Background/Aim. Biomarkers for predicting disease course could facilitate treatment selection in primary glomerulonephritis (PGN). Data on the role of neutrophil gelatinase-associated lipocalin (NGAL) in PGN are limited. The aim of this study was to evaluate the significance of NGAL in predicting treatment outcomes in PGN. Methods. The study included a total of 60 PGN patients followed between 2012 and 2024. At diagnosis, serum NGAL (sNGAL) and urinary NGAL (uNGAL) were measured. Renal function parameters (serum creatinine, proteinuria) and disease outcome–development of end-stage renal disease (ESRD)–were assessed at baseline, after 5 years, and at the end of the follow-up period. The association between NGAL and clinical outcomes was analyzed using appropriate statistical tests. Results. At baseline, median sNGAL and uNGAL levels were 154.71 ng/mL and 13.94 ng/mL, respectively. During a median follow-up of 112 months, 8.33% of patients were lost to follow-up, and 20% developed ESRD. Patients who developed ESRD had higher sNGAL levels (p = 0.027). Using sNGAL, ESRD was fairly predictive (AUC = 0.709; p = 0.036), and sNGAL was associated with time-to-ESRD (Kaplan-Meier analysis, p <0.001). The group with the highest sNGAL showed the lowest 5-year renal survival. Patients with stable or improved estimated glomerular filtration rate (eGFR) had higher uNGAL/creatinine ratio values (p = 0.049). Changes in proteinuria correlated negatively with sNGAL (p < 0.001) and uNGAL (p = 0.005). Conclusion. In PGN, sNGAL could be a predictor of ESRD development, potentially reflecting its pro-fibrotic activity. In contrast, the correlation between NGAL levels and change in proteinuria, as well as the associations between higher uNGAL/creatinine ratios and improved eGFR, suggest a complex and potentially protective role of NGAL in disease progression.

Introduction/Objective. Kidney transplant recipients were at higher risk for COVID-19-associated complications and mortality. The goal was to examine the frequency and outcomes of COVID-19 infection among patients under our center's control, as well as the effects of tocilizumab and anti-SARS-CoV-2 antibodies. Methods. We analyzed a cohort of 220 kidney transplant patients monitored at our center who experienced COVID-19 infection between March 2020 and March 2022. Results. In the period of two years, 55 pts contracted COVID-19 (25%). The average age of the infected was 48.38 years old. In 24% of patients during COVID-19 infection the immunosuppressive therapy did not change. Because of pneumonia development 33% of patients have been hospitalized. Of all infected patients, tocilizumab was used in 7% of patients, of whom three died. AntiSARS-COV-2 mAb was used in 24% of patients, no fatalities were reported. Antivirotic (favipiravir) was used in 4% of patients, in one case fatal. CRRT/HD was applied in 5.5% of patients. Out of all infected, death occurred in 14.5% of patients. The cause of death was severe acute respiratory syndrome (50%), cardiac arrest (25%), or multiorgan failure (25%). All of these patients had serious comorbidities, or were late admitted to the transplant center. Conclusions. The therapeutic use of mAb was reliable, with a significant positive effect on achieving a milder clinical form and shorter duration of the disease. The main risk factors of adverse outcomes of COVID-19 infection in kidney transplant recipients were serious comorbidities and late admission to the transplant center.

