotensin receptor blockers (ARBs) reduced cardiovascular events and mortality in major trials in CKD. The emergence of cardiovascular and renal benefits observed with sodium-glucose cotransporter-2 inhibitors (SGLT2i) from clinical trials of their use as anti-hyperglycaemic agents has led to a revolution in cardiorenal protection for patients with diabetes. Subsequent clinical trials, notably DAPA-HF, EMPEROR, CREDENCE, DAPA-CKD and EMPA-KIDNEY have demonstrated their benefits in reducing risk of HF and progression to kidney failure in patients with HF and/or CKD. The cardiorenal benefits—on a relative scale—appear similar in patients with or without diabetes. Specialty societies’ guidelines are continually adapting as trial data emerges to support increasingly wide use of SGLT2i. This consensus paper from EURECA-m and ERBP highlights the latest evidence and summarizes the guidelines for use of SGLT2i for cardiorenal protection focusing on benefits observed relevant to people with CKD.
Ključne besede: cardiorenal syndrome, cardiovascular, chronic renal failure, diabetic kidney disease, heart failure
Objavljeno v DKUM: 21.02.2024; Ogledov: 241; Prenosov: 14
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7. Accuracy and speed of molecular response reporting with Xpert BCR-ABL Ultra in vitro diagnostic test in CML patientsŠpela Stangler Herodež, Nadja Kokalj-Vokač, Zlatko Roškar, Mojca Dreisinger, 2021, izvirni znanstveni članek Ključne besede: chronic myeloid leukemia, BCR-ABL1 fusion gene, GeneXpert, minimal residual disease, molecular response
Objavljeno v DKUM: 22.01.2023; Ogledov: 595; Prenosov: 65
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8. Analiza pulznega vala pri hemodializnih bolnikihJan Gumilar, 2018, končno poročilo o rezultatih raziskav Ključne besede: aplanacijska tonometrija, arterijska togost, pulzni tlak, končna ledvična odpoved, hemodializa, preživetje, applanation tonometry, pulse pressure, arterial stiffness, chronic kidney disease, haemodialysis, survival
Objavljeno v DKUM: 25.03.2019; Ogledov: 1665; Prenosov: 110
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9. Factors associated with health-related quality of life among university studentsZalika Klemenc-Ketiš, Janko Kersnik, Ksenija Eder, Dušan Colarič, 2011, izvirni znanstveni članek Opis: Introduction: University students are subjected to different kinds of stressors, i.e.academic pressures, social issues and financial problems. This can affect their academic achievements and quality of life.
Objective: The aim of this study was to determine the health-related quality of life of university students, and how it is affected by the presence of chronic diseases, mental disorders comorbidity, and patterns of medical services' use.
Methods: This web-based study included a sample of 1,410 Slovenian university students. We used a self-administered questionnaire, containing a sheet with demographic data, Zung's self-assessment inventories about anxiety and depression, and EQ-5D questionnaire. The main outcome measures were scores on EQ-5D part and VAS part of the EQ-5D questionnaire.
Results: Independent factors associated with the health-related quality of life of university students, were the presence of chronic pain, the presence of depression and anxiety, need for urgent medical help and at least one visit to a clinical specialist in the past year. The independent factors associated with the health status of university students were the presence of chronic diseases, chronic pain, depression and anxiety, a visit to a clinical specialist, a need for urgent medical help and a visit to an emergency unit in the past year.
Conclusion: Health-related quality of life of university students can be seriously affected by the presence of mental disorders and chronic pain. Appropriate health-related measures should be adopted to achieve early recognition of worse health-related quality of life, the presence of mental disorders and other chronic conditions, and to enable their effective treatment.
Ključne besede: quality of life, students, chronic disease, pain, depression, anxiety
Objavljeno v DKUM: 04.08.2017; Ogledov: 1333; Prenosov: 487
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10. Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency settingGregor Prosen, Petra Klemen, Matej Strnad, Štefek Grmec, 2011, izvirni znanstveni članek Opis: Introduction: We studied the diagnostic accuracy of bedside lung ultrasound (the presence of a comet tail sign), N-terminal pro-brain natriuretic peptide (NT-proBNP), and clinical assessment (modified Boston criteria) in differentiating heart failure (HF)- related acute dyspnea from pulmonary (COPD/asthma) related acute dyspnea in the prehospital setting.
Methods: Prospective study was performed at the Center for Emergency Medicine Maribor, Slovenia, between July 2007 and April 2010. Two groups of patients were compared: HF-related acute dyspnea group (n = 129) vs pulmonary-related (asthma/COPD) acute dyspnea group (n = 89). All patients underwent lung ultrasound examination, along with basic laboratory, rapid NT-proBNP testing and chest X-ray.
Results: Ultrasound comet tail sign has 100% sensitivity, 95% specificity, 100% negative predictive value (NPV) and 96% positive predictive value (PPV) for the diagnosis of HF. NT-proBNP (cut-off point 1000 pg/ml) has 92% sensitivity, 89% specificity, 86% NPV and 90% PPV. Boston modified criteria have 85% sensitivity, 86% specificity, 80% NPV and 90% PPV. Comparing the three methods, we found significant differences between ultrasound sign vs NT-proBNP (P<0.05) and Boston modified criteria (P<0.05). Combination of ultrasound sign and NT-proBNP has 100% sensitivity, 100% specificity, 100% NPV and 100% PPV. With ultrasound we can exclude HF in patients with pulmonary related dyspnea who have positive NT-proBNP (> 1000 pg/ml) and previous history of HF.
Conclusions: Ultrasound comet tail sign alone or in combination with NT-proBNP has a high diagnostic accuracy in differentiating between acute HF and COPD/asthma causes of acute dyspnea in prehospital emergency setting.
Ključne besede: lungs, ultrasound, N-terminal pro-brain natriuretic peptide, acute heart failure, chronic obstructive pulmonary disease, asthma, acute dyspnea
Objavljeno v DKUM: 29.06.2017; Ogledov: 2008; Prenosov: 404
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