AIM The most common type of kidney transplantation in Bosnia and Herzegovina is from living donors, but there is a lack of published data on glomerular filtration rate (GFR) values and kidney outcomes in living kidney donors. This study aimed to evaluate the safety of living kidney donation at our centre. METHODS One hundred and seventy living kidney donors at the University Clinical Centre Tuzla were analysed. Initially, there were 170 participants; however, only 31 provided all the required medical data and completed the study. GFR was estimated (eGFR) using the CKD-EPI and MDRD formulas, and a web-based calculator was used to predict GFR > 90 ml/min/1.73 m², along with measurement of creatinine clearance (CrCl). Measured GFR (mGFR) was assessed through technetium-99m diethylene triamine pentaacetic acid (DTPA) renogram, with follow-up visits to estimate post-donation GFR. RESULTS The CKD-EPI, MDRD, and web-based application showed similar diagnostic performances, with MDRD and CKD-EPI systematically underestimating mGFR. CrCl demonstrated strong diagnostic performance. Follow-up visits showed that most donors had post-donation eGFR values between 45 and 89 mL/min/1.73 m², with none progressing to pre-dialysis or the dialysis stage after kidney donation. CONCLUSION CrCl demonstrated strong diagnostic performance in our study population, and the DTPA renogram reliably assessed kidney function. Post-donation eGFR levels were satisfactory, indicating that our diagnostic workup for potential living kidney donors in our centre is safe and effective.

AIM To evaluate the clinical impact of corticosteroids (CS) overuse in inflammatory bowel disease (IBD) patients. Excessive use of CS could delay more efficacious treatment and may indicate poor quality of care. METHOD This is a two-phase study that used Steroid Assessment Tool (SAT) to measure corticosteroid exposure in IBD patients. In the first phase, data from 211 consecutive ambulatory patients with IBD (91 with ulcerative colitis, 115 with Crohn's disease, and five with unclassified inflammatory bowel disease) were analysed by SAT. In the second phase, one year after data entry, clinical outcome of patients with corticosteroids overuse was analysed. RESULTS Of the 211 IBD patients, 132 (62%) were not on corticosteroids, 45 (22%) were corticosteroid-dependent, and 34 (16%) used corticosteroids appropriately, according to the European Crohn's and Colitis Organization guidelines. In the group of patients with ulcerative colitis, 57 (63%) were not on corticosteroids, 18 (20%) were corticosteroid-dependent, and 16 (16%) used corticosteroids appropriately; in the group of patients with Crohn's disease 70 (61%), 27 (23%) and 18 (16%), respectively. Overall, 24 (out of 45; 53%) patients with IBD could avoid the overuse of corticosteroids if they had a timely change of the treatment, surgery, or entered a clinical trial. CONCLUSION An excessive corticosteroid use can be recognized on time using the SAT. We have proven that excessive corticosteroid use could be avoided in almost half of cases and thus the overuse of CS may indicate poor quality of care in those patients.

The John Cunningham virus (JCV) is a polyomavirus that usually infects people at a young age and does not cause any symptoms in immunocompetent individuals. However, in immunocompromised individuals, such as kidney transplant recipients, JCV can cause severe and potentially fatal disease. Unfortunately, JCV has not been researched as extensively as the BK virus and is not mentioned in relevant kidney transplant guidelines. This lack of attention to JCV can lead to less consideration in kidney transplant patients’ care. Surveillance using locally available diagnostic methods is of the utmost importance. The presence of JCV can be diagnosed with urine decoy cells, viruria, or viremia verified by the PCR method. A low threshold for considering JCV as a possible cause of any neurological or renal dysfunction in kidney transplant recipients must be maintained. In such cases, kidney and brain biopsy are indicated. Maintaining the appropriate immunosuppression while avoiding over-immunosuppression to prevent JCV disease is crucial, and the approach should be individual, according to overall immunological risk. We hypothesize that the presence of the JCV can indicate overt immunosuppression and identify kidney transplant recipients more prone to opportunistic infections and diseases, including some malignancies. To explore that, future observational studies are needed.