Introduction. Antibody-mediated rejection is one of the leading causes of graft loss after kidney transplant. Donor-specific antibodies (DSAs) are recognized as biomarkers of transplant rejection. The aim of this study was to describe the association between nonadherence and DSA formation. Case outline. A 21-year-old patient underwent a living-related donor kidney transplant procedure in October 2017. The donor had the same blood type as the patient with one mismatch at the HLA-B and HLA-DR loci. The presence of pre-transplant human leukocyte antigen donor-specific antibodies (HLADSA) was not confirmed. The postoperative course was uneventful. Three months post-transplant, low tacrolimus levels and consequent increase of serum creatinine were evident. Five months post-transplant, the occurrence of HLA-DSA was confirmed along with de novo donor-specific anti-HLA-DQB1*06:04, mean fluorescence intensity (MFI) was 20,725. Acute antibody-mediated rejection of kidney transplant was diagnosed, and the following treatment was applied: corticosteroid pulses, immunoglobulins, and plasmapheresis. Stable graft function persisted over the following one-year period, but over time, low tacrolimus levels, increase in serum creatinine, and proteinuria reappeared. Heteroanamnestic data indicated irregular taking of immunosuppressive drugs and an inadequate hygiene-dietary regimen. Repeated anti-HLA-DQB1*06:04 testing revealed MFI of 5933. Graft biopsy demonstrated elements of chronic active antibody-mediated rejection, acute T-cell-mediated rejection, interstitial fibrosis, and tubular atrophy. Despite repeated anti-rejection therapy, total graft loss occurred. Conclusion. Nonadherence to recommended immunosuppressive regimen brought about the de novo HLA-DSA formation as well as production of antibody-mediated and T-cell-mediated rejection, and consequent total loss of kidney transplant function.

The treatment of chronic kidney disease (CKD) has been considerably transformed in the last couple of years. However, effective management of patients with CKD is still not achieved, despite clear guidelines promoting active screening of high-risk patients, immediate diagnosis based on laboratory markers, and early initiation or intensification of pharmacotherapy like sodium/glucose cotransporter 2 (SGLT2) inhibitors, which showed reliable results in preventing disease progression, complications, and mortality. Following a recent initiative on early diagnosis, nephrology experts from Bulgaria, Croatia, Serbia, and Slovenia discussed the challenges and opportunities related to CKD treatment in the Balkan countries, also reflecting on the heterogenous socio-economic context of the region. The ongoing education of all stakeholders involved in kidney care, structured support for primary care providers, and the improvement of multidisciplinary networks were consistently recognized as key success factors. Optimal CKD management is based on continuity of care and the timely transition of coordination from primary care to nephrology-specialized services.

Introduction. A single pass albumin dialysis (SPAD) is a form of extracorporeal liver support system for removing albumin-bound toxins and water-soluble substances that accumulate in liver failure (LF). Case report. We presented three patients hospitalized for LF and treated using the SPAD at the University Clinical Center of Vojvodina, Serbia, from 2018 to 2019. Two of the patients presented with acute LF and one with acute-on-chronic LF. A total of 6 SPAD sessions were performed on each patient, resulting in decreased serum bilirubin and bile acid levels and hepatic encephalopathy grade. On discharge from the hospital, the liver function was improved in all the patients. Conclusion. SPAD removes the hepatotoxic substances without improvement of synthetic liver function. It represents a supportive treatment for LF patients who do not respond to the standard of care, offering a longer time for bridging to organ transplantation or spontaneous recovery of the liver function.

Introduction/Objective. Fabry disease (FD) is an X-linked lysosomal storage disease that develops as a consequence of mutation in the alpha-galactosidase A (GLA) gene. There are more than 1080 known variants in the GLA gene. Some of them are pathogenic, but most of them are benign or represent the genetic change that can be classified as a genetic variant of unknown significance or simply be a representation of genetic polymorphism. There are two main features of FD, classic form and late-onset variants of disease. The main target organs in patients with FD are the kidneys, heart, and nervous system. Bearing in mind the fact that FD is a rare disease, the best way for active searching of patients is high-risk population screening, after which family screening for every proband case should be performed. Methods. In this paper, we present results of a multicentric pilot study that represents findings from the screening of hemodialysis patients for FD in six hemodialysis units in Vojvodina. Results. We have found one patient with benign mutation and 16 patients with genetic polymorphisms in GLA gene. We have learned that genetic changes in GLA gene can be frequent, but very rarely are of clinical significance and lead to manifestations of FD. Conclusion. Results of this screening study will give us important insights into our future work.

