Objectives: The purpose of this article is to report 10 years of single-centre experience with prostate cancer screening in renal transplant candidates. Patients and methods: This is a single-centre retrospective analysis of results of prostate cancer screening as a part of renal pre-transplant workup. We included all male patients suitable for transplant workup over 10 years. Patients with persistently elevated prostate specific antigen were considered for prostate biopsy. Biopsy results, treatment data and short-term outcomes for patients diagnosed with prostate cancer were collected. Results: We identified 542 patients with a mean age of 52 years. Thirty-one (5.7%) patients were referred to a urologist. Twenty-three (74%) of those referred were biopsied. Histological findings for 10 biopsies (44%) were normal, three (13%) had prostatic intraepithelial neoplasm and nine patients (39%) had invasive adenocarcinoma. One case (4%) was inconclusive. All patients with a normal biopsy proceeded with pre-transplant workup. Out of nine patients diagnosed with prostate cancer, five were transplant listed, two were receiving treatment and two were subsequently deceased. Conclusion: Prostate specific antigen screening with repeat testing and the use of age-adjusted normal values led to the diagnosis of prostate cancer that had major implications for transplant listing. For the majority of cancers the diagnosis did not deny transplant surgery to patients but only delayed listing for transplant.

Two articles in this issue deal with granulomatous acute interstitial nephritis (GIN), a rare disorder seen in 0.5–0.9% of native and 0.6% of transplant renal biopsies [1]. In the first article, Agrawal and co-workers report 10 years of experience with GIN in a tertiary centre in India [2]. In contrast to the experience from Western countries, tuberculosis accounted for more than half of cases. The authors emphasize the challenge of making the diagnosis and recommend a high degree of suspicion [2]. In a second article, Shah and colleagues from the USA [3] review GIN and also highlight current challenges in describing the interesting case of a 69-year-old man with GIN ascribed to doxycycline in whom a positive quantiferon test was received and who eventually died from multi-organ failure. Without autopsy we will never know whether he actually had tuberculosis but their case also reminds us that even with sophisticated testing the cause of GIN remains unclear in a proportion of patients. In this comment, we reflect on both articles and provide some context with an emphasis on pathology and disease patterns worldwide, pitfalls and the diagnostic approach in clinic.

Although kidney transplantation is by far the best method of renal replacement therapy, organ receiver is still not spared of eventual toxic consequences of drugs that are in charge of keeping the transplanted kidney functional. Both calcineurin inhibitors, of which tacrolimus more often, occasionally lead to neurotoxic side effects, mostly mild and reversible and dose-dependent in nature, but they can also be very severe or even fatal. It is very important to be aware of possible neurotoxic effects, to confirm them radiologically, and to prevent or reduce drug effects on nervous system. Sometimes the reduction of dose or substitution with another drug with similar mechanism effect is sufficient to terminate the neurotoxic effects of the drug and still not jeopardize the function of transplanted organ.

Aim. The aim of this study was to compare urinary alpha 1 microglobulin (A1MG) in healthy individuals with and without family burden for Balkan endemic nephropathy (BEN) in an endemic village. Methods. Otherwise healthy inhabitants with microalbuminuria or proteinuria were divided into two groups: with (n = 24) and without (n = 32) family BEN burden and screened for urinary A1MG and A1MG/urine creatinine ratio. Results. Average value of urinary A1MG was 10.35 ± 7.01 mg/L in group with and 10.79 ± 8.27 mg/L in group without family history for BEN (NS, P = 0.87). A1MG was higher than 10 mg/L in eight (33.33%) inhabitants with family history and in 12 (37.5%) without (NS, P = 0.187). Average values of urinary A1MG/creatinine ratio were 1.30 ± 1.59 and 0.94 ± 0.78 in group with and group without family BEN history (NS, P = 0.39, resp.). Elevated values of this ratio were found in 13 (54.17%) inhabitants with and 14 (43.75%) without family history for BEN (NS, P = 0.415). Conclusion. We did not find statistically significant difference in the examined markers between healthy individuals with and without family burden for BEN. We concluded that these markers are not predictive of risk for BEN.

Although kidney transplantation is by far the best method of renal replacement therapy, organ receiver is still not spared of eventual toxic consequences of drugs that are in charge of keeping the transplanted kidney functional. Both calcineurin inhibitors, of which tacrolimus more often, occasionally lead to neurotoxic side effects, mostly mild and reversible and dose-dependent in nature, but they can also be very severe or even fatal. It is very important to be aware of possible neurotoxic effects, to confirm them radiologically, and to prevent or reduce drug effects on nervous system. Sometimes the reduction of dose or substitution with another drug with similar mechanism effect is sufficient to terminate the neurotoxic effects of the drug and still not jeopardize the function of transplanted organ.

Metabolic myopathies represent a small percentage of rhabdomyolysis causes that could lead to acute kidney injury (AKI). This could be prevented if this condition is suspected and timely treated. Carnitine palmityl transferase (CPT) deficiency is the most frequent metabolic myopathy and should be considered whenever recurrent myoglobinuria is suspected, and distinguished from the second frequent one, McArdle disease. We present a case of a patient with two medically misinterpreted episodes of AKI in whom the subsequent diagnosis of CPT deficiency was established based on high index of clinical suspicion and correlation of clinical manifestations to specific metabolic defects. Application of simple measures and lifestyle changes improved our patient’s life quality and prevented potential new life-threatening complications.

UNLABELLED Pregnancy in kidney transplantation is, considering its numerous complications, listed in category of high-risk pregnancies. Complications occur as consequence of action of immunosuppressant drugs and mutual interactions of graft on pregnancy and pregnancy on graft. To asses conception it is necessary for female patient to fulfill conditions after which planning and management of pregnancy are carried out. Planning means a list of actions which altogether have as a goal to decrease risk factors for future mothers and for babies as much as possible. Pregnancy management is also procedural, including numerous hospitalizations, in which pregnancy, fetus and renal function are controlled, on-time identifying potentially dangerous complications and solving ones that might have already occurred. With all given precautions there is still no guarantee for successful pregnancy termination, although given measurements significantly improve possibilities of normal childbirth, like those in general population. KEYWORDS renal transplantation, pregnancy.

INTRODUCTION Kidney transplantation assures considerably better quality of life than the treatment of end-stage renal disease patients with dialysis. GOAL Authors intended to present results of kidney transplantations that were performed for over 13 years in UCC Tuzla. EXAMINEES AND METHODS Total of 100 transplantations have been done over 13 years. The gender and age structure have been presented, as well as number of transplantations per year, type of transplantation (living related donor, living unrelated donor, deceased donor), number and percentage of donors and results of transplantations expressed as survival of both the patient and transplanted kidney/ renal graft. We also wanted to presented other important events such as dates of introduction of certain drugs, dates of first cadaver transplantation, transplantation with desensitization protocols and dates of first living unrelated (spousal/emotional) transplantation. RESULTS The survival of patients and renal grafts were demonstrated by Kaplan-Meier curve, and obtained results were fully in range of results recommended in other literature and by other authors. One-year survival of graft is 94%, with five-year survival being 75%. One-year survival of patients is 95%, and five-year survival of patients was 84%. DISCUSSION Our results have been compared to those from other studies, gaining suggestions for transplantation improvement. CONCLUSION Among all modifications of renal replacement therapy transplantation is by far the method of choice because, its well known advantages aside, it also has an economical advantage over chronic treatment with dialysis and it should therefore become interesting to healthcare systems.