Key Clinical Message Lupus anticoagulant caused aPTT prolongation in rare case can cause bleeding tendency especially when combined with other hemostasis abnormalities. In such cases, aPTT value can be corrected by immunosuppressants within several days of treatment. When anticoagulation therapy is needed vitamin K antagonist are a good option for the initial treatment. Abstract Lupus anticoagulant antibodies despite causing aPTT prolongation are commonly associated with increased risk of thrombosis. We present a rare case of patient when these autoantibodies resulted in dramatic aPTT prolongation and combined with associated thrombocytopenia resulted in minor bleeding events. In presented case treatment with oral steroids resulted in aPTT values correction followed by resolution of bleeding tendency within several days. Later, the patient developed chronic atrial fibrillation and was started on anticoagulation treatment initially with vitamin K antagonist without bleeding complications during follow‐up period. Corresponding changes in patient's aPTT time in a course of whole treatment is presented.

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Background. The role of hyperfiltration in the pathomechanism of diabetic kidney disease has not been well explained. The aim of this study was to determine the prevalence of hyperfiltration in patients with type 2 diabetes. The association between hyperfiltration and clinical parameters were analyzed.Material and methods. 150 patients with type 2 diabetes and eGFR > 60 ml/min/1.73 m(2) were examined. Serum cystatin C concentration was assessed in each patients and glomerular filtration rate (eGFR) was estimated. Hyperfiltration was define as eGFR > 134 ml/min/1.73 m(2) in men and eGFR > 149 ml/min/1.73 m(2) in women.Results. Hyperfiltration was present in 20 (13.3%) of 150 analyzed patients. Hyperfiltration was found in 9 women and 11 men. There was no difference between patient with and without hyperfiltration according to concentration of potassium, triglycerides, total cholesterol and CRP. Also, urinary albumin excretion in both groups did not differ from each other. People with hyperfiltration had a shorter duration of diabetes from diagnosis and were younger. Patients with hyperfiltration had higher HbA(1c) and lower BMI than subjects without hyperfiltration. Hyperfiltration was less frequent in patients taking inhibitors of angiotensin converting enzyme (ACEI) and angiotensin II receptor blockers (ARB).Conclusions. Hyperfiltration is rare in patients with type 2 diabetes. Poor glycemic control increases risk of hyperfiltration, but age and BMI dicrease the risk. Hyperfiltration is less frequently in patients taking ACEI and ARB.

Introduction. The number of patients with chronic kidney disease is still increasing. An early identification of patients with chronic kidney disease is necessary. The markers of renal function used at present are not very specific and sensitive. Thus, big hopes are connected with cystatin C as a better indicator of renal function evaluation. The aim of the carried out research was to draw a comparison between the sensitivity of creatinine and cystatin C in the evaluation of the proportions of glomerular filtration rate (GFR) found in patients older than 65, who have no diabetes. Material and methods. 194 people qualified to undergo the examination. 100 of them were women (51,5% of the examined population) and 94 men (48,5%), all between 65–98. Patients with thyroid gland dysfunction, treated with glucocorticoids (doses above 30 mg conversed into prednisone) and those with the end stage of kidney disease (V stage of NKF) were excluded from the examination. In each case the concentrations of creatinine (Jaffe ́s method) and cystatin C (PETIA method) were marked. On the basis of the obtained concentrations the values of GFR were calculated using the MDRD formula for creatinine concentration and Grubb ́s method for the concentration of cystatin C. Additionally, the patients who qualified underwent a general examination in order to estimate the amount of proteinuria. Results. It was found out in the carried out analysis that both methods of estimating GFR based on the concentration of creatinine (MDRD) and the concentration of cystatin C (Grubb) are useful in the diagnostics of kidney functions in the population undergoing the examinations. Grubb ́s method is said to be more precise diagnostically. A statistically important correlation between the age and the value of GFR calculated on the basis of Grubb’s method both in men and women, was observed. Conclusions. Cystatin C seems to be a better indicator in the estimation of the decrease of GFR in older patients of both sexes than creatinine. The main limitation to use cystatin C widely in the nephrological diagnostics is caused by financial reasons. Geront. Pol. 2010; 18, 3: 120–127 key words: Cystatin C, chronic kidney disease, glomerular filtration rate, old age Wstęp Fizjologiczny proces starzenia się nerek, objawiający się spadkiem filtracji kłębuszkowej, obserwowany jest już od około 35. roku życia. Skutkuje on rozwojem zmian zarówno organicznych (zmniejszenie masy nerek, spadek liczby kłębuszków nerkowych, zmiany stwardnieniowe kłębuszków, rozwój tkanki łącznej w śródmiąższu, skrócenie długości cewek nerko-

Jedną z przyczyn przewleklej choroby nerek, prowadzącą do schylkowej niewydolności nerek, jest nefropatia ziol chinskich. Przyczyną uszkodzenia nerek jest kwas arystolochowy bedący skladnikiem preparatow wspomagających odchudzanie. Wydawalo sie dotychczas, ze preparaty pochodzenia roślinnego są bezpieczne dla nerek. Jednak w ostatnich latach obserwowano wiele przypadkow dzialania nefrotoksycznego tego alkaloidu. W opisanym przypadku potwierdzono te dane. Pacjent w wieku 17 lat, ze wskaźnikiem masy ciala 32,2 kg/m 2 , w ciągu 4 miesiecy stracil 20 kg, stosując miedzy innymi preparaty ziol chinskich. W krotkim czasie u pacjenta doszlo do rozwoju nadciśnienia tetniczego, cech niewydolności nerek az do rozwoju schylkowej niewydolności nerek. Na podstawie biopsji nerki potwierdzono u pacjenta obraz nerki zejściowej z nasileniem przewleklych i nieodwracalnych zmian w obrebie klebuszkow, jak i środmiązszu. Przebieg opisywanej nefropatii moze byc roznorodny, zazwyczaj jednak prowadzi do szybko postepującej niewydolności nerek, az do schylkowej niewydolności nerek, a takze moze sie przyczyniac do powstawania nowotworow drog moczowych. Wydaje sie, ze opisany przypadek moze ulatwic wczesne rozpoznanie tej nefropatii zarowno przez lekarzy podstawowej opieki zdrowotnej, jak i przez nefrologow i urologow, co przy odpowiednio szybkim zaprzestaniu stosowania preparatow ziol chinskich, zawierających kwas arystolochowy, moze zahamowac dalszy rozwoj uszkodzenia nerek. Forum Nefrologiczne 2010, tom 3, nr 4, 272-276