Introduction. Acute kidney injury is a serious complication in critically ill patients in the intensive care units. The incidence varies from 20% to as high as 80%. Acute kidney injury is associated with expensive supportive therapy, high morbidity and poor outcomes. The aim of this study was to determine the incidence, causes, risk factors, treatment options and treatment outcomes of acute kidney injury in critically ill patients. Material and Methods. The study included 44 patients, with an average age of 67 ? 13.20 years. The data were collected during a three-month prospective study at the Department of Emergency Internal Medicine of the Clinical Center of Vojvodina, Novi Sad. Demographic data were collected from the medical records, as well as data on blood tests, comorbidities, use of nephrotoxic agents, and treatment of these patients. Results. Of the 44 patients who were included in the study, 20% developed acute kidney injury. De novo acute kidney injury was diagnosed in 51.22% and 48.78% of patients had acute-onchronic renal failure. The most common type of acute kidney injury was pre-renal, 80.95%. Comorbidities were present in all patients, most often arterial hypertension, in 52.4% of patients. Complete recovery of kidney function was found in 42.86% of patients and the mortality was 28.57%. Conservative therapy was used in 90.48% of patients, while 9.52% of patients required renal replacement therapy. Conclusion. De novo acute kidney injury was found in approximately half of the critically ill patients in the intensive care unit, mainly older patients with comorbidities. The most common type of acute kidney injury was pre-renal. Older age and comorbidities were associated with poor outcomes and high mortality.

Abstract Background and Aims The incidence of Acute kidney injuri AKI during Covid 19 infection is 3 – 15%, up to 50% for patients (pts) with Acute respiratory distress syndrome ARDS. Method From March till December 2020. Department for hemodialysis in Novi Sad did 184 renal replacement therapy (RRT) procedures (proc) on 65 Covid 19 positive pts. Results There were 73,85% men and 26,15% women (p < 0,01), with average (avs.) age of 65,8 years (SD 9,20). Most of them were admitted directly to the Intensive care unit, 64,62% (p < 0,01). The length of stay in hospital ranged from 2 - 61 days (avs. 15,86; SD 11,19). The most common comorbidities were hypertension (86,1%), diabetes (33,8%), coronary disease (30,8%) and chronic obstructive pulmonary disease (21,5%). Most common indication for RRT was acutisation of chronic kidney disease (CKD) 43,08% (p < 0,01) followed by pre-existing end stage renal disease (ESRD) 29,23% and AKI 27,69%. RRT was started 1 - 31 days after the admittance (avs. 8,51; SD 7,33). 57 intermittent hemodialysis proc (30,98%) were done on 13 pts (14,06%) who were hemodynamicly and respiratory stable. The decision to initiate CRRT was made upon the renal indications, the presence of ARDS or significant volume load. A total of 127 CRRT proc (69,02%) were done on 57 pts (87,5%). The most of them were CVVHDF (74,02%) and the rest CVVHD (25,98%). Most commonly used membrane was oXiris 47,24% (p < 0,001) followed by EMIC2 25,98%, Kit 8 17,32% and ST-150 9,45%. Most CRRT proc (89,76%) were done with heparin as an anticoagulant and 10 proc (7,87%) in 5 pts using citrate. 3 proc (2,36%) in 2 pts were done without using anticoagulant. The procedurès duration had to depend on the number of devices, the number of pts requiring CRRT and the number of available trained medical workers. The average achieved length of proc was 712 min. (11 h and 52 min.) (SD 435,07). Most patients had 1 (49,12%; p< 0,001) or 2 (30,69%) CRRT proc, up to 9 (avs. 2,23; SD 1,95). The average achieved ultrafiltration was 2716,41 ml (SD 1016,82). In 23 pts (40,35%) 26 CRRT proc (20,47%) had to be stopped earlier, because of circuit clotting (9,45%; p < 0,001), deterioration of hemodynamic instability/respiratory insufficiency (7,09%), device malfunction (2.36%) and RRT need for another pts (1,58%). ARDS has developed 42 pts (64,61%). The need for vasoactive support had 41 pts (63,08%). 51 pts (78,46%) requiring RRT died. Conclusion Comparing group of pts who survived with group of those who died, greater number of pts with ESRD was in the first group. In survivor group, RRT was started earlier with greater number and shorter duration of proc. In the group of pts who died, there were more ARDS and vasoactive support need. They had a higher levels of CRP, leukocyte count and the neutrophil to lymphocyte ratio.MO677   Table 1. Characteristic of groups of pts who survived and the group of pts who died survived (No 14) died (No 51) p Age 64,14 (SD 11,77) 66,27 (SD 8,45) 0,45 sex M 10 (71,43%) 38 (74,51%) 0,91 fF 4 (28,57%) 13 (25,49%) No of comorbidities 2,86 (SD 0,86) 2,43 (SD 1,06) 0,84 Indication AKI 0 (0%) 18 (35,29%) 0,00 CKD ac 2 (14,29%) 26 (50,98%) ESRD 12 (85,71%) 7 (13,73%) Los in hospital (days) 16,83 (SD 9,29) 15,63 (SD 11,66) 0,37 Los before RRT (days) 2,43 (SD 1,95) 10,18 (SD 7,39) 0,00 Los before RRT (only CRRT) (days) 3 (SD 2,27) 10,43 (SD 7,42) 0,007 No of proc 4,38 (SD 3,38) 1,88 (SD 1,36) 0,008 Duration of proc(min.) 464,17 (SD 27,36) 744,46 (SD 456,48) 0,03 membranes oXiris+EMIC2 15 (42,86%) 78 (84,78%) 0,00 Kit8+ST-150 20 (57,14%) 14 (15,22%) UF/proc (ml) 2799,06 (SD 457,88) 2702,91 (SD 1111,24) 0,14 Anuria Y 8 (57,14%) 20 (39,22%) 0,37 N 6 (42,56%) 31 (60,78%) vasoactive support Y 0 (0%) 41 (80,39%) 0,00 N 14 (100%) 10 (19,71%) ARDS Y 1 (7,14%) 44 (86,27%) 0,00 N 13 (92,86%) 7 (13,73%) WBC (* 10^9/l) 6,91 (SD 2,63) 11,82 (SD 8,63) 0,02 NLR 7,48 (SD 3,92) 17,78 (SD 14,25) 0,017 PLR 266,41 (SD 162,52) 334,60 (SD 322,35) 0,48 CRP (mg/l) 114,68 (SD 141,80) 192,34 (SD 107,23) 0,039 PCT (ng/ml) 3,81 (SD 4,98) 12,67 (SD 26,58) 0,28

Abstract Background and Aims Expended hemodialysis (HDx) with medium cut-off (MCO) membrane enables efficient depuration of middleweight uremic toxins, which play significant roles in inflammation and cardiovascular morbidity. Hemodiafiltration (HDF) is known for good removal of middle molecules but it requires more technical resources and well-functioning dialysis access. The aim of this study is to evaluate the efficacy of depuration of uremic toxins with a high-flux dialyzer during HDF session and with a MCO membrane (Theranova®) in HDx session and its impact on quality of life (QoL) in hemodialysis patients. Method In an open, single-centre, prospective observational clinical study, 28 adult stable HD patients without residual renal function were assigned to be treated by on-line HDF (HDF group) with the APS-21H dialyzer (polysulfone membrane, 2.1 m2, Asahi Kasei Medical Co., Japan) or by HDx (HDx group) with the Theranova® 400 (1.7 m2) and Theranova® 500 (2.0 m2) dialyzers (Baxter International Inc, USA). The study was conducted during 2019-2020 and completed after 12 months period. All patients were receiving maintenance high-flux membrane HDF treatment at least six months before they were enrolled in the study. Groups of patients were matched in age, sex, BMI, dialysis length and underlying disease. Complete blood count (CBC), renal function and inflammation, electrolytes, liver function tests, iron and nutritional status were evaluated at the beginning of the study and after 3, 6, 9 and 12 months. Pre and postdialysis levels for urea, creatinine, albumin, calcium, phosphorus, C-Reactive Protein, kappa and lambda free light chains (FLC), vitamin B12, β2 microglobulin levels were determined in each patient quarterly and reduction rate (RR) for uremic toxins were calculated. Furthermore single-pool Kt/V, dose of erythropoietin therapy (EPO) and vascular access were evaluated during the study, while bioimpedance analysis using Body composition monitor (Fresenius Medical Care, Germany) and QoL using SF-36 questionnaire (Kidney Disease Quality of Life Short Form-KDQOLTM-36) were evaluated at the end of observation period. The values have been reported as mean ±SD. Results There were 28 patients (14 in each group) mean age of 54.24 years (57.71±9.65 in HDx group vs 59.81±7.99 in HDF group). Median dialysis vintage was 4.77 years (5.33 in HDx group vs 6.46 in HDF group, p=0.55). Vascular access was native arteriovenous fistula in 23 patients, arteriovenous graft in 2 patients and tunnelled dialysis catheter in 3 patients (p=0.98). Kt/V was similar in both groups (1.57±0.31 vs 1.45±0.24, p=0.9), as well as weekly dose of EPO (4533.3±1922.3 vs 4233.3±1971.8, p=0.67). Patients in HDF group had a significantly higher interdialysis fluid overload (2,48±1,37 in HDx group vs 3,64±1,33 in HDF group, p=0.04), without difference in relation to the systolic and diastolic blood pressure values, as well as others BCM parameters. There were not significant differences in examined parameters of CBC, renal function and inflammation, electrolytes, liver function tests, iron and nutritional status at the beginning and at the end of the study. RR of small and middle molecules are presented in Table 1. Serum albumin level has decreased from 37.8 g/dL to 36.4 g/dL in 12 months during HDx treatment with maximal change of serum albumin level of -3.7% during that period (Figure 1). Evaluation of Kidney Disease Quality of Life Short Form at the end of study period in both groups is shown in Figure 2. Conclusion Compared to HDF, HDx with MCO membranes show greater RR for large middle molecules such as lambda FLC (45kD), while RRs for middle molecules- kappa FLC (23kD), β2 microglobulin (12kD) and small uremic toxins are similar. During one year of treatment with MCO membranes serum albumin levels remain stable. HDx treatment may improve quality of life, making an impact primarily in energy status and emotional satisfaction.

Abstract Background and Aims Critically ill patients with acute renal impairment (AKI) with a high risk of bleeding require treatment with one of the methods of continuous renal replacement (CRRT) with regional citrate anticoagulation (RCA) or without anticoagulation (NA). The aim of the study was to compare CRRT with RCA using calcium with CRRT in NA regimen. Method A clinical trial included 55 surgical and non-surgical patients with acute kidney injury and an episode of acute kidney injury in chronic kidney disease who were admitted to the Intensive Care Unit (ICU) during 2020. The patients were divided into two groups, RCA- CRRT with 39 and NA-CRRT with 16 patients. Demographic, clinical and lab data before and after CRRT, treatment parameters CRRT and outcomes were analyzed. Results RCA vs NA group did not differ significantly by gender (small, 71.79% vs 56.25%, p = 0.106) and age (56.53 ± 17.55 vs 45.75 ± 13.3, p = 0.220). The NA group had a significantly higher prevalence of liver disease as a reason for the ICU admission when compared to the other group (12.5% vs 0.00%, p = 0.024). The RCA group before CRRT had significantly higher mean values of CRP (173.68 ± 122.06 vs 86.33 ± 51.05, p = 0.01) and significantly lower mean values of total bilirubin (16.78 ± 4.31 vs 40.02 ± 9.22, p = 0.005) and creatinine (463.97 ± 36.24 vs 486.0 ± 36.25, p = 0.001), while after CRRT it had significantly higher average values of total calcium (2.12 ± 0.016 vs 2.11 ± 0.017, p = 0.023) and lower average values of pH (7.29 ± 0.02 vs 7.32 ± 0.015, p = 0.040) and creatinine (463.97 ± 36.24 vs 486.0 ± 36.25, p = 0.001) in relation to the NA group. No significant difference was found in relation to invasive mechanical ventilation, vasopressors therapy, SAPS II score, oliguria / anuria, recovery of renal function, the length of hospital stay and mortality (p> 0.05) (Table 1). Compared to treatment parameters, the RCA group had a significantly lower number of procedures (4.33 ± 2.80 vs 5.81 ± 1.28, p = 0.027) and ultrafiltration rate (2.79 ± 0.19 vs 3.14 ± 0.33, p = 0.015) and significantly longer hemofilter lifespan compared to NA group (24.64 ± 0.48 vs 18.10 ± 0.58, p = 0.000). Although the prevalence of bleeding was higher in the NA group, no significant difference was found between the groups (37.5% vs 28.20%, p = 0.498), as well as in the infusion of red blood cell (33.3% vs 37.5%, p = 0.768), fresh frozen plasma (28.2% vs 50%, p = 0.742) and platelets (35.89 vs 31.25, p = 0.123). The overall citrate accumulation (CA> 2.25) rate was 5.12% in the RCA group (Table 2). The Kaplan-Meier survival analysis using the log-rank test (Mantel-Cox test) for comparing the hemofilter lifespan between RCA and NA regime found a significant difference in survival between the groups (χ2 = 3,789, p = 0,049) (Figure 1). Multiple regression model for testing risk factors SAPS II score, Oxiris membrane, UF, lactate, hemoglobin concentration, platelet count, Activated Partial Thromboplastin Time and Prothrombin Time on hemofilter survival has shown a significant linear relationship without statistical significance in both RCA groups (R=0.544 ; F=1.575) and NA (R=0.757; F=1.171) (Table 3). Conclusion RCA-CRRT did not show a significant difference in the prevalence of bleeding compared to NA-CRRT in the patients with a high risk of bleeding, but the survival rate of hemofilters was significantly longer in RCA-CRRT, which suggested the need for further research.

Introduction: The nutcracker syndrome is a rare clinical entity caused by compression of the left renal vein by the superior mesenteric artery. Epidemiologically opposite, IgA nephropathy is the most common cause of idiopathic glomerulonephritis. A combination of the two diseases has previously been reported in a few cases. Case Report: Herein we report a case of a 22-year-old male patient admitted because of macroscopic hematuria due to excessive oral anticoagulation. He had prior evidence of proteinuria, microhematuria, impaired kidney function, and enlarged left kidney. He presented with fatigue, abdominal pain, nausea, and several instances of vomiting after a meal. A diagnosis of left renal vein compression and IgA nephropathy was made based on clinical, laboratory, radiological findings and kidney biopsy. The vascular anomaly was treated conservatively, while steroids were given to treat glomerulonephritis. The result was complete regression of symptoms, normal laboratory findings, and a significant drop in proteinuria. Conclusion: It is important to evaluate whether patients have nutcracker phenomenon before initiating treatment for IgA nephropathy and vice versa, as hematuria and proteinuria can be overlapping symptoms of both conditions. Renal biopsy should not be hesitated for differential diagnosis, and treatment should be highly individualized.

•Data on immunosuppressive regimens used in KTRs in South-eastern Europe are limited.•Triple therapy was the most common immunosuppressive regimen.•The most common regimen was a CNI, an antiproliferative drug and corticosteroids.•Individual CNI C0 were below the target range in a substantial proportion of KTRs.

Introduction: Chronic kidney disease (CKD) and dialysis treatment could affect oral mucosa and cause qualitative or quantitative changes of saliva. Objective: The aim of the study was to investigate oral manifestations, unstimulated salivary flow rate (USFR), salivary pH value and biochemical composition of saliva in non-diabetic patients with CKD. Design: The study group (PD) consisted of 50 pre-dialysis patients diagnosed with CKD, positive control group (HD) of 25 haemodialysis patients and negative control (H) of 25 age and gender-matched healthy persons. Creatinine clearance rate (CrCI) was calculated from the blood creatinine using the Cockcroft-Gault formula. After a detailed intraoral examination, whole unstimulated saliva samples were collected to determine salivary pH value, and biochemical composition using a spectrophotometric method. Results: Statistical analysis revealed that PD subjects had more oral lesions (p < 0.05) and symptoms (p < 0.001) than controls. The mean CrCI was significantly lower (p < 0.05) in CKD subjects with pale mucosa, xerostomia, dysgeusia, and uremic odour, comparing to those without listed symptoms. PD subjects had significantly decreased USFR and increased pH, urea and creatinine than H controls (p < 0.05). A moderately strong positive correlation between serum and salivary creatinine in both PD (p < 0.05) and HD (p < 0.05) groups was found. Conclusion: This study confirmed that xerostomia and dysgeusia are major symptoms among pre-dialysis patients. Their presence along with uremic odour and pale mucosa is directly related to decreased kidney function. On the diagnostic point, decreased USFR, especially hyposalivation and increased salivary creatinine, should be considered a significant indicator of CKD in stages before dialysis therapy.

Background. The safety profiles of standard therapy versus everolimus with reduced-exposure calcineurin inhibitor (CNI) therapy using contemporary protocols in de novo kidney transplant recipients have not been compared in detail. Methods. TRANSFORM was a randomized, international trial in which de novo kidney transplant patients were randomized to everolimus with reduced-exposure CNI (N = 1014) or mycophenolic acid (MPA) with standard-exposure CNI (N = 1012), both with induction and corticosteroids. Results. Within the safety population (everolimus 1014, MPA 1012), adverse events with a suspected relation to study drug occurred in 62.9% versus 59.2% of patients given everolimus or MPA, respectively (P = 0.085). Hyperlipidemia, interstitial lung disease, peripheral edema, proteinuria, stomatitis/mouth ulceration, thrombocytopenia, and wound healing complications were more frequent with everolimus, whereas diarrhea, nausea, vomiting, leukopenia, tremor, and insomnia were more frequent in the MPA group. The incidence of viral infections (17.2% versus 29.2%; P < 0.001), cytomegalovirus (CMV) infections (8.1% versus 20.1%; P < 0.001), CMV syndrome (13.6% versus 23.0%, P = 0.044), and BK virus (BKV) infections (4.3% versus 8.0%, P < 0.001) were less frequent with everolimus. CMV infection was less common with everolimus versus MPA after adjusting for prophylaxis therapy in the D+/R- subgroup (P < 0.001). Study drug was discontinued more frequently due to rejection or impaired healing with everolimus, and more often due to BKV infection or BKV nephropathy with MPA. Conclusions. De novo everolimus with reduced-exposure CNI yielded a comparable incidence, though a distinctly different pattern, of adverse events versus current standard of care. Both regimens are safe and effective, yet their distinct profiles may enable tailoring for individual kidney transplant recipients.

Introduction. A proliferation-inducing ligand is a membrane binding protein that represents one of the main survival factors for immature, naive and activated B-cells, and is involved in the global immune response. The objective of this study was to determine whether plasma levels of a proliferation-inducing ligand may be used to assess the proliferation of B-lymphocytes in patients with bacterial infections, B-cell malignancies and autoimmune inflammatory disorders. Material and Methods. The study included 91 patients divided into three groups and 30 blood donors assigned to the control group. Group 1 included 34 patients with bacterial infections confirmed by microbiology and/or radiology diagnostic tests; group 2 included 32 patients with B-cell malignancies; and group 3 included 25 patients with autoimmune inflammatory diseases. All plasma samples were assayed for a proliferation-inducing ligand using enzyme-linked immunosorbent assay. The differences between groups were examined by one-way analysis of variance test and post hoc analysis. Results. One way analysis of variance test showed a statistically significant difference in concentrations of a proliferation-inducing ligand in the examined groups. The highest mean value of a proliferation-inducing ligand was found in patients with established bacterial infections (x? = 8,294 ng/ml). Post hoc analysis showed that a proliferation-inducing ligand levels in the plasma samples of patients with bacterial infections were significantly higher than in healthy controls, and patients with hematological and autoimmune diseases, respectively. Conclusion. B-cell proliferation was increased in patients with bacterial infections in regard to patients with other disorders. Therefore, a proliferation inducing ligand can be used to differentiate bacterial infections from other inflammatory disorders and may be helpful in decision making whether to start antibiotic treatment or not. This article has been corrected. Link to the correction 10.2298/MPNS1912362E

Background/Aim. Catheter-related infections are a significant morbidity and mortality cause in patients on hemodialysis. The objective of this study was to determine the incidence, to analyze risk factors and to identify etiological causes of catheter-related infections in these patients. Methods. The study was carried out at the Clinic for Nephrology and Clinical Immunology of the Clinical Centre of Vojvodina, from August, 2012 to May, 2015. One hundred and thirteen patients on chronic hemodialysis participated in the study. The risk factors of catheterrelated infections in the infected patients were to those in the control group, as follows: demographic and laboratory parameters, co-morbidities and the use of immunosuppressive therapy, the length of hemodialysis treatment, urgent catheter placement, the position and placement difficulties, the number of insertions and catheter maneuvering, the existence of permanent vascular access in maturation or without a vascular access in the course of catheter positioning, catheter life, surgical procedures (? 30 days from catheter placing), the length of hospitalization and isolated infection causes. Results. One hundred and ninety-seven catheters were placed in 113 patients, among which 182 of them temporary. The total number of catheter days was 17.842, the incidence of infections was 3.53/1,000 catheter days. During the monitoring period, 63 catheter-related infections were diagnosed, 54 (85.7%) with temporary and 9 (14.3%) with permanent catheters. Multivariate logistic regression analysis (with border values/ levels determined by receiver operating characteristic ? ROC analysis) determined independent predictors of catheter-related infections in the following order: hemoglobin levels < 95 g/l (p < 0.001) and albumin levels < 33 g/l (p = 0.041), catheter duration of > 90 days (p = 0.004), > 2/day catheter maneuvering (p = 0.011) and the duration of hospitalization of > 15 days (p = 0.003). The main pathogen was Staphylococcus spp. Coagulase negative. Conclusion. Intensifying of prevention measures and infection control would significantly reduce the frequency of catheter-related infections and the number of hospitalizations. The timely creation of a native arteriovenous fistula would decrease the use of hemodialysis catheters.

Introduction Post-transplant lymphoproliferative disorder (PTLD) is one of the most severe and often fatal complications observed after solid organ and bone marrow transplantations. Case outline We present a case of a patient born in 1989 who underwent a living related donor renal transplantation at the age of 16. Induction therapy implied the administration of anti-thymocyte globulin and corticosteroids, and maintenance therapy encompassed a combination of three immunosuppressive agents - tacrolimus, mycophenolate mofetil, and corticosteroid. The patient experienced first complications six months after transplantation, manifested as aggravation of tonsillitis symptoms and subsequent dysphagia. Histopathological and immunohistochemical finding of tonsillectomy specimens suggested polymorphic PTLD (with high expression of Epstein-Barr virus latent membrane protein antigen). Definitive diagnosis of diffuse large B-cell lymphoma (CD20+) was established upon analysis of oesophageal bioptate. Antiviral therapy was applied, along with rituximab and a combination of cyclophosphamide, doxorubicin (hydroxydaunomycin), vincristine, and prednisolone (CHOP therapy), whilst the dosage of basic immunosuppressive drugs was reduced. Complex diagnostic procedures confirmed the absence of disease recurrence and stable graft function five years after completing the PTLD therapy. Conclusion The presented case of our patient, who developed PTLD after renal transplantation, demonstrated that appropriate early diagnosis, reduction of immunosuppressive regimens, and vigilant application of immunomodulatory and chemotherapy could result in complete disease remission, yet preserving and maintaining the stable function of the transplant.